IPEP
  • About
    • Who is Eligible?
    • How IPEP Works
    • History
    • FAQ
    • How to Apply
  • Risk Management
    • Safety Resources Library
    • Safety Videos
    • Training Resources
    • Service Requests
    • Public Safety
    • Contact Risk Management
  • Claims
    • Claims Forms
    • Reporting Procedures
    • Contact Claims
  • Employee Benefits
    • Accidental Death Dismemberment
    • Health Insurance
    • Health Insurance Forms
    • FAQ
    • Contact Employee Benefits
  • Public Risk Underwriters
    • Package Programs
    • Preferred Partners
    • Contact PRU
  • Contact
Select Page

Stay Connected with

IPEP Newsletters, Safety Alerts and Training Invitations for current members

training modal

"*" indicates required fields

Name*
Email*
Select an Option:*

Stay Connected with

IPEP Newsletters, Safety Alerts and Training Invitations for current members

training modal

"*" indicates required fields

Name*
Email*
Select an Option:*

Claim Forms

For your convenience, forms needed to file a claim may be downloaded and forwarded to [email protected] upon completion.

First Report of Injury (State Form 34401)
Supervisor's Incident Form
Medical Authorization Form
Wage Statement Form
Mileage Reimbursement Form
Rx First Fill Card

Please access our Claims Kit during a telephonic WC101

Claims Kit

Quick Links

Who is Eligible?

Learn More

How to Apply

Learn More

IPEP Reporting Procedures

Learn More

Toll Free 800.382.8837

Phone 765.457.9161

Fax 765.868.3310

Email [email protected]

  • Disclaimer
  • Legal Notices
  • Your Privacy Rights
  • Do Not Sell/Share/Limit Disclosure
  • Cookies Policy
  • Accessibility
  • Commitment to EEO
IPEP is an Indiana not-for-profit corporation organized in December 1989. Its purpose is to operate a self-funded group program for the purpose of satisfying the obligations of the members under the Indiana Workers' Compensation Act, the Indiana Workers' Occupational Diseases Act and the Indiana Employers' Liability Act. Membership in IPEP is limited to political subdivisions and governmental entities of the State of Indiana.