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IPEP Reporting Procedures

Claims Forms

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For your convenience, forms needed to file a claim may be downloaded and forwarded to ipepclaims@ipep.com upon completion.

First Report of Injury (State Form 34401)

Supervisor's Incident Form

Medical Authorization Form

Wage Statement Form

Mileage Reimbursement Form

Please access our Claims Kit during a telephonic WC101

Are you eligible for membership?