IPEP Reporting Procedures

Reporting Procedures

EMPLOYEE IS INJURED

If Injury results in death or overnight hospital stay call IPEP immediately at 800-382-8837.

COMPLETE FORMS AND SUBMIT TO IPEP

1. FIRST REPORT OF INJURY (Completed by Employer)

2. SUPERVISOR'S INCIDENT REPORT (Completed by Employer)

3. MEDICAL AUTHORIZATION FORM (Completed by Employee)

ipepclaims@ipep.com

fax 765-868-3310

IS TREATMENT REQUIRED?

YES

DIRECT EMPLOYEE TO DESIGNATED OCC HEALTH CLINIC OR ER

CONTACT IPEP FOR ANY REFERRALS

NO

CLAIM IS SET UP AS A RECORD ONLY WITH IPEP

CONTACT IPEP ASAP IF TREATMENT BECOMES NECESSARY

Are you eligible for membership?

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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.

Toll Free: 800-382-8837

Phone: 765-457-9161

302 S Reed Rd. P.O. Box 1247

Kokomo, IN 46903-1247

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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