If Injury results in death or overnight hospital stay call IPEP immediately at 800-382-8837.
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
DIRECT EMPLOYEE TO DESIGNATED OCC HEALTH CLINIC OR ER
CONTACT IPEP FOR ANY REFERRALS
CLAIM IS SET UP AS A RECORD ONLY WITH IPEP
CONTACT IPEP ASAP IF TREATMENT BECOMES NECESSARY
