Indiana
In the event of an on-the-job injury or illness occurring in the State of Indiana, please follow the below steps in order.
- Step 1: Report the injury or illness to your supervisor immediately. Seek medical treatment from a list of providers preselected in your area. DAS Risk Management will provide this list to you.
- Step 2: Document your injury as soon as possible by choosing one of the following options:
- If you work for an agency that reports an injury, illness or near miss using the Workday system, logon to Workday. Select
Report a Safety Incident within the Workday Safety application.
- If your agency has not established an injury, illness or near miss reporting process or you are unaware of the process, please click on this hyperlink. Select Submit a New Risk Management Request, fill-in the fields on the form and select Out-of-State Safety Incident Report under the Type of Request drop down menu, then submit the form.
- Step 3: Please complete the state of Indiana
SF 34401 form immediately and send a copy to DAS Risk Management.
- Step 4: File a claim with the appropriate insurance carrier.
https://www.zurichna.com/claims Your claim will be managed by Zurich, our out of state insurance provider. You should expect a call from Zurich after the claim is filed. Please work with Zurich and provide them with any needed information during the life of your claim.
Please review this link
WCB: Injuries to help familiarize yourself with the claims process.
For any questions or concerns please reach out to DAS Risk Management