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IPRF Documents & Resources

Employers First Report of Injury or Illness (Form 45). The Workers' Compensation Act requires employers (or insurers acting on their behalf) to send the Employers First Report of Injury or Illness (Form 45) reports to the Commission on all accidents involving more than three lost work days. Instructions on how to complete Form 45 are included in this download.

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IPRF Injury Description Report (Form 45-A) is a useful tool in identifying the injury, extent and treatment goals and should be used on all reported workers’ compensation claims.

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IPRF Supervisors Investigation Form (Form 45-B) is also an important tool in the claims investigation process. The form will provide additional information on the incident that maybe helpful in the claims process.

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IPRF Employee Accident/Injury Report (Form 45-C) Employees shall use this form to report all work related injuries, illnesses no matter how minor. This form shall be completed by employees as soon as possible and given to a supervisor for further action.

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IPRF Witness Report (Form 45-D) Supervisors are to use this form to obtain the witnesses account of the injury/accident.  This form shall be completed by witness(s) as soon as possible and given to a supervisor.

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IPRF Questionable Claim Report Form (Form 45-E) will need to be completed where the employer is not certain whether or not the matter is work related should be reported

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IPRF Medical Authorization Release Form (Form 45-F) helps the claims adjuster obtain all medical records and information from hospitals, doctor offices and diagnostic testing facilities that otherwise might take longer due to HIPPA (Health Insurance Portability and Accountability Act) security concerns. With the injured worker signing and dating this form, IPRF Claims Administration would then disseminate the signed form to the medical providers with a written request for all medical records related to the work related injury that was reported.

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IPRF Member Injury/Accident Investigation Tool Kit This kit includes action step that should be taken when a work related injury/accident occurs.  The kit includes the primary IPRF Reports and Forms that will need to be completed and submitted to the IPRF Claims Office as soon as possible.

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IPRF Member Contact Change Form. Please help us to keep your organization current with all IPRF services.  If there is a change in personnel who are assigned as our primary contact, accounting/billing contact, claims contact, loss control contact or the legislative action/alerts liaison contact, please download the "fillable form" and either fax or email as directed on the form.

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IPRF 52 Week Wage Statement Form for claims that go beyond the state statute of three (3) scheduled days off waiting period, total temporary disability (TDD) will be owed on compensable claims. The calculations for this is based on 52 weeks of pay prior to date of injury. 
 
Please Note: In lieu of using the downloadable form, a member may submit a payroll printout but the printout must match the requested payroll information on the "IPRF 52 Week Wage Statement Form."

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State of Illinois Notice to Employee Poster. The State of Illinois and the Federal Government require employers to display state and federal labor law posters in each facility where employees and applicants can view them. Failure to comply with posting regulations can result in fines up to $17,000 (29 USC Sec. 666(I) and 29 USC Sec. 2005)

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The Illinois Handbook on Workers’ Compensation and Occupational Diseases provides a basic explanation of the workers' compensation program, benefits, and procedures at the Commission

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