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Worker's Compensation Board of Indiana

2nd Injury Fund Forms 2nd Injury Fund Forms

2016 Assessment

2015 Assessment

2014 Assessment

2013 Assessment

2012 Assessment

2011 Assessment

2010 Assessment

2009 Assessment

2008 Assessment

2007 Assessment

  • 2007 2nd Injury Recommendation Report and Assessment
  • 2007 Certificate
    Because the assessment calculations differ between carriers and self-insured employers, we have created a unique certification form for each. Please select the appropriate form below.

2006 Assessment

2005 Assessment

2004 Assessment

2003 Assessment

Injured Employee Assistance

Prosthetic Applications

Past Years Assessment Information