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Indiana workers compensation insurance notice fillable form 2025

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The document is an application form for obtaining a Worker's Compensation Clearance Certificate in Indiana, specifically for independent contractors seeking exemption from worker's compensation coverage. It outlines the necessary information required from the applicant, including personal details, business information, and payment instructions. The form also explains the criteria for being classified as an independent contractor versus an employee, and emphasizes the need for certification by the Indiana Department of Revenue and the Worker’s Compensation Board.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Which states require workers compensation insurance?

California: In California, it is a criminal offense to not provide workers compensation for your employees.

What is a DWC 1 claim form?

Form DWC 1 is the official form that California businesses and employees use to file a workers compensation claim. The employee fills out a portion of the form, and the employer fills out the remainder. The employer then sends the completed form to their workers comp insurance company in order to file a claim.

Is workers compensation insurance required in Indiana?

Indiana law requires every business operating in the state to provide workers compensation insurance to their employees, with certain exceptions.

How much is 10% impairment rating payout in Indiana?

For injuries that happened on or after July 1, 2023, those values are: $1,803 per degree for the first 10 degrees of impairment. $2,011 per degree for impairment degrees between 11 and 35.

How much is TTD in Indiana?

Note: Temporary Total Disability (TTD) is paid weekly and is based on 2/3 of the employees average weekly wage (AWW) on the date of the injury. TTD payments are subject to a maximum which varies depending on the date of the injury. The minimum AWW is $75.00.

indiana workers' compensation handbook 2022

Indiana workers Compensation forms indiana workers' compensation requirements for employers Indiana workers Compensation Board Indiana First Report of injury form Indiana Workers Compensation Exemption Form indiana workers' compensation case lookup Indiana workers Compensation officer exclusion Form Indiana workers compensation class codes

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Do independent contractors need workers comp in Indiana?

The Indiana Department of Revenue (DOR) issues a Workers Compensation Exemption Clearance Certificate to individual taxpayers who are independent contractors or otherwise not required to carry workers compensation insurance under the Workers Compensation Act of Indiana.

What happens if I dont carry workers comp insurance?

Workers comp penalties vary by state The penalty for not having workers compensation insurance in California is very similar, but can reach up to $100,000 in fines.

Does a sole proprietor need workers comp in Indiana?

In most cases, you must include yourself in your companys workers compensation coverage in the Hoosier state. However, there are two key exceptions: If youre a sole proprietor. If youre one of the parties in a partnership.

Indiana workers compensation insurance notice fillable form 2025

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