Illinois Required Postings and Forms
Download Illinois Claims Kit
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunch room or time clock. If you have multiple business locations be sure to post the notices at each location.
- Workers’ Compensation Insurance Notice (English and Spanish).
- Anti-Fraud Notice (English and Spanish)
Please print and review the following forms and information:
- IC45 First Report of Injury (FROI). Section 6(b) of the Workers’ Compensation Act requires that you (or insurers acting on your behalf) send reports to the Illinois Workers’ Compensation Commission on all accidents involving more than three lost work days. As soon as you have been notified of a work-related injury or occupational disease, please fill out this form and submit it to the Illinois Workers’ Compensation Commission and EMPLOYERS. This form must be completed within five days from notice of an accident. Fatalities must be reported within two days of the death. The Illinois Workers’ Compensation Commission also accepts the International Association of Industrial Accident Boards and Commissions (IAIABC) first report of injury form: IA-1 IAIABC W.C. First Report of Injury.
- IC85 Employers Supplementary of Injury (FROI). This is a supplemental form that you need to complete and submit to the Illinois Workers’ Compensation Commission (along with form IC45) when workers’ compensation benefits begin or are stopped, there is a change in your employee’s status and/or final compensation is made. The Illinois Workers’ Compensation Commission also accepts the International Association of Industrial Accident Boards and Commissions (IAIABC) first report of injury form: IA-2 IAIABC W.C. Subsequent Report.
- Wage Statement. This form enables us to calculate the correct compensation that may be due to an injured employee. Please complete the form and submit to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than three scheduled work calendar days.
- First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the prescription for his/her work-related injury or occupational disease to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 14791, Lexington, KY 40512-4791. You should also keep a copy on file for your records.
More Illinois Workers’ Comp Resources
- Off-Site Transitional Duty Program – Helping Your Injured Employees Get Back to Work. A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.