Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Notice of Insurance (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Report Forms
IA-1 – First Report of Injury or Illness (Versión en Español)
IC-14 – Employer’s Supplemental Report
Incident Investigation Report (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Injury or Incident (Versión en Español)
Instructions for Injured Worker Handouts
Injured Workers First Fill Prescription Form (Versión en Español)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
Direct Deposit Authorization Form (Versión en Español)
IC-432(1) – Reimbursement for Health Care Travel Expenses (Versión en Español)
Idaho Workers’ Compensation Facts for Injured Workers (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
Idaho Workers’ Compensation Facts for Employers
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
Instructions for State-Specific Forms & Documents
IC-52 – Election or Revocation of Election of Coverage
IC-53 – Declaration under Idaho Code § 72-212(5)
