Worker's Compensation Board of Indiana

Dispute #:

First Name:

Last Name:

Company Name:

First Name:

Last Name:

Provider Name:

County: 02 - ALLEN 03 - BARTHOLOMEW 10 - CLARK 14 - DAVIESS 18 - DELAWARE 19 - DUBOIS 20 - ELKHART 22 - FLOYD 27 - GRANT 34 - HOWARD 39 - JEFFERSON 41 - JOHNSON 43 - KOSCIUSKO 45 - LAKE 46 - LA PORTE 49 - MARION 53 - MONROE 64 - PORTER 67 - PUTNAM 69 - RIPLEY 71 - ST JOSEPH 73 - SHELBY 76 - STEUBEN 79 - TIPPECANOE 82 - VANDERBURGH 84 - VIGO 89 - WAYNE 99 - FULL BOARD

From Date:  

To Date: