Worker's Compensation Board of Indiana
THIS IS QA/TEST SYSTEM
38911 Response Search
Please enter any two values.
Jurisdiction Claim No:
Date of Injury:
Last Name:
First Name:
Search
Clear
Case Details
Jurisdiction Claim No
Disputed No
Date of Injury
Full Name
Parties
PartyID
PartyRoleType
Party Name
Role
Representing
Actions
DisputedNo
Jurisdictionclaimno
Submit
×
38911 Response
(Please select at least one checkbox)
Employee disagrees with the termination of benefits
Employee requires further medical care
Employee believes an independent medical examination (IME) may be helpful to resolve this dispute
characters remaining:
Received Date
Action Date
4/26/2024
Filed By
Email
Submit
Clear
