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Worker's Compensation Board of Indiana

WCB > Forms > 2nd Injury Fund Forms 2nd Injury Fund Forms

2014 Assessment

2013 Assessment

2012 Assessment

2011 Assessment

2010 Assessment

2009 Assessment

2008 Assessment

2007 Assessment

  • 2007 2nd Injury Recommendation Report and Assessment
  • 2007 Certificate
    Because the assessment calculations differ between carriers and self-insured employers, we have created a unique certification form for each. Please select the appropriate form below.

2006 Assessment

2005 Assessment

2004 Assessment

2003 Assessment

Injured Employee Assistance

Prosthetic Applications

Past Years Assessment Information