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Form 5020 Indianapolis Indiana: What You Should Know

NOTE: The following is a sample of the information to be reported to the Third Party administrator. Employers have been cautioned by the Division that the information in this form is confidential and may be shared with any person that has a need for it, including, but not limited to, the following: (1) the Division, the state's legal advisors (including, but not limited to the Attorney General), and the Department of Social Services; (2) the employers. (NOTE: a business injury does not have to result in a loss of time or medical treatment in order to be reported. NOTE: Any information that is submitted via the form is considered voluntarily, and there is no obligation of the state to respond to any injury reports.

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