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Important Information

Use Newest Version of Forms

We've updated all of our forms to reflect our new brand. Download the current version and replace any you have previously saved. We recommend downloading the most up-to-date version each time you submit a form to avoid confusion. Check back for future updates.

New Self-Service Option

Use our Online First Report of Injury feature to file a claim. Registered users can log in to auto-fill policy and preparer information. It's fast, efficient, and allows uploading of supporting documentation.

Download SIF Forms

Our forms are available in Adobe PDF format. Download Adobe Reader free here if you do not have it. Get Acrobat Reader

Documents received after business hours are marked as received the next business day.

Note: Adobe 11 or higher is recommended as it allows you to save typed text in the form to a file on your hard drive. Older versions of Adobe or similar PDF readers may not save your typed text and the document will be blank after saving. Open and review your saved document BEFORE submitting.

Employer
Apply for a policy, request online payroll reporting access, get employer supplemental or restricted duty reports and more.

Agricultural Supplemental Application

Agricultural businesses should include the Agricultural Supplemental Application along with policy applications.

Employer's Supplemental Report

Submit this form at the end of the injured worker's disability or after 60 days if still unable to work.

First Report of Injury

File a claim for a workplace injury or illness using this form. For more convenience, select the Report an Injury link to use our online form.

Online Payroll Reporting Authorization Form

Policy Application

Apply for a workers' compensation policy with SIF.

Restricted Duty Supplemental Report

Submit this form every 14 days while your injured worker is on restricted duty.

Restricted Duty Work – Employer offering work

This work offer should be used when the injured worker is off work and the employer is offering work.

Restricted Duty Work – No accommodation provided

This work offer should be used when the injured worker has continued to work in the same position as the time of injury.

Restricted Duty Work - With accommodation

This work offer should be used when the injured worker has continued to work in their current position with accommodation.

Third-party Web Authorization Form

Accountant or bookkeeping firms, submit this form to request access to your client's policy online. The insured must sign the form authorizing this request.

Trucking Supplemental Application

Trucking businesses should include the Trucking Supplemental Application along with the Policy Application.

Injured Workers
Get forms to assist with your claim such as medical release form and travel expense reimbursement.

Medical Release Form

The Medical Release Authorization Form allows SIF to access medical bills and reports to process your claim in a timely manner.

Travel Expense Reimbursement

Request reimbursement for travel expenses regarding your claim.

Insurance Agents
Register for website access, obtain a SIF policy application and more.

Agency Web Authorization Form

Agents appointed with SIF and have an active book of business, use this form to request web access to view your customer's policies and more.

Agricultural Supplemental Application

Agricultural businesses should include the Agricultural Supplemental Application along with policy applications.

Policy Application

Apply for a workers' compensation policy with SIF.

Trucking Supplemental Application

Trucking businesses should include the Trucking Supplemental Application along with the Policy Application.

Medical Providers
Register for website access and obtain a treatment authorization request form.

Medical Provider EFT Form

Medical providers, use this form to authorize payment by electronic funds transfer. Must be completed and signed by owners or authorized personnel only.

Provider Web Authorization Form

Medical providers, register to view your bills and EOBs on our website.

Surgery and/or Diagnostics Testing Request Form

Medical providers, submit this form to request pre-approval for surgery or diagnostic testing. Not to be used for physical medicine requests.