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Agent
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Claims Kit
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Medical Provider
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Return to Work
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Website Access
Policy Application

Apply for a workers' compensation policy with SIF.

First Report of Injury

Use this form to report a workplace injury or illness.

Workers' Comp Posting Notice (English)

This poster should be placed in a noticeable area in the workplace.

Workers' Comp Posting Notice (Spanish)

This poster should be placed in a noticeable area in the workplace.

Medical Release Form

This form allows SIF to access medical bills and reports to process claims quickly

Travel Expense Reimbursement

Request reimbursement for travel expenses related to your claim

Thirteen Week Wage Form

Use this form to provide wage information for an injured worker who has worked more than twelve weeks prior to the date of injury.

Similar Employee Wage Form

Use this form to provide wage information for an injured worker who has worked less than twelve weeks prior to the date of injury.

Surgery and/or Diagnostics Testing Request Form

Medical providers may use this form to request pre-approval for surgery or diagnostic testing. This form is not for physical medicine requests.

Provider Portal Access Form

Register to view your bills and EOB's in our Provider Portal.

Employer Supplemental Report

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

Restricted Duty Supplement Report

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

Example - Restricted Duty Work Offer Letter

Use this form when the employer is offering work to an injured worker

Example - Work Offer, No Accommodation Required

Use this form when the injured worker has continued to work in the same position as the time of injury

Example - Restricted Duty With Accommodation

Use this form when the injured worker works in their current position with accommodation

Work Status Report

This form helps address work restrictions at the medical appointment. Use this to help accommodate more immediate light- or modified duty. Give this to an injured worker before they go to the clinic.

Third-party Policyholder Website Authorization

This form is for accountant or bookkeeping firms to request access to their client's policy online. The insured must sign to authorize the request.

Agency Website Access

Appointed agents with an active book of business may use this form to request portal access. Our portal shows an agency's policies and more.

Medical Provider Website Access

Medical providers may use this form to register on our secure portal. We provide access to view bills and EOBs, and to submit surgery requests.

Agent icon
Agent
Policy Application

Apply for a workers' compensation policy with SIF.

Claims kit icon
Claims Kit
First Report of Injury

Use this form to report a workplace injury or illness.

Workers' Comp Posting Notice (English)

This poster should be placed in a noticeable area in the workplace.

Workers' Comp Posting Notice (Spanish)

This poster should be placed in a noticeable area in the workplace.

Medical Release Form

This form allows SIF to access medical bills and reports to process claims quickly

Travel Expense Reimbursement

Request reimbursement for travel expenses related to your claim

Thirteen Week Wage Form

Use this form to provide wage information for an injured worker who has worked more than twelve weeks prior to the date of injury.

Similar Employee Wage Form

Use this form to provide wage information for an injured worker who has worked less than twelve weeks prior to the date of injury.

Medical provider icon
Medical Provider
Surgery and/or Diagnostics Testing Request Form

Medical providers may use this form to request pre-approval for surgery or diagnostic testing. This form is not for physical medicine requests.

Provider Portal Access Form

Register to view your bills and EOB's in our Provider Portal.

Return to work icon
Return to Work
Employer Supplemental Report

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

Restricted Duty Supplement Report

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

Example - Restricted Duty Work Offer Letter

Use this form when the employer is offering work to an injured worker

Example - Work Offer, No Accommodation Required

Use this form when the injured worker has continued to work in the same position as the time of injury

Example - Restricted Duty With Accommodation

Use this form when the injured worker works in their current position with accommodation

Work Status Report

This form helps address work restrictions at the medical appointment. Use this to help accommodate more immediate light- or modified duty. Give this to an injured worker before they go to the clinic.

Website Access icon
Website Access
Third-party Policyholder Website Authorization

This form is for accountant or bookkeeping firms to request access to their client's policy online. The insured must sign to authorize the request.

Agency Website Access

Appointed agents with an active book of business may use this form to request portal access. Our portal shows an agency's policies and more.

Medical Provider Website Access

Medical providers may use this form to register on our secure portal. We provide access to view bills and EOBs, and to submit surgery requests.

Mistakes happen, if you spot or realize an error, please contact us and we will work with you to sort things out.
Please be aware that any person who knowingly, and with intent to defraud or deceive any insurance company,
files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony.

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How to use SIF Forms


To download and submit a form:

  • Click on the PDF icon to open the form in a new browser tab.

  • Save the PDF to your computer

  • Once saved, navigate to the PDF on your computer, and open

  • Complete the PDF on your computer, save, and close it

  • Upload the completed form to the SIF website or return it via email

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

Ready to get started with SIF?