Injured Workers Center

Workers' Compensation and You

Information for Injured Workers

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Forms & Resources

The information below applies to most states. To get the most accurate information for your location, select your state using the state selector above.

ICW Group's contact information and address change form.

Change of Contact Information

English & Spanish · Word Doc

Complete this form if your contact information changes while you’re receiving benefits.

ICW Group's Medical Authorization Form

Mileage Reimbursement

English & Spanish · Word Doc

If you travel to get treatment, record your mileage and travel costs on this form to get expenses reimbursed.

ICW Group's Prescription Authorization Form

Direct Deposit

English · PDF

Complete this form to get your benefits deposited directly into your bank account.

ICW Group's Prescription Authorization Form

Prescription Authorization

English & Spanish · PDF

Before filling a prescription, have your employer complete this form.