Injured Workers' Insurance Fund

State of Maryland

Official Website: https://www.ceiwc.com/iwif

Forms & Documents

Browse all Injured Workers' Insurance Fund government forms

All 16 forms

Form Title Topics
Accident-Investigation-Forms_English-Spanish
ACORD 4 - First Report of Injury Form
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH DEBITS)
Back-to-Work-Follow-Up-Form_11-2013
CEIC-Wage-Statement-Information-Form_04-2019
Direct Deposit Authorization Form
Inclusion Form for Sole Proprietors and Partners Election C15R 7/2015
IWIF Direct Deposit Authorization Form
Job-Analysis-Form_Eng-and-Spanish_11.12.15
MDWCC Exclusion Form IC-16 v. 01/2011
Medical Travel Expense Form (CEIWC)
Medical Travel Expense Form (IWIF)
Return-to-Work-Capacity-Form_10-2015
Sole Proprietor's Status Form IC-02 v.12/2015
Temporary Prescription Services ID Form
WORKER'S COMPENSATION - FIRST REPORT OF INJURY OR ILNESS

Contact Information & Office Locations

1 contact point

Chesapeake Employers' Insurance Company

Address:
8722 Loch Raven Boulevard
Towson, MD 21286-2235

Phone numbers:
  • (410) 494-2000 (Main)
  • (888) 410-1400 (Injury)
  • (888) 268-4372 (Fraud)
  • (800) 264-4943 (Out of Area)
Hours of operation:
  • Monday - Friday, 8a.m. - 5p.m.

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