How to Complete and Submit the Indiana Workers’ Compensation Physician’s Report

In an Indiana workers’ compensation claim, the physician’s report is filed on State Form 2118, which the Worker’s Compensation Board publishes as a template the treating doctor can either complete field by field or use as a cover sheet for a dictated narrative report attached behind it.¹ Whatever format the physician chooses, the written statement has to contain five specific elements, Social Security numbers have to be redacted before anything leaves the office, and the finished report goes to the Board either by mail or through its Gateway portal.

The Five Things the Report Has to Contain

Indiana Code 22-3-3-6 sets the required content of a physician’s written statement in a workers’ compensation case. A report from either side’s doctor has to cover all of the following:²

The injury history as the patient described it.
The physician’s diagnosis of the patient’s physical or mental condition.
The physician’s opinion on whether the workplace injury caused the current condition, with the reasoning behind that opinion.
Whether the injury resulted in a disability or impairment, and if so, the physician’s opinion on its extent and the basis for that conclusion.
The physician’s original signature.

A statement that leaves any of these out is open to objection. The same statute also sets a procedural deadline: if the physician does not deliver the statement to the opposing side at least thirty days before a hearing, it cannot be used as evidence and the physician cannot testify about findings from that examination.²

Where to Get Form 2118

The Worker’s Compensation Board posts State Form 2118 on its forms page with the rest of the WCB filings.³ You can print it or complete it digitally. The Board actively encourages using it as a cover sheet with the physician’s own dictated report attached behind, which satisfies the Board’s format expectations while letting the physician write clinical detail in narrative form rather than squeezing it into boxes.

One requirement is easy to miss and will send a filing back for correction: Social Security numbers of injured workers must be redacted from everything submitted to the Board.¹ Check every page of attached medical records before filing, not just the cover sheet.

Filling Out the Report

The top of the form collects identifying information that ties the report to the correct claim: the employee’s name, the employer, and the date of injury. The clinical body of the report then needs the diagnosis (typically with ICD codes), the treatment provided or recommended, and whether the patient can return to work with or without restrictions.

The section that matters most is the one addressing the patient’s recovery status. If the physician concludes the worker has reached maximum medical improvement, meaning further treatment is unlikely to produce significant recovery, that finding opens the door to a permanent partial impairment rating. The impairment number the physician writes down directly controls the dollar value of the benefits the worker receives for lasting physical damage.

Narrative quality matters here more than many clinicians expect. Insurance adjusters and Board reviewers rely on the physician’s written reasoning to decide whether continued treatment is medically necessary or whether the file is ready to settle. A conclusory line like “patient is impaired,” with nothing supporting it, invites challenges from the other side.

Choosing an Impairment Guide

When assigning a PPI rating, the physician is not tied to a single reference. The Board’s guidance states that medical providers may use whichever edition of the AMA Guides to the Evaluation of Permanent Impairment they consider most appropriate to the individual case, and that if one edition would prevent recovery for a particular impairment, an earlier edition should be consulted.⁴ That flexibility is unusual, and it leaves meaningful discretion with the treating physician.

What the Impairment Rating Is Worth

Indiana Code 22-3-3-10 attaches a dollar value to each degree of permanent impairment. For injuries occurring on or after July 1, 2026, the per-degree compensation runs on a graduated schedule:⁵

1 to 10 degrees: $1,970 per degree
11 to 35 degrees: $2,197 per degree
36 to 50 degrees: $3,585 per degree
Above 50 degrees: $4,569 per degree

The average weekly wage used in the impairment calculation is capped at $1,316 for injuries on or after July 1, 2026.⁵ The statute also assigns specific impairment degrees to amputations and loss of function in individual body parts.

Submitting the Report

The completed Physician’s Report can be mailed to the Board’s Indianapolis office:

Worker’s Compensation Board of Indiana
402 West Washington Street, Room W-196
Indianapolis, Indiana 46204⁶

Electronic filings go through the Board’s Gateway portal. Registering requires selecting the “Register” link on the Gateway login page and setting a password of 8 to 15 characters that includes at least one uppercase letter, one lowercase letter, one number, and one special character.⁷

Adjusters submitting impairment documentation must use the dedicated PPI Submission Portal accessible through Gateway. The portal takes the SF 1043 (Agreement to Compensation), the medical report, and the waiver, and lets the adjuster track each submission’s status through review and approval.¹

Save whatever confirmation the system generates. If you mail the report, use certified mail with a return receipt. If there is ever an argument later about whether a report was filed on time, that confirmation or receipt is the proof.

If the Worker Disagrees With the Report

A physician’s report finding that the worker has reached maximum medical improvement is often what prompts the employer to end temporary total disability benefits. When that happens, the employer has to notify the worker on State Form 38911 (Report of Temporary Total Disability/Temporary Partial Disability Termination).³ The worker then has seven days from receiving that form to object to the MMI determination and file the objection with the Board.

If the dispute does not resolve, the worker can get an independent medical examination at the employer’s expense. In Indiana, the Board itself appoints the IME physician rather than letting either side choose. A worker can request the IME by checking the appropriate boxes in the objection section of Form 38911 or by calling the Board’s ombudsman division at (317) 233-3009.⁸ Once the Board approves the request, it picks the doctor and notifies the worker of the appointment. The IME findings carry significant weight at any later hearing, especially when they conflict with the treating physician’s report.

A Note on Reporting Deadlines

The seven- and fourteen-day reporting deadlines under IC 22-3-4-13, and the civil penalties for missing them under IC 22-3-4-15, apply to the employer’s injury report and the insurance carrier’s transmittal to the Board, not to the treating physician’s Form 2118.⁹¹⁰ The deadline that does bind the physician’s report is the thirty-day pre-hearing disclosure rule in IC 22-3-3-6: deliver the statement to the opposing side at least thirty days before a hearing or lose the ability to use it as evidence or testify to its findings.

1
Worker’s Compensation Board of Indiana. Worker’s Compensation Board of Indiana – Home
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Indiana General Assembly. Indiana Code 22-3-3-6 – Physical Examination; Physician’s Statement
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Worker’s Compensation Board of Indiana. WCB Forms
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Worker’s Compensation Board of Indiana. PPI Guide
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Indiana General Assembly. Indiana Code 22-3-3-10 – Injuries Schedule
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Worker’s Compensation Board of Indiana. WCB Contact Us
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Worker’s Compensation Board of Indiana. Gateway – Login
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Worker’s Compensation Board of Indiana. Who Is Eligible
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Indiana General Assembly. Indiana Code 22-3-4-13 – Report of Injuries
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Indiana General Assembly. Indiana Code 22-3-4-15 – Civil Penalties; Schedule