AnonymousReporting Worker's Compensation Board of Indiana This form is to be used to report employers for not carrying a Worker's Comp Insurance policy. If you feel that you are being denied benefits by your employer for other reasons, please contact a case coordinator. Contact information can be found here. Your Name: Your E-mail: * Employer Name: * Employer Address: * Employer Zip: * Complaint: Please note that your name and e-mail address are optional elements. If provided, we will keep you apprised of the progress of our investigation.