iQue Claim Forms - Illinois
First Report of Injury
NOTE: Adobe Acrobat Approval, Standard, or Professional version 5 or newer is required for submitting this form by email.
Please report injuries to iQue as soon as possible.
Wage Statement
Declaración del Salario
This form is necessary in all lost time cases where wages will be paid to the injured worker. The Workers’ Compensation Act requires that we have 52 weeks of prior wage information whenever possible to determine the rate at which they will be paid.
Medical Authorization
Autorización Médica
Authorization to obtain medical information.
Employee Questionnaire
Cuestionario al Empleado
Initial Form to be completed by the injured worker.
Witness Statement
Form to be completed by a witness to the accident.