New IDM Case

Employee

Employee Information View

Employee Preferred Address Street 1

Employee Preferred Address Street 2

Employee Preferred State Code

Employee Preferred Address City

Employee Preferred ZIP Code

Employee Preferred Email Address

Employee Preferred Phone Number

Insured

Does the employee have a current WC claim?

Submitter Email Address

Has the employee contacted the work site?

Comments

Has employee been absent for more than 10 days?

Initial Date of Absence

Expected Return to Work Date

IDM Portal

NoYes

Principal/Supervisor Name

Principal/Supervisor Email

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