River Valley Insurance Group, Inc. logo

(812) 265-2655

Our Policies Come With An Agent ®



Worker's Compensation First Report of Injury form: Click on your state listed below, print, complete and return the form to River Valley Insurance Group, Inc. as soon as possible.

Indiana (pdf)

Indiana Application For Worker's Compensation Clearance Certificate (pdf)

Kentucky (pdf)

Tennessee (pdf)

Release of Information Authorization Form - click here (online form)

FAX: (812) 265-2450

P O Box 365
Madison, IN 47250

EMAIL: cs@rivervalleyinsurance.comLike Us On Facebook
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