Indiana Administrative Code
Title 631 - WORKER'S COMPENSATION BOARD OF INDIANA
Article 1 - WORKER'S COMPENSATION
Rule 1 - Procedures Before the Board; Compensation Payments; Reports; Second Injury Fund
Section 1-23 - Representing litigants before board

(a) The parties to a proceeding before the board may appear either in person or by an attorney. Before any person shall be permitted to represent any party litigant before the board, he or she shall make an oath in writing, showing qualifications as prescribed by law, in the form as follows:

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_____ the undersigned affirms under the penalties for perjury, that the foregoing representations are true: that he or she has been duly admitted to practice law in the Circuit and/or Superior Court of _____ County, Indiana, and in the Supreme Court of the State of Indiana, and is at this time in good standing as a practitioner before said Courts.

__________________________________

Signature of Attorney

__________________________________

Printed Name

__________________________________

Office Address

()

__________________________________

Telephone Number

()

__________________________________

Fax Number

__________________________________

E-mail Address

__________________________________

Attorney #

(b) Failure of any such attorney to comply with the worker's compensation or occupational diseases act as set out at IC 22 may subject the attorney to revocation of the attorney's certificate to practice before the board, upon a hearing on the issue by the full board.