(Optional) enter the user name & password of the injured employee?
  If you are the injured employee, here are our login guidelines:
  User Name: enter the first letter of your first name added to "_" added to your last name (e.g. j_smith for John Smith).
  Password: Use the last 4 digits of your Social Security Number.
User name (of injured employee):
Password (of injured employee):
If unknown, leave blank!