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WORKERS’ COMP
TRUCK OR AUTO ACCIDENT
DISABILITY DENIAL
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PERSONAL INJURY
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Kentucky’s Workers’ Compensation Act: KRS 342
– The Statute setting forth workers’ compensation law
803 KAR 25:010
– Administrative Regulations applicable to Filing a Workers’ Compensation Claim
Kentucky Department of Workers’ Claims
– Website for the Kentucky Department of Workers’ Claims
“Forms” Page
– Listing of specific Forms from the Department of Workers’ Claims Website
Form 101 Application for Resolution of Work Injury
– This is the “complaint” for a work-related injury
Form 104 Employment History
– Form to list chronological work history
Form 105 Medical History
– Form to list chronological medical history
Form 106 Medical Waiver and Consent
– A Release Form allowing parties to request medical records
Form 113 Notice of Designated Treating Physician
– Form to designate a physician to treat the work injury
Form 114 Request for Out-of-pocket expense and Mileage Reimbursement
– Form on which to list mileage for travel to medical appointments and any out-of-pocket expenses
Hearing Site Locations
– Lists the location of Workers’ Compensation Hearing Sites
Kentucky Court of Justice Page
– Link to the Website for the Kentucky Court of Appeals and Supreme Court
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KENTUCKY REVISED STATUTES
KENTUCKY DEPT. OF WORKER'S CLAIMS
FORMS