Kentucky Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for Kentucky Workers' Compensation.

Kentucky Workers' Compensation Telephone Directory


Office of Workers' Claims: 502-564-5550

Workers' Compensation Specialists: 800-554-8601

After Hours Hotline : 800-321-6742

Individual Self-Insured Guaranty Fund: 859-899-8700

WC Administrative Hearings - Bowling Green Office: 270-746-7200

WC Administrative Hearings - Florence Office: 859-283-1235

WC Administrative Hearings - Frankfort Office - Hearing Room 1: 502-573-2165

WC Administrative Hearings - Frankfort Office - Hearing Room 2: 502-573-2166

WC Administrative Hearings - Frankfort Office - Hearing Room 3: 502-573-2167

WC Administrative Hearings - Hazard Office: 606-435-6031

WC Administrative Hearings - London Office: 606-330-2134

WC Administrative Hearings - Louisville Office: 505-595-4844

WC Administrative Hearings - Owensboro Office: 270-687-7389

WC Administrative Hearings - Paducah Office: 270-575-7589

WC Administrative Hearings - Pikesville Office - Hearing Room 1: 606-433-7183

WC Administrative Hearings - Pikesville Office - Hearing Room 2: 606-433-7184

WC Claims Records: 502-564-5550

Drug Free Workplace: 502-782-4555

Drug Free Workplace - Toll Free: 800-554-8601

Ombudsman: 800-554-8601

Fraud: 502-564-3630

Department of Workers' Claims Open Records Request: 502-564-5550

Division of Workers' Compensation Funds: 502-564-5467

WC Funding Commission Executive Director: 502-782-1717

Small Business Ombudsman: 502-564--0684

EDI Proof of Coverage Contact: 502-782-4480

EDI Claims Contact: 502-782-4540

Department of Insurance Commissioner Sharon P. Clark: 502-564-4604

Department of Insurance: 502-564-3630

Department of Insurance - Toll Free: 800-595-6053

Insurance Fraud Investigation - Department of Insurance: 502-564-1461

Department of Workers' Claims Interim Commissioner Robert Walker: 502-564-5550

Department of Workplace Standards Commissioner Perry Kimberlee: 502-564-0952

Office of Administrative Law Judges Chief AL Judge Douglas Gott: 502-564-5550

Office of General Counsel Sam Flynn: 502-564-0081

Workers' Compensation Data Entry Section: 502-782-4402

OSHA - Kentucky State Plan - Frankfort Office: 502-564-3070

Forms & Publications


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,600 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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REMINDER

CHANGE OF ADDRESS FORM FILING REQUIREMENT
Following resolution of a claim in which medical benefits are limited to 780 weeks, the claimant, employer, and medical payment obligor shall notify the Department of Workers' Claims in writing of any change in the claimant’s physical mailing address or email address. [803 KAR 25:290, Section 2(2) and (3)]

The form must either be mailed to the Department or scanned and emailed to KYWC.ClaimsProcessing@ky.gov.

Changes submitted through the EDI process do not satisfy this filing requirement.

Effective Jan. 1, 2019, Settlement Agreements (Form 110) must be submitted electronically through LMS.  The Department of Workers' Compensation (DWC) will not accept nor process paper Settlement Agreements after Jan. 1, 2019. 

Per 803 KAR 25:010 3(1)(b) EFFECTIVE JULY 1, 2017, THE DEPARTMENT OF WORKERS' CLAIMS WILL NO LONGER ACCEPT PAPER FILINGS.

(IA-1) First Report of Injury 1/02
(ia-2) Subsequent Report 1/99
(aww1) Average Weekly Wage Certification 10/16
(awwcon) Average Weekly Wage Certification-Concurrent 10/16
(awwpost) Average Weekly Wage Certification-Post Injury 10/16
(11) Motion to Substitute Party and Continue Benefits 10/16
(fatalform) Fatality Form 10/16
(101) Application for Resolution of Injury Claim 10/16
(102) Application for Resolution of Occupational Disease Claim 10/16
(103) Application for Resolution of Hearing Loss Claim 10/16
(CHECK LIST FOR PET BRIEF) Checklist for Petitioner's Brief N/D
(CHECK LIST FOR RESP BRIEF) Checklist for Respondent's Brief N/D
(104) Plaintiff's Employment History 10/16
(105) Plaintiff's Chronological Medical History 10/16
(101ir) Application for Resolution-Interloctory Relief 10/16
(106) Medical Waiver and Consent 7/03
(107) Medical Report-Injury/Hearing Loss/Psychological Condition 10/16
(108) Medical Report-Occupational Disease 10/16
(109) Attorney Fee Election 3/95
(110-ODHLCWP) Agreement as to Compensation and Order Approving Settlement-Occupational Disease/Hearing Loss 2/20
(110f) Agreement as to Compensation and Order Approving Settlement-Fatality 10/16
(110i) Agreement as to Compensation and Order Approving Settlement-Injury 2/20
(111) Notice of Claim Denial or Acceptance 10/16
(112) Medical Dispute 10/16
(113) Notice of Designated Physician 3/03
(114) Request for Payment for Services or Reimbursement for Compensable Expenses N/D
(115) Social Security Release Form 1/97
(recrelease) Release and Consent To Disclosure N/D
(120ex) Request for Expedited Determination of Medical Issue 10/16
(Form375) Application for Split Coverage N/D
(375w) Application for Split Coverage (Wrap-Up) N/D
(el1-2) Employee Leasing Company Registration Form 4/97
(MTR) Motion To Reopen 10/16
(hls) Workers' Compensation-Hearing Loss Stipulation 10/16
(is) Workers' Compensation-Injury Stipulation 10/16
(ods) Workers' Compensation-Occupational Disease Stipulation 10/16
(SI01) Self-Insurers' Guarantee Agreement 11/05
(SI02) Self-Insurance Application / Employers Application for Permission to Carry his Own Risk Without Insurance 1/04
(SI02R) Employer's Application For Recertification 1/21
(SI02attach) Self-Insurance Application Attachment - Request for Information N/D
(SI03) Continuous Bond 1/04
(SI03attach) Surety Rider 1/04
(SI04) Letter of Credit 1/04
(SI08) Loss Report 10/05
(DFWPApplication) Application/Affidavit/Checklist for Certification of Kentucky Drug-Free Workplace Program Pursuant to 803 KAR 25:280 N/D
(af-corp) Notarized Affidavit of Exemption from the KY Workers' Compensation Act (Corporation or Partnership) 1/97
(af-ind) Notarized Affidavit of Exemption from the KY Workers' Compensation Act (Individual) 1/97
(ManualChangeForm2009) Request for Manual Change 12/09
(ManagedCareUR) Managed Care Utilization Review N/D
(SVC) Safety Violation Alleged by Plantiff/Employee 10/16
(SVE) Safety Violation Alledged by Defendant/Employer 10/16
(recreqforsi) Open Records Request Self Insurance Branch Copies/inspection of Self-Insurance Files N/D
(O R Request) Open Records Request for Copies/Inspection of DWC Claim Files 12/19
(ServiceContractAgreement) Service Contract Agreement N/D
(Subpoena) Subpoena N/D
(SubpoenaDT) Subpoena Duces Tecum N/D
(drugfreebro) BROCHURE- Kentucky Drug Free Workplace Brochure N/D
POSTER - Workers' Compensation Notice 4/09
POSTER - Workers' Compensation Notice - (Spanish) 6/20
(2016 DWC Guidebook) BROCHURE - Workers' Compensation Guidebook 2016
(directdep) Direct Deposit N/D
(continuemed) Application For Continuation Of Medical Benefits 8/18
(changeaddr) Change of Address for Continuation of Benefits 8/18
(medreptcont) Medical Report for Continuation of Benefits 8/18

Chapter 25 Department of Workers' Claims

Chapter 30 Workers' Compensation Funding Commission

Chapter 50 Kentucky Occupational Safety and Health Review Commission

Chapter 131 Revenue Cabinet

Chapter 304 Insurance Code

Chapter 336. Labor Cabinet

Chapter 342 Workers' Compensation