Kentucky Department of Workers' Claims Forms

This document contains the specifications for the receiver's electronic transmission profile in the state of Kentucky. It outlines the technical requirements for receiving electronic transmissions.

This document is used for requesting a certification of coverage in the state of Kentucky. It confirms an individual's insurance coverage for a certain period of time.

This Form is used for reporting medical information to support the continuation of medical benefits in Kentucky.

This form is used for applying to continue receiving medical benefits in the state of Kentucky.

This Form is used for changing the address to continue receiving medical benefits in Kentucky.

This form is used for authorizing the direct deposit of funds into a designated bank account in the state of Kentucky.

This document authorizes a change of address in the state of Kentucky. It is used to notify relevant parties of a new mailing address.

This type of document is a previously filed Form 4 or Form 5 request specific to Kentucky.

This form is used for agreeing on compensation and approving a settlement for an injury case in Kentucky.

This form is used for agreeing on compensation and approving settlements for occupational disease or hearing loss cases in Kentucky.

This form is used for resolving a claim related to hearing loss in the state of Kentucky.

This form is used for applying to resolve a claim related to occupational disease in the state of Kentucky.

This form is used for submitting a vendor application for Electronic Data Interchange (EDI) in the state of Kentucky.

This document is used for applying for a drug-free workplace program in the state of Kentucky. It provides the necessary information and forms to meet the requirements of a drug-free workplace.

This Form is used for reporting fatalities in the state of Kentucky.

This document type is used in Kentucky for filing a motion to reopen a legal case.

This document is used to request access to public records in the state of Kentucky. It allows individuals to obtain information from government agencies and entities.

This document is used for conducting a medical bill audit and utilization review in the state of Kentucky.