Kentucky Workers Comp Claims: Eligibility, Filing and Appeals

Understand the process of Workers Compensation in the state of Kentucky.

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Workers injured on the job in Kentucky, with few exceptions, are covered by the state’s workers’ compensation laws. Workers’ compensation provides financial compensation and medical care.

The Kentucky Department of Workers’ Claims (DWC) is a division of the Kentucky Labor Cabinet and oversees the Kentucky Workers’ Compensation Program. The DWC administers benefits and has jurisdiction over all compensation claims.

Workers Covered Under Kentucky Workers' Comp

In the state of Kentucky, all employers must carry workers’ compensation insurance or become self-insured, except for certain agricultural employers. Even employers with only one employee, part-time or full-time, falls under the purview of Kentucky workers’ compensation, and must have insurance or be self-insured.

Independent contractors, domestic workers, and most volunteers are excluded from workers’ compensation coverage. Volunteer ambulance, fire, and police workers, however, are covered. Separate federal statutes cover federal employees, such as postal workers.

Unlike most other states, Kentucky allows workers to waive their rights to workers' comp and preserve their right to sue their employer. Employees can do this by signing a Form 4 Waiver, which the employer must file with the DWC.

Common Covered Work-Related Injuries

All physical injuries and occupational diseases “arising in and out of employment” are covered workers’ compensation injuries and illnesses. An occupational disease is a condition that develops from the distinct condition of the workplace, and can be a condition that develops over time. Conditions arising from the natural aging process are specifically excluded from coverage. Psychological problems are covered only if they area result of a physical injury.

An injury or illness is covered if it arises during employment. This does not include commuting to and from the workplace, but does include work-related travel. Injuries resulting from horseplay, intoxication, or self-infliction are not usually covered, and compensation for injuries resulting from carelessness may be reduced.

Common injuries covered under Kentucky workers’ compensation law include general workplace injuries such as accidentally broken bones, low back injuries, and hearing loss. Typical occupational disease claims include coal workers’ black lung disease (CWP).

Filing a Workers’ Compensation Claim

First, report the industrial injury or occupational disease to your employer immediately. If your claim is an occupational disease, report the claim as soon as you learn the condition may be related to your employment.

Your employer should then provide you with the forms necessary for filing your workers’ compensation claim. Workers’ compensation claim applications must be notarized and filed with the Department of Workers’ Claims. There are three types of claim applications: Form 101 is for injury claims; Form 102 is for occupational disease claims; and Form 103 is for use in hearing loss claims.

You will also have to file the following forms:

  • Form 104: Employment History
  • Form 105: Medical History
  • Form 106: Medical Waiver and Consent, and
  • Form 115: Social Security Release Form.

All of these forms can be found at the Department of Workers' Claims website.

You should also submit a medical report substantiating your claim. The report should be from your doctor and should detail the relationship between your illness or injury and the work-related event. Also plan to submit documentation of your wages at the time of your injury.

Claim Denials and Appeals

You will receive written notice from your employer’s workers’ compensation insurance carrier if your workers’ compensation claim is denied. You should receive the notice within two months days of reporting your injury to the Department of Workers’ Claims.

One of the major reasons for a claim denial is improper medical documentation and insufficient proof of workplace injury. Claims may also be denied if the employee has not sought medical treatment or has a pre-existing condition that has contributed to the injury or illness.

If your claim is denied, you may appeal the denial. The appeal process will be explained on the letter you receive stating your claim was denied. Your case will be assigned to an Administrative Law Judge, who will hold a Benefit Review Conference and then a hearing. The judge will then issue a written decision.

You may appeal the judge's decision to the Workers' Comp Board, and decisions made by the board may be further appealed through Kentucky appellate courts, but unless the board significantly misinterpreted the law, the courts generally defer to the board's decisions.

For more information, see our article on appealing a workers' comp denial in Kentucky.

Kentucky Workers’ Compensation Benefits

Workers' comp benefits available in Kentucky include medical costs, temporary disability for time off work, and permanent disability payments if the worker has permanent or lingering impairments.

Medical Costs

Your employer is responsible for paying for your medical care, including hospitalization, doctor visits, physical therapy, and prescriptions.You will not be required to pay for any medical care or treatment that is proper and necessary for the treatment of your work-related injury or occupational disease. The workers' comp insurance company will pay your doctor and hospital bills directly.

Choosing Your Own Doctor

If your employer is part of an authorized managed care program, you must choose a doctor within the program. Otherwise, you are free to choose your own doctor.

Lost Wages – Temporary and Permanent Total Disability

If you are unable to work while recovering from your injury, you may be eligible for temporary total disability compensation. You must be unable to work for at least seven days to be eligible for this benefit.

The benefit amount is 2/3 of your average weekly wage, or the state’s average weekly wage, whichever is less. Your employer’s workers’ compensation insurance carrier will pay your benefits on a weekly basis.

Temporary total disability payments end when you reach "maximum medical improvement" (MMI), meaning you are not expected to improve with further treatment, or when you return to work, whichever occurs first. If you are permanently and totally disabled, meaning unable to work in any capacity ever again, these benefits will continue for life.

Unlike other states, Kentucky does not provide temporary partial disability benefits before you reach MMI -- compensation for workers who are able to return to work, but in a limited capacity for reduced wages.

Permanent Partial Disability

You will receive compensation if your workplace injury or occupational disease results in some level of permanent disability. Once you have reached maximum medical improvement, your doctor will assess your permanent impairment rating (if you have any permanent impairment).

The permanent impairment rating determines the amount of compensation you will receive for the permanent disability. The benefits are paid on a weekly basis, with the amount and duration determined by the permanent impairment rating and your average weekly wage at the time of injury. A higher percentage of impairment results in higher compensation paid for a longer period of time.

Age and education level also can play into the formula for calculating permanent partial disability payments. Someone with advanced age and less education will receive greater benefits. For more information, see Kentucky's guidebook to workers' comp.

by: , Contributing Author

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