When You’re Hurt on the Job, Don’t Take on the Workers’ Comp Process Alone

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An injury at work brings normal life to a halt. Suddenly, your top priority is getting better.

Kentucky Workers’ Compensation benefits can give you the income and health care coverage you need to move beyond the medical crisis and back to a fulfilling life.

But sometimes the people in H.R. at your job, or the Workers’ Comp insurance company, aren’t helpful. And the Kentucky Labor Cabinet lists more than 50 forms for workers’ claims on its website.

You don’t know where to start. Wrestling with reams of complicated paperwork is the last thing you need right now.

At Morgan, Collins, Yeast & Salyer, we want to help. Keep reading for an introduction to the forms you need for a successful Workers’ Comp claim.

Or, to get help with your claim directly, contact us today for a free case consultation.

What Forms Start My Claim?

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Soon after a workplace injury — or the onset of an illness caused by conditions at work — you’ll need one of these three forms to start your claim:

FORM 101Application for Resolution of Claim – Injury

If you suffered an injury on the job, this is the form reporting the basics of your Workers’ Comp case, like where you work, when and how the injury happened and what medical treatment you have received so far.

FORM 102Application for Resolution of Claim – Occupational Disease

This form serves the same role as FORM 101, but this is the one you use if it’s an illness, not an injury, that has disrupted your work.

FORM 103Application for Resolution of Claim – Hearing Loss

This is the form you’ll need to start your Workers’ Comp claim if your health problem is a loss of hearing because of your work.

What Other Workers’ Comp Forms Are Required?

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In addition to one of those initial applications, you also must file these supporting forms:

FORM 104Plaintiff’s Employment History

On this form, you’ll provide a list of current and past employers and job titles, when you worked in each job and whether you experienced an injury or exposure to an occupational disease in each job.

FORM 105Plaintiff’s Chronological Medical History

On this form, you’ll list past injuries and illnesses, dates when you had those health problems, doctors you saw and hospitals where you went for treatment.

FORM 106Medical Waiver and Consent

This form gives permission to medical providers to share information needed for your Workers’ Comp claim.

FORM 115Social Security Release Form

If your case resulted from an occupational disease or hearing loss, this form allows the Social Security Administration to share information with the Kentucky Department of Workers’ Claims about your Social Security wages and benefits history.

What Other Forms Might I See?

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These are some other common forms in the Kentucky Workers’ Comp system:

FORM AWW-1Average Weekly Wage Certification

This form documents how much your employer compensated you in the year before your workplace illness or injury.

FORM 113Notice of Designated Physician

This form identifies the doctor who will lead the treatment for your illness or injury.

FORM 114Request for Payment for Services or Reimbursement for Compensable Expenses

This form requests reimbursement for costs of care, treatment, drugs or other expenses related to your claim

For help with these and any other forms you encounter while you’re seeking Kentucky Workers’ Comp, contact us today.

Do I Need A Lawyer?

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If you’re dealing with an uncooperative supervisor, or perhaps a hostile Worker’s Comp insurance company, this situation is probably unlike anything you’ve dealt with before.

But at Morgan, Collins, Yeast & Salyer, we deal with it every day.

In fact, Attorney McKinnley Morgan has been a leader in Kentucky in recent years for the number of Workers’ Comp cases he handles.

Over a five-year period, we helped injured workers get $131 million in workers’ comp benefits.

That’s what we mean when we talk about Kentucky Courage™

At Morgan, Collins, Yeast & Salyer, we know the rules and the specifics of the Kentucky Workers’ Comp system inside and out –– including what forms you need, and when and how to file them.

Contact us now.

Contact us for a Free Consultation
Or Give Us a Free Call 877.809.5352

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