Kentucky Workers Compensation - Official forms

Workers Compensation - Official - Claims

• Application for Resolution of Injury Claim KY-101-WC

Workers Compensation - Official - Coverage

• Application for Split Coverage KY-375-WC
• Application for Split Coverage Wrap Up KY-375W-WC

Workers Compensation - Official - Disputes

• Medical Dispute KY-112-WC

Workers Compensation - Official - Medical

• Medical Report Injury KY-107I-WC
• Medical Report Occupational Disease KY-108CWP-WC
• Medical Report Occupational Disease KY-108O-WC

Workers Compensation - Official - Payments

• Request for Payment KY-HBL-114-WC

Workers Compensation - Official - Wages

• Wage Certification KY-AWW1-WC