Workplace injuries can happen unexpectedly, leaving employees struggling with medical bills and lost wages. In Kentucky, the workers’ compensation system provides financial relief for injured workers, covering medical expenses and wage replacement benefits. However, to receive these benefits, employees must follow specific procedures. This guide details the steps involved in filing a workers’ compensation claim in Kentucky, eligibility requirements, and what injured workers should expect during the process.
Who Is Eligible for Workers' Compensation in Kentucky?
Under Kentucky Revised Statutes (KRS) Chapter 342, most employers are required to carry workers' compensation insurance if they have at least one employee. This includes full-time, part-time, and seasonal workers. However, independent contractors, agricultural workers, and domestic employees may have different coverage requirements.
Common Workplace Injuries Covered
Workers' compensation typically covers a range of work-related injuries and illnesses, including:
- Slips, trips, and falls
- Repetitive motion injuries (e.g., carpal tunnel syndrome)
- Machinery-related accidents
- Exposure to toxic substances
- Strains from heavy lifting
- Workplace violence injuries
It is important to note that self-inflicted injuries, injuries caused by intoxication, or those occurring outside the scope of employment may not be covered under Kentucky’s system.
Steps to File a Workers’ Compensation Claim in Kentucky
1. Report the Injury to Your Employer
The first step is to tell your employer immediately after an injury occurs. Kentucky law requires injured employees to report their injury as soon as possible, preferably within 30 days. Delays in reporting can jeopardize your ability to receive benefits.
When reporting the injury, provide:
- Date, time, and location of the incident
- How the injury occurred
- Symptoms and affected body parts
Employers must then file a First Report of Injury (FROI) with the Kentucky Department of Workers' Claims (DWC).
2. Seek Medical Attention
Kentucky law allows injured workers to choose their own physician for treatment. Be sure to inform your doctor that the injury is work-related so that proper medical documentation is created. The medical provider will submit reports and bills to the employer’s workers' compensation insurance carrier.
Under KRS 342.020, workers’ compensation covers:
- Doctor visits and hospital stays
- Prescription medications
- Physical therapy
- Surgery and rehabilitation
- Mileage reimbursement for travel to medical appointments
If your employer has a Managed Care Plan (MCP), you may need to choose a physician within that network.
3. File a Formal Claim if Necessary
If your employer denies the claim or delays benefits, you may need to file Form 101 – Application for Resolution of Injury Claim with the Kentucky Department of Workers' Claims. The process includes:
- Completing Form 101, providing details about your injury
- Attaching medical records and documentation supporting your claim
- Submitting the form online through the DWC website or via mail
Kentucky law requires claims to be filed within two years of the injury date or two years from the last payment of temporary disability benefits, whichever is later.
Types of Workers' Compensation Benefits in Kentucky
1. Temporary Total Disability (TTD) Benefits
TTD benefits apply if a worker is unable to return to work during recovery. Employees receive two-thirds (66.67%) of their average weekly wage (AWW), up to the state maximum set annually by the DWC.
2. Permanent Partial Disability (PPD) Benefits
If an injury results in permanent impairment but the worker can still perform some tasks, they may receive PPD benefits based on the impairment rating assigned by a physician.
3. Permanent Total Disability (PTD) Benefits
PTD benefits apply when a worker can no longer perform any job due to a permanent disability. These payments continue for life or until the employee qualifies for Social Security benefits.
4. Medical Benefits
Workers' compensation covers all reasonable medical expenses, including surgery, therapy, and medical equipment, as long as the treatment remains necessary for recovery.
5. Vocational Rehabilitation Benefits
If an injured worker cannot return to their previous job, they may qualify for vocational training to learn new skills and transition into a different career.
What Happens If a Claim Is Denied?
Workers’ compensation claims can be denied for several reasons, including:
- Failure to report the injury on time
- Lack of medical evidence connecting the injury to work
- Employer disputes the claim, arguing the injury was not work-related
- Missed filing deadlines
Steps to Appeal a Denied Claim
If your claim is denied, you can file an appeal with the Kentucky Department of Workers’ Claims within 30 days of receiving the denial notice. The process includes:
- Requesting an administrative hearing before an Administrative Law Judge (ALJ).
- Presenting medical records, witness statements, and expert testimony to support your case.
- If the ALJ denies the appeal, you can take your case to the Workers' Compensation Board and, if necessary, the Kentucky Court of Appeals.
Legal representation is recommended during the appeal process to maximize your chances of approval.
How Long Do Benefits Last?
The duration of workers’ compensation benefits depends on the severity of the injury:
- Temporary benefits end when a worker returns to work or reaches maximum medical improvement (MMI).
- Permanent disability benefits may continue for years or until retirement age, depending on impairment levels.
- Medical benefits remain available for life, as long as they are necessary for the work-related injury.
Conclusion
Filing for workers’ compensation in Kentucky requires careful attention to deadlines and documentation. Employees should report injuries immediately, seek medical treatment, and follow up with their employer’s insurance carrier. If a claim is denied, appeals are possible through the Kentucky Department of Workers' Claims.
Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away
Navigating Kentucky Workers Comp Claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.
Contact us now for a free legal review.