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Employee Leasing Company Registration Form (EL1).pdf
  
EL 1 (Employee Leasing Company Registration Form)EL 1 (Employee Leasing Company Registration Form)11/29/2017 4:09 PMSystem Account
Employee Leasing Coverage Requirements.pdf
  
Coverage Requirements for Lessees (KRS 342.615.803 KAR 25.230)Coverage Requirements for Lessees (KRS 342.615.803 KAR 25.230)11/29/2017 4:13 PMSystem Account
Form 101.pdf
  
Form 101Application for Resolution of Injury Claim11/18/2015 2:33 PMSystem Account
Form 102-CWP.pdf
  
Form 102-CWPApplication for Resolution of Coal Workers' Pneumoconiosis Claim11/18/2015 2:33 PMSystem Account
Form 102-OD.pdf
  
Form 102-ODApplication for Resolution of Occupational Disease Claim11/18/2015 2:33 PMSystem Account
Form 103.pdf
  
Form 103Application for Resolution of Hearing Loss Claim11/18/2015 2:33 PMSystem Account
Form 104.pdf
  
Form 104Plaintiff's Employment History​11/18/2015 2:33 PMSystem Account
Form 105.pdf
  
Form 105Plaintiff's Chronological Medical History11/18/2015 2:34 PMSystem Account
Form 106.pdf
  
Form 106Medical Waiver and Consent Form11/18/2015 2:34 PMSystem Account
Form 107-I.pdf
  
Form 107-IPhysician's Medical Report-Injury11/18/2015 2:34 PMSystem Account
Form 108-HL.pdf
  
Form 108-HLPhysician's Medical Report-Hearing Loss11/18/2015 2:34 PMSystem Account
Form 108-OD.pdf
  
Form 108-ODPhysician's Medical Report-Occupational Disease11/18/2015 2:34 PMSystem Account
Form 11.pdf
  
Form 11Motion to Substitute Party and Continue Benefits​11/19/2015 8:42 AMSystem Account
Form 110-CWP.pdf
  
Form 110-CWPAgreement as to Compensation and Order Approving Settlement for Coal Workers' Pneumoconiosis11/19/2015 8:43 AMSystem Account
Form 110-F.pdf
  
Form 110-FAgreement as to Compensation and Order Approving Settlement-Fataility11/19/2015 8:45 AMSystem Account
Form 110-I.pdf
  
Form 110-IAgreement as to Compensation and Order Approving Settlement-Injury11/19/2015 8:46 AMSystem Account
Form 110-OD.pdf
  
Form 110-ODAgreement as to Compensation and Order Approving Settlement-Occupational Disease11/19/2015 8:47 AMSystem Account
Form 112.pdf
  
Form 112Medical Dispute11/18/2015 2:34 PMSystem Account
Form 115.pdf
  
Form 115Social Security Release Form11/18/2015 2:34 PMSystem Account
Form SI-01.pdf
  
Form SI-01Self-Insurers' Guarantee Agreement2/23/2016 3:06 PMSystem Account
Form SI-02 Attachment.pdf
  
Form SI-02 AttachmentSelf Insurance Application Attachment2/23/2016 3:07 PMSystem Account
Form SI-02.pdf
  
Form SI-02Self Insurance Application2/23/2016 3:08 PMSystem Account
Form SI-03 Attachment.pdf
  
Form SI-03 AttachmentSurety Rider11/3/2017 3:26 PMSystem Account
Form SI-03.pdf
  
Form SI-03Continuous Bond2/23/2016 3:11 PMSystem Account
Form SI-04.pdf
  
Form SI-04Letter of Credit2/23/2016 3:12 PMSystem Account
Form SI-08.pdf
  
Form SI-08Loss Report2/23/2016 3:13 PMSystem Account
Lessee Information Form (EL2).pdf
  
EL 2 (Lessee Information Form)EL 2 (Lessee Information Form)11/29/2017 4:15 PMSystem Account
Managed Care-UR Form.pdf
  
Managed Care-UR FormManaged-Care/Utilization Review2/23/2016 3:14 PMSystem Account
Open Records Request Form.pdf
  
Open Records Request FormRequest for copies/inspection of DWC claim files.12/22/2015 11:52 AMSystem Account
Petitioners Brief.pdf
  
Petitioner's BriefChecklist for Petitioner's Brief11/19/2015 10:03 AMSystem Account
Previously Filed Form 4 Request Form.pdf
  
Compliance Branch Open Records Request Form(Request Previously Filed Rejection Notices)6/15/2017 2:46 PMSystem Account
Request to Certify Coverage Form.pdf
  
Compliance Branch Certification of Coverage Requests(Request Certification of Coverage)6/15/2017 2:46 PMSystem Account
Respondents Brief.pdf
  
Respondent's BriefChecklist for Respondent's Brief11/19/2015 10:03 AMSystem Account
Self Insurance Open Records Request Form.pdf
  
Self Insurance Open Records Request FormRequest for copies/inspection of Self-Insurance files.2/12/2016 10:42 AMSystem Account
Service Contract Agreement.pdf
  
Service Contract AgreementService Contract Agreement2/23/2016 3:15 PMSystem Account
Workers Comp Posting Notice.pdf
  
Workers' Compensation Posting NoticeWorkers' Compensation Posting Notice2/24/2016 12:27 PMSystem Account