The Claims Review Section's primary function is processing the Application for Resolution of:  Injury, Occupational Disease, Coal Workers' Pneumoconiosis (CWP) or Hearing Loss claims.  The duties of Claims Review include:  checking applications for inadequacies; researching and verifying insurance coverage for the injury date(s) submitted; routing the claim to other sections for specialized issues; and preparing the claim for imaging into the DWC database.  Once an application has been processed through the Claims Review Section, it is ready to be entered into the DWC database and assigned to an Administrative Law Judge.

 

 

Q.  What documentation is required when filing the application?
A.  The form instructions are included when you click on the link for the desired form application; in addition, you may call Specialists-Ombudsmen services at 1-800-554-8601 to speak with a DWC representative.

 

Q.  How many copies of the application should be included?
A.  The original application MUST be included along with two copies.

 

Q.  When was the application received at DWC?
A.  A representative from the Claims Review section will be able to access the DWC database by DWC claim number, claimant's social security number or name and will provide an update on the receipt and status of an application filing.

 

Q.  The statute of limitations runs today, how can I get the application filed today?
Per 803 KAR 25:010 Section 1 (4b) "A document is transmitted by US registered (not certified) or express mail, or by other recognized mail carriers [Fed Ex], and the date the transmitting agency receives the document from the sender as noted by the transmitting agency on the outside of the container used for transmitting..."; or you may drive the application to DWC at 657 Chamberlin Ave., Frankfort, KY. between 8:00-4:30 pm, Monday-Friday (except recognized State Government holidays).

 

Q.  Why was an insurance carrier notified in a particular claim?
A.  A representative from the Claims Review Section can review the DWC database for the employers' insurance carrier and coverage information.

 

 

Form 101 Application for Resolution of Injury Claim
Form 102-OD Application for Resolution of Occupational Disease Claim
Form 102-CWP Application for Resolution of Coal Workers' Pneumoconiosis Claim
Form 103 Application for Resolution of Hearing Loss Claim
Form 104 Plaintiff's Employment History
Form 105 Plaintiff's Chronological Medical History
Form 106 Medical Waiver and Consent Form
Form 107-I Physician's Medical Report-Injury
Form 108-HL Physician's Medical Report-Hearing Loss
Form 108-OD Physician's Medical Report-Occupational Disease
Form 112 Medical Dispute
Form 115 Social Security Release Form

 

These forms can be found on our forms page.

For further information or questions, please call Acting Section Supervisor-Vicki Harmon at 502-782-4507, Fax 502-564-3792. Vicki.Harmon@ky.gov