Claims Review
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 Claims Review Section focuses on routing and preparation involved in the processing of an Application for Resolution filing. This section reviews the claim for required elements, assembles the file, enters claim information such as parties and addresses into the Department's database, assigns a claim number, and researches insurance coverage through the Department's insurance database. In fiscal year 2013-2014, there were 4,875 new claims filed including 3,716 Applications for Resolution of Injury (Form 101), 627 Occupational Disease (Form 102 and Form 102 CWP), and 532 Hearing Loss (Form 103). Of the 627 Occupational Disease applications, 586 were Coal Workers' Pneumoconiosis applications.

For further information or questions, please call Administrative Section Supervisor:

Sandy Jump Lester
Phone: 502-782-4508
Fax: 502-564-3792

Forms Used
Word PDF - Form 101
Application for Resolution of Injury Claim
Word PDF - Form 102-CWP
Application for Resolution of Coal Workers' Pneumoconiosis Claim
Word PDF - Form 102-OD
Application for Resolution of Occupational Disease Claim
Word PDF - Form 103
Application for Resolution of Hearing Loss Claim
Word PDF - Form 104
Plaintiff's Employment History​
Word PDF - Form 105
Plaintiff's Chronological Medical History
Word PDF - Form 106
Medical Waiver and Consent Form
Word PDF - Form 107-I
Physician's Medical Report-Injury
Word PDF - Form 108-HL
Physician's Medical Report-Hearing Loss
Word PDF - Form 108-OD
Physician's Medical Report-Occupational Disease
Word PDF - Form 112
Medical Dispute
Word PDF - Form 115
Social Security Release Form
* Click the PDF or Word icon to view the form in that format.