The Claims Assignment Section receives and processes all applications for resolution of injury, hearing loss, or occupational disease and assigns those claims to the administrative law judges.  This section verifies completeness and correctness of each file, acknowledges its receipt, schedules the docket for the benefit review conferences in all 12 regions of the state, assigns court reporters for the hearings and generates letters and notices to all parties named in a claim filing.

FAQ’s

Q.  How many copies of the application for resolution do you need?

Q.  Where do we send the application and to whom do we send it?

Q.  Has a judge been assigned to the case yet?
Q.  When was the claim received?
Q.  Has my claim been received?

Q.  Why was the carrier notified in this particular claim?

Q.  What is the insurance carrier’s policy number for this date of injury?

Answers:  The Claims Assignment Section will assist you in obtaining answers for these questions.

Forms Used:

1.   Form 101            Application for Resolution of Injury Claim

2.   Form 102            Application for Resolution of Occupational Disease Claim         

3.   Form 103            Application for Resolution of Hearing Loss Claim

4.   Form 104            Plaintiff’s Employment History

5.   Form 105            Plaintiff's Chronological Medical History

6.   Form 106            Medical Waiver and Consent Form

7.   Form 107-I          Physician’s Medical Report - Injury

8.   Form 108-HL       Physician’s Medical Report – Hearing Loss

9.   Form 108-OD      Physician’s Medical Report – Occupational Disease

10. Form 112            Medical Dispute

11. Form MAO          Medical Fee Dispute and Mediation                       

12. Form 115            Social Security Release Form

For further information or questions, please call Administrative Section Supervisor Rhonda Pack at 502-564-5550, ext. 4500.  Fax 502-564-3792.
Rhonda.Pack@ky.gov