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Instructions double click image to open Kentucky Workers Claims Release 3 First Report of Injury Element Requirements * Legacy TE's prior to 1/16/09. As of 10/27/2011, no longer accepting MTC CO.
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2011 Kentucky R22 R21 MTC A49 R3 FROI DN0085 E1 FEIN YC Insurer 2xx RTW AU IP DN0184 5XX DN0002 SROI PY RB SSN R1 Payee E0 DN0074 I-Insured S1 0xx

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