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KANSAS DEPARTMENT OF LABOR www. dol.ks. gov ELECTION OF EMPLOYEE NOT TO ACCEPT COVERAGE K-WC 50 Rev. 1-17 MAIL Division of Workers Compensation 401 SW Topeka Blvd. Suite 2 Topeka KS 66603-3105 FAX 785 296-0025 Election Not to Accept Coverage Under Kansas Workers Compensation Act by Employee Who Owns 10 Percent or More of Corporate Stock of Corporate Employer To be processed ALL entries on this form must be completed. If not completed using the fillable form feature entries must be neatly...
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Step 1: Start by obtaining a copy of the k-wc 50 rev form.
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Step 2: Read the instructions on the form carefully to understand the required information.
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Step 3: Fill in your personal details such as your name, address, and contact information in the designated fields.
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Step 4: Provide details about your current employment status, including the name and address of your employer.
05
Step 5: Indicate the reason for filling out the form, such as a work-related injury or illness.
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Step 6: Describe the nature of the injury or illness and provide any relevant medical information.
07
Step 7: If applicable, provide details about any witnesses or other parties involved.
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Step 8: Sign and date the form to confirm the accuracy of the information provided.
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Step 9: Double-check all the filled-out information for any errors or omissions.
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Step 10: Submit the completed k-wc 50 rev form to the appropriate authority or your employer as instructed.
Who needs k-wc 50 rev?
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Employees who have experienced a work-related injury or illness need to fill out the k-wc 50 rev form.
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Employers may also require their employees to fill out this form as part of the necessary documentation process.
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Insurance companies and workers' compensation boards often request this form to process claims.
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Medical professionals and legal representatives involved in assessing and handling work-related injury or illness cases may also require this form.
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