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KANSAS DEPARTMENT OF LABOR
www.dol.ks.govPage 1 of 2INFORMATION FOR INJURED EMPLOYEES
KWC 27A (Rev. 719)* THIS NOTICE APPLIES TO ACCIDENTS ON OR AFTER APRIL 25, 2013 *
Employers are required to provide
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To fill out the k-wc 27-a rev form, follow these steps:
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Start by entering the relevant personal information in the designated fields, such as name, address, and contact details.
03
Provide the necessary details about the incident or injury, including the date, time, and location.
04
Describe the nature of the incident or injury in detail, including any specific body parts affected or medical conditions involved.
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If applicable, provide information about any witnesses present during the incident.
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Include information about any medical treatment received or ongoing care required.
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If applicable, include details about any lost wages or other financial impacts resulting from the incident or injury.
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Review the filled-out form for accuracy and completeness.
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Sign and date the form to certify its authenticity.
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Submit the completed k-wc 27-a rev form to the relevant authority or organization responsible for processing workers' compensation claims.
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What is k-wc 27-a rev?
K-wc 27-a rev is a form used to report worker's compensation coverage information.
Who is required to file k-wc 27-a rev?
Employers are required to file k-wc 27-a rev.
How to fill out k-wc 27-a rev?
K-wc 27-a rev can be filled out online or by mail following the instructions provided by the respective state department.
What is the purpose of k-wc 27-a rev?
The purpose of k-wc 27-a rev is to verify that employers have worker's compensation coverage for their employees.
What information must be reported on k-wc 27-a rev?
Information such as employer name, address, policy number, effective date of coverage must be reported on k-wc 27-a rev.
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