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Form 101IRFiled:October 2016 EditionKENTUCKY DEPARTMENT OF WORKERS CLAIMS 500 HERO STREET, 3RD FLOOR, FRANKFORT, KY 40601 Claim No. Application for Resolution Interlocutory ReliefDefendant/Employer
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To fill out the Kentucky Department of Workers form, follow these steps:
02
Obtain the form from the Kentucky Department of Workers website or through your employer.
03
Fill in your personal information, such as your name, address, and contact details.
04
Provide details about your employment, such as your job title, start date, and employer's information.
05
Indicate the date and description of the work-related injury or illness you are reporting.
06
Describe the medical treatment you have received for the injury or illness.
07
If applicable, provide the names and contact information of any witnesses to the incident.
08
Sign and date the form, certifying the accuracy of the information provided.
09
Submit the completed form to the Kentucky Department of Workers or your employer as specified.

Who needs kentucky department of workers?

01
Anyone who has experienced a work-related injury or illness in the state of Kentucky needs the Kentucky Department of Workers form. This form is required to report the incident and receive appropriate compensation and medical treatment.
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Kentucky Department of Workers' Claims (DWC) is the state agency responsible for overseeing workers' compensation claims.
Employers in Kentucky are required to file with the Department of Workers' Claims.
Employers can fill out the workers' compensation forms online or by mail.
The purpose of Kentucky Department of Workers' Claims is to ensure that employees who are injured on the job receive the necessary benefits and compensation.
Employers must report information about the injured employee, the nature of the injury, and the circumstances of the accident.
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