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Form 11 October 2016 Edition KENTUCKY DEPARTMENT OF WORKERS CLAIMS500 Hero Street, 3rd Floor, Frankfort, KY 40601Workers Compensation Claim no. BeforeRequest to Substitute Party and Continue Benefits
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How to fill out department of workers claims

01
Step 1: Obtain the necessary forms and documents from the Department of Workers Claims.
02
Step 2: Fill out the employee information section, including name, address, and contact details.
03
Step 3: Provide details about the incident or injury that occurred at work, including the date, time, and location.
04
Step 4: Describe the nature and extent of the injury or illness, including any medical diagnosis or treatment received.
05
Step 5: Include information about any witnesses to the incident, if applicable.
06
Step 6: Provide details about the employer's workers' compensation insurance, including the policy number and contact information.
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Step 7: Sign and date the claim form, and make a copy for your records.
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Step 8: Submit the completed claim form to the Department of Workers Claims either by mail or in person.

Who needs department of workers claims?

01
Employees who have suffered injuries or illnesses in the workplace and wish to file for workers' compensation benefits.
02
Employers who need to report incidents or injuries that have occurred at their workplace.
03
Insurance companies and legal representatives who require information and documentation related to workers' compensation claims.

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Department of workers claims is a government agency responsible for processing and adjudicating claims related to workplace injuries or illnesses.
Employees who have suffered a work-related injury or illness are required to file department of workers claims.
Department of workers claims can be filled out online or by submitting a paper form provided by the agency. The form must include details of the injury or illness, medical treatment received, and any witnesses.
The purpose of department of workers claims is to provide compensation and benefits to employees who have been injured or become ill due to their work.
Information such as the date and time of the injury or illness, the nature of the injury, the location where it occurred, and any medical treatment received must be reported on department of workers claims.
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