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Form 120EXOctober 2016 EditionKENTUCKY DEPARTMENT OF WORKERS\' CLAIMS 500 HERO STREET, 3RD FLOOR, FRANKFORT, KY 40601 Claim No. Filed:Request for Expedited Medical DeterminationPlaintiff Defendant/EmployerPhone
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How to fill out laborkygovdocumentsform120exkentucky department of workers

01
Start by obtaining the laborkygovdocumentsform120ex form from the Kentucky Department of Workers' website or office.
02
Carefully read all instructions provided on the form to understand what information needs to be filled out.
03
Fill in your personal information, including your full name, address, contact details, and social security number.
04
Provide details about your current employment status, including your job title, employer's name, and work location.
05
Include any relevant medical information or details about the injury or reason for filing the form.
06
Sign and date the form before submitting it to the Kentucky Department of Workers' office.

Who needs laborkygovdocumentsform120exkentucky department of workers?

01
Employees who have suffered a work-related injury and are seeking workers' compensation benefits from the Kentucky Department of Workers.

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This form is used by the Kentucky Department of Workers' Claims for reporting injuries and accidents at the workplace.
Employers in Kentucky are required to file this form when an injury or accident occurs at the workplace.
The form can be filled out online on the Kentucky Department of Workers' Claims website or in person at their office.
The purpose of this form is to report workplace injuries and accidents to the Kentucky Department of Workers' Claims for investigation and compensation purposes.
Information such as the date of the injury, location, description of the incident, and details of the injured worker must be reported on the form.
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