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KANSAS DEPARTMENT OF LABOR www.dol.ks.gov Official Use Only REQUEST FOR WORKERS COMPENSATION RECORDS K-WC 97 (Rev. 3-12) Requestor name: Sara China 952 985-7200 Phone number: () Verified Credentials,
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How to fill out kansas workers compensation release

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How to fill out Kansas workers compensation release:

01
Obtain the form: The Kansas workers compensation release form can usually be obtained from your employer or the Kansas Department of Labor's website.
02
Read the instructions: Carefully read the instructions provided with the form to ensure that you understand the requirements and purpose of the release.
03
Identify the parties: Fill in your personal information, such as your name, address, and contact details. Additionally, provide the details of your employer, including their name, address, and any other requested information.
04
Describe the injury: Provide a detailed description of the injury or illness for which you are seeking workers compensation benefits. Include information such as the date, time, and location of the incident, as well as a description of how the injury occurred.
05
State your medical treatment: Outline the medical treatment you have received or are currently receiving for the injury. This includes any hospitals, clinics, or doctors you have visited, as well as the medications or procedures you have undergone.
06
Specify lost wages: Indicate the dates and duration of any time you have missed or anticipate missing from work due to the injury. This may include both past and future lost wages.
07
Review and sign the release: Carefully review the completed form, ensuring that all information is accurate and complete. Sign the release and date it.
08
Witness signature: If required, have a witness sign the form to confirm that they saw you signing it.
09
Return the form: Submit the completed form to the appropriate party or entity, which is typically your employer or their insurance company.

Who needs Kansas workers compensation release:

01
Employees who have suffered a work-related injury or illness in the state of Kansas may need to fill out a workers compensation release.
02
Employers in Kansas may also require their employees to fill out a workers compensation release as part of their insurance claim process.
03
Insurance companies providing workers compensation coverage in Kansas may request that injured employees complete a release to gather necessary information and assess eligibility for benefits.
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Kansas workers compensation release is a legal document that is signed by an injured worker in exchange for receiving a settlement from their employer's insurance company.
An injured worker who is seeking compensation for a work-related injury is required to file a Kansas workers compensation release.
To fill out a Kansas workers compensation release, the injured worker must provide their personal information, details of the injury, and any relevant medical records.
The purpose of a Kansas workers compensation release is to release the employer and their insurance company from further liability for the worker's injury.
The Kansas workers compensation release must include details of the injury, medical treatment received, and any settlements or agreements reached.
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