The Claims Review Section's primary function is processing the Application for Resolution of:  Injury, Occupational Disease, Coal Workers' Pneumoconiosis (CWP) or Hearing Loss claims.  The Claims Review Section focuses on routing and preparation involved in the processing of an Application for Resolution filing.  This section reviews the claim for required elements, assembles the file, enters claim information such as parties and addresses into the Department's database, assigns a claim number, and researches insurance coverage through the Department's insurance database.  In fiscal year 2011-2012, there were 3,729 new claims filed including 3,360 Applications for Resolution of Injury  (Form 101), 202 Occupational Disease (Form 102 and Form 102 CWP), and 167 Hearing Loss (Form 103).  Of the 202 Occupational Disease applications, 171 were Coal Workers' Pneumoconiosis applications.
 
Forms Used
 
Form 101 Application for Resolution of Injury Claim
Form 102-OD Application for Resolution of Occupational Disease Claim
Form 102-CWP Application for Resolution of Coal Workers' Pneumoconiosis Claim
Form 103 Application for Resolution of Hearing Loss Claim
Form 104 Plaintiff's Employment History
Form 105 Plaintiff's Chronological Medical History
Form 106 Medical Waiver and Consent Form
Form 107-I Physician's Medical Report-Injury
Form 108-HL Physician's Medical Report-Hearing Loss
Form 108-OD Physician's Medical Report-Occupational Disease
Form 112 Medical Dispute
Form 115 Social Security Release Form
 
These forms can be found on our forms page.

For further information or questions, please call Section Supervisor-Vicki Harmon at 502-782-4507, Fax 502-564-3792. Vicki.Harmon@ky.gov


 
 
 
 
 
 
 
 
 
 
Department of Workers' Claims
657 Chamberlin Avenue
Frankfort KY  40601
Phone: (502) 564-5550