Commonwealth of Kentucky Labor Cabinet

Answers

Answers to Questions

Administrative Processing

Where do I get the employee leasing application?
The Employee Leasing Application (Form EL1 and EL2) form. Form also found in "Forms, Documents, Reports and Publications" link.
Department of Workers’ Claims / Security and Compliance / Administrative Processing
How do I apply for 'Split Coverage" or "Wrap Up Coverage'?
A separate insurance policy may be issued if authorized by the Commissioner of the Department of Workers' Claims. Application for Split Coverage or Wrap Up (Form 375) Form. Form also found in "Forms, Documents, Reports and Publications" link.

Department of Workers’ Claims / Security and Compliance / Administrative Processing
Is coverage information for an employer available to the public?
An 'Insurance Coverage Lookup' link is available on this website. You will need the employer name, FEIN (Federal Employer Identification Number) or policy number to search.
Department of Workers’ Claims / Security and Compliance / Administrative Processing

Agreements

Has my Agreement been received and/or approved?
Once the Agreement is approved, you will receive an approved copy by U.S. mail. If you are represented by an attorney, your attorney will receive a copy.
Department of Workers’ Claims / Claims Processing and Appeals / Agreements
In addition to the Form 11, Motion to Substitue Party and Continue Benefits, what documentation do you need to process my request for widow or dependent benefits?
You will need to include a copy of the Death Certificate, Marriage License, and any dependent Birth Certificates. You or your attorney will be contacted if any additional information is needed.
Department of Workers’ Claims / Claims Processing and Appeals / Agreements
What is the discount rate?
The discount rate is established each year and information on the current year's rate can be found in the Guides Section of the Publications are of the Department of Workers' Claims website.
Department of Workers’ Claims / Claims Processing and Appeals / Agreements
Is there a tool available to assist in the calculation of both weekly and lump sum settlements?
Yes. The PPD Calculator is a very helpful tool that illustrates how the Discount Rate and other guidelines apply to the Settlement. Because of Social Security regulations, the PPD Calculator cannot be used for workers who reach retirement age, as defined in KRS during the period of income benefits.
Department of Workers’ Claims / Claims Processing and Appeals / Agreements

Appeals

How much time do I have to file an appeal to the Workers' Compensation Board?
Notices of Appeal to the Board should be filed within 30 days of the Administrative Law Judge's opinion or final order.
Department of Workers’ Claims / Claims Processing and Appeals / Appeals
When is the Petitioner's brief due?
Petitioners have 30 days from the filing of the Notice of Appeal to file a brief.
Department of Workers’ Claims / Claims Processing and Appeals / Appeals
When is the Respondent's brief due?
Respondent's briefs are due 30 days from the filing of the Petitioner's brief.
Department of Workers’ Claims / Claims Processing and Appeals / Appeals

Claims Review

Where and to whom do I send the Application?
ONLY non-represented (Pro Se) individuals may file by paper application; all others must use the LMS electronic filing system. Unrepresented individuals must send the application to:
Department of Workers' Claims
657 Chamberlin Ave.
Frankfort, KY 40601

Department of Workers’ Claims / Claims Processing and Appeals / Claims Review
Has my Claim been received and when was it received?
You will receive an Acknowledgement Letter with the date it was received.
Department of Workers’ Claims / Claims Processing and Appeals / Claims Review
Why was an additional Party added to my Claim?
The Claim is researched and based on our records, any Party with potential liability is included as a Party to the Claim.
Department of Workers’ Claims / Claims Processing and Appeals / Claims Review
A First Report of Injury has already been filed, so why did I receive a letter saying no matching First Report of Injury has been filed?
Information submitted on the Application and information filed electronically on the First Report of Injury do not match. Therefore, there is no matching First Report of Injury on record.
Department of Workers’ Claims / Claims Processing and Appeals / Claims Review

Data Entry

Has my pleading been received and filed by the DWC?
When contacting the Data Entry Section, the following information is needed:
- DWC Claim Number
- Name of plaintiff
- Type of pleading
- Date the pleading was mailed to the DWC
Department of Workers’ Claims / Information and Research / Data Entry
How is a physician assigned a medical index number?
An index number shall be assigned to a physician upon the filing of the physician's qualifications with the DWC. A medical index number is assigned and the Medical Index Listing on the DWC homepage is updated. A copy of the CV is scanned into our Imaging System using the assigned medical index number. Revisions or updates to the CV may be filed with DWC in the same manner.
Department of Workers’ Claims / Information and Research / Data Entry
Can a physician make a request directly to DWC for a medical index number to be assigned?
Yes, however, when a physician provides their curriculum vitae to DWC, a cover letter requesting an index number or informing DWC of revisions to a current CV must accompany the request.
Department of Workers’ Claims / Information and Research / Data Entry
Could you please provide me with the physician's medical index number?
This can be accessed by going to the Worker's Comp Documents page.
Department of Workers’ Claims / Information and Research / Data Entry
Could you please send me a copy of a specific physician's Curriculum Vitae?
You may mail, fax or call in your request for this copy to:
Department of Workers' Claims
Attn: Deana Mitchell, Open Records
657 Chamberlin Ave.
Frankfort, KY 40601
Phone: 502-782-4455
Fax: 502-564-5732
Please provide the physician's name and your mailing address and the copy will be mailed to you.

Department of Workers’ Claims / Information and Research / Data Entry

EDI Claims

How do I become a trading partner with the Kentucky Department of Workers' Claims?
Obtain the KYWC EDI documentation which contains state-specific information required for submitting electronic reports to the KYWC. Obtain the IAIABC Implementation Guide which contains the standardized information used by all jurisdictions that are receiving workers' compensation reports electronically. Be sure to request the proper guide based on the information provided in the KYWC EDI documentation. Establish a mailbox account with one of the value-added networks used by the KYWC. Complete the Trading Partner Agreement, Trading Partner Profile and Transmission Profile and return them to the KYWC by fax or mail. If we have any questions regarding these profiles, we will contact you using the information provided on the Trading Partner Profile. If your profiles have been completed accurately, you will receive written notification that your trading partner account has been established. Do not begin sending test transmissions until you receive this notification.
Department of Workers’ Claims / Information and Research / EDI Claims
What are "test" transmissions?
Test transmissions serve two purposes. Initially, they verify that all technical details regarding the transmission process itself are correct for all three systems involved: yours, the VAN's and the KYWC's. Ultimately, they are used by the KYWC to assess your ability to send acceptable electronic reports.
Department of Workers’ Claims / Information and Research / EDI Claims
What types of test reports should I send?
When testing First Reports of Injury (FROI) with the KYWC, send only original reports (MTC "00"). Upon obtaining production status, all additional first report Maintenance Type Codes (MTC) become reportable. Do not send test transmissions for Subsequent Reports of Injury (SROI) until production status has been obtained for First Reports of Injury. When testing subsequent reports, send only initial payment reports (MTC "IP"). Upon obtaining production status, all additional subsequent report MTCs become reportable.
Department of Workers’ Claims / Information and Research / EDI Claims
When will I be placed in production status by the KYWC?
The KYWC uses an abbreviated testing process in order to place each trading partner in production status as quickly as possible. Trading partners able to send three consecutive transactions containing at least 10 reports each with no more than 30 percent of the reports rejected per transaction will be given production status.
Department of Workers’ Claims / Information and Research / EDI Claims
I just sent an EDI transmission to the KYWC. When can I expect an electronic acknowledgment?
The KYWC downloads incoming EDI transmissions from the VANs each business morning. Functional acknowledgments are returned immediately. Detailed acknowledgments are normally returned by close of business on the same day. Occasionally, the volume of data to be processed causes the detailed acknowledgments to be returned the morning of the following business day.
Department of Workers’ Claims / Information and Research / EDI Claims
What's the difference between a Functional Acknowledgment and a Detailed Acknowledgement?
Functional acknowledgments are used to inform the sender that their EDI transmission was received. They are not supported by the IAIABC flat-file standards, and therefore are only returned to trading partners sending ANSI transactions. Detailed acknowledgments are returned to all trading partners after the electronic acknowledgement has been analyzed by the KYWC. These detailed acknowledgments inform the trading partner that their transactions have been accepted or rejected. If a transaction is rejected, the detailed acknowledgment includes codes which identify any errors found by the KYWC.
Department of Workers’ Claims / Information and Research / EDI Claims
Enough time has passed for me to have received an electronic acknowledgment, but my VAN mailbox is empty. What should I do now?
Contact your value-added network. The VANs keep logs which show when your transmission was uploaded to your mailbox, when the transmission was routed to the KYWC mailbox, when it was downloaded by the KYWC, etc. If this log shows that your transmission was downloaded by the KYWC, contact our office and we will continue this tracking process.
Department of Workers’ Claims / Information and Research / EDI Claims
I received a detailed acknowledgment which says that an original First Report of Injury was rejected, and includes the message, "NON-REPORTABLE: LOST TIME IS NOT MORE THAN A FULL WORK DAY" in the free-form text field. What does that mean?
If an original First Report of Injury is received with a Nature of Injury Code (DN0035) lower than "60," it indicates a traumatic injury is being reported. For a traumatic injury to be reportable to the KYWC, the employee must have missed more than one day. This determination is made by comparing the Date Last Day Worked (DN0065) to the Date of Return-to-Work (DN0068), if any. There must be more than a calendar day separating these two dates. If not, the transaction is rejected and the above message is inserted in the free-form text field for clarification.
Department of Workers’ Claims / Information and Research / EDI Claims
What does "accepted with errors" mean? (Application Acknowledgement Code TE)
This Acknowledgement Code is no longer used. It was used prior to January 16, 2009 and reflected that the record had been received by DWC and accepted with errors. At that time, the coding staff had determined that certain fields within that record required changes to conform to DWC data quality standards. Prior to January 16, 2009, records with errors in the Nature, Cause, Body Part or SIC Code fields were modified by DWC staff and accepted with errors. However, as of January 16, 2009, electronically transmitted records are no longer modified when errors are discovered in these key fields. If an error is found, the record will be rejected and an (00) Original transaction must be resubmitted.
Department of Workers’ Claims / Information and Research / EDI Claims
Prior to January 16, 2009, I received a detailed acknowledgment which says that an original First Report of Injury was accepted with errors, and includes the message, "DE0025 SB 3465, DE0035 SB 65, DE0036 SB 48, DE0037 SB 82" in the free-form text field. What does that mean?
An original First Report of Injury was accepted prior to January 16, 2009 with errors by the KYWC when the only errors found were limited to the following four elements: SIC code (DN0025), Nature of Injury code (DN0035), Part of Body Injured code (DN0036), and Cause of Injury code (DN0037). To assist you in improving your coding skills, a message was inserted in the free-form text field which indicated what the proper code should have been. The above message "DE0025 SB 3465, DE0035 SB 65, DE0036 SB 48, DE0037 SB 82 " is read as follows: "SIC code should be 3465, Nature of Injury code should be 65, Part of Body Injured code should be 48, and Cause of Injury code should be 82." By using this syntax, all four coding errors can be explained using the available space in the free-form text field when necessary. A (CO) correction transaction should be filed on "TE" acknowledgements.
Department of Workers’ Claims / Information and Research / EDI Claims
I have a question about my detailed acknowledgment that is unrelated to the free-form text field. Who should I call?
Your best resource should be those who designed your EDI system. If it is a custom application designed by your company's data processing staff, contact them. A commercial software application should be supported by the contractor/vendor. If you still have questions, e-mail HowardC.Lawson@ky.gov.
Department of Workers’ Claims / Information and Research / EDI Claims
How do I file a first report on a "no lost time" injury so that payment of partial benefits can be reported when the injured party is able to work?
DWC programs are written to calculate the number of lost work days by subtracting the "Date Last Day Worked" from the "Date Returned To Work". "Date Last Day Worked" is a mandatory field, but "Date Returned to Work" is not. File an original First Report of Injury, excluding the "Date Returned to Work". Providing the report meets all remaining edits, it will be accepted. Once the FROI is accepted, you may then file the necessary subsequent reports using the Jurisdiction Claim Number assigned to the Original. Once the Original has been filed, DWC will need for the trading partner to file a Change Report (02) showing the return-to-work date. (Filing "no lost time" claims is not necessary under normal circumstances. The scenario above is unique, and requires the filing of a "no lost time" claim to report partial payment. If you have a no lost time claim, and there are no mitigating circumstances that require further filings of other types of reports, then do not file them.)
Department of Workers’ Claims / Information and Research / EDI Claims
I filed an Original (MTC 00) first report where the injured worker missed more than one full day of work but returned to work before missing a total of seven days. An IP or FS is not required. Unless circumstances change, this injured worker will never miss a total of seven days. How do I report that the injured worker has returned to work, since the filing of a Suspension of Benefits is not applicable?
File a Change (02) record to the Original showing the return-to-work date as you know it to be.
Department of Workers’ Claims / Information and Research / EDI Claims
When a Bi-monthly Periodic Report is filed, how should the Payment Adjustment information be reported?
The Bi-monthly Periodic Report should report the total amount paid to date for each claim.
Department of Workers’ Claims / Information and Research / EDI Claims
Which MTC codes generate a Statute of Limitations letter?
Suspension of Benefits for Return to Work or Medically Deemed Capable of Returning to Work (S1). Denial First Reports (04), as of November 1, 1999, and Denial Subsequent Reports (04). There are two types of letters: timely filed and un-timely filed. A fatality letter to the deceased worker's family is also generated based on data contained in the Date of Death Field which indicates a fatality occurred. DWC staff manually validate each letter before it is mailed in an effort to ensure the claimant receiving the letter is not receiving the letter in error. It is very important when filing any Maintenance Type Code requiring payment data that you refrain from using the 010 code, unless the injured worker has died due to the work-related injury.
Department of Workers’ Claims / Information and Research / EDI Claims
What IAIABC Part of Body Codes are accepted?
The new expanded IAIABC Part of Body codes with 3 A/N characters in the field will be accepted. Kentucky's element table shows DN0083 as a conditional or optional filing.
Department of Workers’ Claims / Information and Research / EDI Claims
What is the correct way to submit the Self-Insurance indicator (DN0024)?
Effective November 30, 2005, if the Employer FEIN (DN0016) and the Insurer FEIN (DN0006) are the same, then the Self-Insurance Indicator (DN0024) should be "Y". If the Self-Insurance indicator (DN0024) is "N" the claim will be rejected. If the Employer FEIN (DN0016) is different than the Insurer FEIN (DN0006), then the Self-Insurance indicator (DN0024) should be "N". In this case if the Self-Insurance indicator (DN0024) is "Y", then the claim will be rejected.
Department of Workers’ Claims / Information and Research / EDI Claims

Enforcement

When is workers' compensation insurance required?
Employers with one or more workers are required to maintain coverage. There are no exceptions for family member employees, temporary, or part time employees. Out-of-state employers performing any work in this state are required to have Kentucky coverage. (Ohio employers refer to next question.)
Department of Workers’ Claims / Security and Compliance / Enforcement
Is Ohio BWC coverage sufficient for work done in Kentucky?
No. An Ohio employer performing work (even temporary) in Kentucky must have a separate insurance policy. Coverage must be afforded by an approved carrier providing benefits in accordance with the Kentucky Workers’ Compensation Act. Kentucky does not accept the Form C-110s filed by Ohio employees as these are not enforceable by Kentucky courts. Any worker injured in this state has the right to file a claim for benefits under terms of our law.
Department of Workers’ Claims / Security and Compliance / Enforcement
What can happen if I do not have workers' compensation insurance for employees?
Non-compliant employers are subject to a fine of $100 to $1,000 per employee. Each employee and each day of violation shall constitute a separate offense. Additionally, an employer may be held liable to an injured employee (or employee of an uninsured contractor or subcontractor) for income benefits including lost wages and medical expenses.
Department of Workers’ Claims / Security and Compliance / Enforcement
What is the difference between employees and independent contractors?
Independent contractors generally are skilled individuals who work in a distinct occupation or business. Courts have determined certain criteria for classification as an independent contractor. The major factors are:
- The nature of the work performed as it relates to the possible employer. An independent contractor’s work is not a regular and recurring part of the possible employer’s business. It is usually for a specific project with a beginning and ending date. An independent contractor provides the same services for other customers.
- The extent of control of the details of the work. An independent contractor provides materials and equipment to perform the job and has potential for profit or risk of loss on the project. An independent contractor does not receive instructions or training from the employer, has the right to hire or fire helpers without permission from other, and has final control of the job.
- Professional skill of the worker. Independent contractors have a specialized skill, trade, or license. They usually maintain a separate place of business, advertise, and have a business telephone.
- Intentions of the parties. A written contract should describe the obligations and responsibilities of each party, a specific project described, dates of project and prices agreed upon in advance. The method of payment is not a primary factor.
Department of Workers’ Claims / Security and Compliance / Enforcement
What if I use 'contract labor?'
This term is often misunderstood by business owners. Refer to the previous question for factors used in determining a worker's classification. Call the Compliance Branch with any questions concerning worker classification.
Department of Workers’ Claims / Security and Compliance / Enforcement
Do members of a Limited Liability Company (LLC) or a partnership have to maintain workers' compensation insurance if there are no employees?
Partnerships or LLCs that consists of 'qualified' partners or members only are exempt from maintaining coverage under certain circumstances. 'Qualified partner or member' is defined by KRS 342.012 as having a meaningful partnership agreement or articles of organization that shows on its face that the partner or member has made some contribution that enables the partner or member to substantially participate in the profits (or loss) of the business as well as participate in the decision making process. The partnership or LLC shall provide upon the request of the commissioner or his or her representative a copy of the partnership agreement or articles of organization for purpose of demonstrating compliance. Coverage is required for any non-qualified partner or LLC member.
Department of Workers’ Claims / Security and Compliance / Enforcement
Is workers' compensation insurance required for officers of a corporation?
Yes. KRS 342.640(2) designates officers of corporations as employees. Corporate officers may exempt themselves from coverage by filing an Employee's Written Notice of Rejection (Form 4). Obtain the form from the Compliance Branch at 502-564-5550 or email LaborKYWCCompliance@ky.gov. The notice is not effective unless the original notarized form is filed with this agency. Filing a Form 4 forfeits your right to workers' compensation benefits. Seeking legal advice from an attorney prior to rejecting coverage is recommended.
Department of Workers’ Claims / Security and Compliance / Enforcement
How do I obtain a copy of a previously filed Form 4 or Form 5?
Make a written request on a Previously Filed Form 4 or Form 5 Request form. Form also found in "Forms, Documents, Reports and Publication" link. Provide the employee's name (social security number if available), and business name and address. Include the approximate filing date if known. The request should include a self-addressed stamped envelope and 75 cents per copy (check or money order payable to Commonwealth of Kentucky Office of State Treasurer). Mail request and payment to:

Department of Workers' Claims
Attention: Compliance Branch
657 Chamberlin Ave.
Frankfort, KY 40601
Department of Workers’ Claims / Security and Compliance / Enforcement
Is an employer required to show proof of coverage?
Kentucky statute requires every employer to display a Workers' Compensation Posting Notice conspicuously at its principal office and other locations, where employees report for payroll and personnel matters. [KRS 342.610(6)] Contact your insurance agent or workers' compensation carrier for a current notice if you did not receive one with your latest policy.
Department of Workers’ Claims / Security and Compliance / Enforcement
What is the purpose of an Affidavit of Exemption by Building Contractor?
Every local building permit official shall require proof of workers' compensation insurance prior to issuing any building permit. An applicant with no employees must certify exemption to the building permit official. Two forms for this purpose: Affidavit of Exemption-Corporation and Affidavit of Exemption-Individual form. Form also found in "Forms, Documents, Reports and Publications" link.

(Do not confuse Affidavits with Form 4)
Department of Workers’ Claims / Security and Compliance / Enforcement
Do employees pay any part of the workers' compensation insurance premium?
Kentucky Revised Statute 342.420 specifically prohibits the employer from deducting premium from wages or salary of any employee entitled to benefits.
Department of Workers’ Claims / Security and Compliance / Enforcement
How do I obtain workers' compensation insurance coverage?
By purchasing a policy from an insurance agent that represents approved insurance companies.
Department of Workers’ Claims / Security and Compliance / Enforcement
How do I request Original Form 4s or Form 5s to be mailed to me from the Department of Workers' Claims?
To Order Blank Rejection Notice (Form 4) or Written Notice of Withdrawal (Form 5), please submit a request to:
LaborKYWCCompliance@ky.gov
Please include the following information when requesting forms:
- Business Name
- Contact Person
- Mailing Address
- Phone Number
- Form Type (Form 4 or Form 5)
- Quantity Requested
Only Original Form 4s and 5s are accepted for processing, no photocopies.
Department of Workers’ Claims / Security and Compliance / Enforcement

Hours

What is the overtime requirement?
Time and one-half must be paid for hours worked in excess of forty (40) hours in a work week.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
May my employer utilize 'comp time' for overtime hours?
Comp time may not be given to an employee who is subject to the overtime law.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
How many hours must I work to be full time?
Kentucky labor laws do not define full-time and part-time employment. Employers are free to define these terms as they choose.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
Am I entitled to a rest period, and do I get paid for this time?
You are entitled to a rest period of at least ten (10) minutes during each four hours you work. The rest period is a paid break.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
Am I entitled to a meal period, and do I get paid for this time?
You are entitled to a reasonable period for a meal no sooner than the third nor later than the fifth hour of your work shift unless you and your employer have mutually agreed to some other arrangement. A duty-free meal period does not have to be paid.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
May my employer require that I work overtime?
There is nothing that prohibits your employer from requiring you to work overtime.
Department of Workplace Standards / Wages, Hours and Mediation / Hours
May my employer require that I work more than eight (8) hours per day?
There is no limitation on the number of hours that your employer can require you to work in a day.
Department of Workplace Standards / Wages, Hours and Mediation / Hours

LMS

What is the Litigation Management System (LMS)?
The LMS is a Web-based application designed to move the workers’ compensation litigation system into the 21st century by allowing stakeholders to file and manage claims electronically rather than the traditional method of filing paper. Toward that end, the LMS provides users with Web-based forms, and further permits interested entities the ability to utilize group functions in an effort to promote work distribution. Additionally, the LMS will greatly improve the scope of the workers’ compensation system by notifying interested users, via email, when Proof of Coverage is reported as canceled to the DWC. The goal of the LMS is to provide significant benefits for anyone (e.g., attorneys, insurance carriers, employers, medical providers, claimants, and others) who have a role in Kentucky’s workers’ compensation process.
The DWC encourages everyone who has an interest in litigating workers’ compensation claims to register with the LMS system. Very basic information is required to register; attorneys, for example, must provide their Kentucky Bar ID and court reporters must provide a tax ID number when registering. As the LMS is coming online, the DWC asks that interested parties, or their representatives, provide to the DWC a list of active cases. The active case list should be in Excel format and include the claim number as well as the style of the case so that the DWC may provide access numbers to those parties. Be advised that the DWC will not be able to provide interested parties with access numbers without this information. Once a party, or a representative, has received the list of access numbers and has registered, the party, or representative, associate to claims using the Claim Number and Access Code in the LMS. Users will thereafter be able to view all pleadings in their cases.
Department of Workers’ Claims / Litigation Management System / LMS
Where can I send my list of active cases?
A party who wishes to send a list of active cases by regular mail should send this information to the following address:

ATTN: LMS Technical Team
DO NOT OPEN IN THE MAILROOM
Department of Workers' Claims
657 Chamberlin Avenue
Frankfort, Kentucky 40601

A party who would like to send a list of active cases via email should send this information to:
LMS Technical Support
Department of Workers’ Claims / Litigation Management System / LMS
Do the requests for access codes need to come from the Site Admin of the LMS group or should they come from each individual attorney handling the claim?
This is an internal business decision that will be unique to each business entity.
Department of Workers’ Claims / Litigation Management System / LMS
Are we going to be assigned the same case # as our attorney's and if our attorneys have registered the claims do we have to register them also?
Attorney support staff will not actually associate to claims because they are not parties. As a member of the attorney’s/law firm’s business group, you will be assigned to the cases your attorney is working by a site admin.
Department of Workers’ Claims / Litigation Management System / LMS
As a site administrator, how will I be able to differentiate group claims from those that are assigned to me?
Site admins can manage group claims as well as their own by toggling between “LMS Group Claims” and “My Claims.”
Department of Workers’ Claims / Litigation Management System / LMS
What is the ETA on my access codes from the list of active claims that I submitted?
We are sending out responses to all previously received emails. In the future, a 3 to 4 day turnaround is anticipated.
Department of Workers’ Claims / Litigation Management System / LMS
Will I have one access code for all of my claims and will I need to enter it each time I want to view a case?
Each claim has its own distinct access code. Once you are associated to the case, you no longer need the access code to retrieve or file information.
Department of Workers’ Claims / Litigation Management System / LMS
As a site admin, will I have access to all the claims in my group? How will I view claims that are assigned to me?
The site admin can see and assign claims to other staff within the firm as well as themselves. After logging in to the system, you are able to toggle between LMS Group Claims and My Claims.
Department of Workers’ Claims / Litigation Management System / LMS
What does the DWC need from me to provide access codes?
We need the claim number as well as the style of the case included on the list of active claims. Again, please send these to us in Excel format. If you have already sent your list and it wasn’t in Excel format, there is no need to resend this list.
Department of Workers’ Claims / Litigation Management System / LMS
Will I have to mail a copy of the pleading to the opposing parties? It seems to me that if I’m in the system and Plaintiff’s counsel is in the system then there’s no reason to incur the cost and delay of mailing paper.
If Plaintiff’s counsel is registered in LMS they will be notified of the filing of your pleadings through the notifications function of LMS. Additionally you will be notified of pleadings filed by opposing parties on your claims in the same way. This is not a certification. You are still responsible for serving parties listed on your certificate of service. The DWC does not in any way accept responsibility for fulfilling your obligation of satisfying your certificate of service.
Once the system is fully operational, users will be able to accept service via LMS by electing to receive paperless notifications. Additionally, attorneys can select the method of service when filing documents electronically.
Department of Workers’ Claims / Litigation Management System / LMS
My screens do not have a button to file documents. Will that come later?
Yes. Currently we have disabled the function to allow you to submit documents due to the change of regulations required to be able to legally submit pleadings to the DWC. Once the regulations are approved, this functionality will be restored.
Department of Workers’ Claims / Litigation Management System / LMS
Associate to a claim as ‘who you are’ means the attorney’s name, or their client’s name?
"Who you are" would be the Plaintiff attorney, Defense attorney, etc. If you are the attorney submitting the information to the LMS system, you are the attorney so please use your name and information. For example: If you are attorney support staff, you would not associate to a claim using your attorney’s name.
Department of Workers’ Claims / Litigation Management System / LMS
If someone other than the site administrator files the claim, will the claim still have to be assigned to that attorney?
Yes, the site administrator will still need to assign the case to the attorney.
Department of Workers’ Claims / Litigation Management System / LMS
If another attorney other than the site administrator files an Application of Adjustment of Claim will the response to the filing come back to the site administrator or will it just go back to the attorney who filed the claim?
If someone from the Attorney/Law Firm business group associates to a claim, they will gain the ability to see the claim on the LMS landing screen. However, it isn’t assigned to anyone within the firm at that time. The Site Administrator of the group will simply need to assign it to staff and/or to themselves in order to file any documents within the Claim in LMS. The application would come back to the attorney who filed the claim once the site administrator assigned that attorney to the claim.
Department of Workers’ Claims / Litigation Management System / LMS
Will the site administrator be able to monitor the filings of attorneys not acting as site administrators? Will the site administrator then be required to assign the claim to an associate attorney?
A site administrator could monitor attorney filings on any claim they assigned themselves to. If they are not assigned to the claim, they can’t review details, including documents.
Department of Workers’ Claims / Litigation Management System / LMS
Are the ALJ Orders being issued in the system now going to start showing up as a new document alert?
Yes, all documents filed within the Claim will show up as a new notification.
Department of Workers’ Claims / Litigation Management System / LMS
Will we be notified by email when new documents are filed?
Notifications aren’t by email.
Department of Workers’ Claims / Litigation Management System / LMS
The information under the accident tab – is that pulled from the EDI submission filed on the claim?
Yes, the information under the accident tab is EDI information.
Department of Workers’ Claims / Litigation Management System / LMS
Some people file more information through EDI that may not require information. Is the EDI information going to be mandatory to make sure the most accurate info is there?
We follow the International Association of Industrial Accidents Boards and Commissions (IAIABC) standard and our edits are in accordance with Kentucky statutes and regulations.
Department of Workers’ Claims / Litigation Management System / LMS
Can you please define style of the case that is needed on the excel spreadsheet to obtain access codes?
An example style is John Doe versus XYZ Corporation. Please include this plus a claim number.
Department of Workers’ Claims / Litigation Management System / LMS
Do you have an estimated date of when we are going to be able to file electronically with the LMS system?
We estimate this will occur on August 1, 2016.
Department of Workers’ Claims / Litigation Management System / LMS
How do I get an access code for my particular cases?
If you have cases in LMS acknowledged prior to March 18, 2016, please send an email to Laborkywclms.technicalsupport@ky.gov and the DWC Technical Team will process your request in the order in which it is received. If you have cases acknowledged after March 18, 2016, your access code for each particular case will be listed on the following types of letters from the Department:
- No Matching First Report of Injury on File (Medical Dispute or Otherwise)
- All Applications for Resolution of Claim
- Benefit Review Conference Scheduled
- Acknowledgement and Assignment of Chief ALJ (CWP)
- Acknowledgement and Assignment to ALJ (Medical Dispute)
Department of Workers’ Claims / Litigation Management System / LMS
Am I allowed to share my Access Codes?
You may share the access code to your case. However, please be mindful that by providing the access code to the claim, you are allowing someone into the litigation file of the injured worker.
Department of Workers’ Claims / Litigation Management System / LMS
How do I file an Application for Resolution of Hearing Loss in the LMS system?
We showed you how to do this in our presentation today. By selecting the nature of injury that you are trying to file (whether it be hearing loss, black lung or carpal tunnel for example), you are driving the system to determine which application will be used.
Department of Workers’ Claims / Litigation Management System / LMS
How do I change information on the original application once it is submitted (date of injury, body part, etc.)?
If you need to change the original application filed with the DWC, file a motion requesting to amend the application with the new information. Please be specific as to why the application should be amended.
Department of Workers’ Claims / Litigation Management System / LMS
Are we able to file a black lung and hearing loss claim on the same application?
No you are not able to do this. When you are filing the application, you would begin with a nature of ‘black lung’ and fill out the pertinent information about the claim. Next you would begin the process of filing a hearing loss claim.
Department of Workers’ Claims / Litigation Management System / LMS
Are we able to file x-rays or exhibits through the LMS system?
No. Please file x-rays and/or exhibits with the DWC at Prevention Park, 657 Chamberlin Avenue, Frankfort, Kentucky 40601. Please be sure to include information as to which claim the x-ray or exhibit is being filed as well as letting us know who/which party is filing it.
Department of Workers’ Claims / Litigation Management System / LMS
If my address changes, can I simply file one change of address for all of my cases?
You will need to file a notice of change of address for all of your cases; not simply one notice.
Department of Workers’ Claims / Litigation Management System / LMS
How long will I continue to receive paper documents from the DWC?
You will continue to receive all documents via paper from the DWC until we are fully electronic. Even if you choose paperless notifications through LMS right now, you will continue to receive paper from the DWC.
Department of Workers’ Claims / Litigation Management System / LMS
Who do I contact if I need assistance with the LMS system?
Please contact the DWC Technical Team for assistance at Laborkywclms.technicalsupport@ky.gov
Department of Workers’ Claims / Litigation Management System / LMS
Am I obligated to mail a copy of the pleading to the opposing parties, especially if we are both in the Litigation Management System?
If Plaintiff’s counsel is registered in LMS they will be notified of your pleadings through the notifications function of LMS. Additionally, you will be notified of pleadings filed by opposing parties on your claims in the same way. This is not a certification. You are still responsible for serving parties listed on your certificate of service. The DWC does not in any way accept responsibility for fulfilling your obligation of satisfying your certificate of service. Once the system is fully operational, users will be able to accept service via LMS by electing to receive paperless notifications. Additionally, attorneys can select the method of service when filing documents electronically. Please note: You may select paperless notifications currently in the LMS system; however, you will continue to receive paper and send paper until the system is fully operational.
Department of Workers’ Claims / Litigation Management System / LMS
When will we be able to submit forms in LMS electronically?
We hope to begin accepting electronic claim filings in August 2016.
Department of Workers’ Claims / Litigation Management System / LMS
What do you do if you know that a claimant has a prior worker’s comp claim but has absolutely no information (claim number, etc.) about the previous claim? Also, if you are claiming a cumulative injury and there is not specific date of injury, how do you answer the date of injury question?
You should file an open records request as you do now to obtain the necessary information to answer the questions during the process of filing the claim. Currently if you are claiming a cumulative trauma injury, the date of injury is dependent upon a multitude of factors established by case law and although the determination of the date of injury can be uncertain it is incumbent on the filing party to allege that date considering all legal and factual issues and the same process should be used in LMS.
Department of Workers’ Claims / Litigation Management System / LMS
How would one go about entering insurance information for a selfinsured employer?
The self-insured employer information is placed in the employer section of the web form and the same information is placed in the insurance section of the web form.
Department of Workers’ Claims / Litigation Management System / LMS
How will you add the specific parts of the body injured under the multiple body parts?
This information is not collected by LMS system at this time; simply select the pertinent ‘multiple body part’ selection.
Department of Workers’ Claims / Litigation Management System / LMS
Does the new LMS system allow carriers to respond directly to pleadings or file responses to petitions?
Carriers are not able to file documents in LMS. Their attorneys are able to file documents, but the carriers themselves are not able to do so. It would be considered the unauthorized practice of law.
Department of Workers’ Claims / Litigation Management System / LMS
Will defense attorneys still be required to file notice of appearance to respond on behalf of the carrier and employer?
Yes, defense attorneys will be required to file a notice of appearance on behalf of the carriers/employers.
Department of Workers’ Claims / Litigation Management System / LMS
Can you bypass the information for the prior workers compensation claim if we don’t have it or it was out of state?
If a prior claim was filed within Kentucky, you need to provide the information. If the prior claim was out of state, you simply provide the state in which the claim was filed.
Department of Workers’ Claims / Litigation Management System / LMS
What if I have multiple roles, such as an attorney and insurance carrier?
Currently, if you have multiple roles such as an attorney as well as an insurance company, you should use two different email addresses for each registration. Please note: if you are an attorney, you would want to register as an attorney for the purpose of serving as the insurance carrier’s attorney.
Department of Workers’ Claims / Litigation Management System / LMS
How will a carrier file a 110 with the DWC where the claim was settled pre‐litigation (no Attorney involved) if they only have read‐only access?
We have concluded the submission of a 110 by anyone other than a pro se party or an attorney is the unauthorized practice of law.
Department of Workers’ Claims / Litigation Management System / LMS
Will paperless notifications have a "subject" that identifies the email as being from KW/DWC?
Notifications will not be sent through email. They will be accessible through LMS by clicking on the “Notifications” item in the blue menu on the left side of the screen. Note: We misunderstood the question asked during the presentation and gave an incorrect answer. This is our correction.
Department of Workers’ Claims / Litigation Management System / LMS
If 1 of your 6 site admins leaves employment, can you replace that person with a new site admin?
The site admins have full control over who is added to and removed from a group. They are also able to grant and remove site admin privileges.
Department of Workers’ Claims / Litigation Management System / LMS
If an Attorney Support Staff has already registered with LMS, what should be done at this time?
We have had a number of questions concerning when to register. The system is available for registration to anyone at this time. However, if you need to be a part of a group in an “Other” role, you must register through an invitation to the group.
Department of Workers’ Claims / Litigation Management System / LMS
Will these calls always be at 2:30 on Monday afternoons?
Our current plan is to continue have them on Mondays at 2:30. There will be no webinar the week of March 28th or April 24th. We will announce the subject of the April 11th webinar on March 21st. Any schedule changes will be sent out via email.
Department of Workers’ Claims / Litigation Management System / LMS
So, for an insurance company we need to create our group with our companies FEIN and then invite all of the users (employees) that we want to have access to LMS to join that group?
Yes.
Department of Workers’ Claims / Litigation Management System / LMS
Our company actually operates as 4 different companies each with FEIN's. Will we (the insurance company) have to have 4 different log‐ons?
Currently it would be best to create four separate groups.
Department of Workers’ Claims / Litigation Management System / LMS
Can I set up a secondary e‐mail address for backup?
If you would like to have yourself in a group in an alternate capacity you should be able to do so by registering another email address and adding it to your group. Remember that a bar ID can only be used once.
Department of Workers’ Claims / Litigation Management System / LMS
Once we have the groups we will have to provide you a list of claims to associate to our group?
Yes. Providing DWC with an Excel spreadsheet listing the claim number and style is the preferred method of submission and will expedite the delivery of your access codes.
Department of Workers’ Claims / Litigation Management System / LMS
To attend the next session Monday and the following Monday, can we use the same call in information or will we be sent a new invite?
A new WebEx invite will be sent prior to each webinar.
Department of Workers’ Claims / Litigation Management System / LMS
For a firm that has 4 different attorneys, would each attorney need to set up their own group or would we need to do a firm group?
It is the firm’s personal preference. The establishment of groups can be tailored to your business practices.
Department of Workers’ Claims / Litigation Management System / LMS
My attorney has already registered. Does he need to contact you to now be a site administrator on a Group Registration?
If your attorney is going to be the site admin, he can create the business group and will automatically become the site administrator. If not, once the business group is created by the site admin, the attorney can be added to the group and made a site administrator.
Department of Workers’ Claims / Litigation Management System / LMS
What is the benefit for an employer to sign up?
LMS is an informational opportunity for the employer. Employers will be able to associate to claims where they are named as the defendant and track the progress of litigations.
Department of Workers’ Claims / Litigation Management System / LMS
If I understood Dwight from a prior meeting, he only wants claims currently in litigation (where a 101 has been filed). Is that still correct for the active claims list?
Yes. Note that beginning Friday, March 18th, 2016 acknowledgement letters will be sent containing LMS access codes on newly filed claims.
Department of Workers’ Claims / Litigation Management System / LMS
As an insurance company, are we able to set up different groups for the individual adjusters, or does it have to be in one group?
The creation of business groups can be tailored to your business practice.
Department of Workers’ Claims / Litigation Management System / LMS
If my adjuster and KY attorney signs up, do I, as the employer need to sign up?
Employer sign-up is optional.
Department of Workers’ Claims / Litigation Management System / LMS
Do the requests for access codes need to come from the Site Admin of the LMS group or should they come from each individual attorney handling the claim?
This is an internal business decision that will be unique to each business entity.
Department of Workers’ Claims / Litigation Management System / LMS
We have multiple underwriting companies and FEINs and people handle claims across those multiple companies under the parent company. Are they going to be able to access all of those groups? Or because they each have their own FEIN and can they only be assigned to 1 group?
Currently, each user (email address) can only be involved with one business group at any time.
Department of Workers’ Claims / Litigation Management System / LMS
Are we going to be assigned the same case # as our attorney's and if our attorneys have registered the claims do we have to register them also?
Attorney support staff will not actually associate to claims because they are not parties. As a member of the attorney’s/law firm’s business group, you will be assigned to the cases your attorney is working by a site admin.
Department of Workers’ Claims / Litigation Management System / LMS
As a site administrator, how will I be able to differentiate group claims from those that are assigned to me?
Site admins can manage group claims as well as their own by toggling between "LMS Group Claims" and "My Claims".
Department of Workers’ Claims / Litigation Management System / LMS
What is the ETA on my access codes from the list of active claims that I submitted?
We are sending out responses to all previously received emails. In the future, a 3 to 4 day turnaround is anticipated.
Department of Workers’ Claims / Litigation Management System / LMS
Does the managing partner have to create the business group?
One of the managing partners of the firm should utilize their bar ID for the LMS business group creation. Once the group has been created, the managing partner can designate up to 5 other site admins to assist with administration of the group.
Department of Workers’ Claims / Litigation Management System / LMS
Will I have one access code for all of my claims and will I need to enter it each time I want to view a case?
Each claim has its own distinct access code. Once you are associated to the case, you no longer need the access code to retrieve or file information.
Department of Workers’ Claims / Litigation Management System / LMS
As a site admin, will I have access to all the claims in my group? How will I view claims that are assigned to me?
The site admin can see and assign claims to other staff within the firm as well as themselves. After logging in to the system, you are able to toggle between LMS Group Claims and My Claims.
Department of Workers’ Claims / Litigation Management System / LMS
What does the DWC need from me to provide access codes?
We need the claim number as well as the style of the case included on the list of active claims. Again, please send these to us in Excel format. If you have already sent your list and it wasn’t in excel format, there is no need to resend this list.
Department of Workers’ Claims / Litigation Management System / LMS

Mediation

Must my employer pay my vacation pay upon termination of employment?
Whether you are paid for unused vacation upon termination of employment depends on the policy or past practice of your employer. Kentucky labor laws do not specifically require that an employer pay an employee for unused vacation upon termination of employment.
Department of Workplace Standards / Wages, Hours and Mediation / Mediation
May my employer make deductions from my paycheck for cash shortages, missing items or damaged items?
Deductions may be made for cash shortages so long as your employer has written authorization from you to make the deduction, the deduction does not cause your wages to fall below the applicable minimum wage and the shortage is from a cash register or cash box that is only used by one employee. Your employer may not make a deduction from your wages for lost or stolen property or damage to property.
Department of Workplace Standards / Wages, Hours and Mediation / Mediation
May my employer terminate my employment for any reason?
This is not within the Kentucky Labor Cabinet's jurisdiction. Please refer to the U.S. Department of Labor.
Department of Workplace Standards / Wages, Hours and Mediation / Mediation
Must my employer notify me of a layoff or termination?
Not under Kentucky law.
Department of Workplace Standards / Wages, Hours and Mediation / Mediation
What are the limitations for child labor (under 18 years of age)?
See our Child Labor Law page.
Department of Workplace Standards / Wages, Hours and Mediation / Mediation

Open Records

How do I make an Open Records request for specific individuals?
Click here to download the Open Records Request Form (MS WORD)
Forward a written request for the documents either by mail or fax to:
Department of Workers' Claims
Attn: Open Records
657 Chamberlin Ave.
Frankfort, KY 40601
Fax: (502) 564-5732

Department of Workers’ Claims / Information and Research / Open Records
What information is required in my request for open records?
You must provide the claimant's name, social security number and/or the DWC Claim number if available. Please specify the document(s) of interest and return mailing address. Please include both the street address and P.O. Box if at all possible. Larger files may not be shipped to a P.O. Box. We do not fax documents.
Department of Workers’ Claims / Information and Research / Open Records
How long will it take to process my open records request?
Records are mailed when payment is received. Cost estimates are typically mailed back to the requester in 2-3 business days.
Department of Workers’ Claims / Information and Research / Open Records
What is the cost of an open records request?
$0.15/page for computer copies and $0.75/page for microfilm copies plus shipping/handling costs.
Department of Workers’ Claims / Information and Research / Open Records
Could you please send me a copy of a specific physician's Curriculum Vitae?
You may mail, fax or call in your request to:
Department of Workers' Claims
Attn: Open Records
657 Chamberlin Ave.
Frankfort, KY 40601
Fax: (502) 564-5732

Department of Workers’ Claims / Information and Research / Open Records
Is there a fee for obtaining copies of a Curriculum Vitae?
Yes. The cost is $0.15 per page, plus postage and a $2.50 request fee. A cost estimate will be mailed to you upon receipt of your request. Documents will be mailed upon receipt of payment.
Department of Workers’ Claims / Information and Research / Open Records

Open Records Request

Is there a specific form to use when submitting a request?
No, there is no form for OSHA or Wage and Hour record requests. A letter is all that is needed.

Department of Workplace Standards / Open Records / Open Records Request
Can requests be sent via email?
No, we only accept hand-delivery, facsimile or by mail.

Department of Workplace Standards / Open Records / Open Records Request
Can the information be emailed back to me?
No, if we have information and it is ready to be released, it is placed on a CD/DVD and mailed. A hard copy will be mailed if the information is only a few pages.

Department of Workplace Standards / Open Records / Open Records Request
Can I pick up the information in person?
Yes, just indicate that you wish to pick up the information in person and be certain that a phone number is on your request so our office can contact you when it is ready.

Department of Workplace Standards / Open Records / Open Records Request
Is there a charge for the information?
Yes, the charge is $11.00 per CD/DVD. If you wish to receive a hard copy, it is ten cents per page and 25 cents per color page. Please indicate in your request that you would like a hard copy rather than a CD. The amount owed will be included in the letter sent with the information requested.
Department of Workplace Standards / Open Records / Open Records Request
How long does will it take to receive a response?
We will respond within 3 business days from the date we receive the request. Some requests are larger than others and will require additional time. If it takes longer than three days to gather the information, a letter will be sent indicating a time period in which it will take to obtain and sanitize the reliable information.
Department of Workplace Standards / Open Records / Open Records Request
Will I receive the entire file?
No, there is certain information that is protected by the statute or regulation. All information that is releasable will be sent, provided the inspection is closed and ready for release.
Department of Workplace Standards / Open Records / Open Records Request

Prevailing Wage

When did the repeal of Kentucky’s prevailing wage statutes take effect?
Because H.B. 3 contained a provision declaring an emergency to exist, the bill went into effect immediately upon being signed by Governor Bevin on January 7, 2017.
Department of Workplace Standards / Wages, Hours and Mediation / Prevailing Wage
Does H.B. 3 apply retroactively so as to relieve the requirement to pay prevailing wage rates on public works projects that were awarded before January 7, 2017 and were subject to the prevailing wage?
No. As stated in Section 15, the repeal of prevailing wage requirements applies to public work projects for which bids had not been awarded as of the effective date of the Act, January 7, 2017. Accordingly, projects that were subject to the prevailing wage and had been awarded before January 7, 2017 must continue to pay prevailing wage rates.
View the Prevailing Wage Rates that were in effect prior to the enactment of H.B. 3.
Department of Workplace Standards / Wages, Hours and Mediation / Prevailing Wage
If a project is currently out for bid, can the public agency re-bid the project without prevailing wage rates?
As stated in Section 15, if bids have been requested but not awarded, then the public authority may request a resubmission of bids to conform to the provisions of H.B. 3.

Department of Workplace Standards / Wages, Hours and Mediation / Prevailing Wage
Does H.B. 3 affect projects that are required to pay prevailing wage rates under federal law?
No. H.B. 3 repealed Kentucky’s statutes pertaining to state prevailing wage requirements. Federal laws that require the payment of prevailing wages on federally funded public works projects are not affected by H.B. 3.
Department of Workplace Standards / Wages, Hours and Mediation / Prevailing Wage
Does H.B. 3 repeal prevailing wage requirements for highway construction projects?
H.B. 3 repealed state prevailing wage requirements for public works projects, including highway construction projects that are funded entirely with state and/or local funds, as of the effective date of the Act. However, as mentioned above, H.B. 3 does not affect provisions and requirements set forth in federal law for the payment of prevailing wages.
Department of Workplace Standards / Wages, Hours and Mediation / Prevailing Wage

Research

How do I file an open records request on a specific company or insurer?
You may file an open records request by fax or mail to the following:
General Counsel/Open Records Request
Department of Workers' Claims
657 Chamberlin Ave.
Frankfort, KY 40601
Fax: 502-564-0681

Department of Workers’ Claims / Information and Research / Research
Where can I get a copy of the Workers' Compensation Guidebook?
The guidebook may be accessed through the DWC Web site under publications 2011 Workers' Compensation Guidebook or you may contact the Research Section and one will be mailed to your address.
Department of Workers’ Claims / Information and Research / Research
Was a WC letter generated and if so, when was it mailed out?
You may find out if/when a statute letter was mailed by contacting Kim McKenzie at 502-782-4484.
Department of Workers’ Claims / Information and Research / Research

Utilization Review

What is utilization review?
Utilization review is generally defined as a review of the medical necessity and appropriateness of medical treatment and services. It is defined for the workers' compensation process as "a review of the medical necessity and appropriateness of medical care and services for purposes of recommending payments for compensable injuries or diseases." Medical services that are rendered or requested for incidents that are noncompensable under KRS Chapter 342 are not subject to utilization review under this administrative regulation. In other words, the assessment of the medical necessity and appropriateness of medical treatment and services is ultimately for purposes of determining the availability of payment for those treatments or services. Medical necessity includes a review of the setting, frequency and intensity of the treatment or service.

Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
What is medical bill audit?
Medical bill audit is the review of all medical bills for services that have been provided to assure compliance with adopted fee schedules. Also, every injured employee must designate a physician pursuant to 803 KAR 25:096. The medical bill audit process must confirm that a physician has been designated.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
Who is required to implement a utilization review program?
All insurance carriers who write workers' compensation insurance in Kentucky, individual self-insured employers and group self-insurance funds must implement a utilization review and medical bill audit program. A written plan describing the program must be filed with the commissioner of the Department of Workers' Claims for approval prior to implementation of the program. Utilization review for an employer that has contracted with an approved Managed Care Organization (MCO) will be carried out within the MCO.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
How does the utilization review process work?
- First level - review
- Second level - appeal
  A party adversely affected by the initial decision may appeal the decision within the utilization review program. The aggrieved party must request reconsideration within 14 days of receipt of the written notice of denial. A review of the initial utilization review decision must be conducted by a different reviewer of at least the same qualifications as the initial reviewer. The decision must be rendered within 10 days of the request for appeal and must be entitled "UTILIZATION REVIEW - RECONSIDERATION DECISION." If the reconsideration decision is made by an appropriate specialist or sub-specialist, the decision is the final utilization review decision and must be entitled "FINAL UTILIZATION REVIEW DECISION."
- Third level - specialist review
  If a party remains unsatisfied with the decision upon appeal, specialty or sub-specialty review may be requested. The right to request specialty review exists only when a specialist has not previously reviewed the matter.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
What claims must be selected for utilization review?
Compensable claims are subject to utilization review when any of the following occur:
- A medical provider requests pre-authorization of a medical treatment or procedure;
- Notification of a surgical procedure or resident placement pursuant to an 803 KAR 25:096 treatment plan is received;
  The total medical cost cumulatively exceed $3,000;
- The total lost work days cumulatively exceed thirty (30) days; or
- An administrative law judge orders a review.
These are minimum criteria. Some utilization review programs review additional claims based on the program's own internal criteria.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
What claims are subject to utilization review?
The following claims are subject to review:
- Utilization review must be applied to all open claims (those claims that have not been concluded by the entry of a final award or settlement) and concluded claims (those claims that have been concluded by the entry of a final award or settlement and the employer or carrier is responsible for the claimant's medical treatment) where: (1) lost work days exceed 30, and the employee remains off work, irrespective of the date of injury; or (2) the records indicate that for the previous one-year period the total medical expenses total $3,000 or more;
- Utilization review must be applied to all concluded claims where compensability has been determined and the payment obligor is responsible for medical expenses for the cure and relief of the work-related injury; or
- Utilization review must be applied in any case where a medical provider requests preauthorization and in any case upon notification of a surgical procedure or resident placement pursuant to a KAR 25:096 treatment plan.
House Bill 2 of the 2018 Regular Session of the General Assembly amended KRS 342.035 to allow an insurance carrier or self-insured employer to waive utilization review.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
803 KAR 25:096, Selection of Physicians and Treatment Plans
Utilization review programs must include a process to assure compliance with the requirements of 803 KAR 25:096 that a physician is designated by the injured employee and that treatment plans are obtained when required.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
How will utilization review affect 803 KAR 25:012, Medical Fee Disputes?
- The request to resolve medical fee disputes, Form 112, has been amended to include a question concerning whether utilization review has been performed. The initial notice of denial and final appeal decision with supporting medical opinions are required attachments to the Form 112.
- Some utilization review programs include an independent medical exam of the patient in certain situations as part of the utilization review process. If such an independent medical exam has been performed, the medical report should also be attached to the Form 112.
- If utilization review is applicable and has not been completed, the medical fee dispute will not be subject to adjudication by an administrative law judge.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
How will utilization review interact with KRS 342.020(1)?
The employer's obligation to render payment for medical treatment and services within 30 days of receipt of a statement for services is tolled during the utilization review process. Following utilization review, the obligation to render payment will be within 30 days of the final utilization review decision.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
Pre-certification - not a synonym for utilization review
Utilization review can occur retrospectively, concurrently or prospectively. In Kentucky's workers' compensation program, "pre-certification" is not a synonym for utilization review, as is often the case in general health care. In Kentucky much of the mandatory utilization review is "retrospective"--i.e., after the medical treatment has been delivered and a bill for services has been generated. Arguments are often made that this frustrates the expectation for utilization review to effectively prevent unnecessary medical services and waste and that utilization review is most effective when it includes "pre" and "concurrent" review. In "pre" and "concurrent" review, proposed treatment is reviewed before services are rendered and before the patient's condition is altered. However, KRS 342 does not authorize such broad preauthorization in workers' compensation cases. 803 KAR 25:096, Selection of Physicians and Treatment Plans, requires treatment plans to be submitted to the payment obligor in advance of certain medical services (i.e., elective surgeries and resident work hardening, pain management and rehabilitation programs).

The following guideline should be used to determine whether prospective, concurrent or retrospective utilization review is required:
- Claims are subject to utilization review upon:
- A carrier may require pre-authorization in situations where a treatment plan must be prepared and furnished to the employer under 803 KAR 25:096:
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review
Penalties
Any entity that fails to comply with utilization review and medical bill audit regulations may be fined by the commissioner of the Department of Workers' Claims pursuant to KRS 342.990(7)(e). Additionally, group self-insurance funds and individual self-insured employers that fail to implement a utilization review and medical bill audit plan place their self-insurance certification in jeopardy. Insurance carriers that fail to comply with 803 KAR 25:190 may be reported to the Kentucky Office of Insurance.
Department of Workers’ Claims / Medical Services and Cost Containment / Utilization Review

Vocational Rehabilitation

Am I eligible for Vocational Rehabilitation Benefits?
Any injured worker may apply for vocational rehabilitation services. You may be eligible for retraining benefits if you have recovered from a work-related injury, but have not regained the physical capacity to return to the job you held before your injury. Kentucky's workers' compensation laws determine who is eligible for vocational rehabilitation services. Vocational rehabilitation may be voluntarily provided by the employer or awarded by an Administrative Law Judge in a litigated claim.
Department of Workers’ Claims / Medical Services and Cost Containment / Vocational Rehabilitation
Where do I go from here?
The first step on your road to rehabilitation is to contact the Department of Workers' Claims at 1-800-554-8601. Our experienced vocational rehabilitation staff will guide you through the process.

If you are an eligible candidate, you will be referred to an evaluation center nearest to your home. After reviewing the results of the evaluation, the specialist will then work with you to map out your rehabilitation goals and establish a plan to help you reach them.
Department of Workers’ Claims / Medical Services and Cost Containment / Vocational Rehabilitation
What are my responsibilities?
- Take an active role in the development and completion of your rehabilitation program;
- Promptly attend all scheduled meetings, appointments and interviews;
- Participate in all requested vocational testing;
- Keep the vocational rehabilitation specialist informed of any changes in phone number, address, medical condition or any other pertinent information.
Department of Workers’ Claims / Medical Services and Cost Containment / Vocational Rehabilitation
How will I benefit?
- Payment of direct school expenses such as tuition, textbooks and required fees for an initial period of 52 weeks;
- Additional training, when justified, may be awarded by an administrative law judge on a case-by-case basis;
- Other educational expenses such as transportation and room and board can be approved on a case-by-case basis;
- Awarded income benefits may be accelerated to provide an increase in weekly benefits during training.
Department of Workers’ Claims / Medical Services and Cost Containment / Vocational Rehabilitation

Wages

What is minimum wage?
Effective July 1, 2009, the minimum wage is $7.25 per hour.
Department of Workplace Standards / Wages, Hours and Mediation / Wages
May my employer change my rate of pay?
Your employer may change your rate of pay so long as you are informed of the change prior to working any hours at the new rate. In other words, the change cannot be retroactive.
Department of Workplace Standards / Wages, Hours and Mediation / Wages
May my employer make my position salaried?
Yes, your employer may make your position salaried but this may or may not effect whether you must be paid overtime for hours in excess of forty (40) in a work week.
Department of Workplace Standards / Wages, Hours and Mediation / Wages
May my employer require direct deposit for every employee?
Your employer can require direct deposit so long as you have the ability to withdraw your entire net pay without having to pay a fee to the financial institution.
Department of Workplace Standards / Wages, Hours and Mediation / Wages
Is my employer required to pay holiday pay?
Holiday pay is not required by Kentucky law.
Department of Workplace Standards / Wages, Hours and Mediation / Wages
When is my employer required to provide me with my final paycheck?
When you leave employment for any reason your employer has until the next regular payday or fourteen (14) days whichever last occurs.
Department of Workplace Standards / Wages, Hours and Mediation / Wages