This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
You should provide your employer with a notice of your accident as soon as possible after the accident in order to ensure proper filing of a workers' compensation claim. Provide your employer with a notice in writing detailing your personal contact information, the cause and extent of the injury, named witnesses, and the work you were engaged in at the time of injury. You or an individual who may rightfully claim payments on your behalf (i.e. a dependent or survivor, should you die) may commence or file a workers' compensation claim. You or the person seeking compensation on your behalf must sign the notice.
Once you provide your employer with information concerning your accident, your employer is expected to maintain a record of all injuries he receives. Should you suffer from an injury that causes you to miss at least one day of work, your employer should file a report with the department. Your employer should also provide a report of the alleged work-related injury or disease within three (3) working days of receiving your notification of your accident and/or injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
All Kentucky employers are required to carry workers' compensation insurance or to be self-insured. Your employer must also communicate or post a Workers' Compensation Notice with information about the insurance program.
After your employer files a report with the department, your employer's insurance provider will be responsible for making a report to the Department of Workers' Claims that the insurance provider is aware of the injury and a potential workers' compensation claim
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
In order to be eligible for a workers' compensation benefits program, you, the employee, must suffer from a work-related injury or occupational disease (with proper filing requirements satisfied as well). Employees are entitled to benefits if injured while performing normal duties during regular working hours or have been diagnosed with a disease or illness as a result of long term exposure to hazards in the workplace.
Most employees are covered by the Workers' Compensation Act; however some kinds of employees are exempt from mandatory workers' compensation coverage. These include farm workers, workers employed within the home (domestic servants), independent contractors of certain sorts, workers protected by federal laws, and members of certain religious denominations whom are exempt from the Workers' Compensation Act.
Kentucky law permits employees to receive benefits even if the employee's mistake or negligence causes the accident. However, this may bar the employee from receiving full benefits.
4. What benefits might I be eligible to receive?
Workers' compensation benefits can include, but are not limited to, medical expenses, wage replacement, and vocational training and rehabilitation.
Kentucky workers' compensation law recognizes three types of disability of which employees may obtain benefits for- temporary total, permanent partial, and permanent total.
- Temporary Total Disability benefits are paid to an injured employee who is unable to return to work for more than seven days. The first seven days are recoverable only should the employee's absence from work exceed two (2) weeks.
Kentucky does not provide benefits for temporary partial disability benefits. Under some other states' workers' compensation programs, these benefits are paid in the amount of the difference in wage earnings should the employee return to work, but return earning less than what the employee made pre-injury. Kentucky does not provide benefits of this sort.
- Permanent Total Disability benefits are paid when the employee suffers an injury that results in the permanent inability to perform any type of work. This status is determined only after full medical improvement has been paid. While the employee's condition is stabilized, this means that no significant improvement is likely to be made.
Permanent total disability will be presumed in the following circumstances:
- Total or permanent loss of sight in both eyes
- Loss of both feet at or above ankle
- Loss of both hands at or above the wrist
- Loss of one hand above the wrist or loss of one foot above the ankle
- Incurable insanity or imbecility
- Total loss of hearing
- Permanent Partial Disability benefits are paid when the employee has a permanent disability, but can return to work. Permanent will describe the type of injury, not the term of payment.
Calculation of payment will depend largely on the extent of your injury, how long you have been out of work, and whether you will be able to return to work. Typically, the payment will be a percentage of your average weekly earnings earned prior to the injury.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Workers' compensation claims are usually settled or agreed upon by you-the injured employee- and your employer. However, if a settlement doesn't seem feasible, there are opportunities through the state workers' compensation department to litigate the claim. To begin this process, you, the employee, must apply for an adjustment of clam with the Department of Workers' Claims. The Department will then assign the case to an Administrative Law Judge (ALJ) to schedule a benefit review conference. A benefit review of conference is an informal proceeding where your case will be discussed. The ALJ will assist in trying to attain settlement, but if one is not possible will determine which issues of the case will need to be resolved.
If issues persist beyond the informal hearing with the ALJ, the ALJ may schedule a formal hearing in a proceeding very similar to a trial. An ALJ will also preside over this hearing and is expected to issue a statement of decision within sixty (60) days of the hearing date.
If you or your employer is not satisfied with the determination made at formal hearing, either of you may file an appeal to the Workers' Compensation Board. The appeal will deal solely with whether the ALJ erred in apply the law to the facts of the case.
6. If I am not happy with the determination, how do I appeal?
Kentucky law articulates that an administrative law judge may not reopen or review any award or determination of a workers' compensation claim for four years unless the issue upon review will relate to fraud; newly-discovered evidence which could not have been realized with the exercise of due diligence; mistake; and change of disability.
However, the decision of the Workers' Compensation Board will be subject to the review of the Kentucky Court of Appeals, based on all matters subject to review by the board and including errors in the application of the law.