FAQ for Kentucky Workers Compensation Claims
Below are common questions and answers about workers compensation law in Kentucky. The questions and answers are a general discussion about Kentucky Workers Compensation law, and not legal advice about a specific claim. There are many exceptions to the general questions and answers discussed here, and laws can easily change before this is updated. Therefore, consult an actual attorney about your specific situation before you take action.
Answer: Kentucky Workers Compensation law is a set of statutes that requires employers to provide medical treatment, lost wages, and other benefits for job related injuries. The specific statutes are found in Chapter 342 of the Kentucky Revised Statutes (KRS).
These laws require employers to pay medical treatment for the “cure and relief” of a work related injury. KRS 342.020. No co-payments or deductibles are paid by the injured worker. Employers can also be required to pay lost wage benefits while an injured worker is off work recovering from an injury, lifetime medical treatment for the injury, permanent disability benefits, and vocational rehabilitation.
Workers Compensation laws vary greatly from one state to another, and by the type of employer. Federal employees, and some employees of Federal contractors, are governed by their own workers compensation laws. Also, maritime and railroad workers are governed by their own workers compensation laws.
Answer: Almost every employee in Kentucky is covered by Kentucky Workers Compensation Law. This includes employees injured the first day on the job, part-time employees, seasonal and temporary employees, minors, and employees of state and local governments. Also workers on probation before being formally hired and employees of businesses with only one worker are eligible for workers compensation benefits. KRS 342.640. Some workers classified as independent contractors can still be eligible for benefits, depending on the specific facts of their job.
Maritime workers, railroad workers, Federal employees, and employees of some Federal contractors may be covered by other workers compensation laws.
Answer: Agricultural workers, domestic servants, true independent contractors, persons working less than 20 days at another’s home, and some charitable workers are excluded from coverage in Kentucky. KRS 342.650. Talk to an attorney if you are in one of these classes to see if you may still be eligible for benefits.
Also, someone who willingly signed forms waiving workers compensation benefits may not be covered.
As stated before, Federal employees, employees of some Federal contractors, railroad workers, and maritime workers are usually not covered by Kentucky Workers Compensation Law, but have similar laws that protect them.
Answer: Almost every physical injury that occurs during work is covered by Kentucky Workers Compensation Law. This includes injuries that develop over long periods of time because of repetitive motion, such as carpal tunnel syndrome and degenerative disc disease. In addition, injuries caused when work accelerates the natural aging process are covered. Injuries caused by exposure to chemicals, coal dust, or asbestos are also covered. Psychiatric injuries may be covered if they are related to a physical injury.
Answer: An employee is required to give notice to their employer of the injury as soon as possible. The employee generally has the right to choose the medical provider that will give treatment. KRS 342.020. If the employer has a “managed care” plan for workers compensation injuries, the employee must select one of the providers in that plan.
Answer: After receiving notice of the injury, the employer must provide the employee benefits within a reasonable time. Failure to timely provide benefits is a violation of Kentucky Law and regulations of the Department of Workers Claims. KRS 342.040, 803 KAR 25:240. If benefits are not timely started, contact an attorney or the Department of Workers Claims (1-800-554-8601).
Answer: Yes. All employers in Kentucky are required by law to carry workers compensation insurance, or be qualified as self-insured. The employer must also post a notice stating the name of its workers compensation insurance carrier. KRS 342. 610, KRS. 342.990.
Answer: Yes. An employer can be fined $1,000.00 per day per employee for failing to have workers compensation insurance. KRS 342.990.
Answer: Yes. If the employer did not have workers compensation insurance, the injured employee can still recover benefits from the Kentucky Uninsured Employers’ Fund.
Answer: Injured workers can receive medical expenses, lost wages, compensation for permanent disability, and vocational retraining. (Coal miners suffering from Black Lung may be eligible for additional benefits.)
Answer: Employers must pay all medical expenses reasonably related to the “cure and relief of the injury.” KRS 342.020. Medical expenses include charges of doctors and chiropractors, prescription expenses, hospital bills, nursing treatment, tests (such as x-rays and MRI’s), durable medical equipment, braces, travel expenses, and many other items. In Kentucky, work related medical expenses can be payable for life. The employee is not required to make co-payments or pay deductibles for medical treatment obtained in Kentucky. Medical expenses are required to be paid within 30 days of receipt by the employer. KRS 342.020.
Answer: Workers receive two-thirds (2/3’s) of their average weekly wage (AWW), while off work and recovering from the injury in Kentucky. This is called Temporary Total Disability Benefits (TTD). For hourly employees, overtime is considered.
The AWW is computed pursuant to a statute, KRS 342.140. If the employee is paid hourly, wages for the one year period prior to the injury, including overtime, are reviewed to determine AWW. There are limits on the weekly amount that can be paid for TTD. (The weekly limit of TTD is $848.41 for a 2018 injury.) An employee must be off work for at least seven days before TTD benefits can be paid. If they are off work for at least 14 days, TTD benefits are paid from the first day off work.
Answer: The amount and length of time of Permanent Disability Benefits depends on several facts. In Kentucky, you look at: the impairment rating assigned by a medical expert; restrictions on the employee’s physical activities; the worker’s average weekly wage at the time of the injury and at return to work; age; and, educational level. KRS 342.730.
Answer: Yes. If the parties settle a claim, benefits can be paid in a lump sum. But, in Kentucky, the employer is not required to pay benefits in a lump sum. Employers are only required to pay permanent disability benefits weekly.
Answer: If an injured worker is unable to return to any job he performed before, an Administrative Law Judge can award Vocational Retraining Benefits. This can allow the employee to receive up to 52 weeks of training to learn a new job.
Answer: Workers compensation insurance carriers (including self insured employers) must pay claims promptly, or they can be fined by the Department of Workers Claims for violation of the Unfair Claims Settlement Practices Act (UCSPA). KRS 304.12-230 and KRS 342.267. The Act also requires the workers compensation carrier to respond within a reasonable time to correspondence and requests for information.
Answer: In Kentucky, if the employer intentionally violated safety regulations, the employee can be entitled to 30% more monetary benefits. If you believe a violation of a safety regulation occurred, you should file a complaint with OSHA. KRS 342.165.
Answer: In Kentucky, if the worker violated a safety regulation, benefits can be reduced by 15%. Also, employees injured because they are intoxicated or under the influence of drugs may not be allowed to receive benefits. Employees injured because of horseplay, and activities clearly outside the scope of employment, may not be eligible for benefits. KRS 342.165.
Answer: In Kentucky, there is a two year statute of limitations to file a workers compensation claim for most injuries. This time begins to run from the date of the injury, or the last payment of TTD, whichever date is later. KRS 342.185. If the injury is due to exposure of the AIDS virus you may have five years to file. In some rare cases, such as where the employer has not filed the correct forms with the Department of Workers Claims, the statute can be extended. Also, for some occupational diseases (such as Black Lung), the period to file a claim is three years after the last exposure. If you are injured because of repetitive motion or cumulative trauma, a claim can be filed up to two years from the date you discovered the work related condition.
Answer: Yes. An employee may file a lawsuit against a third party that caused the injury. For instance, an employee can sue someone that caused an automobile accident that injured him while driving for work. But, he cannot sue his employer, or a fellow employee, unless it is for an intentional injury. The statute of limitations may also be shorter for a third party lawsuit, and often requires a lawsuit to be filed within a year of the injury.
Answer: Yes. In Kentucky, you can receive Social Security Disability benefits in addition to Workers Compensation Benefits. The Social Security Administration may offset its benefits, depending on the amount of workers compensation benefits awarded, and amounts you previously paid into the Social Security system.
Answer: You must submit a completed Application For Resolution of Injury Claim (Form 101, 102, or 103), and attachments, and submit them to the Department of Workers Claims in Frankfort, Kentucky.
Answer: An experienced attorney can provide help in obtaining proper benefits, dealing with the insurance carrier, completing forms, and representing an injured worker before an administrative law judge.
Answer: Attorneys generally handle claims for employees on a contingency fee basis. (This means they do not get paid unless the employee gets benefits.) In Kentucky, attorney’s fees are limited by statute. KRS 342.520 (2) provides an attorney’s fee of 20 percent of the first $25,000, 15 percent of the next $25,000, and 10 percent of the remainder not to exceed $18,000.00. Generally, expenses are also paid by the client, after the attorney’s fee is computed.
Answer: Generally, yes. In Kentucky, you can select the physician to provide treatment for your work related injury. If your employer participates in a managed care plan you can select among physicians that are enrolled in the plan. KRS 342.020(1).
Answer: Yes. In Kentucky, you are allowed to change your designated physician at least once for any reason.
Answer: Yes. If your work is “principally localized” in Kentucky, you can receive benefits under Kentucky workers compensation law, even if you were injured in another state. Also, If you were hired in Kentucky, and your work is not principally localized anywhere, you may still be eligible for Kentucky workers compensation benefits. KRS 342.670.
Answer: MMI means Maximum Medical Improvement. This is the point where a worker’s medical condition has stabilized, and is not getting better or worse.
Answer: Once an employee has reached Maximum Medical Improvement (MMI) from an injury, and also sustained a permanent impairment, she may be entitled to permanent disability benefits. Those are received through a settlement, or an award of an Administrative Law Judge.
Answer: The actual statutes can be found at: http://www.lrc.state.ky.us/KRS/342-00/CHAPTER.HTM
Answer: The regulations are found at: http://www.lrc.state.ky.us/ kar/TITLE803.HTM
Common Abbreviations in Workers Compensation
ALJ Administrative Law Judge
AWW Average Weekly Wage
IME Independent Medical Examination
MMI Maximum Medical Improvement
DWC Kentucky Department of Workers Claims
OSHA Occupational Health and Safety Administration
PPD Permanent Partial Disability
TPA Third Party Administrator
TTD Temporary Total Disability Benefits
UCSPA Unfair Claims Settlement Practices Act
KRS Kentucky Revised Statutes
KAR Kentucky Administrative Regulations
AMA American Medical Association
UR Utilization Review
NOTE: These answers are part of a general discussion about Kentucky Workers Compensation law, and not legal advice about a specific claim. There are many exceptions to the general questions and answers discussed here, and laws can easily change before this is updated. Therefore, consult an attorney about your specific situation before you take action.