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FAQ for Kentucky Workers Compensation Claims

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.

1. Question: What is Kentucky Workers Compensation law?

2. Question: Who is covered by Kentucky Workers Compensation Law?

3. Question: Who is not covered by Kentucky Workers Compensation law?

4. Question: What Injuries are covered by Kentucky Workers Compensation Law?

5. Question: What should an employee do if they are injured at work?

6. Question: How does an injured Employee get Benefits?

7. Question: Is every employer in Kentucky required to have workers compensation insurance?

8. Question: Can an employer be penalized for not having workers compensation insurance?

9. Question: Can I receive workers compensation benefits if my employer did not have workers compensation insurance?

10. Question: What workers compensation benefits are available?

11. Question: What Medical expenses are covered by Kentucky Workers Compensation Law?

12. Question: How much money will I get when I’m off work in Kentucky?

13. Question: How do you compute Permanent Disability Benefits in Kentucky?

14. Question: Can I get Permanent disability benefits in a lump sum?

15. Question: What are Vocational Retraining Benefits?

16. Question: What can I do if the workers compensation carrier does not promptly pay benefits?

17. Question: What happens if my Employer committed a Safety Violation that caused my injury?

18. Question: What if the worker committed a Safety Violation?

19. Question: How long do I have to file a workers compensation claim?

20. Question: Can I file a claim against anyone besides my employer?

21. Question: Can I receive Social Security Disability and Workers Compensation benefits at the same time?

22. Question: How do I file a workers compensation claim in Kentucky?

23. Question: Do I need to contact an attorney about my workers compensation claim?

24. Question: How is my attorney paid?

25. Question: Can I select the doctor to treat me for my Kentucky workers compensation injury?

26. Question: Can I change my workers compensation doctor?

27. Question: Can I receive Kentucky Workers Compensation benefits if I am injured in another state?

28. Question: What is MMI?

29. Question: When do I get permanent disability benefits?

30. Question: Where can I find the Kentucky Workers Compensation Act?

31. Question: Where can I find the regulations for the Kentucky Department of Workers Claims?

1. Question: What is Kentucky Workers Compensation law?

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.

2. Question: Who is covered by Kentucky Workers Compensation Law?

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.

3. Question: Who is not covered by Kentucky Workers Compensation law?

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.

4. Question: What Injuries are covered by Kentucky Workers Compensation Law?

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.

5. Question: What should an employee do if they are injured at work?

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.

6. Question: How does an injured Employee get Benefits?

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).

7. Question: Is every employer in Kentucky required to have workers compensation insurance?

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.

8. Question: Can an employer be penalized for not having workers compensation insurance?

Answer: Yes. An employer can be fined $1,000.00 per day per employee for failing to have workers compensation insurance. KRS 342.990.

9. Question: Can I receive workers compensation benefits if my employer did not have workers compensation insurance?

Answer: Yes. If the employer did not have workers compensation insurance, the injured employee can still recover benefits from the Kentucky Uninsured Employers’ Fund.

10. Question: What workers compensation benefits are available?

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.)

11. Question: What Medical expenses are covered by Kentucky Workers Compensation Law?

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.

12. Question: How much money will I get when I’m off work in Kentucky?

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 $835.04 for a 2017 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.

13. Question: How do you compute Permanent Disability Benefits in Kentucky?

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.

14. Question: Can I get Permanent disability benefits in a lump sum?

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.

15. Question: What are Vocational Retraining Benefits?

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.

16. Question: What can I do if the workers compensation carrier does not promptly pay benefits?

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.

17. Question: What happens if my Employer committed a Safety Violation that caused my injury?

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.

18. Question: What if the worker committed a Safety Violation?

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.

19. Question: How long do I have to file a workers compensation claim?

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.

20. Question: Can I file a claim against anyone besides my employer?

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.

21. Question: Can I receive Social Security Disability and Workers Compensation benefits at the same time?

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.

22. Question: How do I file a workers compensation claim in Kentucky?

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.

23. Question: Do I need to contact an attorney about my workers compensation claim?

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.

24. Question: How is my attorney paid?

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% of the first $25,000.00 recovered, 15% of the next $10,000.00 recovered, and 5% of the remainder recovered, with a limit on total attorneys fee of $12,000.00. Generally, expenses are also paid by the client, after the attorney’s fee is computed.

25. Question: Can I select the doctor to treat me for my Kentucky workers compensation injury.

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).

26. Question: Can I change my workers compensation doctor?

Answer: Yes. In Kentucky, you are allowed to change your designated physician at least once for any reason.

27. Question: Can I receive Kentucky Workers Compensation benefits if I am injured in another state?

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.

28. Question: What is MMI?

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.

29. Question: When do I get permanent disability benefits?

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.

30. Question: Where can I find the Kentucky Workers Compensation Act?

Answer: The actual statutes can be found at: http://www.lrc.state.ky.us/KRS/342-00/CHAPTER.HTM

31. Question: Where can I find the regulations for the Kentucky Department of Workers Claims?

Answer: The regulations are found at: (Chapter 25) 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.