Forms & Paperwork
- Form MTR-2
- Motion to Reopen KRS 342.732 Benefits
- Form 110-CWP
- Agreement as to Compensation and Order Approving Settlement for Coal Workers Pneumoconiosis
- Form 102-CWP
- Application for Resolution of Coal Workers' Pneumoconiosis Claim
- Educational Release Form
- Authorization for Release of Educational Information
- Form IA-1
- Workers Compensation - First Report of Injury or Illness
- Form IA-2
- Workers Compensation - Subsequent Report
- Form Hearing Loss Stipulation
- Workers Compensation - Hearing Loss Stipulation
- Form Injury Stipulation
- Workers Compensation - Injury Stipulation
- Form Occupational Disease Stipulation
- Workers Compensation - Occupational Disease Stipulation
- Form 104
- Plaintiff's Employment History
- Form 105
- Plaintiff's Chronological Medical History
- Form 106
- Medical Waiver and Consent
- Form 107
- Physician's Medical Report-Injury
- Form 108-CWP
- Physician's Medical Report-Occupational Disease
- Form 108-HL
- Physician's Medical Report-Hearing Loss
- Form 108-OD
- Physician's Medical Report-Occupational Disease
- Form 109
- Attorney Fee Election
- Form 110
- Agreement as to Compensation and Order Approving Settlement - Injury
- Form 112
- Medical Fee Dispute
- Form 113
- Notice of Designated Physician
- Form 114
- Request for Payment for Services or Reimbursement for Compensable Expenses
- Form 115
- Social Security Release Form
- Form AWW-1
- Average Weekly Wage Certification
- Form 150
- Workers Compensation Statistical Report
- Form 375
- Application for Split Coverage
- Form 375 EL
- Application for Split Coverage (Employee Leasing)
- Form 375 Wrap-Up
- Application for Split Coverage (Wrap-Up)
- Form 11
- Motion to Substitute Party and Continuation of Benefits
- Manual Change Form
- Manual Change Form
