Claims forms

Please reference the different claims forms below for your specific claims needs:

Required Forms:

Accident Reporting Form (K-WC 1101-A Rev.10-13)

Authorization For Work Comp Medical Treatment Form

Information for Injured Employees (K-WC- 27-A Rev. 4-25)

Workers Compensation Rights and Responsibilities (K-WC 40-A Rev. 10-24)

Employee Wage Report

Best Practice Forms:

Report of Injury – Statement of Understanding (Rev. 7-25)

Work Comp Injury/Illness Reporting Procedure Example (Rev. 7-25)

Workplace Injury Reference Sheet – Accident Reporting Guidelines (Rev. 7-25)