Workers Compensation Claim kit – Kentucky

Who will handle your claims?
The Orlando Claim Office will handle your Kentucky claims, located at:

1035 Greenwood Blvd.
Suite 265
Lake Mary, FL 32795

Phone (800)423-3060
Rose Powell, Manager

How to Report Workers’ Compensation Claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail:                                      [email protected]
To report via fax:                                      1-877-622-6218
To report claims via telephone:       1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms and pamphlets does the employer need to be aware of?

Click on this link for the Kentucky Forms:
http://www.labor.ky.gov/workersclaims/forms/

Kentucky WC Posting Notice
Prominently display the notice where each employee is likely to see the notice on a regular basis. The Kentucky posting notices are available on the Crum & Forster website.  Notices should be displayed in English and Spanish.

1A-1 / Employer’s First Report of Injury
If you report the claim via telephone, you do not need to fill out this form.
If you report the claim via fax, complete this form, and fax it to Crum & Forster at the fax number provided above.

KT-FROI

Employer’s Wage Statement
File this form with the carrier, claimant, and claimant’s representative when the claimant is losing time from work.

KT-AWW-1-wage statement

What is the Waiting Period for Lost Wages in Kentucky?
The waiting period is 7 days. If there are more than 7 days out of work, the employee is entitled to benefits from the first day out of work with a retroactive period of two weeks.

What is the Choice of Physician Rules in Kentucky?
Within 10 days of the date of loss the injured worker must be provided with a Form 113 (Designated Physician Form) which he/she must complete and sign designating their choice of the initial treating doctor. This form is to be forwarded to the carrier.

Within 10 days of the carrier receiving the signed Form 113 (Designated Physician Form) the carrier will send the injured worker a Designated Physician Card which is to be used by the injured worker to present to the authorized doctor in order for care to be provided. A reserve side of the card is also available for the injured worker to select an alternate Designated Physician.

KT-form 113

Preferred Provider Organization Network (PPO)
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:   www.talispoint.com/conduent/cfi

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites

Kentucky Division of Workers Compensation-

http://www.labor.ky.gov/workersclaims/

Multi-State Information: http://www.workerscompensation.com/