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Workers Compensation - Forms and Publications

Accident Reports, Benefits, and Claims Records
Annual Reports
Brochures of Various Agency Sections
Elections
Employers & Employees
Hearings & Settlements
Newsletters
Publications For Sale
Requests For Records
Self-Insurance
Statutes & Regulations

 

Get Acrobat Reader These documents and forms are in PDF format and require Adobe Acrobat Reader which is available for free from Adobe.

Small grey Adobe Acrobat PDF trademark Workers Compensation Practice and Procedure Guide
Small grey Adobe Acrobat PDF trademark K-WC 15 - Claim for Workers Compensation (Rev. 02-06)
Small grey Adobe Acrobat PDF trademark K-WC 107 - Benefit Cards (Rev. 07-08)
Small grey Adobe Acrobat PDF trademark K-WC 140 - Death Benefit Information (Rev. 07-06)
Small grey Adobe Acrobat PDF trademark K-WC 1101 A - Employer's Report of Accident (Rev. 02-06)

         K-WC 1101 A - Employer's Report of Accident (Rev. 02-06) - Interactive
         (Microsoft Word Version)
          K-WC 1101 A - Employer's Report of Accident (Rev. 02-06) - Interactive
         (Microsoft Excel Version)

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Small grey Adobe Acrobat PDF trademark Annual Report 2007
Two important changes have been made in the FY 2007 33rd Annual Statistical Report from previous years. Please note the following changes:
         1) In Section 3, Table 3-9 "2007 Closed Claims Study Claim Costs
             by Part of Body Injured, and Nature and Cause of Injury" on pg. 132
             has been expanded to show the top ten most frequent occurrences.
         2) In Section 3, tables showing detailed claims costs by categories for
             part of body injured, cause of injury, and nature of injury have been
             removed. If you would like receive the data for these particular
             categories, e-mail Robert Soria at robert.soria@dol.ks.gov
             or David Sprick at david.sprick@dol.ks.gov with your request.

         Annual Report 2007 (2.14 MB)

Small grey Adobe Acrobat PDF trademark Annual Report 2006
Two important changes have been made in the FY 2006 32nd Annual Statistical Report from previous years. Please note the following changes:
         1) The Fraud and Abuse statistics and narrative formerly located
             in Section 4 are now located in Section 1 on pages 25-27.
         2) To help distinguish between data for the Workers Compensation
             Board and the regular administrative law court, in this report the
             Judicial unit has been renamed the Administrative Law Judges unit
             and contains greatly expanded statistics and narrative which can
             be found on pages 18-22.
         Annual Report 2006 Section 1 with Cover (275 KB)
         Annual Report 2006 Section 2 (757 KB)
         Annual Report 2006 Section 3 (1,017 KB)
         Annual Report 2006 Appendix (26 KB)
         Annual Report 2006 Complete (2,424 KB)

Small grey Adobe Acrobat PDF trademark Annual Report 2005         
Small grey Adobe Acrobat PDF trademark Annual Report 2004         
Small grey Adobe Acrobat PDF trademark Annual Report 2003
Small grey Adobe Acrobat PDF trademark Annual Report 2002
                   Errata Sheet
Small grey Adobe Acrobat PDF trademark Annual Report 2001

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Small grey Adobe Acrobat PDF trademark K-WC P-100 - Mediation Brochure (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC P-101 - Ombudsman/Claims Advisory Services (Rev. 03-08)
Small grey Adobe Acrobat PDF trademark K-WC 706 - Fraud and Compliance Pamphlet (Rev. 03-06)

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Small grey Adobe Acrobat PDF trademark Workers Compensation Practice and Procedure Guide
Small grey Adobe Acrobat PDF trademark K-WC 50 - Election of Employee Not To Accept Coverage (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 50a - Cancellation of Form 50 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 51 - Employer to Cover Employees Under Act:
         gross annual payroll is $20,000 or less, or agricultural pursuits (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 51a - Cancellation of Form 51 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 113 - Individual, Partner, or Self-Employed to Come Under Act (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 114 - Cancellation of Form 113 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 123 - Employer to Provide Coverage for Volunteer Workers (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 124 - Cancellation of Form 123 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 135 - Employer to Provide Coverage for Persons Performing Public or
         Community Service (Rev. 10-04)
Small grey Adobe Acrobat PDF trademarkn K-WC 135a - Cancellation of Form 135 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 137 - Election of a Non compensated Volunteer Officer, Director,
         or Trustee of a Nonprofit Corporation to be Covered (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 137a - Cancellation of Form 137 (Rev. 10-04)
Small grey Adobe Acrobat PDF trademark K-WC 138 - Workers Compensation Election Information (Rev. 10-04)

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Small grey Adobe Acrobat PDF trademark Workers Compensation Practice and Procedure Guide
Small grey Adobe Acrobat PDF trademark K-WC 25 - Workers Compensation Information for Kansas Employers & Employees
         (Rev. 12-07)
         Para obtener el K-WC 250, la versión de esta publicación en
         español, toque el "mouse" aqui para llegar a nuestra página

         en español: Información Sobre
Small grey Adobe Acrobat PDF trademark K-WC 27 - Important Information for Injured Employees (Rev. 04-06)
         Para obtener el K-WC 270, la versión de esta publicación en
         español,toque el "mouse" aqui para llegar a nuestra página
         en español: Información Sobre
Small grey Adobe Acrobat PDF trademark K-WC 40 - "Posting" Notice (Rev. 03-08)
Small grey Adobe Acrobat PDF trademark K-WC 119 - Information Required By Kansas Workers Compensation Laws
         (Rev. 04-06)
Small grey Adobe Acrobat PDF trademark K-WC 126 - Independent Contractor or Employee? (Rev. 02-06)
Small grey Adobe Acrobat PDF trademark K-WC 136 - Information for Injured Workers (Rev. 02-06)
Small grey Adobe Acrobat PDF trademark K-WC 304 - Tips For Employers To Reduce Workers Compensation Liability
         (Rev. 04-06)
Small grey Adobe Acrobat PDF trademark K-WC 530 - Important Information for Employers Regarding
         Form K-WC 27 and K-WC 270 (Spanish Version) (Rev. 12-06)

Our Employee Tutorial provides important information about workers compensation for injured workers.

Nuevo para 2008: Nuestro Instructivo para Empleados provee información importante acerca de compensación de trabajadores para trabajadores lesionados.

Our Employer Tutorial provides employers with important information about workers compensation, consolidating and supplementing information on issues covered elsewhere on this page and in other locations on our site.

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Small grey Adobe Acrobat PDF trademark Workers Compensation Practice and Procedure Guide
Small grey Adobe Acrobat PDF trademark K-WC D - Final Release (Rev. 01-06)
Small grey Adobe Acrobat PDF trademark K-WC E 1 - Application For Hearing (Rev. 05-07)
Small grey Adobe Acrobat PDF trademark K-WC E 2 - Surviving Spouse or Dependent / Heirs Application for Hearing
         (Rev. 05-07)
Small grey Adobe Acrobat PDF trademark K-WC E 3 - Application For Preliminary Hearing (Rev. 05-07)
Small grey Adobe Acrobat PDF trademark K-WC E 4 - Application For Post Award Medical (Rev. 05-07)
Small grey Adobe Acrobat PDF trademark K-WC E 5 - Application For Review and Modification (Rev. 05-07)
Small grey Adobe Acrobat PDF trademark K-WC 12 - Worksheet for Settlements: Injury Case (Rev. 07-90)
Small grey Adobe Acrobat PDF trademark K-WC 13 - Worksheet for Settlements: Death Case (Rev. 08-90)
Small grey Adobe Acrobat PDF trademark K-WC 139 - Pre-Trial Stipulations (Rev. 08-98)
Small grey Adobe Acrobat PDF trademark K-WC 160 - Statement Regarding Attorney Fees (Rev. 12-06)

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Work Comp Connection August 2008

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Small grey Adobe Acrobat PDF trademark K-WC 300 - Law & Regulations Book Order Form (Rev. 8-07)

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Small grey Adobe Acrobat PDF trademark K-WC 97 - Request For Workers Compensation Records (Rev. 07-08)
Small grey Adobe Acrobat PDF trademark K-WC 98 - Worker's Request For Workers Compensation Records (Rev. 07-08)
Small grey Adobe Acrobat PDF trademark K-WC 99 - Notice on Request for Records (Rev. 07-08)
Small grey Adobe Acrobat PDF trademark K-WC 970 - Request for Workers Compensation Records / Solicitud de Datos de los
         Expedientes de Compensación de Trabajadores (Rev. 08-08)

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Small grey Adobe Acrobat PDF trademark K-WC 20 - Bank Fact Sheet (Rev. 02-07)
Small grey Adobe Acrobat PDF trademark K-WC 105 - Employer's Application Oath to Become a Self-Insurer (Rev. 07-04)
Small grey Adobe Acrobat PDF trademark K-WC 106 - Commonly Asked Questions and Answers Relating to Individual
         Self-Insurance in the State of Kansas (Rev. 07-05)
Small grey Adobe Acrobat PDF trademark K-WC 120 - Application for Self-Insurance (Rev. 02-07)
         If you prefer to download an "interactive" Excel version of this form,
         select:
K-WC 120 - Interactive
Small grey Adobe Acrobat PDF trademark K-WC 121 - Assessment Information (Rev. 09-05)
Small grey Adobe Acrobat PDF trademark K-WC 129 - Certificate of Excess Insurance (Rev. 02-07)
Small grey Adobe Acrobat PDF trademark K-WC 130 - Letter of Credit (Rev. 12-06)
Small grey Adobe Acrobat PDF trademark K-WC 130a - Trust Operational Agreement (Rev. 01-06)
Small grey Adobe Acrobat PDF trademark K-WC 131 - Self-Insurance Aggregate Surety Bond (Rev. 05-05)
Small grey Adobe Acrobat PDF trademark K-WC 131a - Amendatory Rider to Surety Bond (Rev. 12-99)
Small grey Adobe Acrobat PDF trademark K-WC 132 - Indemnity & Guaranty Agreement (Rev. 02-07)
Small grey Adobe Acrobat PDF trademark K-WC 133 - Statement of Insured (Rev. 02-07)
Small grey Adobe Acrobat PDF trademark K-WC 144 - Self-Insurance Information (Rev. 02-07)
Small grey Adobe Acrobat PDF trademark K-WC 158 - Liability Buildup (Rev. 04-93)
Small grey Adobe Acrobat PDF trademark K-WC 309 - Why Audited Financial Statements are Required (Rev. 04-06)
Small grey Adobe Acrobat PDF trademark K-WC 1441 - Information for Self-Insured Employers on the Kansas Workers
         Compensation Act (Rev. 01-06)

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Small grey Adobe Acrobat PDF trademark Workers Compensation Laws & Regulations
         This is the complete set of laws and regulations concerning workers
        compensation in Kansas, incorporating changes made in the
        2006 and 2007 legislative sessions.

 

For assistance, e-mail wc@dol.ks.gov or contact us at:

Kansas Department of Labor
Workers Compensation
800 SW Jackson, Suite 600
Topeka, KS 66612-1227
(785) 296-2996 or (800) 332-0353.

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Page last updated August 28, 2008