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
 |
These documents and forms are in PDF format and require Adobe Acrobat Reader which is available
for free from Adobe. |
Accident Reports, Benefits, and Claims Records
Workers Compensation Practice and Procedure Guide
K-WC 15 - Claim for Workers Compensation (Rev. 02-06)
K-WC 107 - Benefit Cards (Rev. 07-08)
K-WC 140 - Death Benefit Information (Rev. 07-06)
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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Annual Reports
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)
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)
Annual Report 2005
Annual Report 2004
Annual Report 2003
Annual Report 2002
Errata Sheet
Annual Report 2001
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Brochures of Various Agency Units Sections
K-WC P-100 - Mediation Brochure (Rev. 10-04)
K-WC P-101 - Ombudsman/Claims Advisory Services (Rev. 03-08)
K-WC 706 - Fraud and Compliance Pamphlet (Rev. 03-06)
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Elections
Workers Compensation Practice and Procedure Guide
K-WC 50 - Election of Employee Not To Accept Coverage (Rev. 10-04)
K-WC 50a - Cancellation of Form 50 (Rev. 10-04)
K-WC 51 - Employer to Cover Employees Under Act:
gross annual payroll is $20,000 or less, or agricultural pursuits (Rev. 10-04)
K-WC 51a - Cancellation of Form 51 (Rev. 10-04)
K-WC 113 - Individual, Partner, or Self-Employed to Come Under Act (Rev. 10-04)
K-WC 114 - Cancellation of Form 113 (Rev. 10-04)
K-WC 123 - Employer to Provide Coverage for Volunteer Workers (Rev. 10-04)
K-WC 124 - Cancellation of Form 123 (Rev. 10-04)
K-WC 135 - Employer to Provide Coverage for Persons Performing Public or
Community Service (Rev. 10-04)
K-WC 135a - Cancellation of Form 135 (Rev. 10-04)
K-WC 137 - Election of a Non compensated Volunteer Officer, Director,
or Trustee of a Nonprofit Corporation to be Covered (Rev. 10-04)
K-WC 137a - Cancellation of Form 137 (Rev. 10-04)
K-WC 138 - Workers Compensation Election Information (Rev. 10-04)
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Employers & Employees
Workers Compensation Practice and Procedure Guide
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
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
K-WC 40 - "Posting" Notice (Rev. 03-08)
K-WC 119 - Information Required By Kansas Workers Compensation Laws
(Rev. 04-06)
K-WC 126 - Independent Contractor or Employee? (Rev. 02-06)
K-WC 136 - Information for Injured Workers (Rev. 02-06)
K-WC 304 - Tips For Employers To Reduce Workers Compensation Liability
(Rev. 04-06)
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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Hearings & Settlements
Workers Compensation Practice and Procedure Guide
K-WC D - Final Release (Rev. 01-06)
K-WC E 1 - Application For Hearing (Rev. 05-07)
K-WC E 2 - Surviving Spouse or Dependent / Heirs Application for Hearing
(Rev. 05-07)
K-WC E 3 - Application For Preliminary Hearing (Rev. 05-07)
K-WC E 4 - Application For Post Award Medical (Rev. 05-07)
K-WC E 5 - Application For Review and Modification (Rev. 05-07)
K-WC 12 - Worksheet for Settlements: Injury Case (Rev. 07-90)
K-WC 13 - Worksheet for Settlements: Death Case (Rev. 08-90)
K-WC 139 - Pre-Trial Stipulations (Rev. 08-98)
K-WC 160 - Statement Regarding Attorney Fees (Rev. 12-06)
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Newsletters
Work Comp Connection August 2008
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Publications For Sale
K-WC 300 - Law & Regulations Book Order Form (Rev. 8-07)
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Requests for Records
K-WC 97 - Request For Workers Compensation Records (Rev. 07-08)
K-WC 98 - Worker's Request For Workers Compensation Records (Rev. 07-08)
K-WC 99 - Notice on Request for Records (Rev. 07-08)
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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Self-Insurance
K-WC 20 - Bank Fact Sheet (Rev. 02-07)
K-WC 105 - Employer's Application Oath to Become a Self-Insurer (Rev. 07-04)
K-WC 106 - Commonly Asked Questions and Answers Relating to Individual
Self-Insurance in the State of Kansas (Rev. 07-05)
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
K-WC 121 - Assessment Information (Rev. 09-05)
K-WC 129 - Certificate of Excess Insurance (Rev. 02-07)
K-WC 130 - Letter of Credit (Rev. 12-06)
K-WC 130a - Trust Operational Agreement (Rev. 01-06)
K-WC 131 - Self-Insurance Aggregate Surety Bond (Rev. 05-05)
K-WC 131a - Amendatory Rider to Surety Bond (Rev. 12-99)
K-WC 132 - Indemnity & Guaranty Agreement (Rev. 02-07)
K-WC 133 - Statement of Insured (Rev. 02-07)
K-WC 144 - Self-Insurance Information (Rev. 02-07)
K-WC 158 - Liability Buildup (Rev. 04-93)
K-WC 309 - Why Audited Financial Statements are Required (Rev. 04-06)
K-WC 1441 - Information for Self-Insured Employers on the Kansas Workers
Compensation Act (Rev. 01-06)
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Statutes & Regulations
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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