Forms and Publications

Accident Reports and Benefits

Workers Compensation Practice and Procedure Guide
This guide is being revised to reflect changes in the law effective May 15, 2011
K-WC 107 - Benefit Cards (Rev. 07-12)
K-WC 140 - Death Benefit Information (Rev. 07-12)
K-WC 1101 A - Accident Report (Rev. 01-12) Reader Enabled

Annual Reports

Annual Report 2012 (603 KB)
Annual Report 2011 (1.7 MB)
Annual Report 2010 (2.00 MB)
Annual Report 2009 (1.49 MB)
Annual Report 2008 (1.44 MB)
Annual Report 2007 (2.14 MB)
Annual Report 2006 (2.37 MB)
Annual Report 2005
Annual Report 2004
Annual Report 2003
Annual Report 2002   Errata Sheet
Annual Report 2001

Brochures of Various Agency Sections

K-WC-P 100 - Mediation Brochure (Rev. 10-12)
K-WC-P 101 - Ombudsman/Claims Advisory Brochure (Rev. 6-12)
K-WC 706 - Fraud and Compliance Pamphlet (Rev. 06-12)

Elections

Workers Compensation Practice and Procedure Guide This guide is being revised to reflect changes in the law
effective May 15, 2011.
K-WC 50 - Election of Employee Not To Accept Coverage (Rev. 06-12) Reader-Enabled
K-WC 50a - Cancellation of Form 50 (Rev. 06-12) Reader-Enabled
K-WC 51 - Employer to Cover Employees Under Act: gross annual payroll is $20,000
     or less, or agricultural pursuits (Rev. 06-12) Reader-Enabled
K-WC 51a - Cancellation of Form 51 (Rev. 06-12) Reader-Enabled
K-WC 113 - Individual, Partner, or Self-Employed to Come Under Act (Rev. 06-12) Reader-Enabled
K-WC 114 - Cancellation of Form 113 (Rev. 06-12) Reader-Enabled
K-WC 123 - Employer to Provide Coverage for Volunteer Workers (Rev. 06-12) Reader-Enabled
K-WC 124 - Cancellation of Form 123 (Rev. 06-12) Reader-Enabled
K-WC 135 - Employer to Provide Coverage for Persons Performing Public or Community
     Service (Rev. 06-12) Reader-Enabled
K-WC 135a - Cancellation of Form 135 (Rev. 06-12) Reader-Enabled
K-WC 137 - Election of a Non compensated Volunteer Officer, Director, or Trustee of a
     Nonprofit Corporation to be Covered Rev. 06-12) Reader-Enabled
K-WC 137a - Cancellation of Form 137 (Rev. 06-12) Reader-Enabled
K-WC 138 - Workers Compensation Election Information (Rev. 06-12)

Employers and Employees

Workers Compensation Practice and Procedure Guide This guide is being revised to reflect changes in the law
effective May 15, 2011.
K-WC 25 - Workers Compensation Information for Kansas Employers and Employees (Rev.04-13)
K-WC 250 - Información Para Empleadores y Empleados (Rev. 04-13)
K-WC 27 - Important Information for Injured Employees (Rev. 06-12) Applies only to injuries on or after May 15, 2011 and before April 25, 2013
K-WC 27-A - Important Information for Injured Employees (Rev. 04-13) Applies only to injuries on or after April 25, 2013
K-WC 270 - Información Importante Para Trabajadores Lastimados en el Trabajo (Rev. 06-12) Información en este documento es efectiva para accidentes en o después de Mayo 15, 2011 o antes del 25 de Abril, 2013.
K-WC 270-A - Información Importante Para Trabajadores Lastimados en el Trabajo (Rev. 04-13) Información en este documento es efectiva para accidentes en o después de Abril 25, 2013.
K-WC 40 - "Posting" Notice (Rev. 04-13) Applies only to injuries on or after May 15, 2011 and before April 25, 2013
K-WC 40-A - "Posting" Notice (Rev. 04-13) Applies only to injuries on or after April 25, 2013.
K-WC 126 - Independent Contractor or Employee? (Rev. 06-12)
K-WC 530 - Important Information for Employers Regarding Form K-WC 27 and K-WC 270 (Rev. 06-12)

Hearings and Settlements

Workers Compensation Practice and Procedure Guide This guide is being revised to reflect changes in the law
effective May 15, 2011.
K-WC D - Final Release (Rev. 10-12) Reader-Enabled
K-WC E 1 - Application for Hearing (Rev. 12-12)
K-WC E 2 - Surviving Spouse or Dependent / Heirs Application for Hearing (Rev. 12-12)
K-WC E 3 - Application for Preliminary Hearing (Rev. 12-12)
K-WC E 4 - Application for Post Award Medical (Rev. 12-12)
K-WC E 5 - Application for Review and Modification (Rev. 12-12)
K-WC E 6 - Application for Dismissal (Rev. 12-12)
K-WC 12 - Worksheet for Settlements: Injury Case (Rev. 10-12)
K-WC 13 - Worksheet for Settlements: Death Case (Rev. 10-12)
K-WC 28 - Information for Self-Represented Litigants (Rev. 06-12) has important information for injured workers
who are representing themselves in a hearing.
K-WC 112 - Annual Statement (Rev. 11-12) Reader-Enabled
K-WC 139 - Pre-Trial Stipulations (Rev. 12-12) Reader-Enabled
K-WC 160 - Statement Regarding Attorney Fees (Rev. 10-12) Reader-Enabled
K-WC 280 - Información Para Litigantes Representados A Si Mismos (Rev. 06-12) contiene información importante
para trabajadores lesionados que están representándose a si mismos en una audiencia.
K-WC 317 - Order for Production of Records (Rev. 10-12) Reader-Enabled

Newsletter: Work Comp Connection

Subscribe by emailing Shirley.Hastings@dol.ks.gov
2012 Issues
2013 Issues

Publications for Sale

K-WC 300 - Order Form for Workers Compensation Publications (Rev. 12-12) Reader-Enabled

Requests for Records

K-WC 95 Records Download Requestor's Guide (Rev. 10-12)
K-WC 96 - Registration for Access to Electronic Records (Rev. 04-13)
K-WC 97 - Employers/Carrier's Request For Workers Compensation Records (Rev. 06-12)
K-WC 98 - Worker's Request For Workers Compensation Records (Rev. 06-12)
K-WC 308 - Affidavit Attesting to the Use of Public Records (Rev. 02-13)
K-WC 970 - Request for Workers Compensation Records / Solicitud de Datos de los
     Expedientes de Compensación de Trabajadores (Rev. 03-13)
K-WC 980 - Solicitud del Trabajador para Registros de Compensación de Trabajadores (Rev. 03-13)

Self-Insurance

K-WC 20 - Bank Fact Sheet (Rev. 06-12)
K-WC 105 - Employer's Application Oath to Become a Self-Insurer (Rev. 06-12)
K-WC 120 - Application for Self-Insurance (Rev. 06-12)
If you prefer to download an "interactive" Excel version of this form, select: K-WC 120 (Rev. 06-12) - Interactive
K-WC 121 - Assessment Information (Rev. 06-12)
K-WC 129 - Certificate of Excess Insurance (Rev. 06-12)
K-WC 130 - Letter of Credit (Rev. 06-12)
K-WC 130a - Trust Operational Agreement (Rev. 06-12)
K-WC 131 - Self-Insurance Aggregate Surety Bond (Rev. 06-12)
K-WC 131a - Amendatory Rider to Surety Bond (Rev. 06-12)
K-WC 132 - Indemnity and Guaranty Agreement (Rev. 06-12)
K-WC 133 - Statement of Insured (Rev. 06-12)
K-WC 144 - Self-Insurance Information (Rev. 06-12)
K-WC 309 - Why Audited Financial Statements are Required (Rev. 06-12)
K-WC 1441 - Information for Self-Insured Employers on the Kansas Workers Compensation Act and Regulations

Statutes and Regulations

Senate Bill 187 This is the bill containing all changes (additions and deletions) to the workers compensation statutes, signed by Governor Sam Brownback in 2013. This is the enrolled bill version, complete with strikethroughs and italics. The statutes in the bill apply only to injuries sustained at work on or after April 25, 2013. The statutes became effective April 25, 2013. A summary of the changes can be accessed here.

Substitute for House Bill 2134 Enrolled
This is the bill containing all changes (additions and deletions) to the workers compensation statutes, signed by Governor Sam Brownback in 2011. This is the enrolled bill version, complete with strikethroughs and italics. The statutes in the bill apply only to injuries sustained at work on or after May 15, 2011, and before April 25, 2013.

Workers Compensation Laws and Regulations
This is the complete set of laws and regulations concerning workers compensation in Kansas, incorporating changes made in the 2011 legislative session, and 2012 regulatory changes.