Contact Us
Workers Compensation Division
401 SW Topeka Blvd, Suite 2
Topeka, KS 66603-3105
Phone: 785-296-4000
Fax: 785-296-0025
Email: kdol.wc@ks.gov
Guides and Forms
Guides
Workers Compensation Rights and Responsibilities (K-WC 40-A) - Legislative Changes as of July 1, 2024 (SB 430)
- Workers Compensation Laws and Regulations (K-WC 11)
- Workers Compensation Information for Kansas Employers and Employees (K-WC 25) (English)
- Información de Compesación de Trabajadores para Empleadores y Empleados del Estado de Kansas (K-WC 250) (Español)
- Information for Injured Employees (K-WC 27-A) (English)
- Información para Trabajadores Lesionados (K-WC 270-A) (Español)
- Death Benefits Information (K-WC 140)
- Información de Beneficios por Muerte (K-WC 140-S) (Español)
- Table of Maximum Benefits (K-WC 107) (English)
- TABLA DE BENEFICIOS MÁXIMOS (K-WC 1070-S) (Español)
- Practice & Procedure Guide (K-WC 14)
- Independent Contractor or Employee Fact Sheet (K-WC 126)
- Information for Self-Insured Employers on the Kansas Workers Compensation Act and Regulations (K-WC 1441)
- Why Audited Financial Statements are Required (K-WC 309)
- Medicare Set-Aside Arrangement Reference Guide
- Assessment Information (K-WC 121)
- Injuries at Work Guide to Benefits K-CM-G 007
Forms
- Employee Notification Forms (K-WC 530)
- Settlement Agreement – Final Receipt and Release of Liability (K-WC Form D)
- Neutral IME Professionals List
- Fraud or Abuse Report (K-WC 44)
- Annual Statement (K-WC 112)
- Self-Insurance Information (K-WC 144)
- Order Form for Workers Compensation Publications (K-WC 300)
- Settlement Award by Written Stipulation (K-WC 10)
The following forms are provided to be used as follows:
- Application for Benefits (K-WC E-1)
- Surviving Spouse, Dependent or Heir Application for Benefits (K-WC E-2)
- Application for Preliminary Hearing (K-WC E-3)
- Application for Post Award Medical, Termination or Modification of Medical Benefits (K-WC E-4)
- Application for Review and Modification (K-WC E-5)
- Application for Dismissal (K-WC E-6)
Rehabilitation Forms
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