Fatality {Form F}

Form F - FATALITY. This form is used in Kentucky workers’ compensation fatality cases to identify a deceased worker’s dependents and determine benefit eligibility. The form requires information about the decedent and any dependents, including names, addresses, dates of birth, relationship to the decedent, and whether they were dependent or living with the decedent at the time of the accident. If no dependents exist, the filer must certify that fact. Supporting documents such as a marriage license, birth certificates, adoption records, or court orders of guardianship must be attached when applicable. The form must be signed by the claimant and attorney (if represented). www.FormsWorkFlow.com