Kansas > Workers Compensation
Information For Injured Employees K-WC 27 - Kansas
| Information For Injured Employees Form. This is a Kansas form and can be used in Workers Compensation . |
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KANSAS DEPARTMENT OF LABOR www.dol.ks.gov Page 1 of 2 INFORMATION FOR INJURED EMPLOYEES K-WC 27 (Rev. 6-12) * THIS NOTICE APPLIES TO ACCIDENTS ON OR AFTER MAY 15, 2011 * Employers are required to provide this information to each injured worker WHAT TO DO IF AN INJURY OCCURS ON THE JOB If you have any questions about workers compensation benefits, contact the Division of Workers Compensation at the phone number at the bottom of the page. Assistance in Spanish is available. (1) NOTIFY YOUR EMPLOYER IMMEDIATELY: Per K.S.A. 44-520, a claim may be denied if an employee fails to notify their employer within the earliest of the following dates: (A) 30 calendar days from the date of accident or the date of injury by repetitive trauma; (B) if the employee is working for the employer against whom benefits are being sought and such employee seeks medical treatment for any injury by accident or repetitive trauma, 20 calendar days from the date such medical treatment is sought; or (C) if the employee no longer works for the employer against whom benefits are being sought, 20 calendar days after the employee's last day of actual work for the employer. Notice may be given orally or in writing. Where notice is provided orally, if the employer has designated an individual or department to whom notice must be given and such designation has been communicated in writing to the employee, notice to any other individual or department shall be insufficient under this section. If the employer has not designated an individual or department to whom notice must be given, notice must be provided to a supervisor or manager. Where notice is provided in writing, notice must be sent to a supervisor or manager at the employee's principal location of employment. The notice, whether provided orally or in writing, shall include the time, date, place, person injured and particulars of such injury. It must be apparent from the content of the notice that the employee is claiming benefits under the workers compensation act or has suffered a work-related injury. (2) FOLLOW YOUR EMPLOYER'S INSTRUCTIONS for getting medical aid and follow the doctor's instructions. (3) MEDICAL BENEFITS: An injured worker is entitled to all medical services reasonably necessary to cure and relieve the worker from the effects of the injury. The employer has the right to select the doctor who will treat the injury. A worker may seek the services of an unauthorized doctor up to a limit of $500.00. A worker may apply to the Workers Compensation Director to change the authorized treating doctor. Reimbursement for travel to obtain medical treatment is payable at a rate set by law for trips that are five miles or more (round trip). (4) WEEKLY BENEFITS: Benefits are paid by the employer's insurance carrier or self insurance program. Injured workers are not entitled to compensation for the first week they are off work unless they lose three consecutive weeks. The first compensation payment is normally due at the end of the 14th day of lost time. An injured employee is entitled to a weekly amount of 66 percent of his/her average weekly wage up to a maximum of 75 percent of the state's average weekly wage. These benefits are subject to legislative changes. If the injury results in permanent disability, the Kansas Workers Compensation law provides for additional benefits. DIVISION OF WORKERS COMPENSATION OMBUDSMAN / CLAIMS ADVISORY UNIT 401 SW Topeka Blvd., Ste. 2, Topeka, KS 66603-3105 · Phone (785) 296-4000, (800) 332-0353 · Fax (785) 296-0025 American LegalNet, Inc. www.FormsWorkFlow.com Kansas Department of Labor Page 2 of 2 Information for Injured Employees K-WC 27 (Rev. 6-12) RESPONSIBILITIES OF THE EMPLOYER 1. Employers must report all employee injuries to the Division of Workers Compensation within 28 days from the date of injury, or the date the employer learned about the injury, when the employee is wholly or partially incapacitated for more than the remainder of the day, turn or shift. 2. Employers must provide for the payment of workers compensation claims without any charge to employees. 3. Employers must post the Workers Compensation Notice prepared by the Director. 4. Employers must pay compensation benefits, regardless of insurance coverage. 5. Upon receiving notice of an injury, the employer must provide the employee written information to assist the injured worker in understanding his/her rights and responsibilities in obtaining compensation. EMPLOYERS MUST COMPLETE THE FOLLOWING INFORMATION FOR INJURED WORKERS YOUR CLAIM WILL BE HANDLED BY: Company _________________________________________________________________________ Address __________________________________________________________________________ __________________________________________________________________________ Contact Person ____________________________________________________________________ Phone (_________)_____________________________ Email ___________________________________________________________________________ DIVISION OF WORKERS COMPENSATION OMBUDSMAN / CLAIMS ADVISORY UNIT 401 SW Topeka Blvd., Ste. 2, Topeka, KS 66603-3105 · Phone (785) 296-4000, (800) 332-0353 · Fax (785) 296-0025 American LegalNet, Inc. www.FormsWorkFlow.com
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