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KANSAS DEPARTMENT OF LABOR www. dol.ks. gov ACCIDENT REPORT K-WC 1101-A Rev. 1-12 SEE INSTRUCTIONS ON PAGE 2 There is a 250 penalty for repeated failure to file accident reports within 28 days of the date the employer is informed of the accident. Submission does not constitute admission of liability. Page 1 of 2 Mail or fax ORIGINAL report to Division of Workers Compensation 401 SW Topeka Blvd. Suite 2 Topeka KS 66603-3105 Fax 785 296-4216 Direct questions or comments to Toll-free 800...
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You're hurt at work doesn't your employer owe you at least a reasonable roadmap through the workers' compensation system Music Music this is the American Law Journal made possible in part by Beatty Sloan and Geneva decades of experience providing personal attention to personal injury Chartwell law offices representing companies in comp and other business matters the Law Offices of Anthony Del nur providing counsel for injured workers for more than 15 years and the legal intelligence the nation's oldest legal newspaper for lawyers nothing it seems sours the relationship between the boss and the employee more than a work injury but with a comp system designed to sidestep lawsuits and especially if insurance is already in place why the bad blood hello I'm Christopher Norton and welcome to the American Law Journal good to be back on the Comcast network good to be here at the Union League in Philadelphia Pennsylvania good to have my four guests with me today as we discuss workers compensation and that very delicate relationship between the employer and the employee especially if a work injury has taken place George Bailey joins us once again returning to the set with Bailey Alone and digenova for over 25 years now George has zealously represented those injured at work in personal injury matters and medical malpractice Andy Greenberg joins us this evening representing the corporations and third party entities and the carrier's when it comes to workers compensation Toni ruler 16 plus years and practice representing claimants in workers compensation and Social Security disability matters and the Honorable Joseph Taken who has graced our set in the past new setting judge was always good to have you here short trip for you from Tavern Pennsylvania relatives anything we want to remind you if you need more information once we leave the air today it's easy to go to our website law journal tvcom where American law journal tvcom every program that we produce here later goes up to the website as a webcast via the name of an attorney I want to find out more information in about two dozen different areas of law call us toll-free 888 78 law TV write to us at info at law journal com go to the website and get your law on demand a hundred years ago roughly they started this work compensation system designed to take some anger and the rancor out of the attention between the employer and the employees in a system designed to take the rancor out why is it sometimes that employers and employees once someone gets injured at the workplace go to their opposite corners and begin a fight even before a lawsuit is filed why is that I think for an employer standpoint sometimes the work injury isn't the beginning of the problem sometimes the work injury is the culmination of the problem you have an employee who has attendance issues you have an employee who is not performing the job well you have an employee who doesn't get along with a co-worker or a supervisor and sometimes the...
FAQ
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Who is required to file k wc 1101 a?
The K WC 1101 A is a form used for filing a claim for workers' compensation benefits in Kansas. It is typically filled out by an employee who has suffered a work-related injury or illness and wishes to seek compensation.
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How to fill out k wc 1101 a?
To properly fill out Form K-WC 1101-A, also known as the Employer's First Report of Injury or Illness, follow these steps: 1. Start by getting a copy of the form. The document can usually be downloaded from your state's workers' compensation website or obtained from your insurance provider or employer. 2. Provide the employer's information: a. Enter the employer's name, address, and phone number in the appropriate fields. b. If you have a policy or claim number, enter it in the designated space. c. Indicate the date the form is being completed. 3. Enter the employee's information: a. Fill in the employee's full name, address, and other personal details requested. b. Include the employee's Social Security number and date of birth. c. Specify the employee's occupation and hire date, if applicable. 4. Fill in the injury/illness details: a. Provide the date, time, and location of the incident leading to the injury or illness. b. Insert a brief description of how the injury or illness occurred. c. Indicate whether the injury resulted in medical treatment or death. d. If medical treatment was sought, state the name and address of the attending physician. 5. Complete the wage information section: a. Specify the employee's regular and overtime hourly rate, as well as the number of hours typically worked per day and per week. b. Enter the employee's date of hire, the date of the last paid day prior to the injury/illness, and the date of the next anticipated payroll disbursement. c. Insert any additional earnings that should be considered, such as housing or meal allowances. 6. Fill out the employer's section: a. Sign and date the form, indicating your role/title within the company. b. Provide your email address and phone number for contact purposes. 7. If there were witnesses to the incident, their names and contact details can be included in the designated spaces. 8. After completing the form, make two copies. Keep one for your records and submit the other to your insurance provider or the appropriate workers' compensation agency in your state.
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What information must be reported on k wc 1101 a?
The form WC 1101-A is used by employers to report the injury or illness of an employee to their workers' compensation insurance carrier. The information that must be reported on this form includes: 1. Employer's name and address: The name and address of the employer reporting the injury or illness. 2. Employee's name and address: The name and address of the employee who sustained the injury or illness. 3. Accident details: A description of the accident or incident that caused the injury or illness, including the date, time, and location. 4. Injury details: The nature of the injury or illness suffered by the employee, including the affected body part(s), the extent of the injury, and any treatment received. 5. Medical provider information: The name and contact information of the medical provider who initially treated the employee. 6. Previous injuries or illnesses: Any previous injuries or illnesses suffered by the employee that may be relevant to the current claim. 7. Witnesses: If there were any witnesses to the accident or incident, their names and contact information should be provided. 8. Employer's knowledge of the claim: Indication of whether the employer had prior knowledge of the injury or illness before the employee reported it. 9. Compensation payments: Information regarding any compensation paid to the injured employee before the reporting of the claim. 10. Employer's statement: The employer's statement regarding the circumstances surrounding the injury or illness. It's important to note that the specific requirements may vary depending on the state and jurisdiction in which the employer operates.
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What is the penalty for the late filing of k wc 1101 a?
The penalty for late filing of a K-WC 1101-A form would depend on the specific rules and regulations of the organization or institution requesting the form. It is best to consult the relevant authority or the instructions provided with the form to determine the exact penalty for late filing.
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KS K-WC 1101-A Form Versions
| Version | Form Popularity | Fillable & printable |
|---|---|---|
| KS K-WC 1101-A 2012 | 4.8 Satisfied (43 Votes) |
|
| KS K-WC 1101-A 2006 | 4.0 Satisfied (39 Votes) |
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