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KS K-WC 1101-A 2012-2025 free printable template

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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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Obtain a KS K-WC 1101-A form from the relevant agency or website.
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Fill in your personal information, including your name, address, and contact details.
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Provide details regarding the specific claim or service you are requesting.
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Who needs KS K-WC 1101-A?

01
Individuals filing a claim for workers' compensation in Kansas.
02
Employers who need to report a workers' compensation claim.
03
Legal representatives or advocates assisting clients with workers' compensation claims.
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44-557, when an accident occurs, you must make a report with the Division of Workers Compensation within 28 days, after the receipt of such knowledge, if the personal injuries which are sustained by such accidents, are sufficient wholly or partially to incapacitate the person injured from labor or service for more than
Employer Failure to Secure Workers Compensation Insurance: In general, an employer with a payroll exceeding $20,000 must secure workers compensation coverage for its employees. The civil penalty for violating this provision is twice the annual premium or $25,000 , whichever is greater.
Employees need to report their injury to their supervisor or employer within 20 days of the injury. In the case of repetitive stress injuries, the employee needs to report it within 20 days of getting medical treatment. This same rule applies for any injury that occurs over a long period of time.
It is an insurance policy that is provided by the employer (by law) to pay employee benefits for job-related injuries, disability or death. The present law covers all Kansas employers except for those in certain agricultural pursuits or those with a gross annual payroll of $20,000 or less.
The weekly benefits are based on 66.67% of your average weekly wage up to a maximum of 75 percent of the state's average weekly wage.
It is an insurance policy that is provided by the employer (by law) to pay employee benefits for job-related injuries, disability or death. The present law covers all Kansas employers except for those in certain agricultural pursuits or those with a gross annual payroll of $20,000 or less.
Under Kansas statute 44-534, a workers' compensation claim must be filed within three years of the injury or two years from the date of last payment, whichever is later. This means that you have the right to file for workers' compensation long after the date of an original injury.

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KS K-WC 1101-A is a form used in Kansas for reporting workers' compensation claims, specifically for the documentation of injuries or conditions that are related to workplace incidents.
Employers in Kansas are required to file KS K-WC 1101-A when there is an injury that results in time lost from work or medical treatment for employees covered under the state's workers' compensation laws.
To fill out KS K-WC 1101-A, employers need to provide details such as the employee's information, the nature and cause of the injury, treatment provided, and any time lost from work. All pertinent sections of the form must be completed accurately.
The purpose of KS K-WC 1101-A is to provide a standardized method for employers to report workplace injuries and ensure that proper procedures are followed in compliance with Kansas workers' compensation regulations.
The information that must be reported on KS K-WC 1101-A includes the employee's name and address, date of injury, description of the injury, the circumstances under which it occurred, and any medical treatment received along with lost workdays.
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