Kentucky's Application for Resolution of a Claim, Injury opens a workers' compensation case with the Department of Workers' Claims after a workplace injury. The plaintiff and defendant employer's information, the injury's date and location, how it happened, the body part injured, and the medical treatment received are all recorded, along with the treating physician's name and address. The form asks whether the plaintiff has previously filed for or received workers' compensation benefits in Kentucky, whether there was concurrent employment at the time of injury, and the plaintiff's current employer and job. A plaintiff alleging a safety violation under KRS 342.165 must also submit Form SVC, and the three-page application closes with a fraud warning and the submitter's signature.
| Question | Answer |
|---|---|
| Form Name | Kentucky Form 101 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 9 min |
| Other names | ky unemployment claim filing online, kyunemploment, ky unemployment, how to file unemployment kentucky |
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