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Kansas Form Center -

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Form

Description

kwc1101a.pdf Employers Report of Accident- For internal use only. Must be filed via EDI
kwc50.pdf Election of Employee Not to Accept Coverage
kwc50a.pdf Cancellation of Form 50
kwc51.pdf Employer to Cover Employees under Act
kwc51a.pdf Cancellation of Form 51
kwc113.pdf Individual, Partner, or Self-Employed to Come under Act
kwc114.pdf Cancellation of Form 113
kwc123.pdf Employer to Provide Coverage for Volunteer Workers
kwc124.pdf Cancellation of Form 123
kwc135.pdf Employer to Provide Coverage for Persons Performing Public or Community Service
kwc135a.pdf Cancellation of Form 135
kwc137.pdf Election of a Noncompensated Volunteer Officer, Director, or Trustee of a Nonprofit Corporation to be Covered
kwc137a.pdf Cancellation of Form 137
kwc44.pdf Report of Fraud or Abuse (Confidential)
kwcd.pdf Settlement Agreement Final Receipt And Release of Liability
kwce1.pdf Application for Hearing
kwce2.pdf Surviving Spouse or Dependent Application for Hearing
kwce3.pdf Application for Preliminary Hearing
kwce4.pdf Application for Post Award Medical
kwce5.pdf Application for Review and Modification
kwce6.pdf Application for Dismissal
kwc12.pdf Worksheet for Settlements: Injury Case
kwc13.pdf Worksheet for Settlements: Death Case
kwc112.pdf Annual Statement
kwc139.pdf Pre-Trial Stipulations
kwc160.pdf Statement Regarding Attorney Fees
kwc317.pdf Order for Production of Records
kwc321.pdf Joint Petition and Stipulation for Claim Settled
kwc322.pdf Award on Joint Petition and Stipulation for Claim Settled
kwc323.pdf Joint Petition and Stipulation for Reimbursement from WC Fund
kwc324.pdf Order on Joint Petition and Stipulation for Reimbursement from WC Fund
kwc325.pdf Award on Joint Petition and Stipulation for Structured Settlement or Annuity Contract
kwc326.pdf Requirements for Joint Petition and Stipulations
kwcr87-7.pdf Medical Management Closure Report
kwcr93-2.pdf Vendor Referral Report
kwcr93-2IAMC.pdf IAM CREST Vendor Referral Report
kwcr93-3.pdf Rehabilitation Vendor Progress Report
kwcr93-3A.pdf Vocational Assessment
kwcr93-3B.pdf Rehabilitation Plan
kwcr93-3C.pdf Plan Amendment
kwcr93-5.pdf Vocational Rehabilitation Closure Report
kwcr93-10.pdf Vocational Rehabilitation Vendor Application
kwcr93-11.pdf Qualified Rehabilitation Professional Application
kwcr99-8.pdf Vendor's Request for Additional Expenditures
kwc95.pdf K-WC 95 Records Download Requestor's Guide
kwc96.pdf Registration for Access to Electronic Records
kwc97.pdf Request for Workers Compensation Records
kwc970.pdf Request for Workers Compensation Records (Spanish)
kwc98.pdf Workers Request for Workers Compensation Records
kwc980.pdf Workers Request for Workers Compensation Records (Spanish)
kwc308.pdf Affidavit Attesting to the Use of Public Records
kwc20.pdf Bank Fact Sheet
kwc105.pdf Employers Application Oath to become a Self-Insurer
kwc120.pdf Application for Self-Insurance
kwc129.pdf Certificate of Excess Insurance
kwc130.pdf Irrevocable Letter of Credit
kwc130a.pdf Trust Operational Agreement
kwc131.pdf Self-Insurance Aggregate Surety Bond
kwc131a.pdf Amendatory Rider to Surety Bond
kwc132.pdf Indemnity and Guaranty Agreement
kwc133.pdf Statement of Insured
kwc144.pdf Self-Insurance Information
kwc1441.pdf Information for Self-Insured Employers on the Kansas Workers Compensation Act and Regulations
kwc309.pdf Why Audited Financial Statements are Required
kwc28.pdf Information for Self-Represented Litigants
kwc280.pdf Information for Self-Represented Litigants (Spanish)
kwc121.pdf Assessment Information
kwc138.pdf Workers Compensation Election Information
kwc126.pdf Independent Contractor or Employee?
kwcr93-6.pdf Rehabilitation Reporting Guidelines
kwcr93-12.pdf How to Become a Qualified Rehabilitation Professional
kwcr93-13.pdf Important Reminders for Vendors and Qualified Rehabilitation Professionals
kwcr93-20.pdf Law and Regulations for Vocational Rehabilitation
kwc25.pdf BROCHURE - Workers Compensation Information for Kansas Employers and Employees
kwc250.pdf BROCHURE - Workers Compensation Information for Kansas Employers and Employees (Spanish)
kwc27a.pdf NOTICE - Important Information for Injured Employees (Employers are required to provide this form to injured worker) Applies only to injuries on or after April 25, 2013
kwc270a.pdf NOTICE - Important Information for Injured Employees (Employers are required to provide this form to injured worker) Applies only to injuries on or after April 25, 2013 (Spanish)
kwc530.pdf Important Information for Employers Regarding Forms K-WC 27 and K-WC 270
kwc40a.pdf POSTER - Posting Notice Applies only to injuries on or after April 25, 2013