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We offer free access to the most common forms needed relating to Kentucky Workers' Compensation Insurance. We strive to keep these forms up to date and accurate.
As with all the information we provide about state workers' comp rules please verify the accuracy of this information with the Kentucky Department Of Insurance.
If you have questions about any of these forms feel free to contact one of our Work Comp Experts at 888-611-7467. If you are ready you can start a quote online today.
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KY Acord 130 Workers' Compensation Application
The standard application for insurance coverage in Kentucky. The Acord 130 application form is typically completed by the agent and sent to insurance companies for quotes and renewals.
Kentucky Guide to Workers' Compensation Insurance
An employers guide to workers' compensation in Kentucky. Guide produced by the KY Department of Workers' Claims.
Kentucky Workers' Compensation Posting Notice
Employers in Kentucky are required to post this notice of workers' comp coverage in their workplace.
KY Drug-Free Workplace Program Application
Employers may be eligible for a premium discount with their workers' comp carrier for having a drug-free workplace program. This is the application and affidavit for certification.
Kentucky First Report of Injury Form- IA-1
The First Report of Injury Form should be completed by employers and forwarded to your insurance company each time there is a claim..
Kentucky Subsequent Report of Injury Form- IA-2
The KY Subsequent Report of Injury Form should be completed by Employers and forwarded to your work comp carrier when an existing injury reoccurs..
Kentucky Workers' Comp Exemption Form- Individuals and Partners
Individual Building Contractors who would like to exclude themselves from workers' compensation coverage should complete this form and file it with the Kentucky Department of Workers' Claims.
Kentucky Work Comp Exemption Form- Corporations and Partnerships
Building Contractor Officers and Partnerships who would like to exclude themselves from workers' compensation coverage should complete this form and file it with the Kentucky Department of Workers' Claims.
KY Supervisor's Accident Investigation Report
A helpful supervisor report to document workers' compensation claims in Kentucky.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for Kentucky
Kentucky Department of Workers' Claims
657 Chamberlin AvenueFrankfort, Kentucky 40601502-564-5550 http://www.labor.ky.gov/workersclaims/
Kentucky Department Of Insurance
P.O. Box 517Frankfort, Kentucky 40602-0517502-564-3630 http://insurance.ky.gov/
Workers' compensation insurance is required by law for Kentucky employers.
Kentucky forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for Kentucky.
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