|BASIC PRINCIPLES OF WORKERS
COMPENSATION IN KENTUCKY
To bring a successful workers compensation claim,
each worker must prove:
1. You sustained an injury at work; and
2. You timely notified your employer of the work-
To prevent questions of whether you hurt yourself
outside of work, the best practice is to immediately
report any injury in writing and to go to the doctor as
soon as possible. When giving a history of the injury
to the doctor, be sure to tell them that the injury
happened at work.
TIME LIMITS/ STATUTE OF LIMITATIONS
The law requires an injured worker to file a workers
compensation claim within two years from the date of
the injury or within two years of the last TTD
payment, whichever was later. If you have sustained
a cumulative trauma or repetitive motion injury you
need to consult an attorney to determine when you
need to file your claim.
TTD - TEMPORARILY TOTALLY DISABLED
Temporarily Totally Disabled means your condition is
such that you are unable to perform any type of work.
If the insurance carrier has accepted your claim, you
are entitled to draw 2/3 of your normal paycheck if:
1. Your doctor takes you off work; and
2. You have not reached MMI (Maximum Medical
You need to get off work slips from your doctor. If
possible, you need to ask the doctor to write "Off
work because of work-related injury". It is also
helpful if the doctor can specify the date of injury or
the body part affected.
If the insurance carrier has not accepted your claim,
you still need to get off-work slips from your doctor.
If the Judge hearing your claim rules in your favor,
you will be entitled to back payments plus interest for
the time you were held off work.
MMI - MAXIMUM MEDICAL IMPROVEMENT
When one reaches Maximum Medical Improvement,
the doctor is indicating that the injured person has
recovered as much as they will. The injury has
stopped healing itself and the condition is static
enough to assign a permanent impairment rating.
PERMANENT IMPAIRMENT RATING
To obtain compensation for a permanent injury, the
law requires the injured party to prove their injury
merits an “impairment rating” as per the American
Medical Association Guides to the Evaluation of
Permanent Impairment (5th Edition). Some treating
doctors will give a rating for free. If you have to go
see a specialist, a rating may cost anywhere from $550
WHAT IS MY CASE WORTH?
If you are able to prove the elements of a workers
compensation claim, you may be entitled to
compensation for your injuries as well as past and
future medical expenses. The value of your claim is
based upon your impairment rating, your permanent
restrictions, and the wage you made per week at the
time of your injury.
If you can prove that your injury has rendered you
totally unable to work, the Judge may award benefits
for total disability. Total disability benefits are paid
weekly until the age you qualify for normal social
security retirement benefits.
If you cannot prove total disability, the Judge has the
option of finding you partially disabled based upon
your impairment rating. If you can prove you are
physically unable to return to your previous type of
work and you have not returned to other work
making better pay than you earned at the time of your
injury, your impairment rating will be multiplied by
Vocational retraining is also a possibility, but it
requires a showing that you are physically unable to
perform your previous work duties and that your
limited training prevents you from earning similar
wages at any other job.
The maximum medical coverage that a Judge can
award is lifetime treatment which is reasonable and
necessary for the cure and/or relief of the work injury.
A workers' compensation settlement can be paid in a
lump sum. An award from a Judge will be paid out
HEARING WORKERS COMPENSATION CLAIMS
Once a formal claim is filed with the Department of
Worker’s Claims in Frankfort, the case will be
assigned to an Administrative Law Judge. Each party
is given time to submit evidence and take
depositions. Before the case is taken under
submission by the Judge, a settlement conference will
be held. If the case settles, the parties can agree that
compensation will be paid in a lump sum. If the
parties cannot settle, the Judge will render an opinion,
but any award will be granted in weekly payments
instead of a lump sum. Most awards pay over 425
weeks, but some cases allow for longer periods of
payments such as an award of total disability. Each
award usually includes the right to future medical
All bills for medical treatment and prescriptions
related to a work-related injury must be turned in to
the workers compensation carrier. The best way to
submit bills is to ask the front desk at your medical
provider to do it for you. Even if the carrier is
denying payment, all bills must be submitted.
Form 113 - You may be asked to designate a primary
physician using a Form 113. This will be your
gatekeeper doctor. If the carrier is accepting your
claim, they will pay for all work-related treatment
rendered by this physician and any doctor he refers
you to. You can change your designated physician
once without permission from the carrier.
If you seek medical treatment outside the chain of the
Form 113, the carrier may not have to pay those bills.
Form 114 - If the carrier has accepted your claim, all
expenses incurred for access to compensable medical
treatment for a work-injury, including mileage shall be
submitted to the carrier within 60 days on a Form 114.
If the carrier has not accepted your claim, you should
still keep track and submit your mileage because if
you win your claim, you may be entitled to
Medical Fee Disputes
Before an award is rendered in a workers
compensation case, if your doctor is recommending a
treatment or procedure and the carrier is denying
preauthorization, this may be resolved by filing a
medical fee dispute. The first step is to have your
doctor write out a statement describing the procedure
he wants to do and why he thinks it is reasonable and
necessary to treat your work-injury. That statement
has to be turned in to the insurance carrier with a
request for preauthorization. If the carrier still denies
treatment, we can file the medical fee dispute and let
a Judge decide if the proposed treatment is
After an award is rendered, if the carrier is required to
pay all future medical expenses related to the work
injury, they must file a medical fee dispute if they are
denying treatment as unreasonable or they risk
sanctions for acting in bad faith.
For the answers to more specific questions – do not
hesitate to contact me!
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