Kentucky Workers' Compensation Posting Notice Mandatory

COMMONWEALTH OF KENTUCKY 	
WORKERS’ COMPENSATION NOTICE 
 	
Employees of this business are covered by the Kentucky Workers’ Compensation Act (KRS 
Chapter 342).  Conspicuous posting of this Notice is required by law. 
 
Employer Name: _______________________________________________________________________ 
Address: ______________________________________________________________________________ 
Workers Compensation Carrier 
(or third party administrator):  ___________________________________________________________ 
Policy #:________________________, effective _____________ to ______________________________ 
Address: ______________________________________________________________________________ 
Telephone: __________________, Contact Person ___________________________________________ 
 
EMPLOYEES:  IF INJURED – NOTIFY your supervisor IMMEDIATELY; when possible 
Notice should be in writing.  FAILURE to notify your supervisor could result in denial of 
benefits.  OBTAIN MEDICAL CARE.  Your employer must pay for ALL NECESSARY 
MEDICAL CARE to treat a workplace injury.  The employee may select the physician or 
medical facility to render care.  If the employer is enrolled in an approved Managed Care 
Plan employee selection of physicians is LIMITED to the Approved Provider Network, 
except in certain emergencies.  FOR INJURIES REQUIRING CONTINUING CARE the 
EMPLOYEE MUST DESIGNATE A TREATING PHYSICIAN, a form to do so will be 
furnished by your employer or its insurance carrier. 
 
This employer IS    IS NOT    participating in a Managed Care Plan for medical care.  The 
name of the Managed Care Plan is ________________________, its representative is  
______________________________, phone number _________________________________.    
 
DISABILITY BENEFITS to replace wages lost due to a workplace injury are payable 
under the Workers Compensation Act after seven (7) day of disability.  A CLAIM MUST 
BE filed with the Department of Workers’ Claim WITHIN TWO YEARS of the date of 
injury, or last payment of temporary total disability benefits.  
 
NEED ASSISTANCE?  Contact your employer’s claim representative.  If your questions 
about workers’ compensation rights are not promptly answered call THE KENTUCKY 
DEPARTMENT OF WORKERS CLAIMS at 1-800-554-8601 to speak to an Ombudsman 
or Workers’ Compensation Specialist.  
  
EMPLOYER SUPERVISORS – NOTIFY MANAGEMENT IMMEDIATELY OF ALL 
INJURIES SO THAT TIMELY REPORT CAN BE MADE AS REQUIRED BY LAW. 
 
04/09/09