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New Regulations Introduced with Regard to Handling Kentucky Workers’ Compensation Claims

Workers Compensation ClaimsWorkers’ compensation insurance benefits are granted only after a comprehensive medical records review, and this benefit program is governed by various regulations. The types of workers’ compensation coverage required varies with each US state, which makes it very important for employers to check their policy and ensure that it is properly endorsed for the states where their business operates. States may bring in significant changes to the regulations governing their Workers’ Compensation Act, which is of importance and interest to employers, insurers, attorneys and the medical record retrieval companies serving these entities. An instance is the change introduced by the Kentucky Department of Workers’ Claims to the regulations governing KRS Chapter 342, Kentucky Workers’ Compensation Act.

As per Kentucky law, the regulations publicized by the Department of Workers’ Claims govern the routine handling of workers’ compensation claims. Though many changes such as implementation of an electronic filing system may not affect everyday handling of claims, some other changes need to be accounted for by workers’ compensation carriers and employers across Kentucky.

  • The most significant change is that made to the deadline requirement for filing a Notice of Claim Denial or Acceptance (Form 101) – the “Answer” in the workers’ compensation claim.
  • Under the old regulation,
    • The Department of Workers’ Claims used to issue a notice letter and a copy of the claimant’s Application for Resolution of Injury Claim (Form 111) – the “Complaint” in a workers’ compensation claim.
    • After a few weeks, the above mentioned Department would send out a Scheduling Order.
    • These 2 notices typically created confusion regarding when an employer/insurance carrier would have to respond to a worker’s claim.
  • The new regulations have made the responsive pleading requirement very specific.
    • Once the Department of Workers’ Claims receives a plaintiff’s Application for Resolution of Injury Claim, they will issue a Notice of Filing of Application.
    • The employer/insurance company must respond to the Notice of Filing of Application within 45 days – that is, the date upon which the notice was issued by the Department of Workers’ Claims, not the date upon which the notice is received.
    • Under the new regulation, the Notice of Filing of Application will be the only form of notice issued by the Department of Workers’ Claims.

What if you fail to respond to a Notice of Filing of Application? It will result in default judgment. The Board of Workers’ Compensation and the Administrative Law Judges in Kentucky do not usually set aside default judgment entered against employers who fail to file a Notice of Claim Denial or Acceptance promptly. This means that employers and insurers in Kentucky have to be alert with regard to new claims. Workers’ Compensation attorneys will be able to provide them with appropriate counsel in this regard.

Two other significant changes introduced are:

  • Only licensed outside counsel can sign and tender settlement agreements.
  • Claims adjusters with settlement authority must be available by phone during a Benefit Review Conference. Failure to conform to this requirement may lead to sanctions.

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Headquartered in Tulsa, Oklahoma, Managed Outsource Solutions (MOS) provides quality medical record review services to physicians, attorneys, medical legal consultants, insurance companies, private corporations, case or chart review firms, and other organizations.