803 KAR 25:010. Procedure for adjustments
of claims.
RELATES TO: KRS 342.0011, 342.125,
342.260, 342.265, 342.270, 342.300, 342.310, 342.315, 342.710, 342.715,
342.732, 342.760
STATUTORY AUTHORITY: KRS 342.033,
342.260(1), 342.270(3), 342.285(1)
NECESSITY, FUNCTION, AND CONFORMITY: KRS
342.260(1) requires the executive director to promulgate administrative regulations
necessary to implement the provisions of KRS Chapter 342. KRS 342.270(3)
requires the executive director to promulgate an administrative regulation
establishing procedures for the resolution of claims. KRS 342.033 requires the
executive director to prescribe the format and content of written medical
reports. KRS 342.285(1) requires the executive director to promulgate an administrative
regulation governing appeals to the Workers' Compensation Board. This
administrative regulation establishes the procedure for the resolution of
claims before an administrative law judge or Workers' Compensation Board.
Section 1. Definitions. (1)
"Administrative law judge" means an individual appointed pursuant to
KRS 342.230(3).
(2) "Board" is defined by KRS
342.0011(10).
(3) "Civil rule" means the
Kentucky Rules of Civil Procedure.
(4) "Date of filing" means the
date that:
(a) A pleading, motion, or other document
is received by the Executive Director at the Office of Workers' Claims in
Frankfort, Kentucky, except:
1. Final orders and opinions of
administrative law judges, which shall be deemed "filed" three (3)
days after the date set forth on the final order or opinion; and
2. Documents delivered to the offices of
the Office of Workers' Claims after the office is closed at 4:30 p.m. or on the
weekend, which shall be deemed filed the following business day; or
(b) A document is transmitted by United States
registered (not certified) or express mail, or by other recognized mail
carriers, and the date the transmitting agency receives the document from the
sender as noted by the transmitting agency on the outside of the container used
for transmitting, within the time allowed for filing.
(5) "Employer" means
individuals, partnerships, voluntary associations and corporations.
(6) "Employer who has not secured
payment of compensation" means any employer who employs an employee as
defined by KRS 342.640 but has not complied with KRS 342.340.
(7) "Executive director" is
defined by KRS 342.00111(9).
(8) "Latest available edition"
means that edition of the "Guides to the Evaluation of Permanent
Impairment" which the executive director has certified as being generally
available to the office, attorneys, and medical practitioners, by posting prominently
at the office's hearing sites the date upon which a particular edition of the
"Guides to the Evaluation of Permanent Impairment" is applicable for
purposes of KRS Chapter 342.
(9) "Special defenses" means
defenses that shall be raised by "special answer" filed in accordance
with Section 5(2)(d) of this administrative regulation.
Section 2. Parties. (1) The party making
the original application for resolution of claim pursuant to KRS 342.270 or
342.316 shall be designated as "plaintiff". Adverse parties shall be
designated as "defendants".
(2) All persons shall be joined as
plaintiffs in whom any right to any relief pursuant to KRS Chapter 342, arising
out of the same transaction and occurrence, is alleged to exist. If a person refuses
to join as a plaintiff, that person shall be joined as a defendant, and the
fact of refusal to join as a plaintiff shall be pleaded.
(3)(a) All persons shall be joined as
defendants against whom the ultimate right to relief pursuant to KRS Chapter
342 may exist, whether jointly, severally, or in the alternative. An
administrative law judge shall order, upon a proper showing, that a party be
joined or dismissed.
(b) The Special Fund may be joined as a
defendant in accordance with the appropriate statutory provisions for claims in
which the injury date or date of last exposure occurred before December 12,
1996.
(c) Joinder shall be sought by motion as
soon as practicable after legal grounds for joinder are known. Notice of
joinder and a copy of the claim file shall be served in the manner ordered by
the administrative law judge.
Section 3. Pleadings. (1) An application
for resolution of claim and all other pleadings shall be typewritten and
submitted in accordance with this administrative regulation.
(a) For an injury claim, an applicant
shall submit a completed Form 101, Application for Resolution of Injury Claim.
(b) For an occupational disease claim
other than coal workers' pneumoconiosis, an applicant shall submit a completed
Form 102-0D, Application for Resolution of Occupational Disease Claim.
(c) For a hearing loss claim, an
applicant shall submit a completed Form 103, Application for Resolution of
Hearing Loss Claim.
(2) An application for resolution of
claim shall be filed with sufficient copies for service on all parties. The
executive director shall make service by first class mail. Incomplete
applications may be rejected and returned to the applicant. If the application
is refiled in proper form within twenty (20) days of the date it was returned,
the filing shall relate back to the date the application was first received by
the executive director. Otherwise, the date of second receipt shall be the
filing date.
(3) All pleadings shall be served upon
the executive director and shall be served upon all other parties by mailing a
copy to the other parties or, if represented, to that representative, at the
party's or representative's last known address. A certificate of service
indicating the method and date of service and signed by the party shall appear
on the face of the pleading. Notices of deposition and physical examination
shall be served upon the parties and shall not be filed with the executive
director.
(4) After the application for resolution
has been assigned to an administrative law judge, subsequent pleadings shall
include, within the style of the claim and immediately before the claim number,
"Before Administrative Law Judge (name)". Upon consolidation of claims,
the most recent claim number shall be listed first.
(5)(a) All documents involved in an
appeal to the Workers' Compensation Board shall include the language
"Before Workers' Compensation Board" before the claim number within
the style of the claim.
(b) Parties shall insert the language
"Appeals Branch" or "Workers’ Compensation Board" on the
outside of the envelope containing documents involved in an appeal.
Section 4. Motions. (1) The party filing
a motion shall tender a proposed order granting the relief requested.
(2) The party filing a motion may file a
brief memorandum supporting the motion and opposing parties may file brief memoranda
in reply. Further memoranda (for example, reply to response) shall not be
filed.
(3) Every motion and response, the
grounds of which depend upon the existence of facts not in evidence, shall be
supported by affidavits demonstrating the facts.
(4) Every motion, the grounds of which
depend upon the existence of facts which the moving party believes are shown in
the evidence or are admitted by the pleadings, shall make reference to the
place in the record where that evidence or admission is found.
(5) A motion, other than to reopen
pursuant to KRS 342.125 or for interlocutory relief, shall be considered ten
(10) days after the date of filing. A response shall be considered if filed on
or before the tenth day after the filing of the motion.
(6)(a) A motion to reopen shall be
accompanied by as many of the following items as may be applicable:
1. A current medical release Form 106
executed by the plaintiff;
2. An affidavit evidencing the grounds to
support reopening;
3. A current medical report showing a
change in disability established by objective medical findings;
4. A copy of the opinion and award,
settlement, voluntary agreed order or agreed resolution sought to be reopened;
5. An affidavit certifying that a
previous motion to reopen has not been made by the moving party, or if one (1)
has previously been made, the date on which the previous motion was filed;
6. A designation of evidence from the
original record specifically identifying the relevant items of proof which are
to be considered as part of the record during reopening; or
7. A certification of service that the
motion was served on all parties as well as counsel for the parties.
(b)1. A designation of evidence made by a
party shall list only those items of evidence from the original record that are
relevant to the matters raised on reopening.
2. The burden of completeness of the
record shall rest with the parties to include so much of the original record,
up to and including the award or order on reopening, as is necessary to permit
the administrative law judge to compare the relevant evidence that existed in
the original record with all subsequent evidence submitted by the parties.
3. Except for good cause shown at the
time of the filing of the designation of evidence, a party shall not designate
the entire original record from the claim for which reopening is being sought.
(c)1. A motion to reopen shall not be
considered until twenty-five (25) days after the date of filing.
2. Any response shall be filed within
twenty (20) days of filing the motion to reopen.
3. A response may contain a designation
of evidence specifically identifying evidence from the original record not
already listed by the moving party that is relevant to matters raised in a
response.
(d) Any party may use the following forms
provided by the office for motions to reopen:
1. Form MTR-1, Motion to Reopen by
Employee;
2. Form MTR-3, Motion to Reopen by
Defendant; and
3. Form MTR-2, Motion to Reopen KRS
342.732 Benefits.
(7) A motion for allowance of a
plaintiff's attorney fee shall:
(a) Be made within thirty (30) days
following the finality of the award, settlement or agreed resolution upon which
the fee request is based;
(b) Be served upon the adverse parties
and the attorney's client;
(c) Set forth the fee requested and
mathematical computations establishing that the request is within the limits
set forth in KRS 342.320; and
(d) Be accompanied by:
1. An affidavit of counsel detailing the
extent of the services rendered and the time expended;
2. A signed and dated Form 109 as
required by KRS 342.320(5); and
3. A copy of the signed and dated
contingency fee contract.
(8) A motion for allowance of defendant's
attorney's fee shall be:
(a) Filed within thirty (30) days
following the finality of the decision; and
(b) Accompanied by an affidavit of
counsel detailing:
1. The extent of the services rendered
and the time expended;
2. The hourly rate and total amount to be
charged; and
3. The date upon which agreement was
reached for providing the legal services.
(9) The following motions relating to
vocational rehabilitation training provided by the office may be used by all
parties:
(a) Form VRT, Petition for Vocational
Rehabilitation Training; and
(b) Form WVR, Joint Motion and Agreement
to Waive Vocational Rehabilitation Evaluation.
(10) If a plaintiff is deceased, a Motion
to Substitute Party and Continue Benefits shall be filed on Form 11.
Section 5. Application for Resolution of
an Injury Claim and Response. (1) To apply for resolution of an injury claim,
the applicant shall file Form 101 with the following completed documents:
(a) Work history (Form 104), to include
all past jobs performed on a full or part-time basis within twenty (20) years
preceding the date of injury;
(b) Medical history (Form 105), to
include all physicians, chiropractors, osteopaths, psychiatrists,
psychologists, and medical facilities such as hospitals where the individual
has been seen or admitted in the preceding fifteen (15) years and including
beyond that date any physicians or hospitals regarding treatment for the same
body part claimed to have been injured;
(c) Medical release (Form 106);
(d) One (1) medical report, which may
consist of legible, hand-written notes of the treating physician, and which
shall include the following:
1. A description of the injury which is
the basis of the claim;
2. A medical opinion establishing a causal
relationship between the work-related events or the medical condition which is
the subject of the claim; and
3. If a psychological condition is
alleged, an additional medical report establishing the presence of a mental
impairment or disorder;
(e) Documentation substantiating the
plaintiff's preinjury and postinjury wages; and
(f) Documentation establishing additional
periods for which temporary total disability benefits are sought.
(2)(a) The defendant shall file a Notice
of Claim Denial or Acceptance on a Form 111 - Injury and Hearing Loss within
forty-five (45) days after the notice of the scheduling order or within
forty-five (45) days following an order sustaining a motion to reopen a claim.
(b) If a Form 111 is not filed, all
allegations of the application shall be deemed admitted.
(c) The Form 111 shall set forth the
following:
1. All pertinent matters which are
admitted and those which are denied;
2. If a claim is denied in whole or in
part, a detailed summary of the basis for denial;
3. The name of each witness whose
testimony may be relevant to that denial; and
4. A description of the physical
requirements of the plaintiff's job at the time of the alleged injury and the
name, address and telephone number of the individual responsible for gathering
this information for the employer and its insurer.
(d) In addition to the Form 111, a
defendant shall file a special answer to raise any special defenses in
accordance with this paragraph.
1. A defendant may incorporate special
defenses that have been timely raised in the Form 111.
2. A "special answer" shall be
filed within:
a. Forty-five (45) days of the scheduling
order; or
b. Ten (10) days after discovery of facts
supporting the defense if discovery could not have been had earlier in the
exercise of due diligence.
3. A special defense shall be waived if
not timely raised.
4. A special defense shall be pleaded if
the defense arises under:
a. KRS 342.035(3), unreasonable failure
to follow medical advice;
b. KRS 342.165, failure to comply with
safety laws;
c. KRS 342.316(7) or 342.335, false
statement on employment application;
d. KRS 342.395, voluntary rejection of
KRS Chapter 342;
e. KRS 342.610(3), voluntary intoxication
or self-infliction of injury;
f. KRS 342.710(5), refusal to accept
rehabilitation services; or
g. Running of periods of limitations or
repose under KRS 342.185, 342.270, 342.316, or other applicable statute.
Section 6. Application for Resolution of
an Occupational Disease Claim and Response. (1) To apply for resolution of an
occupational disease claim, the applicant shall file Form 102-0D with the following
completed attachments:
(a) Work history (Form 104), to include
all past jobs performed on a full or part-time basis within twenty (20) years
preceding the date of last exposure and all jobs in which plaintiff alleges exposure
to the hazards of the occupational disease;
(b) Medical history (Form 105), to
include all physicians, chiropractors, osteopaths, psychiatrists,
psychologists, and medical facilities such as hospitals where the individual
has been seen or admitted in the preceding fifteen (15) years and including
beyond that date any physicians or hospitals regarding treatment for the same
body part claimed to have been injured;
(c) Medical release (Form 106);
(d) One (1) medical report supporting the
existence of occupational disease; and
(e) Social Security Release Form (Form
115).
(2)(a) The defendant shall file a Notice
of Claim Denial or Acceptance on a Form 111-OD:
1. Within forty-five (45) days after the
notice of the scheduling order; and
2. In accordance with Section 5(2)(b),
(c), and (d) of this administrative regulation.
(b) In addition to the Form 111-OD, a
defendant shall file a special answer to raise any special defenses in
accordance with Section 5(2)(d) of this administrative regulation.
(3) For all occupational disease and
hearing loss claims, the executive director shall promptly schedule an
examination pursuant to KRS 342.315 and 342.316.
Section 7. Application for Resolution of
a Hearing Loss Claim and Response. (1) To apply for resolution of a hearing
loss claim, the applicant shall file Form 103 with the following completed
documents:
(a) Work history (Form 104), to include
all past jobs performed on a full or part-time basis within twenty (20) years
preceding the last date of noise exposure;
(b) Medical history (Form 105), to
include all physicians, chiropractors, osteopaths, psychiatrists,
psychologists, and medical facilities such as hospitals where the individual
has been seen or admitted in the preceding fifteen (15) years and including
beyond that date any physicians or hospitals regarding treatment for hearing
loss or ear complaints;
(c) Medical release (Form 106);
(d) One (1) medical report describing the
hearing loss which is the basis of the claim and, if a psychological condition
is alleged, an additional medical report establishing the presence of a mental
impairment or disorder. Medical reports required under this paragraph may
consist of legible, hand-written notes of a treating physician; and
(e) Social Security Release Form (Form
115).
(2)(a) The defendant shall file a Notice
of Claim Denial or Acceptance on a Form 111 - Injury and Hearing Loss:
1. Within forty-five (45) days after the
notice of the scheduling order; and
2. In accordance with Section 5(2)(b),
(c), and (d) of this administrative regulation.
(b) In addition to the Form 111 - Injury
and Hearing Loss, a defendant shall file a special answer to raise any special
defenses in accordance with Section 5(2)(d) of this administrative regulation.
Section 8. Discovery, Evidence, and
Exchange of Records. (1) Proof taking and discovery for all parties shall begin
from the date of issuance by the executive director of the scheduling order.
(2)(a) Plaintiff and defendants shall
take proof for a period of sixty (60) days from the date of the scheduling
order;
(b) After the sixty (60) day period,
defendants shall take proof for an additional thirty (30) days; and
(c) After the defendant’s thirty (30) day
period, the plaintiff shall take rebuttal proof for an additional fifteen (15)
days.
(3) During the pendency of a claim, any
party obtaining or possessing a medical or vocational report or records shall
serve a copy of the report or records upon all other parties within ten (10)
days following receipt of those reports or records or within ten (10) days of
receipt of notice if assigned to an administrative law judge.
(4) All medical reports filed with Forms
101, 102-0D, or 103 shall be admitted into evidence without further order if:
(a) An objection is not filed prior to or
with the filing of the Form 111; and
(b) The medical reports comply with
Section 10 of this administrative regulation.
Section 9. Vocational Reports. (1) A
vocational report may be filed by notice and shall be admitted into evidence
without further order and without the necessity of a deposition, if an
objection is not filed.
(2) Vocational reports shall be signed by
the individual making the report.
(3) Vocational reports shall include,
within the body of the report or as an attachment, a statement of the
qualifications of the person making the report.
(4) An objection to the filing of a
vocational report shall:
(a) Be filed within ten (10) days of the
filing of the notice or motion for admission; and
(b) State the grounds for the objection
with particularity.
(5) The administrative law judge shall
rule on the objection within fifteen (15) days.
(6) If a vocational report is admitted as
direct testimony, an adverse party may depose the reporting vocational witness
in a timely manner as if on cross-examination at its own expense.
Section 10. Medical Reports. (1) A party
shall not introduce direct testimony from more than two (2) physicians by
medical report except upon a showing of good cause and prior approval by an
administrative law judge.
(2) Medical reports shall be submitted on
Form 107-I (injury), Form 107-P (psychological), Form 108-OD (occupational
disease), Form 108-CWP (coal workers' pneumoconiosis), or Form 108-HL (hearing
loss), as appropriate, except that an administrative law judge may permit the
introduction of other reports.
(3) Medical reports shall be signed by
the physician making the report, or be accompanied by an affidavit from the
physician or submitting party or representative verifying the authenticity of
the report.
(4) Medical reports shall include, within
the body of the report or as an attachment, a statement of qualifications of
the person making the report. If the qualifications of the physician who prepared
the written medical report have been filed with the executive director and the
physician has been assigned a medical qualifications index number, reference
may be made to the physicians index number in lieu of attaching qualifications.
(5) Narratives in medical reports shall
be typewritten. Other portions, including spirometric tracings, shall be
clearly legible.
(6)(a) Upon notice, a party may file the
testimony of two (2) physicians, either by deposition or medical report, which
shall be admitted into evidence without further order if an objection is not
filed.
(b) Objection to the filing of a medical
report shall be filed within ten (10) days of the filing of the notice or the
motion for admission.
(c) Grounds for the objection shall be stated
with particularity.
(d) The administrative law judge shall
rule on the objection within fifteen (15) days of filing.
(7) If a medical report is admitted as
direct testimony, an adverse party may depose the reporting physician in a
timely manner as if on cross-examination at its own expense.
Section 11. Medical Evaluations Pursuant
to KRS 342.315. (1) All persons claiming benefits for hearing loss or
occupational disease other than coal workers' pneumoconiosis shall be referred
by the commissioner for a medical evaluation in accordance with contracts
entered into between the executive director and the University of Kentucky
and University of Louisville medical schools.
(2) Upon all other claims except coal
workers' pneumoconiosis claims, the executive director or an administrative law
judge may direct appointment by the executive director of a university medical
evaluator.
(3) Upon referral for medical evaluation
under this section, a party may tender additional relevant medical information
to the university medical school to whom the evaluation is assigned. This
additional information shall not be filed of record. The additional medical
information shall be:
(a) Submitted to the university within
fourteen (14) days following an order for medical evaluation pursuant to KRS
342.315;
(b) Submitted by way of medical reports,
notes, or depositions;
(c) Clearly legible;
(d) Indexed;
(e) Furnished in chronological order;
(f) Timely furnished to all other parties
within ten (10) days following receipt of the medical information; and
(g) Accompanied by a summary that is
filed of record and served upon all parties. The summary shall:
1. Identify the medical provider;
2. Include the date of medical services;
and
3. Include the nature of medical services
provided.
(4) Upon the scheduling of an evaluation,
the executive director shall provide notice to all parties and the employer
shall forward to the plaintiff necessary travel expenses as required by KRS
342.315(4). Upon completion of the evaluation, the executive director shall
provide copies of the report to all parties and shall file the original report
in the claim record to be considered as evidence.
(5) The administrative law judge shall
allow timely cross-examination of a medical evaluator appointed by the
executive director at the expense of the moving party.
(6) Unjustified failure by the plaintiff
to attend the scheduled medical evaluation may be grounds for dismissal,
payment of a no-show fee, sanctions, or all of the above.
(7) Failure by the employer or its
insurance carrier to pay travel expenses within seven (7) days of notification
of a scheduled medical evaluation may be grounds for imposition of sanctions.
Section 12. Interlocutory Relief. (1)
During a claim, a party may seek interlocutory relief through:
(a) Interim payment of income benefits
for total disability pursuant to KRS 342.730(1)(a);
(b) Medical benefits pursuant to KRS
342.020; or
(c) Rehabilitation services pursuant to
KRS 342.710.
(2) Upon motion of any party, an informal
conference:
(a) Shall be held to review the
plaintiff's entitlement to interlocutory relief; and
(b) May be held telephonically.
(3) Any response to a request for
interlocutory relief shall be served within twenty (20) days from the date of
the request and thereafter, the request shall be ripe for a decision.
(4)(a) Entitlement to interlocutory
relief shall be shown by means of affidavit, deposition, or other evidence of
record demonstrating the requesting party:
1. Is eligible under KRS Chapter 342; and
2. Will suffer irreparable injury, loss
or damage pending a final decision on the application.
(b) Rehabilitation services may be
ordered while the claim is pending upon showing that immediate provision of
services will substantially increase the probability that the plaintiff will
return to work.
(5) If interlocutory relief is awarded in
the form of income benefits, the application shall be placed in abeyance unless
a party shows irreparable harm will result. The administrative law judge may require
periodic reports as to the physical condition of the plaintiff. Upon motion and
a showing of cause, or upon the administrative law judge's own motion,
interlocutory relief shall be terminated and the claim removed from abeyance.
(6) An attorney's fee in the amounts
authorized by KRS 342.320 that does not exceed twenty (20) percent of the
weekly income benefits awarded pursuant to a request for interlocutory relief
may be granted. The approved fee shall be deducted in equal amounts from the
weekly income benefits awarded and shall be paid directly to the attorney.
(7) A party seeking interlocutory relief
may use the following forms:
(a) Motion for Interlocutory Relief, Form
MIR-1;
(b) Affidavit for Payment of Medical
Expenses, Form MIR-2;
(c) Affidavit for Payment of Temporary
Total Disability, Form MIR-3; and
(d) Affidavit Regarding Rehabilitation
Services, Form MIR-4.
Section 13. Benefit Review Conferences.
(1) The purpose of the benefit review conference shall be to expedite the
processing of the claim and to avoid if possible the need for a hearing.
(2) The benefit review conference shall
be an informal proceeding.
(3) The date, time, and place for the
benefit review conference shall be stated on the scheduling order issued by the
executive director.
(4) The plaintiff and his or her
representative, the defendant or its representative, and the representatives of
all other parties shall attend the benefit review conference.
(5) If the defendant is insured or a
qualified self-insured, a representative of the carrier with settlement
authority shall be present or available by telephone during the benefit review
conference.
(6) The administrative law judge may upon
motion waive the plaintiff’s attendance at the benefit review conference for
good cause shown.
(7) A transcript of the benefit review
conference shall not be made.
(8) Representatives of all parties shall
have authority to resolve disputed issues and settle the claim at the benefit
review conference.
(9)(a) The defendant shall provide a
completed Form AWW-1, Average Weekly Wage Certification.
(b) The plaintiff shall bring copies of
unpaid medical bills and documentation of out-of-pocket expenses including
travel for medical treatments.
(c) Each defendant shall bring copies of
disputed medical bills and medical expenses.
(10) Ten (10) days before the benefit
review conference, the parties shall exchange final stipulations and lists of
known witnesses and exhibits that:
(a) Name each proposed witness;
(b) Summarize the anticipated testimony
of each witness;
(c) For medical witnesses, include in the
summary:
1. The diagnosis reached;
2. Clinical findings and results of
diagnostic studies upon which the diagnosis is based;
3. The functional impairment rating
assessed by the witness; and
4. A description of any work-related
restrictions imposed; and
(d) Identify any exhibits.
(11) At the benefit review conference,
the parties shall:
(a) Attempt to resolve controversies and
disputed issues;
(b) Narrow and define disputed issues; and
(c) Facilitate a prompt settlement.
(12) A party seeking postponement of a
benefit review conference shall file a motion at least fifteen (15) days prior
to the date of the conference and shall demonstrate good cause for the
postponement.
(13) If at the conclusion of the benefit
review conference the parties have not reached agreement on all the issues, the
administrative law judge shall:
(a) Prepare a summary stipulation of all
contested and uncontested issues which shall be signed by representatives of
the parties and by the administrative law judge; and
(b) Schedule a final hearing.
(14) Only contested issues shall be the
subject of further proceedings.
(15) Upon motion with good cause shown,
the administrative law judge may order that additional discovery or proof be
taken between the benefit review conference and the date of the hearing and may
limit the number of witnesses to be presented at the hearing.
Section 14. Evidence - Rules Applicable.
(1) The Rules of Evidence prescribed by the Kentucky Supreme Court shall apply
in all proceedings before an administrative law judge except as varied by
specific statute and this administrative regulation.
(2) Any party may file as evidence before
the administrative law judge pertinent material and relevant portions of
hospital, educational, Office of Vital Statistics, Armed Forces, Social Security,
and other public records. An opinion of a physician which is expressed in these
records shall not be considered by an administrative law judge in violation of
the limitation on the number of physician's opinions established in KRS
342.033.
Section 15. Extensions of Proof Time. (1)
An extension of time for producing evidence may be granted upon showing of
circumstances that prevent timely introduction.
(2) A motion for extension of time shall
be filed no later than five (5) days before the deadline sought to be extended.
(3) The motion or supporting affidavits
shall set forth:
(a) The efforts to produce the evidence
in a timely manner;
(b) Facts which prevented timely
production; and
(c) The date of availability of the
evidence, the probability of its production, and the materiality of the
evidence.
(4) In the absence of compelling
circumstances, only one (1) extension of thirty (30) days shall be granted to
each side for completion of discovery or proof by deposition.
(5) The granting of an extension of time
for completion of discovery or proof shall:
(a) Enlarge the time to all:
1. Plaintiffs if the extension is granted
to a plaintiff; and
2. Defendants if an extension is granted
to a defendant; and
(b) Extend the time of the adverse party
automatically except if the extension is for rebuttal proof.
Section 16. Stipulation of Facts. (1)
Refusal to stipulate facts which are not genuinely in issue shall warrant
imposition of sanctions as established in Section 24 of this administrative
regulation. An assertion that a party has not had sufficient opportunity to
ascertain relevant facts shall not be considered "good cause" in the
absence of due diligence.
(2) Upon cause shown, a party may be
relieved of a stipulation if the motion for relief is filed at least ten (10)
days prior to the date of the hearing, or as soon as practicable after
discovery that the stipulation was erroneous.
(3) Upon granting relief from a
stipulation, the administrative law judge may grant a continuance of the
hearing and additional proof time.
Section 17. Discovery and Depositions.
(1) Discovery and the taking of depositions shall be in accordance with the
provisions of Civil Rules 26 to 37, inclusive, except for Civil Rules 27, 33,
and 36 which shall not apply to practice before the administrative law judges
or the board.
(2) Depositions may be taken by telephone
if the reporter administering the oath to the witness and reporting the
deposition is physically present with the witness at the time the deposition is
given. Notice of a telephonic deposition shall relate the following
information:
(a) That the deposition is to be taken by
telephone;
(b) The address and telephone number from
which the call will be placed to the witness;
(c) The address and telephone number of
the place where the witness will answer the deposition call; and
(d) Opposing parties may participate in
the deposition either at the place where the deposition is being given, at the
place the telephone call is placed to the witness, or by conference call. If a
party elects to participate by conference call, that party shall contribute
proportionate costs of the conference call.
(3) The executive director shall
establish a medical qualifications index.
(a) An index number shall be assigned to
a physician upon the filing of the physician's qualifications.
(b) Any physician who has been assigned
an index number may offer the assigned number in lieu of stating
qualifications.
(c) Qualifications shall be revised or
updated by submitting revisions to the executive director.
(d) A party may inquire further into the
qualifications of a physician.
Section 18. Hearings. (1) At the hearing,
the parties shall present proof concerning contested issues. If the plaintiff
or plaintiff's counsel fails to appear, the administrative law judge may
dismiss the case for want of prosecution, or if good cause is shown, the
hearing may be continued.
(2) At the conclusion of the hearing, the
claim shall be taken under submission immediately or briefs may be ordered.
(3) Briefs shall not exceed fifteen (15)
pages in length. Reply briefs shall be limited to five (5) pages. Permission to
increase the length of a brief shall be sought by motion.
(4) The administrative law judge may
announce his decision at the conclusion of the hearing or shall defer decision
until rendering a written opinion.
(5) A decision shall be rendered no later
than sixty (60) days following the hearing.
(6) The time of filing a petition for
reconsideration or notice of appeal shall not begin to run until after the
"date of filing" of the written opinion.
(7) An opinion or other final order of an
administrative law judge shall not be deemed final until the administrative law
judge has certified that a certification of mailing was sent to:
(a) An attorney who has entered an
appearance for a party; or
(b) The party if an attorney has not
entered an appearance.
(8) The parties with approval of the
administrative law judge may waive a final hearing. Waiver of a final hearing
shall require agreement of all parties and the administrative law judge. The
claim shall be taken under submission as of the date of the order allowing the
waiver of hearing. A decision shall be rendered no later than sixty (60) days
following the date of the order allowing the waiver of hearing.
Section 19. Petitions for
Reconsideration. (1) If applicable, a party shall file a petition for
reconsideration within fourteen (14) days of the filing of a final order or
award of an administrative law judge, clearly stating the patent error which
the petitioner seeks to have corrected and setting forth the authorities upon
which petitioner relies. The party filing the petition for reconsideration
shall tender a proposed order granting the relief requested.
(2) A response shall be served within ten
(10) days after the date of filing of the petition.
(3) The administrative law judge shall
act upon the petition within ten (10) days after the response is due.
Section 20. Benefit Calculations for
Settlements. (1) For computing lump sum settlements, the employer shall utilize
the prescribed discount rate for its weeks of liability only, not for the
entire award period. A discount shall not be taken on past due benefits by the
employer or Special Fund. Lump sum settlements shall be calculated as follows:
(a) Determine the entire lump sum
liability:
1. Compute the remaining weeks of
liability in the award by subtracting the number of weeks past due from the
entire number of weeks in the award;
2. Discount the number of weeks remaining
in the award at the prescribed discount rate;
3. Multiply the weekly benefit rate by
the discounted number of weeks remaining (subparagraph 2 of this paragraph) in
the award. This product shall equal the entire future lump sum liability for
the award; and
4. Add the amount of past due benefits to
the future lump sum liability award (subparagraph 3 of this paragraph). The sum
shall represent the entire lump sum value of the award.
(b) Determine the employer's lump sum
liability as follows:
1. The employer's future liability shall
be computed by determining its total weeks of liability less the number of
weeks of liability past due.
2. The number of weeks remaining shall be
discounted at the prescribed discount rate and multiplied by the amount of the
weekly benefit.
3. Multiply the number of past due weeks
by the amount of the weekly benefit.
4. The employer's entire liability for a
lump sum payment shall be determined by adding the results of subparagraphs 2
and 3 of this paragraph.
(c) Determine the Special Fund's portion
of the lump sum liability by subtracting the value of the employer's liability
in lump sum (paragraph (b) of this subsection) from the entire value of the
lump sum settlement (paragraph (a) of this subsection). The remainder shall be
the Special Fund's lump sum liability.
(2) If the employer settles its liability
for income benefits with the employee for a lump sum payment and a
determination is made of the Special Fund's liability, the Special Fund's
portion of income benefits shall be paid commencing with the date of approval
of the employer's settlement and continuing for the balance of the compensable
period.
(3) In computing settlements involving
periodic payments, the employer shall pay its liability over the initial
portion of the award, based on the number of weeks its liability bears to the
entire liability for the claim. The Special Fund shall make all remaining
payments for the balance of the compensable period.
(4) Pursuant to KRS 342.265, election by
the Special Fund to settle on the same terms as the employer shall mean the
Special Fund agrees to settle in the same manner as the employer in either a discounted
lump sum or in periodic payments based upon its proportionate share of the
permanent disability percentage paid by the employer. "Same terms"
shall not include any additional payments the employer included for buy out of
medical expenses, temporary total disability, rehabilitation, or other benefits
for which the Special Fund is not liable.
(5) Parties involved in a lump-sum
settlement of future periodic payments shall use the discount factor computed
in accordance with KRS 342.265(3).
(6) Parties who reach an agreement pursuant
to KRS 342.265 shall file the agreement on the applicable form as listed below:
(a) Form 110-F, Agreement as to
Compensation and Order Approving Settlement- Fatality;
(b) Form 110-I, Agreement as to
Compensation and Order Approving Settlement- Injury;
(c) Form 110-O, Agreement as to
Compensation and Order Approving Settlement - Occupational Disease; or
(d) Form 110-CWP, Agreement as to
Compensation and Order Approving Settlement - Coal Workers' Pneumoconiosis.
Section 21. Review of Administrative Law
Judge Decisions. (1) General.
(a) Pursuant to KRS 342.285(1), decisions
of administrative law judges shall be subject to review by the Workers’ Compensation
Board in accordance with the procedures set out in this administrative regulation.
(b) Parties shall insert the language
"Appeals Branch" or "Workers’ Compensation Board" on the
outside of an envelope containing documents filed in an appeal to the board.
(2) Time and format of notice of appeal.
(a) Within thirty (30) days of the date a
final award, order, or decision rendered by an administrative law judge
pursuant to KRS 342.275(2) is filed, any party aggrieved by that award, order,
or decision may file a notice of appeal to the Workers’ Compensation Board.
(b) As used in this section, a final
award, order or decision shall be determined in accordance with Civil Rule
54.02(1) and (2).
(c) The notice of appeal shall:
1. Denote the appealing party as the
petitioner;
2. Denote all parties against whom the
appeal is taken as respondents;
3. Name the administrative law judge who
rendered the award, order, or decision appealed from as a respondent;
4. If appropriate pursuant to KRS 342.120
or 342.1242, name the director of the Division of Workers’ Compensation Funds
as a respondent; and
5. Include the claim number.
(d) Cross-appeal.
1. Any party may file a cross-appeal
through notice of cross-appeal filed within ten (10) days after the notice of
appeal is served.
2. A cross-appeal shall designate the
parties as stated in the notice of appeal.
(e) Failure to file the notice within the
time allowed shall require dismissal of the appeal.
(f) The executive director shall issue an
acknowledgement to all parties of the filing of a notice of appeal or
cross-appeal.
(3) Number of copies and format of
petitioner's brief.
(a) The petitioner's brief shall be filed
within thirty (30) days of the filing of the notice of appeal.
(b) An original and two (2) copies of the
petitioner's brief shall be filed with the Executive Director of the Office of
Workers’ Claims.
(c) The petitioner's brief shall conform
in all respects to Civil Rule 7.02(4).
(4) Petitioner's brief. The petitioner's
brief shall designate the parties as petitioner (or petitioners) and respondent
(or respondents) and shall be drafted in the following manner:
(a)1. The name of each petitioner and
each respondent shall be included in the brief.
2. The petitioner shall specifically
designate as respondents all adverse parties.
3. The administrative law judge who
rendered the award, order, or decision appealed from shall be named as a
respondent.
(b) The workers’ compensation claim
number, or numbers, shall be set forth in all pleadings before the Workers’
Compensation Board.
(c) The petitioner's brief shall state
the date of entry of the final award, order, or decision by the administrative
law judge.
(d) The petitioner's brief shall state
whether any matters remain in litigation between the parties in any forum or
court other than those for which an appeal is being sought.
(e) The petitioner's brief shall include
a "Need for Oral Argument" designating whether the party requests an
argument to be heard orally before the board and, if so, a brief statement
setting out the reason or reasons for the request.
(f) The petitioner's brief shall include
a "Statement of Benefits Pending Review" which shall set forth
whether the benefits designated to be paid by the award, order, or decision for
which review is being sought have been instituted pursuant to KRS 342.300.
(g) The organization and contents of the
petitioner's brief for review shall be as follows:
1. A brief "Introduction" shall
indicate the nature of the case.
2. A "Statement of Points and
Authorities" shall set forth, succinctly and in the order in which they
are discussed in the body of the argument, the petitioner’s contentions with
respect to each issue of law on which he relies for a reversal, listing under
each the authority cited on that point and the respective pages of the brief on
which the argument appears and on which the authorities are cited. This requirement
may be eliminated for briefs of five (5) or less pages.
3. A "Statement of the Case"
shall consist of a chronological summary of the facts and procedural events
necessary to an understanding of the issues presented by the appeal, with ample
reference to the specific pages of the record supporting each of the statements
narrated in the summary.
4. An "Argument" shall:
a. Conform with the statement of points
and authorities, with ample supportive references to the record and citations
of authority pertinent to each issue of law; and
b. Contain, at the beginning of the
argument, a statement with reference to the record showing whether the issue
was properly preserved for review and, if so, in what manner.
5. A "Conclusion" shall set
forth the specific relief sought from the board.
6. An "Appendix" shall contain:
a. Copies of the final award, order, or
decision of the administrative law judge from which review is being sought;
b. Any petitions for reconsideration filed
by the parties pursuant to KRS 342.281;
c. The administrative law judge’s order
addressing any petitions for reconsideration;
d. Copies of cases cited from federal
courts and foreign jurisdictions, if any, upon which reliance is made; and
e. Copies of prior board opinions in accordance
with subsection (9) of this section.
7. Civil Rule 76.28(4)(c) shall govern
the use of unpublished opinions of the Court of Appeals or Supreme Court.
(5) Respondent's brief, combined brief,
or cross-petitioner's brief.
(a) Each respondent shall file an
original and two (2) copies of a brief, combined brief if cross-petition or
cross-petitioner's brief, within thirty (30) days of the date on which the
petitioner's brief was filed with the Executive Director of the Office of
Workers’ Claims.
(b) The respondent's brief shall include
a "Need for Oral Argument" similar to the statement required of the
petitioner by subsection (4)(e) of this section.
(c) The respondent's brief shall include
a "Statement of Benefits Pending Review" similar to the statement
required of the petitioner by subsection (4)(f) of this section.
(d) Respondent’s counter-argument shall
follow the organization and content of the petitioner's brief as set forth in
subsection (4)(g) of this section.
(6) Reply brief.
(a) If applicable, the petitioner may
file a reply brief within ten (10) days after the date on which the
respondent's brief was served or due, whichever is earlier.
(b) The organization and contents of the
reply brief shall be as provided in Civil Rule 76.12(4)(e), except that an
index, or contents page shall not be required.
(c) If a cross-appeal has been filed, the
cross-petitioner's reply brief may be served within ten (10) days after the
date on which the last cross-respondent's brief was served or due, whichever is
earlier.
(7) Certification. The petitioner's
brief, respondent's brief, and reply brief shall be signed by each party or his
counsel and that signature shall constitute a certification that the statements
contained in the document are true and made in good faith.
(8) Service of notice of appeal,
cross-appeal, petitioner's brief, respondent's brief, and reply briefs on
adverse parties.
(a) Before filing a notice of appeal,
cross-appeal, or any brief with the Executive Director of the Office of
Workers’ Claims, a party shall serve, in the manner provided by Civil Rule
5.02, a copy of the document on each adverse party.
(b) Every brief filed in an appeal to the
Workers' Compensation Board shall bear, on the front cover, a signed statement,
in accordance with Civil Rule 5.03 by the attorney or party that service has
been made as required by paragraph (a) of this subsection. The statement shall
identify by name each person served.
(c) The name of each attorney submitting
a document to the Workers' Compensation Board with a current address and telephone
number shall appear following its "conclusion".
(d) If the respondent is also a
cross-petitioner, the respondent may file a combined brief or separate
cross-petitioner's brief which shall address issues raised by the cross-appeal.
(e) If a separate cross-petitioner's
brief is filed, the format shall be the same as a respondent's brief.
(9) Form of citations.
(a) All citations of Kentucky statutes
and reported decisions of the Court of Appeals and Supreme Court shall conform
to the requirements of Civil Rule 76.12(4)(g).
(b) All citations of Kentucky unpublished
decisions shall conform to the requirements of Civil Rule 76.28(4)(c).
(c) Citations for prior decisions of the
board shall include the style of the case, the appropriate claim or case number,
and the date the decision was rendered.
(10) Number of pages.
(a) The petitioner's brief and the
respondent's brief shall be limited to twenty (20) pages each.
(b) Reply briefs shall be limited to five
(5) pages.
(c) Combined briefs shall be limited to
twenty-five (25) pages.
(d) The parties shall make every effort
to comply with the above page limitations.
(e) Permission to increase the length of
a brief shall be sought by motion, but shall only be granted upon a showing of
good cause.
(11) Sanctions. Failure of a party to
file a brief conforming to the requirements of this administrative regulation
or failure of a party to timely file a response may be grounds for the imposition
of one (1) or more of the following sanctions:
(a) Affirmation or reversal of the final
order;
(b) Rejection of a brief that does not
conform as to organization or content, with leave to refile in proper form
within ten (10) days of the date returned. If timely refiling occurs, the
filing shall date back to the date of the original filing;
(c) Striking of an untimely response;
(d) A fine of not more than $500; or
(e) Dismissal.
(12) Motions.
(a) Except for a brief, a motion or
pleading shall require the original to be filed with the Executive Director of
the Office of Workers’ Claims.
(b) The style of the case, including the
claim number and title of the motion or pleading, shall appear on the first
page of the motion or pleading.
(c) The party filing a motion may file a
brief memorandum supporting the motion and opposing parties may file brief
memoranda in response. To be considered, a response shall be filed within ten
(10) days of the motion. Further responses shall not be filed.
(d) Every motion and response, the
grounds of which depend upon the existence of facts not in evidence, shall be
supported by affidavits demonstrating those facts.
(e) Every motion and response, the
grounds of which depend upon the existence of facts which the moving or
responding party believes are shown in the evidence or are admitted by the pleadings,
shall make reference to the place in the record where that evidence or admission
is found.
(f) Before filing a motion or pleading
with the Executive Director of the Office of Workers’ Claims, a party shall
serve, in the manner provided by Civil Rule 5.02, a copy of the document on
each adverse party.
(g) The filing of a motion to dismiss an
appeal shall stay the remaining time for the filing of a responsive pleading.
If the petitioner's brief has been previously filed and a motion to dismiss has
been overruled, the respondent shall have fifteen (15) days from the order to
file a respondent's brief.
(h) Except for motions that call for
final disposition of an appeal, any board member designated by the chairman may
dispose of a motion. An intermediate order may be issued on the signature of
any board member.
(13) Oral arguments.
(a) Upon motion of a party or upon the
board’s own motion, the board may order an oral argument on the merits in a
case appealed from a decision, award or order of an administrative law judge.
(b) Oral arguments shall occur on a date
and at a time and location specified by the board.
(c) Appeals designated for oral argument
shall be held in abeyance and all subsequent appeal time in the case shall be
calculated from the date of the oral argument.
(14) Continuation of benefits pending
appeal.
(a) Benefits awarded by an administrative
law judge which are not contested shall be paid during the pendency of an
appeal. A motion requesting the payment of these benefits shall not be
required. Uncontested benefits shall include income benefits at an amount
lesser than what was awarded if the issue on appeal addresses the amount of
benefits to be awarded as opposed to the entitlement to income benefits.
(b) Upon the motion of a party pursuant
to KRS 342.300, the board may order payment of benefits pending appeal in conformity
with the award, decision, or order appealed from.
(c) Entitlement to relief pursuant to KRS
342.300 shall be granted upon motion establishing that:
1. The probability of the existence in
fact of:
a. Financial loss;
b. Privation, suffering, or adversity
resulting from insufficient income; or
c. Detriment to the moving party’s
property or health if payment of benefits is not instituted; and
2. There exists a reasonable likelihood
that the moving party will prevail on appeal.
(d) Any response to a motion for
continuation of an award pending appeal shall be served within ten (10) days
from the date of the request and, thereafter, the request shall be ripe for a
decision.
(e) Entitlement to relief by the moving
party and responses shall be shown by:
1. Affidavit if the grounds for the
motion or response depend upon the existence of facts not in evidence; or
2. Supporting memorandum citing to
evidence existing within the record and making reference to the place in the
record where that evidence is found.
(15) Decisions.
(a) The board shall:
1. Enter its decision affirming, modifying,
or setting aside the order appealed from; or
2. Remand the claim to an administrative
law judge for further proceedings.
(b) Motions for reconsideration shall not
be permitted.
(c) The decision of the administrative
law judge shall be affirmed if:
1. A board member is unable to sit on a
decision; and
2. The remaining two (2) board members
cannot reach an agreement on a final disposition.
(16) Appeal from board decisions. If
applicable, pursuant to KRS 342.290, the decision of the board shall be
appealed to the Kentucky Court of Appeals as provided in Civil Rule 76.25.
Section 22. Coverage - Insured Status.
Upon the filing of an application for resolution of claim, the executive
director shall ascertain whether the employer or any other person against whom
a claim is filed and who is not exempted by KRS 342.650 has secured payment of
compensation by obtaining insurance coverage or qualifying as a self-insurer
pursuant to KRS 342.340. If an employer does not have insurance coverage or
qualify as a self-insurer, the executive director shall notify the
administrative law judge and all parties by service of a certification of no
coverage.
Section 23. Withdrawal of Records. (1) A
portion of any original record of the office shall not be withdrawn except upon
an order of the executive director, an administrative law judge, or a member of
the board.
(2)(a) All physical exhibits, including
x-rays, shall be disposed of sixty (60) days after the order resolving the
claim has become final except x-rays filed in coal workers' pneumoconiosis
claims which shall be returned to the party who filed the x-ray.
(b) A party filing an exhibit may make
arrangements to claim an exhibit prior to that time.
(c)1. If an unclaimed exhibit has no
money value, it shall be destroyed.
2. If an unclaimed exhibit has a value of
more than $100, it shall be sold as surplus property.
3. If an unclaimed exhibit has a value of
less than $100, it shall be donated to the appropriate state agency.
4. If an unclaimed exhibit has historic
value, it shall be sent to the state archives.
Section 24. Sanctions. (1) Pursuant to
KRS 342.310, an administrative law judge or the board may assess costs upon a
determination that the proceedings have been brought, prosecuted, or defended
without reasonable grounds.
(2) A sanction may be assessed against an
offending attorney or representative rather than against the party.
(3) If a party is a governmental agency
and attorney's fees are assessed, the fees shall include fees for the services
of an attorney in public employment, measured by the reasonable cost of similar
services had a private attorney been retained.
(4) Failure of a party to timely file a
pleading or document or failure to comply with the procedures required by this
administrative regulation may be treated by an administrative law judge or the
board as prosecuting or defending without reasonable grounds.
Section 25. Payment of Compensation from
Uninsured Employers' Fund. (1) Payment from the Uninsured Employers' Fund of
compensation shall be made upon the determination by an administrative law
judge that the responsible employer failed to secure payment of compensation as
provided by KRS 342.340; and
(a) Thirty (30) days have expired since
the finality of an award or issuance of an interlocutory relief order and a
party in interest certifies the responsible employer has failed to initiate
payments in accordance with that award;
(b) Upon showing that the responsible
employer has filed a petition under any section of the Federal Bankruptcy Code;
or
(c) The plaintiff or any other party in
interest has filed in the circuit court of the county where the injury occurred
an action pursuant to KRS 342.305 to enforce payment of the award against the
uninsured employer, and there has been default in payment of the judgment by
the employer.
(2) The plaintiff may by motion and
affidavit demonstrate compliance with this section and request an
administrative law judge to order payment from the Uninsured Employers' Fund in
accordance with KRS 342.760.
(3) This section shall not be construed
to prohibit the voluntary payment of compensation by an employer, or any other
person liable for the payment, who has failed to secure payment of compensation
as provided by KRS Chapter 342, the compromise and settlement of a claim, or
the payment of benefits by the Special Fund or Coal Workers' Pneumoconiosis
Fund.
(4) Form UEF-P, Motion for Payment from
Uninsured Employers' Fund, provided by the office may be used by the employee.
Section 26. Forms. The Office of Workers'
Claims shall not accept applications or forms in use prior to the forms
required by and incorporated by reference in this administrative regulation.
Outdated applications or forms submitted shall be rejected and returned to the
applicant or person submitting the form. If the application or form is
resubmitted on the proper form within twenty (20) days of the date it was
returned, the filing shall date back to the date the application or form was
first received by the executive director. Otherwise, the date of the second
receipt shall be the filing date.
Section 27. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) Form 101, "Application for
Resolution of Injury Claim", (revised April 2006), Office of Workers'
Claims;
(b) Form 102-0D, "Application for
Resolution of Occupational Disease Claim", (revised June, 2005), Office of
Workers' Claims;
(c) Form 103, "Application for
Resolution of Hearing Loss Claim", (June 2005 Edition), Office of Workers'
Claims;
(d) Form 104, "Plaintiff's
Employment History", (January 1, 1997 Edition), Office of Workers' Claims;
(e) Form 105, "Plaintiff's
Chronological Medical History", (January 1, 1997 Edition), Office of
Workers' Claims;
(f) Form 106, "Medical Waiver and
Consent", (July 2003 Edition), Office of Workers' Claims;
(g) Form 107-I, "Medical Report -
Injury", (revised April 2005), Office of Workers' Claims;
(h) Form 107-P, "Medical Report -
Psychological", (revised April 2005), Office of Workers' Claims;
(i) Form 108-OD, "Medical Report -
Occupational Disease, (April 2005 Edition), Office of Workers' Claims;
(j) Form 108-CWP, "Medical Report -
Coal Workers' Pneumoconiosis", (April 2005 Edition), Office of Workers'
Claims;
(k) Form 108-HL, "Medical Report -
Hearing Loss", (revised April 2005), Office of Workers' Claims;
(l) Form 109, "Attorney Fee
Election", (March 15, 1995 Edition), Office of Workers' Claims;
(m) Form 110-F, "Agreement as to
Compensation and Order Approving Settlement -Fatality", (revised January
2005);
(n) Form 110-I, "Agreement as to
Compensation and Order Approving Settlement - Injury", (revised July
2006), Office of Workers' Claims;
(o) Form 110-O, "Agreement as to
Compensation and Order Approving Settlement - Occupational Disease",
(revised July 2006), Office of Workers' Claims;
(p) Form 110-CWP, "Agreement as to
Compensation and Order Approving Settlement - Coal Workers'
Pneumoconiosis", (July 2002 Edition), Office of Workers' Claims;
(q) Form 111- Injury and Hearing Loss,
"Notice of Claim Denial or Acceptance", (January 1, 1997 Edition),
Office of Workers' Claims;
(r) Form 111-OD, "Notice of Claim
Denial or Acceptance", (January 1, 1997 Edition), Office of Workers'
Claims;
(s) Form 115, "Social Security Release
Form", (January 1, 1997 Edition); and Office of Workers' Claims;
(t) Form AWW - 1, "Average Weekly
Wage Certification ", (January 1, 1997 Edition), Office of Workers'
Claims;
(u) Form MIR-1, Motion for Interlocutory
Relief (May 29, 1997 Edition);
(v) Form MIR-2, Affidavit for Payment of
Medical Expenses (May 29, 1997 Edition);
(w) Form MIR-3, Affidavit for Payment of
Temporary Total Disability (May 29, 1997 Edition);
(x) Form MIR-4, Affidavit Regarding
Rehabilitation Services (May 29, 1997 Edition);
(y) Form VRT, Petition for Vocational
Rehabilitation Training (April 2005 Edition);
(z) Form MTR-1, Motion to Reopen by
Employee (May 29, 1997 Edition);
(aa) Form MTR-2, Motion to Reopen KRS
342.732 Benefits (May 29, 1997 Edition);
(bb) Form MTR-3, Motion to Reopen by
Defendant (May 29, 1997 Edition);
(cc) Form WVR, Joint Motion and Agreement
to Waive Vocational Rehabilitation Evaluation (April 2005 Edition);
(dd) Form UEF-P, Motion for Payment from
Uninsured Employers' Fund (April 2005 Edition); and
(ee) Form 11, Motion to Substitute Party
and Continue Benefits (January 31, 2005).
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Office of
Workers' Claims, Prevention Park, 657 Chamberlin Avenue, Frankfort, Kentucky
40601, Monday through Friday, 8 a.m. to 4:30 p.m. (21 Ky.R. 2576; Am. 3032;
eff. 6-15-95; 22 Ky.R. 2071; eff. 7-5-96; 23 Ky.R. 3958; 24 Ky.R. 349; eff.
7-17-97; 24 Ky.R. 2436; eff. 7-13-98; 27 Ky.R. 1084; 1478; eff. 12-21-2000; 28
Ky.R. 1216; 1638; eff. 1-14-02; 29 Ky.R. 552; 945; eff. 10-16-2002; 30 Ky.R.
94; 648; eff. 10-31-03; 32 Ky.R. 142; 487; eff. 10-7-05; 33 Ky.R. 236; 770;
eff. 10-6-06.)
