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KANSAS DEPARTMENT OF LABOR www.dol.ks.govACCIDENT REPORT KWC 1101A (Rev. 1013) SEE INSTRUCTIONS ON PAGE 2 There is a $250 penalty for repeated failure to file accident reports within 28 days of the.

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If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.

First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within three days from notice of a work-related injury. Fatalities must be reported within 24 hours.

All claim types on a First Report of Injury (FROI) are reportable to the State of Kansas within 28 days of the employer being notified that an injury has occurred.

The Kansas Workers' Compensation Act provides benefits for virtually all work-related injuries, on-the-job accidents, and occupational diseases, including carpal tunnel syndrome. However, some workers' compensation insurance providers may deny your claim on the grounds that: The injury didn't happen at work.

44-557, when an accident occurs, you must make a report with the Division of Workers Compensation within 28 days, after the receipt of such knowledge, if the personal injuries which are sustained by such accidents, are sufficient wholly or partially to incapacitate the person injured from labor or service for more than ...

The employer is required to file an Employer's First Report of Injury or Illness [DWC FORM-001 Rev. 10/05] with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232