Get K-wc E 5 - Application For Review And Modification - Department Of ...

Completing the K-WC E 5 - Application For Review And Modification is essential for individuals seeking to request a review of a prior decision. This guide provides a step-by-step approach to help you accurately fill out the form online, ensuring a smooth submission process.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to retrieve the application and open it for editing.
2. Begin by entering the required docket number in the designated field at the top of the form.
3. Input your personal information, including your first, middle, and last name, as well as your contact phone number and email address. This information is crucial for communication regarding your application.
4. Specify your employer's name in the provided section to establish your employment context.
5. In the section for the date of award or order, enter the date relevant to your initial decision, which your review seeks to address.
6. Clearly articulate the reason for seeking modification as outlined in K.S.A. 44-528. Use the extensive space provided to fully explain your rationale.
7. If you have legal representation, at least one attorney must sign the form as stipulated by K.S.A. 44-536a(a). Ensure the attorney's information is included accurately.
8. Indicate whether you are interested in pursuing the Workers Compensation mediation process by selecting 'Yes' or 'No.'
9. Affix your signature and the date in the designated signature area to verify your application.
10. If applicable, provide the address of the applicant and indicate if the applicant is represented by an attorney, selecting 'Yes' or 'No.'
11. Complete the attorney representing section if applicable, including their printed name, address, email, and phone number.
12. Review all sections for accuracy and completeness to ensure that your application is submitted without errors.
13. Once satisfied, save your changes, and proceed to download, print, or share the completed form as required.

Complete your K-WC E 5 application online today to ensure timely review and modification of your case.