This is one of the official Workers' Compensation forms for the state of Kentucky.
Kentucky Application for Split Coverage Wrap Up
State:
Kentucky
Control #:
KY-375W-WC
Format:
PDF
Instant download
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Public form
Description
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FAQ
The Kentucky Coal Employers Self-Insurance Guaranty Fund provides a safety net for coal operators who self-insure their workers' compensation obligations. This fund helps cover benefits for injured workers when coal operators cannot fulfill claims. If you operate in the coal industry, you may need to consider this fund when filling out the Kentucky Application for Split Coverage Wrap Up.