Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
K-WC-40A – Workers Compensation Rights and Responsibilities
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
Form IA-1 – First Report of Injury
Incident Investigation Report (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Injury or Incident (Versión en Español)
Instructions for Injured Worker Handouts
K-WC 27-A – Information for Injured Employees (Versión en Español)
Injured Workers First Fill Prescription Form (Versión en Español)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
K-WC 25 – Workers Compensation Information for Kansas Employers and Employees (Versión en Español)
Direct Deposit Authorization Form (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
K-WC 530 – Employee Notification Forms Available Online
K-WC 25 – Workers Compensation Information for Kansas Employers and Employees (Versión en Español)
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
Instructions for State-Specific Forms & Documents
K-WC 50 – Election of Employee Not to Accept Coverage
K-WC 113 – Election of Individual to Come Under Act
K-WC 137 – Election of a Noncompensated Volunteer Officer, Director or Trustee
Affidavit of Exempt Status Under the Workers Compensation Act (Versión en Español)
