Free K-WC 107 - Benefit Cards (Rev. 07-08) - Kansas

Department of Labor

Division of Workers Compensation
NOTICE ­ Workers must give notice of accidental injury to their employer within 10 days after date of accident (75 days with just cause). The notice must be in writing for an accident that is the result of a series of events, repetitive use, cumulative traumas or microtraumas. Written notice of an occupational disease is required within 90 days of disablement. CLAIM ­ Workers must serve written claim on the employer, in person or by registered or certified mail, within 200 days of the accident or last paid compensation. Workers with an occupational disease must serve claim within one year from date of disablement. Right to compensation may be forfeited if claim is not served within these time frames. TREATMENT ­ The employer must furnish medical treatment to cure and relieve the effects of the injury. The employee has the right to $500 of unauthorized medical expense. FOR INFORMATION ­ Write KANSAS DEPARTMENT OF LABOR DIVISION OF WORKERS COMPENSATION 800 SW JACKSON ST STE 600 TOPEKA KS 66612-1227 or call: ** General Information..................................................785-296-2996 ** Coverage and Compliance ........................................785-296-6767 Director's Office .......................................................785-296-2996 ** Fraud and Abuse Investigation .................................785-296-6392 ** Mediation .................................................................785-296-0848 Medical Services .......................................................785-296-0846 ** Ombudsman/Claims Advisory ..................................785-296-2996 Rehabilitation ............................................................785-296-2996 Technology and Statistics .........................................785-296-4120 Workers Compensation Board ..................................785-296-8484 Web site................................................................. www.dol.ks.gov NOTE: Sections with (**) available nationwide .....................800-332-0353
K-WC 107 (Rev. 7-08)

See reverse side for total benefits



TABLE OF MAXIMUM BENEFITS - Effective July 1, 2008 Kansas Workers Compensation Law Medical and hospital allowances .................................... no limit Death: spouse and wholly dependent children ............$250,000 Death: heirs (no dependents) ........................................$25,000 Burial allowance ..............................................................$5,000 Permanent total disability ............................................$125,000 Temporary total disability .............................................$100,000 Partial disability............................................................$100,000 Partial disability limited to functional impairment ...........$50,000 Maximum weekly benefits: (7-1-04 to 6-30-05) .................$449 (7-1-05 to 6-30-06) .................$467 (7-1-06 to 6-30-07) .................$483 (7-1-07 to 6-30-08) .................$510 (7-1-08 to 6-30-09) .................$529 Medical mileage for more than 5 miles ­ Call 1-800-332-0353 Maximum benefits where functional impairment only is awarded is restricted to $50,000.
Maximum weeks that may be paid Compensation at $529 per week

Shoulder ........................................... Arm ................................................... Forearm ............................................ Hand ................................................. Leg.................................................... Lower leg .......................................... Foot .................................................. Eye ................................................... Hearing, both ears ............................ Hearing, one ear ............................... Thumb .............................................. Finger 1st (index).............................. Finger 2nd (middle) .......................... Finger 3rd (ring) ................................ Finger 4th (little)................................ Great toe........................................... Great toe, end joint ........................... Each other toe .................................. Each other toe, end joint only ...........

225 .................. 210 .................. 200 .................. 150 .................. 200 .................. 190 .................. 125 .................. 120 .................. 110 .................. 30 .................. 60 .................. 37 .................. 30 .................. 20 .................. 15 .................. 30 .................. 15 .................. 10 .................. 5 ..................

$100,000 $100,000 $100,000 $79,350 $100,000 $100,000 $66,125 $63,480 $58.190 $15,870 $31,740 $19,573 $15,870 $10,580 $7,935 $15,870 $7,935 $5,290 $2,645

Allowance of 10% and not over 15 weeks for healing period following an amputation.