Free K-WC 99 - Notice on Request for Records (Rev. 07-08) - Kansas

RESTRICTED ACCESS TO RECORDS
K.S.A. 44-550b(a)(4) restricts access to the Workers Compensation records listed below:

There are two categories of restricted records: · MedicalRecords · AccidentReports

In order to obtain these records you must be: 1) an employer who has made a conditional offer of employment to a worker; 2) acurrentemployerofaworkerwhohasrequestedworkerscompensationbenefits; 3) an insurance carrier of an employer in item 1 or 2: 4) a representative of the insurance carrier; or 5) a worker seeking his or her own records.

To request restricted records: RecordsrequestformsK-WC97,K-WC98,andK-WC970willbeavailablefromtheKansas DepartmentofLaboreitherfromourTopekaofficeat: Kansas Department of Labor Division of Workers Compensation 800SWJacksonStreet,Suite600 Topeka,KS66612-1227 Telephone:785-296-6762 oryoumaydownloadcopiesofK-WC97,K-WC98,andK-WC970fromourInternet site at www.dol.ks.gov



Thecompletedrequestforrecordsmaybesenttotheaboveaddressorfaxedto785-291-3430. Please fax on white paper, otherwise the request form may not be legible.

K-WC 99 (Rev. 7-08)

DIVISIONOFWORKERSCOMPENSATION 800SWJacksonStreet,Suite600,Topeka,KS66612-1227 Phone:785-296-2996·Fax:785-291-3430·TollFree:1-800-332-0353·[email protected]·www.dol.ks.gov