Blog » Claims FAQs

Claims FAQs

posted Dec 27, 2016

Q.
How do I file a claim?
A.
The Kentucky AGC/SIF now has ONLINE CLAIMS REPORTING available through its website making it easier than ever for you to manage your workers' compensation insurance. This feature allows you to file a workers' compensation claim First Report of Injury (FORM IA-1) electronically, saving you time and improving compliance. By law, workers' compensation claims must be filed within three (3) days from the time an injured worker notifies an employer of a work related injury. Please take this opportunity to review these procedures/guidelines, and if you have any questions about them or during the course of any particular claim, please contact the Fund's Claims Department (Ladegast & Heffner) at (502) 245-8395.
Ladegast & Heffner requests that all workers' compensation first reports of injury claim forms be filed online. The online reporting is set up to guide you through completing the first report accurately and completely which will avoid delays in claims processing caused by incomplete reports.
Please read the following before you begin filing a FORM IA-1 online:
  1. You are required to complete ALL mandatory fields.
  2. Please be sure you have ALL information before beginning the FORM IA-1, as the form cannot be saved for completing later. However, you will be able to print the completed report for your records upon completion and submission.
  3. The NCCI Job Classification Code required on the FORM IA-1 can be found on your Monthly Interim Payroll Report Forms. The Job Class Code used should be the code which the Injured Worker was working at the time of the accident/occupational illness.
  4. In the event that an Injured Worker notifies you of an accident/occupational illness, but does not elect to seek medical attention OR if you elect to pay a claim versus Ladegast & Heffner handling it, a FORM IA-1 must still be filed with us. Simply answer "YES" to the "FILEDOWN" question at the end of the online FORM IA-1 entry. We will keep the form on file for future reference if developments occur at a later date. It will not be factored into your loss experience. However, if you initially elect to pay a claim but then decide that you want Ladegast & Heffner to handle it, you must notify us IN WRITING that you want us to handle the claim. Ladegast & Heffner reserves the right to handle a claim initially filed as a "FILEDOWN" as if we had handled it from the onset. Therefore, any request from you for reimbursement will be subject to our investigation and determination of the claim's validity.
HOW TO FILE A CLAIM ONLINE
If you do NOT already have a user name and password, please follow these directions:
Go to www.kyagcsif.com
  • Click on NEED TO SIGN UP in the top right hand corner of the screen
  • Complete the WEB ACCESS APPLICATION
User authorization will be provided within 24 hours if requested during regular business hours. As a registered user, in addition to other various premium and loss information/reports, you will have access to file claims online. User roles can be created by employers to assign permissions to their personnel for the workers' compensation online account through the Kenucky AGC/SIF.
If you already have a user name and password, please follow these directions:
Go to www.kyagcsif.com
  • Login to your account and from the homepage:
  • Click on the EMPLOYER tab
  • Click on FILE A CLAIM
  • Click on FILE A CLAIM ONLINE to the right of the page
  • Complete the FIRST REPORT OF INJURY or ILLNESS form
  • Click SUBMIT at the bottom of the page
  • PRINT the completed first report of injury for your records
THINGS TO DO AFTER YOU FILE THE CLAIM ONLINE
  1. Please fax or mail any other claims related information such as medical bills, off work documentation and/or any other information you may have relative to the claim. Additionally, if you doubt the validity of a claim, file a FORM IA-1 as required by law, but please mail or fax your concerns and/or facts to the Claims Department.
Fax any accompanying documents to (502) 245-2850 or mail to:                       LADEGAST & HEFFNER CLAIMS SERVICE, INC.                       P.O. BOX 436949                       LOUISVILLE, KENTUCKY 40253-6949

IF YOU DO NOT HAVE INTERNET ACCESS AND MUST FILE THE CLAIM BY MAIL OR FAX:
Complete the FORM IA-1 IN ITS ENTIRETY (ALL UNSHADED AREAS). If submitting the claim by mail or fax, have the injured worker read and sign the back of the form.
  1. Submit the FORM IA-1 within three (3) days of being notified of the injury or occupational illness.
  2. The form will be returned to the Employer/Insured if EVERY UNSHADED AREA on the form is not completed. This could result in a delay of both benefits and timely filing by us to the Department of Workers' Claims.
  3. The NCCI Job Classification Code required on the FORM IA-1 can be found on your Monthly Interim Payroll Report Forms. The Job Class Code used should be the code which the Injured Worker was working at the time of the accident/occupational illness.
  4. In the event that an Injured Worker notifies you of an accident/occupational illness, but does not elect to seek medical attention OR if you elect to pay a claim versus Ladegast & Heffner handling it, a FORM IA-1 must still be filed with us. Please indicate in writing that you wish for the claim to be a "FILEDOWN". We will keep the form on file for future reference if developments occur at a later date. It will not be factored into your loss experience. However, if you initially elect to pay a claim but then decide that you want Ladegast & Heffner to handle it, you must notify us IN WRITING that you want us to handle the claim. Ladegast & Heffner reserves the right to handle a claim initially filed as a "FILEDOWN" as if we had handled it from the onset. Therefore, any request from you for reimbursement will be subject to our investigation and determination of the claim's validity.
  5. Please fax or mail any other claims related information such as medical bills, off work documentation and/or any other information you may have relative to the claim. Additionally, if you doubt the validity of a claim, file a FORM IA-1 as required by law, but please mail or fax your concerns and/or facts to the Claims Department.
Fax any accompanying documents to (502) 245-2850 or mail to:                       LADEGAST & HEFFNER CLAIMS SERVICE, INC.                       P.O. BOX 436949                       LOUISVILLE, KENTUCKY 40253-6949

IMPORTANT INFORMATION YOU SHOULD KNOW
  • Ladegast & Heffner will fulfill the obligation of transmitting the claims information electronically to the Department of Worker's Claims as is required by law. However, you the Employer are required to file online, mail or fax the FORM IA-1 to us within three (3) days of being notified by the Injured Worker of a claim. Please strictly adhere to this requirement as any penalties/fines imposed by the Kentucky Department of Workers' Claims for late reporting to them could ultimately be charged to the Employer/Insured if it is found that the IA-1 was not received by Ladegast & Heffner within the three (3) day time frame afforded to the Employer/Insured by law.
  • Please continue to forward to us throughout the course of a particular claim, any correspondence and/or bills relative to that claim.
  • If you have medical bills for a Kentucky Workers' Compensation claim that you have elected to pay yourself, you as the employer, are entitled to pay the bill(s) pursuant to the Kentucky Medical Fee Schedule(s) which usually results in a reduced payment to the medical provider thereby saving you money. Please contact the Claims Department at (502) 245- 8395, and we will be glad to assist you in adjusting any such bills.
  • All reimbursements to the Employer and/or Injured Worker are subject to all applicable Kentucky Fee Schedules and therefore may not be at 100%.
  • Upon notification from the Employer, Injured Worker, or health care facility that Prescription Medication and/or Durable Medical Equipment (Crutches, Walkers, TENS Units, etc.), are required, Ladegast & Heffner reserves the right to obtain these items from a Preferred Provider in order to control/contain costs, but at no hardship to the Injured Worker.
  • As a standard procedure, all Temporary Total Disability benefits due an Injured Worker shall be mailed to you, the Employer. However, by law, we will mail these checks to an Injured Worker if he/she requests us to do so IN WRITING. Therefore, if disability checks cease coming to you, do not assume that benefits have been terminated. Please inquire.
  • Loss runs are mailed on a monthly basis for the current and previous year. You can instantly access these and older years' loss runs from the Fund's website at www.kyagcsif.com.
Q.
How do I obtain a Form IA-1 (First Report of Injury)?
A.
Click here to file a Form IA-1 online or here to download a Form IA-1.
Q.
Can I pay a claim?
A.
If you elect to pay a claim versus Ladegast & Heffner handling it, the IA-1 must still be completed and mailed to us with a note indicating that you wish to pay this claim. We will keep the claim form on file. It will not be factored into your loss experience. However, if you initially elect to pay a claim, then decide that you want us to handle it, you must notify us IN WRITING. We reserve the right to handle a claim such as this as if we had handled it from the onset, so any request from you for reimbursement will be subject to our investigation and determination of the claim's validity. Any reimbursements to the Employer and/or Injured Worker are subject to all applicable Kentucky Fee Schedules and therefore, may not be at 100%.
Q.
Can I reimburse the Fund for a claim?
A.
In some cases, a Fund Member may reimburse the Fund for a claim. However, please contact the Claims Department at (502) 245-8395 for more details.
Q.
Do I have to report all claims?
A.
Yes. Fund policy requires that the Claims Department be notified of all claims. Even in the event that an Injured Worker notifies you of an accident/occupational illness, but does not elect to seek medical attention, the IA-1 form must still be completed and mailed to us. We will keep the form on file for future reference if developments occur at a later date. Again, it will not be factored into your loss experience.
Q.
What if the injured worker needs special equipment?
A.
Upon notification from the Employer, Injured Worker, or health care facility that Durable Medical Equipment (Crutches, Walkers, TENS Units, etc.), are required, Ladegast & Heffner reserves the right to obtain these items from a Preferred Provider in order to control/contain costs, but at no hardship to the Injured Worker. Please contact the Claims Department for additional details at (502) 245-8395.
Q.
Do workers' compensation disability checks get mailed to the employer or injured worker?
A.
As a standard procedure, all Temporary Total Disability (TTD) benefits due an injured worker will be mailed to you, the Employer. However, by law, we will mail these checks to an injured worker if he/she requests us to do so IN WRITING. Therefore, if disability checks cease coming to you, do not assume that benefits have been terminated. Please inquire. Any permanent partial or permanent total disability checks are mailed directly to the injured worker.

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