Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS
342.395
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
342.260(1) requires the
executive director to promulgate administrative regulations necessary to carry
out the work of the office.
KRS
342.395 requires an employer to file an
employee's notice of rejection of workers' compensation with the office. This
administrative regulation establishes the procedures for filing the rejection
notice, the form of the rejection notice, and the withdrawal of the rejection
notice.
Section 1.
(1) If an employee chooses to reject the
provisions of KRS Chapter 342, the employee shall file a Form No. 4, Employee's
Notice of Rejection of Workers' Compensation Act with his employer.
(2) The notice shall:
(a) Be on an original form obtained from the
Office of Workers' Claims;
(b)
Contain the following information:
1. Employer
data;
2. Employee data;
3. Employer's Workers' Compensation Insurance
data;
4. Employee's notarized
signature; and
5. Employer's
acknowledgment of receipt and filing with the Office of Workers' Claims;
and
(c) Be effective
when the office has received the fully completed Form No. 4.
(3) The employer shall file each
Form No. 4 with the office immediately upon receipt of the form from the
employee.
(4) Each employer shall:
(a) Keep on file a copy of each Form No. 4
signed by a current employee; and
(b) Make those records available for
inspection upon request by a representative of the office.
(5) The office shall reject a filing which
is:
(a) A photocopy;
(b) A facsimile;
(c) Not on an original Form No. 4 obtained
from the office.
Section
2.
(1) If an employee chooses to
withdraw his rejection of the Workers' Compensation Act, the employee shall
file that withdrawal on Form No. 5, Written Notice of Withdrawal of Form No. 4
Rejection Notice with his employer.
(2) The withdrawal notice shall:
(a) Be on an original form obtained from the
office;
(b) Contain the following
information:
1. Employer data;
2. Employee data;
3. Employee's notarized signature;
4. Employer's acknowledgment of receipt and
filing with the office; and
5.
Pursuant to
KRS
342.395(3), the date when
the withdrawal is to become effective; and
(c) Be effective pursuant to
KRS
342.395(3) upon:
1. Filing with the employer, if the employee
did not designate an effective date; or
2. The date designated by the
employee.
(3)
The employer shall file each Form No. 5 with the office immediately upon
receipt from the employee.
Section
3. If an employer or employee wants an acknowledgment from the
office of a Form No. 4 filing or Form No. 5 filing, the employer or employee
shall provide the following with the original Form No. 4 or Form No. 5:
(1) Photostatic copy of the filing;
and
(2) Self-addressed stamped
envelope.
Section 4.
Incorporation by Reference.
(1) The following
material is incorporated by reference:
(a)
Form No. 4, Employee's Notice of Rejection of Workers' Compensation Act (July
1997 Edition), Office of Workers' Claims; and
(b) Form No. 5, Written Notice of Withdrawal
of Form 4 Rejection (July 1997 Edition), Office of Workers' Claims.
(2) The material may be inspected,
copied or obtained at the Office of Workers' Claims, Monday through Friday, 9
a.m. to 4 p.m. at Prevention Park, 657 To Be Announced Avenue, Frankfort,
Kentucky 40601.
STATUTORY AUTHORITY:
KRS
342.260(1)
