HOW TO FILE A CLAIM

Step 1:  Get employee medical treatment if serious.  Call 911, if necessary.  Forms can be completed after treatment is provided.  Otherwise, follow the steps below and send the employee to a designated medical provider.

Step 2:  Complete Employer’s Report of Accident (form K-WC 1101-A).  Mail completed form to:

KMIT Claims Adjuster 

PO Box 2992

Wichita, KS 67201-2992

Step 3:  Provide employee with a copy of Important Information for Injured Employees (form K-WC 27).

Step 4:  Provide employee with Authorization For Work Comp Medical Treatment form.  Complete the top portion and instruct the employee to have the doctor complete the bottom portion.  Instruct the employee to being completed form back to the supervisor after the doctor’s appointment with the designated physician.

For help or questions regarding any claim, please contact:

Marla Dipman or Gene Miller, Claims Adjusters

Phone:  (316) 266-6347

Toll Free:  (800) 288-6732

Fax:  (316) 266-6385

Email: 

All of the above mentioned forms can be found on the website in our “document center.”  Each from is in PDF form so you may print for your use.