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 or e-mail completed form to:
PO Box 2805
Clinton, IA 52733
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:
Gene Miller, KMIT Claims Manager
Phone: 844-702-2353 Ext. 4711
Fax: (844) 702-2354
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.