When dealing with a claim that is questionable in motive, occurrence or circumstances, it is important for you to be pro-active and timely in your response. Follow these steps if you are confronted with a questionable claim:

• Complete and submit the Report of Injury immediately.
• Have the employee complete and sign an Employee's Statement Form. Attach it to the Report of Injury and forward to the KESA Claims Center. KESA recommends having the employee complete an Employee's Statement Form any time the claim is questionable or there is lost time involved.
• Include an explanation of any information you feel is questionable and any additional facts regarding the occurrence. This will flag the claim for further investigation.

Whenever you feel a claim is questionable, you should contact the KESA Claims Center as soon as possible and we will assist you in gathering the necessary investigative and medical information to support or contest the allegations made by the injured employee.

Wage Statement

When an employee incurs a lost time injury (loss of at least one whole day of work) the wage statement (*pdf format) must be completed. The average weekly wage must be established before the workers’ compensation weekly benefits can be calculated and payment of lost wages made.

* Note: You must have Adobe Acrobat Reader to read pdf files. You can download a free version of Acrobat Reader by clicking on the Adobe icon below.