Kentucky 102 form 2026

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The document is an application form for the resolution of a claim related to occupational disease, filed with the Kentucky Department of Workers' Claims. It requires detailed information about the plaintiff, the nature of the occupational disease, exposure details, and any prior claims for workers' compensation. The form also includes instructions for completion and submission, emphasizing the need for accuracy and timely filing of supporting documents.

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Click ‘Get Form’ to open the Kentucky 102 form in the editor.
Begin by filling in your personal information, including your name, Social Security Number, and mailing address. Ensure all details are accurate to avoid processing delays.
Next, provide information about the defendant/employer. Include their business name and mailing address, as well as the insurance carrier's details.
In the 'Nature of Occupational Disease' section, specify the disease claimed and detail when and how you notified your employer about it.
Complete any additional sections regarding dependents, previous claims, and current employment status. Be thorough in providing all requested information.
Finally, review your entries for accuracy. Use our platform’s features to sign and submit your completed form electronically for free.

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