Work-related incidents and illnesses should be reported to KEMI immediately. Kentucky law states that policyholders must report incidents or illnesses to us within three (3) working days of receiving notification of the incident or alleged incident.
The policyholder is responsible for reporting the incident to KEMI in a timely manner.
The fastest and easiest way to report an incident or illness is through submitting the First Report of Incident online. A claim may also be reported by printing the First Report of Incident or Illness, or IA-1 form, and faxing it to 859-425-7822 or mailing to the address below:
ATTN: Claims Unit
P.O. Box 12500
Lexington, KY 40583-2500
To report a claim by phone, call 1-800-640-KEMI (5364) or 859-425-7800 during business hours (Monday – Friday from 8 a.m.-5 p.m.).
KEMI has partnered with OMCA, a managed care network, which has medical providers throughout Kentucky.ACCESS THE OMCA PROVIDER LIST
If you have questions or wish to recommend a new provider to the list, contact us.
Claimants should take prescriptions to a pharmacy and tell the pharmacist to bill the prescription through Mitchell, KEMI’s third-party pharmacy benefit provider.
The claim process for an employer is as follows:
- Report the incident to KEMI immediately.
- Guide the claimant to seek initial treatment. For emergencies where loss of life or limb is a concern, call 9-1-1 or go to the nearest hospital. For non-life threatening incidents or illnesses, find a list of providers here.
- KEMI will assign the claim to an examiner, who will then review the claim and determine if it is approved or denied in accordance with state law.
- If the claim is approved, we will provide you with a claim number for future reference.
- A claims examiner will request information from the policyholder regarding wages, employment, details about the incident, etc.
- We will work with the claimant and medical providers to ensure appropriate care and benefits are provided.
- We may also communicate with the policyholder regarding the status of open claims.
- If you receive any work or medical notes related to the claim, please provide a copy of them to the claims examiner.
- Accommodate restrictions for the claimant if possible to allow them to return to work.
- Once the claimant returns to work and has been released from medical treatment at maximum medical improvement, the claim may be administratively closed.
There are three types of indemnity benefits: temporary total disability (TTD), permanent partial disability (PPD) and permanent total disability (PTD). Each type of indemnity benefit has a different calculation defined by statute and uses specific information related to the claim. KRS 342.730 governs how income benefits are calculated.
For lost time wage benefits, the weekly payment amount is sixty-six and two-thirds percent (66 2/3%) of the claimant’s average weekly wage, subject to a minimum and maximum rate provided by statutes. The average weekly wage is determined by wage information submitted by the employer.
Contact KEMI’s Claims Team at 1-800-640-KEMI (5364) for questions regarding a specific claim.
Wage certifications are a tool utilized for determining a claimant’s average weekly wage so that we can accurately calculate a claimant’s indemnity benefit rate. A wage certification will be sent to policyholders when a claimant has been off work long enough to receive indemnity benefits or when deemed necessary.
Policyholders are generally asked to submit 52 weeks’ worth of wages for the claimant or as many weeks as the claimant has been with the company if he or she has not worked there for a full 52 weeks.
Policyholders may view claim details and statuses on KEMI.com if they are signed in and have administrator access. If you have questions about a claim, you may also contact us.
A claimant is eligible for temporary total disability benefits (TTD) if placed off work for more than seven days by a physician. TTD is payable beginning on the 8th day off work. If the claimant is placed off work for more than fourteen work days, TTD is payable for the initial 7 work days off.
Questions from Claimants
Providers may use your KEMI claim number or a combination of your date of incident and your Social Security Number as a reference for your bills. Providers should use our dedicated P.O. box for medical billing to forward charges to KEMI for services related bills should be submitted to the following address:
P.O. Box 4208
Clinton, IA 52733-4208
KEMI uses Mitchell as our Pharmacy Benefit Manager.
Still have questions?
If you have a claims question, give us a call at 1-800-640-KEMI (5364) or 859-425-7800. You may also use the contact form here.