Claims Questions

When should an injury be reported to KEMI?

Work-related injuries and illnesses should be reported to KEMI immediately. Kentucky law states that policyholders must report injuries or illnesses to us within three (3) working days of receiving notification of the incident or alleged incident.

Who should report an injury?

The policyholder is responsible for reporting the injury to KEMI in a timely manner.

How do I report an injury?

The fastest and easiest way to report an injury or illness is through submitting the First Report of Injury online. A claim may also be reported by printing the First Report of Injury or Illness, or IA-1 form, and faxing it to 859-425-7822 or mailing to the address below:

KEMI
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.).

Where should an injured worker go for treatment?

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.

How should an injured worker fill a prescription?

Injured workers should take prescriptions to a pharmacy and tell the pharmacist to bill the prescription through Mitchell, KEMI’s third-party pharmacy benefit provider.

How does the claims process work?

The claim process for an employer is as follows:

  • Report the injury to KEMI immediately.
  • Guide the injured worker 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 injuries 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 injured worker 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 injured worker if possible to allow them to return to work.
  • Once the injured worker returns to work and has been released from medical treatment at maximum medical improvement, the claim may be administratively closed.
How are benefits calculated for an injured worker?

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 injured worker’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.

 

What are wage certifications?

Wage certifications are a tool utilized for determining an injured worker’s average weekly wage so that we can accurately calculate an injured worker’s indemnity benefit rate. A wage certification will be sent to policyholders when an injured worker 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 injured worker or as many weeks as the injured worker has been with the company if he or she has not worked there for a full 52 weeks.

How can I check the status of a claim?

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.

How long does an injured worker need to be off work to receive temporary indemnity benefits?

An injured worker is eligible for temporary total disability benefits (TTD) if placed off work for at least seven work days by a physician. TTD is payable beginning on the 8th day off work.  If the injured worker is placed off work for more than fourteen work days, TTD is payable for the initial 7 work days off.

Questions from Injured Workers

What billing information do I need to give to my doctor's office?

Providers may use your KEMI claim number or a combination of your date of injury 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:

KEMI
P.O. Box 4208
Clinton, IA 52733-4208

What billing information do I need to give to my pharmacy?

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.

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