The Claim Process

KEMI policyholders are responsible for reporting injuries or illnesses in a timely manner; however, the claimant may submit his or her own First Report of Incident using the IA-1 First Report of Incident form.

Once a work-related incident is reported to KEMI, our Claims Team will move into action by reviewing the information and ensuring the claimant receives the care they deserve.

Once we’ve reviewed the First Report of Incident, we will gather additional information and determine appropriate benefits if the claimant is expected to miss work or needs ongoing treatment from a provider in our network. If the claimant is able to return to work with restrictions, we will work with the policyholder to make those accommodations if possible.

As part of our commitment to you, we want to help you return to work as quickly and safely as possible.

KEMI has a zero-tolerance policy on workers’ compensation fraud to protect our policyholders and their employees.

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Submitting a First Report of Incident

KEMI policyholders are responsible for reporting injuries or illnesses in a timely manner. However, a claimant may submit a First Report of Incident using the IA-1 First Report of Incident or Illness form. Find details below in Frequently Asked Questions > How do I report an incident?

Forms & Resources for Claimants

After a claim is filed with KEMI, we will request additional information from a claimant. Use the forms below to help expedite your claim.

• Direct Deposit
• Direct Deposit (Spanish)
• Medical Waiver & Consent Form (Form 106)
• Notice of Designated Physician (Form 113)
• Claimant Reimbursement Form (Form 114)
• KEMI Contact Card

OMCA Resources
KEMI works closely with the Occupational Managed Care Network (OMCA) to provide quality care for work-related injuries.

• Gatekeeper Acknowledgment Form
• Incident Notice Poster for Employees
• OMCA Frequently Asked Questions
• Employee Grievance Form