Workers Compensation Information Sheet

Submit A Work Comp Claim




Claims should be reported to Risk Management as quickly as possible Phone #852-4654 or Fax #852-0740.  Any questions regarding Workers' Compensation should be addressed to Carol Kloenne #852-4654

Please note:  If the accident or injury involved an overt exposure to recombinant DNA molecules, the Department of Environmental Health & Safety (DEHS) must be notified immediately by phone at 852-6670.  After work hours contact University of Louisville Police Department (502) 852-6111.  University of Louisville is required to notify NIH/OBA of the incident immediately as directed by the NIH Guidelines.

If an employee will be off work for seven (7) or more days, the employee is also required to apply for Family & Medical Leave (FMLA).  Risk Management will notify HR of every employee that is off work for seven (7) or more consecutive days, so FMLA can be activated.  Risk Management can only do this if the department keeps Risk Management informed of the injured employee's work status.

EMPLOYEE Responsibilities:


  • It is the employee's responsibility to immediately report their injury or illness to their supervisor. 
  • Once the supervisors submits the claim, it is the employee's responsibility to sign the Fraud Statement and return it to Carol Kloenne at The employee will receive this form via email after the claim has been submitted.
  • It is the employee's responsibility to make any appointments for treatment and make sure the provider is clear that your visit is a Workers' Compensation claim.  If the employee needs their Workers' Compensation claim number, they need to contact .
  • It is the employee's responsibility to notify their supervisor/department each time their treating physician takes them off work (due to their work-related injury or illness).  The employee must keep their supervisor/department informed of their work status by providing updated off work statements from their treating physician(s), this would including time off for doctor appointments, rehab, physical therapy, etc.
  • The UofL Workers' Compensation carrier will mail to the injured/ill employee a Designated Physician Form (Form 113) and the Medical Waiver and Consent Form.  The two forms should be completed and returned to the Workers' Compensation carrier within 10 days of receiving the forms.


SUPERVISOR Responsibilities:


  • It is the supervisor's responsibility to immediately complete the form linked here. Once submitted it will be sent to Risk Management.  For questions you can  email Carol Kloenne at Note:  Employees should not complete their own Work Comp Claim form.
  • It is the supervisor's responsibility to keep Risk Management informed of the work status of their injured employee(s) by using the WCF-1 Form.

Lost Time and Return to Work Form (WCF-1)

  • It is the supervisor's responsibility to contact Risk Management (as soon as possible) for additional information on how to report employee (off work) lost time.

If Shared Leave is going to be used during the same time as the employee's workers' compensation claim, please contact Risk Management immediately.


Workers' Compensation will begin paying compensation after the employee has been off work due to a work-related injury or illness for at least seven (7) consecutive calendar days.  If the employee is off work for more than fourteen (14) consecutive calendar days, compensation is also payable for the first seven (7) calendar days of the injury.  Workers' Compensation only pays lost time benefits for full days off work, at the direction (in writing) of the treating physician.  The amount of pay from Workers' Compensation is two-thirds (2/3) of the employee's weekly pay.  An employee may use approximately (1/3) their sick and/or vacation leave to bring the total compensation from all sources (UofL and Workers' Compensation) up to the employee's full regular pay.

University Lost Time Benefit:

The University "lost time" benefit is for up to the first 37.5 and/or 40 hours of an employee's lost time claim and is recorded as SLV.  The employee must have a doctor's statement putting the employee off work to receive the University "lost time" benefit.  If an employee returns to work during the first 37.5 and/or 40 hours the University's "lost time" benefit stops.  The benefit can not be restarted, even if there is remaining time left of the first 37.5 and/or 40 hours.  If the employee is off work for 14 days or more workers' compensation will go back and pay the injured employee for the first 37.5 and/or 40 hours they were off on a claim (with doctor's statement).  Since the University paid for up to 37.5 and/or 40 hours of the first time off, and now workers' compensation is also paying 2/3rds for the same time, an overpayment is created.  Risk Management will work with the Payroll Department to get the overpaid funds reimbursed from the employee's pay.

If your employee is missing time, please contact Risk Management to make sure that you are clear on how the employee's time should be reported.

Workers' Compensation does not pay for time off work for a doctors visit, physical therapy, or medical testing.

Please make sure that all claims are reported in a timely manner.  Late or delayed reporting of a claim could jeopardize the compensability of the claim.

If the claim is denied by Workers' Compensation, the employee, or their health insurance is responsible for any payments, including doctor bills, emergency room charges, prescriptions, etc.

If the employee anticipates missing six (6) months or more of work, they may want to file a claim for Long-Term Disability benefits, please contact University Human Resources.

Workers' Compensation Information for Needle Sticks and Tuberculosis Exposures

You may be seen at the following locations for needle sticks and tuberculosis exposures that are work-related:


If you would like more information regarding workers' compensation, please visit the Kentucky Workers Compensation website.

If you have any questions on how to file a claim, please call 852-6926 or email .