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KRHA Workers Compensation Reporting Form


This form is for reporting workers compensation claims.  If you are reporting a business claim please call (316) 267-8388 or Kansas toll free (800) 279-5742.


There is a $250 penalty for repeated failure to file accident reports within 28 days of the date the employer is informed of the accident.  Submission does not constitute admission of liability.

Describe in detail nature and extent of injury, indicate part of body involved.

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