Form 100 Initial Application for Certificate of Filing as a Workers' Compensation Self-insured Group - Kentucky

What Is Form 100?

This is a legal form that was released by the Kentucky Department of Insurance - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 100?A: Form 100 is the Initial Application for Certificate of Filing as a Workers' Compensation Self-insured Group in Kentucky.

Q: Who needs to fill out Form 100?A: Any group seeking to be recognized as a self-insured workers' compensation group in Kentucky needs to fill out Form 100.

Q: What is the purpose of Form 100?A: Form 100 is used to apply for a Certificate of Filing as a Workers' Compensation Self-insured Group in Kentucky.

Q: What information is required on Form 100?A: Form 100 requires information about the group's name, address, contact information, financial statements, and other related details.

Q: Is there a deadline for submitting Form 100?A: There is no specific deadline mentioned for submitting Form 100. However, it is recommended to submit the form well in advance of the desired effective date of self-insurance.

Q: What happens after submitting Form 100?A: After submitting Form 100, the Kentucky Department of Workers' Claims will review the application and notify the group of its decision.

Q: How long does it take to process Form 100?A: The processing time for Form 100 may vary. It is advisable to contact the Kentucky Department of Workers' Claims for an estimate.

Q: What if my Form 100 is denied?A: If Form 100 is denied, the group will be provided with the reasons for denial and may have an opportunity to address any deficiencies and reapply.

Q: Can a self-insured group change its status?A: Yes, a self-insured group can change its status with the Kentucky Department of Workers' Claims by submitting the appropriate forms and meeting the required criteria.

Q: Is assistance available for filling out Form 100?A: Yes, the Kentucky Department of Workers' Claims provides assistance and guidance for filling out Form 100.