Work Comp Election form information
The Kansas Workers Compensation Act allows certain employers or individuals to choose their statusunder the Act. This process is known as filing a written statement of election. Below are the various
election forms presently in use:
Form K-WC 50 is filed by an employee of a corporation who owns 10 percent or more of the corporate stock to elect not to be covered under the Act.
Form K-WC 50a cancels a K-WC 50 election. (See K.S.A. 44-543(b))
Form K-WC 51 is filed by an employer that is exempt from the law to choose to be covered. This includes employers with less than a $20,000 payroll and employers involved in agricultural pursuits.
Form K-WC 51a cancels the election made by K-WC 51. (See K.S.A. 44-505(b)).
Form K-WC 113 is filed by an individual, proprietor, members of LLC's or partner to elect to cover himself or herself under the Act.
Form K-WC 114 cancels the election made by K-WC 113. Both of these forms must be signed by a group pool administrator or an official of the insurance carrier. A signature of an agent is not acceptable. (See K.S.A. 44-542a)
Form K-WC 123 is filed by an employer to elect to provide coverage for all or part of his or her volunteer workers.
Form K-WC 124 cancels the election made by K-WC 123. (See K.S.A. 44-508(b)) is filed by an employer to elect to provide coverage for persons who are performing public or community service as a requirement to receive public assistance or as a result of a contract or diversion, assignment to a community corrections program, or suspension of sentence or as a condition of probation or in lieu of a fine.
Form K-WC 135 is filed by an employer to elect to provide coverage for persons who are performing public or community service as a requirement to receive public assistance or as a result of a contract or diversion, assignment to a community corrections program, or suspension of sentence or as a condition of probation or in lieu of a fine.
Form K-WC 135a cancels the election made by K-WC 135. (See K.S.A. 44-508(b))
Form K-WC 137 is filed by volunteer directors, officers, or trustees of a nonprofit organization to elect coverage under the Workers Compensation Act.
K-WC 138 (Rev. 2-09)
KANSAS DEPARTMENT OF LABOR
DIVISION OF WORKERS COMPENSATION
800 SW Jackson Street, Suite 600, Topeka, KS 66612-1227
Phone (785) 296-2996 • Fax (785) 296-0025 • Toll Free (800) 332-0353
Questions concerning the proper filing or use of elections can be referred to the Ombudsman/
Claims Advisory Section at (800) 332-0353.
www.dol.ks.gov
