{"data":{"id":"us-ky/krs-342.0011","jurisdiction":"us-ky","citation":"KRS 342.0011","heading":"Definitions for chapter.","body":"As used in this chapter, unless the context otherwise requires:\n(1) \"Injury\" means any work -related traumatic event or series of traumatic events,\nincluding cumulative trauma, arising out of and in the course of employment which\nis the proximate cause prod ucing a harmful change in the human organism\nevidenced by objective medical findings. \"Injury\" does not include the effects of the\nnatural aging process, and does not include any communicable disease unless the\nrisk of contracting the disease is increased by the nature of the employment.\n\"Injury\" when used generally, unless the context indicates otherwise, shall include\nan occupational disease and damage to a prosthetic appliance, but shall not include\na psychological, psychiatric, or stress-related change in the human organism, unless\nit is a direct result of a physical injury;\n(2) \"Occupational disease\" means a disease arising out of and in the course of the\nemployment;\n(3) An occupational disease as defined in this chapter shall be deemed to arise out of\nthe employment if there is apparent to the rational mind, upon consideration of all\nthe circumstances, a causal connection between the conditions under which the\nwork is performed and the occupational disease, and which can be seen to have\nfollowed as a natural incident to the work as a result of the exposure occasioned by\nthe nature of the employment and which can be fairly traced to the employment as\nthe proximate cause. The occupational disease shall be incidental to the character of\nthe business and not independent of the relationship of employer and employee. An\noccupational disease need not have been foreseen or expected but, after its\ncontraction, it must appear to be related to a risk connected with the employment\nand to have flowed from that source as a rational consequence;\n(4) \"Injurious exposure\" shall mean that exposure to occupational hazard which would,\nindependently of any other cause whatsoever, produce or cause the disease for\nwhich the claim is made;\n(5) \"Death\" means death resulting from an injury or occupational disease;\n(6) \"Carrier\" means any insurer, or legal representative thereof, authorized to insure the\nliability of employers under this chapter and includes a self-insurer;\n(7) \"Self-insurer\" is an employer who has been authorized un der the provisions of this\nchapter to carry his own liability on his employees covered by this chapter;\n(8) \"Department\" means the Department of Workers' Claims administratively attached\nto the Office of the Governor;\n(9) \"Commissioner\" means the commissioner of the Department of Workers' Claims;\n(10) \"Board\" means the Workers' Compensation Board;\n(11) (a) \"Temporary total disability\" means the condition of an employee who has not\nreached maximum medical improvement from an injury and has not reached a\nlevel of improvement that would permit a return to employment;\n(b) \"Permanent partial disability\" means the condition of an employee who, d ue\nto an injury, has a permanent disability rating but retains the ability to work;\nand\n(c) \"Permanent total disability\" means the condition of an employee who, due to\nan injury, has a permanent disability rating and has a complete and permanent\ninability to perform any type of work as a result of an injury, except that total\ndisability shall be irrebuttably presumed to exist for an injury that results in:\n1. Total and permanent loss of sight in both eyes;\n2. Loss of both feet at or above the ankle;\n3. Loss of both hands at or above the wrist;\n4. Loss of one (1) foot at or above the ankle and the loss of one (1) hand at\nor above the wrist;\n5. Permanent and complete paralysis of both arms, both legs, or one (1)\narm and one (1) leg;\n6. Incurable insanity or imbecility; or\n7. Total loss of hearing;\n(12) \"Income benefits\" means payments made under the provisions of this chapter to the\ndisabled worker or his dependents in case of death, excluding medical and related\nbenefits;\n(13) \"Medical and related benefits\" me ans payments made for medical, hospital, burial,\nand other services as provided in this chapter, other than income benefits;\n(14) \"Compensation\" means all payments made under the provisions of this chapter\nrepresenting the sum of income benefits and medical and related benefits;\n(15) \"Medical services\" means medical, surgical, dental, hospital, nursing, and medical\nrehabilitation services, medicines, and fittings for artificial or prosthetic devices;\n(16) \"Person\" means any individual, partnership, limited partnership, limited liability\ncompany, firm, association, trust, joint venture, corporation, or legal representative\nthereof;\n(17) \"Wages\" means, in addition to money payments for services rendered, the\nreasonable value of board, rent, housing, lodging, f uel, or similar advantages\nreceived from the employer, and gratuities received in the course of employment\nfrom persons other than the employer as evidenced by the employee's federal and\nstate tax returns;\n(18) \"Agriculture\" means the operation of farm pre mises, including the planting,\ncultivation, producing, growing, harvesting, and preparation for market of\nagricultural or horticultural commodities thereon, the raising of livestock for food\nproducts and for racing purposes, and poultry thereon, and any wo rk performed as\nan incident to or in conjunction with the farm operations, including the sale of\nproduce at on-site markets and the processing of produce for sale at on-site markets.\nIt shall not include the commercial processing, packing, drying, storing,  or canning\nof such commodities for market, or making cheese or butter or other dairy products\nfor market;\n(19) \"Beneficiary\" means any person who is entitled to income benefits or medical and\nrelated benefits under this chapter;\n(20) \"United States,\" when  used in a geographic sense, means the several states, the\nDistrict of Columbia, the Commonwealth of Puerto Rico, the Canal Zone, and the\nterritories of the United States;\n(21) \"Alien\" means a person who is not a citizen, a national, or a resident of the U nited\nStates or Canada. Any person not a citizen or national of the United States who\nrelinquishes or is about to relinquish his residence in the United States shall be\nregarded as an alien;\n(22) \"Insurance carrier\" means every insurance carrier or insuran ce company authorized\nto do business in the Commonwealth writing workers' compensation insurance\ncoverage and includes the Kentucky Employers Mutual Insurance Authority and\nevery self-insured group operating under the provisions of this chapter;\n(23) (a) \"Severance or processing of coal\" means all activities performed in the\nCommonwealth at underground, auger, and surface mining sites; all activities\nperformed at tipple or processing plants that clean, break, size, or treat coal;\nand all activities performe d at coal loading facilities for trucks, railroads, and\nbarges. Severance or processing of coal shall not include acts performed by a\nfinal consumer if the acts are performed at the site of final consumption.\n(b) \"Engaged in severance or processing of coal \" shall include all individuals,\npartnerships, limited partnerships, limited liability companies, corporations,\njoint ventures, associations, or any other business entity in the Commonwealth\nwhich has employees on its payroll who perform any of the acts st ated in\nparagraph (a) of this subsection, regardless of whether the acts are performed\nas owner of the coal or on a contract or fee basis for the actual owner of the\ncoal. A business entity engaged in the severance or processing of coal,\nincluding but not limited to administrative or selling functions, shall be\nconsidered wholly engaged in the severance or processing of coal for the\npurpose of this chapter. However, a business entity which is engaged in a\nseparate business activity not related to coal, for which a separate premium\ncharge is not made, shall be deemed to be engaged in the severance or\nprocessing of coal only to the extent that the number of employees engaged in\nthe severance or processing of coal bears to the total number of employees.\nAny employee who is involved in the business of severing or processing of\ncoal and business activities not related to coal shall be prorated based on the\ntime involved in severance or processing of coal bears to his total time;\n(24) \"Premium\" for every self-insured group means any and all assessments levied on its\nmembers by such group or contributed to it by the members thereof. For special\nfund assessment purposes, \"premium\" also includes any and all membership dues,\nfees, or other payments by members of the gro up to associations or other entities\nused for underwriting, claims handling, loss control, premium audit, actuarial, or\nother services associated with the maintenance or operation of the self -insurance\ngroup;\n(25) (a) \"Premiums received\" for policies effective on or after January 1, 1994, for\ninsurance companies means direct written premiums as reported in the annual\nstatement to the Department of Insurance by insurance companies, except that\n\"premiums received\" include s premiums charged off or deferred, and, on\ninsurance policies or other evidence of coverage with provisions for\ndeductibles, the calculated cost for coverage, including experience\nmodification and premium surcharge or discount, prior to any reduction for\ndeductibles. The rates, factors, and methods used to calculate the cost for\ncoverage under this paragraph for insurance policies or other evidence of\ncoverage with provisions for deductibles shall be the same rates, factors, and\nmethods normally used by th e insurance company in Kentucky to calculate\nthe cost for coverage for insurance policies or other evidence of coverage\nwithout provisions for deductibles, except that, for insurance policies or other\nevidence of coverage with provisions for deductibles ef fective on or after\nJanuary 1, 1995, the calculated cost for coverage shall not include any\nschedule rating modification, debits, or credits. For policies with provisions\nfor deductibles with effective dates on or after January 1, 1995, assessments\nshall b e imposed on premiums received as calculated by the deductible\nprogram adjustment. The cost for coverage calculated under this paragraph by\ninsurance companies that issue only deductible insurance policies in Kentucky\nshall be actuarially adequate to cover  the entire liability of the employer for\ncompensation under this chapter, including all expenses and allowances\nnormally used to calculate the cost for coverage. For policies with provisions\nfor deductibles with effective dates of May 6, 1993, through Dec ember 31,\n1993, for which the insurance company did not report premiums and remit\nspecial fund assessments based on the calculated cost for coverage prior to the\nreduction for deductibles, \"premiums received\" includes the initial premium\nplus any reimburse ments invoiced for losses, expenses, and fees charged\nunder the deductibles. The special fund assessment rates in effect for\nreimbursements invoiced for losses, expenses, or fees charged under the\ndeductibles shall be those percentages in effect on the eff ective date of the\ninsurance policy. For policies covering covered employees having a co -\nemployment relationship with a professional employer organization and a\nclient as defined in KRS Chapter 336, \"premiums received\" means premiums\ncalculated using the e xperience modification factor of each client as defined\nin KRS Chapter 336 for each covered employee for that portion of the payroll\npertaining to the covered employee.\n(b) \"Direct written premium\" for insurance companies means the gross premium\nwritten le ss return premiums and premiums on policies not taken but\nincluding policy and membership fees.\n(c) \"Premium,\" for policies effective on or after January 1, 1994, for insurance\ncompanies means all consideration, whether designated as premium or\notherwise, for workers' compensation insurance paid to an insurance company\nor its representative, including, on insurance policies with provisions for\ndeductibles, the calculated cost for coverage, including experience\nmodification and premium surcharge or discount,  prior to any reduction for\ndeductibles. The rates, factors, and methods used to calculate the cost for\ncoverage under this paragraph for insurance policies or other evidence of\ncoverage with provisions for deductibles shall be the same rates, factors, and\nmethods normally used by the insurance company in Kentucky to calculate\nthe cost for coverage for insurance policies or other evidence of coverage\nwithout provisions for deductibles, except that, for insurance policies or other\nevidence of coverage with p rovisions for deductibles effective on or after\nJanuary 1, 1995, the calculated cost for coverage shall not include any\nschedule rating modifications, debits, or credits. For policies with provisions\nfor deductibles with effective dates on or after January  1, 1995, assessments\nshall be imposed as calculated by the deductible program adjustment. The cost\nfor coverage calculated under this paragraph by insurance companies that\nissue only deductible insurance policies in Kentucky shall be actuarially\nadequate to cover the entire liability of the employer for compensation under\nthis chapter, including all expenses and allowances normally used to calculate\nthe cost for coverage. For policies with provisions for deductibles with\neffective dates of May 6, 1993, thr ough December 31, 1993, for which the\ninsurance company did not report premiums and remit special fund\nassessments based on the calculated cost for coverage prior to the reduction\nfor deductibles, \"premium\" includes the initial consideration plus any\nreimbursements invoiced for losses, expenses, or fees charged under the\ndeductibles.\n(d) \"Return premiums\" for insurance companies means amounts returned to\ninsureds due to endorsements, retrospective adjustments, cancellations,\ndividends, or errors.\n(e) \"Deductible program adjustment\" means calculating premium and premiums\nreceived on a gross basis without regard to the following:\n1. Schedule rating modifications, debits, or credits;\n2. Deductible credits; or\n3. Modifications to the cost of coverage from incept ion through and\nincluding any audit that are based on negotiated retrospective rating\narrangements, including but not limited to large risk alternative rating\noptions;\n(26) \"Insurance policy\" for an insurance company or self -insured group means the term\nof insurance coverage commencing from the date coverage is extended, whether a\nnew policy or a renewal, through its expiration, not to exceed the anniversary date\nof the renewal for the following year;\n(27) \"Self-insurance year\" for a self -insured group mean s the annual period of\ncertification of the group created pursuant to KRS 342.350(4) and 304.50-010;\n(28) \"Premium\" for each employer carrying his own risk pursuant to KRS 342.340(1)\nshall be the projected value of the employer's workers' compensation clai ms for the\nnext calendar year as calculated by the commissioner using generally -accepted\nactuarial methods as follows:\n(a) The base period shall be the earliest three (3) calendar years of the five (5)\ncalendar years immediately preceding the calendar year  for which the\ncalculation is made. The commissioner shall identify each claim of the\nemployer which has an injury date or date of last injurious exposure to the\ncause of an occupational disease during each one (1) of the three (3) calendar\nyears to be used as the base, and shall assign a value to each claim. The value\nshall be the total of the indemnity benefits paid to date and projected to be\npaid, adjusted to current benefit levels, plus the medical benefits paid to date\nand projected to be paid for the  life of the claim, plus the cost of medical and\nvocational rehabilitation paid to date and projected to be paid. Adjustment to\ncurrent benefit levels shall be done by multiplying the weekly indemnity\nbenefit for each claim by the number obtained by dividi ng the statewide\naverage weekly wage which will be in effect for the year for which the\npremium is being calculated by the statewide average weekly wage in effect\nduring the year in which the injury or date of the last exposure occurred. The\ntotal value of  the claims using the adjusted weekly benefit shall then be\ncalculated by the commissioner. Values for claims in which awards have been\nmade or settlements reached because of findings of permanent partial or\npermanent total disability shall be calculated u sing the mortality and interest\ndiscount assumptions used in the latest available statistical plan of the\nadvisory rating organization defined in Subtitle 13 of KRS Chapter 304. The\nsum of all calculated values shall be computed for all claims in the base\nperiod;\n(b) The commissioner shall obtain the annual payroll for each of the three (3)\nyears in the base period for each employer carrying his own risk from records\nof the department and from the records of the Department of Workforce\nDevelopment, Education and Labor Cabinet. The commissioner shall multiply\neach of the three (3) years of payroll by the number obtained by dividing the\nstatewide average weekly wage which will be in effect for the year in which\nthe premium is being calculated by the statewide average weekly wage in\neffect in each of the years of the base period;\n(c) The commissioner shall divide the total of the adjusted claim values for the\nthree (3) year base period by the total adjusted payroll for the same three (3)\nyear period. The value so calculated shall be multiplied by 1.25 and shall then\nbe multiplied by the employer's most recent annualized payroll, calculated\nusing records of the department and the Department of Workforce\nDevelopment data which shall be made available for this purpo se on a\nquarterly basis as reported, to obtain the premium for the next calendar year\nfor assessment purposes under KRS 342.122;\n(d) For November 1, 1987, through December 31, 1988, premium for each\nemployer carrying its own risk shall be an amount calcula ted by the board\npursuant to the provisions contained in this subsection and such premium\nshall be provided to each employer carrying its own risk and to the funding\ncommission on or before January 1, 1988. Thereafter, the calculations set\nforth in this subsection shall be performed annually, at the time each employer\napplies or renews its application for certification to carry its own risk for the\nnext twelve (12) month period and submits payroll and other data in support\nof the application. The employer and the funding commission shall be notified\nat the time of the certification or recertification of the premium calculated by\nthe commissioner, which shall form the employer's basis for assessments\npursuant to KRS 342.122 for the calendar year beginning on January 1\nfollowing the date of certification or recertification;\n(e) If an employer having fewer than five (5) years of doing business in this state\napplies to carry its own risk and is so certified, its premium for the purposes\nof KRS 342.122 shall be based on the lesser number of years of experience as\nmay be available including the two (2) most recent years if necessary to create\na three (3) year base period. If the employer has less than two (2) years of\noperation in this state available for the premiu m calculation, then its premium\nshall be the greater of the value obtained by the calculation called for in this\nsubsection or the amount of security required by the commissioner pursuant to\nKRS 342.340(1);\n(f) If an employer is certified to carry its own risk after having previously insured\nthe risk, its premium shall be calculated using values obtained from claims\nincurred while insured for as many of the years of the base period as may be\nnecessary to create a full three (3) year base. After the employer  is certified to\ncarry its own risk and has paid all amounts due for assessments upon\npremiums paid while insured, the employer shall be assessed only upon the\npremium calculated under this subsection;\n(g) \"Premium\" for each employer defined in KRS 342.630 (2) shall be calculated\nas set forth in this subsection; and\n(h) Notwithstanding any other provision of this subsection, the premium of any\nemployer authorized to carry its own risk for purposes of assessments due\nunder this chapter shall be no less than t hirty cents ($0.30) per one hundred\ndollars ($100) of the employer's most recent annualized payroll for employees\ncovered by this chapter;\n(29) \"SIC code\" as used in this chapter means the Standard Industrial Classification\nCode contained in the latest edition of the Standard Industrial Classification Manual\npublished by the Federal Office of Management and Budget;\n(30) \"Investment interest\" means any pecuniary or beneficial interest in a provider of\nmedical services or treatment under this chapter, other t han a provider in which that\npecuniary or investment interest is obtained on terms equally available to the public\nthrough trading on a registered national securities exchange, such as the New York\nStock Exchange or the American Stock Exchange, or on the N ational Association\nof Securities Dealers Automated Quotation System;\n(31) \"Managed health care system\" means a health care system that employs gatekeeper\nproviders, performs utilization review, and does medical bill audits;\n(32) \"Physician\" means physicia ns and surgeons, audiologists holding a doctorate in\naudiology, psychologists, optometrists, dentists, podiatrists, and osteopathic and\nchiropractic practitioners acting within the scope of the license or other credentials\nrequired by his or her specialty of practice in the United States jurisdiction in which\nhe or she is authorized to practice;\n(33) \"Objective medical findings\" means information gained through direct observation\nand testing of the patient applying objective or standardized methods;\n(34) \"Work\" means providing services to another in return for remuneration on a regular\nand sustained basis in a competitive economy;\n(35) \"Permanent impairment rating\" means percentage of whol e body impairment\ncaused by the injury or occupational disease as determined by the \"Guides to the\nEvaluation of Permanent Impairment\";\n(36) \"Permanent disability rating\" means the permanent impairment rating selected by\nan administrative law judge times t he factor set forth in the table that appears at\nKRS 342.730(1)(b); and\n(37) \"Guides to the Evaluation of Permanent Impairment\" means, except as provided in\nKRS 342.262:\n(a) The fifth edition published by the American Medical Association; and\n(b) For psychological impairments, Chapter 12 of the second edition published by\nthe American Medical Association.","path":["KRS Chapter 342"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56771","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:58:30Z","sha256":"03591efc8137d1d109af567bf2ddf4bdf99e810e477348a2010f9d715d6bc7a3","source_id":"us-ky","stale":false,"prev":"us-ky/krs-342.001","next":"us-ky/krs-342.0012"},"notice":"GroundRules: Original legal text. Not legal advice."}