Kentucky Labor Cabinet - Department of Workers' Claims

Employee Leasing Application

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• Must report workers’ compensation policies issued to the employee leasing company or its predecessor(s) that have been cancelled or non-renewed within the last five (5) years

• List, by jurisdiction, of each and every name Lessor has operated under in preceding five years including any
  alternative names and names of predecessors or successors
• List of each and every person or entity currently owning a five percent or greater interest in the employee leasing company
• List of each and every person or entity formerly owning a five percent or greater interest in the employee leasing company or its predecessors, successors or alter egos in the preceding five years

Employee Leasing Application (Renewal)

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Annually

• List, by jurisdiction, of each and every name Lessor has operated under in preceding five years including any
  alternative names and names of predecessors or successors
• List of each and every person or entity currently owning a five percent or greater interest in the employee leasing company
• List of each and every person or entity formerly owning a five percent or greater interest in the employee leasing company or its predecessors, successors or alter egos in the preceding five years

Form EL-2: Lessee Information Form

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Within 90 days of initial registration and every 6 months from the anniversary of the registration.

Every Kentucky Lessee whose workers' compensation insurance coverage for leased employees, as required by KRS 342.340 and KRS 342.640, is provided by an insurance policy in the name of the Employee Leasing Company or related entity must submit this form periodically.

Utilization Review/Medical Bill Audit Application

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Utilization Review/Medical Bill Audit Application (Renewal)

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4 years from the date of submission.