Since Kentucky's 2018 change to KRS 342.020, medical benefits for a work injury or occupational disease end after a set period unless continued. To support an employee's application to continue them, the treating physician completes this one-page report stating whether further treatment is reasonably necessary, explaining why, and describing that treatment in general terms. It is filed with Form CMB-APP-1.
The treating physician completes and signs the whole form, adding medical specialty and address. The employee files the CMB-APP-1 application that it supports.
Download the current version from the source each time; forms change without notice.
Medical Report in Support of Continuation of Medical Benefits
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
When an employee applies to continue workers' compensation medical benefits past the cut-off set by the 2018 change to KRS 342.020. The treating physician's report supports the employee's Form CMB-APP-1 application to the Department of Workers' Claims.
The form asks for a general description of reasonably necessary treatment related to the work injury or disease, after a yes or no opinion with an explanation. It has a few lines for each answer and asks for no codes or itemized plan.