The purpose of the Form 113 is for you to choose a gatekeeper physician in the Occupational Managed Care Alliance (OMCA) network with whom you wish to continue treatment for the life of the claim. OMCA is a managed care organization that works with KEMI and provides a network of medical providers who treat work-related injuries. This list of physicians can be found at OMCA Network.

If you do not anticipate further treatment, please indicate this in the appropriate field on the form.