WKC-13 - Supplemental Report of Injury

Format | FAQs | Pertinent Information

As of June 22, 2020 WI will no longer accept SROI CO, 02, S1, and FN transmissions.

The format table for electronic subsequent reports details the mandatory, optional and conditional data fields for the various acceptable maintenance type codes. In addition, there is helpful information contained in the frequently asked questions and pertinent information sections that address various important topics on subsequent reports.

EDI Format

Below is the element requirement table for electronic supplemental reports being sent to State of Wisconsin, Worker’s Compensation.  It will detail what fields are mandatory, conditional and optional for the various maintenance type codes (MTC) that we accept.

*NOTE: If a code does not exist in the MTC Requirements, then WC does not accept that code.
MTC Requirements are M(mandatory), C(conditional) or O(optional).

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Supplemental Report (WKC-13) Format

Revised 04/13/2000

Requirements by maintenance type code - IAIABC Release 1 Subsequent Rpt of Injury (A49)

IAIABC	IAIABC	IAIABC	IAIABC	POSITIONS		MTC REQUIREMENTS
GROUPING	DN	DATA ELEMENT NAME	FORMAT	BEG	END	IP
TRANSACTION	0001	Transaction Set ID	3 A/N	1	3	M
	0002	Maintenance Type Code	2 A/N	4	5	M
	0003	Maintenance Type Code Date	DATE	6	13	M
JURISDICTION	0004	Jurisdiction	2 A/N	14	15	M
CLAIM ADMINISTRATOR	0006	Insurer FEIN	9 A/N	16	24	M
	0008	Third Party Administrator FEIN	9 A/N	25	33	C
	0014	Claim Administrator Postal Code	9 A/N	34	42	C
	0042	Social Security Number	9 A/N	43	51	M
	0055	Number of Dependents	2 N	52	53	O
	0069	Pre-Existing Disability	1 A/N	54	54	O
	0056	Date Disability Began	DATE	55	62	M
	0070	Date of Maximum Medical Improvement	DATE	63	70	C
	0071	Return to Work Qualifier	1 A/N	71	71	C
	0072	Date of Return/Release to Work	DATE	72	79	O
	0057	Employee Date of Death	DATE	80	87	C
WAGE	0062	Wage	$9.2	88	98	M
	0063	Wage Period	2 A/N	99	100	M
	0064	Number of Days Worked	1 N	101	101	O
	0067	Salary Continued Indicator	1 A/N	102	102	M
ACCIDENT	0031	Date of Injury	DATE	103	110	M
	0026	Insured Report Number	25 A/N	111	135	O
	0015	Claim Administrator Claim Number	25 A/N	136	160	C
	0005	Agency Claim Number	25 A/N	161	185	C
CLAIM STATUS	0073	Claim Status	1 A/N	186	186	O
	0074	Claim Type	1 A/N	187	187	O
	0075	Agreement to Compensate Code	1 A/N	188	188	O
	0076	Date of Representation	DATE	189	196	O
PAYMENTS	0077	Late Reason Code	2 A/N	197	198	C
VARIABLE SEGMENT COUNTERS	0078	Number of Permanent Impairments	2 N	199	200	M
	0079	Number of Payments/Adjustments	2 N	201	202	M
	0080	Number of Benefit Adjustments	2 N	203	204	M
	0081	Number of Paid to Date/Reduced Earnings/Recoveries	2 N	205	206	M
	0082	Number of Death Dependent/Payee Relationships	2 N	207	208	M
VARIABLE SEGMENTS	Permanent Impairments Occurs Number of Permanent Impairments times.
	0083	Permanent Impairment Body Part Code	3 A/N	1	3	C
	0084	Permanent Impairment Percentage	3.2 N	4	8	C
	Payment/Adjustments Occurs Number of Payment/Adjustments times.
	0085	Payment/Adjustment Code	3 A/N	1	3	M
	0086	Payment/Adjustment Paid to Date	$9.2	4	14	M
	0087	Payment/Adjustment Weekly Amount	$9.2	15	25	C
	0088	Payment/Adjustment Start Date	DATE	26	33	C
	0089	Payment/Adjustment End Date	DATE	34	41	C
	0090	Payment/Adjustment Weeks Paid	4 N	42	45	C
	0091	Payment/Adjustment Days Paid	1 N	46	46	C
	Benefit Adjustments Occurs Number of Benefit Adjustments times.
	0092	Benefit Adjustment Code	4 A/N	1	4	C
	0093	Benefit Adjustment Weekly Amount	$9.2	5	15	C
	0094	Benefit Adjustment Start Date	DATE	16	23	C
	Paid to Date/Reduced Earnings/Recoveries Occurs Number of Paid to Date/Reduced Earning/Recoveries times.
	0095	Paid To Date/Reduced Earnings/Recoveries Code	3 A/N	1	3	C
	0096	Paid To Date/Reduced Earnings/Recoveries Amount	$9.2	4	14	C
	Death Dependent/Payee Relationship Occurs Number of Death Dependent/Payee Relationship times.
	0097	Dependent/Payee Relationship	2 A/N	1	2	C

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EDI Subsequent Reports FAQ

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Pertinent Information on Subsequent Reports

We use the standard IAIABC header and footer for all transmissions, and any dataset without these will be rejected. We accept all datasets from each trading partner, determine the type of transmission from the header and then load all FROI datasets prior to SROI datasets.

We do not require an IP to accompany a FROI as some other jurisdictions do.

For A49 IP transmissions we search for the claim in the database based on SSN + injury date (plus or minus six days); we do not search by the Agency Claim Number. If the claim is not found, then the transmission is rejected with a message that reads CLAIM NOT FOUND IN DATABASE.

For A49 IP transmissions we accept any of the medical expense codes (350, 360, 370) and any of the Vocational Rehabilitation codes (380, 390, 400) in the PTD/REDUCED EARNINGS/RECOVERIES segments. All other codes in these fields are ignored.

For A49 IP transmissions we expect the date of the first payment in the Maintenance_Type_Code_Date field and the amount of the first payment in the Payment/Adjustment_Paid_To_Date field. This means that it is very important that the IP be sent out as soon as possible with the actual first indemnity check date. A Maintenance_Type_Code_Date which is later than the actual first indemnity check date may result in the recording of a delayed first payment and a late payment letter, if the delay is long enough to trigger such a letter.

If the payment is late, then we evaluate the Late_Reason_Code and issue a standard late payment letter, with the letter going to either the insurer or employer depending on the code. If the code is blank and the payment is late, then we accept the transmission and send the letter to the insurer.

We use the Date_Disability_Began field to derive the Last Day Worked (LDW) by subtracting one day from the submitted value. In WI the LDW is defined as an exclusive date. The value in the Date_Of_Return/Release_To_Work field gives us the Return to Work (RTW) date and the value in the Payment/Adjustment_Paid_To_Date field gives us the amount paid. The value in the Payment/Adjustment_Weekly_Amount field is the TTD rate, but rather than using the submitted value in this field we derive the TTD rate from the WKC-13A Wage Supplement (submitted via the Internet on our pending reports website). We also derive the days and weeks paid from the LDW and RTW dates rather than accepting the values in the Payment/Adjustment_Weeks_Paid and Payment/Adjustment_Days_Paid fields.

We do not use the Payment/Adjustment_Start_Date and Payment/Adjustment_End_Date fields for two reasons. First, these fields can be misleading in determining if the waiting period is deducted. Second, we have the impression that various carriers interpret the start and end dates differently, so in the interest of consistency we ignore them.

EXAMPLE

• Injury date 06/09/2014 (Monday)
• Date disability began 06/10/2014 (Tuesday)
• Date returned to work 06/16/2014 (Monday)
• Last Day Worked (derived from date disability began) 06/09/2014 (Monday)
• Waiting period 06/10/2014 through 06/12/2014 (Tuesday through Thursday)
• Payment start date 06/13/2014 (Friday)
• Payment end date 06/14/2014 (Saturday)

The correct payment for this example is two days. The payment start date is the first day payable after the three-day waiting period, and the payment end date is the day of the last payment, which is a Saturday because Sunday 06/15/2014 is not compensable. Notice that using payment start and end date makes it impossible to determine the actual LDW and RTW, which in turn makes it impossible to determine if the waiting period was deducted correctly.

The Worker's Compensation Administrative Code [80.02 (2) (e)] requires the insurer to forward a hard copy of the WKC-13 to the claimant. For thoseWKC-13s reported electronically, however, the insurer can generate a letter from the SROI data and send that to the claimant rather than sending a WKC-13 form per se. The following is a list of required fields that must be included in the letter:

• Name of claimant
• Address of claimant
• Social Security Number
• Date of Accident or illness
• Name of employer
• Name of insurer
• Address of insurer
• Type of payment (TTD, PPDSCH, PPDNON, TPD, SALARY)
• Number of weeks and/or days paid
• Date last worked
• Date released to return to work
• Total amount of compensation paid