Indicator 1: Promptness of Submitting First Report of Injury, Form WKC-12

Indicator Description

This indicator measures insurers' compliance with DWD 80.02(2)(b) relating to submission of the First Report of Injury, form WKC-12, to the Department.

Compliance Requirement

DWD 80.02(3)(b) establishes a promptness standard of 70% or more for all required First Reports of Injury. In order to meet the standard insurers are required to submit the First Report of Injury, form WKC-12, to the Department on or before the 14th day after an accident or the beginning of a disability from an occupational disease for all compensable injuries where disability exists beyond the 3rd day after the employee leaves work as a result of an accident or disease.

Standard or Benchmark

DWD 80.02(3)(b), sets the standard for prompt reporting as follows: 70% or more of First Report of Injury are to be received by the Department within 14 days of the date of injury or the last day worked after injury before the first day of compensable lost time.

Source of Indicator Data

The source of the data is from the WKC-12, specifically the "date of injury" and the "last day worked". The data represents only compensable claims for which Supplementary Reports, WKC-13s, were received during the quarter indicating that the first indemnity payment was made.

Only claims for compensable injuries are included in the measurement. Full Denials and no-lost-time claims are excluded. Those claims under insurer investigation are included at the time they become compensable. Claims put on the Worker's Compensation Division's Information Claims Management System without the receipt of a First Report of Injury are considered late. These are known as "non-reported" claims for example Third Party Settlements.

Computation Methodology

Promptness for the First Report of Injury is measured by computing the number of days from the day following the date of injury or last day of work prior to the first day that caused the first day of lost time to be paid, whichever is later, to the day the report is received. There is no time lapse for "non-reported" claims, but they are included as late and shown as No WKC-12 on the claim detail. Full Denials, no-lost-time claims and hearing loss claims are excluded.

State of Wisconsin Average

What this Indicator Measures

This indicator reflects the individual and combined performance of about 180 insurers with respect to their promptness of submitting the First Report of Injury to the Department. These insurers account for over 90% of the claims submitted. The legal standard for insurers is to submit 70% or more of their First Reports of Injury to the Department within 14 days of the date of injury. Data is updated quarterly.

Explanatory Comments for Current Indicator

The industry average for the past 12 quarters remains at 69%. 3rd quarter 2024 performance is at 67%. Most delays in reporting the First Report of Injury are caused by employer failure to report, in a timely manner, lost time injuries to their insurance carriers. Performance improvement measured by this indicator can be directly attributed to intense monitoring by the WC Division as well as insurance carrier concern to engage in informational outreach to employers regarding when the former should be reporting injuries to the latter. In quarters to come the WC Division will continue to look closely at individual insurance carrier/self-insured employer performance measured by this Indicator with an eye towards improving performance even more.

Indicator 1: Promptness of First Reports

Group A - Large Insurers (400 or more paid claims in the previous calendar year)
Group B - Medium Size Insurers (less than 400 but at least 65 paid claims in the previous calendar year)
Group C - Small Size Insurers (less than 65 paid claims in the previous year, but at least 65 claims in the previous three-year period)

PLEASE NOTE: Quarterly summary reports are static. As such they are a snapshot of performance reflected by our database on the 14^th day of every new quarter. As such, actual performance may be different due to changes to the claims for the given quarter after the reports are run.