Self-insurance and Insurance Company Reporting Requirements

Self-insured employers and insurance companies are legally required to submit (via EDI or Internet, paper forms should only be used if these methods cannot be accomplished) all of the following reports to the Worker's Compensation Division:

1. A first report of injury, with the information required by form WKC-12 on or before the 14^th day after an accident or the beginning of a disability from occupational disease. If an employer does not notify the insurance carrier of the injury until after the 14^th day, the insurance carrier shall submit the WKC-12 to the department within 7 days of receiving notice of the injury from any source.
   • If the injury results in a fatality then a first report of injury is due within one day after the date of death. This first report of injury shall be faxed to the Worker's Compensation Division at (608) 267-0394 or reported to the Worker's Compensation Division by phone at (608) 266-1340
2. A supplementary report, with information required by form WKC-13-E on or before the 30^th day following the day on which the injury occurred.
3. The wage information required by form WKC-13-A, if the wage is less than the maximum as defined by s. 102.11(1), Stats. The WKC-13, required in DWD 80.02(2)(b), and the WKC-13-A shall be submitted together unless the wage information required by form WKC-13-A is not available at the time the WKC-13 is submitted. If the WKC-13-A-E information cannot be submitted with the WKC-13 information, the insurance carrier or self-insured employers shall estimate on the WKC-13-E the date by which the WKC-13-A will be submitted.
4. If applicable, a signed statement from the employee to verify that the employee restricts their availability on the labor market to part-time employment, and is not actively employed elsewhere. The employee's statement shall accompany the WKC-13-A. No statement is required if the employee is under the age of 16.
5. A report, using form WKC-13 within 30 days after each of the following events, with a copy of the information to the employee, indicating all worker's compensation payments to date and the periods of time for which any of the following payments were made or salary continuation paid in lieu of compensation:
   1. Payment of compensation is changed from temporary disability or salary continuation paid in lieu of compensation to permanent disability.
   2. Temporary disability benefits or salary continuation paid in lieu of compensation are reinstated.
   3. Temporary partial disability is paid. The insurance carrier or self-insured employer shall also include the information required by form WKC-7359.
   4. Final payment of compensation is made or salary continuation paid in lieu of compensation ended. If there are more than 3 weeks of temporary disability or any permanent disability, or if the injured employee has undergone surgery to treat his or her injury, the insurance carrier or self-insured employers shall submit a final treating practitioner's report together with the final WKC-13 or shall explain why the report is not being submitted and shall estimate when the final practitioner's report will be submitted.
6. When submitting a stipulation or compromise and at the time of hearing, a current form WKC-13 indicating all worker's compensation payments to date and the periods of time which these payments were made.
7. Written notice within 7 days, with a copy to the employee, after each of the following:
   1. Payments are stopped for any reason. If any payments are stopped for a reason others than employee's return to work, the self-insured employers or insurance carrier shall explain why it stopped payments and shall advise the employee what to do to reinstate payments.
   2. A decision to deny liability for payment of compensation is made giving the reason for the denial and advising the employee of the right to a hearing before the division.
   3. Amputation will require an artificial member appliance.
8. Within 14 days of the date of an alleged injury, if the claim is not paid or denied because the insurance carrier or self-insured employer is still investigating the claim, a written explanation of the reason for further investigation, with a copy to the employee. If notice from an insured employer to its insurance carrier is not timely, the insurance carrier shall comply within 14 days of receiving notice of the alleged injury from any source.
9. If increased compensation is due, a final receipt within 30 days of the final payment to the employee, as proof of payment of the increased compensation.
10. If the employee fails to return to a practitioner for a final examination, written notice within 30 days, with a copy to the employee, advising the employee that in order to determine permanent disability, if any, and the final examination is necessary.
11. Written notice if disability extends beyond 13 weeks. Notice shall include a current practitioner's report.

Notices to the employee within 14 days:

An explanation that the claim is not paid because the insurance company or self-insured employer is still investigating the claim. The notice shall specify if additional medical or other information is needed to complete the investigation. The notice shall advise the employee of the right to a hearing before the department if the claim is subsequently denied.

Please include the Worker's Compensation Division's claim number or the Social Security number of the worker on all correspondence, compensation reports and medical reports.