Wisconsin Department of Workforce Development

Medical Report on Industrial Injury

Document Number: WKC-16
Document Title: Medical Report on Industrial Injury
Description: To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results.
Division: Worker's Compensation
Comments: This form is not fill enabled. It can be printed and completed by hand.
Content Contact: Don Martin
Document Attachment:

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