Wisconsin Department of Workforce Development

Reasonableness of Fee Dispute Resolution Request

Document Number: WKC-9498
Document Title: Reasonableness of Fee Dispute Resolution Request
Description: This form should be used ONLY for fee disputes related to treatment provided on or after July 1, 1992.
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:

***Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.