Self-insurance and Insurance Company Reporting Requirements
Self-insured employers and insurance companies are legally required to submit (via EDI, Internet or paper forms only when the previous two submission methods cannot be accomplished) all of the following reports to the Worker's Compensation Division:
- A first report of
injury, with the information required by form
WKC-12-E on or before the 14th
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 14th day, the insurance carrier shall
submit the WKC-12 to the department within 7 days of receiving notice of
the injury from any source.
- A supplementary
report, with information required by form
WKC-13-E on or before the 30th
day following the day on which the injury occurred.
- The wage information
required by form
the wage is less than the maximum wage as defined by s. 102.11(1),
Stats. The WKC-13 required in par. (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-E will be submitted.
- If applicable, a
signed statement from the employee to verify that the employee restricts
his/her 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-E. No statement is required if the employee is
under the age of 16.
- A report, using form WKC-13-E 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 these payments were made:
Payment of compensation is changed from temporary disability to permanent disability.
Temporary disability benefits are reinstated.
Temporary partial disability is paid. The insurance carrier or self-insured employer shall also include the information required by form WKC-7359-E.
Final payment of compensation is made. 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-E or shall explain why the report is not being submitted and shall estimate when the final practitioner's report will be submitted.
- When submitting a
stipulation or compromise and at the time of hearing, a current form
WKC-13-E indicating all worker's compensation payments to date and the
periods of time which these payments were made.
- Written notice within 7 days, with a copy to the employee, after each of the following:
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.
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.
Amputation will require an artificial member appliance.
- 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.
- 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.
- 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.
- Written notice if disability extends beyond 13 weeks. Notice shall include a current practitioner's report.
Notices to EE 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.