Worker's
Compensation Insurance Letters
Date Posted: April 23 1998
Contact Person: Lee Shory, Director, Bureau of Claims Management
Phone Number: (608) 267-9407
Revisions to DWD Admin. Code 80.02
Retention of the WKC-12
April 16, 1998
INS 389
TO: All Worker’s Compensation Insurance Carriers
Self-Insured Employers
Worker’s Compensation Advisory Council
FROM: Gregroy Krohm, Administrator
Worker’s Compensation Division
RE: Retention and correct use of the First Report of Injury, form WKC-12
The recent revisions to DWD 80.02 (1) and the First Report of Injury, WKC-12 have raised some concerns about the Federal Occupational Safety and Health Administration’s
(OSHA) and Wisconsin’s requirements for retaining the employer’s First Report of Injury.
The changes made in DWD 80.02(1) are reporting requirements and do not add retention requirements. Wisconsin’s WC law does not have any retention requirements for form WKC-12. The WKC-12 form is accepted by OSHA as a substitute for the OSHA 101 which must be kept on site for five years. There is no longer a field for entry of an OSHA number on the revised WKC-12 form. This field was seldom used on previous versions and is not required by
OSHA. You may include the OSHA number, clearly identified as such, on form WKC-12 for your cross reference, record keeping purposes.
As a reminder, the WKC-12 is due on or before the 14th day after an accident or the beginning of a disability period. The WKC-12, revised in November, 1997 and February, 1998, are the only versions of the First Report of Injury that we accept. While many insurers use the revised forms, some do not. The Division no longer accepts outdated versions and we will return reports submitted on outdated WKC-12 forms or ones that do not include the required information. The most common error in the use of the new form is the omission of the employer’s, insurer’s and TPA’s FEIN numbers. Our record of reported injuries is associated with these numbers for communication, compliance and research purposes. Please submit the acceptable current versions of the form with complete and correct information.
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