Compensation Claim Flow
- Report of Injury by the Employee
An employee reports a work related injury or illness to the
employer as soon as possible after the accident, or after becoming aware
of the injury. In most situations this report should be made within 30
days. However, the employee must report the injury to the employer
within two years in order to qualify for worker's compensation. If,
however, the employer knew or should have known about the injury, the
statute of limitations for making a claim is 12 years. In the case of
occupational disease and certain traumatic injuries, there is no statute
- Report of Injury to the Worker's Compensation Insurance Carrier
An employer is required to report all work injuries or illnesses to its
worker's compensation insurance carrier within 7 days after actual
knowledge of the injury. If the injury is a fatality, however, the
report must be made to the insurance carrier within 24 hours. The
employer must also report medical only claims to its insurance carrier.
- Report of Injury to the
Insurance carriers must electronically report all lost-time, compensable
injury claims to the WC Division within 14 days after the date of
injury. If the injury is a fatality, however, the employer must make
this report--on paper--to the WC Division as well as the insurance
carrier within 24 hours.
- Payment and Other Related Information Reported to the WC Division
30 days following the date of injury the insurance carrier must
electronically report both the WKC-13 Supplemental Report and the
WKC-13A Wage Information Supplement to the WC Division. The WKC-13 is a
record of all payments (TTD, TPD, Salary Continued., PPD, etc.) made to
the injured employee. If there is more than three weeks of lost time, an
amputation, surgery or PPD a final medical report must also be
reported (via fax or mail) to the WC Division.
- Injured Worker Files Application for a Hearing
An injured worker has twelve years from the date of injury or the date
of last compensation payment to file with the WC Division an application
for a formal hearing before an Administrative Law Judge (ALJ). Litigated
claims whereby the applicant is not represented by an attorney (pro se)
are identified by
Dispute Resolution Staff (DSR)
and an attempt is made
to avoid a formal hearing through informal mediation. If a formal
hearing cannot be avoided, DSR staff ensures the file is complete and
ready for hearing. A pre-hearing conference with an ALJ will also be held
for certain pro se claims, in order to narrow the issues and explain the
- Hearings are Scheduled
Applications for hearing are normally assigned to
an ALJ on a first-in, first-out basis. Hearings are generally held in
the municipality of the applicant's residence. Once assigned, all
parties involved in the case are notified in writing of the date,
time and location of the hearing.
- Formal WC Hearing Held
The ALJ hears evidence presented by both the respondent and claimant at
one or more hearings. Most disputes are resolved with one
hearing. About two-thirds of all for a hearing are settled
without a formal hearing actually being held. Many of these are
compromised or stipulated.
- Decision Rendered
The ALJ issues a decision within 90 days after the close of the record,
which usually means 90 days after the hearing. The typical decision is issued in less than 50 days.
- Appeal to Labor Industry Review Commission (LIRC)
Within 21 days after the ALJ issues a decision either party may file a
petition for review with LIRC.
- Appeal to Circuit Court
Within 30 days after the LIRC decision either party may start an action
in the circuit court of the county in which he or she resides.
- Court of Appeals
Within 45 or 90 days depending on when the notice of entry of judgment
is served, either party may appeal to the Court of Appeals.
- Wisconsin Supreme Court
Within 30 days after the Court of Appeals decision either party may file
a petition for review with the Supreme Court.
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