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  2. Forms Repository
  3. WKC-18798-E, Claims Handling Change Form

Claims Handling Change Form

Document Number: WKC-18798-E

Description: Each section of this form must be completed in its entirety when a self-employer changes their claims handling office (a/k/a third party) administrators (TPA). Anytime a change occurs, a separate form should be submitted to DWD.

Comments: This form is available as an electronic Microsoft Word template or an Adobe print version if you want to print and complete by hand.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-18798-E (Word/24 KB)

WKC-18798 (pdf/104 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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