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The State of Wisconsin requires this employer to have worker's compensa on insurance coverage.
Both employees and employers have rights and responsibili es under the worker's compensa on law.
This employer's worker's compensation insurance carrier or claim administrator is:
Name of Insurance Carrier or Claim Administrator
Mailing Address
City, State, Zip Code
Telephone Number
The Department of Workforce Development is an equal opportunity employer and service provider. If you have a disability and need to access this informa on in an alternate format or need it translated to another language, please contact us.
WKC-19606-P (R. 05/2024)