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In Wisconsin, the Worker's Compensation system requires the filing of medical reports and first reports of injury on a timely basis. Information on when a medical report or first report of injury is required and what information those reports are required to have can be found below. For complete text of provisions, please see Wisconsin Administrative Code DWD 80.02
Medical reports are required under Wisconsin Administrative Code section DWD 80.02 (2)(e) whenever:
Submit medical reports to the Division when:
An employee who reports a work-related injury waives any physician-patient privilege with respect to any condition reasonably related to the condition for which the employee claims compensation.
The health care provider shall, upon request, provide any party or the department with requested information or written material reasonably related to the injury.
The allowable charges for copies of certified medical records are the greater of 45 cents per page or $7.50 per request plus the actual cost of postage. Charges for paper copies of medical records sold to the patient or a person authorized by the patient to receive the medical records are not subject to Wisconsin sales tax. In addition, sales of electronic copies of medical records that are transmitted electronically are also not subject to Wisconsin sales tax.
A treating practitioner may charge a reasonable fee for the completion of the final report, but may not require prepayment of that fee. If there is a dispute regarding the fee being charged for the report, the dispute may be submitted to the department for resolution under s. 102.16 (2) Wis. Stats.
A treating practitioner may charge a reasonable fee for completing a final report not to exceed $100.
A medical report will be considered to be a "final report" when:
Use of WKC-16 Medical Report On Industrial Injury
WKC-12-E, Employer's First Report of Injury or Disease
This form is for the employer to report every work-related injury to its insurance company. If an employee is out more than 3 days due to a work-related injury, or there is PPD, a copy is to be sent to the Worker's Compensation Division by the employer's worker's compensation insurance carrier, not by the employer (unless the claim is a fatality). Except for fatalities, the information on this form must be sent electronically by the employer's worker's compensation carrier to the WC Division.
The following contains some brief instructions that will help you to write better injury descriptions. These consist of three basic parts: cause of the injury, nature of the injury and objects/substances/activities involved in the injury. Descriptions should be specific, concise and to the point
This part of the description answers the general question "what was the employee doing when the accident occurred?" Give us specific details about the activities involved. Some examples include "carrying boxes across the factory floor", "driving a fork lift", "operating a deep fryer", etc.
This part answers the question "what is the injury?" The answer should include the part of body affected, on what side of the body the injury occurred (if applicable) and how the body part was affected. For example, "fractured left wrist", "contusion to forehead and neck strain", "2nd degree burn both hands and stomach", etc.
The specific question "what was happening and what was involved at the moment the injury occurred?" is answered by this part of the injury description. Discuss the immediate cause of the injury and anything involved. For example, "tripped over pipe and fell", "forklift struck door frame, hit head on roll cage", "dropped basket into fryer, hot grease splashed up onto employee", etc.
The employer must complete all relevant sections on this form and submit it to the employers workers compensation insurance carrier or third party administrator within seven (7) days after the date of a work related injury which causes permanent or temporary disability resulting in compensation for lost time. The employer's insurance carrier or third party administrator may request that this form also be used to immediately report any injury requiring medical treatment, even though it does not involve lost work time.
For any work injury resulting in a fatality the employer must also submit this form directly to the Department of Workforce Development within 24 hours of the fatality. The form can be faxed to (608) 267-0394 or reported by calling (608) 266-1340.
An employer exempt from the duty to insure under s. 102.28, Wis. Stats., and an insurance carrier administering claims for an insured employer are required to submit this form to the Department or Workforce Development within 14 days of the date of work injury.
In order to accurately administer claims each of the following sections of this form must be completed.
Employee Section: Provide all requested information to identify the injured employee. If an employee has multiple dates of employment, the "Date of Hire" is the date the employee was hired for the job on which he or she was injured.
Employer Section: Provide all requested information to identify the injured workers employer at the time of injury. Provide the name and Federal Employer Identification Number (FEIN) for the insurance carrier or self-insured employer responsible for the workers compensation expenses for this injury. Also identify the third party claim administrator if applicable.
Wage Information Section: Provide the information requested regarding the injured employee's wage and hours worked for the job being performed at the time of injury.
Injury Information Section: Provide information regarding the date and time of injury. Provide a detailed description of the injury, including part of body injured, the specific nature of the injury (i.e. fracture, strain, concussion, burn, etc.) and the use of any objects or tools (i.e. saw, ladder, vehicle, etc.) that may have caused the injury. Provide the name of the person preparing this report and the telephone number at which they may be reached if additional information is needed.