Worker's Compensation Insurance Letters

February 17, 1998

INS 387

To: All Worker’s Compensation Carriers and Self-Insured Employers

From: Gregory Krohm, Administrator

Subject: Introduction of Revised Forms, WKC-12, WKC-13 and WKC-13-A

In order to facilitate the new Worker’s Compensation law changes that became effective January 1, 1998, we have revised our form WKC-12, WKC-13, and WKC-13-A. For your convenience, copies of the final revised versions of those are enclosed.

In order to speed the processing of claims and reduce errors, the First Report of Injury form, WKC-12, was modified in February, 1998. A copy of it is enclosed. The February, 1998 version is on the Internet. We will accept the November, 1997 version which was originally sent with Insurance Letter 384 dated December 29, 1997. If you have not started to use the November, 1997 version, please convert to the February version. We urge all carriers to use the new forms immediately. We will continue to accept pre-November 1997 versions only until April 1, 1998. After that date, non-complying forms will be returned for resubmittal on the proper forms.

The WKC-13-A contains several changes. It includes instructions on the reverse side and is designed to help your staff compute TTD rates accurately. One new aid is direct access to a wage analyst through a special e-mail address, which will produce same day responses to specific questions.

We urge you to begin using these revised forms as soon as possible. You may reproduce these forms. If you re-create these forms within your own automated systems, ensure they duplicate these formats and contain the form numbers. If you are making minor revisions, obtain authorization from the Worker’s Compensation Division before using them. The word processing file to create these forms can be downloaded easily from our website:

Please ensure that your staff or your claim administrators receive, understand, and submit these forms when due.

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