2. Worker's Compensation
3. Letters of Insurance
4. Standard Letters
5. BIP Letters

BIP Letters

• BIP1ST - Your response to our previous requests for a first WKC-13, Supplementary Report on Accidents and Industrial Diseases, for the claim referenced above is overdue


• BIP45A - This is a request for overdue information. The Wage Information Supplement, form WKC-13A, has not been submitted as required in accordance with DWD 80.02(2)(c) of the Wisconsin Administrative Code. The wage information should be submitted with the first WKC-13


• BIP45B - WKC-17673-E - This is a request for overdue information. The Wage Information Supplement, WKC-13A, you submitted was incomplete. Please provide the form requested below and return this form to the Worker's Compensation Division within 30 days

Gross Earnings

1. During the 52-week period prior to the week of injury, how many weeks did the employee work at the same type of employment during the time of injury?
2. What were the employee’s total earnings during those weeks? (Include any bonus or premium, but exclude tips.)

• BIP45D - WKC-17674-E - The Wage Information Supplement, WKC-13A, you submitted was incomplete. We need to determine the correct average weekly wage for computing the TTD rate. Please answer the following questions and return this form to the Worker’s Compensation Division within 30 days.

Part-time work:

1. How many hours per week was the employee scheduled when injured?
2. How many other employees worked the same schedule of hours per week?
3. How many full-time employees did the same type of work?

• BIP45H - WKC-17675-E - This is a request for overdue information. The Wage Information Supplement, WKC-13A, you submitted was incomplete. We need to determine the correct average weekly wage for computing the TTD rate. Please answer the following questions and return this form to the Worker’s Compensation Division within 30 days.

Gross earnings:

1. During the 52-week period prior to the week of injury, how many weeks did the employee work at the same type of employment during the time of injury?
2. What were the total earnings during those weeks? (Include bonus or premium pay but exclude tips)

Part-time work:

1. How many hours per week was the employee scheduled when injured?
2. How many other employees worked the same schedule of hours per week?
3. How many full-time employees did the same type of work?

• BIP45M - WKC-17676-E - This is a request for overdue information. The Wage Information Supplement, WKC-13A, you submitted was incomplete. We need to determine the correct average weekly wage for computing the TTD rate. Please answer the following questions and return this form to the Worker’s Compensation Division within 30 days.

1. During the 52-week period prior to the date of injury, how many weeks did the employee work at the same type of employment during the time of injury?
2. What were the total earnings during those weeks? (Include bonus or premium pay, but exclude tips.)
3. In the 13-week period prior to the date of injury, was the employee paid premium pay or time-and-a-half pay? ____Yes _____No
   If 'Yes', after how many hours?
4. Was the company's or department's work schedule for the employment at which the employee worked at the time of the injury in effect for 13 or more weeks prior to the date of injury? ____Yes _____No

• BIP45P - This is a request for overdue information. We received wage information that indicates the average weekly wage used for computing the TTD /PPD rate(s) may be incorrect. For verification of the correct average weekly wage, please submit the following information to the Worker's Compensation Division within 30 days:

• A week-by-week listing of gross taxable earnings for the 52-week period ending immediately prior to the week in which the injury occurred. Include earnings for overtime, bonuses, incentive or performance pay, commissions and all other taxable earnings excluding tips.
• If the employee received tips, send a week-by-week list of the tips reported.
• If the employee worked for this employer less than 52 weeks prior to the week of injury, list earnings from the date of hire.

• BIP77A - This is our second request for this information. Our calculations of the disability amounts due and paid to date for this claim are shown below. Please pay the balance due promptly and confirm that your payment has been made by submitting an amended Supplementary Report, WKC-13, within 30 days of the date of this letter. If you disagree with our calculation of the amount due and have paid a different amount, please explain the basis for your payment on the amended WKC-13.
• BIPFNL - Your response to our previous requests for an updated WKC-13, Supplementary Report on Accidents and Industrial Diseases, for the claim referenced above is overdue.
• BIPINV - Your response to our previous request for a WKC-13, Supplementary Report on Accidents and Industrial Diseases, indicating the disposition of your investigation on the claim referenced above is overdue. Please advise us of the results of your investigation on the claim referenced above.
• BIPMED - Your response to our previous requests for a final medical report from the treating doctor for the claim referenced above is overdue. The final medical report includes information stating the extent of any permanent partial disability and the worker’s end of healing for the above claim.