In workers compensation claims in Wisconsin, following a work related injury, if the injured employee misses three days of work, the employer is required to notify its insurance company within seven days of the accident or, for occupational disease, within seven days after the beginning of disability. See Wis. Admin. Code Sec. DWD 80.02(1). If disability persists beyond the third day, self-insured employers and insurance carriers must also file a first report of injury on Form WKC-12, with the DWD on or before the 14th day after the accident or onset of disability. If the insurance carrier has not been given timely notice of the accident or onset of disability, the carrier must submit Form WKC-12 within seven days after receiving notice. Wis. Admin. Code DWD § 80.02(2)(a). WKC-12 forms are not admissible as evidence. See Wis. Stat. Sec. 102.40.
Whenever an insurance carrier files a WKC-12, it must also file Form WKC-13, listing the worker’s comp benefits paid to date, and a Form WKC-13-A, which provides the employee’s wage information so the correct worker’s comp benefits are paid. See Wis. Admin. Code § DWD 80.02(2)(b), (c). These forms are due on or before the 30th day after the accident or onset of disability.
If temporary disability extends beyond three weeks, there is permanent disability, or any surgery, the insurance carrier (or self-insured employer) must also submit a final medical report along with the final Form WKC-13. See Wis. Stat. § 102.13(2)(c) and Wis. Admin. Code § DWD 80.02(2)(e)4. An insurer need not submit a final medical report for any injury if the insurer denies the employee’s claim for compensation and the employee does not contest that denial. Wis. Stat. § 102.13(2)(c). When payments are stopped, the notice must give must give the reason for denial. See Wis. Admin. Code § DWD 80.02(2)(g). Finally, if compensation payments are stopped the insurance carrier must give written notice, with a copy to the employee, within seven days after stopping payments or making the decision to deny liability for payments. See Wis. Admin. Code § DWD 80.02(2)(g).
An insurance company’s decision to deny liability for workers compensation payments because the insurer is still investigating the claim must be made by written notice to the employee within 14 days after the alleged injury or within 14 days from the date the insurer received notice of the injury. The insurer must state specific reasons for the denial and advise the employee of the right to a hearing with the DWD. Wis. Admin. Code § DWD 80.02(2m).
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