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Worker's Compensation

Summary of Reporting Requirements in DWD 80.02

WHO REPORTS	WHEN	WHAT	TO WHOM	RULE
Insured Employers	Within 1 day after date of death	Death	Department and Carrier	80.02(1)
	Within 7 days from date of accident or beginning of a disability from occupational disease	Compensable injury	Carrier	80.02(1)
	Within 7 days from date of accident or beginning of a disability from occupational disease	Unpaid medical bills	Carrier	80.02(1)
Self-insured employers and insurance carriers	Within 14 days from date of accident or beginning of a disability from occupational disease	WKC-12 [First Report of Injury]	Department	80.02(2)(a)
	Within 30 days following the day on which the injury occurred	WKC-13 [Supplementary Report, i.e. payment information]	Department	80.02(2)(b)
	With the WKC-13 (or later)	WKC-13-A [Wage Information Supplement] with the WKC-13 if wage less than maximum. (Later if wage information not available at time of WKC-13 submission)	Department	80.02(2)(c)
	With the WKC-13	Self Restriction to Part-Time Work Statement, if applicable, with the WKC-13-A	Department	80.02(2)(d)
	Within 30 days of the event	Updated WKC-13 if: 1. Compensation changes from temporary disability to permanent disability 2. Temporary disability is reinstated 3. Temporary partial disability is paid (include the WKC-7359 TPD Worksheet) 4. Final payment of compensation made.  If applicable, include a final medical report with the WKC-13, or explain why the report is not being submitted and provide an estimated submission date. A final medical report is applicable when: (a) there is more than three weeks of temporary disability (except in the case of a hernia), (b) there is permanent partial disability and/or (c) the injured employee has undergone surgery--except to correct a hernia--in order to treat his or her injury	Department and employee	80.02(2)(e)
	Submission of a stipulation or compromise	Up to date and current WKC-13	Department	80.02(2)(f)
	At the time of hearing	Up to date and current WKC-13	Department and employee’s attorney	80.02(2)(f)
	Within 7 days of the event	Written notice if: 1. Payments stopped for any reason. If reason is other than employee’s return to work, provide explanation for reason of stopped payments and what employee can do to reinstate payments 2. Liability denied after concession of liability is made, giving a reason for the denial and advising the employee of the right to a hearing before the department 3. Amputation	Department and employee	80.02(2)(g)
	Within 14 days of the date of an alleged injury	Written notice if: 1. Liability denied, giving a reason for the denial and advising the employee of the right to a hearing before the department 2. Explanation that claim is not being paid because of further investigation, to specify if additional medical or other information is needed and to advise the employee of the right to a hearing before the department if the claim is subsequently denied	Department and employee	80.02(2m)(a)
	30 days (after final payment)	If increased compensation due, a final receipt as proof of payment of that increased compensation	Department and employee	80.02(2)(i)
	30 days (after employee fails to attend final medical examination)	Written notice that in order to determine permanent disability, if any exists, the final examination must be attended	Department and employee	80.02(2)(j)

Updated 6/12/03

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