Important Notice Regarding Workers Compensation Claims

 WORK RELATED INJURIES MUST BE REPORTED IMMEDIATELY

Every accident, whether the employee has lost time from work or not, must be reported. Please complete a WKC-12-E Employer’s First Report of Injury or Disease form and send it directly to your company. Notice to the agent (Neckerman Insurance Services) does not constitute notice to the carrier. See your insurance policy or click here for your carrier’s contact information.

WKC-12 Print Version

WKC-12 -E Electronic Version

Please do not wait until you receive a medical bill to submit a claim. The insurance company and you, as the employer, are required to abide by strict guidelines for reporting claims as set by State of Wisconsin Statute and Administrative Rules. Therefore, it is imperative that claims be reported promptly. In the State of Wisconsin, a WKC-12-E form should be filed within one day of the date of injury where it is suspected that your employee will lose time from work.

Death of an Employee

If the injury results in the death of an employee your claim must be reported to both:

  1. your insurance company and
  2. the WCD within 24 hours of the injury.

Other On-The-Job Injuries

Other on-the-job injuries should be reported promptly.  Failure to do so can result in the imposition of a fine by the State of Wisconsin—these penalties can be severe and are not covered by your Workers Compensation policy.  For more information, visit the WCD website shown below.

Injury Occurs Outside of Wisconsin

If a work related injury occurs in any other state, you must refer to your insurance policy or call our office to learn how claims should be reported.  Generally states require a claim to be reported within one day of the date of the injury for lost time, within 24 hours if the injury results in death of the employee or within three days for other work related accidents or illnesses where medical attention is sought.  You must refer to your policy for each state’s specific requirements.

Importance of Early Reporting

Early reporting allows your insurance carrier time to investigate the injury and begin any case management that your employee may need.  It also provides ample time to pay medical bills and lost wages on behalf of your employee. You may contact the Worker’s Compensation Division of the DWD at:

Wisconsin Department of Workforce Development, Worker’s Compensation Division

201 E Washington Avenue, Room C100, PO Box 7901

Madison Wisconsin 53707-7901

Phone 608-266-1340/Fax 608-267-0394

www.dwd.state.wi.us/wc