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Filing Requirements

The University of Wisconsin System
Office of Safety and Loss Prevention
Post Office Box 8010
Madison, Wisconsin 53708-8010
608-263-7330 Environmental/Occupational Health & Safety
608-263-4381 Risk Management
608-263-4381 Workers' Compensation
608-262-8589 FAX

TO: Universities of Wisconsin Supervisor

FROM: Office of Safety and Loss Prevention Worker’s Compensation Office

RE: Worker’s Compensation - Filing Requirements

The Wisconsin Administrative Code 80.02 was revised effective January 1, 1998. This section pertains to filing requirements of worker’s compensation forms and in part states:

Reports: The employer (the UW campus) must submit a first report of injury [WKC-12] on or before the 7th day after an accident or the beginning of a disability from occupational disease to Universities of Wisconsin Administration. For self insured employers, like, the State of Wisconsin, Universities of Wisconsin Administration must in turn file the WKC-12 with the Worker’s Compensation Division, Department of Workforce Development (DWD) by the 14th day.

The Worker’s Compensation Division is now holding employers accountable for these filing requirements.

Please note that once the employee advises you of an injury, or you become aware of an injury, it is your responsibility to complete and file the WKC-12 form immediately with your campus worker’s compensation coordinator. Although by practice we require the employee to complete the Employee’s Work Injury and Illness Report, by Statute it is the employer’s responsibility to report and file the WKC-12, First Report of Injury. Do not wait for the employee to complete their report before you complete the WCK-12.

If employee does not lose time initially at the time of injury, and subsequently loses time from work due to the work injury, the claim has changed to a lost time claim, which requires a supplemental report. Please advise your campus Worker’s Compensation Coordinator immediately so we can advise Universities of Wisconsin. Administrative Rules state the first payment must be made by the 14th day after the employee leaves work as a result of the accident or disease.

The Administrative Code further provides enforcement procedures to ensure compliance with filing deadlines. Failure to submit reports or information as required may result in a fine of $100. In addition, a 10% delayed payment penalty may be assessed.

In accordance with Wisconsin Statutes, the $100 fine and 10% delayed payment assessment are penalties, and are charged to the employer - not the insurer. This means, the employing department is responsible for the penalty payment; it is not paid from the worker’s compensation claim.

Letters will be issued by the Worker’s Compensation Division to Universities of Wisconsin Administration at the time of delayed reporting, advising of an assessed fine. The Universities of Wisconsin will expect explanation for delayed reports. Invoices will be issued annually by the Worker’s Compensation Division.