Wisconsin Association of Worker's Compensation Attorneys, Inc.
 

The information contained on this Web site is published as a service to attorneys and the public with the understanding that we are not rendering any legal or other professional services to people accessing this Web page.  We only provide legal services to parties who retain us as as lawyers to represent them.  Due to the rapidly changing nature of the law, information available on these Web pages may be outdated.  Therefore, you must always research original sources of authority and update the information provided to ensure accuracy.  Finally, you should consult your own lawyer for legal advice.
 

Forms, Tools and Tips

Our members have contributed a variety of useful resource materials for attorneys and others who are involved in investigating, managing, and litigating Wisconsin worker's compensation claims.  This resource page includes various forms in MS Word and MS Excel formats.  The page will also include other resources, such as significant circuit court and LIRC decisions that are not available online elsewhere.



Badger - Wisconsin State Animal




Wage and Benefit Chart
Revised Jan 2011

Compliments of Tom McSweeney: Medical Support Made Easier
                                                  & Medical Report Form

Wisconsin Worker's Compensation Act and DWD Chapter 80

The pamphlet edition of the Wisconsin Worker's Compensation Act (WKC-1-P, Rev. 12/2004) includes the Worker's Compensation Act, the administrative rules (DWD 80), various related statutes, and all of the basic forms.  It is current through December 2004. Once again, it is not available from the Wisconsin Worker's Compensation Division, DWD.  You instead order it from the Wis. Department of Administration, Document Sales Unit, 202 S. Thornton Avenue, P.O. Box 7840, Madison, WI 53707-7840:

Wisconsin Worker's Compensation Act (WKC-1-P, R. 12/2004), with amendments to December 2004; Stock # 1403D; $5.15 each (plus sales tax)

You may order by phone using your VISA or MasterCard, at (800) 362-7253 -or- (608) 264-9419.  If you need more information you may call them at (608) 266-3358.

Note that various footnote annotations by the Department appear in the pamphlet edition of the WCA. The supreme court ruled in several cases that such annotations in the Department’s pamphlet edition are relevant in construing statutes. Green Bay Packaging, Inc. v. ILHR Dept., 72 Wis. 2d 26, 34, 240 N.W.2d 422 (1976); Pigeon v. DILHR, 109 Wis. 2d 519, 524, 326 N.W.2d 752 (1982); Lisney v. LIRC, 171 Wis. 2d 499, 513, 493 N.W.2d 14 (1992).

In addition to the pamphlet edition of the Worker's Compensation Act, you will also need:

The Latest Amendments to the Wisconsin Worker's Compensation Act

2007 Amendments 

The 2007 amendments to the WCA were finally passed in 2008, and became effective on April 1, 2008. 2007 Senate Bill 430 was passed as 2007 Wisconsin Act 185.  (Note that 2007 Senate Bill 430 includes the Legislative Reference Bureau's plain language analysis of the amendments.)

An updated Wage and Rate Chart (WKC-9572-P), showing the new TTD and PPD rates that are effective 4/1/08, is available the Department Web site at: http://www.dwd.state.wi.us/dwd/publications/wc/WKC-9572-P.pdf. There was also a mileage reimbursement increase. The new mileage reimbursement and the rate changes are discussed in the Department's Insurance Letter 471.

2005 Amendments

The 2005 amendments to the Wisconsin WCA were finally passed in 2006 and they were published on March 31, so they became effective on Saturday, April 1, 2006.   Senate Bill 474 was passed as 2005 Wisconsin Act 172 and it is now available at: http://www.legis.state.wi.us/2005/data/acts/05Act172.pdf

 
You might also want to take a look at 2005 Senate Bill 474, that includes the analysis by the Legislative Reference Bureau:  http://www.legis.state.wi.us/2005/data/SB-474.pdf
 
 
Note that the mileage rate changed effective January 1, 2006, to $.385 per mile.  See the Department's Insurance Letter 458 at: http://www.dwd.state.wi.us/wc/Letters/insurance/pdfs/Ins458.pdf.  In 2006, we had had a very unusual situation in which the mileage rate went up again, only four months after the last increase.  Effective May 1, 2006, the rate increased to $.425 per mile.  See Department Insurance Letter 462 at: http://www.dwd.state.wi.us/wc/Letters/insurance/pdfs/Ins462.pdf
 
I hope it is not significant that the statutory amendments became effective on April Fool's Day.

Phil Lehner


Coverage Lookup provides a means for employees, attorneys, and others to obtain insurance carrier claims processing information for a particular coverage, injury, or illness date. Employer and insurance carrier information is updated weekly:  https://www.wcrb.org/WCRB/CoverageLookup/CoverageLookupSearch.aspx

 

Citation of ALJ and LIRC decisions on WC claims -  Darlene Martin v. St. Francis Home, WC Claim No. 1998-059173 (LIRC May 19, 2003), Footnote 1:

The applicant objects to the respondent's citation to the DILHR ALJ's decision case, asserting that Wis. Stat. § 809.23(3) prohibits the citing of a nonpublished opinion as precedent or authority. However, the court of appeals has held that Wis. Stat. § 809.23(3) does not prohibit the citation of circuit court decisions -- at least as for the limited purposes of persuasive, rather than binding, authority -- suggesting that the non-citation rule is limited to unpublished court of appeals decisions. Brandt v. LIRC, 160 Wis. 2d 353, 361-65 (Ct. App. 1991). Moreover, Wis. Stat. § 809.23(3) by its terms is limited to citations "in any court of this state."

Commission decisions are based on their own facts, and are not binding authority. See: Nick v. State Highway Commission, 21 Wis. 2d 489, 495 (1963) (administrative agencies like the commission are not bound by their own prior determinations) and Nelson Bros. v. Revenue Dept., 152 Wis. 2d 746, 756 (Ct. App. 1989) (administrative agencies are not bound by the strict doctrine of stare decisis). Nonetheless, the appellate courts consider whether the commission has previously issued decisions on an issue when considering the applicable level of deference on review. Langhus v. LIRC, 206 Wis. 2d 494, 503 note 7, 557 N.W.2d 450 (Ct. App. 1996); Virginia Surety v. LIRC, 2002 WI App 277, 16, 17, 258 Wis. 2d 665, 679-80, 654 N.W.2d 306.

Date Calculator Spreadsheet - Calculates the number of days/weeks between two dates
Format: MS Excel
Contributed by Michael B. Kulkoski, 7/04

Spreadsheet to Compute Present Value of a PTD Claim with SSDI Offset
Format: MS Excel
Contributed by: Attorney James A. Pitts, Schoone, Leuck, Kelley, Pitts & Knurr, S.C.
Date: 6/04 (Presented at the WAWCA 2nd Annual Seminar on 7/15/04)
Also: How to Calculate the Value of a Permanent Total Disability Claim
For life expectancy figures: U.S. Life Tables - 2001, U.S. DHHS, CDC

Advancement or Lump Sum Request form, WKC-136 (R. 07/2001)

Social Security Disability Insurance (SSDI) Benefit Offsets (Wis. Stat. § 102.44(5))
(1)  WKC-6156 Social Security Information Request
(2)  WKC-6119 Social Security Reverse Offset Worksheet
(3)  Addresses of Wisconsin Social Security Administration Offices - for requesting offset information
(4)  SSA Table of Triennial Redetermination Ratios
(5)  Fee for SSA to Complete a SS Information Request: Effective 11/05, the Social Security Administration is charging $46.00 to fill out a WKC-6156 Social Security Information Request, to provide the information you need to compute the offset of Social Security disability insurance benefits against worker's compensation benefits.  A letter from the SSA, describing the new policy, is available here.
(6)  Department's 1987 Memo on SSDI Offsets: In computing SSDI offsets, the Department's memo of 1987 is still relevant. (Optional: The exhibits to the Department's 1987 memo, with sample computations.  43 pages, 1.35 MB.)

Work Search Record Form
Format: MS Word
Contributed by: Tom McSweeney, 12/03
Note: Recommended for use on LOEC claims, to document work search by applicant

ALJ Phone Numbers
Format: MS Word
Contributed by: Tom McSweeney, 11/03
Note: List of phone numbers with voice mail for Madison ALJs, to use when you need to leave a message about a settlement.  (Only includes ALJs who have authorized listing their numbers.)

Hearing Notes Forms
Hearing Summary Form
Exhibit List - Applicant's
Exhibit List - Respondent's
Format: MS Word
Contributed by: Phil Lehner, 12/03

TTD Claims by Retired Employees - There is no published appellate precedent on this issue.  However, there is a 1983 circuit court decision that is always cited for the proposition that there is no TTD payable to retired employees.  The very well-written decision by Circuit Court Judge J. Richard Long in General Motors v. LIRC (a/k/a the Hoff case) is available here.  Judge Long's decision was affirmed in an unpublished court of appeals decision that is also available here.

Hearing Loss Calculator Spreadsheet
Format: MS Excel
Note: Includes maximum PPD rates for 1989-2004
Contributed by: John Griner, 1/04
Note: Revision of 1/04 to make it closer to that which the DWD uses. 

WKC-9488 (Rev. 5/03): Voluntary and Informed Consent for Disclosure of Health Care Information
Format: This is the MS Word version of the Department's revised medical authorization form.
Comment: The form has been extensively revised to comply with the HIPAA Privacy Rule.  It is now two pages and the employee must sign the form on the bottom of both pages.  If Option B is checked on the form, then the employee must also sign in the box next to that option.  Keep in mind that you are not supposed to modify the standard state form.
Contributed by: Phil Lehner, 7/03

Temporary Partial Disability Calculator Spreadsheet
Format: MS Excel
Comment: This is similar to the WKC-7359 form
Contributed by: James L. Bartells, 7/03

WC Case Value Calculator Spreadsheet
Format: MS Excel
Comment: Includes present value calculation for unaccrued benefits
Contributed by: James L. Bartells, 7/03

WKC-3 (Rev. 2/2000): Medical Treatment Statement
Format: MS Excel
Contributed by: Scott C. Woldt, 4/03

WKC-16-B (Rev. 7/2001): Practitioner's Report on Accident or Industrial Disease in Lieu of Testimony
Format: MS Excel
Contributed by: Scott C. Woldt, 4/03

A Guide to Wisconsin Legal Information Sources, Wisconsin Lawyer, Vol. 75, No. 10, October 2002

Appeals to the Court of Appeals or Supreme Court



A Word of Caution

The information contained on this Web site is published as a service to attorneys and the public with the understanding that we are not rendering any legal or other professional services to people accessing this Web page.  We only provide legal services to parties who retain us as as lawyers to represent them.  Due to the rapidly changing nature of the law, information available on these Web pages may be outdated.  Therefore, you must always research original sources of authority and update the information provided to ensure accuracy.  Finally, you should consult your own lawyer for legal advice.

 

 
 

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