Injury/ Illness Forms
The Worker’s Compensation Act provides benefits when at the time of injury the employee is performing service growing out of and incidental to his or her employment. Injuries should be immediately reported to your supervisor who will provide an Employee Occupational Injury and Illness Report.
You have the choice of physician, chiropractor, psychologist or podiatrist licensed in the State of Wisconsin to provide reasonable and necessary treatment to cure and relieve the effects of injury. You have the choice of a second physician. Simultaneous treatment by two doctors is not accepted, nor is a third choice of physician unless referred by your primary doctor. Doctors within a clinic are not considered a change of doctors.
When you seek medical treatment, tell the provider you have a worker’s compensation claim. Medical bills should be submitted to the worker’s compensation coordinator, listed below. Should you receive medical bills, including prescriptions, submit them to the worker’s compensation coordinator.
The State of Wisconsin provides managed health care services to injured State employees. Utilization review is performed on all inpatient hospitalizations, surgical procedures, MRI and CT scans, and physical therapy and chiropractic treatment. If such treatment is recommended by your doctor, promptly notify your worker’s compensation coordinator prior to having such treatment.
Should an injury result in more than three days lost time from work, contact your worker’s compensation coordinator. Medical documentation is required to substantiate disability payments under Worker’s Compensation.
For further information regarding worker’s compensation, please contact:
Office of Risk Management
780 Regent St., Suite 105
Madison, WI 53715
This page briefly explains options available under the Wisconsin Worker’s Compensation Act, and does not constitute a legal document. The law and bargaining unit agreement would prevail in the event of a discrepancy.