Wi workers compensation 2026

1. Click ‘Get Form’ to open the wi workers compensation form in the editor.
2. Begin by entering the WC Claim Number and Employee Name at the top of the form. Ensure that all personal information is accurate to avoid delays.
3. Fill in the Employee's Social Security Number, Address, Injury Date, Date of Birth, and Telephone Number. This information is crucial for processing your claim.
4. Next, provide details about the Employer Name and diagnosed disability/injury. Be specific to ensure clarity regarding the nature of the claim.
5. Indicate any work restrictions or limitations that apply to the employee. This helps in assessing rehabilitation needs.
6. Complete the Insurer section with their Mailing Address and Claim Representative's contact details for follow-up purposes.
7. Select services planned by checking appropriate boxes such as Vocational Evaluation or Job Placement, and provide a description if necessary.
8. Finally, have the Vocational Rehabilitation Specialist sign and date the form before preparing it for submission. Ensure copies are sent to both the insurance company and Worker's Compensation Division.

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