License Application for Workers' Compensation - Wisconsin 2026

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The document is a license application form for individuals seeking to represent clients before the Department of Workforce Development under the Worker's Compensation Act. It requires personal information, employment history, details about any felony convictions or disbarments, references, and a statement of relevant experience in Worker's Compensation matters.
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  1. Click ‘Get Form’ to open the License Application for Workers' Compensation in our editor.
  2. Begin by entering your personal information, including your name, Social Security Number (SS#) or Federal Employer Identification Number (FEIN#), and telephone number. Ensure all required fields are filled accurately.
  3. Indicate whether you have ever been convicted of a felony or disbarred from practicing law. If applicable, provide details in the designated areas.
  4. Outline your employment record by listing your positions held over the last three years, starting with your most recent job. Include employer names, addresses, and phone numbers.
  5. Provide three non-family references along with their contact information. This includes their names, phone numbers, and addresses.
  6. Write a brief statement about your background and experience related to Workers' Compensation matters.
  7. For any hearings attended without a license, list the hearing dates, case names, and parties you represented.
  8. Finally, review all entered information for accuracy before signing and dating the application at the bottom of the form.

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Under the Workers Compensation Act (Act), you must carry workers compensation insurance if you do any one of the following: Employ 3 or more full-time or part-time employees. You must have insurance on the day you employ the third person.
To file a claim, an injured worker must: complete an Uninsured Employers Fund Claim Application (by calling (608) 266-3046 and requesting the UEF application form be mailed to them)
While workers cannot be fired in Wisconsin while on workers compensation, there are also protections when it comes to returning to the job. For example, employers need reasonable cause to refuse to rehire a worker from their previous job.

Related Searches

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People also ask

While workers cannot be fired in Wisconsin while on workers compensation, there are also protections when it comes to returning to the job. For example, employers need reasonable cause to refuse to rehire a worker from their previous job.
For temporary disability calculations involving the 3-day waiting period, indemnity is due for the first 3 days after the injury only if temporary disability exists for more than 7 calendar days after the day of injury.
Wisconsin workers compensation law requires many employers to have workers compensation insurance, which covers the medical expenses of a work-related injury and awards an employee 2/3 of their average weekly wage for the time they are not able to work due to the injury, among other coverages.
Intentional acts: When a worker intentionally causes their workplace injuries or illnesses, they are not covered under a workers comp insurance policy. Illegal activities: Employee injuries due to illegal activities at the worksite are not covered by an organizations workers compensation insurance policy.
Workers compensation is protection mandated by Wisconsin law for a worker and his or her dependents against injury and death occurring in the course of employment. It is not health insurance and is not intended to compensate for disability other than disability caused by injury arising out of employment.

Related links

DOA Worker Compensation Forms

Workers Compensation PreHearing and Hearing Appearance Application. Contact Us 101 E Wilson St, Madison, WI 53703

Learn more
INDEPENDENT CONTRACTORS AND WORKERS

Who is covered by the Workers Compensation Act?.. Nearly all employers in Wisconsin are covered. This includes both public and private employers. Nearly all

Learn more
2011 Publication 334

Dec 21, 2011 What must I do if I have employees? See Employment Taxes in chapter 1. Do I have to start my tax year in January, or can I start it in any other.

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