Fillable wkc 176 form 2026

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The document is a Compromise Agreement from the Department of Workforce Development's Worker’s Compensation Division in Wisconsin. It outlines the process for settling disputes related to worker's compensation claims, including necessary information about the employee, employer, and insurance company. The agreement allows parties to settle their disputes with the option for the employee to petition for modification within one year. It includes sections for signatures and attorney fees.

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Click ‘Get Form’ to open the fillable WKC 176 form in the editor.
Begin by entering the WC Claim Number at the top of the form. This is essential for tracking your claim.
Fill in the Employee Name, Birth Date, and Social Security Number. Note that providing your SSN is voluntary but may expedite processing.
Complete the Employee Mailing Address section with your current address, ensuring accuracy for correspondence.
Indicate the Date of Alleged Injury and provide details about your Employer and Insurance Company, including their addresses.
Specify whether it is disputed or undisputed that you were employed by the respondent employer.
Enter your Employee Earned Weekly Wage and Compensation Previously Paid amounts in the designated fields.
Review all sections carefully before signing. Ensure that all parties involved have signed where required.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (175 Votes)
2009	4.4 Satisfied (57 Votes)

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Where to submit workers compensation forms?

Submit forms online through the Employees Compensation Operations and Management Portal (ECOMP). On the ECOMP site you can register for an account, initiate a claim, upload documents, submit forms, and access your case. OWCPs Federal Employees Program has made a variety of forms available online.