This form is used for Wisconsin Worker's Compensation insurance carriers to provide information to the Wisconsin Department of Workforce Development (DID). This information includes basic information about the company, contact information, business type, policy type, policy limits, and Third Party Administrators (TPAs). TPAs are companies that specialize in administering workers’ compensation claims in the state of Wisconsin. The form also provides a section to update any changes in information that have been made since the last submission. The form requires that the following information be provided: company name, contact information, business type, policy type, policy limits, and TPA information (if applicable). The form also requires that TPAs provide their contact information, the services they provide, and a list of the specific Wisconsin counties where they offer services.
Wisconsin This form is used for collecting pertinent information from new Worker's Compensation insurance carriers as well as updating changes in information. The form also provides a section to submit or update information pertinent to Third Party Administrators
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How to fill out Wisconsin This Form Is Used For Collecting Pertinent Information From New Worker's Compensation Insurance Carriers As Well As Updating Changes In Information. The Form Also Provides A Section To Submit Or Update Information Pertinent To Third Party Administrators?
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