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Wisconsin Medical Report on Industrial Injuries -- To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results.

State:
Wisconsin
Control #:
WI-SKU-2359
Format:
PDF
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Medical Report on Industrial Injuries -- To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results. The Wisconsin Medical Report on Industrial Injuries -- To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results -- is a form used to report an injury sustained by an employee while on the job in Wisconsin. This form is intended to provide a detailed description of the injury and medical care provided, as well as the extent of the employee's disability. There are three types of Wisconsin Medical Report on Industrial Injuries, which are: 1. Report of Industrial Injury with Temporary Disability: This form is used to report an injury sustained by an employee that results in a temporary disability of more than three weeks. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received. 2. Report of Industrial Injury with Permanent Disability: This form is used to report an injury sustained by an employee that results in a permanent disability. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received. 3. Report of Industrial Injury with Death: This form is used to report an injury sustained by an employee that results in death. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received.

The Wisconsin Medical Report on Industrial Injuries -- To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results -- is a form used to report an injury sustained by an employee while on the job in Wisconsin. This form is intended to provide a detailed description of the injury and medical care provided, as well as the extent of the employee's disability. There are three types of Wisconsin Medical Report on Industrial Injuries, which are: 1. Report of Industrial Injury with Temporary Disability: This form is used to report an injury sustained by an employee that results in a temporary disability of more than three weeks. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received. 2. Report of Industrial Injury with Permanent Disability: This form is used to report an injury sustained by an employee that results in a permanent disability. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received. 3. Report of Industrial Injury with Death: This form is used to report an injury sustained by an employee that results in death. It must be filed by the insurer or self-insured employer and includes information about the employee, the injury, and the treatment received.

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Wisconsin Medical Report on Industrial Injuries -- To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results.