Workers' Compensation

How and When to File a Claim

If you've sustained an injury or contracted an illness at work, please notify your supervisor immediately. This is true even in circumstances where your injuries or illness may be minor and do not require medical treatment.

PLEASE NOTE: Do not list Social Security Numbers (SSN) on any of the documents.

To begin a Workers' Compensation claim, complete the Employee's Work Injury and Illness Report and submit it to your supervisor or Workers' Compensation Coordinator. This should be done within 24 hours of the date of injury.

Your supervisor and employing department will then complete the Supervisor Incident Analysis and then Employer's Report of Injury.

These forms will then be sent to the Risk Management, 21 N. Park St. Suite 5301, Madison WI 53715. In a short time, the employee will be contacted by a Workers' Compensation Examiner.

Information for the New Claimant: Workers' Compensation Overview
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Workers' Compensation Eligibility

Workers' Compensation law provides benefits to employees who are in the service of an employer. This includes classified employees, LTEs, faculty, academic staff, student assistants, and student hourlies.

Workers' Compensation, in the State of Wisconsin, is governed by the Wisconsin Department of Workforce Development.

Workers' Compensation Benefits

Medical Benefits
You are entitled to medical, surgical, chiropractic, psychological, podiatric, dental, and hospital treatment "as may be reasonably required to cure and relieve the effects of the injury."

Wage Benefits
Benefits are equal to 2/3 of your average weekly wage up to a current maximum of $1,441.50 and are not taxable. Benefits are payable until your medical provider releases you to return to work, working your regularly scheduled hours.

Vocational Retraining Benefits
If your medical practitioner determines that you have permanent restrictions and are unable to return to your job, you may be eligible for vocational retraining. If enrolled and participating in a qualifying program of vocational retraining and/or on-the-job training, you may be eligible for additional Temporary Total Disability benefits for at least the first 80 weeks and payment for certain expenses such as travel, lodging, and meals.

Independent Medical Evaluation (IME)
You may be required to undergo an IME by a practitioner selected by your Workers' Compensation Claims Examiner. You will be notified in writing as to the date, time, place, and name of the practitioner. You are not required to travel more than 100 miles to this examination unless the Department of Workforce Development determines that circumstances warrant you traveling a greater distance, or the place where you have been receiving medical treatment is more than 100 miles from where you live. You will be reimbursed for travel and lost wages during the time of the examination.

You have the right to have your own physician present at the examination at your own expense. You also have the right to have a translator provided by yourself present at the exam if you have difficulty speaking or understanding the English language.

Following the examination, you will receive a copy of the report.

You are eligible to be reimbursed for mileage for travel to obtain medical treatment. The rate of reimbursement is set by the Department of Workforce Development at $0.51 per mile.

Mileage Reimbursement Form
Mileage Expenses, UW1113

Return to Work (RTW)
You may be eligible for continued temporary disability or partial disability benefits if you are released to return to work with temporary restrictions.

If the University cannot or does not make work available, you will be entitled to temporary disability benefits until the end of the healing period or until work is offered within your limitations, whichever is sooner.

If you refuse to return to work once temporary restrictions can be accomodated, you will forfeit the right to continued disability benefits.

Commonly Used Forms

Employee Report of Injury and Illness
English | Spanish/Español | Hmong/Hmoob | Tibetan/བོད་ཡིག

Employer Report of Injury
Employer's First Report of Injury or Illness, WKC-12e

Supervisor Incident Analysis
Supervisor's Incident Analysis and Prevention Report, WKC-SUP

Mileage Reimbursement Form
Mileage Expenses, UW1113

HIPPA Medical Records Release
Voluntary and Informed Consent for Disclosure of Health Care Information, WKC-9488

Lost Time Record
Workers' Compensation Employee Record of Lost Time, UW1059

Other Resources

Frequently Asked Questions

Wisconsin Department of Workforce Development

Environment, Health & Safety Department

Office of Biological Safety

Office of Chemical Safety

Research Guide for Chemical Safety

Environmental and Occupational Health

NPS Prescription Drug Card
The State of Wisconsin has partnered with NPS to have prescriptions for your work-related injury filled at no expense to you. A prescription drug card will be sent to you from this company.

Contact Information

For more information or general questions, please contact the Workers' Compensation general email. Workers' Compensation is located at:

21 N. Park St., Ste 5301
Madison, WI 53715
Phone: (608) 265-9475
Fax: (608) 265-3624