Governor - Scott K. Walker Adjutant General - Major General Donald P. Dunbar

How and When to File a Claim

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

To begin a Worker's Compensation claim, complete the Employee's Workplace Injury or Illness Report  under Safety Forms, and submit it to your supervisor or Risk Officer.

Your supervisor and employing department will then complete the Supervisor and Safety Coordinators Investigation Report for Injury or Illness and then Employer's First Report of Injury or Disease

Please take the Physicians Certification DOA-6125 with you when seeking medical treatment.

These forms will then be sent to the Risk Officer, Joint Force Headquarters, 2400 Wright Street, Madison, WI 53714.


Worker's Compensation Eligibility

Worker's 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.


Worker's Compensation Benefits

Worker's 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.

    • 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." The Department of Administration makes these determinations.

    • Wage Benefits

Benefits are equal to 2/3 of your average weekly wage up to a maximum of $1,318.50 and are not taxable. Benefits are payable until you reach a healing plateau.

    • 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 Worker's 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.


Mileage

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

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 Department of Military Affairs 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. If you refuse to return to work once temporary restrictions can be accommodated, you will forfeit the right to continued disability benefits.

State Human Resources Office
E-Mail:  
Phone: (608) 242-3153
Fax: (608) 242-3168

Location:
2400 Wright Street
Madison, Wisconsin

Mailing Address:
Department of Military Affairs
WING-SHR
P.O. Box 14587
Madison, WI 53708-0587

AA Officer
Joni Mathews
Director, State Human Resources
Department of Military Affairs
Work: (608) 242-3163
Fax: (608) 242-3168
Cell: (608) 218-0406

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