DWD 80.02(2)(d)(d) For injuries occurring before April 10, 2022, if applicable, a signed statement from the employee verifying that the employee restricts his or her availability on the labor market to part-time employment, and is not actively employed elsewhere. The employee’s self-restriction statement shall accompany the WKC-13-A, but no statement is required if the employee is under the age of 16. DWD 80.02(2)(dm)(dm) For injuries occurring on or after April 10, 2022, if applicable, a signed statement from the employee verifying that the employee restricts his or her availability to part-time employment, an employment application indicating an hour or shift preference, or other evidence to establish the employee chose to work less than full-time. The employee’s self-restriction statement, employment application, or other evidence to establish the employee chose to work less than full-time shall accompany the WKC-13-A1. DWD 80.02(2)(e)(e) A report within 30 days after each of the following events occurs, with a copy to the employee, using form WKC-13 indicating all worker’s compensation payments to date and the periods of time for which any of the following payments were made or salary continuation paid in lieu of compensation: DWD 80.02(2)(e)1.1. Payment of compensation is changed from temporary disability or salary continuation in lieu of compensation to permanent disability. DWD 80.02(2)(e)2.2. Temporary disability benefits or salary continuation in lieu of compensation are reinstated. DWD 80.02(2)(e)3.3. Temporary partial disability is paid. The insurance carrier or self-insured employer shall also include the information required by form WKC-7359. DWD 80.02(2)(e)4.4. Final payment of compensation is made or salary continuation paid in lieu of compensation ended. If there are more than 3 weeks of temporary disability or any permanent disability, or if the employee has undergone surgery to treat the injured employee’s injury, other than surgery to correct a hernia, or if the injured employee sustained an eye injury requiring treatment on 3 or more occasions outside of the employers premises, the insurance carrier or self-insured employer shall submit a final treating practitioner’s report together with the final form WKC-13 or shall explain why the report is not being submitted and shall estimate when the final treating practitioner’s report will be submitted. DWD 80.02(2)(e)5.5. When a self-insured employer or insurance company transfers an open claim, with 26 weeks or more of temporary disability or permanent total disability paid, to a new claims handling office or third party administrator, the self-insured employer or insurance company shall file a paper form WKC-13 with the new claims handling office or third party administrator. The self-insured employer or insurance company shall file a paper copy of the form WKC-13 with the department upon request made by the department. The department may require a self-insured employer or insurance company to submit form WKC-13 for open claims with less than 26 weeks of temporary disability or permanent total disability paid upon request made by the department. DWD 80.02(2)(f)(f) When submitting a stipulation or compromise, and at the time of hearing, a current form WKC-13 indicating all worker’s compensation payments to date and the periods of time for which these payments were made. DWD 80.02(2)(g)(g) Written notice within 7 days, with a copy to the employee, after each of the following: DWD 80.02(2)(g)1.1. Payments are stopped for any reason. If any payments are stopped for a reason other than the employee’s return to work, the self-insured employer or insurance carrier shall explain why it stopped payments and shall advise the employee what to do to reinstate payments. DWD 80.02(2)(g)2.2. A decision to deny liability for payment of compensation for reported claims after a concession of liability is made, giving the reason for the denial and advising the employee of the right to a hearing before the division of hearings and appeals. DWD 80.02(2)(i)(i) If increased compensation is due, a final receipt within 30 days of the final payment to the employee, as proof of payment of that increased compensation. DWD 80.02(2)(j)(j) If the employee fails to return to a practitioner for a final examination, written notice within 30 days, with a copy to the employee, advising the employee that in order to determine permanent disability, if any, the final examination is necessary. DWD 80.02(2)(k)(k) By June 30 of each calendar year, a self-insured employer or insurance company shall file a report with the department that lists the date and amount of payment for permanent total disability and supplemental benefits paid during the previous calendar year on a form prescribed by the department. DWD 80.02 NoteNote: To obtain a copy of the forms under this subsection, contact the Department of Workforce Development, 201 East Washington Avenue, P.O. Box 7901, Madison, Wisconsin 53707-7901 or access forms online at http://www.dwd.wisconsin.gov. DWD 80.02(2m)(2m) Self-insured employers and insurance companies; notice to employee. DWD 80.02(2m)(a)(a) For all injuries under sub. (1) (a), self-insured employers and insurance companies shall provide written notice to the employee within 14 days of the date of an alleged injury indicating one of the following: DWD 80.02(2m)(a)1.1. A decision to deny liability for payment of compensation giving the specific reason for the denial and advising the employee of the right to a hearing before the division of hearings and appeals. DWD 80.02(2m)(a)2.2. An explanation that the claim is not paid because the insurance company or self-insured employer is still investigating the claim. The notice shall specify if additional medical or other information is needed to complete the investigation. The notice shall advise the employee of the right to a hearing before the department if the claim is subsequently denied. DWD 80.02(2m)(b)(b) If the notice of injury from the employee to the insured employer or from the insured employer to its insurance company was not made within 7 days of the date of the alleged injury, the insurance company shall provide notice under par. (a) 1. or 2. within 14 days of receiving notice of the alleged injury from any source. DWD 80.02(3)(3) Evaluation. In evaluating whether payments of compensation and reports made by insurance carriers and self-insured employers were prompt and proper under the provisions of ss. 102.28 (2) and 102.31 (3), Stats., and before undertaking to revoke the exemption from insurance under s. 102.28 (2) (c), Stats., or before recommending under s. 102.31 (3), Stats., to the commissioner of insurance that enforcement proceedings under s. 601.64, Stats., be invoked the department will consider all of the following performance standards together with all other factors bearing on the performance and activities of the insurance carrier or self-insured employer: DWD 80.02(3)(a)(a) Payment of first indemnity. Whether 80% or more of first indemnity payments are mailed to the injured employee in 14 days or less following the date of injury or the last day worked after the injury before the first day of compensable lost time. DWD 80.02(3)(b)(b) First report of injury. Whether 70% or more of reports required under sub. (2) (a) are received by the department within 14 days of the date of injury or the last day worked after injury before the first day of compensable lost time. DWD 80.02(3)(c)(c) Correct and complete names. Names of self-insured employers on reports filed with the department must be correct and complete. The name of an insurance group is not a substitute for the name of the individual company insuring the risk. The name of an insurance service company is not a substitute. DWD 80.02(3m)(3m) Reporting by electronic, magnetic or other media.