Think Your Doctor’s Opinion Is Enough to Beat a Worker’s Compensation Denial? Not Without This Form.

If you’ve been hurt at work in Wisconsin and your claim has been denied, you might assume your doctor’s medical opinion alone will be enough to counter the opinion of the insurance company and its hired doctor. Unfortunately, that’s not the case. One essential document stands between your doctor’s assessment and getting the benefits you deserve: the WKC-16-B form.

This form is critical in documenting your doctor’s opinion on your work injury, your work restrictions, and your permanent disability, and it can make or break your claim.

What Is the WKC-16-B Form?

The “Practitioner’s Report on Accident or Industrial Disease in Lieu of Testimony,” or WKC-16-B, is the official medical report used in worker’s compensation claims. It provides a standardized way for your healthcare provider to document:

• The diagnosis related to your work injury
• Whether your condition was caused or aggravated by your job
• Your temporary and permanent work restrictions
• Any permanent partial disability (PPD) rating that applies
• Whether any future treatment is recommended

Because this form is “in lieu of testimony” the opinions on this form can be used as evidence in your worker’s compensation hearing instead of the doctor having to come to testify. Opinions that are only stated in your medical records do not have the same weight. This form bridges medical opinion and legal standards, allowing your doctor’s opinions to support your claim in front of a judge.

Who Can Complete the WKC-16-B?

Under Wisconsin law, only certain providers are qualified to provide opinions on a WKC-16-B form. These are:

• Medical Doctors (MD)
• Doctors of Osteopathy (DO)
• Chiropractors (DC) (for conditions within chiropractic scope of practice)
• Podiatrists (DPM) (for conditions within podiatric scope of practice)
• Psychologists (PhD or PsyD) (when the claim involves psychological injury or mental health components)

Importantly, other providers such as Physician Assistants (PA-C) or Nurse Practitioners (NP) are not authorized to independently complete all causation and disability opinions on the WKC-16-B. If they complete the form, it must also be signed by an MD or DO to be considered valid evidence.

What if Your Doctor Won’t Complete the WKC-16-B Form or Completes It Incorrectly?

An incomplete or inaccurate WKC-16-B form is a common challenge in Wisconsin worker’s compensation cases. Many treating physicians may not be familiar with the specific requirements of the form or may hesitate to give opinions on key elements like causation or permanent partial disability (PPD) ratings. This hesitation can stem from a lack of experience with worker’s compensation law, concern about legal implications, or uncertainty about the medical-legal standards involved.

If your doctor is unwilling or unable to complete the form correctly, you have a few options:

• Request a referral to a specialist, such as an occupational medicine physician, who understands the nuances of the form and the legal standards in Wisconsin. These specialists are likely more familiar with how to document causation and impairment in a way that supports your claim.
• Work with an experienced worker’s compensation attorney who can communicate directly with your medical providers. An experienced attorney will know how to explain what is required on the WKC-16-B, clarify the legal language, and guide doctors through completing the form accurately. This can make providers more comfortable and willing to provide detailed, legally sufficient medical opinions.
• Consider obtaining a supplemental or independent medical evaluation if your current provider / clinic is unable or unwilling to complete the form.

Ensuring the WKC-16-B form is completed properly is critical because an incomplete or incorrect form can prevent your case from moving forward or preclude you from getting the benefits you deserve.

How to Talk to Your Doctor About Completing the WKC-16-B Form

Approaching your doctor to complete the WKC-16-B form can feel intimidating, but clear communication is key. Here are some tips to help you and your doctor get the information your worker’s compensation claim needs:

1. Be Prepared: Bring a copy of the WKC-16-B form with you to your appointment so your doctor can see exactly what needs to be filled out and so you can discuss the form with the doctor.
2. Explain the Importance: Let your doctor know this form is required to challenge the denial of your worker’s compensation claim. Explain that it documents your injury, how it’s related to your job, and any lasting impairment. Note also that this form is in lieu of their testimony so that they likely will not need to appear at a hearing to testify.
3. Ask for Specifics: Encourage your doctor to complete all relevant sections, especially the causation boxes and any permanent partial disability ratings if applicable. Remind them these are critical to your case.
4. Offer Support: If your doctor seems unsure about any part of the form, ask if they would be willing to speak with a worker’s compensation attorney who can clarify legal or medical-legal questions.
5. Follow Up: If the form isn’t completed at your appointment, check back regularly or ask the clinic staff about the status. Timely completion will help move your claim along.

Need Help? Contact a Worker’s Compensation Attorney

If the WKC-16-B form is posing a challenge or you don’t know where to start when preparing your case to fight a worker’s compensation denial, you’re not alone. Reach out today to an attorney who can guide you through the process and make sure your medical evidence supports your claim.