Compromise Agreement {WKC-176}

WKC-176 - COMPROMISE AGREEMENT. This form is used in Wisconsin to document a settlement between an injured worker and their employer (or the employer's insurance carrier) in a worker’s compensation claim administered under Chapter 102 of the Wisconsin Statutes. The purpose of the form is to record the terms of a mutually agreed-upon resolution of a disputed or undisputed claim related to a work-related injury, including details such as the employee’s wage, compensation previously paid, and the nature of any disability. The form requires signatures from the employee, their attorney (if any), and the employer or insurer, and must be approved by the Department of Workforce Development (DWD). It also advises the employee of their right to petition DWD to set aside or modify the agreement within one year of approval. While completing the form is voluntary, failure to do so may delay the processing of the claim. The form also collects personally identifiable information and outlines how it may be used. www.FormsWorkflow.com