Practitioners Report On Accident Or Industrial Disease In Lieu Of Testimony {WKC-16B}

WKC-16B - PRACTITIONER’S REPORT ON ACCIDENT OR INDUSTRIAL DISEASE IN LIEU OF TESTIMONY. This form is used by the Wisconsin Department of Workforce Development, Worker’s Compensation Division, to obtain medical information in connection with a worker’s compensation claim. This form allows a licensed medical practitioner to provide details about an employee’s injury or occupational disease without the need for live testimony at a hearing. It is used to record important information such as the description of the accident or work-related exposure, the resulting physical or mental disability, medical diagnosis, treatment dates, work restrictions, prognosis, and whether the condition is temporary or permanent. The practitioner must also provide an opinion on whether the accident or exposure directly caused or aggravated the condition. This report is considered prima facie evidence in worker’s compensation proceedings if submitted at least fifteen days before a hearing. By completing this form, the practitioner certifies the accuracy of the medical findings and opinions, which are then used by the Department and the parties involved to assist in the resolution of the worker’s compensation case. www.FormsWorkflow.com