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Wisconsin Supplemental Payments Reimbursement Request for Workers' Compensation

State:
Wisconsin
Control #:
WI-WKC140-WC
Format:
Word; 
PDF; 
Rich Text
Instant download
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Public form

Description

This Supplemental Payments Reimbursement Request is one of the official workers' compensation forms for the the state of Wisconsin. This Official Workers' Compensation form is fillable in pdf and Word format. This Medical Report complies with all applicable statutory requirements.

How to fill out Wisconsin Supplemental Payments Reimbursement Request For Workers' Compensation?

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Wisconsin Supplemental Payments Reimbursement Request for Workers' Compensation