Filed on behalf of the employee, or the employer or insurance carrier.
Hearing: if not so filed, it will be necessary to produce the doctor to give oral testimony at the time of hearing.
Social Security Number: provision of the Social Security Number is voluntary. Failure to provide it may result in an information processing delay.
Voluntary: completion of this form is voluntary and failure to complete the form may result in a delay in the administration of Chapter 102.
Licensing: if not licensed and practicing in Wisconsin, state where the practitioner is licensed and practicing.
| Question | Answer |
|---|---|
| Form Name | WKC-16-B-E |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 41 |
| Avg. time to fill out | 7 min |
| Edition | Rev 06/2026 |
| Issuing agency | Department of Workforce Development, Worker's Compensation Division |
| Filing deadline | Fifteen days prior to the date of hearing, with the department and the other parties |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | WKC-16-B-E, WKC-16-B, WKC 16 B, WKC-16, WKC16B, Form WKC-16-B-E, Practitioner's Report on Accident or Industrial Disease in Lieu of Testimony |
| Official source | WKC-16-B-E (Rev 06/2026), Department of Workforce Development, Worker's Compensation Division |
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