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Dwd.wisconsin.gov/wc e-mail DWDDWC dwd.wisconsin.gov EMPLOYER S FIRST REPORT OF INJURY OR DISEASE Fatal Injuries Employers subject to ch. Or Self-Insured Employer Insurer FEIN Name and Address of Third Party Administrator TPA Used by the Insurance Company or Self-Insured Employer TPA FEIN WAGE INFORMATION Wage at Time of Injury Specify per hr. If this section is completed and retained the employer will not have to complete the OSHA 301 form. IWIF Employee s Report of Injury To be completed by...
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What is midwest family mutual?
Midwest Family Mutual is an insurance company that provides coverage for individuals and families in the Midwest region.
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Policyholders who have coverage through Midwest Family Mutual are required to file claims and submit necessary documentation to receive benefits.
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Policyholders must report details about the incident or claim, as well as any relevant documentation requested by Midwest Family Mutual to process the claim.
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