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Employer Bulletin

All Employers
Vol. 17, No. 4
February 16, 2000

Income Continuation Insurance Claim Process Approved

The Department of Employe Trust Funds (ETF) has been reviewing its processes in an effort to improve customer service. As a result, staff recommended revisions to the Income Continuation Insurance (ICI) Claim Process, and the Group Insurance Board (GIB) approved these revisions at a recent meeting.

The revisions not only reduce processing time for payment of initial ICI benefit payments, but also address employe's concerns about their employer's access to confidential medical records. In addition, ETF has created new claim packets, which include a copy of the ICI booklet, an ICI Claim Form and the ICI Medical Report. Employes can obtain a claim packet from their employer.

If you have a supply of old claim forms (ET-5301 or ET-5310), please destroy them and use the new forms. Effective April 1, 2000, ETF will no longer accept the old claim forms.

New ICI Claim Process

The new claim process allows us to process several steps simultaneously. This involves the use of three separate ICI forms. They are as follows:

  • ICI Claim Form (ET-5352)
    Completed by the employe and forwarded directly to ETF.
  • ICI Medical Report (ET-5350)
    Completed by the employe and given to the employe's physician to complete. Employe's physician forwards the completed report directly to ETF.
  • ICI Employer Statement (ET-5351)
    Sent to the employer by the claims administrator upon receipt of the claim form from ETF. Employer completes the statement and mails it to ETF.

Questions about the new claim process should be directed to the claims administrator, United Wisconsin Insurance Company (UWIC). Their toll-free telephone number is: (800) 452-4250.

New ICI Claim Form Packets Now Available

Order new claim form packets from ETF. To place an order, please use one of the following methods. Allow three weeks for delivery.

  • Call ETF Supply and Mail Services at (608) 266-3302.
  • Complete the order form and mail to ETF, PO Box 7931, Madison WI 53707-7931.
  • Fax a copy of the order form to ETF at (608) 267-4549.
  • E-mail ETF by clicking contact us on our Internet site.


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