Work comp: Form -- Interim Status Report (ISR)

The Interim Status Report (ISR) form is submitted by the insurer, self-insured employer or third-party administrator to the Department of Labor and Industry (DLI) and is used to notify DLI of the continuing compensation payment status on longer-term claims. DLI also used the form to verify calculation of benefits and for statistical data.

To ISR form updates DLI when there are continuing payments of one of the following types of compensation benefits:

• temporary total disability (TTD);

• permanent total disability (PTD);

• temporary partial disability (TPD);

• permanent partial disability (PPD);

• retraining;

• dependency (DEP); or

• supplementary (SB).

The ISR form also updates DLI with specific details about all payments of compensation, all amounts withheld, amounts paid for attorney fees and Social Security benefits or other government benefits paid to the claimant that may coordinate with workers' compensation benefits.

This form must be filed with DLI annually, for as long as payments continue (at one year after the last payment form was filed with the department). This form must also be filed upon specific request from the Department of Labor and Industry.

The following statutes and rules provide requirements concerning the ISR form:

• Minnesota Statutes 176.231, subd. 5;

• Minnesota Statutes 176.231, subd. 10; and

• Minnesota Rules 5220.2540, subp. 3.