Wisconsin workers compensation claims require a medical evaluation of the injuries involved.

Workers compensation claims require a medical evaluation of the injuries involved.

When you suffer a workers compensation injury in Wisconsin, you are entitled to benefits and you have rights. Benefits refer to the money paid to you by the workers compensation carrier. You have the right to these monetary benefits and also the right to control your medical care related to the work injury. In order to exercise your rights, it helps to know what they are and understand how they are applied. If you are injured at work, educating yourself about your worker compensation rights is a smart thing to do. Once you understand the law, you can make intelligent decisions about how to move forward and secure the benefits you are entitled to.

This article should help you gain a basic understanding about the rights, benefits, and common questions surrounding workers compensation in Wisconsin. If you have questions about your specific situation, please call or email me. I am happy to discuss your situation and to answer your questions, free of charge.

WHAT TYPES OF INJURIES ARE COVERED?

Workers compensation in Wisconsin recognizes three types of injuries:

Direct Injury – A direct injury occurs on a specific date. For example, if you are working and break your arm, you have suffered a direct injury.

Overuse / Repetitive Use Injury – If your job requires you to perform repetitive motions that eventually lead to an injury, workers compensation in Wisconsin covers that injury. For example, if your job requires that you repetitively lift items over your head and eventually your shoulder gives out, you are entitled to workers compensation in Wisconsin.

Pre-Existing Condition Made Worse – If you have a pre-existing condition  and your work injury made the condition worse, workers compensation in Wisconsin covers this type of injury. For example, if you have a bad back, but your job duties make your condition worse and you now need back surgery, you are entitled to workers compensation in Wisconsin.

WHAT SHOULD YOU DO IF INJURED AT WORK?

If you are injured at work, seek medical assistance as soon as possible. By reporting your injury right away, you create a clear and immediate record of the injury. Later, the insurance company may try to prove you were not injured at work. If there is clear medical evidence that you sought treatment soon after the injury,  you have a stronger chance of being paid your benefits.

Additionally, make sure when you describe your injury, you do so consistently. This means describing your injury accurately, and in a similar way, when discussing the injury with your medical providers. The way you describe the injury goes into your medical records. If you describe your injury one way to your doctor and another way to the physical therapist, the insurance company may try to discredit you and deny your claim.

It is important to report even minor injuries, as sometimes what at first appears minor can become a serious injury. For example, a small pop in your back may later turn out to be a herniated disc. Reporting the small injury early may make the difference between a claim approval or denial.

TERMS YOU SHOULD KNOW

When people discuss workers compensation in Wisconsin, they use a lot of jargon. The following is a brief guide to some key terms and what they mean.

Healing Period – The time period after you injured yourself at work and are healing from the injury.

Maximum Medical Improvement – This is the point in time at which your doctor says you have recovered as much as possible following the injury. You may not be back to where you were prior to the injury, but you are no longer healing. This is also called a “healing plateau” or “end of healing.”

Independent Medical Evaluation (IME) – An examination by the insurance company’s doctor.

BASIC BENEFITS

In Wisconsin, injured workers are entitled to certain standard benefits. These benefits include pay for:

• lost wages (temporary disability)
• permanent disability
• medical bills
• mileage for driving to and from doctor’s appointments

Temporary Total & Temporary Partial Disability Benefits
If you are injured at work and unable to work while healing, then workers compensation in Wisconsin will pay you 2/3 of your pre-disability wages. These benefits are known as temporary total disability (TTD) benefits. For example, if you injure your knee at work and are off work for 3 weeks, then you are entitled to 3 weeks of pay at 2/3 of your regular pay rate.

If you are able to work on a limited basis, but unable to perform all of the duties of your job, then you are entitled to temporary partial disability (TPD) benefits. For example, if the injured worker can only work four hours per day as opposed to his normal eight hours per day, then he is entitled to 2/3 of the difference between his normal pay and his reduced pay. Similarly, these benefits also apply to situations in which the injured worker can work the same number of hours, but due to his injury, can only perform work that pays less. For example, if the injured worker earned $15 per hour prior to his injury, but now can only perform light-duty work that pays $10 per hour, then he is entitled to 2/3 of the difference between the $15 per hour and the $10 per hour. Both of these situations are categorized as TPD benefits.

Permanent Partial Disability Benefits
Additionally, after you have reached maximum medical improvement you may be entitled to permanent partial disability (PPD) benefits. PPD benefits are paid either when your injury results in permanent work restrictions or if the medical treatment for the injury carries a minimum disability benefit. These benefits are not tied to your wages, but rather are calculated based on body part injured and the year of the injury.

Worker’s compensation in Wisconsin assigns a number of “weeks” to specific body parts. For example:

Knee 425 Weeks @ $322 / week (2013)
Shoulder 500 Weeks @ $322 / week (2013)
Hip 500 Weeks @ $322 / week (2013)
Back / Neck 1000 Weeks @ $322 / week (2013)

Your doctor will assign a percentage of disability for your injury: 0% for a body part with no disability and up to 100% for a body part that has been amputated or has lost all ability. For example, your doctor might say you have a 10% PPD at your hip because your work injury has made it painful to stand for long periods. This means your claim is worth 50 weeks of PPD (10% of 500 weeks). The value of these 50 weeks will be based on the year you were injured. For example, if your injury occurred in 2012, your PPD rate is $312 per week. However, if you were injured in 2013, the rate was increased to $322 per week. A chart detailing the relevant PPD rates may be found here. So, for a 10% PPD to the hip from a 2013 injury, your claim is worth $16,100 (50 weeks @ $322 per week).

Beyond this, certain medical procedures carry automatic minimum PPD ratings. For example, if you injure your back at work and undergo a discectomy and fusion surgery, workers compensation in Wisconsin will pay you a minimum of 10% PPD because this surgery inherently implies a degree of permanent disability.

Your doctor can assign additional PPD benefits beyond the minimum based on loss of range of motion, pain, or other impairments to your function. For example, if you undergo a discectomy and fusion surgery, you are entitled to a 10% minimum PPD benefit. Your doctor, however, may believe that you have additional disability due to weakness in your back or a loss of range of motion. In that event, your doctor may assign an additional amount of PPD, such as 3% PPD for pain and weakness in addition to the 10% minimum PPD. The benefits for the 13% PPD for a 2013 back injury would be calculated as follows:

$41,860 (13% x 1000 weeks @ $322 per week)

Medical Bill & Mileage Benefits
If you are injured at work, you are entitled to have your medical bills paid by the worker’s compensation carrier, including mileage for driving to medical appointments. This benefit can extend for as long as twelve years. Your medical providers bill the workers compensation insurance company directly for their services.

ADDITIONAL BENEFITS FOR SPECIAL SITUATIONS

Beyond the basic benefits that workers compensation in Wisconsin provides, in certain circumstances, there are additional benefits available to injured workers.

What if Your Injury Permanently Prevents You From Returning to Your Previous Job?
If you are injured so badly that you are permanently unable to return to work, then workers compensation in Wisconsin may provide you with retraining and/or loss of earning capacity benefits.

Retraining benefits are available to any injured employee whose permanent restrictions do not allow him to return to work at his previous position and who is not able to earn at least 90% of his pre-disability wages. Retraining benefits basically pay you 2/3 of your pre-disability earnings to take courses, usually at a technical college, which will allow you to earn close to what you could earn at the time of your disability. Your retraining program will be tailored to fit your occupational interests as well as your previous work history and educational background. You will also receive compensation for your travel and meal expenses and, in certain circumstances, your tuition and books.

Loss of earning capacity benefits apply only if you have injured your neck, back, head, or torso. If you suffer an injury to these body parts and are unable to earn at least 90% of your pre-disability wages, then you may be entitled to loss of earning capacity benefits. These benefits provide additional PPD benefits to compensate for your loss of ability to earn money due to the work injury.

What if Your Employer Fires You?
If you are injured at work, you may not be fired without reasonable cause. This means you cannot be fired simply because you were injured at work or because you temporarily cannot perform your job duties. If your employer unreasonably fails to return you to work after you reach maximum medical improvement, you may be entitled to an additional benefit of one year’s wages.

What if You Are Hurt Because Your Employer Did Something Unsafe? 
Workers Compensation in Wisconsin provides your benefits increase by 15% if your employer’s unsafe working conditions contributed to your injury.

What if Your Injury Leaves a Scar?
If your injury leaves a scar on a part of your body that is visible while working, such as your arms, hands, face or neck, you may be entitled to a 15% increase in your benefits. This also applies if your injury leads to amputation of a body part.

DISABILITY BENEFITS TIMELINE

The benefits surrounding a workplace injury can be confusing, so a visualization of the process may help understand how it works. The following timeline summarizes the benefits following a workplace injury in most situations.

Disability Benefits Timeline - Workplace Injury Wisconsin

WHAT ARE MY RIGHTS?

Beyond entitlement to the benefits discussed above, workers compensation in Wisconsin provides you important medical consultation rights:

You have the right to see two doctors of your own choosing. This means that if you are injured at work, you may see your own doctor and any doctor to whom you are subsequently referred.

You can seek a second opinion and see whoever you would like for this second opinion. If the second opinion doctor refers you to other medical providers, you have the right to seek this treatment and it should be paid for.

You have the right to meet with your doctor in private. If the workers compensation carrier sends a nurse to your appointments, you have the right to ask that the nurse wait to speak with your doctor after your appointment.

Important Note: Workers compensation in Wisconsin also allows the insurance company to send you to one of its doctors for a review of your claim. If this happens, it likely means your claim will soon be denied. You should know this doctor is working for the insurance company and is not on your side.

Right to an Attorney
You have the right to speak with an attorney about your workers compensation claim at any time. While many workers compensation claims go smoothly, some valid claims are denied when insurance companies think they might be able to save money by challenging them. In these situations, the insurance company hopes you simply accept the denial without standing up for yourself. The following “red flags” indicate your claim may be denied soon:

• The insurance company wants you to see its doctor
• Your doctor and the insurance company doctor disagree
• The insurance company asks you to give a statement
• More than two weeks have passed since your accident, and you have yet to receive benefits

If any of these things happen to you, it may be a good idea to consult with an attorney who knows the law and has strategies to help you keep your benefits.

If your workers compensation claim IS denied, you have the right to a hearing in front of an administrative law judge. If you can present sufficient evidence, the judge will reverse your claim denial and reinstate your benefits. While you CAN go through this process alone, an experienced attorney will help you in the following ways:

1. An experienced workers compensation attorney knows what evidence you need to present to the judge in order to win your case.

2. The insurance company will have an attorney and will know the rules. You will likely be at a disadvantage without legal counsel.

3. Most workers compensation claims settle without a hearing. An experienced workers compensation attorney will help you settle your claim for the maximum value.

4. Insurance companies will try to take advantage of individuals without an attorney. The insurance company will not explain all the benefits you may be entitled to and will try to get you to agree to give up your claims.

5. Perhaps most importantly, once you are represented by an attorney, your attorney will communicate directly with the insurance company or its lawyer. This will allow you to focus on getting better and relieve the stress that often comes with dealing with an insurance company.

You may be concerned an attorney will cost too much or that the trouble may not be worth it. First, if you have been injured at work, Hawks Quindel offers free consultations. Second, Hawks Quindel’s attorneys work on a contingent fee basis. That means that we do not get paid for our work unless we recover benefits for you.

While legal help is not free, most clients feel it is well worth the investment. No attorney can charge you more than 20% of your total recovery, which is what almost every lawyer will charge. Hawks Quindel’s workers compensation attorneys charge the same 20% fee as those who have far less experience.

If you have been injured at work contact an experienced worker’s compensation attorney at Hawks Quindel for a free consultation.

Bill Parsons

Family & Divorce

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