WORKER'S COMPENSATION What is Worker's Compensation? If you are injured at work, the Wisconsin Worker's Compensation Act limits you to worker's compensation benefits as compensation for your injuries. The policy behind the Act is to avoid costly litigation between employees and employers for injuries by providing compensation to injured employees regardless of who is at fault for their injuries. Employers are required to have worker's compensation insurance for this purpose. The worker's compensation insurance carrier is responsible for paying the injured employee's worker's compensation benefits. What should I do first if I am injured at work? Immediately report the accident to your employer. Seek medical treatment from an employer authorized doctor. You should also start to document everything about the event and seek the advice of Rodli, Beskar, Krueger & Pletcher, S.C. Can I see my own doctor in a worker's compensation case? The employer shall offer to the injured employee his or her choice of any doctor licensed to practice and practicing in Wisconsin. By mutual agreement, the employee may have the choice of a doctor not licensed in Wisconsin. The employee has the right to a second choice of doctor on notice to the employer or its insurance carrier. Under what circumstances am I entitled to worker's compensation benefits? To become entitled to worker's compensation benefits, an employee must sustain an injury. Injury is defined as mental or physical harm to an employee caused by accident or occupational disease. Occupational disease is mental or physical harm that results from occupational exposure but that is not so sudden or traumatic as to fit within the definition of an accident. To be compensated, an injury must occur while the employee is in the course of his or her employment. Injuries that occur when an employee has deviated from the course of employment are not compensable. There is not a clear distinction between "in the course of employment" and "deviating from the course of employment." For example, going to or from work or going to the washroom or getting fresh air is not a deviation from employment if the employee is on the employer's premises, unless the extent of the departure is so great that an intent to abandon the job temporarily may be inferred. What types of worker's compensation benefits are available? Medical Treatment for Injury: An injured employee is entitled to unlimited medical, surgical, chiropractic, psychological, dental and hospital treatment. The worker's compensation insurance carrier is also liable for reasonable and necessary treatment to prevent further deterioration in the condition of the employee or to maintain the existing status of such condition whether or not healing is completed. Temporary Disability Benefits: Temporary disability benefits refer to wage loss during the healing period. The healing period is the period of time during which an injured employee is both suffering from the injury and submitting to treatment, and before the medical condition becomes stationary. Where wage loss is total, the employee is entitled to temporary total disability (TTD) benefits. The TTD rate equals two-thirds of the employee's average weekly wage subject to a maximum wage limit. When an employee is still in the healing period and returns to work with restrictions, such as a limit on the number of hours that may be worked in a week, the employee will have partial wage loss. In this situation the employee is entitled to temporary partial disability (TPD) benefits. An employee receiving TPD benefits will receive a proportion of the TTD benefits equal to the employee's partial wage loss. Permanent Disability Benefits: A worker has a permanent disability if at the end of the healing period, he or she has permanent effects of the injury. In theory, these benefits compensate an employee for future loss of earnings. Permanent disability benefits accrue weekly after temporary disability benefits stop. Just how many weeks of permanent disability an employee is entitled to depends upon the type of injury. Permanent disabilities are based upon scheduled injuries or non-scheduled injuries. Scheduled injuries are impairments to any member or faculty of the body except the torso and head. Wisconsin Statutes provide how many weeks of permanent disability an employee with a scheduled injury is entitled to based upon the injured body part. Non-scheduled disabilities are impairments to the torso and head, except that auditory and visual impairments are scheduled injuries. Employees with unscheduled injuries are entitled to benefits for 1000 weeks. The permanent total disability (PTD) weekly benefit is the same as the TTD weekly benefit. An employee's total PTD recovery is calculated as follows: Disability percentage (100%) multiplied by the weekly benefit, then multiplied by the number of weeks assigned to the injured body part. An employee's total PPD recovery is calculated using the same equation. However, the permanent partial disability (PPD) weekly benefit is subject to a lower maximum wage limit, so most employees are entitled to the maximum PPD weekly benefit. Also, an employee with a PPD will have a disability percentage less than 100%. The employee's physician will determine the appropriate percentage. Retraining Benefits: Employees suffering from permanent disability may be eligible for the equivalent of additional TTD benefits as well as certain expenses if they are participating in a qualifying program of vocational retraining. If an employee enrolls in a course of vocational rehabilitation or participates in on-the-job training through the State of Wisconsin's Department of Workforce Development, the employee is entitled to temporary disability benefits for at least the first 80 weeks of the retraining period. The employee is also entitled to necessary expenses of travel, lodging and meals. Death Benefits: When an employee dies due to a work related injury, or when a permanently totally disabled employee dies from any cause, his or her dependants are entitled to a death benefit. What if my employer does not hire me back after my injury? An employer, who without reasonable cause, refuses to rehire an employee after the employee has sustained a work injury may be found liable for up to one year's lost wages. A case for unreasonable refusal to rehire can only be established if suitable work within the employee's physical and mental limitations was available with the employer. What if my claim for worker's compensation benefits is denied by the worker's compensation insurance carrier? If the insurance carrier denies liability for an employee's claim or disputes the extent of the employee's injury. Rodli, Beskar, Krueger & Pletcher, S.C. will investigate your claim and, if it has merit, we will file an application for hearing with the Department of Workforce Development (DWD). Occasionally, the DWD will schedule a prehearing conference in front of an Administrative Law Judge (ALJ) to identify the disputed issues of the claim. Otherwise, the DWD will schedule a formal hearing in front of an ALJ in one of 25 locations in the state. The employee is usually given the opportunity to choose where the hearing will be held. It can be many months before the hearing is actually held. Accordingly, it is important to contact us immediately so that an application for hearing can be filed. Do I have to submit to an examination by a doctor selected by the insurance carrier? An employee who claims benefits, must submit to one or more reasonable examinations by a doctor selected by the insurer if the insurer requests it in writing. Generally, the employee shall not be required to travel more than 100 miles to participate in the examination. Expenses for travel and wages lost as a result of the examination must be paid in advance. Do I have to pay an attorney up front to represent me? A worker's compensation attorney's fee is based upon work done on behalf of the injured employee. The attorney's fee can be no greater than 20% of the amount recovered on behalf of the injured employee. (This information is intended to be viewed as general information. Your individual situation or needs require consultation with the advice of an attorney. Please call or e-mail Ken Pletcher regarding your particular case, questions or concerns.)