Answers To Common Workers’ Compensation Questions

What Injuries Are Covered By Workers’ Comp?

Wisconsin workers’ compensation law covers injuries from either a single accident or develop from job duties over time. Generally, workers’ compensation benefits must be paid even if the injury was your fault.

All compensation and medical payments are based on medical reports from your doctors. Without prompt and regular reports to the insurance company and/or your employer, your workers’ comp payments may be delayed. If your claim is denied, the insurer must inform you within seven days of its decision and advise you of your rights to a hearing.

First Steps In Workers’ Compensation

If you are hurt at work, immediately report your accident to your supervisor. If there is no specific accident, but, for example, the job duties over time hurt your back or neck, tell your co-workers and supervisor. Seek first aid and medical attention, and report how the accident happened or the injuries developed to the emergency room doctor and/or your doctor.

It is important that you make every effort to return to work, within medical restrictions, as soon as possible after an injury. Your employer and your practitioner must agree to your returning to some form of work; it is important that you talk to them about returning.

Every time you visit the doctor, make sure to get an off-work excuse, keep a copy for yourself, and give a copy to your employer, the insurance company and your lawyer.

May I Choose My Treating Practitioner?

You may choose any physician, and some other specialists, licensed in the state. You are allowed two different choices under the law; however, any health care provider one of your choices refers you to is considered part of your first choice. Therefore, it is best to have your first treating doctor refer you to specialists so you retain your second choice.

Your employer or the insurance company has the right to have you examined by a practitioner of its choice. Your compensation may be delayed if you do not agree to have these examinations.

You have the right to every type of treatment which is reasonable and necessary to cure you, as ordered by your practitioner. This includes hospitalization, therapy, tests and prosthetic devices. Medicine is paid for, as is any reasonable travel expense necessary to receive treatment.

Who Pays The Medical Bills?

The insurance carrier or self-insured employer is required to pay your medical expenses and mileage. Send any bills you receive to your employer or its insurer. If you paid any of your medical expenses, send itemized receipts to your employer (if self-insured) or its insurer for reimbursement. An insurer or self-insured employer may challenge a health care provider’s fee as unreasonable or treatment as unnecessary. If so, it may refuse to pay the charge in question and must notify the provider of the dispute. Once a provider receives notice of a dispute about fees or treatment, the provider may not ask you to pay the bill. If you receive a bill for treatment when such a dispute exists, please contact your insurance carrier or, if self-insured, your employer.

How Is Compensation Paid?

During the time you are healing from your injury, you will get two-thirds of your weekly wage, up to the maximum rate for the year of injury.

When Will I Get My First Check?

In most cases, the first payment will be made by the insurance company within 14 days of your last day worked. You may cash compensation checks without fear of losing any of your legal rights to more compensation.

What Compensation Is Paid For Permanent Disability?

After you have healed as much as possible from your injury, your doctor will determine if you have any permanent disability. For permanent disability, you will receive additional compensation. Benefits are paid monthly, not in one lump sum, unless there is a settlement.

Unlike most injuries, back and neck permanent injuries are compensated in a different manner that involves a determination of future wage loss. These loss of earning capacity or vocational retraining claims can be complicated and large, resulting in the insurance company using experts and lawyers. Accordingly, most injured workers making a back or neck injury for loss of earnings or retraining, would be well advised to speak with an experienced workers’ compensation lawyer before making any decisions, or even speaking with the insurance company.

What If My Claim Is Disputed?

If there is a dispute over your benefits between you and the insurance company, you or your lawyer may request the Workers’ Compensation Division to resolve it by holding a hearing before an Administrative Law Judge. The process involves filing an application for a hearing, backed up by relevant medical records and doctor’s reports. A physician assistant or advanced practice nurse prescriber can give opinions on diagnosis and necessity of treatment but not on whether your injury is work-related or the extent of any permanent injury.

What If I Get A Lawyer?

If you hire an attorney in a disputed case, the attorney will get paid 20 percent of the amount of compensation the attorney obtains for you. In addition, there are also costs for medical and vocational reports, but most experienced lawyers will advance the necessary costs and get reimbursed at the end of the case.

What If My Employer Won’t Rehire Me?

Under most circumstances, the law does not guarantee a job after an injury, and the employer is not required to hold one open or create one. However, up to one year’s back pay may be due if an employer “unreasonably refuses” to rehire an injured worker, usually if they hired someone else for the same job but told you they had no work available.

What If I Can’t Return To My Job?

Some workers may not be able to return to the same type of work they did before their injury. If your doctor or employer indicates that you cannot return to your former job, you may be eligible for vocational rehabilitation services. One resource is the State Division of Vocational Rehabilitation (DVR), which has offices throughout the state.

What If I Do Not Want To Go To School For Retraining?

An injured worker cannot be forced to go to school. If a worker has a nonscheduled permanent injury, usually to the back or neck, then a lawyer may help you get loss of earning capacity benefits.

When Is Increased Or Decreased Compensation Paid?

If an employer has not followed a state or federal safety order and an injury results, the employer must pay 15 percent more in compensation, up to a maximum of $15,000. This is in addition to any other compensation. Payment is due even if the employee’s carelessness caused the injury.

How Long Is My Claim Open?

You must report the injury to your employer within two years to qualify for workers’ compensation. If the injury is reported or a payment is made within two years, the claim is usually held open by law for 12 years from the date of the injury or the date of last payment to you, whichever is later. This can be important if your condition changes during this time. In the case of an occupational disease, such as an occupational hearing loss, carpal tunnel syndrome, etc., there is no time limit for filing a claim. For some serious traumatic injuries such as total loss of a hand, arm, vision loss, permanent brain injury, or partial or total hip or knee replacement, there is no time limit for filing a claim. It is important to save your records of the last payment for 12 years.

What Is A Compromise?

Your employer or the insurance company may ask you to settle. This is called a compromise. If there is a valid dispute over the amount of disability or whether an injury is work-related, you and the insurance company may decide to settle your claim. All compromises must be approved by the Workers’ Compensation Division. Before negotiating or signing a compromise it is important that you understand what future benefits you may be giving up. Normally, you will not receive additional compensation after the compromise. Most employees should not enter into a compromise without legal advice.

At McCormick Law Office, in Milwaukee, we provide clients with a free initial consultation and are available after-hours by appointment, including home and hospital visits. Contact us to discuss your legal resolution by calling 877-412-7409.