In Wisconsin, Workers Compensation Benefits are Only Recoverable When an Employee Suffers an Injury

In Wisconsin, Workers Compensation Benefits are Only Recoverable When an Employee Suffers an Injury

To recover workers’ compensation benefits in Wisconsin, a worker must have suffered an “injury.”  An injury can be either physical or mental harm caused by an accident.  An Accidental/Physical Injury causing harm is like when a trip or fall causes a broken bone.  An accidental injury can also aggravate or accelerate a pre-existing condition or ailment beyond its normal progression, such as an aging sore back that is worsened by heavy lifting.  Another type of injury is Occupational Disease which is physical or mental harm caused by occupational exposure.  Such is not sudden or traumatic or the result of a single incident.  An occupational disease is a process usually extending over a considerable period.  There can be a steady deterioration, swift or slow.  There can be improvements and relapse.  There can be recovery and reoccurrence.  For instance, a series of traumatic work-related back injuries can lead to an occupational disease.

So, to repeat, an accident can cause physical injury, described as either traumatic, occurring suddenly, or over some time.  

A Mental injury can result from a physical injury termed a Physical-Mental Injury.  A Mental injury can also occur due to some non-traumatic event occurring at work, termed a Mental-Mental Injury.  A mental injury can also aggravate a physical ailment or condition, termed a Mental-Physical Injury.

Confused?!  Don’t be…let’s back up and dissect the difference between an Accidental Injury and Occupational Disease.

An Accidental injury, occurring traumatically is recoverable if it is medically reasonable that the injury caused harm, such as a fall by a roofer from a ladder that resulted in a broken bone.  But what if the injury is not as dramatic as a fall?  Instead, the roofer hurts his back when he bends down to pick up a case of 75-pound shingles.  If the bending movement and weight is dramatic enough that it is medically probable that the motion aggravated the aging, low back beyond its normal progression or deterioration, then such injury will be recoverable for workers compensation benefits.  However, just a Wisconsin worker suffering an ache or pain at work is not enough to make it a recoverable injury. The ache or pain must be serious enough that it requires medical treatment.  Also, an injury that occurs at work must be related to the work, meaning a heart attack occurring at work where the worker was not under undue stress will be deemed nothing more than a coincidence for occurring at work and not recoverable for workers’ compensation benefits.

If you have suffered an accidental injury at work, you need to report it immediately to your supervisor, who is required to obtain the proper paperwork so that an Incident Report can be completed and given to the worker’s compensation insurance carrier.  Always get a copy of the Incident Report or take a picture of it on your phone.  Keep in mind that employers hate work injuries, and sometimes they like to ignore them or act like they never happened.  So, the injured worker must protect themself and help document the injury on their own too.  A good way to document a work injury is to:

  • Take pictures of the scene;
  • Take pictures of the body part involved if bruising, swelling or bleeding is evident;
  • Document the names and addresses of witnesses and try to commit them by a text or email message, getting them to discuss the injury and what they saw and did in response;
  • Try to record statements from co-workers and witnesses.  Get them talking and record their comments, observations, and responses on the voice app of your smartphone.  Keep in mind, that everybody is recording on their cell phones these days;
  • Have witness also complete Incident Reports and keep copies by taking a picture of it on your smartphone:
  • Keep a journal of the event. Answer the basic questions in detail Who (witnessed or came to your aid), What (a detailed description of what happened to you), Where (describe the area and conditions where the injury occurred), Why (try to recreate why the injury occurred), and When (date and time the injury occurred).

Seeking medical treatment as quickly as possible is another form of documenting the injury.  Make sure you describe to the medical staff that the injury occurred at work and how it happened in detail.

An injury that falls under Occupational Disease requires a process and cannot result from a single incident.  An example of an occupational disease is silicosis which can only be acquired as a result and an incident of working in an industry over an extended period.  When reporting a work injury as an occupational disease, it is sometimes difficult to determine the actual date of injury.  The first date of interrupted work with the employer whose employment caused the disability can be used, meaning that the first date of wage lost or the date that the employee steps away from his/her scheduled work duties to attend to the disease (i.e., a first medical appointment can be attributed as the date of the occupational disease).   When reporting an occupational disease to your employer and answering questions to the worker compensation insurance carrier, it is important to remember to include certain details in your description of the injury/disease:

  • Give a detailed and accurate description of the job duties performed;
  • Give specific descriptions of the duration, frequency, and repetitiveness of the specific offending job;
  • Try to locate an actual written job description that is true and accurate for the job you did;
  • Know the weight and height of items that you regularly push/pull/carry/lift;
  • Document your work environment/exposures with pictures, obtain the Material Safety Data Sheet (MSDS) for products that you are exposed to on the work site, and keep a journal of symptoms;
  • Seek specialized medical treatment for your symptoms;
  • Describe if your symptoms increase during employment or improve when off work.

Why are these details important?  An occupational disease is an injury resulting from the wear and tear of long-term employment activities, so such activity needs to be described to your medical providers to arm them with a strong basis of information upon which to rely on when supporting your injury as an occupational disease.  Judges want to know the intensity, frequency, and duration of the work you perform to determine if your condition is truly occupational.  Providing a written description of your work to your treating doctor to reference and have in your medical file gives credibility to your doctor’s opinion of work-relatedness because it shows that your doctor is fully aware of the job you performed.   Keep in mind that line supervisors will be called to testify at the hearing to minimize the activity of your job which caused your injury.  They will be coached to testify that their job was physically easy, that it did not involve repetitive movement, or that the lifting of weight was minimal.  So having a copy of the actual job description of your work is a great way to discredit such adverse witnesses.  If able, taking pictures of the specific details of your job, such as equipment, machinery, stations, sites, and conditions, will be helpful when telling your story, especially when describing it to your doctor and testifying at a hearing.

Still unsure what category of work injury you are suffering?  No worries, it’s complicated for sure.  Learn more when you call the Mays Law Office at (608)257-0440 for a free telephone consultation.  Attorney Lisa Pierobon Mays knows the right questions to ask and prides herself on representing Wisconsin injured workers.

10 Myths about Filing for Workers’ Compensation in Wisconsin

10 Myths about Filing for Workers’ Compensation in Wisconsin

When you file for workers’ compensation in Wisconsin, it is up to you to make sure you receive the benefit you deserve. Your employer (or its insurance company) will fight your claim by all means available and will not hesitate to deny benefits if it has any grounds to do so.

As a result, when filing for workers’ compensation, you must make informed decisions. This means relying on accurate information and avoiding mistakes based on common myths about injured workers’ legal rights. Here is the truth behind 10 common myths about filing for workers’ compensation in Wisconsin:

Myth #1: Workers’ Compensation Covers You if You Are Unable to Work Due to an Injury

Truth: Workers’ compensation only covers injuries suffered in the “course of employment” for eligible employees.

One of the most common myths about workers’ compensation is that you can file a claim any time you suffer an injury that prevents you from working. While Social Security disability covers injured workers regardless of how they get hurt, workers’ compensation does not. To qualify for workers’ compensation, you must suffer your injury in the “course of employment,” and you must be an eligible employee under Wisconsin law.

Myth #2: You Must Be Doing Your Job When You Get Injured to File for Workers’ Compensation

Truth: “Course of employment” is not limited to performing your job duties.

While you must suffer your injury in the “course of employment” to qualify for workers’ compensation, this does not mean you need to do your job when you get injured. Eligible employees can also file claims for benefits when they slip on the way to the bathroom or suffer injuries in other job-related accidents.

Myth #3: Your Employer Can Tell You Where To Go for Treatment

Truth: In Wisconsin, injured workers have the right to choose their medical providers when they file for workers’ compensation.

Wisconsin law provides injured workers with the absolute right to choose their doctors when they get injured on the job. The Wisconsin Department of Workforce Development (DWD) explains, “An injured worker has the right to a first and second choice of doctors licensed to practice and practice in this state.” If your employer tries to tell you where to go for treatment, you should view this as a red flag and seek advice from a local workers’ compensation lawyer promptly.

Myth #4: You Will Automatically Receive Medical Benefits if You Get Injured on the Job

Truth: Workers’ compensation benefits are not automatic. You must file a valid claim on time and be prepared to fight for the benefits you deserve.

Workers’ compensation is a “no-fault” system in Wisconsin. This means eligible employees can obtain benefits without needing to prove the cause of their injuries (other than proving that they suffered their injuries in the “course of employment”).

However, this does not mean that you will receive medical benefits automatically. To make sure you receive these benefits, you should report your injury promptly and ensure your doctor accepts workers’ compensation insurance. As you move forward, you will need to work with your lawyer to ensure you receive the full benefits you deserve.

Myth #5: All Employees Receive the Same Workers’ Compensation Benefits

Truth: If you are eligible for workers’ compensation, your benefits will be calculated based on your medical needs, your wage or salary, and other relevant factors.

Not all employees are entitled to the same workers’ compensation benefits. To ensure you receive the full benefits you deserve, you will need to work with a lawyer who can help you obtain full medical coverage and accurately calculate your disability benefits based on the effects of your injury, your “average weekly wage,” and all other relevant factors.

Myth #6: You Aren’t Eligible for Workers’ Compensation if You Are Still Able To Work

Truth: Eligible employees can obtain medical benefits regardless of their ability to work, and partial disability benefits are available in many cases.

You do not have to be out of work to file for workers’ compensation in Wisconsin. At a minimum, you are entitled to medical benefits to cover the cost of your diagnosis and treatment. If you can only work in a limited capacity, you may also be entitled to partial disability benefits.

Myth #7: An “Independent Medical Examination” is Independent

Truth: “Independent medical examinations” are designed to help employers, and insurance companies prematurely terminate injured workers’ benefits.

After filing for workers’ compensation, your employer’s insurance company may ask you to submit an “independent medical examination.” Despite their name, these exams are not independent, and if you aren’t careful, you could lose the benefits you deserve.

Myth #8: If Your Employer Denies Benefits, Your Workers’ Comp Claim is Over

Truth: Wrongful workers’ compensation denials are common. If your employer denies your claim, you should speak with a lawyer about filing an appeal.

If your employer denies your workers’ compensation claim, you should not accept this as the outcome. Unfortunately, wrongful denials are common, and many injured workers find themselves needing to file an appeal.

Myth #9: You Don’t Need a Lawyer to File for Workers’ Compensation

Truth: While this is technically true, there are many reasons to put an experienced workers’ compensation lawyer on your side.

Although you have the option of trying to handle your workers’ compensation claim on your own, this is not your best option. There are many ways an experienced workers’ compensation lawyer can help you.

Myth #10: Hiring a Workers’ Compensation Lawyer in Wisconsin is Expensive

Truth: Hiring a workers’ compensation lawyer costs nothing out of pocket and hiring an experienced lawyer can help maximize your take-home recovery.

When you seek legal representation for your workers’ compensation claim, an experienced lawyer will only take your case if the lawyer believes he or she can help maximize the amount you take home. You should not have to pay anything out of pocket and should not incur any legal fees unless your lawyer helps you collect benefits.

Request a Free Consultation with a Madison Workers’ Compensation Lawyer

Do you need to know more about filing for workers’ compensation in Wisconsin? If so, we encourage you to contact us promptly. For a free and confidential consultation with an experienced Madison workers’ compensation lawyer, call 608-257-0440 or tell us how we can reach you online now.