THE WORKERS COMPENSATION INSURANCE IS DENYING MY WORKERS COMPENSATION BENEFITS CLAIMING IT IS IDIOPATHIC

You were hurt at work and the workers compensation insurance company is denying your benefits claiming that you suffered an IDIOPATHIC injury.  What does this mean?

In Wisconsin, the workers compensation system under Chapter 102 of the Wisconsin Statutes provides benefits such as lost time, medical treatment expense, medical mileage reimbursement, and permanent disability to Wisconsin workers who are injured on the job.  This system is considered a no-fault system, which means that the injured worker does not need to prove that anyone was at fault for their injuries to receive benefits.  Nevertheless, workers compensation insurance companies come up with all kinds of reasons to deny a claim and one of the more common reasons is to claim that the injury is “idiopathic.”

WHAT IS AN IDIOPATHIC INJURY?

Webster Dictionary defines Idiopathic as “arising spontaneously” or “from an unknown cause.”

Some examples of idiopathic injuries are if an employee faints, suffers a seizure or blacks out due to a personal condition, the resulting injury could be an idiopathic injury.  For instance, if an employee’s leg gives out while normally walking or standing at work this might result in an idiopathic injury.  Also, if an employee slips and falls while on the job, where there is no object, or residue on the floor to cause the slip, the employee might have sustained an idiopathic injury, which would not be compensable.

While it may be fun to play with this word, and name call it right back on the IDIOT-PATHETIC insurance adjuster who is denying your workers compensation benefits, but in serious, this office is seeing this defense being used more and more against injured Wisconsin workers in the denial of workers compensation benefits.

Perhaps, a better term for this defense is to call it an “unexplained injury” which arises from purely a personal cause, like a disease, physical disability, or a condition personal to the injured worker.  To recover workers’ compensation benefits, the employment must place the employee in a position that somehow increases the dangerous effects of a fall.    

HOW DOES WISCONSIN TREAT IDIOPATHIC INJURIES?

In the Wisconsin workers compensation setting, idiopathic or unexplained injury cannot be due to a force completely personal to the employee.  The easiest example of an idiopathic injury is a heart attack suffered at work.  Only under very special circumstances of extreme stress endured on the job, would a heart attack suffered at work be considered a compensable work injury because heart attacks are caused by heart disease, not work events or exposure.

Many Wisconsin injured workers ask how it can be that a fall on-the-job, on their employer’s premises, causing injury excuse the employer’s workers compensation insurance carrier from the responsibility of covering medical treatment and lost time?  Such a premise just feels wrong and unfair.  Unfortunately, Wisconsin is in the minority of states that does not allow compensation for unexplained or idiopathic falls.

In Wisconsin, slipping on a clean, unobstructed cement/hard floor will not be considered a special hazard of employment and will be deemed idiopathic. However, in Attorney Lisa Pierobon Mays’ experience, slip and fall injuries are always more involved than that.  Hazards exist that can render what appears idiopathic explainable, such as elevators, stairs, ladders, scaffolds, sharp edges, corners, and water to name a few.  Sometimes injured workers do not know or remember what caused their fall and resulting injury because falls happen so fast.

Claims involving potential idiopathic injuries are fact intensive and fact specific, so it is very important for the injured worker to reflect on and timely investigate their fall before documenting or completing an Incident Report of the injury requested by their employer.  The workers compensation insurance carrier will use a statement of “I do not know what happened” against the injured worker as a basis to claim Idiopathic injury to deny workers compensation benefits.

HOW TO OVERCOME THE DEFENSE OF IDIOPATHIC?

In Attorney Lisa Pierobon Mays’ experience, a denial of benefits under the idiopathic defense can be overcome when the Wisconsin worker sustains an idiopathic injury that was aggravated or accelerated due to work-related activities. Examples are:

• Slip and Fall Due to Seizure: An employee with epilepsy experiences a seizure while on a ladder at work and falls, causing injury. While the seizure may be idiopathic, the fall and resulting injury were related to the work environment and activities (being on the employer’s ladder), so the injury might be covered.
• Injury During Diabetic Event: A diabetic employee experiences a drop in blood sugar, causing them to faint. In the process, they hit their head on a machine, causing a severe head injury. The injury from the fall could be eligible for workers’ compensation (hitting the head on the employer’s machine), even though the fainting spell was due to a personal health condition.
• Injury Exacerbated by Work: An employee with a pre-existing back condition injures their back further while lifting heavy equipment at work. Even though the initial back condition is idiopathic, the worsening of the injury due to work activities (lifting the employer’s heavy equipment) could make the case eligible for workers’ compensation.

As you can see every injury is fact specific so after a fall that results in an injury, the injured employee should try to document the fall and consider their recollection carefully. Steps to take are:

*Build a timeline and consider your actions and activities before the injury occurred,

*Revisit the scene, take pictures, request surveillance footage,

*Speak to witnesses,

*Retrace your steps to try and determine why and how the fall occurred are all ways to combat a defense of idiopathic injury.

In doing so, the injured worker might learn the reason for their fall.  For instance, slippery surfaces caused by spills or leaks, footwear required by the employer, objects on the floor or in the way, fast walking due to rushed work effort or response to an emergency, along with uneven surfaces are often the reason for the fall.  Workers without preexisting disabilities generally do not just fall on a clean, dry, smooth surface.  There is always more to the story that needs to be flushed out when explaining the circumstances of the injury to the employer and their workers compensation insurance carrier.   Moreover, the details of the fall need to be consistent, especially when describing it to medical providers because this is another source of credible documentation.

CALL MAYS LAW OFFICE FOR A FREE CONSULTATION

Lastly, call Attorney Lisa Pierobon Mays so that she can explore the facts and circumstances with you to give further suggestions.  Mays Law Office offers free consultations to all Wisconsin injured workers.  Mays Law Office has the coveted 5 Star Google rating from their former clients proving that they get results.

When you get arrested for drunk driving in Wisconsin, it can be tempting to ignore your situation. Dealing with your OWI or PAC ticket can be stressful, and the last way you want to spend your time is meeting with a lawyer and going to court.

But ignoring your OWI or PAC charge is a mistake—and many reasons exist.

It would be best if you did everything you possibly could to protect yourself when you are facing a drunk driving charge in Wisconsin. If you are a first-time offender, you face steep fines, a six to nine-month driver’s license suspension, and other consequences. If you are a repeat offender, the consequences at stake are even more significant—and may even include jail time. Having a conviction on your record will also negatively impact your life for years to come, and in Wisconsin, drunk driving charges are not eligible for expungement.

Why You Shouldn’t Ignore Your OWI or PAC in Wisconsin

If this isn’t enough, here are even more reasons not to ignore your Wisconsin OWI or PAC:

1. Your OWI or PAC Case Will Proceed Without You

Even if you ignore your OWI or PAC case, the court system will. Your case will proceed without you; you will almost certainly be convicted if you do nothing. At this point, the judge will have no choice but to consider the prosecution’s sentencing recommendation, which means that you will most likely face the harshest sentence possible based on the facts of your case.

Also, don’t forget that having an OWI or PAC conviction on your record means you will face even more significant penalties if you get convicted again. Next time, jail time could be on the table, and you could lose your driver’s license for a year or longer.

2. You Can Be Charged with Failure to Appear

If you ignore your OWI or PAC charge in Wisconsin, you can also be charged with failure to appear when your court date arrives. The judge can issue a bench warrant for your arrest based on your failure to appear. The judge can also impose additional penalties—and when you eventually make an appearance in court, the judge isn’t going to be sympathetic to your situation.

3. There Are Several Ways to Fight an OWI or PAC Charge in Wisconsin

One of the most important reasons not to ignore your case is that there are several ways to fight OWI and PAC charges in Wisconsin. This is true regardless of whether you were driving drunk at the time of your arrest. An experienced lawyer will be able to evaluate all potential defenses and develop a strategy focused on protecting you to the fullest extent possible. Depending on the circumstances, this could even mean helping you avoid a conviction entirely.

4. You May Be Able to Negotiate a Reduced Charge

If avoiding a conviction entirely isn’t realistic, your next best option may be to negotiate a reduced charge. Prosecutors will consider plea deals for OWI and PAC charges in appropriate cases. While you will face some consequences if you accept a plea deal, the consequences will be far less severe than those you would face after an OWI or PAC conviction.

Negotiating a favorable plea deal requires experienced legal representation. You need to know what type of deal to seek and be able to negotiate with the prosecutor’s office effectively. This means that you need an experienced lawyer on your side. A lawyer with experience handling OWI and PAC cases in Wisconsin will know how to approach the prosecutor’s office with an offer—and will be able to help ensure that seeking a plea deal is your best option.

5. Hiring a Lawyer to Fight Your OWI or PAC Can Be Your Cheapest Option

Given the substantial costs of ignoring an OWI or PAC charge in Wisconsin, hiring an experienced lawyer can be your cheapest option. Whether your lawyer can negotiate a plea deal or fight your charge in court, hiring a lawyer can save you substantial money in the long run.

6. You Owe it to Yourself and Your Family to Stand Up for Your Legal Rights

Finally, if you are facing the life-altering consequences of an OWI or PAC conviction, you owe it to yourself and your family to stand up for your legal rights. Regardless of the facts of your case, you do not deserve to face unnecessary and unjust punishment. From police miscues to prosecutorial misconduct, many issues can lead to an unfair conviction, and under no circumstances should you be willing to accept this as the outcome of your case.

Discuss Your Wisconsin OWI or PAC Case with a Lawyer for Free

Our lawyers rely on decades of experience to effectively represent individuals facing OWI and PAC charges in Wisconsin. To discuss your case for free with one of our experienced lawyers, call 608-305-4518 or tell us how we can reach you online today.

Some recent success stories from the criminal defense side of Mays Law Office, LLC.

In the Village of Marshall four teenagers were charged with one count each of disorderly conduct and damage to public property.  The charges arose from an incident in which a public park’s bathrooms and concession stand were vandalized. An onlooker flagged down an officer and reported what she had just seen. Four of the teenagers were identified and subsequently questioned by the officer.  Each one gave conflicting and shifting accounts of what occurred.  The only consistency is that each one denied being involved and suggested that the others were responsible. A little over a week prior to the matters proceeding to trial, Attorney John Orth was retained to represent one of the teens.  After obtaining police reports Attorney Orth made contact with the prosecuting attorney.  Her position was that given the fact that no one was accepting any responsibility, she would not be offering any plea deals or concessions and simply proceed to trial and let the judge decide which, if any, of the teens were being truthful.  When the trial was about to commence, Attorney Orth requested a meeting with all of the parents present. After a rocky start with each of the parents being angry in varying degrees with their own children, the other children, and the police, Attorney Orth set about seeking some common ground, common sense, and a unified plan for how to proceed.  As always, the number one objective is to avoid convictions and sometimes that requires creativity, flexibility, and persuasion.  After some back and forth between the prosecuting attorney and the group of parents, Attorney Orth was able to reach a solution that was beneficial to all involved.  Rather than proceeding to trial and having the judge try to sort out the truth, Attorney Orth was able to convince the prosecuting attorney to agree to hold the charges open for 60 days.  During that time each of the teens would agree to perform eight to ten hours of community service for the Parks Department and all of the families would split the relatively modest restitution for repairing the damage four ways.  Upon fulfilling these obligations, all charges were dismissed.  An event that began with palpable anxiety and angry grumbling ended with a group of families lightheartedly chatting and catching up.

Attorney Stephen Mays was contacted by the distraught mother of a 17-year-old boy, ND, who was being held in the county jail for days pending a bail hearing before a court commissioner. He was being charged with felony reckless endangering of safety for allegedly driving at a speed in excess of 115 MPH in a high-traffic business district with a 35 MPH speed limit.  While ND’s conduct may have been impulsive and perhaps reckless (two things teenagers often are), Attorney Mays was determined not to have a young man be saddled with a felony conviction that could haunt him for the rest of his life.  By focusing on the positive attributes in ND’s life – great grades, being in the process of obtaining a pilot’s license, working multiple jobs – Attorney Mays we able to convince the prosecuting attorney that this is a promising young man with a bright future that would be all but destroyed by a felony conviction and greatly hampered by any conviction.  Attorney Mays got the charge reduced to a misdemeanor charge of negligent operation of a motor vehicle and secured a deferred prosecution agreement ultimately resulting in dismissal of the charge.  In the end, ND won’t have so much as even a speeding ticket to show for this incident.

Following a three-month long intensive investigation by the Federal Drug Enforcement Agency working in conjunction with local law enforcement, GV was arrested in a sting operation executed by the Wisconsin State Patrol. The investigators obtained warrants to track all of GV’s movements by GPS and ultimately determined that a storage unit was the nexus of his activities and a warrant for its search was obtained.  While the State Patrol was detaining GV in a traffic stop that ultimately led to his arrest for misdemeanor possession of cocaine, the search warrant for the storage unit was executed.  Among other evidence, agents seized an entire pound of cocaine.  Initially charged in state court for simple possession of cocaine while the evidence from the storage unit was being processed, GV was referred by a trusted friend to Attorney Orth for representation.  Given the overwhelming strength of the evidence and the fact that law enforcement methodically followed proper procedures and secured valid warrants every step of the way, the best strategy was to work out the best deal possible.  And to do so for not only the current misdemeanor charge, but to begin negotiations on the upcoming felony possession with intent to deliver while there was still a possibility to wrap that more serious charge into a state court agreement.  Were it to be filed in the Federal District Court, GV would be facing sentencing guidelines that would ensure a lengthy prison sentence given the amount of cocaine seized.  Ultimately, Attorney Orth was able to convince the prosecutor to agree to impose but stay a two-year prison sentence and instead place GV on probation for three years.  One pound of cocaine and not a day in prison – no small feat.

LR was charged with felony stalking of underage victims.  The alleged victims in this case were his step-grandchildren – the children of LR’s second wife’s son and his wife.  During the height of the COVID-19 pandemic, the children’s parents had concerns about their grandmother’s and LR’s level of safety precautions and drastically reduced the amount of exposure LR and his wife were allowed to have with the children.  This conflict ultimately led to a souring of relations between the two families and LR and his wife were told to have no contact with them.  However, given that all parties live in the same small town, incidental contact would be practically inevitable.  In instances in which that would happen, LR found it to feel awkward and downright mean spirited to ignore the children.  Instead, he would simply wave or say hello.  These seemingly innocuous gestures incensed the children’s parents.  And as often unfortunately happens, what might have been a minor and easily correctable dispute turns into a potentially life altering event when law enforcement is brought into the picture.  Given the serious charge LR was now facing, he turned to Mays Law Office for assistance. Over the course of nearly three years of persistent advocacy, investigation and negotiation, Attorney Mays was successful in convincing the prosecuting attorney that the allegations reported by the parents were, in fact, simply trumped up, concocted out of sheer anger and lacking any real merit.  Throughout that time, Attorney Mays made it perfectly clear that he would absolutely not settle for anything less than outright dismissal.  And in the end, that’s exactly what he secured for LR.

Mays Law Office is proud of the results that they continually get for their clients. This kind of strong advocacy comes in many forms that can only be mastered with experience and a strong reputation. Attorneys Mays and Orth have more than 45 years of combined experience defending their clients in criminal matters with superb results.  Contact them today for a free consultation.

In Wisconsin, when a worker is injured and claims compensation for workers compensation benefits, the workers compensation insurance carrier has the right to send the injured worker to see their “Independent Medical Examiner” under Wis. Stat. Sec. 102.13(1). This type of medical examination can only take place with a physician, chiropractor, psychologist, dentists, podiatrist, physician assistant, or an advanced nurse practitioner. To be clear, these medical appointments are better described as an adverse medical examination because medical treatment is not being rendered. What is being rendered by this doctor is a written medical report that will offer medical opinions as to the cause, extent of the injury, medical diagnosis and prognosis, and reasonableness of medical treatment. Often, the medical report is created solely for the workers compensation carrier with a desired outcome to deny workers compensation benefits. Ultimately, the insurance carrier is hoping for a medical opinion from their Examiner that gives a medical opinion that will allow them to deny the injured worker benefits.

How Should the Injured Worker Behave at The Examination?

In Wisconsin, these appointments are selected and scheduled by the workers compensation carrier, not the injured worker.  Again, medical treatment is not going to be rendered to the injured worker at these appointments.  This appointment will generally not last longer than 20 minutes.  The injured worker should be aware that they are being watched carefully from the moment that they enter the parking lot.  It has been said that some doctors will even wait in their vehicle so that they can see the injured worker arrive, park, exit their vehicle, and walk across the parking lot and into the building hoping to see any inconsistencies in pain symptoms and physical restrictions.  Creepy and bizarre?!  Absolutely yes!  In turn, Attorney Lisa Pierobon Mays suggests that the injured worker be a good observer too.  Take pictures of anything that seems unprofessional, like a dirty examination room.  Also, the injured worker is permitted by law to bring a witness into the examination.  The injured worker should never be chatty with the Examiner.  Be polite but cautious, be respectful but not friendly, be cooperative but not overly talkative because the more you say, the more what you say can and will used against you.

What Will the Adverse Examiner Do at The Appointment?

The biggest thing that the Examiner wants is to get you talking.  They will ask specific questions of you, like:

• What is the date of the injury?
• How did the injury occur?
• Do you have pain symptoms and describe the pain?
• Describe/recite your medical treatment;
• Describe prior injuries and similar symptoms before the work injury occurred;
• What alleviates the pain?
• What aggravates the pain?

These are fair and appropriate questions so be prepared with accurate, complete answers. Remember, you are the best historian of your injury so if you do not know simple things, like your pain symptoms or how the injury occurred in detail, then you will not appear credible to the Examiner and he/she will use this against you in their report that will ultimately be reviewed by the Judge at a potential hearing.

Will the Adverse Examiner Touch Me?

It is very likely that the Adverse Medical Examiner will perform a physical examination of your body so be prepared by wearing appropriate clothing. Wear loose clothing, do not wear tight-fitting clothes, like jeans. Do wear tank tops and shorts under your main clothing because if you are asked to remove your shorts or pants you have a full undergarment on. Never agree to disrobe completely and wear a paper gown. This is an intimidation tactic and completely unnecessary for this type of an examination. Again, keep your witness in the examination room with you so that you do not feel vulnerable and alone with the Examiner who is a stranger to you.

During the physical examination, the Examiner will ask that you sit on an exam table and request to inspect the part of your body that is injured. The Examiner will lightly palpitate, which means examine you with light touching/pressing on the injured area. Verbalize to the Examiner if any touching hurts you. The Examiner will then ask you to perform some movement exercises to test your range of motion. Again, describe truthfully any pain that you experience with such movement. You may be asked to lay on the table on your back, side, and then on your belly for more palpation or range of motion testing. You will be continuously asked if any of the touching/palpation or movements hurts. Be honest and do not exaggerate any pain as the Examiner is looking for such inconsistency or exaggeration of pain to attack your credibility.

When the examination is over, remember that you are being watched as to how you get off the examination table, move, and leave the examiner’s parking. Again, the Examiner and his staff are hoping to see and document anything that puts the truthfulness of the work injury in question. So, if you are restricted from climbing stairs due to a knee injury, then use the elevator, and not the stairs when exiting.

Attorney Lisa Pierobon Mays is Proud to Have Been Involved in Changing Wisconsin Law in Favor of Protecting Wisconsin Injured Workers During Adverse Examinations.

In the past, Wisconsin law allowed the Examiner to meet with the injured worker, male or female, alone and without any observation from a witness, such as a spouse, parent, other family member, or even a friend. This policy was obviously problematic, especially where it was a male doctor examining female injured workers. Often, these adverse medical examinations require a certain level of disrobing and a hands-on physical exam of the injured worker. Such a situation is intimidating, and downright creepy, where a trusted doctor-patient has NOT been selected or even established.

Attorney Pierobon Mays initiated awareness with the Wisconsin Worker’s Compensation Advisory Council pushing for a change to be made in the workers compensation legislation. The Council on December 13, 2021 approved such a change and the agreed upon bill, passed by the Wisconsin Legislature, now allows observers to be present, chosen by the employee, during such examination.

Lastly, the best course of action for the Wisconsin injured worker who is asked to submit to an “Independent Medical Examination” coordinated by the workers compensation insurance carrier is to call Attorney Lisa Pierobon Mays at (608)291-9402 so that she can remind you of these Do’s and Don’t’s and get you properly prepared. Initial consultations are always free.

When you get arrested for drunk driving in Wisconsin, you need to be very careful to protect yourself. A conviction for operating a vehicle while intoxicated (OWI) or driving with a prohibited alcohol concentration (PAC) can lead to steep penalties. It can negatively impact your life in other ways as well; and, between fines, court costs, and increased insurance premiums, it can prove incredibly expensive.

How can you protect yourself after a drunk driving arrest? At this stage, there are both steps you need to take and mistakes you need to avoid. Here are 10 “Dos” and “Don’ts” for individuals facing OWI/PAC charges in Wisconsin:

DO: Exercise Your Right to Remain Silent

When you are facing a drunk driving charge in Wisconsin, you should exercise your right to remain silent. It’s true what they say on TV: Anything you say can and will be used against you.

This applies not only when it comes to talking to police and prosecutors (which you shouldn’t do without your lawyer present), but also when it comes to discussing your case with others or on social media. When you are facing an OWI or PAC charge, you should only discuss your case with your defense lawyer.

DON’T: Assume You Can Talk Your Way Out of a Conviction

Many people assume that they will be able to walk into court and talk their way out of a conviction. But, this is not the case, and it reflects a fundamental understanding of the nature of drunk driving prosecutions. Judges in Wisconsin take OWI and PAC charges very seriously; and, even if you don’t deserve to be found guilty, saying the wrong thing could still lead to a conviction.  

DO: Make Sure You Know Your Court Date

After a drunk driving arrest, your initial court appearance will take place relatively quickly. You need to make sure you know your court date, and you need to make plans to be there on time (unless your defense lawyer says otherwise).

When you appear in court, you need to dress and act professionally, and you need to do exactly what your defense lawyer says. Appearing before a judge with your future on the line is not a time to take chances.

DON’T: Miss Your Court Date

Missing your court date after a drunk driving arrest can be a very costly mistake. If you miss your court date, the judge can issue a bench warrant for your arrest, and you can face consequences regardless of whether you deserve to be convicted of OWI or PAC.

DO: Get Counseling or Treatment if You Need It

Many people struggle with alcohol dependence. If you need counseling or treatment, you should seek help promptly. While it can be difficult to admit that you have a problem, getting the counseling or treatment you need is the right choice, and you will be glad you did it.

Going to counseling or seeking treatment will also show the judge that you are taking your situation seriously. This can help with your defense—and, if you aren’t sure where to go, your lawyer can give you some options.

DON’T: Get Caught Driving Drunk Again

While you have an OWI or PAC charge pending, one of the biggest mistakes you can make is driving drunk again. If you get another OWI or PAC charge, the risks you are facing will increase significantly. Repeat offenders face enhanced penalties in Wisconsin, including the possibility of up to six months in jail.

DO: Start Thinking About the Defenses You May Have Available

Regardless of the facts of your case, you have defenses available. At the very least, your defense lawyer can argue that the prosecution’s evidence doesn’t prove your guilt beyond a reasonable doubt.

But, there are numerous ways to beat an OWI or PAC charge in Wisconsin, and now is a good time to start thinking about the defenses you may have available. If you think a defense may apply, make a note to discuss it with your defense lawyer.

DON’T: Make Assumptions or Rely on “Defenses” That Don’t Work

While there are several ways to fight a drunk driving charge, there are also many “defenses” that don’t actually work. When you are facing an OWI or PAC charge, you need to make informed decisions about your defense, and you need to avoid making any assumptions that could lead to a conviction.

DO: Talk to a Wisconsin Drunk Driving Defense Lawyer

Given the penalties you are facing and all of the various mistakes that can lead to unnecessary consequences, you need an experienced Wisconsin drunk driving defense lawyer on your side. You should hire a lawyer as soon as possible, and your first step is to schedule a free, no-obligation consultation.

While some people worry about the cost of hiring a defense lawyer, hiring an experienced lawyer can actually save you money in the long run. If your lawyer is able to get your charge reduced or help you avoid a conviction entirely, this could save you thousands of dollars in penalties, surcharges, and increased insurance premiums.

DON’T: Try to Handle Your OWI/PAC Case on Your Own

Regardless of whether you believe you are innocent or guilty, you should not try to handle your OWI/PAC case on your own. It simply isn’t worth it. You have too much at stake, and there is too much an experienced drunk driving defense lawyer can do to help you.

Contact Us for a Free OWI/PAC Defense Consultation in Middleton, WI

If you need more information about what to do (or what not to do) after a drunk driving arrest in Wisconsin, we invite you to get in touch. We will arrange for you to speak with one of our lawyers in confidence as soon as possible. To schedule a free, no-obligation consultation with a lawyer at our Middleton, WI law offices, call 608-257-0440 or tell us how we can reach you online now.