I HAVE BEEN HURT AT WORK – WHAT SHOULD I DO TO PROTECT MYSELF?
You have been hurt at work, you are scared and do not know what to do or who to listen to. Mays Law Office hears this question every single day. Attorney Lisa Pierobon Mays talks to injured workers daily – free of charge. Every story varies but the emotions are always the same – fear, confusion, uncertainty, and even anger. No one wakes up and thinks “Oh Boy, I sure hope I get hurt at work today.” Accidents causing injuries at workplaces happen daily and fault, for the most part with certain legal exceptions, is not a factor in Wisconsin. So, let’s say you slip and fall because a puddle of water was left on the floor, or you are walking too fast and miss a step running up the stairs and you blow out your knee. In those kinds of situations, blame and fault is not a factor to be considered and not a reason to be denied workers compensation benefits.
So, what is the process once a Wisconsin worker injures himself? The first question is whether the injury is serious enough that medical treatment is required? Obviously, any injury involving broken bones, stitches, serious pain, difficulties with mobility should be medically treated immediately. All work injuries should be reported to the employer so that an Incident/Accident Report can be timely completed by you and your supervisor. Work comp claims can and have been denied for failure to report them timely to the employer; by not doing so raises suspicion and puts the injured workers credibility and honesty at risk. With such information, your employer is responsible for notifying their workers compensation insurance carrier so that a claim can be opened, an investigation started, and benefits for lost time and medical treatment paid.
Once a workers compensation claim is filed, everyone has responsibilities. The Employer is responsible to comply with any requests for complete, truthful, and timely information made by the workers compensation carrier. The Workers Compensation Insurance Carrier is responsible to diligently investigate the claim, respond to the employer’s reporting of the claim, talk to witnesses, get a statement from the injured worker as to the details how the work injury occurred. The insurance carrier should also be reviewing medical records and sending out medical authorizations for the injured worker to sign for the review of their relevant medical records. All of this is necessary for the workers compensation carrier to make a timely decision to either accept or deny, in good faith, the workers compensation claim.
The Injured Worker is responsible to give true and accurate statements as to how the injury occurred to their employer, the workers compensation insurance carrier, and their doctors. Every statement of recollection must be consistent as to date, time, details, witnesses, and pain symptoms. Any inconsistency can, and likely will, be used against the injured worker to deny the claim. The injured worker must maintain a good relationship with their medical providers. Meaning, do not miss doctor’s appointments. Do not disregard your doctor’s advice, treatment, and recommendations. Keep in mind that your doctor will not be keen to support your claim if you have been a difficult patient. Doctors like patients that follow their treatment, listen to their recommendations, and appear to want to get better. Maintaining integrity with your doctors is of utmost importance because your comments and behavior is being documented in your medical records with every single communication that you have with them and their medical office staff, meaning their medical assistants, nurses, and even receptionist. Also, the injured worker must keep their employer informed of their physical restrictions and availability to work. Don’t just do this verbally. It should be done by phone, text, email, and in writing so that the employer does not claim that you abandoned your job by failing to communicate after the injury.
Remember, an Injured Worker must never be seen doing anything that would be considered inconsistent with their injury. Stay away from posting on social media as pictures can be damaging and misunderstood. For instance, an injured worker suffering from a sore knee should not be posting pictures with their volleyball club team in a competitive setting. It is only logical to assume that an injured worker with a knee injury would not be able to play volleyball. Likewise, keep in mind that insurance companies hire investigators to conduct surveillance so be watchful as to how you appear to others, in public and even in your own yard, garage, porch, and deck!
HOW LONG DOES IT TAKE TO GET MY WORKERS COMPENSATION BENEFITS?
If the workers compensation insurance company does not make payment of your benefit within 14 days of receiving notice of the injury, then they must notify you that they are still in the process of investigating your claim. If the insurance company denies your claim, then they must inform you within 7 days of its decision. If these timelines are violated, call Attorney Lisa Pierobon Mays for her guidance and potential involvement.
CAN MY EMPLOYER FIRE ME FOR GETTING HURT AT WORK?
In Wisconsin, employers are not allowed to penalize you for claiming an injury or filing a work injury. Being terminated will not preclude the injured worker from receiving their workers compensation benefits. The employer’s carrier will still be responsible for covering lost time benefits and medical bills. In those situations, Attorney Pierobon Mays will advise you how to discuss the employer’s behavior with the insurance adjuster because employers who behave this badly are likely not being honest with their insurance companies about you and your work injury.
CAN I CHOOSE WHAT MEDICAL DOCTOR TREATS ME?
The injured Wisconsin worker has the sole right to choose their own doctor. If you want a second opinion, you must notify the workers compensation carrier of such. In an emergency, the employer may arrange for your treatment until you are able to choose for yourself. Employers and their workers compensation carriers will try to persuade you to see “the company doctor.” Letting the employer dictate who and where you get medical treatment is never going to be in your best interest because the company doctor, employer, and insurance carrier are all sleeping in the same bed and their interests are aligned against yours.
When it comes to medical treatment, the injured worker has the right to every type of treatment which is reasonable and necessary to cure you if it is prescribed by your doctor. This includes clinic visits, tests and imaging, therapy, hospitalizations, and prescriptions. Reimbursement for your travel/mileage to receive such treatment is also paid to you at .51 cents a mile. Keep receipts and provide such to the insurance adjuster assigned to your claim.
DO I HAVE TO LET THE WORKERS COMPENSATION NURSE CASE MANAGER INTO MY APPOINTMENTS?
Wisconsin workers feel that their privacy is being violated when the workers compensation nurse shows up at her medical appointment and insists on going into the examination room and participates in the medical appointment by asking questions of the doctor. Attorney Pierobon Mays cautions every injured worker to deny such access and forbid this intrusion. All that is required of the injured worker is to sign medical authorizations that allow the nurse case manager access to the medical records and doctor. The nurse can always request to speak to the doctor about the injured worker’s medical care and treatment. Whether the doctor is willing to have such discussions is up to him or her.
DO I GET MY FULL SALARY FOR BEING OFF WORK DUE TO PHYSICAL RESTRICTIONS?
While in a healing phase, the Wisconsin worker gets only 2/3 of their average weekly wage up to a determined maximum rate for the year of injury. It is 2/3 because it is tax free. Payment is based on a 6-day work week, regardless of the number of days per week that you worked. So, your daily payment is 1/6 of your weekly payment. The Wisconsin Department of Workforce Development can determine, if in doubt, whether your benefit payment is accurate. Your first lost time disability (referred to as “TTD”) check should be paid to you within 14 days of your last workday due to the injury. You can cash your check without any concern of waiving your legal rights.
DO I HAVE TO RETURN TO WORK WHEN I AM ON PHYSICAL RESTRICTIONS?
The simple answer is Yes but only if the kind of work being offered is truly accommodating within the injured workers doctor mandated physical restrictions. The employer knows that offering an injured employee accommodating work keeps the exposure of lost time benefits low. Moreover, good employees are an asset and every company knows that it is better to work with their employees rather than lose them. Every employee lost is a loss to the business in terms of productiveness, efficiency, skills, profit, and morale.
If the employee refuses truly accommodating work then their lost time benefit, also known as temporary total disability will be waived. Never refuse work. If doubt, call Attorney Lisa Pierobon Mays so that she can review the circumstances of your claim to better advice.
THE WORKERS COMPENSATION WANTS ME TO SEE THEIR DOCTOR, CALLED AN INDEPENDENT MEDICAL EXAMINER – DO I HAVE TO GO?
Oftentimes, Attorney Lisa Pierobon Mays gets calls from an injured worker because they have been instructed that they must go see a workers compensation insurance doctor, termed “Independent Medical Examiner” or an “IME.” Ironically, there is nothing independent about these doctors. These doctors are hired by the workers compensation insurance companies with a bent toward denying benefits. These doctors do not offer medical treatment. They see the injured worker for 15-30 minutes, usually at a rented facility, ask a few questions, all in the hopes that the worker will say or do something inconsistent to give them a bit of information to use against the worker. Like, when one injured worker told the doctor that, before the injury, he enjoyed weightlifting. The alleged Independent Medical Examiner then used this information of weightlifting against the injured worker claiming that the injury was not caused by the lifting of the 100-pound machine which caused the worker to drop to his knees screaming in pain because he herniated a disk in his back.
The quick answer is that the injured workers does have the attend the independent medical examination, but it is essential that they call Attorney Pierobon Mays so that she can prepare you on how to behave, suggest that you take a witness, what to document, and what to say and not say at this appointment. Also, the carrier is required to pre-pay your roundtrip mileage before, not after, the appointment. If not, there are consequences for the insurance carrier. Also, if time is lost from work to attend the appointment, then the carrier needs to reimburse the injured worker accordingly.
WHAT HAPPENS IF MY WORKERS COMPENSATION CLAIM IS DENIED?
If your claim is denied by the workers compensation carrier/handler then you can request a formal hearing with an administrative law judge at the Wisconsin Department of Workforce Development. An application for hearing must be completed to get this process started. Also necessary is medical proof in the form of a document called “Practitioner Report of Injury in Lieu of Testimony” which needs to be completed properly by your treating physician, specialist, or surgeon. In this form, your medical provider will describe your diagnosis and prognosis and give an opinion as to whether he/she agrees that such injury is work-related. These forms can be obtained on the State website at dwd.wisconsin.gov/wc. You can represent yourself at a hearing, however it may be best to hire an attorney as the paperwork and legal process gets complicated, confusing, and difficult to complete. Moreover, injured workers often feel overwhelmed and intimidated having to communicate with the judge and attorney representing the workers compensation carrier. The playing field is equalized when each side has an attorney.
Mays Law Office, Attorney Lisa Pierobon Mays has been successfully representing and winning for Wisconsin injured workers for over 25 years. She understands the workers compensation system and will pursue every single benefit for the injured worker. Injured workers are relieved when they learn that they do not have to pay her anything upfront for her representation. Attorney Pierobon Mays gets paid when she gets money for the injured worker. The recovery attorney fee is 20% of such recovery, plus reimbursement for claim expenses.
WHAT DOES IT MEAN TO HAVE A PERMANENT PARTIAL DISABILITY (PPD) BENEFIT?
Once you are healed, or deemed at a healing plateau by your doctor, permanent disability will be considered. If your injury has resulted in a permanent disability, then you will receive a monthly check, often described as PPD. This is not paid in a lump sum but over a period of weeks/months, depending on the location of your injury. Each part of the body has a different number of weeks assigned. For instance, if you doctor assesses 10% permanent disability to your shoulder, this is equal to 10% of 500 weeks or 50 weeks. Very serious injuries like those injuries to the back or head are compensated differently if it involves future wage loss. These types of complex injuries should always involve an attorney representing the injured worker. Attorney Lisa Pierobon Mays at Mays Law Office has handled many of these types of complex injury claims.
WHAT IF MY WORK INJURY IS SO SEVERE THAT I CANNOT RETURN TO MY OCCUPATION?
Call Attorney Lisa Pierobon Mays if your injury is so severe and you have concerns that you will never be well enough to return to the same type of employment. Wisconsin law includes benefits that consider scenarios like this called vocational claims. If your injury causes permanent physical restrictions that prevent you from returning to work making the same rate of pay then a claim for retraining, or in some situations, loss of earning capacity may apply. These are valuable but complex claims that require an attorney’s assistance.
WHEN SHOULD I HIRE A WORKERS COMPENSATION ATTORNEY?
While the Wisconsin Workers Compensation System was originally developed to relieve the injured worker from the cost of hiring an attorney, that only applies in a perfect world where the work injury claim has been fully conceded/accepted and the worker is getting ALL the benefits that he is entitled, without argument, delay, or hassle from the workers compensation insurance carrier.
Sadly, rarely does this “Perfect World” happen when a Wisconsin worker is injured. The workers compensation insurance carrier always has an eye out looking for an opportunity to deny the claim, lessen its exposure and responsibility. With that mindset, the insurance company looks for any reason to not pay, delay and ultimately find a reason to deny the claim. These carriers have many tricks up their sleeves to either never pay or stop benefits. They may claim that the injury never occurred at work, or that the injury is personal to the worker, and therefore not related to what happened on the job. Or, they may claim that the worker did not report the injury timely, or that the factual rendition of how the injury occurred is not true. Sometimes, the carrier just ignores the workers and does not even respond to the report of injury and just hopes that the worker will just go away.
Mays Law Office has seen and heard it all from workers compensation insurance carriers. When hiring an attorney, the injured worker needs to make sure that they are choosing an attorney who has years of experience representing injured workers and aggressively advocates to ensure that the worker is getting every benefit they are entitled to under the law.
Even if you are not quite ready to hire an attorney, at the very least, make a call to Mays Law Office for a free consultation to discuss with Attorney Lisa Pierobon Mays if you are being treated lawfully by the insurance company and getting every monetary benefit under the law.
I HAVE NEVER HIRED AN ATTORNEY BEFORE, WHAT SHOULD I EXPECT WHEN MEETNG WITH A WORKERS COMPENSATION ATTORNEY?
Keep in mind that every work injury is different, unique, and requires it owns customized approach. If the timing and circumstances of your claim calls for it, then Attorney Lisa Pierobon Mays will invite you to come to her Middleton/Madison office, if convenient, to discuss your claim further. This in-person meeting is still part of the free consultation provided by Mays Law Office. The meeting will last about an hour and half so that all the details of your denied claim can be thoroughly discussed and documented. At the end of this meeting, a well-developed plan will be formalized as to how your workers compensation claim will be pursued. Attorney Pierobon Mays will detail everything that you can expect and will be involved in the injury claim EVERY STEP OF THE WAY. Your claim will NEVER be assigned to another attorney or a paralegal. Every email, phone call, and correspondence will involve Attorney Pierobon Mays.
Attorney Pierobon Mays has been representing Wisconsin injured workers since 1997 – that’s over 25 years of experience fighting and winning. Attorney Lisa Pierobon Mays is not intimidated by any Wisconsin employer or workers compensation insurance carrier. See her actual results by doing a simple Google review search. You will see 5 Stars ratings from her actual clients who have found her effective, respected, and aggressive in achieving positive results for them.
Mays Law Office knows that suffering a work injury is scary and intimating but Attorney Lisa Pierobon Mays is only a phone call away from answering all of your questions and easing your concerns.