Attorney Lisa Pierobon Mays Uses Her Opponent’s “IME” Report

Attorney Lisa Pierobon Mays Uses Her Opponent’s “IME” Report

The mark of a good attorney is when she finds a way to use her opponent’s evidence against them. August 2024 brought Attorney Lisa Pierobon Mays’ client K.K. (initials used to preserve client’s anonymity) a successful settlement by intimidating opposing counsel with his own medical expert’s report.

KK worked for a machine fabricator which required him to repeatedly lift 50-pound parts when fabricating grain shoots. From July 23 thru July 26, 2022, KK was tasked to repeatedly bend at the waist from floor to chest to lift, load, and unload heavy parts into a machine. In doing so, he felt a pop and pain sensation in his low back with ongoing throbbing pain. Realizing that this was more than a pulled muscle, KK promptly informed his supervisor of his pain who instructed him to go home to rest, apply ice, and medicate. The next day, KK had worsening pain, so he went to urgent care and then follow-up with his primary doctor. He was prescribed strong pain medication and physical therapy. Despite weeks of therapy, KK had no improvement so his doctor ordered MRI imaging of his spinal cord in October 2022. The 2022 MRI showed a disk herniation in his low back requiring surgery. The surgery was performed in July 2023.

Before the disk herniation discovery, the workers compensation carrier accepted responsibility for the claim, meaning they were paying workers compensation benefits and agreed that the injury occurred at work. However, once the insurance carrier got notice that an MRI showed a serious disk herniation, they scheduled KK for a medical examination with a doctor of their choosing. The insurance carrier self-named this examination an “independent medical examination,” however nothing could be further from the truth as such examinations are far from independent, complete or even honest.

The so-called Independent Medical Examiner met with KK only once in April 2023 and from that he declared that his work-injury was no more than a lumbar strain and that all he needed was a four-week course of physical therapy.  With this, all benefits were denied, and KK was left to fend for himself in terms of his finances and medical treatment expenses.  This was devastating for KK and his family; KK had never suffered pre-existing issues with any part of his back.  He did everything his employer asked of him repeatedly, over days, lifting heavy 50-pound material causing injury.  He reported his injury immediately, sought medical treatment, and tried everything to get better.  When he became too expensive with an upcoming surgery, the workers compensation carrier found a hack doctor to deny his claim arguing that he suffered no more than a strain when an MRI indicated a disk herniation.

With the insurance denial, KK was forced to find legal counsel to fight for him.  He contacted Mays Law Office and hired Attorney Lisa Pierobon Mays in May 2023 before his July 2023 surgery.  The surgery was successful, and the surgical findings were consistent with the MRI for a disk herniation.  KK was able to return to work and is now working without restrictions.

Attorney Lisa Pierobon Mays filed an appeal with the State for the workers compensation insurance carrier’s denial of benefits.  A hearing was scheduled for August 1, 2024.  Before this hearing, the insurance company expressed interest in settlement.  Attorney Pierobon Mays responded that while Client KK would be interested in settlement short of going to hearing, the settlement monies would have to be enticing if the insurance carrier wanted a closed file.  Attorney Pierobon Mays told opposing counsel that she would not discount the claim too much as she felt confident that she would win the claim at hearing.  Attorney Pierobon Mays noted to opposing counsel that the report of their doctor was poor.  First, the report pre-dated the July 2023 surgery, so it was missing any discussion of the July 2023 surgery and the surgical findings which proved that KK suffered more than a lumbar strain, and in fact had a disk herniation with stenosis.  So, the surgical findings substantiated the seriousness of the work injury and undermined the credibility of the insurance doctor.  Moreover, remember the insurance company’s doctor accepted that an injury had occurred at work and that physical therapy was necessary with a period of healing and restricted work.   Yet, the insurance carrier never paid the therapy bills nor did they pay KK a lost time benefit while he was unable to work without restriction.  Failure by an insurance company to pay conceded benefits is illegal in Wisconsin under our Workers Compensation Act.  Attorney Pierobon Mays made it clear to opposing counsel that, if a successful settlement was not reached prior to the August hearing then she would file a penalty claim (awardable up to $30,000) for failing to pay a conceded/undenied benefit.  Opposing counsel fought back very little because he knew that he was trapped due to the poor handling of the claim and the facts and evidence were in favor of a win for KK.   

KK‘s workers compensation injury claim was settled before the hearing giving KK more money in his pocket than if he had gone to hearing and won!  Moreover, the insurance carrier was responsible for paying back the private health carrier and a large portion of the unpaid medical expense.  KK was very happy with the results that Attorney Lisa Pierobon Mays got for him.  He avoided having to testify at a hearing, got more money in his pocket, and did not have to worry about past medical treatment expense.  He has returned to work with no residual symptoms from his back injury and working without restriction.

Mays Law Office is proud to announce another successful representation and result for a Wisconsin injured worker who recovered workers compensation benefits.  Feeling frustrated too?  Call Mays Law Office at 608)257-0440.  Attorney Lisa Pierobon Mays is only a call away for a free consultation to answer all your questions

Attorney Lisa Pierobon Mays Wins Huge Settlement Victory For Her Work Injury Client In 2024

Attorney Lisa Pierobon Mays Wins Huge Settlement Victory For Her Work Injury Client In 2024

The year 2024 started off especially successful for Attorney Lisa Pierobon Mays with the settlement of a workers compensation injury that involved life-changing injuries to a Wisconsin worker who had a long work history with the same employer doing very strenuous work.  Client S.S. (“SS”) worked as a Diesel Mechanic for a small Wisconsin City Municipality for over 16 years when he was seriously hurt on the job due to heavy mower falling off its hoist while he was working under it.  The 500-pound mower fell off its lift, about 5 feet to the ground, landing on SS’s backside and pinning him. SS landed face down and was pinned to the ground at his hips and low back. SS was able to free himself and scream for Help. A co-worker heard him, called for 911 who kept him stable despite his dropping blood pressure until Med Flight arrived and flew him to the hospital.

SS’s injuries were severe. His urethra was torn from his bladder requiring a catheter. He also suffered a pelvic fracture and injury to his groin. SS’s rehabilitation progress was painful and lengthy.  Regaining mobility took months, pain was constant requiring strong pain medication, nerve blocks, and surgery was performed to repair his urological injuries. SS continues to suffer chronic symptoms and pain.  He is no longer able to work as a diesel mechanic, or any job suitable for his skills and mobility issues. He is deemed functionally permanently and totally disabled, meaning his injury is debilitating enough to deem him not marketable in a normal job setting with his skill set.   Even his time-of-injury employer of over 16 years claimed that they did not have accommodating work for him and dismissed/terminated him from their employment.

The Workers Compensation Insurance Carrier accepted responsibility and paid workers compensation benefits of lost time, medical treatment, medical mileage, and some permanent partial disability but then cut SS off additional workers compensation benefits claiming that he had hit a healing plateau with improvement.  The insurance carrier argued that while SS was no longer able to work as a diesel mechanic, he was not permanently totally disabled and that he was still able to work. With this, they offered SS a minimal settlement amount for the difference in his lower earning capacity now compared to what he made as a diesel mechanic. Confused and uncertain, SS and his family turned to Attorney Lisa Pierobon Mays of Mays Law Office. Attorney Pierobon met with SS and advised him that his claim was worth much more than what the workers compensation carrier was offering.

After hiring Mays Law Office, Attorney Pierobon Mays worked with SS’s medical specialists to complete paperwork supporting his injury as totally and permanently disabling. Attorney Pierobon Mays also hired a Vocational Rehabilitation Expert who met with SS to discuss his past education, work and wage-earning history, current medical condition, chronic pain symptoms, and physical restrictions to give an opinion on SS’s current occupational abilities.

In response, Opposing Counsel hired multiple medical experts to discredit SS’s total disability claim.  One expert even gave a preposterous opinion that the 500-pound mower that landed on SS only caused a contusion to his low back. Opposing Counsel was out for blood when he hired a private investigator to secretly surveil SS over several days, recording video of him with the family horses in a snowy paddock on his own property.  While SS’s mobility in the snow and presence around the horses was of some concern, Attorney Pierobon Mays believed that Opposing Counsel was hoping for more dramatic video footage of SS doing things that he once enjoyed, such as riding the horses, stock car racing, snowmobiling, actively coaching football and hockey, volunteer firefighting, and hunting. Attorney Pierobon Mays argued that the omission of such activities in SS’s life proved the seriousness of SS’s injury because a person would never truly give up all of these fulfilling things, once loved by SS, if he could still physically do them.

Settlement negotiations intensified days before the scheduled hearing in May 2024 where Attorney Lisa Pierobon Mays and Opposing Counsel argued back and forth the strengths and weaknesses of each other’s case. Ultimately, the workers compensation insurance carrier agreed to settle for more than five times the amount that they originally offered to SS before hiring Attorney Lisa Pierobon Mays!  In addition, Attorney Lisa Pierobon Mays helped coordinate that a large portion of the settlement monies be placed into an Annuity that would pay monthly benefits, guaranteed, until Summer 2044 and then monthly thereafter for SS’s lifetime.  This settlement would sustain SS comfortably during his lifetime and leave a legacy for his family should he pass before 2044.  SS was overcome with emotions and relief with the settlement terms as the litigation was weighing heavy on his mental health.

Attorney Lisa Pierobon Mays has been representing injured workers for almost three decades. She aggressively advocates for the Wisconsin injured worker. Attorney Pierobon Mays works directly with every single one of her clients. Her clients are never pushed off to a paralegal or legal secretary, she handles every single communication with them.  This kind of attention to detail has given Attorney Lisa Pierobon Mays the coveted 5 Star Google Rating based on true and honest reviews from her past client’s. Such an accomplishment is very hard to achieve because Google demands authenticity and refuses to delete unfavorable reviews.

Attorney Lisa Pierobon Mays is not intimidated to take on prominent business or their insurance companies when an injured Wisconsin worker has been treated unfairly in the denial of workers compensation benefits. A free consultation is offered at Mays Law Office so do not hesitate to call Mays Law Office at (608)257-0440.  Attorney Lisa Pierobon Mays is happy to answer your questions.

Death Benefit and Partial Dependency

Death Benefit and Partial Dependency

WORKERS COMPENSATION ATTORNEY LISA PIEROBON MAYS RECOVERS MONEY FOR PARENTS DUE TO THE DEATH OF THEIR ADULT SON

The New Year started up with a bang for Mays Law Office with a significant settlement for parents, Mr. & Mrs. T, who received a sizable amount due to the death of their 29-year-old son.

Son died in 2022 in a fiery crash while traveling to a worksite.  In Wisconsin, when a death occurs at work, the workers compensation carrier for the employer must pay a death benefit equal to four times the employee’s average annual earning, subject to a maximum amount.  This money is paid to the Dependent(s) of the injured employee who died.  The law is clear, according to Wis. Stat. sec. 102.51(2)(a):

No person shall be considered a dependent unless that person is a spouse, a domestic partner [under Wis. Stat. ch. 77], a divorced spouse who has not remarried, or a lineal descendant, lineal ancestor, brother, sister, or other member of the family, whether by blood or by adoption, of the deceased employee

If Total Dependency cannot be established (often the case seen for parents of adult children), the surviving parent(s), if not estranged from the deceased employee, are automatically entitled to a benefit of at least $6500 Wis. Stat. sec. 102.48(1).  In addition, if the deceased employee contributed at least $500 in support to the parents in the 52 weeks before the death then they also may claim further benefits through either Total or Partial Dependency.

In the matter of Mr. and Mrs. T, their 29-year-old Son passed away at the age of 29 without a wife or child.  At the time of his death, he lived with his parents sleeping in his childhood bedroom to help his parents with the house and Wisconsin family farm.  Son’s help was greatly needed because his father, Mr. T, is an amputee with other ailments and Mrs. T was recovering from cancer.

Son’s contributions to the house and farm were significant.  While he never directly contributed monies to his parents, he contributed by providing machinery, labor, and goods to the house and farm business.  Son was more skilled than most farm laborers, in his ability to weld, farm equipment maintenance, concrete pouring, car maintenance, etc.  His contributions were significant, but never recorded, or itemized with documentation in writing, such as receipts, payments proven by bank account deposits, journaled, or memorialized making their credibility difficult to prove beyond verbal assertions.  However, it was clear that there was some level of dependency Mr. & Mrs. T had on their son in the 52 weeks leading up to his death.

Testimony from several witnesses would have been offered to establish son’s support and efforts in shoveling snow, pressure washing, farm labor, home chores, improvement projects, lawn and field care, and vehicle maintenance.   Son’s contributions to the house and farm were unique and invaluable.  He was literally second hand to Mr. T on the farm, which included skilled tasks, such as concrete pouring, machinery repair, welding, and electrical.  Around the house, he did all the car maintenance, landscaping, Spring and Fall clean-up.  Son also contributed to purchasing tools, equipment, machinery, and a truck to be used on the farm business.  But again, no written documentation could actually prove it, such as in a Leasing Agreement.  The only proof was testimony and receipts of son’s purchases, however the hours that such machinery was used/borrowed by the farm was no more than a best guess estimate so the valuation of such was dubious at best.

Regardless of such proof problems, the workers compensation carrier was still required to pay 4x of the son’s annual earnings, but the money would be held by the Wisconsin Injury Supplemental Benefit Fund (WISBF) until the issue and extent of partial dependency was established.  So, Attorney Lisa Pierobon Mays filed for Hearing naming the State of Wisconsin Department of Justice as Respondent as they were charged with defending the Fund’s disbursement, holding, and use of the money.  WISBF is a fierce zealot in protecting its money, so in response, WISBF/DOJ asserted that the son provided no more than what a grown son would be expected to do for his parents.  An insulting defense and one where Attorney Pierobon Mays retorted back that adult children have their own busy lives to lead with family, job, and social commitments of their own to take care of.  While an adult child generally does help with some basic household chores, Mr. and Mrs. T’s son’s contributions, for the 52 weeks preceding his death, went above and beyond what an adult child would reasonably be expected to do.  This son was an exceptional human being according to all that knew him.

The WISBF also defended that Mr. and Mrs. T’s claim was excessive in the amount they demanded considering no documentation was available to prove all of son’s contributions.  The WISBF claimed that the death benefit money is better disbursed to widows and orphans of deceased workers, rather than Mr. & Mrs. T.  Attorney Lisa Pierobon Mays pointed out that Wis. Stat. sec. 102.48(2) does not give priority, under a partial dependency claim, to unrelated widows and orphan children where partial dependency is alleged.

At Mediation, the WISBF/DOJ relented and conceded that partial dependency of son to Mr. and Mrs. T did exist, and a sizable offer was made to settle the claim shy of a Hearing.

Now, Attorney Pierobon Mays did not stop advocating for Mr. and Mrs. T because she had also filed a Penalty claim against the employer’s workers compensation insurance carrier for failing to properly handle the file right after their son’s death.  Think back to the beginning of this article when you read that if no Total Dependency by wife or child is found, then a portion of the death benefit (4x average annual earnings) goes to the non-estranged parent(s) of the deceased employee.  Non-estranged parents are automatically entitled to a benefit of at least $6500 under Wis. Stat. sec. 102.48(1).  The significant word is “automatically.”

Despite demands by Attorney Lisa Pierobon Mays to the workers compensation carrier to make an automatic payment of $6500 to Mr. and Mrs. T, the carrier and their attorney ignored and refused to do so.  In response, Attorney Lisa Pierobon Mays filed a penalty claim against them forcing their hand to make payment.  However, the damage had been done in not doing so sooner.

At Mediation, this Penalty was also pursued and payment in the amount of $3000 (almost ½ of the =$6500) was offered to resolve the claim shy of a Hearing. Attorney Pierobon Mays and her clients agreed that this was enough of a stinging slap on the wrist so that this type of misconduct would hopefully not happen in the future to other grieving parents.

GOING TO A WORKER’S COMPENSATION HEARING?  HERE’S WHAT TO EXPECT.

GOING TO A WORKER’S COMPENSATION HEARING?  HERE’S WHAT TO EXPECT.

The workers compensation insurance adjuster is not being reasonable and now I need to go to a Hearing to have a judge decide my benefits? What should I expect?

Attorney Lisa Pierobon Mays represents only Wisconsin injured workers. Every client scheduled to go to Hearing is litigated by Atty. Pierobon Mays.  Prior to the hearing, Lisa will thoroughly prepare her client for the Hearing.  She meets with them a few days prior to the hearing and works with them over several hours to get them prepared and ready to give testimony – basically telling the Administrative Law Judge with the Office of Workers Compensation Hearings the details of the injury and how it has impacted the injured worker. Attorney Pierobon Mays’ clients always feel well-prepared for a Hearing.  Lisa believes the more prepared her clients are to give testimony, the more confident they will feel at the Hearing.  Another way she prepares her client is to take the mystery out of it, here is what occurs at a Hearing.

WHERE WILL MY WORKERS COMPENSATION HEARING BE HELD?

Hearings are scheduled at various locations throughout the state of Wisconsin. In general, the geographical location for the Hearing is determined by the location of the employee’s residence, or where the injury occurred. The greatest travel convenience for the injured worker (also called the Applicant) is the priority city for the scheduling of a Hearing. The biggest city closest to such will be selected.  So, for example. an Applicant who resides in Baraboo will have their Hearing scheduled in Madison.    

After a Hearing date is set, all parties are notified by a written, blue-colored notice. The Notice of Hearing is usually mailed to the parties eight to ten weeks in advance, but hearings can be scheduled with as little as ten days’ notice in emergency cases.

WHO ATTENDS THE HEARING?

The parties required to attend the Hearing is the Applicant (injured workers), her Attorney, the Attorney (called Opposing Counsel) for the workers compensation insurance company, a representative for the insurance company or employer, if desired by them.  Also, all relevant witnesses, the Judge, and the Court Reporter.

HOW LONG DOES THE HEARING TAKE?

The Office of Worker’s Compensation Hearings schedules Hearings in 4-hour time slots, starting at 8am and finishing at Noon.  Or, starting at 1pm and finishing at 4pm.  If the parties run out of time, then a continued hearing will be scheduled, usually within a few months, as the Scheduler needs to coordinate to ensure that all parties, including the judge, are available.

WHAT DOES THE JUDGE DO AT A HEARING, WILL SHE QUESTION ME?

At Hearing, the Administrative Law Judge is actively involved and in charge of handling all the preliminaries.  The Judge is responsible for making sure that all the necessary parties are present, that the issues of the claim are mutually understood.  The Judge is responsible for protecting the record of the claim by allowing testimony and evidence to be pursued by all the parties.  Any objections to such are resolved by the Judge with a ruling on the record.  The Judge swears in all witnesses who promise to give truthful testimony. The Judge is also protective of the Court Reporter, who transcribes/stenographs testimony and marks exhibits, by making sure that she can properly hear and see the live testimony. 

Hearings are intended to be somewhat informal, and the Judge will often interrupt when the injured worker (Applicant) is giving testimony for clarification or to ask her own questions of the Applicant.  Keep in mind, the Judge wants to make a well-informed and thorough decision so anything that the Judge feels is confusing or not explored, then she will follow-up on. 

WHAT DOES IT MEAN TO GIVE TESTIMONY AND THE BURDEN OF PROOF?

At Hearing, the injured worker (Applicant) has the burden to prove that he is entitled to monetary benefits because a work injury caused lost time/wages, medical expense, and permanent disability.  Such issues are proven by the Applicant testifying as to the details of the injury such as who, what, where, when, and why details of their injury.  As to the medical questions, a physician generally does not come to the hearing to testify but instead answers a series of questions on a 2-page form approved by the State of Wisconsin Division of Hearings and Appeals. 

Applicants should be prepared to testify and know what questions are going to be asked of them on direction examination.  Simple rules should be followed by the Applicant such as always speak with audible words.  Nodding or shaking of the head to respond Yes or No is not allowed because the Court Reporter only transcribes verbal words.  Also, “Uh uh” or “Uh huh” means nothing to the Court Reporter and should never be uttered by any witness when testifying.  Other Do’s and Don’ts when testifying, tantamount to winning and losing at Hearing, are taught at Mays Law Office.  Attorney Lisa Pierobon Mays always prepares her client’s a few days before the Hearing so that they are ready and confident to give testimony at the Hearing.

WILL OPPOSING COUNSEL BE MEAN TO ME ON CROSS EXAMINATION?

Workers’ Compensation Hearings are generally amicable.  Contentious behavior at a Hearing is deemed unproductive and Judges will be protective of a witness being treated with disrespect.  However, Cross-Examination questions feel different than those on direct.  For instance, a witness who is asked, “What is the weather like outside today?” is given broad freedom to answer the question.  On Cross-Examination, the questions will not be so open-ended, instead the same question will be asked “Isn’t is true that the weather is cloudy and cold today?”  A simple is suggested in the question, that answer being a “Yes” or “No”.  Applicants often feel cornered by questions on Cross-Examination because they are unable to break free and speak their own words.  Attorney Lisa Pierobon Mays always prepares her clients for this type of questioning.  She reminds them that she always gets the last word with her client on Redirect Examination where she can circle back to any questions asked on Cross-Examination that need further detail or explanation.

CAN I BRING A FRIEND OR SPOUSE TO THE HEARING?

Absolutely Yes you can bring someone to support you at the Hearing.  Attorney Lisa Pierobon Mays encourages a supporting person come to the Hearing. A Workers Compensation Hearing can be intimidating with the presence of a Judge, Court Reporter and Opposing Counsel.  Nervous feelings are expected so Lisa tells her clients that if they are feeling nervous when giving testimony then their support person will be seated in a visible spot where they can see a friendly face supporting them. 

If your support person is also going to be a witness, then the Opposing Counsel will likely make a Motion to Sequester your witness which means that the witness needs to remain out of the Hearing room until it is time for him to give testimony.  Once the testimony is done then they can stay and watch the rest of the Hearing.   

DOES THE JUDGE DECIDE WHETHER I GET BENEFITS AT THE CONCLUSION OF THE HEARING?

No, the Administrative Law Judge has a lot to consider after the Hearing.  They like to thoroughly review all the Exhibits, read portions of the testimony transcript, and allow the parties a few weeks to follow-up on anything that was discussed but not resolved at the hearing, such as updated medical records or billing itemizations.  Once the record is closed then the Judge should have a written decision in 90 days, however this is not mandatory, just suggested.

CAN MY CLAIM SETTLE AFTER A HEARING?

Workers Compensation claims often do settle after the Hearing.  A Hearing gives both sides the opportunity to see the strengths and weaknesses of their case.  An Applicant who testifies well at Hearing and if very little damaging evidence is presented by Opposing Counsel, then it is a good sign that the claim will likely go in favor of the Applicant.  In those cases, Opposing Counsel will go back to their client, the Worker Compensation Insurance Carrier, to update and advise them of such and encourage them to reinitiate settlement discussions.  Attorney Lisa Pierobon Mays always keeps her clients updated on all settlement discussions, patiently answering all questions, and addressing all concerns that her client’s may have.

A Wisconsin injured worker should never feel forced to settle their workers compensation claim. It is their right to have a Hearing decided by an Administrative Law Judge. When hiring a Wisconsin workers compensation attorney, the injured worker needs to choose carefully who they want as their advocate. Too many attorneys want to just settle claims and move on to the next client. Attorney Lisa Pierobon Mays never stops advocating for her client.  She always keeps the client’s best interest as a priority.      

Check out what our clients have said about our representation on Google and see our perfect 5 Star Google Rating.

FAQs About Wisconsin Workers Compensation

FAQs About Wisconsin Workers Compensation

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 workers compensation 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.

Idiopathic Defense

Idiopathic Defense

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.

CALL NOW