What is the Workers’ Compensation Process in Wisconsin?

What is the Workers’ Compensation Process in Wisconsin?

As an employee in Wisconsin, it is up to you to protect your legal rights when you get injured on the job. This includes making sure you receive the workers’ compensation benefits you deserve. While workers’ compensation laws are designed to protect injured employees, securing benefits isn’t easy, and you must be able to navigate the process successfully to avoid unnecessary financial strain.

10 Steps In the Wisconsin Workers’ Compensation Process

How do you file a claim for workers’ compensation benefits in Wisconsin? Here is an overview of the major steps in the process:

1. Determine If You Are Eligible for Workers’ Compensation

The first step you need to take is to determine if you are eligible for workers’ compensation. While most employees (and most job-related injuries and illnesses) are eligible, there are some exceptions. If you are not eligible for benefits, you will need to speak with a lawyer about filing a different type of claim; and, in this scenario, you may need to avoid taking some of the other steps discussed below.

If you are an employee (i.e., you receive a regular paycheck and a W-2) and you got injured on the job, then you are most likely eligible to file for workers’ compensation benefits. But, to make sure, you should consult with a lawyer promptly.

2. Report Your Injury or Illness

Once you determine that you are eligible for workers’ compensation, the next step is to report your injury or illness to your employer. Under Wisconsin law, you must provide notice within two years, but it is best to file your injury or illness report as soon as possible. If your employer provides you a form to complete, you should complete the form; and, if you have questions or concerns, you should speak with a lawyer before returning the completed form to your employer.

3. Seek Medical Treatment

Seeking medical treatment—and following through with your medical care—is an important part of the workers’ compensation process in Wisconsin. If you don’t seek treatment, or if you ignore your doctor’s advice, this could prevent you from collecting the benefits you deserve. In Wisconsin, injured employees have the right to choose their own doctor, and you should avoid seeing a company doctor if at all possible.

4. Document Your Workers’ Compensation Claim

As you work through the recovery process, you should document your workers’ compensation claim to the best of your ability. For example, you should take detailed notes about what happened, record the hours and days you miss from work, and keep all of your medical records together in a file.

5. Find Out if Your Claim is Approved or Disputed

After you report your injury or illness to your employer, your employer will file a claim with its workers’ compensation insurance company. It has seven days to do so. At this point, you will be waiting to find out if the insurance company is going to approve or dispute your claim. If the insurance company approves your claim, it should provide immediate coverage for your medical expenses, and you should begin receiving disability benefits (partial wage replacement) as soon as you become eligible.

6. Pursue a Stipulation-of-Facts or Compromise Agreement if Necessary

If your employer’s insurance company disputes your workers’ compensation claim (as is often the case), you will need to decide on the best path forward. Frequently, this involves negotiating a stipulation-of-facts or compromise agreement. Your lawyer can advise you on whether either of these options makes sense in your case; and, if so, your lawyer can negotiate with the insurance company on your behalf.

7. Challenge the Denial of Your Workers’ Compensation Claim

If the insurance company is unwilling to negotiate a compromise, or if you receive a denial before hiring a lawyer, you will need to determine whether you have grounds to challenge the insurance company’s decision. There are several grounds for challenging workers’ compensation denials, although not all grounds will be available in all cases.

At this point, you may need to request a hearing before an Administrative Law Judge (ALJ) at the Wisconsin Department of Workforce Development (DWD). If you request a hearing, the insurance company is required to participate, and the ALJ may try to mediate an informal resolution before your hearing date arrives. If your case goes to a hearing, your lawyer will present your claim to the ALJ, the insurance company will present its defenses, and then the ALJ will render a binding decision.

8. Be Prepared to Deal with Other Challenges

While dealing with a denial is one possibility, you may need to be prepared to deal with various other challenges as well. For example, underpayment of disability benefits is not uncommon, and insurance companies will frequently try to terminate injured employees’ disability benefits prematurely. When you have a workers’ compensation claim, it is important to know your legal rights, and you will want to contact your lawyer promptly if you believe that you are being treated unfairly.

9. Go To Court if Necessary

Even if you take your claim to a hearing and the ALJ rules against you, this is not necessarily the end of your workers’ compensation claim. If you believe that the ALJ’s ruling is incorrect, you can have your lawyer take your claim to court.

10. Determine if You Have a Claim Outside of Workers’ Compensation

Finally, when going through the workers’ compensation process as an employee, it is also important to determine if you have a claim outside of workers’ comp. While your benefits can provide a financial lifeline, they will not cover all of the financial and non-financial costs of your injury or illness. If you have a claim outside of workers’ comp, you may be entitled to additional compensation—including full compensation for your loss of income, pain and suffering, and other losses.

Discuss Your Legal Rights with an Experienced Wisconsin Workers’ Compensation Lawyer

Are you dealing with a job-related injury or illness? If so, we encourage you to contact us for more information. To speak with an experienced Wisconsin workers’ compensation lawyer in confidence, call 608-257-0440 or request a free consultation online now. 

HOW CAN YOU ASSIST YOUR ATTORNEY IN WINNING YOUR WISCONSIN WORKERS COMPENSATION CLAIM?

HOW CAN YOU ASSIST YOUR ATTORNEY IN WINNING YOUR WISCONSIN WORKERS COMPENSATION CLAIM?

Most injured workers have never had to hire an attorney and the thought of even talking to an attorney can be frightening.   However, if your work injury has been denied workers’ compensation benefits, then the likelihood of hiring an attorney is high.  When meeting with the injured worker, the attorneys at Mays Law Office are looking for certain things in determining whether to take the claim on for representation.  You can help the attorney see you in a favorable light if you have been diligent.  Things that a Wisconsin attorney likes to see are:

THE WORK INJURY WAS REPORTED IMMEDIATELY TO THE EMPLOYER

Wisconsin injured workers who get hurt at work need to report the injury to their employer that same day, or at least within a few days after it occurred.  Formally documenting the injury is important because delay can cause a denial of benefits.  In turn, the employer needs to timely report work injuries to their worker’s compensation insurance carrier.  Documenting the injury is important for both the employer and the injured worker.  Taking pictures of the area where the injury occurred, machinery or equipment involved, speaking to witnesses, and documenting the details of the injury is crucial to investigate the claim.      

THE WISCONSIN INJURED WORKER GOT MEDICAL TREATMENT TIMELY FOLLOWING HER INJURY

Wisconsin workers that are hurt on the job need to seek medical treatment within a few days of the injury occurring.  In doing so, the injury is medically documented, and treatment options are considered and started.  Workers that choose to self-treat serious injuries versus seeking timely medical treatment is not helpful and implies that the employee is not hurt that badly and the healing process is delayed. 

THE INJURED WORKER LISTENS TO HIS WISCONSIN DOCTOR AND FOLLOWS THEIR TREATMENT RECOMMENDATIONS

Seeking medical treatment is the correct first step, the next step is following the medical recommendations of your doctor.  If your doctor prescribes physical therapy, then it is important that Wisconsin injured workers participate in therapy and not miss appointments.  If the doctor puts the injured workers on physical restrictions, then it is important for the injured worker to not participate in any activity that exceeds the restrictions, either personally or occupationally.  A supportive doctor is absolutely necessary for getting Wisconsin worker’s compensation benefits.  Doctors are only supported when they have a patient that is diligent in trying to get better.  

THE WISCONSIN INJURED WORKER MUST BE A GOOD HISTORIAN

When speaking with a Mays Law Office attorney it is helpful that the injured worker has a good memory of their injury.  Meaning, the how and when it happened, the pain and symptoms that occurred, the details of how the injured worker responded to the pain, and the actions they took in response to it.  It is a good idea to take pictures of cuts, abrasions, and bruising, and keep a journal of how the symptoms progress.  Calendaring the dates of visits to medical providers is important when chronicling the story and details of the injury.  Every work injury has a story and the details are very important in establishing that the injury is credible.  Keeping all written documentation from the employer, workers’ compensation carrier, and medical records is helpful when putting together the details of the injury story.    

THE WISCONSIN INJURED WORKER IS OPEN AND HONEST WITH HER ATTORNEY

Your attorney is your advocate.  Withholding information is never a good idea because once revealed by opposing counsel it can undercut the credibility of the injury and relationship with your attorney.  Very few disputed Wisconsin work injuries are perfect; this is why they are disputed.  So, arming your attorney with ALL the information is the best course of action because then the Mays Law Office attorney can be prepared on how to handle all of the facts, even those facts that may not be favorable to the injured worker.  An attorney that learns about the unfavorable facts late puts them at a disadvantage in succeeding for you.   

THE WISCONSIN INJURED WORKER LISTENS TO HIS ATTORNEY

With any great team, leadership is important.  Follow the leadership of your attorney.  Your relationship with your attorney will likely last several months to a year, maybe even longer.  The Wisconsin workers’ compensation process can be slow.  So, avoiding unnecessary delay is crucial.  Always return your attorney’s calls and messages quickly.  When your attorney asks for information, make it a priority.  Ask questions if you are confused.  A successful result is not achieved by just the Mays Law Office attorney.  It is achieved when the injured worker is an active participant by being responsive, cooperative, and attentive.    

THE WISCONSIN INJURED WORKER SHOULD STAY AWAY FROM POSTING ON SOCIAL MEDIA

It is no secret that Wisconsin employers, their workers’ compensation insurance carrier, and opposing counsel will do a search of the injured worker on the Internet.  They are looking for postings and pictures of the Wisconsin injured worker behaving inconsistently with their injury.  So, if you have a shoulder injury, do not be seen in posts with the local bowling league, or holding a bow and arrow kneeling next to an impressive kill.  Remember a “picture is worth a thousand words” and the impression these posts leave is that the injured worker is not disabled from their work injury but living a full and dynamic life.  Many injured workers will claim that the picture was just for show and boastful in truth they never really participated in the activity.  Regardless, these posts are hard to refute.  The question the Judge will grapple with is if you were okay lying about the post to your friends and followers then you are likely okay with lying to boast the seriousness of your injury.  Credibility is a threshold question in Wisconsin worker’s compensation disputes.  Claims can be won and lost on credibility alone.       

THE INJURED WORKER KEEPS HIS MAYS LAW OFFICE ATTORNEY UPDATED ON HIS MEDICAL TREATMENT

There is nothing more frustrating for Wisconsin workers’ compensation attorneys than unnecessary delay.  Workers’ compensation claims take a while before they are ready for a hearing in front of an Administrative Law Judge.  Delay due to lack of communication is a real problem.  Often the attorney is waiting for the injured worker to complete all her medical treatment before asking the doctor to complete the final paperwork offering opinions as to disability and permanent physical restrictions.  It is unfortunate when the attorney finds out that treatment ended months earlier.  Remember, the attorney does not come to your medical appointments, so we are dependent on medical updates from the injured worker.  At Mays Law Office, we try to connect by phone or email, with our clients monthly so that unnecessary delay is avoided.    

THE INJURED WORKER IS PATIENT AND REALISTIC AS TO THE OUTCOME OF THEIR WISCONSIN WORKERS’ COMPENSATION CLAIM

Sometimes when a Mays Law Office attorney first meets with an injured worker, the worker proclaims that their claim is worth a million dollars.  The recovery of worker’s compensation benefits is dictated by the Wisconsin Legislature and very few work injuries, not involving paralysis or death, have a million-dollar valuation. There are no sympathetic jurors in Wisconsin workers’ compensation claims.  It is governed by Wisconsin Statute, Chapter 102, and determined by an administrative law judge at a hearing who is required to follow certain legislative perimeters.  Be reminded that Wisconsin workers’ compensation attorneys, like Mays Law Office, are paid a 20% contingency fee of what they receive for the Wisconsin injured worker, so their interests are in line with the injured worker.  The more the attorney gets for the injured worker, the bigger their 20% fee will be.  Keeping a realistic perspective as to the value of the work injury and allowing the process to play out patiently is invaluable to a good working relationship with your attorney.   

In sum, following these simple suggestions will help contribute to a successful result when pursuing Wisconsin workers’ compensation benefits.  Call Mays Law Office at (608)257-0440 if your claim for benefits has been denied.   

How Much Are Legal Fees for Workers’ Compensation Cases in Wisconsin?

How Much Are Legal Fees for Workers’ Compensation Cases in Wisconsin?

If you’ve been injured on the job in Wisconsin, you probably have questions about filing for workers’ compensation. You may also have questions about hiring an attorney. For example, you may want to know how much it will cost to hire an attorney to represent you.

Understanding Attorneys’ Fees for Workers’ Compensation Cases in Wisconsin

There are a few important facts about attorneys’ fees for workers’ compensation cases in Wisconsin. With a clear understanding of these facts, you can make an informed decision about your legal representation:

1. Attorneys Handle Workers’ Compensation Cases on a Contingency-Fee Basis

The first thing to know is that attorneys handle workers’ compensation cases on a contingency-fee-basis. This means two things: (i) you never have to pay anything out of pocket, and (ii) you never have to pay anything unless your lawyer helps you secure benefits. Your initial consultation is free, you do not have to pay a retainer, and you will never receive a monthly legal bill for your attorney’s services.

If your attorney helps you secure workers’ compensation benefits, your legal fees will be calculated as a percentage of your award. As discussed below, this percentage is capped under Wisconsin law, and attorneys cannot charge contingency fees for certain benefits.  

2. Wisconsin Law Caps Attorneys’ Contingency Fees in Workers’ Compensation Cases

As explained in the Wisconsin Administrative Code, in workers’ compensation cases, attorneys can only charge “a maximum attorney’s fee of 20% of the amount in dispute.” So, let’s say, for example, that your employer’s insurance company provided coverage for your medical expenses, but it is disputing liability for temporary disability. In this scenario, only your temporary disability benefits are in dispute, so your attorney would only be able to charge a 20% contingency fee on any temporary disability benefits he or she is able to help you recover.

There are other limitations on attorneys’ fees in Wisconsin workers’ compensation cases. For example:

  • Workers’ compensation attorneys cannot charge fees for helping injured workers secure medical benefits “to the extent that other sources, such as group insurance, are available to pay such expenses.”
  • When assisting injured workers with permanent total disability benefits claims, attorneys cannot collect a fee for securing “compensation awards due beyond 500 weeks.”
  • When an injured worker hires an attorney to assist with securing workers’ compensation benefits that are not in dispute, “the fee charged may not exceed 10 percent [of the benefits secured], but [must] not . . . exceed $250.”

3. You Can Take Home More with an Experienced Attorney Representing You

Twenty percent of your benefits may seem like a lot, especially if you will be relying on your benefits to cover your bills while you cannot work. But, this is a bit of a misconception. Here’s why:

When you hire an attorney to help you collect disputed workers’ compensation benefits, you are relying on your attorney to do something you cannot do on your own. Without an attorney representing you, there is a very real possibility that you will not receive any benefits for your on-the-job injury. So, even though you are paying an attorney to represent you, you are still taking home more than you would have collected by yourself. Thus, hiring an attorney is well worth it, and the reality is that with all of the work involved in collecting disputed workers’ compensation benefits, 20% is a very reasonable fee.

Factors to Consider When Choosing a Workers’ Compensation Attorney

Since all attorneys in Wisconsin charge the same legal fees for handling workers’ compensation cases, what factors should you consider when choosing an attorney to represent you? Some of the most important factors include:

  • Focus on Workers’ Compensation – You will want to choose an attorney who focuses his or her practice on workers’ compensation. This does not have to be the attorney’s sole practice area, but you will want an attorney who regularly represents injured workers.
  • Years of Experience – Understanding Wisconsin’s workers’ compensation system and understanding the claims process clearly requires years of legal experience. When you have a workers’ compensation claim, it is important to put experience on your side.
  • Positive Client Reviews – Positive client reviews are always a good sign. You can check Google as well as lawyer rating websites like com to see if a lawyer consistently receives five-star reviews.
  • Awards and Recognition – Awards and recognition can also speak to a lawyer’s ability to provide effective legal representation. For example, at Mays Law Office, we have been named the “Best Workers’ Compensation Attorneys in Madison” by Expertise.com and received a People’s Choice award from Madison.com.
  • Availability and Accessibility – When you have a workers’ compensation claim, you need an attorney who is available to assist you immediately. You also need your attorney to be accessible. You should be able to get in touch by phone, text, or email, and if your attorney is unavailable due to prior commitments, he or she should get back to you as soon as possible.
  • Commitment to Your Recovery – It is important to feel confident that your attorney is committed to your recovery. The outcome of your workers’ compensation claim could impact your life for months—if not years—to come. With this in mind, your attorney should be prepared to do everything he or she can to help maximize your benefits.
  • Makes You Feel Comfortable – Finally, choosing an attorney who makes you feel comfortable is important. You will need to share personal information with your attorney, and being open and honest will be key to maximizing your recovery. If you don’t feel comfortable during your initial consultation, you should schedule another appointment with someone else.

Schedule a Free, No-Obligation Consultation about Your Workers’ Compensation Case

If you have been injured on the job in Wisconsin and would like to know more about how an attorney can help you, we encourage you to get in touch. To schedule a free, no-obligation consultation at our law offices in Madison, WI, please call 608-257-0440 or send us your contact information online today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10 Myths about Filing for Workers’ Compensation in Wisconsin

10 Myths about Filing for Workers’ Compensation in Wisconsin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Request a Free Consultation with a Madison Workers’ Compensation Lawyer

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

Wisconsin Recognizes Injuries Occurring in the “Course Of Employment”

Wisconsin Recognizes Injuries Occurring in the “Course Of Employment”

FOR THE RECOVERY OF WORKERS COMPENSATION BENEFITS, WISCONSIN RECOGNIZES INJURIES OCCURRING IN THE “COURSE OF EMPLOYMENT”

For an injury to be covered for workers compensation benefits in Wisconsin, it must have occurred in the “course of your employment.” This means that the time, place, and circumstances under which the accident takes place must be considered.  It is liberally construed to favor all service that can in any sense be said to reasonably come within it.  This is good since so many of us have unconventional work settings and hours working from our homes, satellite offices, and cars.  Now more than ever, what the “course of employment” includes can be confusing.

WHAT DOES “COURSE OF EMPLOYMENT” MEAN?

According to Wisconsin Statute sec, the course of employment is determined by whether or not the injury occurred while the employee was performing a service growing out of and incidental to her employment.  102.03(1)(c ).  The most recognizable work injuries occur at or on the worksite, under the employer’s business roof, like in factories or office settings.  But what about when an employee is hurt on the job, but it occurs away from the traditional worksite?  The course of employment is read broadly to include many job situations and sites, such as the employee who slips and falls and injures his knee in the employer’s designated parking lot, even if the injury occurred before or after the shift.  Being in the designated parking lot is enough to be considered in the course of employment.

DOES MY INJURY HAVE TO OCCUR WHILE I AM WORKING?

The Wisconsin injured worker does not have to be in work mode to recover workers compensation benefits.  Consider the employee of the worksite to run an errand directed by the employer.  If the employee has a motor vehicle accident with injury while picking up lunch for the company lunch meeting, their injuries will be deemed during employment.  The act of picking up the lunch furthered the interest of the employer, who directed a meeting over the lunch hour.

Other company get-togethers can also fall under the course of employment even if they appear recreational or party-like.  If the get-together is mandated, authorized, or directed by the employer, then injury occurring during it can be considered during employment.

IF I GET HURT AT HOME WHILE WORKING, CAN I GET WORKERS COMPENSATION BENEFITS?

During the Covid pandemic, we saw employees working from their homes more often.  An injury occurring at home, such as a fall resulting in an injury when taking the trash out to the curb for pickup, can be considered during employment.  This may seem surprising but think of it this way, the trash that was collected was, in part, because the injured employee works full hours from home, and has work equipment in their homes, such as a computer, files, desk, printer, and shredder.  The trash accumulating in the house is like trash in a work or office setting.  Ultimately, it will be a covered injury for Wisconsin workers compensation benefits if working from home was necessary for the employer rather than a complete convenience for the employee.

IF I GET HURT WHILE TRAVELING FOR WORK, CAN I GET WORKERS COMPENSATION BENEFITS?

Injury to traveling employees, like those in sales, who suffer an injury during their travels, will be covered by Wisconsin worker’s compensation benefits, even if the injury occurs during off-hours.  Consider the traveling employee who meets with a client or co-workers for drinks after the workday and suffers a concussion due to a fall in the bar/restaurant.  This period of deviation will still be considered in the course of employment as long as the deviation is not purely private or personal to them.  It is generally accepted in Wisconsin that casual encounters with a co-worker or client while on a business trip are still in the course of employment.

IF I GET HURT WHILE TAKING A BREAK AT WORK, CAN I GET WORKERS COMPENSATION BENEFITS?

Wisconsin recognizes that during a workday, employees will need moments or brief pauses from their duties to handle the various necessities of life and personal needs, such as using the restroom.  This is called the personal comfort doctrine.  Technically, the employee is not performing services for the employer. However, these breaks in the workday are justified because the employer receives an indirect benefit where their employees are personally comfortable.  Therefore, such deviations still fall into the course of employment category.   So, lunch and coffee breaks, smoking, and leaving the workstation for a drink of water or some fresh air while on the employer’s premises are not a deviation from consideration of being in the course of employment.

IF I GET HURT WHILE RELAXING OR PLAYING AROUND AT WORK, CAN I STILL GET WORKERS COMPENSATION BENEFITS?

What about those situations where employers allow or even encourage frivolity in the work setting, such as ping-pong, darts, tossing the football, or a round of basketball during work hours?  Will injury occurring during such horseplay be covered for workers compensation benefits in Wisconsin?  The answer is a cautionary Yes, but the level of such horseplay needs to be considered.  The true answer will be situational with every case.  A review of the extent to which the practice or nature of the horseplay has or had become an accepted, or even expected, part of the employment must be analyzed.  So, if a lunchtime altercation breaks out during a game of darts and one co-worker intentionally throws a dart directly at another co-worker, causing injury. It is unlikely that workers’ compensation benefits will cover the such injury.  But if it is well-known and accepted that dock workers regularly throw around the football during slow periods of shipping and receiving, and a traumatic torn rotator cuff injury results, then this will likely be considered in the course of employment for workers compensation coverage.

SO, IS EVERY INJURY OCCURRING AT WORK COVERED BY WORKERS COMPENSATION?

Not every injury during work hours or in the workplace is compensable for workers’ compensation benefits in Wisconsin.  For instance, injury resulting from an idiopathic fall will not be covered for benefits.  Idiopathic is an injury that arises spontaneously for which the cause is unknown.  So, a Wisconsin injured worker who describes their fall at work as occurring without reason or explanation will be considered idiopathic and personal to them.  It occurs most often when the employee is walking and falls for no known reason.  It will be considered that the fall occurred due to their condition and not related to any condition, danger, or circumstance arising from the work or workplace.

Remember that every injury has its specific set of facts and nuances.  Feel comfortable and welcome to contact Attorney Lisa Pierobon Mays at Mays Law Office (608)257-0440/www.mayslaw.net to describe your situation for a free consultation.

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