What Types of Injuries Does Workers’ Compensation Cover in Wisconsin?

by Mays Law Office | May 1, 2022 | Workers Compensation

You were injured on the job in Wisconsin. Are you entitled to workers’ compensation benefits? While there are a few factors that will determine your eligibility, one factor that isn’t particularly relevant is the nature of your injury. Here’s why:

In Wisconsin, workers’ compensation benefits are available to eligible employees who get injured on the job. As long as your injury is job-related, it doesn’t matter what type of injury you suffered. While programs like Social Security disability (SSD) only cover certain types of injuries, this isn’t the case with workers’ compensation.

Common Job-Related Injuries Covered By Workers’ Compensation

While all types of job-related injuries are eligible for workers’ compensation in Wisconsin, some injuries are more common than others. Here are 10 examples of common injuries covered by workers’ compensation:

1. Soft Tissue Injuries

Soft tissue injuries involve damage to ligaments, muscles, and tendons. Sprains and strains are the most common soft tissue injuries. These injuries involve stretching the tissue beyond its limit of elasticity, and workers can typically recover with rest and rehabilitation. Tears are less common, but they are also much more serious. In many cases, workers who experience ligament, muscle, and tendon tears will need surgery.

2. Lower Back Pain

Lower back pain is also an extremely common work injury. Similar to soft tissue injuries, lower back pain can result from a wide range of causes. These include traumatic accidents (i.e., falls and collisions) as well as repetitive strain (i.e., lifting or bending over repeatedly at work over an extended period of time).

3. Broken Bones

Broken bones can vary widely in terms of their severity. While some broken bones will heal with stabilization and rest, others will require invasive surgery. The location of a bone fracture (i.e., a broken finger, ankle, or rib) can impact the recovery process as well as an employee’s ability to work during his or her recovery.

4. Burns

Burns are common injuries for employees who work around heavy equipment and machinery. Engines and other moving parts can become extremely hot, and contact with hot surfaces can immediately cause severe, painful, and debilitating burns. Burn injuries are also common among electricians, welders, and others who work in high-risk occupations. Prolonged sun exposure and contact with toxic chemicals can cause severe burns as well.

5. Severe Cuts and Bruises

While minor cuts and bruises may only require basic first aid, severe injuries can necessitate stitches, sutures, and other forms of medical care. The costs of this care can add up quickly, and workers may need to take time off in order to fully heal.

6. Concussions and Other TBI

Concussions are the most common type of traumatic brain injury (TBI), and they can happen in a broad range of scenarios. They are common injuries in vehicle collisions, falls, impacts from falling objects, and other work-related accidents. Rest is critical following a concussion, as the brain needs time to fully heal. When employees return to work too soon, they are at greater risk of suffering a second concussion and potentially being diagnosed with post-concussion syndrome.

7. Neck Injuries

Neck injuries, including whiplash, can also result from vehicle collisions, falls, and other common work-related accidents. Depending on their severity, neck injuries will often have lingering effects, and in some cases they will lead to long-term complications. If you are experiencing neck pain after an accident at work, you should see a doctor as soon as possible. You have the right to choose your own doctor under Wisconsin law.

8. Eye, Ear, and Nose Injuries

Our eyes, ears, and noses are fragile. Loud noises, bright lights, flying objects, closing doors, and many other work-related hazards can cause potentially serious eye, ear, and nose injuries. Broken noses, corneal abrasions, loss of vision, ruptured eardrums, and tinnitus are just a handful of examples of injuries employees commonly suffer on the job.

9. Repetitive Stress Injuries

Repetitive stress injuries (also called repetitive strain injuries) occur when the body wears down over time. Employees in nearly all occupations perform some sort of repetitive movement, and this repetition can cause wear and tear that eventually results in a serious injury. Some examples of common work-related repetitive stress injuries include:

Carpal tunnel syndrome
De Quervain’s syndrome
Shin splints
Tendonitis
Tennis elbow
Trigger finger

Due to the deadlines that apply to workers’ compensation claims in Wisconsin, filing a claim for a repetitive stress injury can present some unique challenges. As a result, if you are in pain due to repetitive stress at work, you should speak with a workers’ compensation lawyer as soon as possible.

10. Overexertion Injuries

Overexertion injuries happen when workers attempt to perform tasks their bodies can’t handle. This includes common tasks such as lifting items off of the ground, using hand tools, and attempting to push or pull heavy objects. It also includes working to the point of exhaustion. While many employees feel pressured to take on high-risk tasks, proof that an employer is responsible for an employee’s injury is not required when filing for workers’ compensation in Wisconsin.

The Severity of Your Injury Determines the Benefits You Can Receive

While the nature of your injury does not affect your workers’ compensation eligibility, the severity of your injury is a factor in determining which workers’ compensation benefits you can receive. If you are able to work through your injury, then you will only be able to obtain medical benefits (coverage for the costs of your diagnosis and treatment). If you are out for less than seven days, you can also collect disability (partial wage replacement) benefits after a three-day waiting period. If you are out for more than seven days, you can collect disability benefits for the entire period you are unable to work.

Request a Free Consultation with a Madison Workers’ Compensation Lawyer

If you would like to know more about filing for workers’ compensation benefits in Wisconsin, we encourage you to get in touch. To schedule a free and confidential consultation with a Madison workers’ compensation lawyer at Mays Law Office, please call 608-257-0440 or inquire online today.

IME Exams in Wisconsin

by Mays Law Office | Apr 27, 2022 | Workers Compensation

Mays Law Office, LLC. is here to protect you from the intimidation of the so-called “IME/Independent Medical Examination” allowed in Wisconsin.

A Wisconsin injured worker files for workers compensation benefits with their employer’s workers compensation insurance carrier and before paying benefits, the insurance company demands that the injured worker see an “independent medical examiner.”

What is this and what should the injured worker expect?

To be clear, in Wisconsin, these appointments are completely selected and scheduled by the workers compensation carrier, and not the injured worker. They are far from being “independent” or impartial. In fact, a better description, would be to call them an “adverse medical examination” because there is NO medical treatment rendered and the medical report is created solely for the workers compensation carrier with a desired outcome to deny workers compensation benefits. Ultimately, the insurance carrier is hoping for a medical opinion from their examiner that gives a medical basis and opinion that will allow them to deny the injured worker benefits.

In Wisconsin, an adverse medical examination can only take place with a physician, chiropractor, psychologist, dentists, podiatrist, physician assistant, or an advanced nurse practitioner. It is the workers compensation insurance carrier that gets to choose who the injured worker will see for a medical examination. The location of such an examination can be no further than 100 miles of the injured workers primary residence as the crow flies. The time and date should be discussed before the examination is scheduled in the event the injured worker has a scheduling conflict. However, this respectful communication with the injured worker is rarely communicated and instead a date and time is given. The insurance company is required to provide, in advance of the examination, prepaid roundtrip mileage. Not providing such advanced payment ahead of time can give the injured worker a basis to not appear. Also, reimbursable to the injured work, prior to the examination, is anticipated wage loss, meals, and lodging, if applicable. Information regarding the adverse medical examination must be provided to the injured worker in advance and in writing. The notification must provide clearly the following information:

Date, time and location of the appointment;
Details for changing such date, time, and location, should a conflict exist;
The injured workers right to have their own physician, chiropractor, dentist, and so on, present at such appointment;
The right to receive the adverse medical examiner’s report(s) once completed and received by the insurance company or employer;
The injured worker’s right to have a translator present at the exam if a language barrier exists.

Generally, the workers compensation insurance carrier provides the medical examiner with the injured workers medical information and records prior to the examination, but often the examiner never reviews or looks at the information before the examination. In fact, during the medical examination, the medical examiner very often seems to know little to nothing about the injured worker’s medical condition, diagnosis, prognosis and will rely on the injured worker to fill him in on his medical history and details of the work injury and subsequent medical treatment. Obviously, this is infuriating for the injured worker who has been compelled to go to this examination with a doctor, who at the time of the appointment, appears ignorant to the injured worker’s medical condition.

In preparing to meet with the adverse medical examiner, the Wisconsin injured worker should:

*Dress casually with an eye toward removing their shirt or pants in the event the examiner wants to do a limited examination of their body. Wearing a pair of athletic shorts, athletic top/bra can prevent the injured worker from being instructed to disrobe. In almost every situation, an injured worker should never be naked during these examinations;

*Do not take any pain medication ahead of the examination. This way the examiner sees the injured worker in their purest form, without medication to mask the pain. So, for example, if it hurts to raise your arm because of a shoulder injury occurring at work then the examiner should see such pain exhibited.

*Respond only to the examiner’s questions and never be too talkative. The more the injured worker speaks and tells the examiner, the more such information will be misconstrued, taken out-of-context, and used against the injured worker.

*Take pictures of the examination room if it is dirty or unprofessional appearing. Keep a journal/notes/recordings of anything unusual. Such information can be used to discredit the adverse examiner’s credibility/opinions. Mays Law Office had a client that was put into a dirty examination room and asked to sit on an examination table that was soiled/wet from the last patient! A picture was taken and used against the insurance company for relying on an unprofessional physician to support their denial of benefits.

*Be consistent in your behavior and movements with your injury and physical restrictions. So, for instance, if you have a low back injury and you have a restriction of no bending, then do not be seen bending over to remove your shoes for the examination. Or, if you require a cane for mobility then make sure you have and use your cane at the examination.

In sum, the Wisconsin injured worker needs to keep in mind that they are being watched from the moment they enter and leave the examiner’s parking lot as the examiner and/or his staff are hoping to see and document anything that puts the truthfulness of the work injury in question. So, if the injured worker is prohibited from climbing stairs due to their knee injury, then use the elevator, and not the stairs, to reach the examiner’s second floor office.

Attorney Lisa Pierobon Mays is proud to have been involved in changing Wisconsin law in favor of protecting injured workers during adverse medical examinations.

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

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

Lastly, the best course of action for the Wisconsin injured worker who is asked to submit to an “independent medical examination” coordinated by the workers compensation insurance carrier is to call Attorney Lisa Pierobon Mays at (608)257-0440 so that she can remind you of these Do’s and Don’t’s and get you properly prepared. Initial consultations are always free.

Top 10 Questions to Ask when Hiring a Wisconsin Workers Compensation Attorney

When Should I Hire a Wisconsin Workers Compensation Attorney?

If you are hurt on the job in Wisconsin, you should immediately file an Incident Report with your employer for submission to their workers compensation insurance carrier. If the injury causes you to miss time from work due to physical restrictions set by your medical doctor and the workers compensation insurance company has not paid you a lost time benefit or medical treatment expenses, within a reasonable period of time, then you should call an attorney. Once the insurance carrier raises a “dispute” or suggests that your claim will be denied then you need to look into hiring a Wisconsin attorney who concentrates their practice in workers compensation, like Attorney Lisa Pierobon Mays at Mays Law Office.

Do I Have to Meet with You at Your Office?

No, to hire Mays Law Office you do not have to step foot in our office if not convenient or desired. Mays Law Office is located in Dane County in the Madison/Middleton area. If visiting, please know that we have ample free parking with handicap accessibility. We have a first floor office so accessibility is a breeze for our clients. Moreover, our office is always open from 8am until 5pm. Often, client’s will stop in without the need for an appointment to drop off necessary documents. We are also able to conduct phone and Zoom meetings with our clients. U.S. Mail, facsimile, and E-Mail are all ways to exchange necessary documents and information too. We represent people from all over the State of Wisconsin and around the United States who often are not able to visit our office. Mays Law Office strives to litigate your claim as stress-free as possible.

If I Hire You, Will You be Handling My Workers Compensation Claim?

For almost three decades, Attorney Lisa Pierobon Mays has been representing and winning for Wisconsin’s injured worker in workers compensation claims. From your first to your last call, all questions and concerns, will be solely handled by Attorney Pierobon Mays. While we have a friendly and knowledgeable legal staff that may assist in the simple clerical matters of your claim, the strategy, timing, progress, and resolution of your workers compensation claim will be handled by Attorney Pierobon Mays. Attorney Pierobon Mays will meet with you at the initial consultation, handle all your questions and concerns throughout the litigation, communicate with you directly as to issues and updates, and appear at all hearings on your behalf. We do not believe in signing up client’s to then transfer their file to an associate attorney or paralegal. Attorney Pierobon Mays is a managing partner at Mays Law Office and the buck stops with her when it comes to representing her clients.

Can I Find Reviews from Your Former Clients?

Absolutely and we encourage you to research us because we are so proud that 100% of Mays Law Office client’s who reviewed us on Google gave a 5-Star rating as to their experience. Please know that a Google Review is highly reputable because the recipient of the Review, whether good or bad, is never allowed to review, alter, change, or delete it. Google notifies us only after the Review has been submitted. So check us out on Google and see what our past clients are saying about the lawyers at Mays Law Office.

What is Mays Law Office’s Success Rate for Getting Their Client’s Money?

Attorney Lisa Pierobon Mays has never taken on a workers compensation client that she did not feel that she could win. Keep in mind, Attorney Lisa Pierobon Mays gets paid only when her client gets paid. So, if Attorney Pierobon Mays does not perform intelligently, aggressively, and efficiently in representing her client then her work is for nothing. So, the old saying, “you eat what you kill” is appropriate when answering this question. Mays Law Office has every incentive to work hard for their workers compensation clients because they only get paid when you do.

How Much Does Mays Law Charge to Represent an Injured Worker?

In Wisconsin, injured workers are charged under a contingency fee rate that can be no higher than 20% of the amounts recovered for the injured worker. In addition, expenses (such as interoffice copies, postage, mileage, and charges incurred to get certified medical records and doctor’s reports) paid for litigating/pursuing the workers compensation claim are reimbursable if agreed to in the retainer agreement/contract.

How Do I Know If My Workers Compensation Claim is Worth Hiring An Attorney?

If you were hurt at work, reported the injury timely, sought medical treatment within a reasonable amount of time, suffered lost time from work, and the injury is serious (more than a sprain or strain lasting only a few weeks) then it is very likely that a workers compensation attorney should be hired to pursue your workers compensation benefits. An injury claim that has been factually or medically denied by the workers compensation carrier may not be an easy win but it does not mean that it should not be appealed to the State. Keep in mind, workers compensation insurance company’s hate paying out on injury claims. If they have any basis to deny a workers compensation claim, no matter how small, then they will do it. Do not be intimidated into thinking that your injury claim is not worth fighting for. A denial of workers compensation benefits raises a lot of negative emotions – anger, rejection, fear, stress, frustration. Attorney Lisa Pierobon Mays knows and understands these emotions and her goal is to ease your mind, worries, and stress from the moment you hire her to pursue your workers compensation claim.

What Kinds of Workers Compensation Benefits Can You Get for Me?

In the State of Wisconsin, workers compensation benefits are governed by state statute, Chapter 102 (also called the Workers Compensation Act). Allowable benefits for the injured worker are dictated by this statute and very different from other types of civil damages. The injured worker can expect recovery of their lost time/wage for missed work due to being on medical restrictions. The lost time wage is based on 2/3 of their average weekly wage, subject to a statutory cap for high income earners, fixed as of the date of the injury. It is 2/3 because it is tax-free. The calculation of the average weekly wage (a/k/a AWW) can be complicated due to certain legal nuances and should be reviewed by the State of Wisconsin Department of Workforce Development for accuracy.

The injured worker is also entitled to 100% payment/reimbursement of their medical treatment related to the injury, along with medial mileage reimbursement at .51 cents for roundtrip doctor and therapy appointments, plus mileage incurred to pick up related prescription medications.

Once the injured worker reaches a “healing plateau,” meaning that moment in time when the injury has healed to the best it is going to get, a treating practitioner/doctor should be asked to consider assigning a percentage of permanent disability, called permanent partial disability or PPD rating for the worker’s functional loss. If PPD is assessed, then it is payable at a weekly rate equal to two-thirds of the employee’s average gross weekly earnings at the time of the injury, subject to a maximum rate determined by statute. The calculation is a mathematical formula that can be determined by a workers compensation attorney, such as those at Mays Law Office.

It is significant to understand if the injury and resulting PPD is deemed scheduled (pertains to limbs, eye and ears) or non-scheduled (pertains to torso/back, head, systemic and mental). The distinction is important because each are compensated differently. Scheduled injuries can lead to a vocational claim for Retraining. While non-scheduled injuries can lead to claims for Loss of Earning Capacity or Permanent Total Disability. Each claim encompasses significant and distinct monetary consequences. If an injury causing permanent disability with resulting wage loss occurs, then an analysis should be conducted by an attorney who concentrates their practice in handling Wisconsin workers compensation claims. Mays Law Office offers free consultations for such an analysis.

Another monetary benefit called Disfigurement can be awarded if scarring or a limp results from the injury. Disfigurement awards compensation for the likelihood that wage loss will arise from a negative perception that may not be justified by a functional limitation or loss. It is a quasi anti-discrimination statute to counter the potential for wage loss for unsightly scars that may cause conscious, or even unconscious, discrimination during the hiring process. The award for such a claim can be up to one year the worker’s average annual earnings, subject to a cap. Such an award is dependent on several factors and a workers compensation attorney should be consulted when considering and pursuing such a claim.

Lastly, if a Wisconsin worker dies and their death is proximately related to the work injury then death benefits are awarded to their dependents at four times the employee’s annual earnings, subject to caps. When death occurs to the Wisconsin injured worker who was permanently and totally disabled, or permanently partially disabled, but it is unrelated to the work injury, limited death benefits are also payable to dependents.

Burial expenses are also payable where a Wisconsin workers dies from a work injury.

Do I Have to Go to a Hearing or Will You Settle My Claim?

Unlike some of the bigger injury law firms in Wisconsin, Mays Law Office does not take on new clients with an eye toward just settling them out. To do so, is not truly advocating for the client. Attorney Lisa Pierobon Mays has a reputation for aggressive representation when dealing with workers compensation insurance companies. Mays Law Office never settles a workers compensation claim until every potential benefit has been pursued and a true valuation of the claim can be determined and discussed with the client and the client has a good understanding of the strengths and weakness of their claim. The client is given a full opportunity to ask questions and provide input. Sometimes a settlement cannot be reached because the workers compensation insurance carrier is not offering a fair monetary settlement. In that case, Attorney Lisa Pierobon Mays will encourage the client to proceed to a hearing to present the claim to an administrative law judge for a determination. Before any hearing, Attorney Pierobon Mays will have thoroughly prepared the client so that he/she feels confident and ready to proceed. Ultimately, it is always the client’s decision as to whether to settle their workers compensation claim or proceed to hearing.

When Should (and Shouldn’t) You Consider a Workers’ Compensation Settlement in Wisconsin?

by Mays Law Office | Mar 21, 2022 | Workers Compensation

In Wisconsin, employees who are eligible to receive workers’ compensation benefits typically receive these benefits on a weekly basis. But, what if this doesn’t work for you? What if you need money up front to pay bills you couldn’t pay while you were waiting for your benefits to come through? What if you don’t want to worry about your employer (or its insurance company) terminating your benefits prematurely?

In these scenarios, it might make sense to try to negotiate a workers’ compensation settlement.

What is a Workers’ Compensation Settlement?

A workers’ compensation settlement is an agreement to resolve your claim for a specific amount—typically in one lump-sum payment. If you and your employer (or your employer’s insurance company) can agree on the amount you are rightfully owed, then you can enter into a settlement agreement that results in payment and termination of your claim.

While this might sound better—and can be better—than receiving weekly benefit checks, there is one critical factor to keep in mind: Once you accept a workers’ compensation settlement, you can’t go back and ask for more. Even if you discover later that your injury is worse than you thought, you will still have to live with the amount you accepted in your settlement.

Can You Get a Workers’ Compensation Settlement in Wisconsin?

Settling is an option in Wisconsin. If you have a workers’ compensation claim and it is in your best interests to settle, then you can attempt to negotiate a settlement with your employer (or its insurance company).

Note that we said you can “attempt” to negotiate a settlement. Even if you are clearly entitled to benefits, your employer (or its insurance company) is not obligated to enter into settlement negotiations. You can try to convince your employer (or its insurance company) that settling is best for everyone, but you shouldn’t expect it to listen—or make a reasonable settlement offer—unless you have an attorney on your side.

When Should You Consider a Workers’ Compensation Settlement?

So, should you consider a workers’ compensation settlement? As we recently discussed, settling too early can be disastrous, as it can leave you without the money you need to cover your medical bills, rent, utilities, and other expenses. Generally speaking, you should not consider accepting a workers’ compensation settlement if:

You are still receiving treatment and do not yet have a clear understanding of your full medical needs;
You have not determined your weekly disability benefit rate (rather than relying on your employer (or its insurance company) to calculate your benefits for you); and/or,
You have not consulted with an attorney to make sure it is in your best interests to accept a workers’ compensation settlement.

On the other hand, if you have recovered as much as you are going to recover (or if you have a clear understanding of your path to recovery), and if you have consulted with an attorney to make sure you know how much you are entitled to receive in disability, then it might make sense to ask your attorney to enter into negotiations on your behalf. But, even then, you will need to consider the potential tax implications, your eligibility for Social Security disability (SSD) and other benefits, and various other factors before deciding whether to accept a settlement.

How Do You Negotiate a Fair Workers’ Compensation Settlement?

Let’s say it is in your best interests to settle your workers’ compensation claim. How do you negotiate?

Theoretically, workers’ compensation settlement negotiations should be fairly straightforward. If you know how much you are entitled to receive and for how long, then determining the value of your claim involves a simple math calculation.

Unfortunately, this isn’t how it works in real life. If you enter into settlement negotiations, your employer (or its insurance company) will take advantage and try to pay you as little as possible. Rather than simply paying what they owe, they will offer less (perhaps much less) hoping to entice you into a quick—but unfair—settlement.

With this in mind, negotiating effectively requires clear proof of the value of your claim. It also requires the ability to withstand and overcome these companies’ aggressive negotiation tactics. You need to know what your claim is worth, and you need to be prepared to say, “No,” even if there is money on the table.

As a practical matter, negotiating a fair workers’ compensation settlement requires legal representation. Many companies won’t even take your negotiation efforts seriously if you don’t have an attorney. On the other hand, hiring an attorney shows that you are serious, and hiring an experienced attorney is one of the best things you can do to improve your chances of obtaining a fair settlement.

Should You Wait to Seek a Workers’ Compensation Settlement?

Given everything we’ve discussed, you might be wondering if you should wait to seek a workers’ compensation settlement. Simply put, the answer could be, “Yes.” In many cases, it will make sense to delay settlement negotiations until you have had the opportunity to learn more about your situation.

With that said, you should not delay your workers’ compensation claim. While you technically have up to two years to file a claim in Wisconsin, the Department of Workforce Development (DWD) recommends filing your claim within 30 days, and it is in your best interests to file your claim as soon as possible. Not only does filing a claim start the process in motion, but it also helps avoid many of the issues that can lead to workers’ compensation denials.

Discuss Your Claim with a Madison Workers’ Compensation Lawyer for Free

Were you injured on the job? Do you have questions about seeking a workers’ compensation settlement in Wisconsin? If so, we encourage you to contact us for more information. To discuss your claim with an experienced Madison workers’ compensation lawyer at Mays Law Office in confidence, call us at 608-257-0440 or request a free consultation online today.

The Nuts & Bolts for Injured Wisconsin Workers

by Mays Law Office | Mar 1, 2022 | Workers Compensation

In Wisconsin, physical and mental injures due to accidents or occupational exposure on the job/worksite are deemed workers compensation injuries entitled to benefits for lost time, payment of medical treatment, reimbursement for mileage, and potentially retraining or loss of earning capacity, with certain injuries, if the injury is so serious that it affects your ability to earn the same amount of wages.

Location of Work Injury

If the injury occurs at the workplace, even if the workplace is your house, will be considered a “work injury.” If your job requires you to travel, and an injury occurs while travelling then that is also considered a “work injury,” unless you deviated from your work duties for a personal reason, such as stopping to get your haircut or shopping for your personal needs. Work injuries that occur, even at you own fault, are generally also conserved a “work injury.”

Timing of 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.

Choice of Medical Treatment

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. The insurance company does have the right to have you examined by a doctor of their choice which they will call an “Independent Medical Examiner.” however be forewarned these doctors are far from “independent” in their review of you. These doctors are not hired or intended to provide you with any medical treatment. They are hired by the insurance carrier with an eye toward denying your workers compensation injury claim. Call Mays Law Office, Attorney Lisa Pierobon Mays immediately if you are asked to see the insurance companies “independent medical examiner.” She will prepare you for this meeting and give you suggestions on what to say/not say, how to present yourself, and how to document your visit with this doctor who is paid by the insurance company to see you.

When it comes to medical treatment, the injured worker has the right to every type of treatment which is reasonable and necessary to sure you. Or prescribed by your doctor. This includes clinic visits, tests & imaging, therapy, hospitalizations, and prescriptions. Reimbursement for your travel/mileage to receive such treatment is also paid to you. Keep receipts and provide such to the insurance adjuster assigned to your claim.

Lost Time Benefit Check (a/k/a TTD)

While you are in a healing phase, you will get a lost time check for 2/3 of you average weekly wage up to a determined maximum rate for the year of injury. Its 2/3 because its tax free. Payment is based on a 6-day work week, regardless of the number of days per week that you actually worked. So, your daily payment is 1/6 of your weekly payment. The Wisconsin Department of Workforce Development can determine, if in doubt, that 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 worked due to the injury. You can cash your check without any concern of waiving your legal rights.

Permanent Disability Check (a/k/a PPD)

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 To Do If Your Injury 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 in order 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” should 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 you choose to hire an attorney as often the paperwork gets complicated, confusing, and difficult to complete. Moreover, injured workers often feel overwhelmed and intimidated having to communicate with the attorney representing the workers compensation carrier. The playing field is equalized when each side has an attorney, who concentrates his/her practice in workers compensation. 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 only gets paid when she gets money for injured worker.

Should I Settle My Workers Compensation Claim?

The injured worker is often enticed to settle their work injury claim by the workers compensation carrier with an offer of money. No settlement should ever be reached until the injured worker has reached a full healing plateau where medical treatment has ended, or the future medical needs are fully understood and valued. Settling a work injury claim too early can be disastrous for the injured workers as they may be giving up too much in compared to the amount offered. After a claim is settled, it is very difficult to change it and you will not receive additional compensation beyond the amount of the compromise.

Contact Mays Law Office Before Settling Your Claim

A settlement should never be reached without, at least, talking to an attorney first. Attorney Lisa Pierobon Mays gets calls regularly from injured workers telling her that the workers compensation adjuster is offering them a monetary settlement. Lisa will review your claim with you to understand what the potential value of your claim is and advise as to whether settlement now, versus later, is a good decision. All of this can be done in a phone or in-office free consultation to (608)257-0440. Never assume that the worker compensation carrier has your best interests in mind. The injured worker often does not realize all the potential benefits that they are giving up with a settlement, and the insurance companies are as always trying to lessen their exposure which rarely matches up with what the injured worker needs.

Denied Workers Compensation in Wisconsin

by Mays Law Office | Feb 9, 2022 | Workers Compensation

Denied Workers Compensation?

In January 2022, an injured worker called Mays Law Office. For privacy reasons let’s call this injured worker “J.C.” J.C. visited our website Mays Law Office and saw that we offer free legal consultations with an attorney. Immediately J.C. was connected to Attorney Lisa Pierobon Mays. J.C. proceeded to tell Lisa that she got hurt at work back in November 2020. J.C. stated that she started her workday symptom-free but while working repetitively on a machine containing a diecast mold, she felt and heard a horrible popping sensation in her right shoulder while aggressively scrubbing the mold with her outstretched right arm. Lisa listened to J.C.’s story and then started asking some poignant questions, like did she report the injury to her supervisor? Did she seek timely medical treatment? What medical treatment had she received, and what was the diagnosis and prognosis of her right shoulder injury according to her doctors?

Pretty quickly Attorney Pierobon Mays could see that J.C. had done everything right in reporting the injury and seeking medical treatment that same day, yet still the workers compensation carrier was giving her the run-around as to accepting her claim for workers compensation benefits. J.C.’s claim had been bounced around to three different insurance adjusters, questions by J.C. to adjusters were often left unanswered, referral for medical treatment, like an MRI was delayed pending slow approval by the workers compensation adjuster, and then only one day before her pre-scheduled right shoulder surgery in August 2021, approval for the rotator cuff surgery was delayed by the workers compensation insurance carrier demanding that she first see their doctor, termed an “Independent Medical Examiner.” J.C. had been suffering with pain in her right shoulder for almost 9 months and now, one day before her much needed surgery, it was being delayed! Regardless, J.C. complied, cancelled her surgery, and saw the insurance company’s doctor. Despite repeated calls by J.C. to the insurance carrier, she never heard anything more from the insurance company for another 2 months. Then in November 2021, J.C. got a letter stating that the workers compensation insurance carrier was denying all benefits for any care, treatment, or disability related to her right shoulder. J.C. was dumb-founded and angry as a whole year of pain had gone by and a very needed surgery was not going to be covered. Moreover, her sore right shoulder was taking a toll on the rest of her body, specifically her left arm because it was trying to accommodate for her weak, dominant, right arm.

Attorney Lisa Pierobon Mays heard enough and encouraged J.C. to come into Mays Law Office located in Middleton, Wisconsin. An appointment was scheduled for the following day and J.C. was instructed to bring all of her paperwork (correspondence, notes, medical notes) so that they could review it together and come up with a plan of attack. The following day, J.C. met with Attorney Lisa Pierobon Mays and it was quickly discovered that the delay and denial of medical treatment by the workers compensation insurance company was erroneous and likely made in bad faith, which in Wisconsin is filed as a penalty claim and can be worth up to $30,000. In reviewing the insurance company’s doctor report, it was clear that he believed that the right shoulder surgery was necessary and related to the work that J.C. had done while working on the machine back in November 2020. Attorney Pierobon Mays told J.C. that quick measures had to be taken to hold the workers compensation insurance carrier accountable and responsible. The goal was to get the surgery back on the calendar as soon as possible; J.C. hired Lisa to move forward in her representation.

Attorney Lisa Pierobon Mays immediately filed the necessary paperwork, alerting the head judge for the State of Wisconsin Department of Workforce Development (termed “DWD”) that J.C.’s claim required special attention due to the alarmingly illegal decisions made by the workers compensation insurance carrier. In turn, the State responded immediately by assigning the claim to an administrative law judge who within two days reviewed Attorney Pierobon Mays’ submissions and agreed that the denial was clearly erroneous. The Judge ordered the insurance carrier to approve the surgery, based on their own doctor’s report that such surgery was reasonable, necessary, and related to the November 2020 work injury. Fearing the repercussions of its error, the workers compensation insurance carrier quickly hired its own lawyer. Yet, even the insurance company’s lawyer agreed with Attorney Pierobon Mays’ position that J.C.’s claim for benefits had been erroneously denied. Attorney Lisa Pierobon Mays diligently worked with opposing counsel to get J.C.’s worker compensation injury claim back on track. Surgery is now scheduled for right shoulder to be done in a few weeks and lost-time benefits for missing work will be paid to J.C. without issue or delay from the day of surgery forward. All medical treatment will also be paid by the workers compensation carrier.

While it is a happy ending that J.C.’s claim is now being handled properly, consider the cost it took to get it there. J.C. suffered ongoing pain, delayed medical treatment, personal and financial stress, a fatigued body overcompensating for an injured arm, and now attorney fees of 20% deducted from her lost-time benefits. All of this needless suffering because the insurance company failed to treat J.C. fairly and legally according to the laws of Wisconsin. This story is tragic but not uncommon. Workers’ compensation injury claims are often not handled properly. Insurance adjusters come and go causing files to be regularly transferred to a new claims adjuster; attention to detail and accuracy is often lost when adjusters are changed. Moreover, insurance adjusters are many times downright rude, demeaning, and condescending to injured Wisconsin workers. Injured workers are made to feel like they have done something wrong in simply filing a workers compensation claim. The injured worker’s credibility and integrity is regularly questioned and assaulted by adjusters who make them feel like they are only money-seeking. The penalty claim in Wisconsin for Bad Faith rarely gives the injured worker back what they have lost as the award (up to $30,000) is not guaranteed because it is based on many more complicated factors.

Mays Law Office is proud of the work it did for J.C. and takes on every call and claim with an eye toward an aggressive and effective approach to keep workers compensation insurance companies responsible and accountable. In sum, never assume you are being treated fairly by an insurance company. Call Attorney Lisa Pierobon Mays today at 608)257-0440.

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