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.

The Nuts & Bolts for Injured Wisconsin Workers

The Nuts & Bolts for Injured Wisconsin Workers

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.

After a Work Injury, do not Expect a Motherly Hug from the Workers Compensation Insurance Company

After a Work Injury, do not Expect a Motherly Hug from the Workers Compensation Insurance Company

While some injured workers are treated fairly in Wisconsin, most unfortunately are not. Most injured workers are treated rudely, even with skepticism as to whether they truly were hurt. One could even ask if Adjusters are trained to belittle the Wisconsin injured worker. Dont put up with it, call Mays Law Office at (866)257-0440 for a free consultation and tips on what the workers compensation carrier won’t tell you, such as 

You are entitled to 100% reimbursement for medical mileage to/from doctor and therapy appointments

If you are getting a lost time benefit (also called TTD benefit), is the average weekly wage calculated correctly – most are not; 

You can choose your own doctor/medical provider – never treat with the “company doctor

If instructed to see an IME or socalled “Independent Medical Examinerthere is nothing “independentabout this exam. You have rights on how to handle these insurance-paid exams

Nurses assigned to attend your medical appointments do not have the automatic right to come into your exams or guide your medical treatment; 

Employers have to offer you accommodating work that meets your physical restrictions while healing from a work injury, if not then a losttime benefit needs to be paid to you for missing work; 

If your injury is severe enough to cause permanent disability and you have lost your job, or an equivalent paying job, then likely you are eligible to pursue Retraining or a loss of Earning Capacity 

Claim; 

If your injury is severe enough that it leaves you disfigured, such as a serious scar, limp, amputation then you are entitled to an additional benefit called Disfigurement

Be cautious – don’t let the workers compensation insurance carrier stall, claiming week after week that they are “investigating” your injury. Likely, if the claim takes more than two weeks to investigate then it will be denied. Call Mays Law Office immediately. Never accept a denial of your work injury without calling or Emailing Mays Law Office first, Ipmays@mayslaw.net 

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