A “disability” for purposes of Wisconsin workers’ compensation benefits differs from that used for other benefits, such as Social Security Disability Insurance. To understand the benefits that may be available to you, it’s vital to have a good grasp on the way the state Division of Workforce Development approaches the question.
As the Hayward and Winter workers’ compensation attorneys at Lein Law Offices can explain, medical expenses can be paid regardless of whether you are able to return to work, but payments for lost wages are based on disability – either temporary or permanent.
Although “disability” isn’t expressly defined by the state’s workers’ compensation statutes, Wis. Stat. § 102.01(2)(c) indicates that eligibility for disability payments is based on whether one sustains wage losses or reductions as a result of physical or mental harm caused by a disease or accident that is work-related.
Physical harm may include things like:
- Sprains/ strains
- Paralysis of certain body parts
- Loss of hearing, vision
Mental harm, meanwhile, is outlined as including:
- Nervous disorders
- Traumatic neurosis
If mental harm or emotional stress occurs without actual physical trauma, the injured worker will need to show alleged harm stemmed from a work condition falling outside the typical day-to-day stresses and tensions sustained by all employees.
These conditions may stem from traumatic physical or mental harm that happened all-of-a-sudden, unexpectedly while employee was engaged in some employment-related activity. They can also arise from exposure to a substance, condition or activity that resulted in physical or mental harm (i.e., an occupational disease). For example, one could suffer lead poisoning or mesothelioma as a result of exposure to toxic substances at work (lead and asbestos, respectively). One may suffer some type of infection, such as pneumonia or tuberculosis due to exposure to elements or someone else with the infection. Alternatively, one might suffer back problems that resulted from repetitive motion over time.
Temporary total disability benefits and temporary partial disability benefits may be awarded for the period of time during which the worker is actively convalescing for the injury or illness and is unable to return to work. This determination is made by a physician. Payments are made based on ensuring worker doesn’t take home less than two-thirds their total salary during this period of recovery.
Permanent partial disability and permanent total disability are figured differently, and only once a worker has attained maximum medical improvement, meaning your treating physician has determined with a reasonable degree of medical certainty that your improvement has plateaued and the condition is unlikely to get any better, regardless of what treatments you receive.
Determining the nature and extent of a work injury is a key part of a claimant’s treatment, but it’s not an exact science. In fact, it’s been compared to something of an art. Because the disability rating isn’t always black-and-white, it’s often critical to have an experienced workers’ compensation lawyer available to help ensure a fair claim. Your final disability rating will be up for decision by the medical doctor.
Physicians conduct this evaluation based on a host of guides and relative percentages and may use more than one formula. Ultimately, though the percentage will hinge on the doctor’s own personal experience and knowledge combined with consideration of clinical findings and clear anatomical damages. Injuries that involve, for example, range of motion, are mostly objective, with the doctor able to verify his or her opinion with a range of tests, x-rays and other unbiased proof.
Other elements may be a bit more subjective. For instance, how can one accurately evaluate another’s pain level? We know pain is clearly a disabling condition, but you can’t measure it with a medical scan or blood test. The physician will need to delve into whether complaints are consistent with the injury, if it’s consistent with the anatomic pattern, whether it interferes with one’s ability to work, and what types of activities make it worse. Some physicians may rely on specialists’ guidelines, such as the Manual for Orthopedic Surgeons in Evaluating Permanent Physical Impairment, which offers pain grading.
Workers’ compensation lawyers in Wisconsin know there is a difference between what is considered a workers’ compensation disability and a general impairment. The aforementioned group notes that permanent disability isn’t necessarily a question asked purely from a medical standpoint, but in terms of whether one’s ability to engage in work-related activity is lacking or reduced by an impairment that isn’t expected to improve markedly in the future.
For example, while a person who is blind may be deemed by the American Medical Association as 85 percent impaired, Wisconsin workers’ compensation laws consider the blind to be 100 percent disabled.
Seeking experienced legal help as soon as possible can allow for the best chance of making a successful recovery.