Wisconsin Work Injuries: Your Benefits Explained
Wisconsin workers’ compensation benefits schedules can be complex, highly case-specific and often a challenge to secure. Having a workers’ compensation lawyer in Hayward or Winter to help you fight for the best possible outcome can make a world of difference to your case.
Types of wage loss benefits available under workers’ compensation can include:
- Temporary partial disability benefits;
- Temporary total disability benefits;
- Permanent partial disability benefits;
- Permanent total disability benefits;
- Death benefits to spouse and dependents.
These benefits are in addition to medical expense compensation for all reasonably related expenses – including mileage – as well as payments for rehabilitation, vocational training and prescription/ non-prescription drug treatment (when dependence stemmed from a work injury). Note that while workers’ compensation is a no-fault system, certain causal failures by employers or employees (i.e., failure to provide a safe workspace, failure to abide company’s drug and alcohol restrictions) can result in an award addition or reduction in favor of the other party.
Some workers may have the right to claim third-party liability if someone other than an employer or co-worker was negligent, as outlined in Wis. Stat. §102.29. Those who prevail can pursue damages like pain and suffering. Third-party liability payments may affect your workers’ compensation coverage/ benefits, so it’s important to speak with a workers’ compensation attorney first before signing any settlement agreement.
An estimated 97 percent of Wisconsin employees work at companies required to purchase workers’ compensation insurance, according to the Department of Workforce Development, which reports an annual average of 5,300 workers’ compensation claims in the state.
Medical Expense Coverage – Wisconsin Workers’ Compensation
All reasonable and necessary medical expenses for work-related injuries and occupational diseases are payable to workers in Wisconsin. This is true regardless of whether the employee misses any time from work. These benefits include all doctor bills, hospital bills, medical and surgical supplies, and medical devices, including artificial limbs, crutches and wheelchairs.
Reasonableness and necessity are established by medical examinations and conclusions.
Medical providers should be informed at the outset of your treatment that you have or plan to file a workers’ compensation claim, so they bill appropriately. Workers have the right to choose their doctor, so long as they are licensed in the state to provide necessary and reasonable care to cure and relieve the injury/ illness effects.
Wisconsin Temporary Partial Disability Benefits
Temporary partial disability benefits are paid to a worker who sustained an employment injury after which an employee can still work, but only fewer hours or in a lesser-paying position due to the industrial accident or disease. Eligibility is determined and documented by a physician. Although “disability” isn’t defined in Wisconsin workers’ compensation statutes, we know based on Wis. Stat. § 102.01(2)(c) that it’s understood to mean loss of wages or limitations caused by an injury defined to be a “mental or physical harm to an employee caused by an accident or disease.” In layman’s terms, it’s a work-related injury or occupational illness.
These benefits are paid proportionate to allow for one to receive an amount that together with reduced wages would amount to two-thirds of one’s average weekly wages prior to the injury. Benefits under this umbrella are paid until one’s condition is stabilized and the employee has reached “maximum medical improvement,” meaning with a reasonable degree of medical certainty, one’s condition is unlikely to further improve.
Wisconsin Temporary Total Disability Benefits
Temporary total disability benefits in Wisconsin are paid during the healing period after workplace injury or illness, during which time one is receiving active treatment, prior to reaching maximum medical improvement (a plateau of improvement).
Like temporary partial benefits, temporary total disability (TTD) allow for a worker to receive an amount that would equal two-thirds the average weekly wage. Payments are only available in the window of time during healing and while one suffers actual wage loss. In no case can one’s benefits exceed the amounts as outlined in Wis. Stat.§ 102.11(1), the statute that explains how workers’ average weekly wages are calculated and updates caps annually. Where wage loss is only partial, workers will receive temporary partial disability benefits.
Wisconsin Permanent Partial Disability Benefits
Benefits for permanent partial disability are awarded when an employee doesn’t recover fully from the injury and is not expected to do so. Benefits are awarded for lost earning capacity -actual and potential, with amounts varying depending on the seriousness of one’s condition.
For instance, if your right arm must be amputated because of a work-related incident, you may receive temporary total disability benefits while you recover and are not able to work at all. If you’re able to return to work in some capacity, but in a lesser-paying role, you would receive temporary partial disability benefits until doctors determined you reached maximum medical improvement.
You may receive payments ensuring your income equals two-thirds your average weekly wage, retroactive to the date of your maximum medical improvement. However, the state also has a “schedule” of injuries, and payments/ length of benefits – equal to two-thirds your average weekly wage but varying depending on the type of injury and when you sustained it. Your doctor is responsible to sign off on your “rating” of disability – from 0 percent to 100 percent – based on functional loss. This schedule is outlined in Wis. Stat. §102.52. For example, the loss of an arm at the shoulder is payable for 500 weeks, an arm at the elbow for 450 weeks and hand for 250 weeks. If that arm or hand is your dominant, the period of disability extends by 25 percent.
Wisconsin Permanent Total Disability Benefits
Permanent total disability benefits are generally only considered for those cases of extremely serious injury that bars an employee from ever returning to gainful employment of any kind. For instance, if you lose use of both eyes, both arms, both legs, an arm and a leg or some other extreme condition that would keep you from working at all, you would be entitled to permanent total disability benefits. These are payable for life at the rate of two-thirds your average weekly wage at the time of injury (with maximum payments specified by annually-reviewed statutes).
Wisconsin Workers’ Compensation Death Benefits
Death benefits are outlined in WI Stat.§ 102.46-102.51. In cases where a worker’s death results from work-related injury and decedent leaves behind one or more who had been wholly dependent for support (typically spouses, domestic partners and minor children), benefits are paid in an amount four times his or her average annual earnings. However, if the worker had been receiving workers’ compensation benefits prior to death, death benefits added to the disability benefit can’t equal more than two-thirds the weekly wage. Burial and funeral expenses are also payable, in amounts regularly reviewed by legislators.
If decedent left behind none who were wholly dependent, partial dependents and death benefits may be payable to any whom the department determines would have benefitted from decedent’s support – in amount deemed in line with that support, so long as it doesn’t exceed two-thirds the worker’s annual weekly wage prior to work accident/ illness.
Special Benefits for Certain Injured Workers, Survivors
There are also several benefits that may be paid, depending on the circumstances:
- Supplement benefits (Supplemental Benefit Fund);
- Additional death benefit for Children (Children’s Fund);
- Pre-existing disability, indemnity benefits (Second Injury Fund);
- Payment of certain barred claims (Barred Claims Fund);
- Uninsured Employers Fund (paid to injured employees working for companies illegally lacking workers’ compensation insurance coverage).
Maximum limitations on benefits are outlined in Wis. Stat. § 102.44.