Understanding the Workers Comp’ Wisconsin Benefits Process

Recovering from a traumatic injury is incredibly difficult, especially when it keeps you out of work. Facing a sudden loss of income makes providing for yourself and your family incredibly stressful. Are you wondering how you can receive benefits from your work-related injury? Well, we have all the answers. Keep reading to find out how you can successfully file a workers compensation claim in the state of Wisconsin.

Wisconsin Workers’ Compensation Benefits: Key Takeaways

• Coverage requirements: Most WI employers with three or more employees must carry workers’ compensation insurance.
• Immediate steps: Report your injury to your supervisor within 30 days and seek medical attention immediately to protect your claim.
• Doctor choice: You have the right to choose your own medical provider in Wisconsin, though emergency care may be arranged by your employer.
• Filing your claim: Your employer and their insurer handle the formal filing once you report the injury, and you should receive your first check within 14 days of lost time.
• Covered benefits: WI workers’ comp covers 100% of reasonable medical costs, two-thirds of your lost wages, and vocational retraining if you cannot return to your job.
• Legal help: Consider hiring an experienced WI workers’ comp attorney if the insurer denies your claim, disputes your disability rating, or offers an unfair settlement.

Which Wisconsin Employers Must Provide Workers’ Compensation Insurance?

Workers’ compensation insurance under Wisconsin state law is protection mandated by state law for a worker and the worker’s dependents against injury and death occurring in the course of employment. Wisconsin operates under a no-fault compensation principle. This means every eligible employee can receive medical coverage and wage replacement for a work-related injury, regardless of who caused the accident. It is important to note the employees who are generally covered by worker’s compensation. These rules apply if:

• A company hires three or more full-time or part-time employees.
• An organization employs one or more full-time or part-time workers and pays gross, combined wages of $500 or more in any calendar quarter for work done in Wisconsin.
• The employer is a farmer who employs 6 or more workers on any 20 days during a calendar year.

Certain Workers Do Not Have Automatic Coverage Under WI State Law

Even though Wisconsin automatically covers the vast majority of employees, state laws exempt a few specific roles from this coverage. It is important to be made aware of these limits before you file your claim.

These exceptions include:

• Domestic servants
• Certain farm workers
• Volunteers
• Real estate brokers/agents
• Members of religious sects
• Employees of Native American tribal enterprises
• Any person whose work does not align with the trade, business, profession, or occupation of their employer (i.e., independent contractors)

What To Do Whenever A Work-Related Injury Occurs

When an injury occurs in your workplace, taking immediate action protects physical recovery and financial benefits. First, notify your supervisor as soon as possible. WI law gives you a deadline of 30 days to report your injury, so be sure to file your claim beforehand. Delays can lead to disputes, disrupt your recovery process, and potentially lead to appeals. Your employer will then submit the incident report to its insurance carrier who notifies Workers’ Compensation Division. Documenting the incident in writing can help you with your claim as well. Having this written evidence such as time and description of injury can provide insurers with proof for your claim and help you in any legal case you may pursue. Once approved, your insurance carrier will pay for your medical treatment, compensation for lost wages, and death benefits to your dependents.

Choosing a Medical Provider for Treatment: What to Know

As the injured employee, you have the right to choose your own medical provider after being injured at your workplace. By mutual agreement with your employer, you may also be able to go to a qualified practitioner not licensed in WI. If you later find a second provider while treating your injury/illness, it becomes your duty to contact your employer or insurance carrier. In case of an emergency, your employer may arrange your treatment until you are able to choose your own practitioner. It is wise however to choose certain specialists for specific injuries.

These specialists include:

• Physicians
• Psychologists
• Pediatrists
• Dentists
• Chiropractors
• Physician assistants
• Advanced practice nurse prescribers

Steps for Filing Your WI Workers’ Comp Claim

To avoid delays, it is your responsibility to report your injury as soon as possible. You must also receive any medical attention necessary after your injury. This can include going to the emergency room, depending on your injury’s severity. After reporting the injury to your employer, they will then report it to their insurance carrier and the Wisconsin Workers’ Compensation Division. After that, you should then receive a check. This is usually within 14 business days and covers reasonable medical expenses. You are also able to receive wage benefits for lost income while you suffer or heal from your injuries. With these wage benefits, there is a certain waiting period until you are able to start receiving payment for your injuries. In WI, the waiting period is 3 business days. Saturdays are included in the waiting period, regardless of whether they are normally scheduled or worked. However, Sundays are not included in this waiting period. You will then be paid on the 4th day of lost wages.

Workers’ Comp Wisconsin Benefits Guide: What Does It Cover?

Workers’ compensation insurance in WI has certain restrictions on what it covers. It is important to understand exactly what the policy covers while filing your claim.

Medical Expenses

Wisconsin Department of Health Services covers all medical expenses related to the work injury until you reach maximum medical improvement. Travel expenses and lost time to receive these treatments also count as medical expenses for your work-related injury.

Covered medical expenses related to your work injury may include:

• Doctor bills
• Hospital bills
• Medicines
• Crutches
• Artificial limbs
• Medical/surgical supplies

Lost Wages

Lost wage benefits in WI equal two-thirds of your average weekly wage before taxes. The state caps this amount on the year of your injury and depends on your injury’s severity.

• Temporary Partial Disability (TPD)/Temporary Total Disability (TTD): Benefits to sustain an employee while recovering from an injury. Your doctor determines which payment you receive, based on the two-thirds rule for your average weekly wage.
• Permanent Partial Disability (PPD)/Permanent Total Disability (PTD): Cash benefits for employees who do not fully recover after their injury. The amount you receive is dependent on the severity of your permanent disability.

Necessary medical treatment costs to help you recover from your injury also qualify for compensation under the Wisconsin Administrative Code. This includes any mileage to receive treatment or vocational rehabilitation services due to your workers’ comp claim.

Vocational Rehabilitation Services And Job Retraining Benefits

If your work injury leaves you with a permanent disability that prevents you from returning to your formal job, you are eligible for Vocational Rehabilitation (VR) services. These services can help you find a new job where you can earn the same compensation as you did before your injury. The programs are available through Wisconsin’s Division of Vocational Rehabilitation (DVR) and can be pursued through your workers’ comp claim. If you decide to enroll in retraining benefits, you may be eligible for additional Temporary Total Disability benefits for the first 80 weeks. Additional money for travel, meals, and lodging may be included within these benefits.

Permanent Restrictions And Return-To-Work Requirements

An evaluation of permanent disability is crucial for your treatment and benefit compensation. Your medical provider has the main say in establishing your disability rating. This rating can be based on the doctor’s personal knowledge, experience, and weight of your injury findings. Your pain can also be graded as subjective symptoms including:

• Mild
• Moderate
• Severe
• Very severe

If receive job offers that fall within your medical restrictions, it is important to document them. This can protect your workers’ comp benefits. If you refuse a job offer that is reasonable light work suitable for your injuries, they will suspend your wage-loss benefits. On the other hand, if your employer has suitable work for you but fails to rehire you after injury, they are then liable to pay you up to one year’s wages for lost work.

Death Benefits for Surviving Dependents

When death results from a workplace injury, there are death benefits available for the deceased person’s eligible dependents.

The programs that help dependents of deceased workers include:

• Children’s Fund: A benefits fund to support minor dependent children whose parent died of a work-related injury.
• Second Injury Fund: Pays permanent partial disability (PPD) for at least 200 weeks when an employee would have been entitled to compensation for their work-related injury.
• Barred Claims Fund: A compensation fund for individuals whose injuries were credible, but filed after the state’s statute of limitations ended.

How Independent Medical Evaluations Work During the Claims Dispute Process

The Workers’ Compensation Act allows employers and insurance companies to request an Independent Medical Evaluation (IME) from your healthcare providers. This is to determine a variety of factors that play a role in making determinations based on your injury circumstances. The worker’s comp insurance company can schedule these examinations once every six months with a medical examiner within a 100-mile radius of your home. Insurance companies and self-insured employers must reimburse you for any costs related to the IME.

This can include any:

• Transportation
• Meals
• Lodging
• Wage-loss costs

If the insurer disputes your claim, they may refer you for a possible settlement through Alternative Dispute Resolution (ADR). ADR can include separate or joint communication by a Division representative with you and the insurance company representative. This is so both sides have the chance to give the Division representative information about your injury. That way, both parties can reach an agreement to resolve any differences. If the Alternative Dispute Resolution cannot be resolved properly, you can request a formal hearing from an Administrative Law Judge to review your case. This can involve completing an application to receive a hearing, as well as medical evidence to support your injury claim.

When To Get A Lawyer for Your Workers’ Comp Wisconsin Case

In several cases, hiring an attorney is strongly recommended to help you win your claim. You should hire an attorney when:

• You are denied benefits
• Your condition permanently prevents you from working again
• Your settlement doesn’t fully cover your losses

When evaluating your legal options, keep these key Wisconsin rules in mind:

• Contingency rules: Your lawyer may take a small percentage of your settlement. But this is a small cost for receiving the help you need to get the maximum benefits possible for your injury.
• Suing third parties: If you were injured by a third party, they are liable for your losses. This is also a separate legal issue from your workers’ comp claim.
• SSDI and workers’ compensation overlap: You may receive both of these benefits, you just have to notify your insurance carrier or self-insured employer.
• Scar and permanency benefits: If you are permanently disfigured from your work injury, you are eligible to receive compensation for it. That amount cannot to exceed your annual average earnings.

Don’t wait to submit your workers’ compensation claim in Wisconsin. LegalASAP can connect you with a nearby attorney who can review your occupation-caused injury claim for free.

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