FAQ – Worker’s Comp

Am I Eligible for Worker’s Compensation Benefits?
What Choices Do I Have for My Treating Doctor?
What Do I Do with Medical Bills?
How Much Compensation Am I Entitled to?
Do I Have Permanent Disability?
What if My Claim Is Rejected?
What if My Employer Refuses to Rehire Me?
Can I Be Retrained?
Do I Need an Attorney?

Am I Eligible for Worker’s Compensation Benefits?

Wisconsin law covers mental and physical injuries in the workplace. It covers accidental injuries and occupational injuries. Unlike other personal injuries, the negligence of a worker compensation applicant is generally not an issue. Key questions in a worker’s compensation case are whether the injury occurred during the course of employment and whether the injury arose out of the employment. These legal/medical questions can be very complex and the assistance of legal counsel may aid in the recovery of benefits.

Compensation and medical payments are based on medical reports from your health care provider. Prompt filing of reports is important to avoid delays in payment. Various deadlines apply in worker’s compensation cases. For example, if the insurer does not make payment because it is still investigating your claim, it must notify you within 14 days after it receives notice of the injury. If your claim is denied, the insurer must inform you within 7 days of its decision and advise you of your rights to file an Application for Hearing.
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What Choices Do I Have for My Treating Doctor?

An injured worker may choose any physician, chiropractor, psychologist, podiatrist, dentist, physician assistant, or advanced practice nurse prescriber licensed in the state. Referrals from one practitioner to another still constitute one choice. If you later select a second practitioner, you must notify your employer or the insurance company.

Under applicable worker’s compensation laws, your employer or the insurance company has the right to have you examined by a practitioner of its choice. This examination is known as an independent medical examination (IME). There are various rules relating to IMEs including the distance an injured worker may be compelled to travel, payment of mileage and lost wages, and number of IMEs. Assistance of legal counsel aids you in protecting your rights as it relates IMEs. Your compensation may be delayed if you do not agree to have these examinations.

The worker’s compensation laws provide that an injured worker is entitled to every type of treatment which is reasonable and necessary to cure you, as ordered by your practitioner. This includes hospitalization, therapy, tests and prosthetic devices. You are also entitled to reasonable travel expense necessary to receive treatment.
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What Do I Do with Medical Bills?

For a compensable claim, the insurance carrier or self-insured employer is required to pay your medical expenses and mileage.

An insurer or self-insured employer may challenge a health care provider’s fee as unreasonable or treatment as unnecessary. If so, it may refuse to pay the charge in question and must notify the provider of the dispute. Once a provider receives notice of a dispute about fees or treatment, the provider may not ask you to pay the bill. If questions arise concerning these bills, contact an attorney, your employer’s worker’s compensation insurance carrier or your employer.
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How Much Compensation Am I Entitled to?

While healing from your injury, you will get two-thirds of your weekly wage up to the maximum rate for the year of injury. Payment is made on the basis of a six-day workweek, Monday through Saturday, regardless of the number of days per week you actually work. Other rules apply to part-time, seasonal, and overtime work. The assistance of legal counsel may aid you in collecting all the temporary disability benefits you are entitled to.
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Do I Have Permanent Disability?

After you have healed as much as possible from your injury, your practitioner will determine if you have any permanent disability. For a permanent disability, you will receive additional compensation.

Compensation for permanent disability depends upon the body part or parts that are injured. The loss of a finger, hand, arm, leg, or foot is calculated on a functional basis. Other injuries, such as neck, back, and head are compensated in a different manner, which can include a determination of lost earning capacity. The assistance of legal counsel will aid an individual in presenting evidence to support loss of earning capacity as well as verify permanent disability from a functional standpoint.
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What if My Claim Is Rejected?

If there is a dispute between you and the employer or insurer that cannot be settled, you may request the Division resolve it by holding a hearing before an Administrative Law Judge.

You may file an application for a hearing if you believe you can prove that you did not receive all of your benefits. You must have medical proof of your claim. This proof is the written opinion of a physician, chiropractor, psychologist, physician assistant, advanced practice nurse prescriber, podiatrist, or surgeon. A dentist, physician assistant, or advanced practice nurse prescriber can give opinions on diagnosis and necessity of treatment but not on whether your injury is work-related or how disabled you are from the injury. Legal counsel can assist you in completing an Application for Hearing and submitting supporting medical documentation.
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What if My Employer Refuses to Rehire Me?

The law does not guarantee a job after an injury, and the employer is not required to hold one open or create one. However, if an employer “unreasonably refuses” to rehire an injured worker, you may claim up to one year’s back pay.
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Can I Be Retrained?

If you are unable to return to the same type of work you did before an injury, you may be eligible for additional worker’s compensation benefits in the form of vocational rehabilitation. The Wisconsin Division of Vocational Rehabilitation affords placement and retraining services to eligible individuals. The procedures for obtaining worker’s compensation benefits retraining can be complex. The aid of legal representation can be beneficial in obtaining additional worker’s compensation benefits through vocational rehabilitation.
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Do I Need an Attorney?

As discussed above, legal representation can be beneficial in a number of respects in a worker’s compensation case. Employers and insurance companies almost always retain lawyers to represent them in disputed cases. You are well advised to consult an experienced worker’s compensation attorney for your claim. I will be happy to talk with you.
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