Benefits for Work-Related Injury or Illness

IN WISCONSIN, WHAT KIND OF BENEFITS ARE AVAILABLE IN CASES OF A WORK-RELATED INJURY OR ILLNESS?

Workers Compensation benefits in Wisconsin are paid either through insurance policies purchased by employers, or (in some cases) through self-insured workers compensation programs set up mostly by large companies or by units of government. Most employers carry workers compensation insurance coverage. It is these Insurers which provide most worker's compensation benefits to injured workers.

Workers compensation A worker can be injured by an on-the-job accident or by disease or other impairment, which was caused or aggravated by on-the-job exposure.

There are several kinds of benefits payable to injured employees or in some cases, their families, and the principal benefits in Wisconsin are:

  • Medical Benefits - There is full, complete and unlimited coverage of all bills for medical treatment and for hospital services provided to injured workers.
  • Indemnity Benefits - These are weekly cash payments to workers intended to partially replace lost income. In Wisconsin, there are several different kinds of payments that make up indemnity benefits. The principal kinds are:

◊ Temporary Total - Currently, two-thirds of an employee's earnings, subject to a maximum, are paid to injured workers until they recover from work-related injuries and return to work.◊ Permanent Total - Injured workers who are 100% disabled due to a work-related injury are entitled to receive two-thirds of their earnings, subject to a maximum weekly amount for the remainder of their lives.

◊ Permanent Partial - Workers who sustain permanent partial disability receive supplementary compensation in addition to two-thirds of earnings, subject to a current maximum for a specified number of weeks related to the degree of disability. For example, a worker who suffers the loss of a leg at the hip joint receives 500weeks of permanent partial payments. Correspondingly, if the worker loses a little toe at the second or distal joint, only 4 weeks of permanent partial payments are received.

◊ Death Benefit - there are several benefits payable when an employee is fatally injured dependent upon the worker's family status at the time of death. A maximum burial expense is also payable.

  • Vocational Rehabilitation - The cost of rehabilitation (for example, tuition for classes at a technical college, or costs of an apprenticeship program) is fully covered and the injured worker is also entitled to weekly indemnity payments during the rehabilitation period.

Worker's compensation insurance provides distinct benefits for employees who have injuries or illnesses related to employment:

  1. Coverage of all reasonable and necessary medical costs.
  2. Benefits for temporary wage loss [Temporary Partial Disability (TPD) or Temporary Total Disability (TTD)] sustained by an employee while recovering from injury. Eligibility for temporary disability benefits are determined and must be documented by a doctor. Benefits for temporary wage loss due to disability are based on two-thirds of the employee's wage rate up to a specified maximum amount.
  3. Benefits for permanent disability [Permanent Partial Disability (PPD) or Permanent Total Disability (PTD)] if the employee does not fully recover from the injury. Permanent disability is awarded for the potential, or actual, loss of earning capacity. The amount of benefit payment for permanent disability depends on the seriousness of the permanent disability.
  4. Vocational rehabilitation.
  5. If a death occurs to an injured employee, death benefits and burial expense will be paid up to specific limits.

** Medical Benefits. There is full, complete, and unlimited coverage of all bills for medical treatment and for hospital services provided to workers injured in the course of their employment.

** Indemnity Benefits. There are weekly cash payments to workers to generally replace lost income. In Wisconsin, there are several different kinds of payments that make up indemnity benefits. The principle kinds are:

  • Temporary Total. In 2008, two-thirds of an employee's earnings, subject to a maximum of $XXX per week, are paid to injured workers until they recover from work-related injuries and return to work. In 2009, the maximum is $XXX per week.
  • Permanent Total. Injured workers who are 100% disabled due to a work-related injury, are entitled to receive two-thirds of their earnings subject to a maximum weekly amount that is $XXX in 2008 and $XXX in 2009 for the remainder of their lives.
  • Permanent Partial. After the healing period has ended, workers who sustain permanent partial disability receive additional compensation of two-thirds of their earnings, subject to a maximum of$242 per week in 2005 and $242 per week in2006, for a specified number of weeks related to the degree of disability.
  • Death Benefit. There are several benefits payable when an employee is fatally injured dependent upon the worker's family status at the time of death. The maximum payable for a worker with dependents is $XXX in 2008 and $XXX in 2009. A maximum burial expense of $6,000 currently is also payable.

*Vocational Rehabilitation. The cost of rehabilitation is fully covered, and the injured worker is also entitled to weekly indemnity payments during the rehabilitation period.

TO BE ELIGIBLE FOR WORKERS COMPENSATION BENEFITS, DO I NEED TO PROVE SOMEBODY ELSE WAS AT FAULT?

No. Wisconsin has adopted a no-fault Workers Compensation system. You generally are eligible for workers compensation benefits if you require medical care for an injury or illness caused by a risk present in the workplace, regardless of whether you, a fellow employee, or your employer is careless or negligent. Note:

If somebody not working for your employer caused the injury or illness, you may also be able to pursue a THIRD PARTY claim. Also, if your injury or illness is caused by your employer's failure to follow a safety rule or regulation, they may be subject to a penalty which could result in greater benefits paid to you.

In 1911, Wisconsin adopted a Workmen's Compensation Act (Act). This provided for a new remedy under essentially a "no-fault" system in which a worker no longer had to prove negligence on the part of the employer, and the employer's defenses were eliminated. The intent of the law was to require an employer to promptly and accurately compensate a worker for any injury suffered on the job, regardless of questions of fault. In return, the Act limited the amount that a worker could recover. Workers are entitled to (1) certain wage loss benefits, (2) the cost of medical treatment, and (3) certain disability payments. Under the old system, workers had been able to recover for pain and suffering, loss of enjoyment of life, and other damages that a jury might award. Recovery under worker's compensation is limited to these three areas, no matter how serious the injury