Workers' Compensation FAQs

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 larger 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 benefits are payable in cases of injury or disease caused by something in the workplace. 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.

INJURIES COVERED BY THE LAW

The worker's compensation law of Wisconsin defines an injury as any mental or physical harm due to workplace accidents or diseases, including accidental damage to artificial limbs, dental appliances and teeth. Injuries covered include:

* Physical harm or injury such as bruises, burns, cuts, fractures, crushing injuries, hernias, sprains, strains, stiffness, amputation, loss or paralysis of part of the body, sudden loss of hearing, sudden loss of vision and disfigurement.

* Mental harm including nervous disorders, hysteria, and traumatic neurosis. The effects of brain hemorrhage caused by an industrial accident may also result in such harm. If the injury is mental harm or emotional stress without a physical trauma, the injured employee must show that it resulted from a situation of greater dimensions than the day-to-day mental stresses and tensions which all employees experience.

* Accidental injury such as physical or traumatic mental harm occurring suddenly and unexpectedly as a result of some employment-related activity.

* Occupational disease is chronic physical or mental harm caused by exposure over a period of time to some employment-related substance, condition or activity. Occupational disease includes loss of hearing and deterioration of bodily functions. Examples of common types of occupational disease are dermatitis (skin trouble), infection, silicosis, tuberculosis, pneumonia, lead poisoning, multiple chemical sensitivity and respiratory disease. In addition, occupational disease includes deterioration of bodily function caused by working conditions over a period of time. For instance, hernias and back trouble caused by repetitive motion or repeated strain over a period of time are considered occupational diseases under the law.

Occupational Deafness. Benefits are payable if prolonged exposure to noise causes permanent partial or total loss of hearing.

Eye glasses and hearing aids may be replaced only when a personal injury entitles the employee to medical treatment or payment of worker's compensation benefits. If a pair of glasses drops to the floor, with no personal injury, there is no payment or replacement.

WHAT KIND OF BENEFITS ARE AVAILABLE?

There are several kinds of benefits payable to injured employees or in some cases, their families. 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

WHO IS COVERED BY THE WORKER'S COMPENSATION LAW?

All employees working for an employer (other than farmers) with three or more workers are protected immediately by the Worker's Compensation Act. Employers with fewer than three workers come under the law if they pay wages of $500 or more in any quarter of a calendar year. Their workers are covered 10 days after the end of that quarter. Farm workers are covered if the farm employer has six or more employees on 20 or more days in a calendar year.

Nearly all workers in Wisconsin are covered. This includes both public and private employers. Nearly all private and public employees in Wisconsin are covered under the Act, including employees who are family members (except for farmers in some cases), minors, part-time employees and corporate officers.

There are a few classes of workers who are covered by federal laws and are not covered by the Act. Employees of the federal government (such as postal workers, employees at a veteran's administration hospital, or members of the armed forces) are covered by federal laws. People who work on interstate railroads are covered by the Federal Employers Liability Act. Seamen on navigable waters are covered by the Merchant Marine Act of 1920, and people loading and unloading vessels are covered by the Longshoremen's and Harbor Worker's Compensation Act.

The only employee exceptions to the Act's insurance requirement are: (1) domestic servants, (2) any person whose employment is not in the trade, business, profession or occupation of the employer, (3) some farm employees, (4) volunteers, including volunteers of non-profit organizations that receive money or other things of value totaling not more than $10.00 per week, (5) religious sect members that qualify and are certified for an exemption, (6) employees of Native American tribal enterprises (including casinos), unless the tribe elects to waive its sovereign immunity and voluntarily become subject to the Act. Virtually all other workers and employers are subject to the Act.

THE INJURY OR DISEASE MUST ARISE OUT OF "EMPLOYMENT" - WHAT IT MEANS

Worker's compensation benefits are payable, "Where, at the time of injury, the employee is performing service growing out of and incidental to his or her employment." The employee must prove that the injury happened while engaged in some activity related to employment.

On The Job Injuries

The most frequent types of accidents occurring on the job are through the impact of a falling or moving object, slips or falls, or strains or overexertion.

Injured While Going To And From Work

Usually, the only time an employee can be compensated for an injury which happens on the way to or from work is if it occurs on company-owned property, or under conditions cited in the law. Company sponsored cars and vanpools are not covered.

Injured On Company Steps Or On Company Owned Parking Lot

Injuries occurring on steps leading to the company, or on a customary path through the employer's property, or in a company-owned or designated parking lot are compensable.

Injured While Attending To Personal Needs

Generally, an employee who is injured at work while attending to personal needs, such as smoking, eating, getting refreshments or going to the lavatory, is paid worker's compensation. Injuries off the employer's premises during a break or lunch hour are usually not covered.

An employee injured on the employer's premises during the lunch hour, wash-up time or while changing clothes is covered by the law.

Injured While Doing Something Of A Strictly Private Nature

When an employee is injured in the performance of an act which is undertaken for a strictly private purpose or to satisfy his or her own curiosity, and it is apparent the job has been abandoned for the time being, the employee is not covered.

For example, an employee driving on the job who runs a private errand and deviates from the ordinary driving route would not be compensated.

Injuries While Off Company Property, But Still On The Job

An injury occurring away from the company premises, but while the employee is still performing service for the employer and under the employer's direction and control, is compensable. If the employee is being transported by the employer when injured, he or she will be entitled to benefits whether or not the incident occurred on the employer's property. An employee whose employment requires travel is considered to be performing services at all times while on a trip. The employee is covered while traveling in airplanes, cabs, or while in eating places and hotels, provided there has been no deviation for a personal purpose.

Traffic Accidents Are Compensable

A traffic accident while on company business will be compensated. An employee on company business who has a heart attack while driving, resulting in an auto accident, is compensated for the injuries caused by the accident but may not be compensated for the heart problem. A delivery person who is injured in a traffic accident or while unloading merchandise at a different company will be compensated.

Injured During Horseplay Or Fighting

The circumstances surrounding horseplay or fighting determines if an injured worker should be compensated. If the injured employee started the horseplay or was the aggressor in the fight, it is unlikely that the employee will be paid compensation. On the other hand, if an employee is injured as the result of horseplay started by others, or was attacked without provocation, he or she may be awarded compensation.

Injured Because Of Self-Inflicted Wound

The law provides that if an injury is intentionally self-inflicted, it is not compensable (with suicide as the extreme case).

GIVING PROPER NOTICE OF INJURY TO THE EMPLOYER

When a person is injured or suffers a disease that is work related, the immediate goal is to take care of the condition through proper first aid treatment or medical attention. Remember, the injury and the need for medical attention must be reported to the employer to establish a worker's compensation claim. Even minor injuries should be reported because they may develop into something more serious.

As a general rule, an injury should be reported. A very late report may cause an employer to suspect that the accident occurred at home or, perhaps, not at all. Notice can be given verbally or in writing. It should include 1) the time, 2) the date, 3) type of injury or illness, 4) part of the body involved, 5) the circumstances surrounding the injury or the first appearance of disease and 6) the need for medical attention. If the notice is verbal, the employee may want to keep a written record of the information and the person notified in case a question comes up later.

Time Limit Of Two Years

An injured employee should give notice to the employer within 30 days of any injury. In the case of an occupational disease, the employee should give notice within 30 days of the time the employee knows about the disability and its relation to the employment. However, if notice is not given within 30 days, it is still possible to give notice any time within two years of the date the injury occurred, the onset of the disease, or the date the worker first realized that such injury or disease was caused by his or her work.

If the employer receives notice within two years and the employer was not misled by the fact that earlier notice was not given, benefits may be payable. The two-year limit does not apply if the employer knew or should have known of the injury.