On the job injuries can happen in any occupation. Whether the result of a work-related accident or due to dangerous conditions you are exposed to on the job site, the injuries you suffer can impact every area of your life. You may be unable to work or perform tasks required of your job. Meanwhile, your medical care and treatment leaves you facing a mountain of medical bills. When you suffer injuries that threaten your health and financial security, our Wauwatosa workers’ compensation attorneys at Groth Law, S.C., are here to help.
What Is Workers’ Compensation
Workers’ compensation is a type of insurance that employers are generally required to purchase for their employees in Wisconsin. When a worker suffers a work-related injury or illness, the employee can file a workers’ compensation claim with the insurance provider for medical expenses and/or lost wages.
Under the Wisconsin Workers’ Compensation Act, employers are required to provide insurance benefits for any worker who becomes injured or ill while performing services or job duties that are a part of their job or incidental to their employment. Even if you were responsible for the accident that led to your injuries, you may be entitled to workers’ compensation benefits in Wisconsin provided the injuries were not self-inflicted and alcohol or drugs were not involved.
Sometimes an employer or the workers’ compensation insurance company might dispute a worker’s claim. If that happens, you may need an experienced Wauwatosa workers’ compensation lawyer to advise you on what to do and how to proceed.
Workers’ Compensation Should Cover Most Work Injuries
Employers in Wisconsin are required to provide workers with workers’ compensation insurance, which means that when a worker is injured or becomes severely sick while on the job, he or she is entitled to workers’ compensation benefits during recovery. Under the Wisconsin Workers’ Compensation Act, most injured or sick public and private workers are covered, for reasonable medical expenses, as well as compensation for lost wages due to their work-related injuries or illness. This is true regardless of whether they work on a full or part-time basis.
According to the Bureau of Labor Statistics (BLS), the most common work-related injuries suffered by clients include:
- Injuries due to slips, trips, and falls;
- Crushing injuries due to being struck by or against an object;
- Electrocutions and chemical or thermal burns;
- Severe cuts and amputations of limbs or body parts;
- Overexertion and repetitive stress related injuries;
- Injuries caused by acts of violence on the part of customers or co-workers;
- Diseases due to exposure to chemicals or toxic substances.
Any of the above conditions can have serious and potentially life-threatening impacts. Unfortunately, the BLS reports that roughly 100 workers in Wisconsin die as the result of their injuries each year. Those that do recover often face ongoing medical costs, along with disabilities that prevent them from working now and in years to come.
Those who may be excluded from coverage include:
- Some types of farm hands or domestic workers
- Volunteers and nonprofit employees making under a set amount of income
- Workers who are covered under other types of employee compensation and benefit programs, such as some federal workers, merchant marines, and longshoremen
Wisconsin Workers’ Compensation Statistics
According to information provided by the Wisconsin Department of Workforce Development:
- As of 2017, 97 percent of the state’s workforce was covered by a workers’ compensation policy. The high percentage of coverage, the department notes, was due to concentrated efforts, including investigative efforts by the Bureau of Insurance Programs to bring employers into compliance with state law.
- In 2017, there were 127,728 active workers’ compensation policies, with 273,462 linked employers and locations.
- As of May 2018, the state database contained 740 open, non-litigated permanent total disability workers’ compensation claims.
- There were 105 workplace fatalities in the state in 2016.
- Wisconsin averages nearly 31,000 workers’ compensation claims each year. Of those, approximately 10 percent are denied.
- According to 2015 figures, the state’s total workers’ compensation-related indemnity was $233,466,385. The cost of workers’ compensation-related medical expenses stood at
$665,575,145. Note that these figures do not reflect self-insured losses. An estimated 13-15 percent of Wisconsin’s workforce is self-insured.
A Snapshot of Workplace Injuries
The United States Department of Labor’s Bureau of Labor Statistics reported the following information based on 2017 figures:
- There were 2,811,500 total reportable cases of workplace injuries, illnesses, and fatalities in the U.S. Of those cases, more than 882,000 resulted in missed days of work.
- The median number of missed work days due to a workplace injury in 2017 was 8.
- 5,147 people in the nation lost their lives due to workplace injuries.
- Road incidents rank among the highest causes for workplace fatalities in all private sectors. About 1,300 workers died during work-related travel.
- Slips, trips, and falls are a common cause of both workplace injuries and fatalities. More than 227,000 workers were injured and 887 died due to falling, slipping, or tripping. Fatal falls were at their highest level of incidence in 26 years of Census of Fatal Occupational Injuries reporting.
What Employees Are Covered By Workers’ Compensation?
Nearly all Wisconsin employees are eligible for workers’ compensation benefits, with few and limited exceptions. For instance, domestic servants, some farm hand employees, volunteers or non-profits who earn no more than 10 dollars a week, and certified religious sect members are often not eligible. There are also a few exceptions for:
- Federal workers and railroad workers, who are covered by the Federal Employers Liability Act
- Seamen, who are covered under the Merchant Marine Act of 1920
- Workers who load and unload ships, who are covered by the Longshoremen’s and Harbor Workers’ Compensation Act.
All other workers generally are covered by under Wisconsin’s Workers’ Compensation Act.
What Is Covered By Workers’ Compensation?
Wisconsin workers’ compensation benefits are administered through the state’s Department of Workforce and Development (DWD). The following benefits may be available to you through the workers’ compensation program:
- Reasonable and necessary medical expenses, including diagnostic testing, treatment, and follow up care related to your job-related injury or illness.
- Vocational rehabilitation and retraining, if needed
- Wage benefits for the work time that is lost due to recovery from your work-related injury or illness. While you recover from your injury or illness you may be entitled to temporary partial disability payments (TPD) if you are unable to perform certain tasks or functions at your job. You may be entitled to temporary total disability (TTD) if you are unable to work at all during your recovery period.
- If you suffer permanent disabilities as a result of your injury or illness, you may be entitled to either partial or total disability benefits. The amount of compensation is based on the severity of your injuries, and the actual and potential amount of earnings lost.
- If your injuries prevent you from returning to your previous job or trade, you may be able to get retraining to help you enter a more suitable position or career field
- Death benefits to surviving family members, if applicable. In the unfortunate event that a worker’s injuries or illness prove fatal, surviving family members may be entitled to reimbursement for funeral and burial costs, along with compensation to make up for future losses in contributions and earnings.
Wisconsin Workers’ Comp in the News
According to a December 2017, report from The Cap Times, injured workers in Wisconsin face numerous hurdles when trying to obtain workers’ compensation benefits. The results of a study into the situation revealed that the decisions of the Labor and Industry Review Commission (LIRC), assembled to hear appeals to workers’ compensation denials, has tended to be employer-friendly for the past several years. Further, the workers’ comp decisions handed down by administrative law judges that end up going to appeal before the LIRC have doubled from 29 percent in 2007 to 59 percent in 2016. The state’s Department of Workforce Development receives about 30,000 workers’ compensation claims each year, and about 5,000 of those are contested and scheduled for a hearing before an administrative law judge. The majority of those cases are settled before the case goes to trial, the report notes.
An October 2018, article published by Business Insurance stated that Wisconsin is one of three states with the highest workers’ compensation medical payments per claim, coming in at just under $20,000 per claim. However, in spite of steady increases in claims for a number of years, the state has experienced little growth in medical payments per claim since 2014.
In February 2018, the Claims Journal reported that a state court of appeals decision opened the door for temporary workers to file workers’ compensation claims against their employers or personal injury litigation. The case at the heart of the decision revolved around the 2014 death of a temporary worker while he was a passenger in an automobile owned by Alpine Insulation and driven by another temporary worker. The man who died was actually employed by a drywall company, but assigned to work with Alpine. The man left behind five children, some of which were still minors at the time of his death. A wrongful death suit against Alpine and its insurance agency by the man’s family was denied by the Milwaukee Circuit Court because the man was actually an employee of the drywall company. While the appellate court stated that he was, in fact, an employee of the drywall company even though his services were being leased to Alpine. However, the court said that a claim could be filed against the drywall company, or else the decedent’s family could file a workers’ compensation claim.
Should You File a Claim or File a Lawsuit?
If you become injured on the job, there is a process that must be followed in order to seek compensation. The initial step is to file a claim, with the option of a lawsuit only becoming available if there are other negligence issues involved in your case or if you have been denied compensation. Here are the highlights of the claims process:
- You inform your employer of your injury. Your employer is required to provide you with the forms you need to fill out in order to submit your claim to the Wisconsin Department of Workforce Development.
- Within 14 days of receiving notice of your injury, your employer’s insurance carrier (or your employer, if self-insured) must notify you if your claim is still being investigated.
- If the insurance agency approves your claim, then you can obtain the necessary medical treatment from the doctor of your choosing, provided that doctor is licensed in Wisconsin. Your employer may also require an independent medical examination from a doctor of their choosing and you must attend that examination or risk having your benefits delayed or denied.
- If your claim is approved and your injury requires you to miss at least three days of work, you can receive temporary total disability benefits that will cover two-thirds of your average weekly wage or up to the weekly wage cap, which is determined once a year based on average salaries statewide.
- If the insurance carrier denies your claim, it must notify you in writing within seven days of when it reaches that decision. The denial letter will provide information as to how you can schedule a hearing to appeal the decision.
- If your claim is denied and you’ve requested a hearing, there will be opportunities to negotiate a settlement with your employer’s insurance carrier either through informal mediation or a pre-trial conference.
- If negotiation efforts fail, then you will attend a hearing before an administrative law judge, who will render a decision. If your claim is again denied, it is possible to appeal the administrative law judge’s decision to the Labor and Industry Review Commission. If that appeal is unsuccessful or there are additional legal claims that you opt to pursue, you also may have the option to file a lawsuit.
- Many times, when a case is appealed, the insurance agency may make an offer of compromise, which is a settlement offer generally consisting of a lump sum payment to cover your lost wages, medical payments, and permanent disability. It is important to speak to an experienced workers’ compensation attorney before accepting a compromise settlement, as the amount offered may not be enough to cover your expenses. Once you settle, you are no longer able to ask for additional compensation.
Call the Groth Law Firm for Help With Your Workers’ Compensation Disputes
When you are injured or become ill due to your work, you are likely entitled to workers’ compensation benefits while you recover. You need a trusted legal advocate working to ensure your rights and interests are protected. An experienced Wauwatosa workers’ compensation lawyer can help you determine your eligibility, file a claim, or deal with a dispute.
At Groth Law, S.C., we have extensive knowledge and years of experience helping clients in Wauwatosa and the surrounding areas get the compensation they deserve.
Contact us today for a free, confidential consultation to see how our Wisconsin workers’ compensation lawyers can assist you. Reach us online or by calling (414) 240-0707. We are on your side, helping you get the compensation that you deserve for your work-related injury or illness.