Wisconsin Workers Comp Claims: Eligibility, Filing and Appeals
Understand how workers' comp works in the state of Wisconsin.
The Workers' Compensation Division of the Wisconsin Department of Workforce Development administers the workers’ compensation program in Wisconsin. Employers with three or more employees, or any employer with payroll of approximately $2,000 or more in payroll per year, must obtain workers’ compensation insurance or be self-insured. Only large companies that satisfy certain financial criteria can self-insure for workers’ compensation purposes. The state also has an Uninsured Employers Fund to compensate injured workers if the employer is not insured.
Workers Who Are Covered by Workers' Compensation
Not all individuals working in the state of Wisconsin are covered by the workers’ compensation laws. Volunteers and independent contractors are not considered employees, and are therefore excluded from workers’ compensation coverage. Farm workers are not covered unless the employer has six or more employees on any twenty days in a calendar year. Separate federal statutes cover federal workers.
Work-Related Injuries Covered
Wisconsin workers’ compensation covered both physical and mental injuries. Conditions that develop over time, known as occupational diseases, are covered if the condition or disease is directly linked to the distinct conditions of the workplace.
If you travel for work, you are covered at all times during your work-related travels, unless you deviate from your work activities for purely personal reasons. Commuting to and from work is not considered work-related travel, and is not covered by workers’ compensation.
Filing a Wisconsin Workers’ Compensation Claim
The first step to getting workers' comp benefits in Wisconsin is to report the injury or occupational disease to your employer. Your employer will provide the necessary forms for you to complete and submit to the Wisconsin Department of Workforce Development. It is your employer’s responsibility to file the necessary paperwork with the workers' comp insurance carrier (which will then report your injury to the Wisconsin Worker’s Compensation Division).
Be prepared to provide detailed information about your claim, including date of the accident or injury, your current wages, medical records, and other supporting documents. These may or may not be requested at the initial filing of your workers’ compensation claim, but you will have to provide them upon request.
Workers’ Compensation Claim Denials
Your employer, if it is self-insured, or its workers’ compensation insurance carrier must notify you within 14 days of receiving notice of your injury if the insurer is still investigating your claim. If the insurance carrier denies your claim, the insurance carrier must notify you within seven days in writing of its decision to deny your claim.
Review the letter denying your claim very closely. The letter contains information about how to obtain a hearing to challenge the claim denial.
Workers’ compensation claims can be denied for a variety of reasons. Sometimes, the issues are simple, such as incomplete information or lack of the required supporting documents. Occasionally disagreements between doctor’s reports can lead to a claim denial. Alternatively, your employer may dispute that your injury occurred at work.
Appealing a Wisconsin Workers’ Compensation Denial
First contact your employer’s workers’ compensation insurance company to determine the reason(s) for your claim denial. Denial issues can often be settled through mediation, discussion, and/or providing additional supporting evidence.
If you cannot reach a quick resolution with the insurance carrier, request a hearing to challenge the denial of your workers’ compensation claim. If you can't settle the case after informal mediation and/or a pre-hearing conference with an administrative law judgeALJ), you will then attend a hearing before the ALJ, who will issue a decision regarding your claim. It is possible to appeal the ALJ decision to the Workers' Comp Division for review, and to the Wisconsin courts if necessary.
For more information, see our article on appealing a workers' comp denial in Wisconsin.
Wisconsin Workers’ Compensation Benefits
The workers' comp program pays for medical costs, temporary disability, and permanent disability.
Your employer will pay for all medical care reasonable and necessary for the treatment of your industrial injury or occupational disease.
In Wisconsin, you may choose your own doctor. The doctor can even be a chiropractor, psychologist, podiatrist, dentist, physician assistant, or advanced practice nurse prescriber licensed in Wisconsin. If you switch doctors during the administration of your claim, notify your employer and its workers’ compensation insurance carrier.
Your employer may also require you attend an independent medical examination. Your employer will choose the doctor(s) performing the exam. You must attend the examination, or your workers' comp benefits can be delayed or terminated.
Temporary Disability Payments for Wage Loss
If you are unable to work while recovering from your injury or illness for at least three days, you can receive wage loss payments, called temporary total disability benefits. You will receive two-thirds of your average weekly wage at the time of injury, subject to an annual cap. For 2017, you cannot receive more than $961 per week. You will receive a check on a weekly basis, with the first check arriving approximately 14 days after your last day at work.
If you are able to work in a part-time or light-duty position, but you're earning less than you normally do, you can receive temporary partial disability benefits. These benefits are calculated by taking your percentage of wage loss and multiplying it by what your temporary total disability rate would be.
Permanent Disability Compensation
Permanent disability compensation is aimed at compensating workers for the permanent loss of function caused by a work-related injury or occupational disease. If you heal completely, you will not receive permanent disability compensation. If you do not heal completely, your doctor will assign you a disability rating stated as a percentage.
If you are totally and permanent disabled, you will receive benefits at your temporary total disability rate for the rest of your life. A total and permanent disability is one that leaves a worker unable to work in any capacity. Only the most serious impairments will qualify, such as the loss of both eyes, arms, or legs.
If you are partially disabled, you will be eligible for a permanent partial disability award. The weekly benefit amount is two-thirds of your average weekly wage, subject to an annual cap. For 2017, the maximum benefit is $362. However, the length of the award depends on whether your injury appears on a state schedule.
Wisconsin has a schedule of injuries to certain body parts--such as an arm or a leg--and a corresponding number of weeks of payment. For example, a total loss of use of a hand at the wrist is worth 400 weeks. If you have a 15% disability rating, you will receive 60 weeks of payment.
If your injury does not appear on the schedule, your payments will be based on 1,000 weeks for a total body impairment. For example, if you have a 20% whole body impairment, you will receive 200 weeks worth of payments.
These awards are paid on a monthly basis, not in a lump sum.
When to Talk to a Workers' Comp Attorney
If you've been denied workers' comp benefits, you should hire an experienced workers' comp lawyer. Although you aren't required to have a lawyer when attending a hearing or a denial of claim meeting, having legal representation will ensure you receive the benefits that you are entitled to.
If your claim was accepted and you are trying to work out a permanent disability settlement with the insurance company, hiring a lawyer isn't as important, but a lawyer can almost always get you a better settlement that you could on your own.