After suffering an injury or illness at work, employees can file a workers’ compensation claim. The process is sometimes complicated, especially if the injury or illness is severe. Workers’ compensation pays for medical expenses and lost wages that result from work-related injuries or illnesses.
An employee who suffered an injury or illness because of work should file a workers’ compensation claim immediately.
Because some injuries are minor, workers’ compensation in Wisconsin does not pay for the first three days of disability because of an injury. However, if the injury causes you to miss work for seven calendar days in Wisconsin, you may recover compensation for the first three days. Additionally, you only count Sundays in Wisconsin if you usually work on them.
Additionally, Wisconsin does not count the day of the injury, even if you were paid for the hours worked.
Since workers’ compensation is a no-fault system, the employer and/or the insurance company cannot deny your claim by accusing you of being negligent, even if your negligence caused your injury or illness.
You do not have to prove your employer's negligence caused your injuries. However, neither the employer nor the insurance company makes it easy to recover compensation for a claim. The employer and/or insurance company can use other defenses to deny your claim.
You must, however, show that your employment caused you injury or illness. Injuries are not necessarily those that happen immediately, such as a fall. Injuries and illnesses can include repetitive injuries, such as carpal tunnel, mental injuries, such as post-traumatic stress syndrome, and occupational diseases, such as cancer, from working with a particular chemical.
Filing a Workers' Compensation Claim
If you suffer injuries on the job or become ill because of your employment, you must notify your supervisor immediately. Even if you think the injury is minor, notify your supervisor, it could turn into something bigger.
You must also obtain medical attention, whether first aid, emergency room, walk-in clinic, or seeing your doctor. Keep all medical information, records, and invoices, as you may need them.
If you wait to obtain medical attention, the workers’ compensation insurance company or your employer may deny your claim, stating that the injury or illness did not happen at work or it is not as bad as you allege.
Your employer must report your injury or illness to its workers’ compensation insurance carrier. The insurance carrier reports the injury or illness to the state workers’ compensation division. The insurance should start paying for reasonable and necessary medical expenses and lost wages. You might run into trouble if the insurance company does not believe your injuries or illness is necessary or reasonable.
Your first check comes 10 to 14 days after you report the injury or illness, depending on the state. Your claim remains open for several years (six in Wisconsin). Keep all documentation regarding your workers' compensation claim for at least 12 years.
What Workers’ Compensation Does Not Cover?
To recover compensation from workers’ compensation, you must have suffered injuries at work.
Workers’ comp does not cover:
- Injuries you suffered on the way to or from work unless it is on company-owned property.
- Injuries sustained while you are on break, but not on the employer's property.
- Injuries suffered because of fighting or horseplay.
- Self-inflicted wounds.
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Document, Document, Document
Always keep a written record of your injury, the care you receive, doctors’ bills, and your recovery process. The amount of benefits you receive depends on the facts of the case. You will need the documentation to prove the severity of your injuries should complications arise and you have to go to a workers’ compensation hearing. Your testimony must match what you reported earlier.
Documentation should include:
- The date and time you suffered the injury or the date you first knew about an occupational disease. Workers’ compensation bases compensation on the date of injury.
- The cause of the accident, such as a fall, strain, overexertion, etc.
- The type of injury, e.g., sprain, hernia, cancer, etc.
- The location of the injury or illness, such as a finger, leg, or respiratory system.
- What you did when you suffered the injury.
- The source of the injury or illness, e.g., a faulty safety harness or working with a specific chemical.
- A description of the object that caused the injury.
- Your physical symptoms.
- How long the symptoms lasted and whether they stopped and recurred.
- Names and contact information of witnesses.
- Every doctor you saw because of your injuries or illness, and the appointment date.
- A list of expenses related to the injury or illness. Copies of medical bills are the best documentation. You can also include transportation.
- The days you lost work due to the injury.
- Written records of statements (verbal and written) made to the workers’ compensation insurance company and/or the employer.
- Copies of agreements or settlements for the workers’ comp claim.
Contested Workers’ Compensation Claims
While most claims take 10 to 14 days, a contested claim usually takes much longer.
Contested claims include:
- Claims that workers’ compensation denied.
- Claims where workers’ compensation does not pay some or all of the compensation.
- Claims where workers’ compensation pays but refuses long-term or permanent payments.
Any of these claims could take time to resolve. If your employer or workers' compensation contests your claim, you should immediately retain a workers' comp attorney if you have not already done so.
The Flow of a Regular Claim
Once you report a workers' compensation claim to your employer, it goes through several steps. The sooner you report a claim, the sooner you can get paid. While you have up to 30 days to file a report, you should not wait until the last minute. However, the statute of limitations can be longer, and specific traumatic injuries or occupational diseases may not have a statute of limitations.
Even with occupational illnesses, you should report them within days of learning of the illness. For example, if you developed cancer from chemicals you worked with a year ago and just received a diagnosis, report it immediately.
Your employer has seven days to report your injury or illness to its insurance carrier. However, if the injury caused the death of a loved one, the employer has 24 hours to report the death to its workers’ compensation insurance carrier.
The insurance carrier must then report lost time and injury claims to the Workers’ Compensation Division within 14 days of the date of your injury. As with the employer, the insurance carrier has only 24 hours to report a death to the Workers’ Compensation Division.
The insurance carrier has 30 days after the date of the injury to submit wage information to the Workers’ Compensation Division.
The Flow of a Disputed Claim
If an employer or its workers’ compensation insurance carrier disputes a claim, it takes longer for you to receive compensation.
The process for payment if it disputes the claim is:
- You must apply for a hearing. You have up to six years from the date of the injury to apply for a hearing with an administrative law judge.
- Always retain a workers' compensation attorney to help you through the process and ensure the workers' compensation insurance company and/or your employer do not violate your rights.
- The administrative law judge schedules a hearing on a first-come, first-served basis. They will notify you when they schedule your hearing.
- The administrative law judge hears evidence that you, your employer, and the workers’ comp insurance company present. About 80 percent of the cases resolve with the first hearing.
- The administrative law judge can take up to 90 days after the close of the record to issue her decision. However, the administrative law judge issues most decisions within 50 days.
- If you disagree with the administrative law judge’s decision, you have 21 days to file a petition with the Labor Industry Review Commission for review.
- If you disagree with the Labor Industry Review Commission’s decision, you have 30 days to file an appeal with the circuit court in your county.
- If you disagree with the circuit court, you have 45 to 90 days to file an appeal in the court of appeals. The number of days you have depends on when the court serves you with the notice of entry of judgment. At this step, both parties could appeal to the Court of Appeals.
- If you disagree with the Court of Appeals, you can appeal to the Supreme Court for your state. Both parties may file an appeal with the Supreme Court.
Going through the appeals could take several months, even with an attorney, depending on how much evidence you saved.
* The process and timeframes may differ from state to state.
Returning to Work
Your employer does not have to hold a job for you after an injury once your doctor says you can return to work. Your employer is only obligated to hold a position for you if your doctor does not recommend returning to work.
However, your employer must offer you suitable employment if available—it cannot fire you because you filed a workers’ compensation claim. Thus, when your doctor clears you to return to work, you should contact your employer to arrange to start work, even if you do not feel 100 percent better.
If you do not feel 100 percent and return to work, you have more of a case for additional benefits because you tried. However, if you refuse an offer to work, then return a month or two later and find that your injuries still prevent you from doing your job, you will have a more challenging time getting additional workers’ compensation benefits.
If your doctor advises you to return to work for light duty, you should return to work. The work may differ from your original job, but your injury may not limit you there. If not, you can request additional benefits.
The best way to return to work is to work with your doctor and employer. If needed, your doctor can explain your limitations. You, your doctor, and your employer could also create a plan to return to work.
The plan should include:
- Methods of communication between you, your doctor, and your employer.
- A write-up of your injuries or illness and limitations so that all parties understand your limitations.
- Any workers’ compensation rules that are not clear to you or your employer.
- Accommodations for limited or restricted work.
- A contact person to work with the insurance company.
- Regular updates between you, your employer, and your doctor.
You may also want to include a method to forward reviews between you, the doctor, and your employer. If everyone keeps in touch regarding your abilities, you will have an easier time restarting workers’ compensation benefits, if needed.
Contact a workers’ compensation lawyer as soon as possible after a work injury or if you learn about an illness connected to work.