In Wisconsin, injured workers have the right to receive wage loss benefits and medical treatment for their injury, regardless of who caused the injury, as long as it was not self-inflicted to obtain benefits or occurred during horseplay or fighting that the injured worker instigated. However, the process of obtaining these benefits can be confusing and overwhelming.
A Green Bay workers' compensation lawyer from Nicolet Law Accident & Injury Lawyers fight for your delayed or denied benefits. Contact Nicolet Law Accident & Injury Lawyers today.
What Is Workers Compensation?
In Wisconsin, most employers must provide workers’ compensation, a form of no-fault insurance policy that compensates for wage loss, medical treatment, and other benefits to individuals who have suffered a work-related injury.
This policy takes effect on the first day of the worker’s employment and the state requires it of employers who:
- Have more than three full-time or part-time employees.
- Employ one or more full or part-time employees for whom they have paid more than $500 in any calendar quarter. In this situation, the employer must provide workers’ compensation by the 10th day of the first month of the following quarter.
- Are farmers who employ six or more workers on the same day for any 20 days of the calendar year. These employers must have a workers’ comp policy by the 10th day following the 20th day of this employment level.
- Out-of-state employers who have employees working in Wisconsin.
The Available Benefits
Injured workers in Wisconsin can seek the following benefits after a work-related injury:
- Coverage of all reasonable and necessary medical expenses to treat the injury.
- Benefits for income lost while the worker heals from their injury. You can receive temporary partial disability, which is provided to sustain an employee who can only work limited hours during their recovery. You may also seek temporary total disability, which provides up to two-thirds of the worker's average weekly wages while they cannot perform any work-related duties because of the injury.
- Permanent benefits for workers who experience disabilities due to their injury and will need long-term wage loss assistance. Permanent partial disability benefits are available for workers who can still perform some work but at a lower income. Permanent total disability benefits are available for those who sustain an injury that renders them permanently unable to perform any job-related tasks.
- Vocational rehabilitation and training provide injured workers with the means to earn new job skills if they can no longer do the specific tasks related to their job but can still perform some work.
- A death benefit for family members, including the expense of a funeral service and burial or cremation.
Note that a medical provider determines your disability status—not you, your employer, or the insurance company providing your employer’s workers’ compensation policy.
How to Obtain Workers Compensation Benefits in Green Bay
If you have experienced an injury in a workplace accident in Green Bay, these are the steps to filing a workers’ compensation claim:
- Tell your supervisor of your injury, even if it is minor and you do not believe it requires medical attention. If the condition worsens hours or days after it occurs and you need medical treatment, your employer will know when and have an official accident report on record.
- Obtain necessary medical attention, whether that involves first aid or a visit to the emergency room.
- Your employer is responsible for reporting your injury to the insurer who carries their workers’ compensation policy. The insurer is then required to report the injury to the Wisconsin Workers’ Compensation Division.
- The insurer will pay any reasonable medical expenses. If your doctor orders you to refrain from working for at least three workdays, you are qualified to receive wage loss benefits.
- You should receive compensation for wage loss from the insurer within 14 days of your reported injury. No compensation is available for the first three days of missed work unless your injury keeps you out of work for at least seven workdays.
- Workers' compensation claims generally remain open for six years from the date of the last payment you received. Claimants should hang onto the documentation about their injury.
Can Your Benefits Be Denied?
Yes. Like other insurance providers, those administering workers' compensation policies for Green Bay employers can deny coverage of benefits in certain instances and will investigate to prevent fraud.
Some of the reasons include:
- Your employer believes the accident that caused your injury was intentional or resulted from horseplay or fighting.
- Your employer does not believe the accident happened at work. Avoiding this accusation is the main reason for informing your supervisor immediately if you sustain an injury and establishing an early paper trail to prove the injury was work-related.
- Your employer believes that your accident resulted from impairment by drugs or alcohol. If you were impaired when the accident occurred, you may lose the right to all benefits except the provision of medical treatment.
- You did not receive medical treatment. If your injury was serious enough to result in missed work and wage loss, it is likely serious enough to require medical treatment. Failing to obtain medical treatment for an injury can result in the loss of workers’ compensation benefits.
Appealing a Green Bay Workers Compensation Denial
If your employer has denied your workers’ compensation benefits, you can request a hearing before the Workers’ Compensation Division of the Wisconsin Department of Workforce Development. You can request the forms for the hearing through the division, and when you have submitted these completed forms, your case will go to an administrative law judge.
If you do not have legal representation, the division will generally request that you attend an informal mediation with your employer and the employer's insurance provider. Suppose you cannot settle. In that case, the administrative law judge will preside over the hearing, where you must provide medical documentation and other evidence of how your injury occurred. If the administrative law judge denies your claim, you have 21 days from that denial to appeal your claim before the state Labor and Industry Review Commission. This appeal begins when you file a petition with the commission.
If you are still not satisfied with the outcome following your appeal, and there is a legitimate question of the law, you can appeal the decision through the Wisconsin circuit court. This option is only available for questions of the law, however, not for dissatisfaction with the outcome of your claim.
Employers can also appeal workers' compensation decisions if they feel you do not deserve the benefits the insurance company granted you.
Can You File a Personal Injury Lawsuit Instead of Seeking Workers Comp Benefits?
The provision of a workers’ compensation policy generally bars an employee from filing a personal injury lawsuit against an employer due to a workplace injury. However, there are a few circumstances in which the personal injury claims process is the right avenue to obtain compensation for a workplace injury, such as when the injury results from third-party negligence.
Third-party negligence means that someone else who is not your employer or coworker exhibited careless or reckless behavior that caused you to become injured on the job.
Examples of circumstances where this comes into play include:
- Transportation accidents caused by another roadway user while you were completing driving tasks related to your employment, such as being employed as a delivery driver and being injured in an accident caused by a distracted driver on the road.
- Construction accidents after a subcontractor or a worker from another company performing services at the same job site placed a hazard resulting in the accident.
What if the Employer Does Not Have a Workers Compensation Policy?
Many people believe that if state law requires your employer to provide you with a workers' compensation policy and does not, you can seek compensation through a personal injury claim. However, the Wisconsin Department of Workforce Development notes that the injured worker should file their claim to the Uninsured Employers Fund (UEF) in these circumstances. This statewide fund pays the valid claims of injured workers whose employers failed to obtain the required insurance. Penalties collected from employers who fail to comply with the workers' compensation requirement fund the UEF.
To file a claim with the UEF, you must complete a fund application and provide required documentation about your injury and employer. The claimant must also provide relevant documentation such as payroll checks, check stubs, bank records, tax statements, and other information that will assist fund administrators in determining whether the employer is liable for the injury. You must also document medical treatment, vocational services, and other expenses if they are related to the claim.
The Most Common Workplace Injuries Suffered in Green Bay
Nearly 60,000 workplace injuries took place in Wisconsin in one year. This means about 3.1 injuries per 100 full-time equivalent workers—much higher than the national average of 2.7. More than 1,700 of these injuries resulted in days missed from work, a transfer to another job to accommodate the injury, or restrictions placed on the duties the worker could perform.
Some of the most common workplace injuries include:
- Slips, trips, and falls due to wet, icy, or oily floors; unprotected sides or holes in flooring; or falling from ladders or roofs at construction sites.
- Exposure to harmful substances or fumes can result in chemical burns, inhalation burns, or even permanent illnesses due to toxic exposure.
- Fires and explosions occurring at the job site.
- Overexertion or muscle strains resulting from manually lifting heavy objects; improper lifting technique; repetitive motions; pushing, carrying, or throwing objects; typing or operating a mouse without using ergonomic products.
- Being struck by equipment or falling objects is one of the more common workplace injuries at construction sites. This type of workplace injury can result from poorly guarded machinery, falling tools or materials, heavy equipment, or bumping into an object or equipment.
- Crashes or collisions include workers falling from a vehicle, getting trapped beneath a rolled vehicle; being struck by objects falling from a vehicle; and transportation accidents involving workers employed as drivers.
- Injuries resulting from animal attacks or workplace violence.
How a Green Bay Workers Compensation Lawyer Can Help
If you experienced an injury in an accident, inform your supervisor and seek immediate medical treatment. If you have difficulties with your workers' compensation claim, the first thing to do is seek guidance from a Green Bay workers' compensation lawyer. Workers' compensation appeals are often challenging to understand, and a simple error can result in a loss of your right to appeal or seek benefits.
Our lawyers can tell you about the workers' compensation claims process, determine if you need to appeal a decision, and assist with other matters. For your free case evaluation, contact Nicolet Law Accident & Injury Lawyers online or call (920) 504-3655. Reach out to Nicolet Law Accident & Injury Lawyers today to get started.