Workers’ Compensation
What is workers' compensation?
Workers' compensation is a state-mandated insurance program that provides compensation to employees who suffer job-related injuries and illnesses. While the federal government administers a workers' comp program for federal and certain other types of employees, each state has its own laws and programs for workers' compensation.
In general, an employee with a work-related illness or injury can get workers' compensation benefits regardless of who was at fault -- the employee, the employer, a coworker, a customer, or some other third party.
Work related injuries include:
- hearing and vision loss
- carpal tunnel
- toxic exposure
- accidents that occure off the work site (if you are performing services for your employer)
While you are off work, you may be eligible for two-thirds of your weekly gross pay and all medical expenses. The maximum amount changes yearly.
How long do I get benefits?
Typically you will receive benefits until your doctor says you are done healing. If your doctor states that your healing is sufficient for you to return to work, possibly with temporary restrictions and your employer cannot offer work within your temporary restrictions, benefits continue.
What happens if I have permanent restrictions?
If your doctor says your injury has caused permanent restrictions (like lifting, bending or standing), then you receive benefits on the amount of disability the doctor states.
Can I choose my own doctor?
Yes. Your employer can only send you to its doctor in an emergency. Thereafter you have the right to see any doctor. (In a dispute, the employer also can send you to its doctor for evaluation but not treatment.) You should consider choosing a doctor who specializes in your kind of injury.
What if I get hurt so badly I can't return to my job?
If your employer cannot take you back under your doctor's permanent restrictions, you may be entitled to a cash award or retraining benefits. If a Division of Vocational Rehabilitation counselor or vocational expert sets up classroom retraining, you can get paid weekly benefits.
Are benefits different if I have a limb injury versus a back or torso injury?
Yes. If you have an injury to your torso (back or neck, head or lungs) and you cannot return to your job, you may qualify for loss of earning capacity (future wage loss) benefits in addition to your permanent disability.
What if a work injury aggravates a prior non-work injury?
The employer takes you "as-is". You may be eligible for benefits for lost time, permanency and medical expense.
Can I sue my employer?
No, but you can sue some other person or company (machine manufacturer, truck driver, maintenance worker) if the person responsible for your injury is not an employee of your company.
What happens if the company does something unsafe?
While you could not sue your employer, your worker's compensation benefits may increase by 15%.
Do I lose my benefits if I'm hurt because I do something unsafe?
No, but your benefits may be reduced by 15%.
Can I get more benefits if the injury leaves a scar?
If your injury or the surgery leaves a scar on your hands, face or arms, you may be eligible for additional benefits.
Can I get worker's compensation and Social Security Disability at the same time?
Yes. There is a formula that entitles you to a specific amount of money monthly.
If I have hearing problems, what can I do?
After retirement, if your doctor says the noisy workplace caused your hearing loss, you may be eligible for benefits, including hearing aids.
I have a breathing problem; what should I do?
See a lung specialist. If your breathing problems were caused by work, you may be eligible for benefits, including claim for asbestosis, silicosis and lung cancer.
Can I be fired by my employer for filing a workers’ compensation claim?
No. Unless you violate a company policy unrelated to your injury, your job is protected while you are in the healing period.
Oh, my aching back; I can't work or lift anymore.
If you have been doing heavy work for many years, or if you hurt your back in a single accident, you may claim permanency, retraining and loss of earning capacity benefits.
What time limits are important in reporting an injury?
You should report any injury right away. Your claim is valid for twelve (12) years from your injury (or last benefits payment). There is generally no time limit for occupational disease (lung, back injuries, joint replacements, amputations, etc.).
When should I get a lawyer's help?
Whenever you face these problems:
Your doctor and the company doctor disagree.
- The insurance company asks you to give a statement.
- You cannot return to work because of your injury.
- You are asked to sign a settlement document.
- It is more than two weeks since your injury and you have no benefits.
- You are fired after your injury.
How much are lawyer fees?
Lawyer's fees are charged in worker's compensation ONLY if the claim is successful. By state statute, fees are fixed at 20% of the amount in dispute plus certain costs related to the case.
Who pays workers' compensation benefits?
In Wisconsin, employers are required to purchase insurance for their employees from a workers' compensation insurance company (also called an insurance carrier). In some states, however, very small companies (with fewer than three or four employees) are not required to carry workers' compensation insurance. In some states, larger employers who are clearly financially stable are allowed to act as their own workers' compensation insurance companies (also called self-insuring).
When a worker is injured, his or her claim is filed with the insurance company — or self-insuring employer — who pays medical and disability benefits according to a state-approved formula.
Are all on-the-job injuries covered by workers' compensation?
Workers' compensation covers most, but not all, on-the-job injuries. The workers' compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer's or employee's carelessness. But there are some limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving:
- self-inflicted injuries (including those caused by a person who starts a fight)
- injuries suffered while a worker was committing a serious crime
- injuries suffered while an employee was not on the job
- injuries suffered when an employee's conduct violated company policy
Does workers' compensation cover only injuries or does it also cover long-term problems and illnesses?
Your injury need not be caused by an accident — such as a fall from a ladder — to be covered by workers' compensation. Many workers receive compensation for injuries that are caused by overuse or misuse over a long period of time — for example, repetitive stress injuries such as carpal tunnel syndrome or back problems. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions — for example, heart conditions, lung disease, and stress-related digestive problems.
Do I have to be injured at my workplace to be covered by workers' compensation?
No. As long as your injury is job-related, it's covered. For example, you will be covered if you are injured while traveling on business, doing a work-related errand, or even attending a required business-related social function.
What kind of benefits will I receive?
The workers' compensation system provides replacement income, medical expenses, and sometimes vocational rehabilitation benefits — that is, on-the-job training, schooling, or job placement assistance. The benefits paid through workers' compensation, however, are almost always relatively modest.
If you become temporarily unable to work, you'll usually receive two-thirds of your average wage up to a fixed ceiling. But because these payments are tax-free, if you received decent wages prior to your injury, you'll fare reasonably well in most states. You will be eligible for these wage-loss replacement benefits as soon as you've lost a few days of work because of an injury or illness that is covered by workers' compensation.
If you become permanently unable to do the work you were doing prior to the injury, or unable to do any work at all, you may be eligible to receive long-term or lump-sum benefits. The amount of the payment will depend on the nature and extent of your injuries. If you anticipate a permanent work disability, contact your local workers' compensation office as soon as possible — these benefits are rather complex and may take a while to process.
What if my employer tells me not to file a workers' compensation claim or threatens to fire me if I do?
You should document the conversation and immediately contact an attorney to discuss options
 BACK TO THE TOP
|
