Wisconsin's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers, sole proprietors and children working on family farms.
Exemptions from coverage may apply to certain employees, including employees of very small employers, employees of small farming operations, domestic servants and casual laborers.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including necessary medical care.
The employee may choose the initial treating physician. The employee may change doctors with the permission of the workers' compensation insurer or self-insured employer.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than seven days indemnity benefits become retroactive to the date of the injury. The seven days do not necessarily have to be consecutive.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's pre-injury wage, subject to a cap, and may continue for the duration of the temporary disability. Offsets may apply for Social Security benefits.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Wisconsin PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury wage, subject to a cap and may continue indefinitely. An offset may apply for Social Security disability benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Wisconsin PPD benefits are determined based on a statutory schedule or, for unscheduled injuries, based upon an assessment of the injured worker's functional impairment. Benefits are calculated based upon 2/3 of the worker's average weekly wage, subject to a cap. [If not weekly] Benefits for unscheduled injuries are payable for a maximum of 1,000 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Wisconsin, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable until the injured worker reaches maximum medical improvement.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on the deceased worker's annual salary, subject to a cap in amount. Benefits may continue for minors until the age of 18, and may continue past the age of majority if the dependent is disabled up to a maximum total period of fifteen years. Spousal benefits end upon remarriage, at which time any balance remaining on the spouse's benefit may be reassigned to the children. If a spouse dies before receiving the full benefit, the balance may be paid to the spouse's estate.
Attorney fees are capped at 20% of the disputed amount. If there is no dispute, fees are capped at 10% of the amount awarded up to a maximum of $250. Legal fees are subject to review by an administrative law judge with the Workers' Compensation Division.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Wisconsin Department of Workforce Development
Workers' Compensation Division
201 East Washington Avenue
P. O. Box 7901
Madison, WI 53707-7901