You are entitled to all reasonable and necessary medical expenses “to cure and relieve from the effects of the injury.” Sec. 102.42(1) Wis. Stats. This includes:
- Medical treatment
- Chiropractic treatment
- Psychological treatment
- Podiatric treatment (foot problems)
- Dental treatment
- Supplies such as crutches, appliances, artificial members, and training in the use of such supplies.
Note: This list is not exhaustive. If you have questions about whether certain types of treatment are covered under Worker’s Compensation, contact us. Acupuncture, for example, generally is not covered.
You can choose your own doctor. You also get a second choice, but no third choice, and there are limitations on out-of-state treatment. However, multiple doctors within a clinic constitute “one” choice, and if your doctor refers you to another doctor outside your doctor’s clinic, that referral does not count as a choice. So the Wisconsin rule about where you can get treatment for a work injury is fairly liberal.
Medical expenses include maintenance treatment and necessary follow-up care: You may be entitled to medical treatment after you have reached your end of healing (also known as maximum medical improvement or plateau of healing), if your doctor states you that you need ongoing treatment to deal with the effects of your work injury.
Beware: Worker’s compensation carriers often fail to pay for such ongoing treatment. Carriers often believe that end of healing means they have no obligation to pay for any further medical treatment. (They equate end of healing with end of treatment.)
Example: We represented a woman who had badly fractured her ankle at work. The surgeon had to install plates and screws in order to repair the complex fractures in her ankle. Her employer and its worker’s compensation carrier conceded her injury was work-related and paid for the surgery and other treatment expenses and for her time off work.
She returned to work and all seemed fine initially. However, within a few years, she began having increasing pain in that ankle. Her surgeon thought that removing some of the hardware would relieve her pain. The worker’s compensation carrier refused to pay for the proposed surgery and for the time she would be off work to recover from that second surgery because it “had closed the file.” The carrier continued to refuse even after the surgeon explained that the need to remove some of the hardware was a direct result of her initial injury, which the carrier had conceded.
We filed an application for hearing on behalf of the injured worker. As a result of our efforts, the worker’s compensation carrier had to pay for the proposed surgery and our client’s time off work to recover. The carrier also paid a sizeable penalty for its bad faith in denying the claim because we could demonstrate that the carrier had no reasonable basis for its refusal.
Please contact us if your employer’s worker’s compensation carrier is not paying for medical expenses your doctor finds necessary during your healing period and after you have reached your end of healing. We can help you obtain the treatment your doctor finds you need as the result of your work injury.