I have just been hurt at work. What do I do?
Report your injury to your employer and get medical care immediately. When you report your injury, be sure you do all of the following:
- Report it to your supervisor or another person charged with receiving reports of injury from employees. Do NOT just tell a co-worker. You must report your injury to a person in authority.
- Give your employer a complete and accurate account of what happened.
- If you have had prior problems of a similar nature, do not deny them. Denying previous problems can damage your credibility and weaken your case. Since Wisconsin law says your employer takes you “as is,” prior similar problems do not necessarily hurt your case.
When you go to get medical care, be sure you do all of the following:
- Give the doctor a complete and accurate account of what happened.
- If your job duties have been causing you pain and problems (dysfunction) in a particular area (back, knees, hips, shoulders, etc.), explain to your doctor what physical movements hurt that part of your body, when and how often you do them in your job, how long you have been doing that job, and when your problems began.
- Again: if you have had prior problems of a similar nature, do not deny them. Denying previous problems can damage your credibility and weaken your case. Since Wisconsin law says your employer takes you “as is,” prior similar problems usually do not hurt your case.
How much does the worker’s compensation carrier have to pay me for my time off work?
During the time you are healing from your work injury and your doctor has taken you off work entirely, the carrier pays you two-thirds of your average weekly wage.
This is called the temporary total disability or TTD rate.
Example: If your average weekly wage is $900, your temporary total disability rate is two-thirds of that: $600 per week. So for each week your doctor has you off work entirely, you are entitled to $600 in worker’s compensation benefits.
If my doctor says I can go back to work part-time, how much does the worker’s compensation carrier have to pay me for the wages I lose?
The worker’s compensation carrier pays you a proportion of your lost wages at the temporary partial disability or TPD rate.
Example: Assume that your average weekly wage is $900 per week; therefore, your temporary total disability rate is $600 per week. If you go back to work half-time, your employer pays you your regular wage for the 50% you work ($450 minus regular deductions), and the worker’s compensation carrier pays you 50% of the temporary total disability rate of $600: $300.
The worker’s compensation carrier wants to take a statement from me. Should I do this?
You are not required to give a statement to the worker’s compensation carrier. Remember that the main aim of the insurance company is to either deny your claim entirely or limit it as much as possible.
We strongly recommend that you contact us to discuss your case before you decide to give the worker’s compensation carrier a statement. We do not often recommend it.
The worker’s compensation carrier has been paying for my time off work and my medical treatment, and now they are telling me I have to go see a doctor they have chosen. Can I refuse?
No, not if you want to continue receiving worker’s compensation benefits or to make a claim for worker’s compensation benefits. The law allows the worker’s compensation carrier to schedule a reasonable medical evaluation by a doctor of its choosing, and you are required to attend. They call these evaluations “independent medical evaluations,” but we call them “defense medical evaluations” as there is nothing “independent” about them. These are doctors selected by and paid for by the worker’s compensation carrier. Remember this when you attend the examination.
The carrier must meet various requirements. See Defense Medical Examination for details. One of these is that it must pay your mileage (at the reimbursement rate in effect at the time of the appointment, currently 51 cents per mile) in advance.
If you do not attend the defense medical evaluation, the worker’s compensation carrier can stop your worker’s compensation benefits until you attend their evaluation.
If the worker’s compensation carrier has set up such an appointment, we highly recommend that you contact us to discuss your case before you go.
I had back problems before my back injury at work. Should I mention this when I go to get treatment for my work injury?
Yes. Your treatment providers need all relevant information in order to evaluate and treat you in the most appropriate manner. The fact that you have had prior problems of a similar nature – known as a “pre-existing condition” – does not necessarily mean that you are not entitled to worker’s compensation benefits. If your work injury aggravated your pre-existing condition beyond its normal progression (made it worse than it otherwise would have become), you may well be entitled to worker’s compensation benefits. Wisconsin Worker’s Compensation law says that the employer “takes the employee as the employer finds him/her.” This means, in this example, that if you have a pre-existing back problem when you start work, you may more easily hurt your back at work than will a co-employee who starts work with a fully-healthy back. A propensity for injury does not qualify as a defense for your employer or its insurance carrier.
Warning: If you have a history of pre-existing problems and treatment, but fail to acknowledge that history, you may reduce your credibility and make it harder to win your case. In other words, if at hearing the judge concludes that you hid relevant information from your doctors – or from the doctor the defense hired to examine you – (essentially that you lied to your doctors or to the workers’ compensation carrier), the judge may decide not to believe your testimony on other points as well.
My back just keeps getting sorer and sorer, and now I cannot do the lifting I am expected to do for my job. My doctor has taken me off work and is sending me to physical therapy. I did not have a specific injury at work or anyplace else, but I do a lot of lifting, bending, and twisting at work. Can I get worker’s compensation benefits?
If your doctor believes that your work contributed to your back problems to the required extent (the work was a “material contributory cause” or a “material contributory causative factor”), then you may have a claim for worker’s compensation benefits. These injuries are known as occupational injuries or “wear and tear” injuries. We believe wear and tear injuries are underreported because many employees don’t understand that such injuries can support legitimate claims for worker’s compensation. Contact us for a free evaluation of your circumstances.
What if I had back problems off and on before I even began my job?
Be sure your doctor understands how your prior back problems differ from your current back problems. Here are some examples:
- If you had back problems only intermittently (“off and on”) before, but now you have back pain that is continuous, tell your doctor.
- If your prior back pain was different in quality, location or intensity compared to your current back pain, be sure your doctor understands that.
- If your prior back problems never (or rarely) caused you to lose time from work, but your current back problems are sufficiently severe and ongoing that your doctor has taken you off work entirely or has you on severe work restrictions, be sure your doctor understands how much worse your current problems are.
My doctor says I have “healed” from my work injury, but I have permanent partial disability (PPD) and permanent work restrictions. The worker’s compensation carrier says I am fine and can return to my regular job. The carrier has closed my case. What should I do?
This is a good time to contact us. If the permanent work restrictions your doctor has given you prevent you from doing your normal work and your employer is not offering you a job within your doctor’s permanent work restrictions, you may have a claim for retraining or, in the case of back injuries and other injuries to the torso and head, you may have a claim for loss of earning capacity. In some cases, you may have both claims.
Also, if for any reason, including the opinion of its own doctor, the carrier refuses to pay the amount due you for the functional permanent disability (PPD) your doctor has assessed, you can have a judge decide whether you are entitled to the PPD your doctor has rated. It is in your best interest to hire a lawyer knowledgeable in work injury claims to represent you when you have a serious dispute with the worker’s compensation carrier. The carrier will have a lawyer and we recommend that you do as well. Contact us to discuss your case.
I have had two knee surgeries, and although my pain is better than it was before, I have a limp that my doctor says I am stuck with for the rest of my life. What can I do?
As a result of the ruling in a case we took to the Wisconsin Supreme Court, you may now receive a cash award for a significant limp as such limps now qualify as compensable disfigurements. Previously, disfigurement claims were traditionally limited to burns, other scars, and amputations.
The amount of money you receive for your limp depends on the severity of your limp and how it may affect your employment. Sometimes these cases are settled, and sometimes they go to a hearing where an administrative law judge decides the amount of the award for the disfiguring limp.
The worker’s compensation carrier has assigned a nurse to go with me to all of my medical appointments. The nurse comes into the appointments with me, and I do not get much opportunity to talk with my doctor. Can I tell the nurse to stay out of my appointments with my doctor?
Yes, you can, and you should. The carrier can hire a nurse, sometimes called a nurse case manager, to communicate with your doctor, but you do NOT have to let the nurse come into your appointments.
Some nurses are persistent and will try to convince you they are there to help you. But make no mistake about it: these nurse case managers are paid by workers’ compensation carriers, and they report to the carriers. They are not working for you, no matter how much they try to convince you they are.
The worker’s compensation carrier wants me to sign medical authorizations to get my medical records. Must I do this?
Technically no, but many times signing the authorizations works for the best. If you have questions about medical authorizations (or about authorizations for the release of other records), please contact us.
I have to travel some distance to see my doctors and my physical therapist. Do I receive any money for gas for those trips?
Yes. You are entitled to reimbursement for your mileage to and from all appointments related to your work injury. It does not matter how near or how far. The current reimbursement rate is 51 cents per mile.
Do I get mileage reimbursement for trips to the pharmacy to fill prescriptions for my work injury?
Yes. However, if you visit the clinic or the hospital for evaluation or treatment of your work injury and you fill your prescription at the clinic or hospital pharmacy while you are there (so there is no separate trip to fill the prescription), you receive mileage reimbursement for just the one roundtrip.
The worker’s compensation carrier has offered me some money to settle my case, but I have to sign some paperwork I don’t really understand. What should I do?
You should not sign any paperwork you do not understand. We strongly recommend that you contact us for a consultation before you accept any type of settlement or sign any paperwork. You may be giving up substantial benefits including benefits you have no idea you have.
Worker’s compensation carriers like to settle claims early and for relatively small amounts of money. We can help you understand what the proposed settlement means. If it says it is “full and final,” it means you are giving up all claims for further benefits. You definitely should get legal advice before you do this. Please contact us.