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The Worker's Compensation Act provides for payment of reasonable medical expenses and compensation for lost wages resulting from work-related injuries or disabilities. These benefits are the responsibility of the self-insured employer or the employer's worker's compensation insurance carrier.
Important Note: If You Are Receiving BOTH Worker's Compensation Benefits And Social Security Disability Payments: An injured worker is required by law to notify the employer's worker's compensation insurance carrier (or self-insured employer) if receiving both worker's compensation benefits and Social Security Disability Payments.
You are entitled to worker's compensation benefits if you are injured on the job or became ill as a result of the job. You, your employer and the worker's compensation insurance carrier have various responsibilities for the work-related injury/illness.
In the event you are hurt at work or become ill, it is your responsibility to:
You should act to notify your employer and get medical attention without delay. A delay may negatively affect your health and may even jeopardize your potential worker's compensation benefits. Failure to report your injury/illness to your employer within two years could result in your claim for worker's compensation benefits being denied.
It is your employer's responsibility to report your injury/illness to its insurance carrier or claims administrator. The insurance carrier will then report your injury/illness to the Wisconsin Worker's Compensation Division.
The insurance carrier will pay for reasonable and necessary medical expenses. If your doctor authorizes you off of work for more than three days, you will receive compensation for lost wages.
If you are due compensation for your injury or illness:
Once your claim is established, it will usually remain open for six years from the date of injury or the last payment to you, whichever is later. Some claims may remain open longer. We recommend you save your medical and payment records for at least twelve years in the event your condition changes during this time.
Nearly all employees in Wisconsin are covered. In fact, when talking about worker's compensation, it is easier to discuss the exceptions.
The only employee exceptions to the Wisconsin Worker's Compensation Act insurance coverage requirement are:
Other exceptions from the Wisconsin Worker's Compensation Law include:
Regardless of how long an employee has been working for an employer, or whether or not he/she is in a probationary or training status, coverage for Workers Compensation purposes begins on the first day of work.
However, in order to expedite the processing of your claim, you should immediately report your injury or ailment to your supervisor.
It is your employer's responsibility to report your injury to their worker's compensation insurance carrier (or claims handling office).
In most cases, the first payment will be made by the insurance company within 14 days of your last day worked. If payment takes longer, you should contact your employer or their insurance carrier to find out the reason for delay.
There is a three-day waiting period. The first 3 days of lost time after the injury are not compensable. Compensation is payable beginning on your 4th day of lost time. If your disability extends beyond 7 calendar days, the 1st 3 days of lost time would be picked up and paid retroactively.
Basic benefits may include:
An employee reports a work related injury or illness to the employer as soon as possible after the accident, or after becoming aware of the injury. In most situations this report should be made within 30 days. However, the employee must report the injury to the employer within two years in order to qualify for worker's compensation. If, however, the employer knew or should have known about the injury, the statute of limitations for making a claim is six (6) years. In the case of occupational disease and certain traumatic injuries, there is no statute of limitations.
An employer is required to report all work injuries or illnesses to its worker's compensation insurance carrier within 7 days after actual knowledge of the injury. If the injury is a fatality, however, the report must be made to the insurance carrier within 24 hours. The employer must also report medical only claims to its insurance carrier.
Insurance carriers must electronically report all lost-time, compensable injury claims to the WC Division within 14 days after the date of injury. If the injury is a fatality, however, the employer must make this report--on paper--to the WC Division as well as the insurance carrier within 24 hours.
Within 30 days following the date of injury the insurance carrier must electronically report both the WKC-13 Supplemental Report and the WKC-13A Wage Information Supplement to the WC Division. The WKC-13 is a record of all payments (TTD, TPD, Salary Continued., PPD, etc.) made to the injured employee. If there is more than three weeks of lost time, an amputation, surgery or PPD a final medical report must also be reported (via fax or mail) to the WC Division.
The ALJ issues a decision within 90 days after the close of the record, which usually means 90 days after the hearing. The typical decision is issued in less than 50 days.
Within 21 days after the ALJ issues a decision either party may file a petition for review with LIRC.
Within 30 days after the LIRC decision either party may start an action in the circuit court of the county in which he or she resides.
Within 45 or 90 days depending on when the notice of entry of judgment is served, either party may appeal to the Court of Appeals.
Within 30 days after the Court of Appeals decision either party may file a petition for review with the Supreme Court.
Studies show that the longer workers are off work after an injury, the harder it is for them to return to work.
If you have been advised by the doctor to return to work, an attempt should be made to return to the job even if you may not feel 100% up to it. By returning to work as directed by your doctor, you will be in a stronger position to obtain additional benefits if you attempted to return than if you refused an offer of work.
Your doctor may advise you to return to lighter, restricted work during your healing period. This work is generally different from what you were doing before your injury. It often is to your advantage to return to work early within the limitations set by your doctor.
You can work with your employer and doctor to develop a customized plan for returning to work. An effective return to work plan should include:
There is no legal guarantee that a job will be available for you after an injury. The employer is not required to hold a position open or create a new position once you are released to return to work.
However, when suitable employment with your employer is available and within your physical and mental limitations, your employer should offer you the employment. If your employer, without reasonable cause, refuses to rehire you when suitable employment is available, you may be eligible for compensation of wages lost during the period of refusal, up to one year of wages.
You may file an application for a formal hearing for the compensation of lost wages if you believe that your employer did not have a good reason for not rehiring you.
Through the hearing process, a determination will be made on the availability of suitable employment. However, any written rules or policies issued by the employer and/or provisions of collective bargaining agreements with respect to seniority will impact the availability of suitable employment.
If your claim is denied, in full or in part, and you believe that you should receive benefits (or further benefits), your dispute may be handled through a formal hearing or through an informal alternative dispute resolution process.
If you have not retained an attorney, your claim will initially follow the informal process. Your claim will be referred to a specialist in the Divisions Alternative Dispute Resolution (ADR) Unit. The ADR staff will review your claim to determine the issues in dispute and assure that the medical information submitted supports your claim for benefits. If the ADR staff believes that the issues can be resolved without a formal hearing, you and the insurer will be contacted in an attempt to resolve your dispute.
If the issues cannot be resolved through the informal alternative dispute process, you may request a formal hearing with an Administrative Law Judge (ALJ). To request a hearing, you will need to complete an application for hearing form and provide medical information to support your claim. While it is not a requirement, many people believe that it is beneficial to have an attorney involved in the hearing since it is a legal proceeding.
As a legally binding procedure, the ALJ is required to obtain information from all parties during the hearing. The ALJ reviews all pertinent information related to the hearing and issues a decision based on his/her findings. This decision by the ALJ becomes a formal "order" to which the parties of the hearing must adhere. The order specifies the conditions under which the dispute will be resolved.
You may appeal a decision by an ALJ if you believe the decision was incorrect. Your appeal would be made to the Labor and Industry Review Commission (LIRC). Your case would be reviewed by LIRC and they will provide you with a decision. If you disagree with the decision from LIRC, you may appeal to circuit court.
If your injury/illness occurred on or after July 1, 1996 you may file a claim for worker's compensation benefits through the Uninsured Employers Fund (UEF).
The UEF pays worker's compensation benefits on valid worker's compensation claims filed by employees who are injured while working for illegally uninsured Wisconsin employers.
When a compensable claim is filed, the UEF pays the injured employee worker's compensation benefits as though the uninsured employer had been insured.
To file a claim, an injured worker must:
Your claim will be thoroughly investigated after it has been filed. In verifying the information submitted in support of your claim for compensation, the department or its agent may need to share information with other government agencies such as those responsible for tax collection, unemployment insurance, medical assistance, vocational rehabilitation, family support or general relief.
You will be notified of the status of your claim within 14 days after receiving your completed UEF claim application. The Worker's Compensation Division or its agent will:
The Division or its agent will notify you of the status of your claim at least once every 30 days from the date of the first notification that the claim is under review until the first indemnity payment is made or the claim is denied.
Funds for paying benefits from the UEF are obtained from penalties assessed against employers for illegally operating a business without worker's compensation insurance. The penalties are mandatory and non-negotiable. Additionally, uninsured employers are required to reimburse for benefit payments made by the UEF. The UEF uses aggressive collection action (including warrants, levies, garnishment and execution against property) to secure penalty assessments and reimbursement of benefits payments.
One of the bedrock principles of worker's compensation is universal coverage. That means that virtually every employee is covered. Therefore, virtually every employer has to have worker's compensation insurance. Specifically, the law defines the following as employers who must have worker's compensation insurance:
Universal coverage really means universal. Even out-of-state employers with employees working in Wisconsin must have a worker's compensation policy with an insurance company licensed to write worker's compensation insurance in Wisconsin. If an out-of-state employer has a worker's compensation insurance policy with an insurance company not licensed to write in Wisconsin, they must obtain a policy from a Wisconsin licensed insurance company.
Universal coverage also applies to those employers who are financially sound (and usually quite large) that are "self-insured". Being Self-insured means that the employer is not required to obtain worker's compensation insurance from an insurance company because they can bear the financial obligations of paying claims from their own internal resources. The Department of Workforce Development grants permission for employers to become self-insured.
The Wisconsin Compensation Rating Bureau (WCRB) has designed a worker's compensation insurance coverage lookup application to assist in the lookup of an employer's insurance carrier.
The Insurance Coverage Lookup provides a means for:
Wisconsin law requires most employers to provide workers' compensation insurance. The Coverage Lookup provides information for:
Employer and insurance carrier information is updated weekly.
The Coverage Lookup allows users to determine the insurance company that was covering the business on the date of an injury using the folllowin search criteria:
The Coverage Lookup can also be used to determine if an employer has a current Wisconsin worker's compensation insurance policy.
The Insurance Coverage Lookup is located on the WCRB web site and an insurance carrier name, address and telephone number is provided.