Settling a Wisconsin workers compensation claim is complicated and an injured worker should only do so knowing all the issues. This is not an exhaustive list, but here are seven basic topics a worker should be considering before signing away his or her workers comp rights.
Is the Claim Accepted or Denied
If a claim was originally paid, the insurance company will be more likely to offer a favorable settlement. When a claim is denied from the beginning, the insurer will heavily discount an offer if they make one at all.
Outstanding Medical Bills
If you have outstanding work-related medical bills, they should be included on a WKC-3 form with supporting itemized bills. Payment of past bills should be part of any negotiation closing out a claim. Likewise, if health insurance paid bills workers comp should have paid, the health insurer may be entitled to being paid back, something called subrogation.
If a treating physician states there is a permanent injury as a result of the work-related injury or condition, and assigns a permanent partial disability percentage, there should be a payment of PPD benefits over a period of weeks or years a applicable.
Scheduled or Nonscheduled
If an injury is to a scheduled body part like a knee or shoulder, the PPD benefits are fairly straightforward and often a compromise between the range given by the treating doctor and the IME doctor. In unscheduled cases, such as a back or head injury, the issue is much more complicated and involves multiple factors the insurer is not going to consider unless forced to by an experienced workers compensation attorney.
If a permanent injury includes permanent work restrictions or limitations from an unscheduled injury prevent a return to work or cause a significant loss of earning ability, there may a higher level of benefits called loss of earning capacity benefits and/or vocational retraining benefits. But again, the workers compensation adjuster will almost never tell an injured worker about such benefits. It is up to the injured worker to figure it out.
If a worker is on or likely to become eligible for Medicare in the near future, the claim usually cannot settle where future workers compensation coverage is closed out. This is because Medicare does not want to cover work injury related treatment. Any case with potential Medicare issues must be settled very carefully to insure the injured worker has some future medical coverage available. Also, in Wisconsin we are a reverse offset state, meaning that workers compensation benefits may be offset to a degree by SSD benefits but SSD benefits are not offset by workers compensation benefits.
Hearing or Settlement
Under workers compensation law, there is no entitlement to a lump sum for future PPD or loss of earning capacity benefits. If a case goes through a successful hearing and order, the future benefits will be paid in monthly increments. Past or accrued benefits are paid in a lump sum. In a settlement, a lump sum for all contested benefits is generally paid by the insurance company in a lump sum, however, the Workers Compensation Department judge will usually require unaccrued or future benefits be put into a restricted bank account. You can withdraw a monthly amount and the account is owned by you and part of your estate.
McCormick Law Office in Milwaukee, Wisconsin.