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The worker's compensation program applies to anyone injured while at work. While the benefits under worker's comp overlap with social security benefits, in most states they involve more money. In worker's comp, there generally is no requirement that the disability continue for a full year, so benefits should commence immediately. For most injured persons, there should be no problem receiving worker's comp benefits at the beginning. Typically, medical bills should be paid in their entirety. The battle lines with worker's comp will be over the length and the extent of the benefits.
Under the Wisconsin worker's comp program, benefits are generally divided into two time periods: the temporary disability period and the permanent disability period. This classification assumes that the injured person will have some level of recovery. When the extent of that recovery has leveled off, the injured person has been said to have reached his or her "healing plateau." For injured persons with some prospect of returning to work, they will receive temporary total disability, "TTD", until they reach the healing plateau. TTD benefits are generally 2/3 of what a injured person was making at the time of the injury, without deduction for withholding or taxes.
The battle begins when the insurance company's doctor determines that the injured person has hit the healing plateau. At such point, TTD benefits stop and the injured person's benefits are transformed to permanent partial disability, "PPD". PPD is limited in duration and equals only about $150 per week, depending on the year of injury. The length of time that the PPD payments are received will depend on the size of the permanent disability rating. Permanent disability ratings for brain injuries, neck and back injuries, and certain other injuries, are expressed in terms of percentages of the "body of the whole." Both the injured person's doctor and the insurance companies doctor will rate the disability, in such percentage. In converting such percentage rating to dollars, the system assumes that 100% of disability, equals 1000 weeks. Thus, a 10% permanent disability rating equates to 100 weeks of PPD, so something around $15,000.
That is all the insurance company will tell you about permanent benefits. But with almost all seriously injured persons, there will be a much greater entitlement to benefits: the loss of earning capacity claim. The Wisconsin worker's comp system compensates for vocational loss which might exceed the strictly medical diagnosis. If the vocational experts determination of disability exceeds the physicians, the vocational experts opinion will control. A vocational expert is a counselor who rates the injured person's ability to earn a living in the work place. Even if the doctors rating is only 10%, if the vocational expert says that a injured person has lost 50% of his ability to earn a living, then the PPD rating is 50%. The extent of vocational rating is determined by comparing the injured person's earning ability before and after the accident. If the injured person was a truck driver making $30,000 a year before the accident, but now can only earn $10,000 a year, he has a 67% loss of earning capacity. Thus, such injured person would be entitled to PPD benefits for 667 weeks.
The system gets a little more confusing when either the vocational expert or the doctor determines that the disability percentage is 100%. A determination that a surivivor is permanently, totally disabled, does not provide for PPD (the $150 a week) for 1,000 weeks. Better. It provides the equivalent of the TTD benefit for life. As explained above TTD is 2/3 of previous earnings (usually higher than PPD). For example, if a injured person was earning $400 per week prior to the injury, TTD would be $267, instead of the $150 a week.
It is considerably more difficult to convince a worker's comp judge that a injured person is disabled, than it is with social security. Further, insurance companies face little or no penalty for cutting off benefits.
Worker's comp also provides benefits for vocational retraining, through cooperation with the State of Wisconsin department of vocational rehabilitation.
There is little question that a injured person with a claim for permanent disability needs an attorney to represent him. In Wisconsin, fees are done on a contingent basis, equal to 20% of the benefits that the attorney recovers for the injured person . The initial appointment to see a worker's comp attorney, in almost all cases, will be without charge.
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