How Does Workers’ Compensation Payment Work?

After a work injury, trying to navigate the workers’ compensation process on your own can be overwhelming. The procedures and paperwork involved and the need for timely medical care and recovery can leave you feeling uncertain and stressed. However, understanding how workers’ compensation benefits work, what injuries are covered, and how the claims process unfolds can significantly ease this burden. By fully understanding how the entire process works, you can ensure that you receive the support and financial assistance you need to focus on your recovery and return to work as soon as possible.

At Spine and Joint Institute of Milwaukee, we are committed to making the workers’ compensation process as straightforward as possible, while our medical professionals help you recover from your work injuries. By carefully documenting your injury and treatment, you won’t need to worry about compiling medical records for your claim. Working with us allows you to concentrate on healing, knowing that we support you throughout the workers’ compensation claim process.

What is Workers’ Compensation?

Workers’ compensation is a state-mandated insurance program designed to protect employees injured or ill due to their job duties. Whether you sustain an injury in a workplace accident or develop a condition over time due to repetitive tasks, workers’ compensation provides financial and medical benefits to help you recover.

This system is intended to provide a “no-fault” safety net, meaning that employees do not need to prove their employer’s negligence or wrongdoing to receive benefits. Instead, the focus is on providing prompt care and compensation for your injury or illness. In exchange for these benefits, employees typically waive their right to sue the employer for workplace-related injuries, creating a streamlined process for obtaining medical care and financial support.

What Does Workers’ Compensation Cover for an Injured Employee?

Workers’ compensation provides comprehensive care for employees who suffer injuries or illnesses due to their jobs. It covers various costs associated with treating and recovering from a workplace injury or occupational disease, helping workers manage the financial and physical burdens that can arise from such incidents. Some key benefits that workers’ compensation typically covers include:

Medical Expenses

One of the most crucial aspects of workers’ compensation is the coverage for medical care related to your injury or illness. This can include a wide range of services necessary for your recovery, such as:

Doctor Visits: Any consultations with physicians, specialists, or other healthcare providers related to the injury.

Hospital Stays: If your injury requires hospitalization, workers’ compensation will cover the associated costs, including room charges, nursing care, and medical procedures.

Surgical Procedures: If your injury requires surgery, workers’ compensation will typically cover the costs of the procedure and any related expenses.

Medications: Prescription drugs, including pain medications and other medications related to your recovery, are often covered.

Rehabilitation Services: This includes physical therapy, chiropractic treatments, occupational therapy, and any other medical rehabilitation that may be necessary to regain full function.

Workers’ compensation ensures that the injured worker can access all the necessary medical care without having to worry about out-of-pocket costs or billing disputes.

Wage Replacement

When you’re injured and unable to work, workers’ compensation provides wage replacement benefits to help you maintain some financial stability during your recovery. These benefits typically amount to a percentage of your lost wages—usually around two-thirds of your average weekly earnings before the injury. The exact rate and calculation method may vary depending on the specifics of the injury and your state’s laws.

For example, if your injury causes you to miss work for an extended period, wage replacement benefits will help compensate for that loss of income, ensuring you can continue to meet your financial obligations while focusing on healing.

Disability Benefits

If your injury results in permanent damage or long-term impairment, workers’ compensation can provide disability benefits to help compensate for the lasting impact on your ability to work. These benefits are categorized into two types:

Temporary Disability: If you cannot work for a short period due to the injury, temporary disability benefits may replace a portion of your wages for the duration of your recovery.

Permanent Disability: In cases where an injury leads to permanent physical or mental impairments, permanent disability benefits are designed to compensate for the reduced earning capacity that results from the impairment. The benefits are calculated based on the severity of the disability and its impact on your ability to return to work or perform daily activities.

These disability benefits help ensure that injured workers aren’t left financially vulnerable due to the lasting effects of their injuries.

Rehabilitation

Recovery from a workplace injury or illness often requires more than just medical treatment—it can also involve rehabilitation services aimed at restoring function and helping you return to work. Workers’ compensation may cover:

Physical Therapy: Designed to help you regain strength, mobility, and range of motion after an injury.

Chiropractic Care: Some workers’ compensation programs will cover chiropractic treatments if necessary for recovery.

Vocational Rehabilitation: Vocational rehabilitation services may be provided if your injury prevents you from returning to your previous job. This can include retraining programs, career counseling, and job placement assistance to help you transition into a new line of work.

These services are intended to help you recover fully and, if possible, return to work in a role that aligns with your capabilities post-injury.

Psychological Counseling

Injuries, especially severe ones, can lead to emotional and psychological challenges. If your injury results in mental health issues—such as anxiety, depression, or post-traumatic stress disorder (PTSD)—workers’ compensation may cover the cost of psychological counseling or therapy. This ensures that you receive the necessary support for your mental and emotional well-being, which is just as important as physical recovery.

For example, if the physical pain of an injury leads to anxiety about returning to work or adjusting to a new routine, psychological counseling can be a vital part of your overall recovery plan.

Travel Expenses

If your injury requires ongoing medical treatment or physical therapy, workers’ compensation can also cover travel expenses related to medical appointments. This includes reimbursement for mileage, public transportation, or other reasonable travel costs incurred while seeking medical care for your work-related injury or illness. This helps reduce the financial strain of attending appointments, mainly if you must travel long distances to receive specialized care.

Who Pays for Workers’ Compensation?

In Wisconsin, employers are responsible for paying workers’ compensation premiums. These premiums are an insurance expense that businesses must pay to a workers’ compensation insurance carrier who then is responsible for managing the claims process and distributing benefits to injured workers.

Premiums vary depending on several factors, including the nature of the business, the industry risk level, and the employer’s claims history. The insurance carrier works with the employer to ensure that workers receive medical care, wage replacement, and other benefits they need following a work-related injury or illness.

How Does Workers’ Comp Pay You?

Once your workers’ compensation claim is approved, the payment process generally works as follows:

1. Wage Replacement: If you cannot work, the workers’ compensation insurance typically covers around two-thirds of your average weekly wages, which are tax-free.
2. Payment for Medical Care: Your medical expenses related to the injury will be covered, including hospital visits, surgeries, physical therapy, and rehabilitation services.
3. Disability Benefits: If your injury leads to permanent disability, you may qualify for permanent disability benefits, which help replace your lost earning capacity.

What Happens if Your Claim is Denied?

Sometimes, workers’ compensation claims are denied. If this happens, you have the right to appeal the decision. This can involve presenting additional medical evidence or attending a hearing before the workers’ compensation board. If your claim is initially denied, it’s crucial to consult a medical professional and a workers’ compensation attorney to ensure your case is adequately reviewed.

Special Considerations for Workers’ Compensation Claims

When filing a claim, there are a few key factors to keep in mind:

Document Everything: Keep detailed records of your injury, treatments, and any communications with your employer or insurance carrier.

Follow Treatment Plans: Comply with medical treatment recommendations to ensure your claim remains valid.

Understand Your Coverage: Review your employer’s workers’ compensation policy to know what’s covered and any steps you must follow.

What Happens if You Accept Workers’ Compensation?

When you accept workers’ compensation benefits after being injured on the job, you’re entering into a legal agreement that provides a clear path to receiving the necessary support for your recovery. However, you need to understand the implications of accepting these benefits, particularly the trade-off you make by waiving certain legal rights.

Waiving the Right to Sue Your Employer

One of the most significant consequences of accepting workers’ compensation is that you waive your right to sue your employer for negligence related to your injury or illness. This is a core feature of the workers’ compensation system and is known as the “exclusive remedy rule.”

Here’s what that means:

No Lawsuits for Negligence: By accepting workers’ compensation benefits, you forfeit the ability to file a lawsuit against your employer, even if the injury was caused by their negligence or unsafe working conditions. In other words, you cannot sue them for damages if your injury was caused by an unsafe workplace practice or an employer’s failure to provide adequate safety measures.

Benefits Instead of Legal Action: In return for giving up your right to sue, workers’ compensation provides a quicker, more efficient way to receive medical care, wage replacement, and disability benefits. Rather than going through lengthy and often expensive legal battles, you get access to benefits more immediately, allowing you to focus on healing.

While this might feel like a trade-off, it’s designed to protect employees and employers from personal injury lawsuits’ costs, delays, and complexities. The workers’ compensation system ensures that injured workers receive financial and medical support without needing to prove fault or go through prolonged litigation.

Benefits for Injured Employees

Injured employees can benefit from workers’ compensation in several critical and supportive ways, helping them recover physically, financially, and professionally. These benefits are designed to provide comprehensive support during the healing process and help employees return to work as quickly and safely as possible.

1. Medical Treatment. Workers’ compensation covers the cost of necessary medical treatment related to the injury. This includes hospital visits, surgery, physical therapy, diagnostic tests, medications, and ongoing medical care. Injured workers are entitled to receive care from healthcare providers approved by the workers’ compensation system, which may include specialists like orthopedic surgeons, physical therapists, chiropractors, and other medical professionals. For instance, at a specialized facility like the Spine and Joint Institute, employees may receive tailored treatments such as spinal adjustments, joint therapy, or advanced rehabilitation to help speed up recovery and improve mobility.

2. Wage Replacement. If an injury prevents you from working, workers’ compensation ensures you don’t lose all income during your recovery period. The compensation typically replaces a percentage of your average weekly wages, often around two-thirds of your pre-injury income. While this doesn’t fully replace your lost wages, it helps ensure you can still manage essential living expenses, reducing the financial stress that often accompanies time off work. This benefit continues for as long as you are unable to work, or until you reach a certain level of recovery, depending on the severity of the injury.

3. Rehabilitation and Retraining. In cases where the injury results in permanent impairment or changes to your ability to perform your previous job, workers’ compensation provides vocational rehabilitation services. This may include job retraining, education, or assistance finding a new role within your capabilities. Vocational programs can help employees learn new skills, earn certifications, or transition into different career paths that accommodate their physical limitations. This ensures that injured workers don’t just recover, but are also supported in regaining their independence and future earning potential.

4. Permanent Disability Benefits. For employees whose injuries result in permanent disability, workers’ compensation provides compensation to help cover the long-term impacts of the injury. The extent of the disability is evaluated, and based on this evaluation, a one-time settlement or ongoing monthly payments may be provided. This benefit can cover both physical impairments and any lost earning potential as a result of the injury.

5. Death Benefits. In tragic cases where an employee’s injury leads to death, workers’ compensation can provide benefits to the deceased worker’s surviving family members. This typically includes financial support for spouses, children, or other dependents, helping them cope with both the emotional and financial burdens of losing a loved one. The benefits may cover funeral costs, as well as ongoing financial assistance for the surviving family.

6. Psychological Support. Workers’ compensation can also cover mental health treatment if the injury leads to psychological conditions like depression, anxiety, or post-traumatic stress disorder (PTSD). Many workers experience emotional distress as a result of an injury, especially if it is severe or long-term. Access to counseling and therapy ensures that employees can recover not only physically but emotionally as well, improving their overall well-being and ability to return to the workforce.

7. Legal Representation. If there are disputes or difficulties in securing the benefits you’re entitled to, workers’ compensation provides access to legal assistance. Attorneys specializing in workers’ compensation law can help navigate the process, ensuring you receive the maximum benefits available, and represent you in cases of denied claims, appeals, or negotiations for settlements. This legal support helps protect your rights and ensures you aren’t taken advantage of by insurance companies or employers.

How to Make Sure You Get the Workers’ Compensation Benefits You Deserve After an Injury on the Job

To ensure that you’re receiving the full benefits from your workers’ compensation claim, follow these steps:

1. Notify Your Employer Immediately: Report your injury immediately to avoid delays in the process.
2. Seek Medical Attention: Get the necessary treatment, ideally through a provider familiar with workplace injuries, such as Spine and Joint Institute of Milwaukee.
3. File the Claim: Complete any required paperwork and submit it to your employer’s insurance provider.
4. Keep Records: Maintain copies of all medical records, treatments, and communications about your claim.
5. Consult an Expert: If your claim is denied or delayed, consult a workers’ compensation lawyer or contact Spine and Joint Institute of Milwaukee for guidance.

Work Injury Doctors Helping You Heal While Aiding Your Workers’ Compensation Claim

At Spine and Joint Institute of Milwaukee, we fully understand the challenges and frustrations injured workers face during their recovery. The workers’ compensation process can be complicated and overwhelming, but we are dedicated to guiding you through every step. Whether recovering from a sudden, acute injury or managing a long-term or chronic condition caused by repetitive work, we provide the comprehensive care and support you need to heal.

Our team is committed to delivering personalized medical treatment to help you recover fully and quickly. Beyond your physical recovery, we also assist you in navigating the complex workers’ compensation claims process, ensuring you understand your rights and receive the benefits you’re entitled to. From timely medical care to answering questions about your benefits, we aim to make your recovery journey as smooth and stress-free as possible.

Contact us today by submitting a form online or calling our office at 414-643-9000 to schedule an appointment.