INJURED AT WORK!
 NOW WHAT?
 Find answers to FAQ below

ROBISON LAW, LLC                                                   
Wisconsin Workers Compensation Lawyer
Representing Injured Workers in Wisconsin
 




1. Were you told "You don't need an attorney. We can work this out on our own."  
    
This should be a red flag for any injured worker. Your employer and its workers compensation insurance company are not required to inform you of your legal rights. By calling a workers compensation attorney, you may discover you are entitled to a lot more than you are being offered.

2.  Were you taken to the hospital in an ambulance? 

   When an ambulance is called for a work injury, a report is filed with OSHA. OSHA and the police will then conduct an investigation. Your employer may not want this. 

    If you or another employee are seriously injured at work, insist that an ambulance be called immediately.  The paramedics are interested in saving your life and limb. Your employer may have other interests. 
 
3. What is Occupational Health anyway?

  
    My experiences with occupational health doctors is usually not good. Some record vague histories of the injuries, making it hard to document a claim. Some refer to injured workers who do not improve after a treatment as "malingers," meaning someone who is faking an injury to get money from a workers' compensation case. Most workers I know would rather have their health and be free of pain, rather than have any workers' compensation money.
    
Far too often, the occupational health doctor will give an injured worker a clean bill of health even if he or she is still in pain. Remember, the occupational health doctor may be serving the employers and not the injured worker. In fact, several websites for occupational health doctors boast that they are serving the employers of their community.

My advice: Beware of Occupational Health! Don't visit the doctor that your employer recommends or has a contract with. Find your own. If possible, try see a doctor in sports medicine, orthopedics, or neurology.

4.  Was there a sufficient report of your injury made?

    Do not rely on your company to make a detailed or accurate account of how your injury occurred. Your employer may have an interest in not reporting your accident.  When you make a claim, the risk rating of the employer goes up, and so do the company's workers compensation premiums.  One has to wonder why the premiums are so high when the workers' compensation insurers seldom pay out what is owed . . .
   
    After a work place injury, take every step possible to accurately describe how the accident happened. Write it down, make a recording, send your employer an email of the account and also copy that email to yourself.  Preserve all written documentation.  If you believe that your injury involved a defective machine or an unsafe employment practice you should call OSHA. Always obtain copies of forms that you fill out for your employer. Always read them to be sure that they are accurate. Do not let your employer coerce you into saying something or signing a document that is not true or accurate. 
    
    And remember, right up there with "You don't need an attorney," is "You don't need to make a comp claim, we will take care of you; trust us, we are a corporation."  If your employer refuses to make the claim for you, call me and I will.

5. My employer promised me that he would take care of me, and that I didn't need to report my injury to workers compensation? Should I fill out a report anyway?

    Let's take an example of a 50 year old man who worked at a company for 14 years and injured his back at work. He trusted his employer and thought he had a good relationship with them. The employer convinced the worker not to file a claim or hire an attorney, and promised that they would pay for his back surgery and time off of work, and that he should not worry because he would always have a job.  The worker did not report the injury as being work related to his physicians and the employer did not report it to its workers' compensation carrier. 

    After the back surgery, the worker was given permanent restrictions that prevented him from returning to his job. As promised, his employer fired him. You can only imagine what a mess this would cause a workers' compensation attorney. Take my advice, always report your injury to your employer, and ask for a copy of the documents.  If your employer will not give you the documents, or if you are injured at work and your medical bills are not being paid by workers' compensation, do yourself a favor and call an attorney immediately. Let the attorney straighten it out.

6. Do I need an attorney?

    You would have to be an exceptionally talented person to take on a trained attorney hired by the insurance company. The insurance company's attorney went to law school and knows the rules and loopholes inside and out. The insurance company's attorney is typically very smart, and is being paid a very good amount of money to make sure you lose. Ask yourself this question - "How many workers' compensation cases have you tried? Is this your first? Do you think it's the insurance company's attorney's first hearing?

    Attorneys in Wisconsin who often represent injured workers (applicants - people who are applying for a hearing) can be very useful to you in these situations. I was personally trained by an excellent trial attorney from Wisconsin, Tom Fitzpatrick, and I have been to the rodeo many times on behalf of injured workers. In Wisconsin, applicant's attorneys can only charge a maximum of 20% on disputed benefits, 10% if benefits are not disputed - but that requires substantial work on behalf of the attorney to obtain for the injured worker, or a $250.00 fee in case of non-disputed benefits and a small amount of work. Attorneys also can charge for the costs of medical and hospital billing records. 

    Remember, your attorney's fees will be scrutinized by an administrative law judge to make sure that your fees are fair, and that the attorney can prove the incurred costs that he or she is charging.  One of the leading experts on workers' compensation in Wisconsin, Attorney Joe Danas (in my experience, he represents insurance companies and employers such as Walmart), states in his book that applicant's who hire attorneys receive 25% more benefits than those that do not.  If you are not represented, don't count on your employer or the workers' compensation carrier to tell you what benefits you deserve. 
     
  Would you attempt to diagnosis your own medical condition, and perform surgery on yourself?  It could save you some money . . . Even if you did not like doctors, you wouldn't perform back surgery on yourself. As an attorney, I have stepped into cases where someone decided to go it alone, but it did not work out so well for the applicant.  Think twice about being your own attorney.

    My initial consultation is free. The most I can charge by law is 20% and costs. I only recover if you win or receive a settlement.  I have fought successfully for benefits for applicants ranging from hundreds of dollars up to hundreds of thousands of dollars.  All claims and questions of injured workers are worth my time.

7.    I am scheduled to see a doctor hired by the insurance company, what is going to happen?

    Insurance companies hire doctors, Independent Medical Examiners, or IMEs, as part of the process of reviewing your claim and looking for a way to deny it.  The IME doctor is paid a good amount by the insurance company, so before you go there you can guess whose side the IME is on. The IME is not your doctor, and if you relied on his or her advice and died from it, the IME could not be sued for malpractice - that is the law in Wisconsin.  

    In fact, nobody but you and the IME will ever really know what took place inside the examining room. Why? Because, the IME works in secret, and will not allow you to have anyone with you but your doctor. I have had many clients who stated that the IME doctor never touched them, but then the IME doctor filled out a report stating that he did many tests to prove that the patient was faking the injury.  Do not trust the IME, document the visit thoroughly immediately, take notes during the exam if you have to. 

    We had a trial years ago where the IME worked three days a week doing exams and writing reports for insurance companies and he made over $90,000.00 a year. Just about all the cases he reviewed said the exact same thing; pre-existing injury, not work related. I can name several IME doctors in Wisconsin who own airplanes,fly to the different insurance company appointments around Wisconsin, and make hundred of thousands of dollars selling out injured workers for insurance companies.
 
    If your case survived the occupational health doctor, it probably will not survive the IME.  Most of IME doctors I hate. I have little regard for them as people, since I cannot stand people that will sell out others to get rich. It is unethical, but it is legal; thank your congress for that. The IME will do whatever needs to be done to put the final dagger into your case. 

8.    The workers compensation carrier denied, or stopped paying my benefits, what should I do?

    The most common reasons that your workers compensation insurer will deny or stop paying your benefits are: (1) you saw an IME and he or she sold you out; (2) your doctor said the injury was not work related; (3) your doctor, or the IME, said that you do not need any more medical treatment, that you reached an end of healing and should go back to work; (4)  the insurer stopped paying, but does not have a good reason; I call this the "We don't want to pay you" defense.
    Of those four, number (1) is the most common reason why your benefits stop, and number (4) is the least common. Most insurance companies play by the rules - they will hire an IME, he or she will write a report saying your injury is not work related, and they either won't pay you, or they will stop paying you.     
     I have had several "We don't want to pay you" cases. In this situation, the client received a letter that said the insurance company did not think the injury happened at work, but the insurance company did not have any documentation to support the denial.  Other times, without any legal reason, a letter might come in the mail and state that payment is stopping. Normally, after the lawyer calls the insurance company adjuster, the adjuster or the insurance company's attorney, states that there was a "misunderstanding" and benefits resume. 
    If any of the four above happen, call an attorney and find out what your rights are. You have the choice of two treating physicians; one doctor might think an injury is work related, while another does not. After a formal denial of benefits by an insurance company, you will probably have to file for a hearing if you want more benefits.

9.    What happens at a workers' compensation hearing?

    A workers' compensation hearing is not like what you see on Law and Order.  Most hearings do not take place in courtrooms, but in rooms in municipal buildings. You do not get a jury. The person who tries your case is an administrative law judge, or ALJ.  You do not get to pick the judge, and you cannot substitute on the judge.  ALJ's are hired for their skill in workers compensation law, they are attorneys who practiced in the field of workers compensation and who took examinations to become judges. They are very skilled and knowledgeable about work injury cases. I have never left a hearing feeling cheated or treated unfairly.
    At a workers compensation hearing you will be placed under oath to testify and you or your attorney can call witnesses.  Your doctor does not have to testify,if he or she fills out a form on your behalf and the report is filed with the department. The insurance company will ask you questions, they will also question your witnesses, and the insurance company may have witnesses of its own. The ALJ may even ask questions of any witness. All testimony is transcribed by a court reporter, and the record is preserved for the future. 
    Most cases do not go to a hearing since about 90% of all workers compensation cases settle out of court, sometimes even minutes before the hearing.

10.    How long will it take me to get a hearing?
    
    That is a really good question, after all of the paperwork is completed, the wait is supposed to be from 2 to 6 months. This is normally not the reality.  Back when I used to work in LaCrosse in 2006 the wait was about 8 to 14 months. The most aggravating part of the my job, and the most frustrating thing for an injured worker who was denied benefits and medical treatment - and who is usually jobless and broke by the time the hearing arrives, is waiting for a hearing.
    
    In La Crosse, I had enough of watching my clients suffer. A group of attorneys urged our clients to contact their representatives, and let them know just how bad the impact was for the wait time.  In response to the complaints, the department issued what is called a Certificate of Readiness (COR), a form that was meant to reduce the wait time. However, with budget cuts, wait times, are once again on the rise.
    
    Even worse, the attorneys for the insurance companies got together and cried "no fair." Now the insurance company's can file objections to CORs, and cause further delay to your hearing.  Although the COR started off with good intentions, it is steadily becoming a vestigial piece of paperwork.  That is what the insurance companies want. So long as you have no income or cannot afford medical care, the insurance company has the upper hand, and can literally starve you into taking a low ball settlement. Delay favors the insurance company.
    
    If you are in this situation, call me, we will pick a day to go see your local representative and let him or her know just how much you are suffering waiting for your hearing. I urge every injured worker who has not received a hearing after 6 months to call their representative and demand justice.

11. I won or settled my case, when do I get paid?

    After you win or settle your case, expect about 60 to 90 days for payment.  After a hearing, an ALJ has to issue a written order, by law, they have up to 90 days.  Most ALJs will have the order written in about 20 to 40 days after your hearing. Based on their work loads, that is completely understandable. Expect 20 days after the order is issued for your check to arrive to you from the insurance company.
 
    If you settle a case, expect the final settlement paperwork to be finished within two weeks.  After the parties circulate and sign the agreement, possibly another week, the signed agreement goes to an ALJ for his or her approval.  The judge will read the agreement, and if the ALJ deems it is in the workers interest, the judge will produce a written order approving the settlement for payment. Once again, that normally takes 20 to 40 days, and 20 days after that for the insurance company to pay. 
    
12.    I lost my case, what happens now?

    If you lost and either you or your attorney believe that the ALJ did not have all of the facts or the law right, you can file an appeal.  Your first line of appeal is to the Labor and Industry Review Commission (LIRC). Judges at the LIRC will review the record from your case, and your arguments.  Afterward, the LIRC judges will write an opinion. If they agree with you, you may have another shot at a hearing; or you could win.  If they disagree with you, you lose. However, you have an another chance to appeal the case to the Judicial branch (circuit courts) of government, all the way up to the State Supreme Court if necessary. Keep in mind, if you win, the other side has the same rights of appeal. 

13.    What is my case worth?

    This is a difficult question to answer, and is very fact specific. Without sitting down with you and going over your wage earning history, age, work history, education, degree of injury, type of injury, date of injury, circumstances and causes of your injury, and medical treatment; there is almost no way of giving you a good answer. In fact, many clients see improvements months after good medical treatment, and go back to work.  Giving you an understanding of what your case might be potentially worth is just one part of the free consultation that I provide.  It is usually best to come to my office and be prepared to answer these questions and provide documentation.