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Worker's Compensation for Workers

Overview

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.

FAQs

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.

As a Worker you are Responsible to:

In the event you are hurt at work or become ill, it is your responsibility to:

  • Tell your supervisor that you are hurt immediately, even if you think your injury is minor and will heal without medical attention.
  • Obtain any necessary medical attention. This may include first aid, seeing a doctor or going to the emergency room.
  • Maintain all relevant medical and payment records for possible future use.

Don't Delay

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.

Your Employer's Responsibility & the Insurance Carrier's Responsibility

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:

  • You should receive a check from your employer's insurance carrier (some large employers are self-insured) generally within 14 days after your injury/illness.
  • There is a three-day waiting period for compensation that includes Saturday and may include Sunday, if you normally work on Sunday. No compensation is paid for these first three days unless you are off work for more than seven days. In that case, the first three days are paid for retroactively.

Established Claim

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.

Exceptions to the Wisconsin Worker's Compensation

The only employee exceptions to the Wisconsin Worker's Compensation Act insurance coverage requirement are:

  • domestic servants
  • some farm employees
  • volunteers including volunteers of non-profit organizations that receive money or other things of value totaling not more than $10.00 per week
  • religious sect members that qualify and are certified

Exceptions Covered by Other Worker's Compensation Law

Other exceptions from the Wisconsin Worker's Compensation Law include:

  • Employees of the federal government such as postal workers, employees at a veterans administration hospital , or members of the armed forces are covered by federal workers' compensation laws
  • People who work on interstate railroads are covered by the Federal Employers Liability Act
  • Seamen on navigable waters are covered by the Merchant Marine Act of 1920, and people loading and unloading vessels are covered by the Longshoremen's and Harbor Worker's Compensation Act.

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:

  • Coverage of all reasonable and necessary medical expenses.
  • Benefits for temporary wage loss during the healing period - temporary partial disability (TPD) or temporary total disability (TTD) are provided to sustain an employee while recovering from an injury. Eligibility for temporary disability benefits is determined and must be documented by a doctor. Benefits for TTD due to disability are based on two-thirds of the employee's wage up to a specified maximum amount for the year of injury.
  • Benefits for permanent partial disability (PPD) or permanent total disability (PTD) are paid if the employee does not fully recover from the injury. Permanent disability is awarded for the potential or actual loss of earning capacity. The amount of benefit payment for permanent disability depends on the severity of the permanent disability.
  • Vocational rehabilitation and retraining.
  • If a death occurs, death benefits and burial expense will be paid to qualified beneficiaries up to specified limits.
  1. Report of Injury by the Employee

    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.

  2. Report of Injury to the Worker's Compensation Insurance Carrier

    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.

  3. Report of Injury to the WC Division

    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.

  4. Payment and Other Related Information Reported to the WC Division

    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.

  1. Injured Worker Files Application for a Hearing
    An injured worker has six years from the date of injury or the date of last compensation payment to file with the WC Division an application for a formal hearing before an Administrative Law Judge (ALJ). Litigated claims whereby the applicant is not represented by an attorney (pro se) are identified by Dispute Resolution Section (DRS) and an attempt is made to avoid a formal hearing through informal mediation. If a formal hearing cannot be avoided, DRS staff ensures the file is complete and ready for hearing. A pre-hearing conference with an ALJ will also be held for certain pro se claims, in order to narrow the issues and explain the hearing process.
  2. Hearings are Scheduled
    Applications for hearing are normally assigned to an ALJ on a first-in, first-out basis. Hearings are generally held near the municipality of the applicant's residence. Once assigned, all parties involved in the case are notified in writing of the date, time and location of the hearing.
  3. Formal WC Hearing Held
    The ALJ hears evidence presented by both the respondent and claimant at one or more hearings. Most disputes are resolved with one hearing. About 80% of hearing requests are settled without a formal hearing actually being held. Many of these are compromised or stipulated.
  4. Decision Rendered

    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.

  5. Appeal to Labor Industry Review Commission (LIRC)

    Within 21 days after the ALJ issues a decision either party may file a petition for review with LIRC.

  6. Appeal to Circuit Court

    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.

  7. Court of Appeals

    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.

  8. Wisconsin Supreme Court

    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:

  • An on-going relationship among the worker, employer and the doctor to ensure that all parties are familiar with the nature and extent of the injury/illness as well as worker’s compensation rules.
  • Reasonable accommodation guidelines for placement in restricted or limited work
  • A main contact person to work with the insurance carrier
  • Regular reviews and updates from the worker, employer and doctor.

What Happens If My Employer Does Not Rehire Me Once I Can Return To Work?

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 Division’s 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:

  • complete an Uninsured Employers Fund Claim Application (by calling (608) 266-3046 and requesting the UEF application form be mailed to them)
  • provide the required documentation (such as copies of relevant payroll checks, check stubs, bank records, wage statements, tax returns) to the department or its agent in order to determine whether the employer is liable for the injury/illness
  • document any medical treatment, vocational rehabilitation services and other bills or expenses

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:

  • mail the first indemnity payment
  • deny the claim
  • provide the reason(s) that the claim is still under review

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:

  1. The state and its municipalities, including each county, city, town, village, school district, sewer district, drainage district and other public or semi-public corporation
  2. Persons, except farmers, who usually employ three or more employees in one or more trades, businesses, professions or occupations in one or more locations
  3. Person, excluding farmers, who usually employ fewer than three employees, effective on the tenth day of the first month after the calendar quarter in which wages of $500 or more were paid for services
  4. Farmers who employ six or more employees on 20 or more days in any calendar year, effective 10 days after twentieth day of employment.
  5. Persons who purchase a worker's compensation insurance policy

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.

Who Uses the Lookup?

The Insurance Coverage Lookup provides a means for:

  • Employees
  • Attorneys
  • Heath Care Providers
  • And others to obtain insurance carrier claims processing information for a particular coverage, injury, or illness date.

The Coverage Lookup and Employers

Wisconsin law requires most employers to provide workers' compensation insurance. The Coverage Lookup provides information for:

  1. Employers that have purchased a Wisconsin worker's compensation insurance policy
  2. Employers (parent companies and their subsidiaries) that have obtained State of Wisconsin approval to self-insure.

Employer and insurance carrier information is updated weekly.

Search Criteria

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:

  • An accident date (October 1991 to present)
  • By employer name
  • By employer address

The Coverage Lookup can also be used to determine if an employer has a current Wisconsin worker's compensation insurance policy.

Insurance Coverage Lookup

The Insurance Coverage Lookup is located on the WCRB web site and an insurance carrier name, address and telephone number is provided.

Injured worker rights

  • An injured worker may have the right to receive benefits.An injured worker may receive benefits regardless of who caused or helped cause the injury. An injured worker does not have a right to benefits if:
    • the worker injured himself or herself intentionally
    • the worker was injured while voluntarily participating in an off-duty activity
    • the injury occurred during horseplay or fighting initiated by the injured worker
  • An injured worker has the right to receive the medical care reasonable and necessary to treat a work-related injury or illness.
    • An injured worker has the right to a first and second choice of doctors licensed to practice & practicing in this state. Any out-of-state or third choice of doctors must be made by mutual agreement with the insurance carrier unless you have a referral from your doctor
    • An injured worker does not need to get approval to go to a different doctor if:
      • for emergency treatment
      • within the same partnership or clinic
      • as the original doctor selected
      • upon referral from his/her original choice of doctors
  • An injured worker has the right to confidentiality. Only people who are parties to a claim or agents of these parties, have the right to information in the Division's files.

Injured worker responsibilities

  • An injured worker has the responsibility to tell his or her employer about a work-related injury or illness.An injured worker must tell his or her employer immediately of the injury, or as soon as possible after the worker first knew the illness might be work-related.
  • An injured worker has the responsibility to submit to reasonable medical or surgical treatment. However, an employee may refuse surgery which might endanger life or limb.
  • An injured worker has the responsibility to submit to reasonable examinations scheduled by the insurance carrier (or self-insured employer).
  • An injured worker has the responsibility to tell the insurance carrier any time the worker's income changes.
    • An injured worker who is getting benefits must tell the insurance carrier paying the benefits if the worker's income changes. The injured worker must tell the insurance carrier regardless of whether income went up or down.
    • An injured worker who has stopped working since the injury must tell the insurance carrier if the worker starts working again or has a job offer.
  • An injured worker has the responsibility to tell the doctors how the injury occurred and if the worker believes the injury may be work-related.If possible, an injured worker should tell the doctor before the doctor provides treatment.
  • An injured worker has the responsibility to tell the insurance carrier how to contact him or her.An injured worker should contact the insurance carrier if the worker's home address, work address, or phone number changes, so that they may be contacted when necessary.