Worker’s Compensation Walkthrough

Jim is employed as a mechanic at ABCAutomotive, while helping a client he slips and falls on an oil slick, injuring his right knee. Jim immediately reports the injury to human resources, and an injury report is completed. He then goes directly to the hospital where his doctor orders an MRI, which reveals that he partially tore his meniscus as a result of the fall. Jim is scheduled to undergo a meniscectomy in two weeks to repair the torn meniscus, in the meantime he is off of work per his doctor. At this point, Jim is entitled to payment for the cost of, reasonable and necessary, medical treatment as well as disability payments while he is off of work in the form of a weekly check, equal to two-thirds of his average weekly wage, known as temporary total disability payments (TTD).

Jim receives his first TTD check to cover the first two weeks he was off. However, prior to his scheduled surgery he is informed by the workers compensation insurance carrier that he must attend an independent medical examination (IME). After the visit with the medical examiner he does not receive the following week’s TTD check, when he calls to see what is the hold up he is informed that his scheduled surgery has been postponed, pending the IME results. Two weeks later he is informed that his worker’s compensation claim has been denied because the independent medical examiner determined that his injury was pre-existing. At this time, Jim contacts Tabak Law. After an initial consultation, Jim retains a Workers Compensation Lawyer at Tabak Law and the appeals process begins.

Immediately Tabak Law and their skilled Workers Compensation Lawyer makes contact the worker’s compensation insurance carrier and request Jim’s entire file. Jim is then advised to proceed with the surgery, submitting the medical expenses to his primary personal insurance, who will later be reimbursed. Fortunately, Jim’s meniscectomy goes extremely well and he is released back to work without restrictions, just four weeks after the surgery. At this time, all of Jim’s medical records, bills as well as a final report from Jim’s treating physician are requested. After receiving the bills and the report, a demand is prepared petitioning for payment of the related medical bills, transportation costs, temporary total disability as well as partial permanent disability (PPD). In Wisconsin, several mandatory minimum partial permanent disability percentages exist. A meniscectomy is governed by Wis. Admin Code § DWD 80.32 and provides for a minimum of 5% permanent partial disability (PPD). A sample Demand can be found below:

Medical Bills

• Accelerated Rehabilitation, United Hospital = $ 5,759.75

Transportation

To and from doctors’ appointments. 6 appointments x 8.4 miles round trip = $ 25.70

TTD

Temporary Total Disability from 7/8/14—8/8/14

Average Weekly Wage ($613.33 x 2/3)–TTD Rate x 4 weeks

$ 1,635.55

PPD

5% x 425 weeks @ $322.00 (Maximum weekly PPD Rate-2015)

$ 6,842.50

•         TOTAL $ 14,263.50

At this point, negotiations between the defense attorney and your Workers Compensation Lawyer at Tabak Law can begin. In a majority of claims, we are able to arrive at a settlement prior to going before a judge. However, this is not always the case, as such all of our claims for benefits are prepared to go to a hearing from the very beginning. In Jim’s case, after two months of negotiations and the filing of a hearing application and a certificate of readiness, an offer is made that Jim is extremely happy with. The claim is settled, a contract is drawn up, payments are made and Jim’s life can return back to normal.