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Workers’ Compensation FAQs
What Is A Permanency Rating And Do You Need One?
The Wisconsin Department of Workforce Development (DWD) oversees the state’s workers’ compensation insurance department. In order to receive benefits for a workplace injury resulting in a permanent partial or permanent total disability, the injured worker must receive an official rating by an approved medical provider. The permanency rating will be used to determined the level and duration of permanent total disability (PTD) or permanent partial disability (PPD). The DWD periodically updates the schedule benefits to be paid for specific permanent partial disabilities. In some cases, the scheduled amount may be used as the basis for a lump sum settlement.
Can A Permanency Rating Be Disputed?
Absolutely. Remember, most injured workers are forced into using a doctor approved by the state’s Department of Workforce Development, who oversees workers’ compensation insurance benefits. In short, doctors may be interested in getting a worker back on the job with as little cost to the employer or the insurance provider possible. Workers who receive a lower rating than they feel they deserve, or who are ordered to return to work with no permanency rating at all, have the right to appeal.
What You Need To Know Before Returning To Work
It is only natural that injured workers want to return to their jobs as soon as possible. But returning prematurely can mean additional injuries or turning a temporary disability into a permanent one. Here are some common sense factors to consider before returning to work:
- If your workers’ compensation doctor says you have obtained your maximum medical improvement (MMI), make sure you agree before returning to any level of work for your employer. If you do not feel as if you are capable of returning to work, you have the right to challenge the report.
- If your doctor says you can return to work without restrictions, you have the right to challenge the decision. Remember, once you return to work in your old job capacity, you will stop receiving temporary disability pay benefits.
- If your doctor says you are fit to return to work with some restrictions, it is important to clarify with your employer whether you will return to your previous level of pay. If the restrictions mean reduced wages or earnings, you have the right to appeal the decision.
If you need to discuss appealing any decision regarding workers’ compensation medical care or benefits, talk to us right away.
What Is A “Healing Plateau” And How Does Impact Benefits?
It is important to remember that doctors who treat injured workers must be approved by the Wisconsin Department of Workplace Development (DWD), which oversees the state’s workers’ compensation insurance program. That means they are under some pressure to treat the injury and return the worker to the job as quickly as possible. When the doctor decides the patient has reached a point when he or she can return to work in some capacity, it is called maximum medical recovery or the healing plateau.
The DWD will refer to the written doctor’s statement to determine the extent of temporary or permanent partial disability. At that point, the injured worker is often ordered to return to work at their prior level of work or in some reduced capacity. Pay benefits outlined above will be determined based on the DWD decision.
Can The Healing Plateau Be Challenged?
Absolutely. Many injured workers are ordered to return to work before they, themselves, feel comfortable with their level of recovery. The DWD provides a process for appealing the doctor’s report and the decision to order an injured back to work.
What If Your Workers’ Compensation Claim For Medical Expenses Is Denied?
The workers’ compensation insurance provider may deny reimbursement for medical expenses for a variety of reasons, including seeking treatment from an unapproved health care provider.
The most common reason an injured worker’s claim for medical costs is denied is due to the examining doctor reporting a related pre-existing condition on the medical records.The worker has the right to seek a second opinion and appeal the insurance provider’s decision through the Wisconsin Department of Workforce Development (DWD), which oversees the workers’ compensation program for the state.