Permanent Partial Disability and How it Could Affect You.

Permanent Partial Disability and How it Could Affect You.

by | Mar 17, 2025 | 2025, Article, Worker's Compensation

When thinking about workers’ compensation injuries, workers understandably focus on the immediate necessities of (1) getting medical expenses paid and (2) wage replacement for missed work. Medical expenses and wage replacement, also known as, temporary total disability (TTD) or temporary partial disability (TPD) make up two out of the three main workers’ compensation benefits. However, workers need to make sure they are taking advantage of the third main benefit afforded under Wisconsin Workers’ Compensation law: permanent partial disability (PPD).

Because workers’ compensation is a no-fault system, there is no payment for pain and suffering, as there is in normal fault-based claims like auto accidents or slips and falls. That said, Wisconsin’s Workers’ Compensation law does allow for payment for permanent functional loss or impairment caused by a work injury. When an injured worker’s doctor decides that the worker has reached an “end of healing” or “healing plateau,” the doctor may assign a percentage of permanent disability to the affected body part. This rating takes into account the permanent losses the employee will have such as, range of motion, loss of endurance, weakness, pain, and other elements.

This percent of functional disability is determined by the worker’s treating physician. Wisconsin PPD ratings are not required to follow the American Medical Association (AMA) Disability Guidelines. The ratings are left up to the discretion of the treating physician with some guidance from the AMA. Also, there are certain scheduled injuries and surgeries that will qualify a worker for a minimum percentage, e.g. total knee or total shoulder replacement would equal 50% minimum.
In terms of calculating the PPD benefit, the PPD percentage assigned is multiplied by the number of weeks the total body part is “worth” if the body part was completely lost. For example, a shoulder is “worth” 500 weeks, this means if a worker’s entire shoulder was amputated, he or she would be entitled to 500 weeks of PPD. If a doctor assigns the worker, for example, 12% PPD to the injured shoulder, that worker is entitled to 60 weeks of PPD payments (.12 x 500). For injuries occurring after January 1, 2025, the PPD weekly rate is $446. To illustrate, the 12% PPD for a shoulder injury, occurring after January 1, 2025 is worth $26,760 (.12 x 500 x $446).

While PPD benefits are not huge sums of money, especially compared to personal injury awards, these are claims that injured workers need to make sure they are asking their treating physicians about once an end of healing is reached. Even a few percentage points of permanency can provide the injured worker needed compensation during a very stressful period.

If you have been injured at work and have questions, or your work compensation claim has been denied by the insurance company, please reach out to our experienced Workers’ Compensation Attorneys for assistance.

Understanding Medical Payments Coverage

Understanding Medical Payments Coverage

by | Dec 26, 2024 | 2024, Article, Personal Injury

Medical payments coverage through your automobile insurance is often an overlooked and sometimes misunderstood coverage. Reasonably, consumers are more interested how much coverage they have for liability (if they are at fault), underinsured/uninsured (if someone else is at fault but not sufficiently insured), or collision/comprehensive (how much it will cost to get their vehicle repaired). In terms of premium dollars allocated, medical payments coverage ranks low.

It is important to understand your medical payments coverage because if you are in an accident, regardless of fault, it is often the first “pot of money” that pays for medical treatment. Medical payments coverage is what is known as “no fault” coverage, it pays for medical expenses incurred because of an accident regardless of whether you or someone else is at fault.

  1. What dollar amount you are covered for; the most common medical payments limit is $10,000 per person. However, coverages can range from as low as $1,000 (not recommended) all the way up to $100,000.
  2. You should check your policy to see whether your medical payments coverage is primary or secondary/excess. Most medical payments coverage is primary; that is, medical payments would pay and be used up before normal health insurance starts paying. However, there are some insurers that have their medical payments coverage as excess or secondary. In this scenario, the accident-related treatment would have to be first submitted to normal health insurance, and medical payments coverage would pay what remains, such as any deductible, co-pay, coinsurance, and/or if the treatment was denied by health insurance.
  3. You will want to know by when the coverage must be used. Some policies are written that the coverage must be used within one year of the accident; some policies say use within three years of the accident; and, even some are written that if treatment is started within one year of the accident, then they will cover it for three years from the accident date.
  4. if you receive a settlement or judgment from the at-fault party or their insurer, your insurer, that paid medical expenses on your behalf, may have the right to subrogation/reimbursement for the payments made. Fortunately, all medical payments coverage insurance in Wisconsin is subject to the Made Whole and Common Fund doctrines, which can be used to reduce the amount that has to be paid back to your insurance company out of any settlement/judgment.

As you can see, medical payments coverage is not a simple issue of have it vs. don’t have it. Depending on how much coverage you purchased and how the policy is written will determine how the coverage is utilized after an accident. Of course, contacting and retaining a skilled attorney can help you strategize how to effectively use medical payments coverage to minimize your out-of-pocket expenses after an accident. If you are in a vehicle accident, don’t be a vitcim twice, make an appointment for a free consultation with one of our skilled personal injury attorneys.

Shipwrecked by a Sidewalk

Shipwrecked by a Sidewalk

by | Aug 5, 2024 | 2024, Article, General

Family walking on main street of historic north american town

With the exponential growth of technology occurring today, there is an often-repeated adage that “the law struggles to keep up with technology.” As such, it is always interesting when the highest Wisconsin court must spend its limited time with the bleeding edge issue…. what is a sidewalk?  The recent Wisconsin Supreme Court decision, Sojenhomer LLC v. Village of Egg Harbor, shows that the Court still must decide, and for the first time, a very early 20th century issue.

Anyone who has spent time in Door County during the summer can attest to the incredible busyness of its towns lined with shops, wine tastings and restaurants. The heavy traffic, combined with parked vehicles and pedestrians on two lane highways can lead to tight and dangerous corridors. In 2015, after hearing numerous complaints about the dangerousness of downtown Egg Harbor for pedestrians, specifically the area of the intersection of County Highway G and State Highway 42, the Village of Egg Harbor decided to act. The Village decided to add a new sidewalk on the on the east side of the County Highway G, among other changes. To build the sidewalk, the Village needed to acquire, through its condemnation power, the 0.009 acres that belonged to Sojenhomer LLC; on that property, Sojenhomer operated the Shipwrecked Brew Pub and Restaurant and used that .009 acres for parking.

Sojenhomer sued to stop the Village on the grounds that the condemnation was prohibited by Wis. Stat. § 32.015, which bars the use of condemnation powers to establish “a pedestrian way.” In Sojenhomer’s eyes, obviously a sidewalk is a pedestrian way, so the Village could not condemn its property to build its desired sidewalk. Unsurprisingly, the Village took the opposite view:  “a pedestrian way” and a “sidewalk” were distinct and separate things. Illustrating how unsettled the matter was, the local circuit court agreed with the Village; the Wisconsin Court of Appeals agreed with Sojenhomer.

As the decider of last resort, the Wisconsin Supreme Court agreed with the Village:  the legislature’s definition of “pedestrian way” does not include “sidewalk.”  Appropriate for the exciting nature of dried concrete, the Court relied on good old-fashioned statutory interpretation rules to reach its decision. The Court found that the statute used the terms “sidewalk” and “pedestrian way” in ways that each term had separate, non-overlapping meaning. To the Court, the fact that various statutes used both terms indicates that the terms were not one in the same. Moreover, when the legislature first introduced the term “pedestrian way,a way designated for pedestrian travel” –  in 1949, the statutes already contained a definition of “sidewalk” as “that portion of a highway between the curb lines and adjacent property lines.” In other words, if a pedestrian way was a sidewalk or a sidewalk was a pedestrian way, there would be no reason for both terms to exist.

The Court noted that sidewalks are a ubiquitous feature of road projects across the state, and if the legislature wanted to prohibit the use of condemnation to build sidewalks, they could have done so easily and clearly. Instead, when limiting condemnation powers, the legislature did not include the word “sidewalk” and instead included the seldom-used phrase “pedestrian way.”

If any dedicated reader has made it this far, he or she hopefully recognizes the slightly tongue-in-cheek nature of this issue. Yet, this case serves as an important reminder and illustration that our courts continue to grapple vigorously (this was a 4-3 decision) with issues and words that most residents would consider antiquated. The ever-changing nature of our world, and its attendant needs, highlight how the stale terms and law must be constantly applied to new fact scenarios every day.

Whose Insurance Should Pay for Vehicle Repairs?

Whose Insurance Should Pay for Vehicle Repairs?

by | Feb 5, 2024 | 2024, Article, Personal Injury

car accident, paperwork, injury, lawyer,

After an accident, a new or potential client will often ask me: “Who should handle my wrecked vehicle – my insurance company or the at-fault driver’s insurance company?”  True-to-attorney form, I often respond, “it depends.”

Assuming both insurance companies have property damage coverage, there are pros and cons to each approach. Sometimes it comes down to what is most important at that time: speed and convenience or trying to maximize every possible dollar recovered.

Even though someone else was at fault for the accident, many people will go through their own insurance company for their damaged or totaled vehicle (assuming they have purchased Collision Coverage). Collison Coverage is no-fault coverage, i.e. coverage doesn’t depend on whether you or someone else caused the accident. For this reason your insurance company (ideally) will start processing the claim right away: paying for repairs, or if your car is a total loss, paying for the actual cash value of the vehicle (minus the deductible).  If you have rental coverage, often limited to 30 days, your insurance company will handle that as well.

On the other hand, if you go through the at-fault insurance company for your damaged or wrecked car, there can be a delay in payment as the insurer will want to complete its liability investigation to make sure its insured was indeed responsible for the accident. You may have to wait for the liability insurer to speak with its insured, get police reports and maybe even require a statement from you, which can be fraught with risk. Also, there is the consideration that the at-fault insurance company is an adverse party that has no contractual relationship with you – it doesn’t have the obligation of good faith and fair dealing that you have with your own insurance company.

Given all these potential downsides, why go through the at-fault insurance company?  In addition to not having to make a claim against your own insurance company and theoretically staving off any premium increase, you can potentially recover additional types of damages against the at-fault insurance company.

Even if properly repaired, people intrinsically know that a car that has been in an accident is not worth as much as the equivalent vehicle that has not been an accident. Against the at-fault insurance company, you can pursue a diminished value, or loss of value, claim that takes into consideration that even properly repaired vehicles have diminished value in the eyes of potential buyers. Next, rental coverage with your own insurance company is limited to the coverage in the policy (often 30 days), there is a claim for “loss of use,” against the at-fault insurance company that is for the reasonable period necessary to repair the vehicle or obtain a comparable permanent replacement if your vehicle is totaled. Wis. J.I. CIVIL 1800; Kim v. Am. Fam. Mut. Ins. Co., 176 Wis. 2d 890 (1993). So, if repairs take months, the at-fault insurance company is responsible for paying for a rental or providing you the equivalent value, and you are not limited to the day or dollar limit of your own insurance policy limits

Therefore, the decision of which insurance company to go through for vehicle damage when you are not at fault for the accident, is personal and situational dependent. It is one of many things that an experienced accident attorney can help you navigate following a crash.

If you have questions, or need help following an accident, please reach out to one of our experienced accident and personal injury attorneys.

 

When Will I Receive My Worker’s Compensation Payments?

When Will I Receive My Worker’s Compensation Payments?

by | Dec 18, 2023 | 2023, Article, Personal Injury, Worker's Compensation

At our firm we field many inquiries from individuals who have had the misfortune of sustaining a work injury that naturally have the question:  When do I start receiving benefits from the workers’ compensation insurer?

Very broadly speaking, as every case/situation is unique, workers’ compensation benefits often break down into three main categories:  temporary disability benefits, permanent disability benefits and medical expenses. For this article the focus is on the  first category:  temporary disability benefits, which is a form of wage replacement if the injured work is either (1) completely off work – known as “temporary total disability” or (2) partially off work with reduced hours or wages – known as “temporary partial disability.” Understandably looking to make sure they can pay bills, put food on the table and maintain their life, the injured worker is often curious when and how they start receiving disability payments.

If the injured worker is completely off work, they are entitled to two-thirds of their average weekly wage, subject to a cap. (For injuries occurring after January 1, 2023, the maximum weekly wage is $1,870.50, resulting in a weekly benefit of $1,247.00) What is frequently confusing is when those benefits begin; this implicates what is colloquially known as the three-day/seven-day rule. By, Wis. Stat. § 102.43:

“If the injury causes disability, an indemnity shall be due as wages commencing the fourth calendar day from the commencement of the day the scheduled work shift began, exclusive of Sundays only, excepting where the employee works on Sunday, after the employee leaves work as the result of the injury, and shall be payable weekly thereafter, during such disability. If the disability exists after seven calendar days from the date the employee leaves work as a result of the injury and only if it so exists, indemnity shall also be due and payable for the first three calendar days, exclusive of Sundays only, excepting where the employee works on Sunday.”

What does this all mean?  In short, there is a three-day waiting period for any disabilities lasting seven days or less; if the worker misses seven days or less because of work injury, he or she does not get paid for the first three days but can be paid for days four to six. However, if the worker remains off work beyond the seventh day, the worker is paid for those first three days of missed work and the subsequent days thereafter.

Temporary total disability payments continue while the worker’s treating practitioner states that the worker needs to be off work completely because of the work injury, or, as long as the practitioner places temporary physical restrictions that the employer cannot accommodate (i.e. doctor imposes temporary restrictions of no lifting more than 10 pounds, and alternate sit/stand every 30 minutes, but worker’s duties involve continuously lifting 50 pound boxes while standing).

At some point, the treating practitioner will put the injured worker at “end of healing.” This is the point when the worker reached his or her healing plateau; this concept is often described as the point where the worker isn’t getting any better or any worse, (also called stationary). Once this occurs, temporary total and partial disability benefits will cease. Then, the question becomes what, if any, permanent disability benefits is the injured worker entitled to?  This would be a topic for another day.

Of course, the above is meant to be a very generalized view and explanation of temporary disability benefits. Every case varies widely depending on the injury, treatment, and whether an insurance company “independent medical examination” is involved. As always, feel free to reach out to our experienced Worker’s Compensation Attorneys for any questions about your work injury.