Please note that this question and answer session is not intended to be legal advice.
What is the waiting period prior to paying temporary disability benefits?
The waiting period prior to paying benefits is three days. If disability (temporary or permanent) exists after seven calendar days from the date the employee leaves work as a result of the injury, benefits are paid for the waiting period.
When an employee is injured, what percentage of their wage is paid in temporary total disability (TTD) and permanent total disability (PTD) benefits?
Disability benefit rates are equivalent to two-thirds of an employee’s average weekly wage, subject to the maximum cap in effect on the date of injury. There is a maximum rate that can be paid, and that rate is dependent on the date of injury. TTD benefits are paid until an employee reaches an end of healing and/or returns to work without restrictions. PTD benefits are paid for life.
How do I calculate an employee’s average weekly wage?
Whichever is higher: The average gross wages earned in the 52 weeks prior to the injury or base hourly rate times normal weekly hours worked. See § 102.11, Wis. Stats. Minimum is set at $30.
How are fractional weeks calculated when making indemnity payments?
TTD benefits are paid for each day, except Sunday, at the daily rate of one-sixth of the weekly rate.
What is temporary partial disability (TPD)?
TPD is paid when an employee is injured, but is still able to work on a restricted basis. An employee’s TPD rate is based on the ratio of actual wage loss during disability to their average weekly wage, times the TTD rate. For example, an employee limited to half-time work receives one-half the TTD rate. A WKC-7359-1-E can be used to calculate TPD.
What is permanent partial disability (PPD)?
PPD is a physical impairment following a work injury. PPD can be scheduled or unscheduled. Generally, scheduled PPD involves the limbs (from the shoulders to the fingers and the hips to the toes), and unscheduled injuries involve the head and torso, to include mental health claims. Scheduled PPD ratings can be found at § 102.52, Wis. Stats and DWD 80.32. Unscheduled injuries involving the spine are also found at DWD 80.32.
How is permanent partial disability (PPD) calculated?
PPD is the equivalent of two-thirds of an employee’s average weekly wage, subject to the maximum cap per § 102.11(1), Wis. Stats. The maximum cap is dependent on the date of injury. PPD is determined once an employee reaches an end of healing, and then is paid weekly or monthly. PPD is not based upon AMA guidelines. There may be a deduction for preexisting PPD ratings.
What is a multiple injury variation?
When an injury causes more than one compensable permanent disability, benefits are increased. See § 102.53, Wis. Stats. If you have more than one PPD rating, there may be an offset, as a proximal injury is reduced by the disability resulting from a more distal injury. See DWD § 80.50.
There are many additional aspects to the handling of worker’s compensation claims such as vocational retraining, loss of earnings capacity, death benefits, bad faith claims, safety violations claims, unreasonable refusal to rehire claims, etc. Each of these aspects involves additional benefit calculations or penalties. If you are an employer or insurance adjuster and have any questions regarding claims handling, please contact us for answers to your questions.