Read Wisconsin Customer WC Benefit Overivew (Rev.11-09) text version

Workers Compensation Claim

Customer Workers Compensation Benefit Overview ­ Wisconsin

INDEMNITY ISSUES

Temporary Total Benefits $30.00 Min, $808.00 max, 3 day waiting period (excluding Sundays if not normally scheduled), 7 day retro period, unlimited benefits. Two thirds of AWW. AWW based on the hourly rate times the wage rate or the last 52 weeks wage, whichever is higher. 6 day work week used. First payment due within 14 days of first day of lost time. No min or max ­ rate is based on the ratio of actual weekly wage loss to average weekly wage times the TTD rate. 3 day waiting period, 7 day retro period, unlimited benefits. No min, Two thirds of AWW up to $282.00 max. Limited benefits ­ 1000 weeks for whole body, all other body parts scheduled. State specific ratings by physician. $30.00 Min, $808.00 max. Unlimited benefits Up to 4 years average annual wage paid weekly at TTD rate. Maximum burial expense of $6,000. Must be certified by DVR for appropriate 2 or 4 year program. TTD, meals, and travel expenses are paid during training. Maximum payment for private voc services is $1,453.00 Yes. Can full and final if dispute is causation or extent greater than 200 weeks. None

Temporary Partial Benefits

Permanent Partial Benefits

Permanent Total Benefits Fatality Benefits Vocational Rehabilitation

Settlement Allowed Cap on benefits, exceptions

MEDICAL ISSUES

Initial Choice of Provider Change of Provider Medical Fee Schedule Managed Care Utilization Review Treatment Guidelines Medical Mileage Reimbursement Rate Ability to Terminate Medical Treatment Employee choice. One IME allowed. Follow up IMEs allowed every 6 months as long as with same physician. One provider change allowed. Referrals not considered a change. None None None. Prospective only based on physician review. In place, however cannot be relied upon without supporting medical opinion. $.485 per mile. No limit on medical treatment reasonably and necessarily required to cure or relieve the injury. IME needed to terminate.

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Customer Workers Compensation Jurisdictional Resource ­ Wisconsin MEDICAL ISSUES

Settlement Allowed Cap on benefits, exceptions Yes if causation dispute. No cap. Exception is usual and customary reductions using Wisconsin certified database.

OTHER ISSUES

Staff Counsel Griner & Associates 445 South Moorland Road - Suite 100 Brookfield, WI 53005 Phone Direct Dial: 262-780-3987 Hearings require attorney or claim handler participation Occupational Diseases Second Injury Fund availability Attorney or licensed hearing examiner participation. Handled same as occupational injury. If the employee had at least 200 weeks of disability (combined disability from any part of body whether health condition or work related) and has a minimum of 200 weeks of disability from a new WC injury, the employee would be entitled to the amount of the lesser of the two. If the combination of the preexisting and the WC claim results in PTD the WC carrier is responsible for all benefits. Social Security Payments.

Other Offset Opportunities

STATE WC WEBSITE LINK: http://www.dwd.state.wi.us/wc

The Travelers Indemnity Company and its property casualty affiliates One Tower Square Hartford, CT 06183 travelers.com

This material does not amend, or otherwise affect, the provisions or coverages of any insurance policy or bond issued by Travelers. It is not a representation that coverage does or does not exist for any particular claim or loss under any such policy or bond. Coverage depends on the facts and circumstances involved in the claim or loss, all applicable policy or bond provisions, and any applicable law. Availability of coverage referenced in this document can depend on underwriting qualifications and state regulations.

© 2009 The Travelers Companies, Inc. All rights reserved Page 2 of 2

C E - 1 0 1 7 1 Rev. 11/09

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Wisconsin Customer WC Benefit Overivew (Rev.11-09)

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