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.