Workers' Comp and the Waiting Period Trap

 

The Wisconsin Worker’s compensation statute has included certain incentives for employees and employers to encourage injured workers to return to work as soon as possible. These incentives have been part of the statute since it’s inception in 1911. The primary incentive for workers is the three day waiting period. Other than the experience mod, the application of the waiting period is one of the most misunderstood sections of the statute. A recent bulletin issued by the Department of Workforce Development (DWD) has added to the confusion.

Statute 102.43 contains the waiting period terms:

"If the injury causes disability, an indemnity shall be due as wages commencing the 4th 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 a result of the injury, and shall be payable weekly thereafter, during such disability. If the disability exists after 7 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 3 calendar days, exclusive of Sundays only, excepting where the employee works on Sunday."

Let's look at the key wording:

• There must be "disability" determined by a doctor.

• Sunday does not count unless the employee normally works on Sunday.

• Saturday does count regardless if the employee is scheduled to work. This is the biggest trap where employers get caught.

• The waiting period starts "after the employee leaves work as a result of the injury." The employee must leave their work station to trigger the waiting period.

• The day the employee is injured does not count towards the waiting period. I have seen very few employers pay the employee for the remainder of the day. The statute does not require employers to pay beyond the actual hours worked. Some do pay for time spent seeking medical care.

• The waiting period does not apply if the employee is disabled from working beyond seven calendar days. Note this is calendar days, not work days.

Why is understanding this point so important to employers?

If the carrier must pay disability benefits, that claim will cost the employer 3X as much in premium. If only medical care is paid by the carrier the premium impact will be less than the cost of the medical bills. If disability benefits are paid that claim may cost the employer 3X the total cost of the claim in premium.

    For example:

    
$1,000 Total Cost of the Injury
    $1,000 Medical expenses only
    $600 Increase in WC Premium
    $1,000 Disability and Medical expenses
    $2,500 Increase in WC Premium

What must an employer do to minimize cost?

1. Employees must report all incidents by the end of the shift.

2. Employers must report all incidents to their carrier.

3. Employee must be advised immediately that alternative work is available and it is the employee’s responsibility to report their availability to work.

4. Develop a relationship with a medical provider that supports efforts of return to work.

5. Educate supervisors regarding their role in the WC process.

 

Contributed by Frank Wegner, R & R Insurance Services
Copyright 2001
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