Section EMP.04.18 — Disability Benefits

(a) Definitions. As used in this Ordinance:

(1) "Temporary disability" occurs during the healing period for an injury. "Temporary disability benefits" is the compensation a worker receives for wage loss that occurs during this healing period.

(A) A worker can receive temporary total disability benefits when there is complete wage loss.

(B) A worker can receive temporary partial disability benefits when there is a partial wage loss.

(2) "Permanent disability" occurs when a worker has permanent effects from an injury at the end of the healing period for that injury. "Permanent disability benefits" is the compensation a worker receives for these permanent effects and is compensation for future losses of earnings, theoretically.

(A) A worker can receive permanent total disability benefits when they have total physical impairment for industrial use of both eyes, or the loss of both arms at or near the shoulder, or of both legs at or near the hip, or of one arm at the shoulder and one leg at the hip, or in other circumstances as appropriate.

(B) A worker receives permanent partial disability benefits when he or she suffers permanent effects less than total impairment.

(b) Rates. Compensation rates are based on a worker's "average weekly wage," which is the wage rate in effect at the time of the injury. The average weekly wage is used to calculate the worker's wage loss and applicable disability benefits.

(1) The compensation rates for disability benefits are subject to the maximum and minimum limits as described in Wis. Stat. § 102.11(1) and its periodic updates.

(2) The average weekly wage is calculated based on a worker's daily earnings at the time of the injury. The daily earnings are multiplied by the number of days and fractional days normally worked per week. For a complete description of how to calculate the average weekly wage and calculating the wage in special situations, see Wis. Stat. § 102.11(1)(a) to (g).

(3) The average annual earnings for this Ordinance shall consist of fifty (50) times the worker's average weekly wage.

(c) Compensation. Benefits shall be due starting after the third day of disability, excluding Sundays unless the employee regularly works Sundays. If the disability exists beyond 7 days, the employee may receive benefits for the first 3 days.

(1) Temporary Total Disability. If the injury causes temporary total disability, the worker shall receive temporary total disability benefits. These benefits are two-thirds of the average weekly wage, subject to the maximum and minimum amounts discussed above in subsection (b)(1) of this Section.

(A) There is no limitation on the number of weeks that a worker can receive temporary disability benefits, unless limited elsewhere in this Ordinance.

(B) The worker may be eligible for supplemental benefits of up to $233, as described in Wis. Stat. § 102.44(1), if on continuous temporary total disability for 24 months.

(i) is released for full-duty work by a health care practitioner; or

(ii) is given a limited release to return to light-duty work and the employer can accommodate the restrictions (the limitations in subsections (c)(2)(C) and (c)(2)(D) of this Section shall apply in relation to the worker's temporary total disability benefits); or

(iii) has reached the maximum medical improvement for the injury.

(2) Temporary Partial Disability. If the injury causes temporary partial disability, the worker shall receive such proportion of temporary total disability benefits as the actual wage loss of the worker bears to the worker's average weekly wage at the time of the injury.

(A) Benefits are subject to the maximum and minimum amounts discussed in subsection (b)(1) of this Section.

(B) There is no limitation on the number of weeks that a worker can receive temporary disability benefits.

(C) A worker may be given a limited release to return to work by a health care practitioner during a period of temporary partial disability.

(i) An employer is not required to make light-duty work available while a worker is on a limited release. If the employer chooses to do so, the worker shall be notified that the light-duty position is temporary.

(ii) If the employer provides light-duty work at a lower wage than the worker's normal wage at the time of the injury, the worker is entitled to temporary partial disability benefits proportional to the wage loss.

(iii) If the worker refuses the offer of light-duty work, the worker is only entitled to temporary partial disability benefits based on the proportional wage loss as discussed in subsection (c)(2)(C)(ii) above.

(D) If the worker does not inform the employer of a limited release for work, the worker loses eligibility for continuing temporary disability benefits, even if the worker does not expect light-duty work to be offered. This does not apply if the health care practitioner only informs the employer of the limited release.

(E) Temporary partial disability benefits shall end on the date the worker is released for full-duty work by a health care practitioner or has reached the maximum medical improvement for the injury.

(3) If, at the end of the healing period, a doctor determines that the worker has permanent effects from the injury that impact the ability to work, the worker may receive permanent disability benefits.

(4) Permanent Total Disability. If there is total physical impairment, the permanent total disability benefit rate is the same as that for temporary total disability or two-thirds of the average weekly wage, subject to the maximum and minimum amounts discussed above in subsection (b)(1) of this Section.

(A) The worker may be eligible for a supplemental benefit to the permanent total disability benefit of up to $233 per week. Eligibility for and amount of such a supplemental benefit is described in Wis. Stat. § 102.44(1).

(B) A worker on permanent total disability is eligible for benefits for the rest of his or her life. The worker's dependents will be eligible for a death benefit, regardless of cause of death, unless the worker has exceeded his or her lifetime disability benefits of 1000 weeks of total disability.

(5) Permanent Partial Disability. If the permanent effects result in less than total impairment, permanent partial disability benefits are paid at the rate of two-thirds of the average weekly wage for the period provided in the permanent partial disability schedule. These amounts are subject to the maximum and minimum amounts discussed above in subsection (b)(1) of this Section.

(A) The permanent partial disability schedule sets out the number of weeks that a worker receives further benefits at the end of the healing period. The time periods in the schedule vary depending on the location and degree of the permanent effects. The schedule can be found in Wis. Stat. § 102.52. The application of the permanent partial disability schedule is discussed in Wis. Stat. §§ 102.53 to 102.56.

(B) For permanent partial disabilities not covered by the permanent partial disability schedule, such as those to the head and torso, the number of weeks of compensation shall bear such relation to 1,000 weeks as the injury bears to one causing permanent total disability. During this period (not to exceed 1,000 weeks), compensation shall be paid at the rate of two-thirds of the average weekly wage.

(C) When calculating permanent partial disability, in no case shall the compensation be greater than 100% of permanent total disability.

(6) Mental Injury. Benefits for mental injuries shall be paid for a maximum of two (2) years at the rate of two-thirds of the average weekly wage, subject to the maximum and minimum amounts discussed above in subsection (b)(1) of this Section.

(7) Death.

(A) Where death proximately results from the injury and the deceased leaves a person wholly dependent for support, the death benefit shall equal 4 times his or her average annual earnings, but when added to the disability indemnity paid and due at the time of death, shall not exceed two-thirds of the weekly wage for the scheduled number of weeks. This benefit shall be paid to those persons wholly dependent for support as determined by the ALJ.

(B) If death occurs, other than as a proximate result of the injury before disability compensation ends, death benefits and burial expense shall be allowed as followed:

(i) if the injury proximately caused permanent total disability, the injury shall be treated as if it had caused death, or

(ii) if the injury caused permanent partial disability, the remaining compensation shall be applied toward funeral expenses and any remaining sum paid to persons wholly dependent for support.

(C) However, if the worker is not survived by any persons wholly dependent for support, those persons who were partially dependent on the deceased worker for support may receive such benefits as ordered by the ALJ.

(8) If the disability period involves a fractional week, compensation shall be paid for each day of such week, except Sundays only, at the rate of one-sixth of the weekly compensation.

(d) Burial Expenses. In cases where death of the worker proximately results from the injury, reasonable burial expenses shall be paid, not exceeding $6,000.00.