Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.
Detailed Answer
When you suffer a work-related injury in Wisconsin and pursue a personal injury claim against a third party, you may receive benefits from both your workers’ compensation insurer and a personal injury settlement. Wisconsin law addresses this overlap through a statutory lien and subrogation rights under Wis. Stat. § 102.29. Understanding these rules helps you maximize your recovery and satisfy legal obligations.
1. Statutory Lien and Subrogation
Under Wis. Stat. § 102.29(1m)(b), your employer’s workers’ compensation insurer has a lien on any compensation you obtain from a third-party tortfeasor. The lien equals the total benefits (medical, wage loss, rehabilitation) that the insurer has paid or will pay due to the injury.
2. Notice and Timing Requirements
The insurer must assert its lien by providing written notice to you or your attorney within 30 days after you file a third-party action. Failure to timely assert the lien can reduce or eliminate the insurer’s reimbursement right (see Wis. Stat. § 102.29(1m)(c)).
3. Allocation of Settlement Proceeds
You and the insurer typically negotiate an allocation of the settlement among past medical expenses, past wage loss, future medical care, pain and suffering, and other damages. Wisconsin courts generally allow the insurer to recover only from the portion allocated to past medical expenses and past wage loss that the insurer has paid. Allocations to pain and suffering or future costs typically remain with you.
4. Dispute Resolution
If you and the insurer cannot agree on the lien amount or allocation, either party may petition the circuit court for a hearing under Wis. Stat. § 102.29(1m)(c). The court determines a fair reimbursement based on paid benefits and proper settlement allocation.
5. Reimbursement Process
Once allocation is set, the insurer issues a demand for payment. You must satisfy the lien from the settlement proceeds before disbursing net recovery to yourself or other claimants (lawyers, medical providers).
Helpful Hints
- Notify your workers’ compensation insurer early if you plan to sue a third party.
- Keep detailed records of all benefits paid: medical bills, wage-loss checks, rehabilitation costs.
- Work with your personal injury attorney to draft a clear settlement allocation.
- Check that your insurer timely asserts its lien under Wis. Stat. § 102.29(1m).
- If negotiation stalls, consider filing for a statutory lien hearing in circuit court.
- Allocate a portion of your settlement to pain and suffering to maximize your net recovery.
- Consult an attorney experienced in both workers’ compensation and personal injury coordination.