Statutory Caps on Medical Benefits
In Wisconsin, the maximum reimbursable amount for medical treatment under workers' compensation is $1,000,000 per claim. This ceiling applies to all covered services, including hospital stays, surgeries, and prescription drugs, unless a higher limit is stipulated in the employer's policy.
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Wage Replacement Limits
Wage replacement benefits are calculated at two‑thirds of the employee's average weekly wage, subject to a statutory maximum of $1,200 per week. The benefit period varies by injury severity: temporary total disability (TTD) can be paid for up to 104 weeks, while permanent partial disability (PPD) benefits are capped at a total of $40,000.
Employer Liability and Penalties
Employers who fail to provide required coverage may face penalties up to $10,000 per day of non‑compliance, plus interest on unpaid premiums. Additionally, the state can impose a surcharge on the employer's insurance policy equal to 5% of the annual premium for repeated violations.
Comparative Table of Key Limits
| Benefit Type | Statutory Limit | Notes |
|---|---|---|
| Medical Expenses | $1,000,000 per claim | Can be increased by employer policy |
| Weekly Wage Replacement | 2/3 average weekly wage, max $1,200 | Applies to TTD and PPD |
| Temporary Total Disability Duration | Up to 104 weeks | Depends on injury severity |
| Permanent Partial Disability Total | $40,000 per claim | Based on injury rating |
| Employer Non‑Compliance Penalty | $10,000 per day + 5% surcharge | For each violation instance |
How Limits Affect Claimants
Claimants must understand that once the statutory caps are reached, additional expenses or wage losses are not covered unless the employer's policy provides higher limits. Workers can appeal for supplemental benefits if the injury is deemed exceptionally severe, but such cases require substantial medical documentation and often a hearing before the Wisconsin Workers' Compensation Division.
Key Takeaways for Employers
Employers should review their workers' compensation policies annually to ensure limits exceed statutory minima, reducing the risk of out‑of‑pocket costs. Maintaining accurate payroll records helps calculate correct wage replacement benefits and avoids penalties for underpayment.