FAQs

The following information is from the Wisconsin Board on Aging and Long Term Care:

How does the Ombudsman Program differ from the Division of Quality Assurance?

The Division of Quality Assurance provides the regulatory oversight to long term care facilities.  The Ombudsman Program, while working within the boundaries of the regulatory requirements, provides advocacy to long term care consumers, insuring that their concerns are heard and considered.

Does the Ombudsman Program serve the entire state of Wisconsin?

Yes. Each county in the State of Wisconsin has a Regional Ombudsman.  In addition, Ombudsman coordinate access to services for out of state residents who will be moving to Wisconsin.

The following information is from the Wisconsin Board on Aging and Long Term Care:

What types of concerns do ombudsmen address?

Ombudsmen serve persons age 60 and older who live in Wisconsin nursing homes and assisted living facilities, or who are receiving community-based services under the Family Care or the Community Options Program.  Most frequently expressed concerns are about substandard care, complaints about access to providers or services of choice, providers not treating consumers with dignity and respect, inappropriate discharge of a resident from a facility, as well as how to make a choice in long term care service providers.

The following information is from the Wisconsin Board on Aging and Long Term Care:

My father lives in a nursing home, but the staff hints that he may have to leave if his behavior does not improve. How can the Ombudsman Program help?

Persons may not be discharged from a nursing home without thorough preparation, planning and notice, and may only be discharged to what will be considered a safe and permanent setting. This would include persons who are transferred from a nursing home to a hospital for treatment of behavioral challenges. This transfer may not be considered a discharge from the facility, and the facility has the above obligation.

The Ombudsman Program may be of assistance to the facility in terms of assisting with problem-solving the behavioral challenges and assisting with referrals to other community education and support agencies. Residents and families served with a notice of involuntary discharge under these circumstances should call the Ombudsman Program immediately.

What is a Long Term Care Ombudsman?

An Ombudsman (Om-budz-man) is an advocate for long term care consumers aged 60 and over who reside in nursing homes or group homes or are participants of the Community Options Program.

After analyzing the results of 82 studies from 1965-2003, Canandian Researchers from McMaster University in Hamilton, Ontario, say that non-profit nursing home provide better care than their for-profit counterparts.

While three studies found that for-profit nursing homes provided significantly better care, forty studies found that non-profit nursing home administered better care. The remaining 39 studies had mixed results.

Additional analysis revealed that non-profit nursing homes did better in four quality measures:

1. More or higher quality staffing
2. Lower rates of pressure ulcers a.k.a. pressure sores or bed sores
3. Less use of physical restraints
4. Fewer deficiencies cited by regulatory agencies

The researchers calculated that the United States would receive 500,000 more hours of nursing care per day if all homes were non-profit. In addition, the researchers also calculated that 7,000 of 80,000 pressure ulcer cases in the U.S. were directly linked to for-profit ownership of nursing homes.

Pitman, Kyle & Sicula, S.C. is a Wisconsin law firm with a devoted nursing home abuse practice. Our nursing home abuse and neglect trial team is the largest in the state and has successfully represented abused and neglected nursing home residents throughout Wisconsin.

Take a look at our auto accident checklist:

It may be helpful to print the checklist and keep a copy in your vehicle at all times.

Pitman, Kyle & Sicula is a Wisconsin personal injury law firm handling car accident cases throughout the state.  Our Wisconsin injury attorneys have successfully represented injured people in almost every county. We know Wisconsin.

Try our nursing home checklist:

Pitman, Kyle & Sicula, S.C. is a Wisconsin law firm with a devoted nursing home abuse practice. Our nursing home abuse and neglect trial team is the largest in the state and has successfully represented abused and neglected nursing home residents throughout Wisconsin.

Actually, there is rarely anything “Independent” about medical exams requested by an insurance company.  The insurance company pays for the exam.  It’s easy to understand that the doctor is biased.  This quote from an “Independent” medical doctor is eye opening:

“If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

Read the story from the New York Times.  It deals with workers’ compensation in New York, but it is certainly relevant for Wisconsin’s workers’ compensation claims.

Something interesting about this article is the changes that NY has implimented for its “I.”M.E.’s.  They allow the exams to be tape recorded or videotaped.  Seems reasonable to me!  In Wisconsin, personal injury law plaintiffs’ attorneys who ask that an exam be taped or recorded receive a strong objection from the insurance company.  Sometimes even having a friend or family member attend an exam isn’t allowed.

Last I checked, no Wisconsin Appellate Court has held whether a Defense Medical Exam (that is a more accurate description) performed for a personal injury claim may be tape recorded or videotaped.  Federal Courts have held that a Defense Medical Exam regarding a psychiatric examination may be recorded.  Zabkowicz v. West Bend Co., 585 F. Supp. 635 (E.D. Wis. 1974). (See this outline from an Insurance Defense Firm located in Milwaukee, Wisconsin).

-Attorney Jonathan Groth

I think I need to write about a few things that I commonly hear from clients and a few things that I commonly say to clients.

Whenever someone asks about the value of a claim, or what we will “go after” for compensation I always say something like “the law allows us” or a “jury would be allowed to consider” or “we could ask a jury.”

I don’t use these phrases to scare clients and make them think we are going all the way to a trial.  In fact, the vast majority of my clients never see a courtroom.  I say these things because ultimately, the only way to force an insurance company to compensate an injured victim is by taking the case to a jury.  Once the jury decides and decides on a verdict that is what the insurance company has to pay.  Obviously there is always the possibility of appeals but that is a post for another day…if jury trials are rare, then I’m sure you can imagine how rare appeals are.

Settlements made presuit, or after a suit is filed, are all based on guessing what a jury would award.  This is the reason you hire a attorney.  You hire an attorney to give you an educated guess as to what a jury would award considering the law, facts, and all the miscellaneous information related to the claim.

No one knows what a jury would award, but who better to give you advice on the value of a personal injury matter than an attorney who has dedicated his career to knowing what amount of money a jury would use to compensate an injured person and his/her family.

-Attorney Jonathan Groth

Pitman, Kyle & Sicula is a Wisconsin personal injury law firm handling cases through out the state.  Our Wisconsin injury attorneys have successfully represented injured people in almost every county. We know Wisconsin.

I get comments like that a lot.  I think it is more of a colloquialism than anything.

Injured people should hire an attorney to avoid a lawsuit. Personal injury attorneys can do more good for you the earlier you hire them. 

If a dog bite, car accident, or other incident happens and you hire a lawyer a few days later, my best guess is that there is less than a 10% chance the case will go to a jury trial. I can say that by looking at my current caseload.

By hiring a personal injury attorney you have not filed a lawsuit. It is probably more accurate to say that you have a “claim” against the at-fault party. If a lawsuit is necessary, then we’ll certainly file it, (and I can tell you as a personal note I’ll enjoy taking depositions and going to trial if need be) but in many cases a lawsuit won’t be necessary.

You hire a lawyer to protect you from accusations from other drivers (i.e. in order to reduce/remove alleged contributory negligence that insurance companies will throw at you). You hire a lawyer to make sure you include every bit of compensation that the law allows. You hire a lawyer to make this process as painless as possible.

Don’t get me wrong, I’ve handled a large number of cases where my client didn’t come to me until months or a year or so after the collision.  Sometimes the insurance company strung the person along and then when the unreasonable offer came I was the very next call.  In those cases there isn’t much we can do.  A lawsuit needed to be filed.

These are all things you’ll need to discuss with your personal injury attorney.

-Attorney Jonathan Groth

Pitman, Kyle & Sicula is a Wisconsin personal injury law firm handling cases through out the state.  Our personal injury lawyers have successfully represented injured people in almost every county. We know Wisconsin.

I was asked recently about a worker’s compensation question.  For full disclosure I handle only workplace injuries against third parties.  For example, if you are driving a work vehicle and involved in a car accident, then I would help you obtain compensation for pain and suffering, mileage to the doctor, doctors bills, property damage, rental vehicle and lost wages etc. This claim is against the at-fault driver, i.e. the third party.

In addition to the claim against the at-fault driver, the injured person has a claim with workers compensation insurance.  These types of claims are called first party claims.  I don’t handle these.  But, I work with attorneys across Wisconsin who do a great job.

Anyway, the question was whether an employer can force an employee to sign a contract to waive any worker’s compensation benefits.

This is what I found from Wisconsin’s Office of the Commissioner of Insurance:

An employer subject to the Act may not withhold or collect any money from employees or any other person, including independent contractors and subcontractors, to pay for worker’s compensation insurance. To do so is illegal. Also, no agreement by an employee waiving rights to compensation is valid. [s. 102.16 (3) and 102.16 (5), Wis. Stat.]

-Attorney Jonathan Groth

Pitman, Kyle & Sicula is a Wisconsin personal injury law firm handling cases through out the state.  Our personal injury lawyers have successfully represented injured people in almost every county. We know Wisconsin.