Workers’ comp. is a payment provided to workers in Wisconsin and most U.S. states when an injury or sickness takes place in the workplace. No worker is expected to pay high medical treatment costs or live without any financial support if they have to take time off work to recover from a sickness or injury. It’s just a question of filing a workers’ comp. claim. Most workers would expect to receive what they are entitled to without a hitch. All too often, though, workers’ comp. claims are denied by the insurer of the employer. Sometimes there is a good reason but often there isn’t. If this has happened to you don’t wait too long but talk to an experienced Wisconsin workers’ comp. attorney who will tell you whether your case may be won if you appeal. Wisconsin Workers’ Comp. Law In the state of Wisconsin the organization responsible for the administration of workers’ comp. is called the Wisconsin Workers’ Compensation Division. Most employers are required to take out workers’ comp. insurance coverage for their employees. This is either bought from a private insurer or if permitted to do so the employer can be self insured. This means it has to prove it has funds available to pay sick and injured employees for the duration of the disability. Wisconsin has a no-fault system which should entitle you to regular workers’ comp. payments, even if you contributed in some way to the cause of the accident. Typically as long as your injury took place at work there is little reason to think that you may have your workers’ comp. denied. However, because it’s a no-fault system, workers might only receive certain benefits. These include: weekly payments for loss of wages compensation for partial disability that’s permanent such as loss of use of a part of the body necessary and reasonable medical care vocational rehabilitation in order to find more appropriate work if required. It’s your employer's job to file a claim with its insurer on your behalf. You will need to tell your employer within thirty days of the injury taking place but if you fail to do this after two years you will no longer be eligible to collect workers’ comp. You are permitted to choose your own physician. The insurer has 30 days to accept or deny your workers’ comp. request. The benefit has to be paid no later than fourteen days following your last day on the job. Why is a Workers’ Comp. Claim Sometimes Denied? There are several quite obvious reasons that could cause a denial of a workers’ comp. claim as listed below: information missing on the claim form; insufficient costing of medical treatment; where and when the injury took place is disputed by the employer; an administrative mistake by another employee at your workplace; it is alleged you deliberately injured yourself or behaved foolishly at work causing the accident to happen; it is alleged you were drunk or affected by drugs causing the accident’ the illness reported was a pre-existing condition that had nothing to do with your job. How to Appeal a Workers’ Comp. Denial in Wisconsin The 1st step to follow once you have received your denial notice is a request for a hearing from the Workers' Comp Division of the Wisconsin Department of Workforce Development. The Division is responsible for assigning an Administrative Law Judge to your case. First of all, the Administrative Law Judge will suggest mediation but if this doesn’t work the judge will set a date for a pre-hearing conference. You will need to provide sufficient evidence that the injury took place at work which means providing relevant documentation such as doctors’ reports and witness’s statements. If the administrative judge doesn’t repeal the denial you can appeal through the Labor Commission, but you are only given 21 days to appeal. This appeal is assessed by the Labor and Industry Review Commission (LIRC), which can alter a decision made by an administrative judge. If this fails your next defense is through the Wisconsin circuit court. You may not be eligible to file an appeal in this way as it typically handles cases where interpretation of the law is under question. It’s important to consult a workers’ comp. attorney before going to this stage. The Reasons for Hiring a Worker’s Comp. Attorney An experienced workers’ comp. attorney knows how to handle workers’ comp. denials and will help to ensure you get the benefit you deserve. Most attorneys who deal with workers’ comp. work on contingency. This means that their legal fee is only recovered if and when your compensation payment is made. This makes it easier financially to use a workers’ comp. attorney rather than try and tackle an appeal all by yourself.
