If you get hurt or sick at work in Wisconsin, workers’ compensation is supposed to be there to pay your medical bills and cover some of your lost income. But sometimes workers’ comp insurance companies refuse to pay valid claims. A claim denial can leave you unable to pay for your care or meet your basic needs.
Workers covered under workers’ comp have the right to appeal the partial or total denial of their claims. But it’s not a process they can realistically handle on their own.
Nicolet Law Accident & Injury Lawyers represents injured workers throughout Wisconsin in workers’ compensation appeals. We fight to ensure that employers and insurance companies fulfill their financial and moral obligations to workers who get hurt or sick on the job. Contact us today to learn about what we can do for you. Reach out to a Wisconsin workers compensation appeals lawyer.
A Seasoned Team of Wisconsin Workers’ Comp Lawyers
Nicolet Law Accident & Injury Lawyers is an award-winning law firm that represents Wisconsin workers in all aspects of the workers’ compensation claim process. We have decades of experience advocating on behalf of Wisconsinites who got hurt or fell ill in connection with doing their jobs. Our team handles many types of workers’ comp disputes and has a storied track record of getting our clients favorable results.
Workers’ comp appeals constitute a critical focus of our practice. Our lawyers firmly believe that workers’ compensation insurance carriers and the employers they represent should live up to their solemn promise to support workers who get hurt or sick on the job.
With Nicolet Law Accident & Injury Lawyers in your corner, you can rest assured that you have a team that knows how to build the strongest possible case for why you deserve full benefits on your claim.
Overview of Workers’ Compensation Claims and Appeals
Nearly all Wisconsin employers must carry workers’ compensation insurance for their employees. If you work at a full-time or part-time job in Wisconsin, chances are that you are covered by a workers’ comp insurance policy or its equivalent. Importantly, you are likely covered by workers’ comp even if you are undocumented. If you got hurt or sick on the job in Wisconsin and have questions about whether workers’ compensation covers you, contact Nicolet Law Accident & Injury Lawyers today for a free consultation.
Rights and Benefits
Workers’ compensation insurance guarantees Wisconsin workers basic rights and benefits that protect them from the costs of a work-related injury or illness.
- Payment for all reasonable and necessary medical care for a job-related injury or illness
- If a worker is (1) completely unable to return to work, or (2) is allowed to return to work but with restrictions their employer can't accommodate, the worker is entitled to Temporary Total Disability (TTD) payments during the healing period. TTD benefits come in at 2/3rds of the worker's average weekly wage at the time of injury.
- If the worker is still in his/her healing period and able to return to work with restrictions, but his/her restrictions limit the number of hours he/she can work or force a pay reduction, the worker may be entitled to Temporary Partial Disability (TPD) payments. TPD payments cover a portion of the difference between the workers' take home pay and his/her average weekly wage at the time of injury (assuming there's a wage loss).
- Vocational rehabilitation or job retraining
- In the event of a fatal injury or illness, income replacement, death benefits, and funeral or burial costs
Importantly, in most cases, workers in Wisconsin have the right to receive these benefits regardless of how a job-related injury or illness happened or who was at fault. You can claim workers’ comp even if you caused the accident or condition that resulted in you getting hurt or sick.
Claims and Decisions
To obtain workers’ comp benefits in Wisconsin, workers should promptly report a work-related injury or illness to their employer and seek immediate medical attention. Once an employee has taken these steps, it’s generally up to the employer to notify the workers’ compensation insurance company.
The insurer must, in turn, notify the Wisconsin Department of Workforce Development - Worker’s Compensation Division (DWD) and then pay for the worker’s medical care and (when required) replace a portion of the worker’s lost earnings.
In other words, unlike in some states, injured or sick Wisconsin workers generally do not have to file paperwork to start a workers’ comp claim, but they should document how and when the injury happened. So long as they’ve promptly reported their injury or illness to their employer and sought medical treatment for it, their employer and the workers’ comp carrier should take care of paying their medical bills and, when a disability occurs, sending them replacement earnings within 14 days.
But sometimes, a workers’ compensation insurance company refuses to pay medical or income replacement benefits. For example, the insurer might dispute a doctor’s assessment that the worker cannot return to work because of a temporary or permanent disability. Or the insurer might disagree that a worker needs a particular type of medical treatment. Or the insurance might simply make a mistake in processing a claim. Or, based on their own medical support, the insurer can disagree that the work activities could have caused the injury. The insurer can also dispute the extent of the work injury based off their own medical support.
In those and similar cases, the insurer might partially or totally deny a workers’ comp claim and refuse to pay it. If that happens, the insurer must inform the worker of its decision in writing.
Wisconsin workers who receive notification from an insurance company of a partial or total workers’ comp claim denial generally have the right to dispute it through a multi-tiered review process. The DWD uses a variety of terms to describe each stage of that process, but for simplicity, we refer to all of them as appeals.
An appeal is a request for an authority to review a workers’ compensation insurance company’s partial or total claim denial. It involves presenting evidence and arguments in writing and, sometimes, making a case in a courtroom trial-type setting.
In Wisconsin, a worker who disagrees with a workers’ comp claim denial has the right to appeal and have it reviewed:
- If an injured worker files an appeal without an attorney, the DWD has authority to schedule an informal, pre-hearing conference with an Administrative Law Judge (ALJ) to resolve the dispute:
- Next, in a formal hearing with an ALJ who either works through the DWD’s Worker's Compensation Division or the Office of Worker's Compensation Hearings (OWCH);
- Next, by the Wisconsin Labor & Industry Review Commission (LIRC), without a hearing; and
- Finally, by the Wisconsin courts.
To be clear, nothing requires a worker to press a workers’ comp appeal through each of these levels of review. But the worker has the legal right to do so. And the experienced workers’ comp appeals team at Nicolet Law Accident & Injury Lawyers can handle the entire process for them.
Here’s Why You Need Our Workers’ Comp Lawyers
If you disagree with a Wisconsin workers’ comp claim decision you’ve received, we strongly urge you to contact an experienced lawyer immediately. Nicolet Law Accident & Injury Lawyers offers a free consultation to anyone in that situation. In a consultation, a member of our team can learn about your circumstances and explain your potential options for pursuing an appeal.
Do not try to handle the workers’ comp appeal process on your own. If you want to achieve the most favorable result possible in a Wisconsin workers’ comp appeal, you will need a skilled lawyer by your side from the get-go. Here’s why.
The Complicated Laws Can Trip You Up
The idea of workers’ comp is simple—workers should not have to pay for harm they suffer on the job. But its implementation is anything but straightforward. Workers’ compensation law is a complicated topic. It involves interpreting densely worded statutes and regulations. Furthermore, workers' comp has its own language and it's easy for terminology like MMI, TTD, TPD, PPD, PTD, and AWW to overwhelm you.
The success or failure of a claim can turn on subtle facts or nuanced legal principles.
A workers’ comp appeal, in other words, isn’t something you can wing your way through. There’s a good chance most of the issues will fly right over your head. And the workers’ compensation insurance company you’re up against handles disputes like yours every day. It’s a mismatch and a recipe for disaster.
To make it a fair fight, you will need a lawyer who has as much experience and sophistication as the insurance representatives who denied your claim and the hearing officers who will decide your appeal. Nicolet Law Accident & Injury Lawyers is that kind of team.
Early Mistakes Can Doom Your Appeal
Wisconsin offers multiple levels of appeal in workers’ comp cases, but that doesn’t mean you have the opportunity to present your case multiple times. Just the opposite. By and large, you only get one shot at choosing the evidence and legal arguments to make in favor of your appeal of an adverse claim decision. That happens at the formal hearing before an Administrative Law Judge.
At every appeal stage after that one, you’re generally stuck with the facts and points of law you chose to rely on earlier.
Mistakes in the early stages of a workers’ comp appeal, in other words, can cost you dearly. For example, if you forget to present a key piece of evidence in your first hearing, you won’t use it later, even if its omission turns an otherwise strong appeal into a sure loser. The most reliable way to avoid making those sorts of costly mistakes is to have an experienced lawyer handle all stages of your workers’ comp appeal from the moment you receive your denial forward.
Services We Can Provide in a Wisconsin Workers’ Comp Appeal
Nicolet Law Accident & Injury Lawyers handles every step of the appeals process in Wisconsin workers’ compensation cases. We have the resources and sophistication to pursue appeals of any size or level of complexity.
Depending on our client’s needs, we can:
- Investigate the circumstances of a workplace injury or illness and identify its cause.
- Investigate whether an employer or insurer took appropriate steps in processing an initial workers’ comp claim.
- Review correspondence from a workers’ comp insurance company to a worker relating to a claim denial.
- Handle all further interactions between our client and a workers’ comp insurance company.
- Gather evidence and witness statements to support an appeal of an adverse claim decision.
- Work with medical or financial experts to develop additional support for our client’s case on appeal.
- Participate in an informal appeal hearing or other settlement negotiation on our client’s behalf.
- Present our client’s case on appeal in a formal hearing in front of an ALJ.
- Prepare the written filings necessary to take appeals from adverse decisions issued by an ALJ, the LIRC, or a state court.
- Take steps to enforce the terms of a favorable settlement or judgment.
At Nicolet Law Accident & Injury Lawyers, we recognize that having your workers’ comp claim denied can put you under significant financial strain. That’s why we routinely represent clients in workers’ comp appeals on a contingent fee basis. We begin working on our clients’ cases without charging upfront fees or billing by the hour. Instead, our fee consists of a percentage of any money we succeed in securing on our clients’ behalf. We only get paid if we deliver results.
Contact an Experienced Wisconsin Workers’ Compensation Appeals Lawyer Today
As a worker who got hurt or sick because of an accident or dangerous condition at work, you need and deserve the benefits guaranteed to you under Wisconsin’s workers’ compensation laws. But that doesn’t mean your employer’s workers’ compensation insurance carrier will make good on its obligations to you. Improper or illegal claim denials happen all the time, and when they do, you need an experienced lawyer to pursue an appeal on your behalf. Reach out to a Wisconsin personal injury lawyer.
Nicolet Law Accident & Injury Lawyers fights tirelessly for Wisconsin workers. We know the ropes of the workers’ comp appeals process and have a track record of success for our clients. If you suffered harm in connection with your work in Wisconsin and workers’ comp has denied your claim, contact us at (715) 377-2141 as soon as possible for a free consultation to learn about your rights and options.