Denial of your workers’ comp claim is, unfortunately, not a rare experience for people. Employers and insurers often look for reasons to deny a claim, whether a new one or one based on an aggravated injury. However, many of the claims are denied for technical reasons that can be fixed, or a misunderstanding of the medical evidence. With the right legal help at your side, you can pursue the compensation you are owed.
The Wisconsin workers’ compensation lawyers at Axis Legal, LLC are ready to help you. You are not alone, and you have legal rights.
Why Wisconsin Workers’ Comp Claims Get Denied
Knowing why your claim was denied can help you fight back against the decision. Common reasons include:
- The employer disputes the injury happened at work
- The insurer claims there’s not enough medical evidence
- Delays in reporting the injury
- Allegations of a pre-existing condition
- Disputes over whether treatment is “reasonable and necessary”
- The employer tries to claim that you were not performing work duties at the time
Step 1: Carefully Read the Denial Letter
They must explain why they denied your claim. The denial letter may reference:
- Missing medical documentation
- Conflicting statements
- Employer disputes
- Questions about work-relatedness
- Issues with your work restrictions
Step 2: Talk to Your Doctor and Gather Medical Evidence
Medical documentation is very important to your case. After a denial:
- Ask your doctor to clarify your diagnosis
- Request updated work restrictions
- Ensure your provider clearly states the injury is work-related
- Gather treatment notes, imaging results, and referrals
If the insurer claims your injury is not work-related, a strong medical opinion can make or break your appeal.
Step 3: Contact the Wisconsin Department of Workforce Development (DWD)
If you can’t resolve the denial on your own, you are able to file an appeal with the Wisconsin DWD’s Workers’ Compensation Division. You do this, with the help of your attorney, by filing an Application for Hearing.
Once filed:
- Your case is assigned to an Administrative Law Judge (ALJ)
- Both sides exchange evidence
- A hearing is scheduled
This process is similar to a mini-trial.
Step 4: Prepare for the Hearing
At the hearing, the ALJ will review evidence from both sides. You may need to present:
- Medical records
- Witness statements
- Accident reports
- Job descriptions
- Work restrictions
- Wage information
The insurer will likely have legal representation so it is better for you to be represented too.
Step 5: Attend the Hearing
During the hearing:
- You may testify about how the injury happened
- Your doctor’s opinion may be submitted
- The insurer may present its own medical expert
- The judge may ask questions to learn more about the facts
After reviewing all evidence, the ALJ will issue a written decision. If the judge rules in your favor, the insurer must pay the benefits owed.
Step 6: If You Lose, You Can Appeal Again
If the administrative law judge denies your claim, you have the right to a different appeal. This time it goes to the Labor and Industry Review Commission (LIRC). After that, you may even be able to appeal to the Wisconsin Circuit Court or the Court of Appeals.
What Benefits You Can Still Receive After a Denial
A denial does not automatically eliminate your right to:
- Medical treatment
- Temporary disability benefits
- Permanent disability benefits
- Vocational retraining
- Mileage reimbursement
If your injury is legitimate and work-related, you may still receive full benefits once the dispute is resolved.
You Have the Right To Appeal a Denied Claim: Get in Touch With an Experienced Workers’ Comp Attorney in Wisconsin for Help
A denial can be very frustrating and stressful, but it doesn’t have to be the end of the road. In fact, many denials are done with the hope that you’ll just accept the ruling and not fight back. That leaves you stuck with the burden of your medical bills and lost time at work. It doesn’t necessarily have to be that way.
Worn down at work? Let the experienced Wisconsin workers’ compensation lawyers at Axis Legal, LLC review your case. Contact us today for a free, no-risk evaluation.