Why would my claim be denied?
There are a number of reasons your employer’s insurance carrier may decide to deny your Wisconsin workers’ compensation claim and what to do about denial of claims.
Delay in filing: While it is recommended that you notify your employer of your workplace injury or job-related illness immediately, you have up to two years from the date of the injury to file a claim. Failure to comply with this deadline could result in the forfeiture of workers’ compensation benefits, which cover the cost of medical expenses, lost wages, and vocational rehabilitation and retraining. There is no time limit to report an occupational illness.
Insurance company does not believe injury or illness was job-related: If your claim states that you received head trauma or a back injury while at work and the insurer has reason to believe that those injuries—or any alleged workplace injuries—occurred anywhere other than at work, they may deny your claim.
Injuries are consistent with a previously documented physical problem: An insurance company may refute your claim if the injury you sustained at work is due to a previous physical impairment that was aggravated by your work. For example, if you suffered a knee injury in a high school football game and then re-injured your knee several years later while on the job, your employer’s insurance company may find that grounds for denial of workers’ compensation benefits.
What do I do if my claim is denied?
The most important step to take following the denial of your workers’ compensation claim is to contact an experienced Wisconsin workers’ compensation benefits attorney who will assess your claim and offer skilled legal advice regarding the next course of action. Some Wisconsin workers’ compensation disputes can be settled through methods of alternative dispute resolution (ADR) such as mediation or arbitration.
If ADR is not an option, Attorney Lisa Pierobon Mays will help you formally request a hearing before an Administrative Law Judge (ALJ), where she will vigorously represent your interests as an injury Wisconsin worker.