Wisconsin Workers Comp Claims: Eligibility, Filing and Appeals

Understand how workers' comp works in the state of Wisconsin.

The Workers' Compensation Division of the Wisconsin Department of Workforce Development administers the workers’ compensation program in Wisconsin. The vast majority of employers in Wisconsin are required to purchase workers’ compensation insurance from private carriers or be a self-insured employer. (Employers with three or more employees, or any employer with payroll of approximately $2,000 or more in payroll per year, must obtain workers’ compensation insurance or be self-insured.Only large companies who satisfy certain criteria can self-insure for workers’ compensation purposes.

The state also has an Uninsured Employers Fund to compensate injured workers if the employer is not insured.

Workers Who Are Covered by Workers' Compensation

Not all individuals working in the state of Wisconsin are covered by the workers’ compensation laws. Volunteers and independent contractors are not considered employees, and are therefore excluded from workers’ compensation coverage. Farm workers are not covered unless the employer has six or more employees on any twenty days in a calendar year. Separate federal statutes cover federal workers.

Work-Related Injuries Covered

Wisconsin workers’ compensation covered both physical and mental injuries. Conditions that develop over time, known as occupational diseases, are covered if the condition or disease is directly linked to the distinct conditions of the workplace.

If you travel for work, you are covered at all times during your work-related travels, unless you deviate from your work activities for purely personal reasons. Commuting to and from work is not considered work-related travel, and is not covered by workers’ compensation.

Filing a Wisconsin Workers’ Compensation Claim

The first step to getting workers' comp benefits in Wisconsin is to report the injury or occupational disease to your employer. Your employer will provide the necessary forms for you to complete and submit to the Wisconsin Department of Workforce Development. It is your employer’s responsibility to file the necessary paperwork with the workers' comp insurance carrier (which will then report your injury to the Wisconsin Worker’s Compensation Division).

Be prepared to provide detailed information about your claim, including date of the accident or injury, your current wages, medical records, and other supporting documents. These may or may not be requested at the initial filing of your workers’ compensation claim, but you will have to provide them upon request.

Workers’ Compensation Claim Denials

Your employer, if it is self-insured, or its workers’ compensation insurance carrier must notify you within 14 days of receiving notice of your injury if the insurer is still investigating your claim. If the insurance carrier denies your claim, the insurance carrier must notify you within seven days in writing of its decision to deny your claim.

Review the letter denying your claim very closely. The letter contains information about how to obtain a hearing to challenge the claim denial.

Workers’ compensation claims can be denied for a variety of reasons. Sometimes, the issues are simple, such as incomplete information or lack of the required supporting documents. Occasionally disagreements between doctor’s reports can lead to a claim denial. Alternatively, your employer may dispute that your injury occurred at work.

Appealing a Wisconsin Workers’ Compensation Denial

First contact your employer’s workers’ compensation insurance company to determine the reason(s) for your claim denial. Denial issues can often be settled through mediation, discussion, and/or providing additional supporting evidence.

If you cannot reach a quick resolution with the insurance carrier, request a hearing to challenge the denial of your workers’ compensation claim. If you can't settle the case after informal mediation and/or a pre-hearing conference with an administrative law judgeALJ), you will then attend a hearing before the ALJ, who will issue a decision regarding your claim. It is possible to appeal the ALJ decision to the Workers' Comp Division for review, and to the Wisconsin courts if necessary.

For more information, see our article on appealing a workers' comp denial in Wisconsin.

Wisconsin Workers’ Compensation Benefits

The workers' comp program pays for medical costs, temporary

Medical Benefits

Your employer will pay for all medical care reasonable and necessary for the treatment of your industrial injury or occupational disease.

In Wisconsin, you may choose your own doctor. The doctor can even be a chiropractor, psychologist, podiatrist, dentist, physician assistant, or advanced practice nurse prescriber licensed in Wisconsin. If you switch doctors during the administration of your claim, notify your employer and its workers’ compensation insurance carrier.

Your employer may also require you attend an independent medical examination. Your employer will choose the doctor(s) performing the exam. You must attend the examination, or your workers' comp benefits can be delayed or terminated.

Temporary Disability Payments for Wage Loss

If you are unable to work while recovering from your injury or illness for at least three days, you can receive wage loss payments, called temporary disability. You will receive 2/3 of the weekly wage you were making at the time of injury, subject to certain maximums. You will receive a check on a weekly basis, with the first check arriving approximately 14 days after your last day at work.

Permanent Disability Compensation

Permanent disability compensation is aimed at compensating workers for the permanent loss of function caused by a work-related injury or occupational disease. If you heal completely, you will not receive permanent disability compensation.

The amount of compensation you'll get for permanent disability is determined once you have reached maximum medical improvement, meaning your condition will not improve with additional treatments. Your doctor will determine how much, if any, permanent impairment you have related to your workers’ compensation claim.

The permanent impairment rating assessed by your doctor will be used to determine the amount of your permanent disability compensation. Specifically, the rating determines the number of weeks worth of compensation will be paid to you, and your weekly wage determines the weekly amount you are owed. The maximum weekly payment in 2012 is $312. The award is paid monthly, not in a lump sum.

When to Talk to a Workers' Comp Attorney

If you've been denied workers' comp benefits, you should hire an experienced workers' comp lawyer. Although you aren't required to have a lawyer when attending a hearing or a denial of claim meeting, having legal representation will ensure you receive the benefits that you are entitled to.

If your claim was accepted and you are trying to work out a permanent disability settlement with the insurance company, hiring a lawyer isn't as important, but a lawyer can almost always get you a better settlement that you could on your own.

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