If your Wisconsin workers' compensation claim was denied by the insurance company or your employer, you will receive written notice of the denial from your employer or the workers' compensation insurance carrier. Pay close attention to the written notice, as it contains information about how to appeal the denial of your workers' compensation claim. (For information on filing a claim in Wisconsin, see our article on Wisconsin workers' comp claims.)
The first step after you receive notice of your claim denial is to request a hearing. You will request a hearing from the Workers' Comp Division of the Wisconsin Department of Workforce Development. You can request the forms for a hearing through the Division (you can request a hearing application form online or by calling (608) 266-1340. The Division will then assign your case to an Administrative Law Judge.
The next best thing to do is to talk to an attorney. The appeals process is a complex legal process, involving sophisticated legal rules of procedure and evidence. If you do not present certain evidence at the initial stages of appeal, you may be prevented from introducing the evidence later on.
The Administrative Law Judge will hold a hearing regarding the denial of your workers' compensation claim. Before the hearing, if you aren't represented by an attorney, the Division will encourage you to do informal mediation to try to come to an agreement with your employer or the insurance company. If you can't settle, the judge will schedule a pre-hearing conference.
You will need to present medical evidence to support your claim. The evidence can be a written opinion from your doctor. If the dispute is whether your condition is work-related, you must have an opinion from a physician, chiropractor, or psychologist. A dentist, physician assistant, or advanced practice nurse prescriber cannot attest to what caused your injury, but can write an opinion about your diagnosis and recommended treatment.
If you receive a denial from an administrative law judge should note and want to make a workers' compensation appeal to the Labor Commission, you have only 21 days to act. Therefore, it is important to get acquainted with the process quickly and to take immediate action.
Appeals are first handled by the Labor and Industry Review Commission (LIRC), an independent administrative agency with the authority to review and change decisions made by administrative judges in certain types of cases, including workers' compensation cases.
If you want to appeal, you should file a petition with the LIRC that outlines the reasons you disagree with the judge's decision. The LIRC provides a form and allows petitions to be filed online or directly with them in Madison. You can also submit petitions to the offices of the Workers' Compensation Division in Madison, Milwaukee, or Appleton.
If you are dissatisfied with the decision of the Labor and Industry Review Commission, you may be able to appeal to the Wisconsin circuit court. This opportunity is limited to cases in which there is a question of law and is not an option for someone who merely disagrees with previous decisions.
A "Compromise" is a settlement agreement reached between you and your employer or its insurance company. If the issue on appeal is denial of your claim, the insurance company may offer to settle with you and provide you a lump sump of cash to cover your medical expenses and compensate you for lost wages and any permanent disability. The Division must approve any compromise before it can go into effect.
You should consult a workers' comp attorney before accepting any offer of compromise to ensure that you understand what rights you are giving up by making the agreement. In the vast majority of cases, a compromise will terminate your workers' compensation claim, so you are ineligible to receive any additional workers' compensation benefits outside of what is provided in the compromise.
When most people think about appealing a workers' compensation decision, they focus on an injured employee's rights to appeal. It is important to note, however, that Wisconsin workers' compensation law allows either party to appeal benefits that are denied or granted. This means that employers or insurance companies can appeal to block your individual's access to benefits or to have them decreased.
You are much more likely to win workers' comp benefits and/or get a larger amount of money for permanent disability and future medical costs if you hire a skilled workers' comp attorney to represent you during settlement talks and hearings.