Understanding workers' compensation in Wisconsin

Understanding workers' compensation in Wisconsin

What to do when your ongoing compensation is denied

When you're injured on the job, depending on the nature of the injury, you may need an extended period to recover. Wisconsin workers' compensation laws are intended to ensure you receive the compensation you need to weather the financial difficulties incurred from an injury on the job. But what happens when your employer and doctor disagree? If your health care provider says you need more treatment for your injury and your employer denies your ongoing workers' compensation, knowing your legal rights is essential. 

Wisconsin workers' compensation particulars

Under workers' compensation laws in Wisconsin, most companies are required to have workers' compensation insurance if they employ three or more people, or pay wages of $500 more in any quarter of a calendar year. That coverage exists to provide injured workers with the medical treatment they need and provide for lost wages, rehabilitation and retraining when necessary. The law allows workers all reasonable and necessary medical treatment. 

Understanding the health care providers involved in your case

It's important to know several health care providers may be involved in determining the correct course of action for your injury because their associations can lead to disagreements on the care you need. 

Your primary care physician is the provider you likely have seen in the past for care and may have seen when you were first injured. Your primary care physician or other health care provider may be the same as the treating workers' compensation doctor, but that is not always the case. 

The treating workers' compensation doctor is the provider treating you for your employment-related injury. This may be a different provider than your primary care provider, particularly if your treatment requires a specialist. 

In addition to these two providers, an independent medical exam (IME) doctor is hired by the insurance company to conduct medical exams on their behalf. The IME doctor is not treating you and has no duty to assist you with your healthcare, they merely give an opinion on whether the claimed injuries are work-related and the extent to whether the treatment was reasonable and necessary.  The IME doctors often disagree with the treating workers’ compensation doctor.  

When the IME doctor and treating doctors disagree either as to causation or course of treatment, there can be limits on the insurance payouts or denial of coverage altogether. And that can put you in a bind. For example, you may want to keep your job while healing from your injury and preventing more significant harm. If your claim is denied entirely or even partially and you believe your benefits should be greater, your dispute may be dealt with in one of two ways: an informal dispute resolution process or a formal hearing. 

If you don't have an attorney on your side, it's most likely you will enter into an informal alternative dispute resolution process. During this process, your claim goes to the Wisconsin Workers' Compensation Division's Alternative Dispute Resolution Unit, which will review your case. The ADR personnel may try to resolve the dispute between the two of you without a formal hearing. 

If the informal alternative dispute resolution process doesn't bring your claim to a satisfactory conclusion, you can apply for a formal hearing. Formal hearings are held with an Administrative Law Judge, and the judge's decision is legally binding. It is highly recommended that you retain an attorney for a formal hearing so that someone is looking out for your best interests. 

If you wish to dispute the judge's decision, you can appeal to the Wisconsin Labor and Industry Review Commission. If you disagree with their decision, you can appeal your case to the circuit court. 

Your due diligence

Ensuring your needs are met and your rights are protected requires some diligence. Here are some ways to protect yourself throughout the workers' compensation claim process.  

  • Write it down. Keep records of how much work you are able to perform or if you are unable to work entirely. If you cannot work at all, it's important to avoid risking being injured again. Your workers' compensation attorney can advise you on how to proceed.
  • Return to work, if possible. If you can function at your place of employment with restrictions, it's best to return to work so you can keep your job and continue to be paid even if your workers' compensation benefits are denied.  Ask for an accommodation. 
  • If you get re-injured, revisit the provider. At times, workers who return to the job may get re-injured. If that happens to you, inform your employer and follow up with the provider who treated you for the original injury and request that they provide documentation of the re-injury. This may help support your case. 

With all of these issues, workers’ compensation cases can become very complex.  For these reasons and more, securing a trusted workers' compensation attorney is key.  

Your workers' compensation attorney looks out for your interests

When there is a dispute about a claim — for example, if your health care provider feels you need additional treatment, and your claim is denied — having the support and legal advice you deserve is key to knowing and protecting your rights. You may wish to retain a workers' compensation attorney, like those at Johns, Flaherty & Collins, serving clients in La Crosse, Holmen and beyond. Employment and labor law is one of our practice areas. 

Cases involving labor law can become heated, and having a workers' compensation lawyer on your side can make all the difference, particularly when there is a dispute about your ongoing workers' compensation. The reality is that benefits are often initially determined by insurance companies, who always have lawyers on their side. Even if you have been denied your ongoing compensation, our workers' compensation attorneys may be able to help you recover lost wages as well as injury and medical treatment benefits. 

Consult with an attorney on your workers' compensation claim

To learn more about Wisconsin law related to workers' compensation, including information about benefits coverage, denial of a claim, and what to do if your employer does not have insurance, you can find that information at the Wisconsin Department of Workforce Development website

And if you've been injured at work and want to talk with an attorney about your rights and responsibilities related to workers' compensation, we can help. Having a lawyer looking out for your well-being is important, whether you’re just beginning the process of filing a claim or have been denied an ongoing workers' compensation claim. Give us a call to learn more about how an attorney can help you get the compensation you deserve for work-related injuries, lost wages or disability


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