Denied Workers Compensation in Wisconsin

Denied Workers Compensation in Wisconsin

Denied Workers Compensation?

In January 2022, an injured worker called Mays Law Office.  For privacy reasons let’s call this injured worker “J.C.”  J.C. visited our website Mays Law Office and saw that we offer free legal consultations with an attorney.  Immediately J.C. was connected to Attorney Lisa Pierobon Mays.  J.C. proceeded to tell Lisa that she got hurt at work back in November 2020.  J.C. stated that she started her workday symptom-free but while working repetitively on a machine containing a diecast mold, she felt and heard a horrible popping sensation in her right shoulder while aggressively scrubbing the mold with her outstretched right arm.   Lisa listened to J.C.’s story and then started asking some poignant questions, like did she report the injury to her supervisor?  Did she seek timely medical treatment?  What medical treatment had she received, and what was the diagnosis and prognosis of her right shoulder injury according to her doctors?    

Pretty quickly Attorney Pierobon Mays could see that J.C. had done everything right in reporting the injury and seeking medical treatment that same day, yet still the workers compensation carrier was giving her the run-around as to accepting her claim for workers compensation benefits.  J.C.’s claim had been bounced around to three different insurance adjusters, questions by J.C. to adjusters were often left unanswered, referral for medical treatment, like an MRI was delayed pending slow approval by the workers compensation adjuster, and then only one day before her pre-scheduled right shoulder surgery in August 2021, approval for the rotator cuff surgery was delayed by the workers compensation insurance carrier demanding that she first see their doctor, termed an “Independent Medical Examiner.”  J.C. had been suffering with pain in her right shoulder for almost 9 months and now, one day before her much needed surgery, it was being delayed!  Regardless, J.C. complied, cancelled her surgery, and saw the insurance company’s doctor.  Despite repeated calls by J.C. to the insurance carrier, she never heard anything more from the insurance company for another 2 months.  Then in November 2021, J.C. got a letter stating that the workers compensation insurance carrier was denying all benefits for any care, treatment, or disability related to her right shoulder.  J.C. was dumb-founded and angry as a whole year of pain had gone by and a very needed surgery was not going to be covered.  Moreover, her sore right shoulder was taking a toll on the rest of her body, specifically her left arm because it was trying to accommodate for her weak, dominant, right arm.   

Attorney Lisa Pierobon Mays heard enough and encouraged J.C. to come into Mays Law Office located in Middleton, Wisconsin.  An appointment was scheduled for the following day and J.C. was instructed to  bring all of her paperwork (correspondence, notes, medical notes) so that they could review it together and come up with a plan of attack.  The following day, J.C. met with Attorney Lisa Pierobon Mays and it was quickly discovered that the delay and denial of medical treatment by the workers compensation insurance company was erroneous and likely made in bad faith, which in Wisconsin is filed as a penalty claim and can be worth up to $30,000.  In reviewing the insurance company’s doctor report, it was clear that he believed that the right shoulder surgery was necessary and related to the work that J.C. had done while working on the machine back in November 2020.  Attorney Pierobon Mays told J.C. that quick measures had to be taken to hold the workers compensation insurance carrier accountable and responsible.  The goal was to get the surgery back on the calendar as soon as possible; J.C. hired Lisa to move forward in her representation. 

Attorney Lisa Pierobon Mays immediately filed the necessary paperwork, alerting the head judge for the State of Wisconsin Department of Workforce Development (termed “DWD”) that J.C.’s claim required special attention due to the alarmingly illegal decisions made by the workers compensation insurance carrier.  In turn, the State responded immediately by assigning the claim to an administrative law judge who within two days reviewed Attorney Pierobon Mays’ submissions and agreed that the denial was clearly erroneous.  The Judge ordered the insurance carrier to approve the surgery, based on their own doctor’s report that such surgery was reasonable, necessary, and related to the November 2020 work injury.  Fearing the repercussions of its error, the workers compensation insurance carrier quickly hired its own lawyer.  Yet, even the insurance company’s lawyer agreed with Attorney Pierobon Mays’ position that J.C.’s claim for benefits had been erroneously denied.  Attorney Lisa Pierobon Mays diligently worked with opposing counsel to get J.C.’s worker compensation injury claim back on track.  Surgery is now scheduled for right shoulder to be done in a few weeks and lost-time benefits for missing work will be paid to J.C. without issue or delay from the day of surgery forward.  All medical treatment will also be paid by the workers compensation carrier.     

While it is a happy ending that J.C.’s claim is now being handled properly, consider the cost it took to get it there.  J.C. suffered ongoing pain, delayed medical treatment, personal and financial stress, a fatigued body overcompensating for an injured arm, and now attorney fees of 20% deducted from her lost-time benefits.  All of this needless suffering because the insurance company failed to treat J.C. fairly and legally according to the laws of Wisconsin.  This story is tragic but not uncommon.  Workers’ compensation injury claims are often not handled properly.  Insurance adjusters come and go causing files to be regularly transferred to a new claims adjuster; attention to detail and accuracy is often lost when adjusters are changed.  Moreover, insurance adjusters are many times downright rude, demeaning, and condescending to injured Wisconsin workers.  Injured workers are made to feel like they have done something wrong in simply filing a workers compensation claim.   The injured worker’s credibility and integrity is regularly questioned and assaulted by adjusters who make them feel like they are only money-seeking.  The penalty claim in Wisconsin for Bad Faith rarely gives the injured worker back what they have lost as the award (up to $30,000) is not guaranteed because it is based on many more complicated factors.

Mays Law Office is proud of the work it did for J.C. and takes on every call and claim with an eye toward an aggressive and effective approach to keep workers compensation insurance companies responsible and accountableIn sum, never assume you are being treated fairly by an insurance company.  Call Attorney Lisa Pierobon Mays today at 608)257-0440.



10 Important Facts about Workers’ Compensation in Wisconsin

10 Important Facts about Workers’ Compensation in Wisconsin

You got injured or sick on the job. Do you qualify for workers’ compensation benefits? If so, what do you need to do to collect the benefits you deserve? Here are 10 important facts about filing for workers’ compensation benefits in Wisconsin:

1. Workers’ Compensation Covers “Employees”

The first thing you need to know about workers’ compensation is that benefits are available to “employees.” If you are an independent contractor, then you generally are not eligible to receive benefits.

Most workers in Wisconsin are employees. If you work for a company, receive a regular paycheck, and receive a W-2 at the end of the year, then you almost certainly qualify. If you receive 1099 instead of a W-2, this suggests that you are an independent contractor—although it is possible that you are being misclassified.

2. Most (But Not All) Employees Are Covered

Wisconsin law requires most employers to carry workers’ compensation insurance that covers their employees. But, there are a few exceptions. For example, farms are generally excluded, and some employers are subject to federal workers’ compensation laws instead of Wisconsin’s workers’ compensation statute.

The law also excludes certain types of employees from workers’ compensation eligibility. Domestic workers and volunteers are two examples. But, as the Wisconsin Department of Workforce Development (DWD) notes, “[n]early all workers in Wisconsin are covered.” So, if you have gotten injured or sick on the job, it is worth speaking with a Madison workers’ compensation lawyer about your legal rights.

3. The Uninsured Employers Fund Covers Employees Whose Employers Don’t Have Insurance

While Wisconsin law requires most employers to carry workers’ compensation insurance, not all employers follow the law. To protect employees whose employers don’t follow the law, the Wisconsin DWD has established the Uninsured Employers Fund (UEF). If you are entitled to workers’ compensation benefits and your employer doesn’t have insurance, you can hire a lawyer to help you file a claim with the UEF.

4. Workers’ Compensation Covers Physical and Mental Harm in Wisconsin

As the Wisconsin DWD explains, an “injury” for workers’ compensation purposes is, “any mental or physical harm due to workplace accidents or diseases.” The DWD provides the following examples of physical and mental harm:

  • Burns
  • Crushing injuries
  • Cuts and bruises
  • Dermatitis
  • Disfigurement
  • Emotional stress
  • Fractures
  • Hernias
  • Hysteria
  • Infections
  • Loss or paralysis of a body part
  • Loss of hearing or vision
  • Nervous disorders
  • Respiratory diseases
  • Sprains and strains
  • Stiffness
  • Traumatic neurosis

It is important to emphasize that these are just examples. Many more types of job-related injuries and illnesses are covered. If you have any questions about your eligibility you should talk to a Madison workers’ compensation lawyer promptly.

5. You Can (and Should) Choose Your Own Doctor

After suffering a job-related injury or illness, it is important to seek treatment promptly. Under Wisconsin law, you have the right to see “any physician, psychologist, chiropractor, dentist, physician assistant, advanced practice nurse prescriber or podiatrist who is licensed to practice in Wisconsin.” Your employer cannot tell you where to go for treatment; however, you may have to submit to an examination by a doctor who has been selected by your employer. If you receive a request for an “independent medical exam” (or “IME”), you should discuss the request with your lawyer before submitting to the examination.

6. Workers’ Compensation Covers Must (But Not All) Forms of Medical Treatment

If you have a workers’ compensation claim in Wisconsin, you are entitled to receive the treatment you need to get better or to achieve your “maximum medical improvement” (or “MMI”). However, not all forms of treatment are covered. For example, Wisconsin law specifically excludes physical therapy, massage, and pain clinic services from coverage, “unless the treatment is ordered by a doctor or . . . the employer or insurance company specifically agrees in advance to pay for such treatment.”

7. You Must Notify Your Employer of Your Injury or Illness

While you might be hesitant to tell your employer that you have an injury or illness, this is a key step in the process of filing for workers’ compensation benefits. The Wisconsin DWD recommends filing a report within 30 days, but you should generally report your injury or illness as soon as possible. Technically, you have up to two years to file a report with your employer. However, waiting this long can make it much more difficult to collect the benefits you deserve.

It is also important to understand that your employer cannot legally fire you or take other adverse employment action based on the fact that you decided to file for workers’ compensation benefits. Filing for workers’ compensation is your right, and you cannot be punished for exercising it.

8. You May Qualify for Temporary Disability, Permanent Disability, or Both

In addition to coverage for your eligible medical expenses, you may qualify for temporary or permanent disability benefits. You may also qualify for both. These benefits cover a portion of your lost wages while you are unable to work (or while you are only able to work in a limited capacity). Calculating your disability benefits requires a detailed understanding of Wisconsin’s workers’ compensation benefit schedule, and it is best to work with an experienced Madison workers’ compensation lawyer to ensure that you are seeking the maximum benefits available to you.

9. Workers’ Compensation Disputes are Common

From denying that employees’ injuries are work-related to underpaying employees’ benefits, workers’ compensation disputes are common. Hiring a lawyer will help minimize your risk of facing a dispute; and, if you encounter a dispute, your lawyer will be able to handle it for you.

10. You Can Hire a Madison Workers’ Compensation Lawyer at No Out-of-Pocket Cost

Finally, you can hire a Madison workers’ compensation lawyer to handle your claim at no out-of-pocket cost. At Mays Law Office, we help injured workers apply for benefits and deal with benefit denials. To discuss your workers’ compensation claim in confidence, contact us today.

Talk to a Madison Workers’ Compensation Lawyer for Free

Do you have a workers’ compensation claim in Wisconsin? If so, we can help. Call 608-257-0440 or contact us online to get started with a free and confidential consultation.