What is the Workers’ Compensation Process in Wisconsin?
As an employee in Wisconsin, it is up to you to protect your legal rights when you get injured on the job. This includes making sure you receive the workers’ compensation benefits you deserve. While workers’ compensation laws are designed to protect injured employees, securing benefits isn’t easy, and you must be able to navigate the process successfully to avoid unnecessary financial strain.
10 Steps In the Wisconsin Workers’ Compensation Process
How do you file a claim for workers’ compensation benefits in Wisconsin? Here is an overview of the major steps in the process:
1. Determine If You Are Eligible for Workers’ Compensation
The first step you need to take is to determine if you are eligible for workers’ compensation. While most employees (and most job-related injuries and illnesses) are eligible, there are some exceptions. If you are not eligible for benefits, you will need to speak with a lawyer about filing a different type of claim; and, in this scenario, you may need to avoid taking some of the other steps discussed below.
If you are an employee (i.e., you receive a regular paycheck and a W-2) and you got injured on the job, then you are most likely eligible to file for workers’ compensation benefits. But, to make sure, you should consult with a lawyer promptly.
2. Report Your Injury or Illness
Once you determine that you are eligible for workers’ compensation, the next step is to report your injury or illness to your employer. Under Wisconsin law, you must provide notice within two years, but it is best to file your injury or illness report as soon as possible. If your employer provides you a form to complete, you should complete the form; and, if you have questions or concerns, you should speak with a lawyer before returning the completed form to your employer.
3. Seek Medical Treatment
Seeking medical treatment—and following through with your medical care—is an important part of the workers’ compensation process in Wisconsin. If you don’t seek treatment, or if you ignore your doctor’s advice, this could prevent you from collecting the benefits you deserve. In Wisconsin, injured employees have the right to choose their own doctor, and you should avoid seeing a company doctor if at all possible.
4. Document Your Workers’ Compensation Claim
As you work through the recovery process, you should document your workers’ compensation claim to the best of your ability. For example, you should take detailed notes about what happened, record the hours and days you miss from work, and keep all of your medical records together in a file.
5. Find Out if Your Claim is Approved or Disputed
After you report your injury or illness to your employer, your employer will file a claim with its workers’ compensation insurance company. It has seven days to do so. At this point, you will be waiting to find out if the insurance company is going to approve or dispute your claim. If the insurance company approves your claim, it should provide immediate coverage for your medical expenses, and you should begin receiving disability benefits (partial wage replacement) as soon as you become eligible.
6. Pursue a Stipulation-of-Facts or Compromise Agreement if Necessary
If your employer’s insurance company disputes your workers’ compensation claim (as is often the case), you will need to decide on the best path forward. Frequently, this involves negotiating a stipulation-of-facts or compromise agreement. Your lawyer can advise you on whether either of these options makes sense in your case; and, if so, your lawyer can negotiate with the insurance company on your behalf.
7. Challenge the Denial of Your Workers’ Compensation Claim
If the insurance company is unwilling to negotiate a compromise, or if you receive a denial before hiring a lawyer, you will need to determine whether you have grounds to challenge the insurance company’s decision. There are several grounds for challenging workers’ compensation denials, although not all grounds will be available in all cases.
At this point, you may need to request a hearing before an Administrative Law Judge (ALJ) at the Wisconsin Department of Workforce Development (DWD). If you request a hearing, the insurance company is required to participate, and the ALJ may try to mediate an informal resolution before your hearing date arrives. If your case goes to a hearing, your lawyer will present your claim to the ALJ, the insurance company will present its defenses, and then the ALJ will render a binding decision.
8. Be Prepared to Deal with Other Challenges
While dealing with a denial is one possibility, you may need to be prepared to deal with various other challenges as well. For example, underpayment of disability benefits is not uncommon, and insurance companies will frequently try to terminate injured employees’ disability benefits prematurely. When you have a workers’ compensation claim, it is important to know your legal rights, and you will want to contact your lawyer promptly if you believe that you are being treated unfairly.
9. Go To Court if Necessary
Even if you take your claim to a hearing and the ALJ rules against you, this is not necessarily the end of your workers’ compensation claim. If you believe that the ALJ’s ruling is incorrect, you can have your lawyer take your claim to court.
10. Determine if You Have a Claim Outside of Workers’ Compensation
Finally, when going through the workers’ compensation process as an employee, it is also important to determine if you have a claim outside of workers’ comp. While your benefits can provide a financial lifeline, they will not cover all of the financial and non-financial costs of your injury or illness. If you have a claim outside of workers’ comp, you may be entitled to additional compensation—including full compensation for your loss of income, pain and suffering, and other losses.
Discuss Your Legal Rights with an Experienced Wisconsin Workers’ Compensation Lawyer
Are you dealing with a job-related injury or illness? If so, we encourage you to contact us for more information. To speak with an experienced Wisconsin workers’ compensation lawyer in confidence, call 608-257-0440 or request a free consultation online now.