Attorney Lisa Pierobon Mays is dedicated to fighting for injured workers, ensuring they receive the compensation they deserve. Recently, she successfully represented Rosa, a hardworking immigrant mother from Mexico, in a contested Administrative Law Hearing, securing the workers’ compensation benefits the insurance company tried to deny.

Rosa’s Story: A Journey of Hard Work and Sacrifice

Rosa immigrated to the United States in 2015, determined to build a better future for her three daughters. With limited options, she turned to housekeeping—the only industry she knew well. She found steady work at a large apartment complex, where she remained employed for nine years. Rosa built a reputation as a reliable, hardworking employee, known for her strong work ethic, good attendance, and ability to handle physically demanding tasks without restrictions.

Her job as the main housekeeper required continuous movement, lifting, bending, and carrying heavy loads. She rarely took breaks and was only seated during her designated lunch period. Outside of work, Rosa led an active, fulfilling life—biking, fishing, snow playing, and playing basketball with her daughters. She also took daily walks with her 70-pound Husky to the park.

Rosa was in excellent health, with no history of back pain or prior injuries. She never smoked, drank, or used drugs. But on Monday, October 4, 2021, everything changed.

The Workplace Injury That Changed Everything

On that Monday, Rosa was performing a routine task—emptying an outdoor dog waste bin that was about three to four feet tall and securely attached to a pole. As she attempted to remove the plastic bag, she realized it was stuck on a screw inside the bin. Using both arms, she applied force to dislodge it. Suddenly, the bag released, and the unexpected momentum sent Rosa falling backward onto the hard asphalt surface.

The impact was brutal. A sharp, stabbing pain shot through her lower back and into her left leg. She lay on the ground, unable to move, her body overcome with pain. As tears streamed down her face, two concerned residents rushed to her aid, bringing a chair for support while they called an ambulance.

At the hospital, Rosa was diagnosed with a serious lower back injury, and doctors immediately restricted her from returning to work. She was placed on a treatment plan, but as time went on, her condition did not improve.

A Battle Against the Insurance Company

Despite acknowledging Rosa’s injury, the workers’ compensation insurance carrier refused to take responsibility for the full extent of her disability. They claimed that she suffered only a minor strain and had fully recovered—a blatant misrepresentation of her medical reality.

To justify their decision, they relied on an outdated and incomplete medical evaluation from an adverse examiner who:

• Ignored three MRIs that showed nerve root encroachment, a condition that matched Rosa’s pain symptoms.
• Failed to conduct a full neurological assessment of Rosa’s left leg, ankle, and foot.
• Did not ask Rosa to remove her shoe and orthotic, missing the fact that she could not move her toes or bear weight on her left heel.
• Contradicted his own findings, noting that Rosa had limited lumbar mobility, positive straight leg raises, difficulty walking, and reliance on crutches and an AFO brace, yet still concluding that she had healed.

With this flawed evaluation, the insurance company denied further treatment and compensation, leaving Rosa in pain and without financial support.

The Medical Evidence That Proved Rosa’s Disability

In contrast, Rosa’s treating medical specialists provided extensive evidence proving the severity and permanence of her injury. Since January 2022, Rosa had undergone:

• 1.5 years of physical and water therapy, which improved mobility but did not relieve pain.
• Multiple cortisone injections, all of which failed to provide lasting relief.
• Neurological and surgical consultations, with no viable treatment options left.

Her physician collaborated with an Orthopedic Manual Therapist, who conducted a Functional Capacity Evaluation. The results were clear: Rosa could not even perform sedentary work.

A Vocational Specialist later reviewed all medical records and concluded that Rosa was permanently and totally disabled for employment purposes.

Justice for Rosa: A Hard-Fought Victory

At the Administrative Law Hearing, Attorney Lisa Pierobon Mays challenged the insurer’s flawed medical assessment and presented overwhelming evidence of Rosa’s permanent disability. She highlighted the clear discrepancies in the adverse examiner’s report, demonstrating that the insurance company’s denial was based on incomplete and misleading information.

Her compelling arguments, supported by Rosa’s credible testimony and thorough medical and vocational evidence, left no room for doubt. The court ruled in Rosa’s favor, granting her the workers’ compensation benefits she was rightfully owed.  The benefits of:

*Lost Time from Work  (termed TTD in Wisconsin) with NO offset for Long Term Disability Benefits already paid to her for the same time period;

*15% Permanent Disability rating (termed PPD) in Wisconsin;

*Payment of all of Rosa’s medical treatment expense and reimbursement of her medical mileage, and;

*The Insurance Carrier will continue to be responsible for all future medical treatment and potential for future claims.

The Judge did reserve ruling on an award for Rosa’s claim for loss of earning capacity because she had not attempted to return to the workforce in any capacity since her injury or attempted any vocational rehabilitations.  Mays Law Office will pursue this claim on Rosa’s behalf in the near future once she has achieved better English language skills and attempted to return to work and/or seek services with the Department of Vocational Rehabilitation.

A Life Forever Changed

Before her injury, Rosa was an independent, energetic mother, fully engaged in her daughters’ lives. She worked hard to provide for her family, balancing work and recreation with ease. Now, her injury has taken away her ability to work and enjoy the activities she once loved.

She struggles with chronic pain, mobility limitations, and the emotional toll of losing her independence. Tasks that were once simple—cooking, cleaning, even walking—are now difficult and exhausting. Despite these challenges, Rosa remains determined to rebuild her life. Thanks to Attorney Pierobon Mays’ tireless advocacy, she now has the financial support needed to focus on her health and care for her daughters.

Attorney Lisa Pierobon Mays – Fighting for the Rights of Workers

Attorney Lisa Pierobon Mays continues to fight for injured workers, ensuring they are not ignored, dismissed, or denied their rights. Insurance companies may try to minimize claims, but with a skilled attorney, workers can get the justice they deserve.

For those struggling with workers’ compensation denials, Attorney Pierobon Mays is ready to stand up, fight back, and win. Because every worker—regardless of their background—deserves fair treatment under the law.

As discussed last month, we have seen a recent trend of insurance companies denying injured employees’ claims for workers’ compensation benefits. As a result, if you have recently had your workers’ compensation claim denied, you are not alone. In this situation, it is essential to make sure you know your options—and to make sure you take action before you lose the options you have available.

So, what can (and should) you do?

While some workers’ compensation denials are justified, many are not. If your denial was unjustified, you can file an appeal. Keep reading to learn about the grounds for filing an appeal, the steps involved in filing an appeal, and why it is essential to hire an experienced workers’ compensation lawyer to represent you (which costs you nothing out-of-pocket).

What You Need to Know if Your Workers’ Compensation Claim Was Denied

The most important thing you need to know is that a denial is not necessarily the end of your workers’ compensation claim. If your denial was wrongful, you have clear legal rights, and an experienced workers’ compensation lawyer can assert your legal rights on your behalf. Here are seven more essential facts to know if your workers’ compensation claim was denied in Wisconsin:

1. Why Was Your Workers’ Compensation Claim Denied?

When facing a workers’ compensation denial, one of your first steps should be determining why your claim was denied. This will then allow you (or your lawyer) to determine if you have grounds to file an appeal.

As we said above, some workers’ compensation denials are justified. For example, if you are not an eligible employee or did not file your workers’ compensation claim in time, you may not be entitled to benefits (though you may have other options for seeking financial compensation). However, filing an appeal could be your next step if your denial was unjustified, which is not uncommon.

2. Is the Denial Unjustified?

When is a workers’ compensation denial unjustified? As we discussed in our previous article, some of the most common reasons for workers’ compensation denials include the following:

• Not reporting the work injury promptly
• Inadequate medical documentation of the injury
• Inadequate other evidence of the injury or its cause
• A dispute about whether the injury is work-related
• A dispute about a pre-existing condition
• Violations of company policy
• Failure to cooperate during the claims process
• Missing deadlines during the claims process
• Employee classification issues
• Inconsistent or conflicting statements

While these can all potentially be legitimate grounds for denying a workers’ compensation claim, insurance companies frequently use these as excuses to unfairly deny benefits to injured workers unfairly. Your workers’ compensation lawyer will be able to determine if your denial was unjustified, and if it was, your lawyer will assist you with fighting for the benefits you deserve.

3. Do You Have the Documentation You Need to Prove Your Right to Benefits?

In some cases, overcoming a workers’ compensation denial involves providing additional documentation to the insurance company. While workers’ compensation insurance companies are obligated to process injured employees’ claims in good faith, they do not have to pay benefits if there is a legitimate question about whether benefits are owed.

Once you determine the reason for your denial, one of the following steps is determining if you have (or can obtain) the documentation you need to prove your right to benefits. Your workers’ compensation lawyer can assist with this as well, and, depending on the circumstances, it may be possible to submit this additional documentation and secure the benefits you deserve without going through the formal appeals process.

4. Filing a Workers’ Compensation Appeal

If your employer’s insurance company is unwilling to pay the benefits you deserve, you will likely need to file a workers’ compensation appeal. Due to the stakes and complexity of the issues involved, having an experienced workers’ compensation lawyer on your side is essential.

You will need to file your appeal with the Wisconsin Workers’ Compensation Division. The Division’s Alternative Dispute Resolution (ADR) Unit will handle your appeal. Depending on the circumstances, at this stage, you may need to participate in informal alternative dispute resolution or attend a hearing at the ADR Unit, or both.

5. The Informal Alternative Dispute Process

The informal alternative dispute process allows you to obtain the benefits you deserve without going to a formal hearing. The ADR Unit can require insurance companies to participate in the formal hearing process; however, it cannot require them to agree to pay benefits.

6. Formal Hearings Before the Workers’ Compensation Division ADR Unit

If the informal alternative dispute process is unlikely to be effective or fails to produce a favorable outcome, you have the right to fight for the benefits you deserve at a formal hearing before the Workers’ Compensation Division ADR Unit. An administrative law judge (ALJ) at the ADR Unit will hear arguments and evidence from both sides, and then it will render a binding decision.

7. Appeals to the Labor and Industry Review Commission (LIRC) and Circuit Court

While the ALJ’s decision is binding, it is not necessarily the final word on your workers’ compensation claim. If you disagree with the decision, you can file another appeal with the Labor and Industry Review Commission (LIRC). If the LIRC rules against you, you can take your claim to Circuit Court. All of these are formal legal procedures that also require experienced legal representation.

Discuss Your Claim with an Experienced Madison Workers’ Compensation Lawyer for Free

Are you dealing with a workers’ compensation denial in Wisconsin? If so, we encourage you to contact us for a free, no-obligation claim assessment. To speak with an experienced Madison workers’ compensation lawyer at Mays Law Office in confidence as soon as possible, call us at 608-305-4518 or tell us how we can reach you online now.