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What can I do if my workers' compensation claim is denied?

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When a person in Wisconsin suffers an injury on-the-job, they may find they are unable to work for a period time as they recover from the injury. This could be costly, as the worker may incur a hefty amount of medical expenses with no means to pay either them or their everyday living expenses if they aren't earning any wages. For these reasons, the worker may pursue workers' compensation benefits following a workplace injury.

Unfortunately, not every claim for workers' compensation benefits is approved. This can be distressing, especially if the worker feels they have a valid claim. However, it is possible to appeal a denied claim for workers' compensation benefits.

First a denied claim will be reviewed by a staff member of the Division's Alternative Resolution Unit. This person will determine what issues are being raised with regards to the denied claim. They will also ensure that the medical information submitted with the application for benefits supports the worker's claim. The staff member may decide that the dispute does not require a formal hearing. When this happens, an attempt will be made to try to reach a resolution informally.

If this resolution does not resolve the dispute, then a worker can ask for a formal hearing before an Administrative Law Judge. The hearing is legally binding. The ALJ will consider the information presented by both sides to the dispute. The ALJ will then issue a formal, binding order with regards to the dispute.

If a worker believes the ALJ's ruling is wrong, then he or she can have the claim reviewed by the Labor and Industry Review Commission. If the worker is not satisfied with the LIRC's ruling, his or her final option is to pursue an appeal with the circuit court.

So, if a worker's claim for benefits is denied, it does not have to be the end of the story. An appeal may be possible. Since most people do not have experience appealing a denied claim for workers' compensation benefits, it can help to seek professional legal guidance, so they can make informed decisions regarding their claim.

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Mays Law Office, LLC

6405 Century Avenue
Suite 103
Middleton, WI 53562

Phone: 608-535-4719
Fax: 608-257-0441
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