Accepted But Still Unpaid: How Attorney Pierobon Mays Held an Insurance Carrier Accountable
By Attorney Lisa Pierobon Mays
One of the most frustrating experiences an injured worker can face is having their workers’ compensation claim accepted – only to have benefits unnecessarily delayed for months.
Recently, Attorney Lisa Pierobon Mays of Mays Law Office successfully represented M.M., a health care employee, whose case demonstrates why injured workers often need experienced legal representation even after their claim has been conceded.
A Conceded Claim Shouldn’t Become a Battle
M.M. injured his left knee while working for a home health care company on April 25, 2025. The employer’s workers’ compensation carrier accepted responsibility for the injury and paid medical treatment throughout his recovery.
On August 22, 2025, Mr. M. reached his healing plateau. His treating orthopedic specialist, assigned a 5% permanent partial disability (PPD) rating to the left knee.
Under Wisconsin workers’ compensation law, payment of statutory PPD benefits should follow once the carrier has the necessary medical information.
Mr. M. promptly notified the workers compensation carrier of his permanent disability rating and requested payment.
Instead of issuing benefits, the adjuster responded that additional medical records were needed -even though the claim had already been accepted and this carrier had been receiving medical records throughout the claim.
Then…nothing happened.
Weeks Turned Into Months
Five weeks passed without payment.
Mr. M. again contacted the claims adjuster seeking an update. This time, he received no response at all.
With no explanation, no payment, and no communication, Mr. M. was forced to retain Mays Law Office on October 17, 2025 and now incur legal expense.
Mays Law Office immediately contacted both the insurance carrier and its defense legal counsel requesting a straightforward explanation:
Why had a conceded claim with an undisputed permanent disability rating still not been paid?
No meaningful explanation was provided.
Silence Is Not a Legal Defense
Over the following months, Attorney Pierobon Mays repeatedly requested the legal and factual basis for withholding benefits.
We received none.
No independent medical examination (IME) was scheduled.
No contrary medical opinion existed.
No medical evidence disputed the treating practitioner’s findings.
Yet benefits remained unpaid.
Faced with an unreasonable delay, our office filed a WKC-7 Hearing Application with the Wisconsin Department of Workforce Development seeking not only payment of benefits but statutory penalties for the carrier’s conduct.
Among the claims asserted were:
- Delay in payment under Wis. Stat. § 102.22
- Bad-faith delay under Wis. Stat. § 102.18(1)(bp)
- Violations of Wisconsin Administrative Code provisions governing prompt payment of workers’ compensation benefits
The Carrier’s Own Medical Examiner Agreed
Months later, an extraordinary fact emerged.
The workers compensation carrier’s own medical examiner completed his IME report on March 26, 2026. His conclusions supported payment of:
- Temporary Total Disability benefits;
- Permanent partial disability benefits;
- Outstanding medical expenses exceeding $20,000.
Yet that report was not immediately disclosed to Mr. M or his attorney, Attorney Lisa Pierobon Mays.
Instead, it was withheld for more than ten weeks, while benefits continued to go unpaid.
By the time the report was finally produced and only after the request of such by Attorney Lisa Pierobon Mays with only 2 weeks left before the rapidly approaching indemnity hearing.
Attorney Pierobon Mays of Mays Law Office had already warned both the workers compensation carrier and defense counsel months earlier that the denial lacked any reasonable basis.
After learning that the carrier’s own expert now agreed benefits were owed, Attorney Lisa Pierobon Mays strongly objected to the withholding of the report, admonishing opposing counsel that:
“As an officer of the DWD tribunal, you are expected to act with honesty and integrity to all parties. Your withholding of this report for another ten weeks is calculating and callous.”
Even then, no meaningful explanation or defense followed.
A Second Penalty Filing
Because benefits still had not been paid despite the carrier’s own medical evidence supporting payment, Attorney Lisa Pierobon Mays filed a SECOND occurrence of bad-faith and delay claims.
The legal issues included:
- Delay in payment under Wis. Stat. § 102.22
- Bad faith under Wis. Stat. § 102.18(1)(bp)
- Violations of Wisconsin workers’ compensation administrative rules requiring prompt handling of claims
Wisconsin law permits substantial penalties when an insurer acts in bad faith. Under Wis. Stat. § 102.18(1)(bp), the Division may award a penalty of the lesser of 200% of the compensation due or $30,000 for each occurrence of bad faith.
Our office also relied upon the principles established in Brown v. LIRC, demonstrating both the absence of any reasonable basis for denying benefits and reckless disregard of that lack of a reasonable basis.
The Result
As the litigation progressed and the evidence became overwhelming, opposing counsel ultimately agreed to resolve the penalty claims.
The resolution resulted in:
- Payment of all outstanding workers’ compensation benefits;
- Payment of the previously delayed permanent disability benefits;
- Payment of unpaid temporary disability benefits;
- Payment of outstanding medical expenses;
- Reimbursement of attorney’s fees;
- Additional compensation recognizing the unnecessary inconvenience, stress, delay, and hardship Mr. M. endured because of the mishandling of his claim.
Why This Case Matters
This case illustrates an important reality.
Just because an insurance company accepts responsibility for an injury does not mean it will voluntarily pay every benefit owed.
Delays can become costly—not only financially, but emotionally—for injured workers trying to move forward with their lives.
Wisconsin’s workers’ compensation system provides protections against unreasonable delays and bad-faith claim handling. Those protections, however, often require experienced legal advocacy to enforce.
At Mays Law Office, Attorney Lisa Pierobon Mays believes insurance companies and their attorneys should be held accountable when they fail to honor their legal obligations. When benefits are wrongfully delayed, we pursue every remedy available under Wisconsin law.
Attorney Lisa Pierobon Mays believes that every injured worker deserves more than an accepted claim. They deserve to be treated fairly and when blatant mishandling of an injured workers claim is seen, Attorney Lisa Pierobon Mays demands justice.
Recent Comments