Filing for Workers Compensation in 2025: A Guide for Wisconsin Residents

Filing for Workers Compensation in 2025: A Guide for Wisconsin Residents

If you’ve been injured on the job in Wisconsin, you may be entitled to workers’ compensation benefits. But, this doesn’t mean that filing for benefits will be easy. From strict deadlines to challenges that can arise along the way, there are several important issues to be aware of—and you will want to work with an experienced lawyer who can help you seek the full benefits you deserve.

So, what do you need to know about filing for workers’ compensation in 2025? Here is a guide for Wisconsin residents:

Who Can File for Workers’ Compensation in Wisconsin

As a general rule, workers’ compensation benefits are only available to employees. As the Wisconsin Department of Workforce Development (DWD) explains, “Nearly all employees in Wisconsin are covered. . . . [and] when talking about worker’s compensation, it is easier to discuss the exceptions.”

So, who isn’t covered? Independent contractors are not classified as employees under Wisconsin law, and, as a result, they generally are not eligible to file for workers’ compensation benefits. Wisconsin’s workers’ compensation statute also excludes:

  • Domestic workers
  • Certain religious and farm employees
  • Volunteers who receive no more than $10 per week

Additionally, certain types of employees are covered under federal workers’ compensation statutes instead of Wisconsin law. These statutes—which apply to federal employees, postal workers, railroad workers, and maritime workers, among others—have different eligibility requirements. If you’ve been injured or fallen ill on the job, an experienced workers’ compensation lawyer will be able to assist you with determining your eligibility.

How Long You Have to File for Workers’ Compensation

Technically, employees in Wisconsin typically have up to two years to file a claim for workers’ compensation benefits. When this two-year “limitations period” starts to run depends on the circumstances involved:

  • If you were injured in an on-the-job accident, the limitations period will typically run from the date of your accident.
  • If you have a work-related repetitive stress injury, the limitations period will typically run from the date that you first realized that you needed medical care.
  • If you are coping with an occupational illness, the limitations period will typically run from the date that you got sick (or, in some cases, from the date you realized you were ill).

These are just the general rules—various exceptions can apply, and the two-year limitations period can be extended to six or twelve years in some cases. However, while you may have years to file your workers’ compensation claim, it is best to file your claim promptly. Not only will this help you avoid unnecessary issues with your claim, but it will also help ensure that you receive the benefits you deserve as soon as possible.

How to File for Workers’ Compensation Benefits in Wisconsin

There are a few steps involved in filing for workers’ compensation benefits in Wisconsin. First and foremost, you should see a doctor to diagnose, treat, and document your work-related injury or illness right away. Under Wisconsin law, you have the right to see a doctor of your own choosing.

Once you have obtained treatment, your next priority should be to report your injury or illness to your employer. As the Wisconsin DWD also explains, “You should act to notify your employer… without delay. A delay may negatively affect your health and may even jeopardize your potential worker’s compensation benefits.”

After you report your injury or illness to your employer, your employer should begin the claims process with its insurance company. If it doesn’t, you can file a complaint with the Wisconsin DWD. In any case, it will be important to have an experienced lawyer on your side at this stage, as you need to make sure you do not unknowingly settle for less than you deserve.

Calculating Your Workers’ Compensation Benefits

What workers’ compensation benefits are you entitled to receive? The answer to this question depends on your specific circumstances. Generally speaking, three types of workers’ compensation benefits are available to eligible workers in Wisconsin:

  • Medical Benefits – These benefits should cover “all reasonable and necessary medical expenses” related to your workplace injury or illness.
  • Disability Benefits – If your injury or illness prevents you from working (or restricts your ability to work), you may be eligible for temporary or permanent disability benefits.
  • Vocational Benefits – If you need help getting back to work after your injury or illness, you may be eligible to receive vocational rehabilitation and retraining benefits as well.

The specific amount of benefits you are entitled to receive depends on your medical needs, your current wage or salary, how long you will be unable to work, and various other factors. Once again, an experienced workers’ compensation lawyer can help make sure you do not unknowingly leave any money on the table.

Dealing with Issues After You File Your Workers’ Compensation Claim

While some workers’ compensation claims go fairly smoothly, employees can encounter a variety of issues when pursuing their claims for benefits. Insurance companies deny workers’ compensation claims for various reasons, and many workers have their benefits terminated far too soon.

When you hire a lawyer to represent you, your lawyer can help you avoid unnecessary issues—and, if any issues arise, your lawyer can deal with them on your behalf. Depending on the circumstances, this may involve dealing with your employer (or its insurance company) directly, or it may involve filing a workers’ compensation appeal. In either scenario, it is critical to ensure that you are making informed decisions, as mistakes and oversights can leave you without the benefits you need for your recovery.

Schedule a Free Consultation with a Madison, WI Workers’ Compensation Lawyer Today

At Mays Law Office, we have decades of experience helping Wisconsin residents claim the workers’ compensation benefits they deserve. If you are dealing with a work-related injury or illness, we invite you to contact us for more information. To schedule a free consultation with a Madison, WI workers’ compensation lawyer as soon as possible, call us at 608-291-9402 or tell us how we can help online today.

ATTORNEY LISA PIEROBON MAYS WINS WORKERS COMPENSATION CASE FOR INJURED IMMIGRANT WORKER

ATTORNEY LISA PIEROBON MAYS WINS WORKERS COMPENSATION CASE FOR INJURED IMMIGRANT WORKER

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.

What Can I Do if My Workers’ Compensation Claim Was Denied in Wisconsin?

What Can I Do if My Workers’ Compensation Claim Was Denied in Wisconsin?

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.

New Worker’s Compensation Dashboard Highlights Injury and Claim Statistics in Wisconsin

New Worker’s Compensation Dashboard Highlights Injury and Claim Statistics in Wisconsin

The Wisconsin Department of Health Services recently launched a new workers’ compensation dashboard that provides information about workplace injuries and workers’ compensation claims in the state. The data published through the dashboard provide some interesting insights into trends, common injuries, and the compensation awarded to injured workers and their families. Here are some highlights based on the most-recent data available:

More than 20,000 Employees File Workers’ Compensation Claims in Wisconsin Each Year

According to the latest data in the dashboard, more than 20,000 employees file workers’ compensation claims in Wisconsin each year. While the total number of claims filed has dropped in the past couple of years, this is still a lot of claims.

On average, 76.7% of all workers’ compensation claims filed over the past five years were paid (with the most recent data coming from 2023). Of course, this means that 23.3% of workers’ compensation claims—or nearly one in four—are unsuccessful.

Strains Are the Most Common Injuries Leading to Workers’ Compensation Claims in Wisconsin

The Wisconsin Department of Health Services’ workers compensation dashboard shows that strains, sprains, and tears are the most common injuries leading to workers’ compensation claims by a fairly significant margin. Of the 126,738 claims filed from 2019 to 2023, 49,087 involved these types of injuries. According to the dashboard, the most common causes of workers’ compensation claims in Wisconsin are:

  • Strains, sprains, and tears
  • Slips, trips and falls
  • Miscellaneous causes
  • Being struck or injured by an object
  • Cuts, punctures, and scrapes
  • Getting caught in or under an object
  • Striking against or stepping on an object
  • Burning and scalding
  • Motor vehicle accidents

The dashboard also identifies the most common body parts involved in workers’ compensation claims in Wisconsin. From most common to least, the body parts most commonly injured in work-related accidents are:

  • Shoulders
  • Lower back
  • Knees
  • Fingers
  • Ankles
  • Wrists
  • Hands
  • Feet
  • Body systems

Manufacturing is the Most Dangerous Industry, But Transportation and Material Moving are the Most Dangerous Occupations

Based on the dashboard’s data, manufacturing is the most dangerous industry for workers in Wisconsin. Approximately one in five workplace injuries in Wisconsin involve manufacturing, and the manufacturing industry has a workers’ compensation claim rate of 9 per 1,000 full-time equivalent employees. The industries with the highest numbers of workers’ compensation claims in Wisconsin over the past five years are:

  • Manufacturing
  • Healthcare and social assistance
  • Retail trade
  • Transportation and warehousing
  • Public administration
  • Construction
  • Administrative and support services
  • Wholesale trade
  • Educational services

But, while manufacturing may be the most dangerous industry for workers in Wisconsin, drivers face the highest risk of getting injured on the job. According to the dashboard, the occupations with the highest numbers of workers’ compensation claims in Wisconsin over the past five years are:

  • Transportation and material moving
  • Production
  • Office and administrative support
  • Healthcare practitioners and technical services
  • Construction and extraction
  • Installation, maintenance, and repair
  • Building and grounds cleaning and maintenance
  • Healthcare support
  • Food preparation and serving-related occupations

Lifting Injuries and Shoulder Injuries Are Among the Most Expensive for Employers and Their Insurance Companies

Overall, the Wisconsin Department of Health Services’ workers compensation dashboard shows that lifting injuries are the most expensive for employers and their insurers. Self-insured employers and workers’ compensation insurance companies paid more than $17 million in total non-medical costs (lost time, permanent partial disability, and permanent total disability) for lifting injuries in 2023. Fall-related injuries are the next most-expensive, followed by: sprains, strains, and tears; pushing and pulling injuries; and injuries from twisting and repetitive motion.

Given that lifting injuries are so common, it is not a surprise that shoulder injuries are among the most expensive for employers and their insurers as well. Shoulder injuries accounted for approximately 20% of all non-medical costs paid in 2023, followed by injuries to the knees, lower back, ankles, wrists, and feet. In terms of the nature of workers’ injuries, sprains, strains, and tears are the most costly, followed by fractures and contusions.

Dozens of Wisconsin Families Are Forced to Cope with Fatal Workplace Accidents Every Year

Sadly, the dashboard’s data show that dozens of families in Wisconsin lose loved ones to fatal workplace accidents every year. While the dashboard does not provide detailed information on these fatal accidents, it is safe to assume that many of them occur in the state’s most-dangerous injuries and most-dangerous occupations, which we covered above. When workplace accidents lead to fatalities, spouses and other eligible family members are entitled to seek workers’ compensation death benefits under Wisconsin law.

Are You Struggling to Cope with the Effects of a Work-Related Accident in Wisconsin?

Are you struggling to cope with the effects of a serious or fatal work-related accident? If so, you may be entitled to workers’ compensation benefits under Wisconsin law. Eligible employees and family members can file workers’ compensation claims on a “no fault” basis, which means that proof of the cause of your (or your loved one’s) accident is not required. While there are some exceptions, these exceptions do not apply in most cases.

If you have a workers’ compensation claim, there are specific requirements you need to meet (including strict deadlines), and mistakes and delays can prove very costly in some cases. With this in mind, it is important that you take action as soon as possible. You can hire a lawyer to help with your workers’ compensation claim at no out-of-pocket cost, and you can rely on your lawyer to fight for the benefits you deserve on your behalf.

Schedule a Free Consultation with a Madison Workers’ Compensation Lawyer today

If you or a loved one has been involved in a workplace accident in Wisconsin, we strongly encourage you to contact us for more information about your legal rights. We represent employees and families in workers’ compensation claims statewide. To schedule a free consultation with a Madison workers’ compensation lawyer at Mays Law Firm as soon as possible, call us at 608-291-7609 or tell us how we can reach you online today. 

BE AWARE – There is a Trend by Workers Compensation Insurance Carriers to Deny Benefits?

BE AWARE – There is a Trend by Workers Compensation Insurance Carriers to Deny Benefits?

Worker compensation insurance carriers love to find reasons to deny workers compensation benefits.  Here are the top 10 trending reasons to deny benefits.

  1. Not Reporting the Work Injury Promptly
    In Wisconsin, while there is no definitive deadline to report a work injury to your employer, late reporting will lead insurers to question the validity of the claim.  Insurers fail to see that injured workers are often scared to report an injury for fear of repercussions.  Moreover, injured workers often wait on reporting an injury in the hope that it will heal or is not serious enough to report.
  2. Supportive Medical Documentation is Lacking
    A Wisconsin workers compensation injury will be denied if there is insufficient medical evidence linking the injury to the workplace exposure or incident.  For example, if the medical treatment records do not mention that the accident or injury occurred at work then the reviewing adjuster will consider this a red flag when determining whether to accept or deny the claim.   It is important for the injured worker to consistently describe to their medical providers the details of how the symptoms/injury occurred so that it is formally documented in the medical records.
  3. A Factual Dispute Exists as to Whether the Injury is Work-Related
    A workers compensation insurance company can argue that the injury did not occur because of work-related activities or unrelated to the job if it is not factually supported with details and/or witnesses.  For instance, if you fall and get injured at work but you then report that you have no idea how or why you fell then the claim will likely be denied.  Facts need to support that the injury occurred because the worker was in a zone of danger, such as water or oil on the floor where the worker fell acting as a trip hazard.  It is not enough for the injured worker to claim that because they fell and injured themselves then the claim should be compensable.  Something about the conditions of the employer’s premises had to have put the injured worker in a place of danger.
  4. Similar Pre-Existing Injury/Condition
    A workers compensation injury claim will always get denied if the injury or symptoms can be attributed to a pre-existing condition.  For example, back pain documented in medical records weeks, months, and even a year prior to the work injury will allow the insurance carrier to claim that later back injury occurring and reported on the job was pre-existing and not related to the work.
  5. Violation of Company Policy
    If the injury occurs because the worker failed to use a safety device then compensation can be reduced for the employee’s failure to obey a reasonable safety rule.  Also, no compensation will be paid if the employee violates an employer’s policy concerning drugs or alcohol use if the violation is causal to the employee’s injury.
  6. Injured Worker Fails to Cooperate
    When an injury occurs, the workers compensation carrier must do an investigation into the details of the injury.  Such an investigation requires employee cooperation.  The employee will be asked to give a recorded statement detailing who, what, where, and why details of the injury.  They will also be asked to sign medical authorizations so that the insurance carrier can get access to their medical records.  Moreover, they must keep the insurance carrier updated on changing physical restrictions and whether the employer is providing accommodating work.  If an injured worker fails to cooperate and communicate with the insurance carrier, then their uncooperativeness will be used against them to suspend or deny benefits.
  7. Evidence of Injury is Lacking or Insufficient
    The last thing an injured worker thinks about after a workplace injury occurs is documenting it.  Most injured workers know to report their injury to their supervisor/employer but many do not know that timely details should be recorded and saved.  To substantiate the injury, pictures of the scene, equipment, work conditions, witnesses’ names and contact information should be gathered and saved.
  8. Missed Deadlines for Filing a Workers Compensation Injury Claim
    Workers compensation claims typically have a statute of limitations.  Wisconsin Statute Sec. 102.17(4) currently provides that a Hearing Application for benefits may be filed within 12 years after the last payment of primary compensation by the insurance carrier for an occupational injury.  The time limit is 6 years for a traumatic injury (occurring after March 2, 2016).  Missing such filing deadlines to toll the claim can lead to an automatic denial by the Department of Workforce Development – Division of Hearings and Appeals.
  9. Employee Classification Issues
    In Wisconsin, if a worker is classified as an “Independent Contractor” versus an Employee then they may not be eligible for workers compensation benefits.  However, classification of such is tough because nine statutory requirements must be met in order to be classified as an Independent Contractor.   Mays Law Office encourages any injured worker who has been denied benefits because of independent contractor status to contact our office to discuss if your employment truly falls under the nine requirements.
  10. Inconsistent or Conflicting Statements
    Workers compensation insurance companies love to find inconsistencies or discrepancies between the worker’s account of the injury.  Finding such allows them to deny benefits.  Adjuster’s dig through medical records looking for such discrepancies.  They seek out witnesses hoping to contradict the injured worker.  Finding such allows them to point to such inconsistencies as a basis for their denial.

Outsmart Workers Compensation Insurance Companies – Tips to Prevent Denial of Work Injury Claims:

  • If you are injured, then report it immediately to a supervisor.  Document such reporting with an email or text message.  Document the injury by taking pictures, keeping notes of the details, and talk/text to witnesses to save their statements.
  • Know and follow your employer’s protocols.  Timely complete an Incident Report and keep a copy of it or take a picture of the report with your telephone.
  • Seek medical attention immediately, give your medical provider a detailed explanation of how the injury occurred and the symptoms you suffered.  Keep a journal of your medical treatment as to dates and providers.
  • Provide consistent explanations of how the injury occurred to your employer, the insurance carriers, and medical providers.
  • Consult with an experienced workers compensation attorney, like Mays Law Office, to navigate the claims process.  Mays Law Office offers free consultations.

Unfortunately, there is a trend in the insurance industry to deny workers compensation claims. Here’s why:

  1. Profit Motivation
    Workers’ compensation insurance companies are for-profit business entities. It is logical to assume that paying out fewer benefit claims allows them to retain more revenue thereby increasing their profitability.
  2. Reduced Payouts
    An insurance carrier that denies benefit claims, even if only temporarily, is able to delay and often completely eliminate the need for payouts.  Insurance carriers know that a certain percentage of injured workers will not fight/appeal for benefits after an initial denial.  The intimidation of being contentious or hiring a lawyer is too stressful for many injured workers.  This tactic allows workers’ compensation insurance companies to invest and grow their reserves while reducing their immediate liabilities.  Mays Law Office encourages Wisconsin injured workers who have been denied benefits to call for a free consultation.  They will be treated with respect and honesty, and safe from intimidation.
  3. Deterrence of Fraudulent Claims & Negotiation Strategy
    Workers compensation insurance companies want to send a strong message to employees to not file questionable workers compensation claims. Strict scrutiny of claims discourages fraudulent or exaggerated claims, which would otherwise lead to significant financial losses. Denials are often strategic. By denying a claim initially, worker’s compensation insurers intimidate, and pressure injured workers who are financially destitute into settling for a lower amount than they might otherwise receive. Readily approving injury claims set a precedent to other employees and encourages more claims of a similar nature. Denials send a message to other employees that claims will be rigorously evaluated and defended against. Attorney Lisa Pierobon Mays will not be intimidated; she will take on any Wisconsin employer who unjustly denies workers compensation benefits to an injured worker.
  4. Policyholder Retention
    Employers hate work injury claims because it can affect their insurance rates.  Some employers who purchase workers compensation insurance may even seek out certain carriers that keep their premiums low. Denying claims and minimizing benefit payouts helps insurers manage the loss ratios that affect premiums.
  5. Legal and Administrative Costs
    While denying benefit claims can lead to legal litigation, workers compensation insurance companies have significant legal resources.  They have attorneys on speed dial that they refer such litigation to.   They see the cost of litigation as worthwhile because of the savings from not paying out the claim.

Workers compensation insurance companies are betting that for every 5 injury claims they deny, only 2-3 will hire an attorney to recover benefits.  They are relying on the savings of those injured workers that did not fight for benefits.  Moreover, in Wisconsin, injured workers who have only unpaid medical treatment expense in dispute are likely left without legal defense because attorneys in Wisconsin are precluded from taking any attorney fee on the recovery of just medical bills.  With this, an injured worker is looking for an attorney who will represent them for free.  Most attorneys will not take on a file without some compensation for their time.  So, Wisconsin injured workers in this situation are left without representation due to this statutory regulation in our workers compensation law.

While it is true that workers compensation insurance companies are financially incentivized to deny or limit claims, they are also bound by legal obligations to act in good faith.  If they do not, they will be faced with penalty claims that give the injured worker additional monies.  Mays Law Office has been very proactive in keeping insurance carriers legally honest in their handling of claims.   Attorney Lisa Pierobon Mays will not hesitate to file a penalty claim against any employer or insurance carrier if benefits clearly should be paid.

Wisconsin injured workers who feel their claims are unjustly denied should consider consulting with an experienced workers compensation attorney, like Attorney Lisa Pierobon Mays, to challenge the decision.  Free consultations are offered at Mays Law Office.  Check out Mays Law Office’s 5-Star Google Reviews from actual past clients – positive reviews and results are the best indicator of a good attorney.

5 Key Facts About Workers’ Compensation Claims in Wisconsin: Deadlines, Notice Requirements, and More

5 Key Facts About Workers’ Compensation Claims in Wisconsin: Deadlines, Notice Requirements, and More

If you’ve been injured on the job in Wisconsin, it is up to you to protect your legal rights. While you may be entitled to workers’ compensation, your employer isn’t going to pay voluntarily—and it might even dispute your claim for benefits.

With this being the case, one of the most important things you can do is learn what it takes to protect your legal rights after an injury on the job. Here is an overview of some of the key facts you need to know:

Key Fact #1: Wisconsin Has Strict Deadlines for Workers’ Compensation Claims

The first thing you need to know is that Wisconsin has strict deadlines for workers’ compensation claims. These deadlines can be confusing—and they can be different in different circumstances—so it is generally best to file your workers’ compensation claim as soon as possible.

As the Wisconsin Department of Workforce Development (DWD) explains, “[y]ou should act to notify your employer and get medical attention without delay.” As it goes on to explain, “[a] delay may negatively affect your health and may even jeopardize your potential worker’s compensation benefits. . . . [and f]ailure to report your injury/illness to your employer within two years could result in your claim for worker’s compensation benefits being denied.”

While the deadline for filing a workers’ compensation claim can be extended to six years—or even 12 years—in some cases, you do not want to wait any longer than necessary to assert your legal rights. You should report your injury to your employer promptly; and, if you have questions or concerns about reporting your injury, you should talk to an experienced workers’ compensation lawyer right away.

Key Fact #2: Employers Dispute Their Employees’ Claims for Benefits in Many Cases

One of the reasons why it is important to file your workers’ compensation claim promptly is that your employer might dispute your claim for benefits, as we mentioned above. If you wait to file, this will give your employer an excuse to argue that your injury might not be work-related. If you can’t prove that you are eligible for benefits, you won’t receive the benefits you deserve.

Along with filing your workers’ compensation claim promptly, there are some additional steps you can take to help maximize your chances of securing the full benefits you deserve. These include taking photos of the accident scene and/or your injuries with your phone, taking detailed notes, and seeing a doctor as soon as possible.

Key Fact #3: You Can (and Should) Choose Your Doctor

Under Wisconsin law, you have the right to choose your doctor when you need treatment for a job-related injury. Unlike other states, in Wisconsin, your employer cannot tell you where to go for treatment. The Wisconsin DWD makes this clear, stating:

“When a worker reports an injury, the employer shall offer the worker the right to select a doctor of the worker’s choice for treatment. The employee may select any physician, psychologist, chiropractor or podiatrist licensed to practice in Wisconsin.”

When you have a workers’ compensation claim (or think you might have a workers’ compensation claim), you should be sure to tell your doctor that your injury is related to your employment. This way, your doctor can note the cause of your injury in your medical records, and this can help with your claim for benefits.

If you decide to see a different doctor for any reason, you are allowed to make one change without your employer’s approval. But, “[a]fter changing doctors once, any further change may be made only by mutual agreement between the employee, employer and [the employer’s] insurance carrier.”

Key Fact #4: Your Employer Should File a Claim with Its Insurance Carrier

One of the first steps you need to take when you have a workers’ compensation claim in Wisconsin is to notify your employer. This initial notification does not need to be in any specific form, though you should make sure it is in writing; and, if your employer has an incident report form, you should fill out the form as completely and accurately as possible.

Once you report your injury, your employer should file a claim with its insurance carrier. Under Wisconsin law, employers have seven days to file a claim after learning of an on-the-job injury. Once an insurance carrier receives a claim, it then has 14 days to file a report with the Workers’ Compensation Division of the Wisconsin DWD.

You should keep track of these deadlines to the best of your ability (or hire a workers’ compensation lawyer to keep track of them for you). If your employer or its insurance carrier does not timely process your claim, you may need to take further action to collect the benefits you deserve.

Key Fact #5: You Will Need to Be Careful to Ensure You Receive Full Workers’ Compensation Benefits

Even if your employer files a timely claim, this does not necessarily mean that you will receive full benefits. Various issues can still arise at this stage. For example, your employer (or its insurance carrier) may question whether your injury is truly job-related or whether you exacerbated your injury by waiting to seek treatment.

If you have a claim for workers’ compensation benefits, you are entitled to coverage for your medical costs from the date you were injured, and you are entitled to disability benefits if you miss four or more days from work. These benefits should continue for the duration of your eligibility. However, employers (and their insurance carriers) frequently attempt to prematurely terminate employees’ benefits as well—and this is another important factor you will need to keep in mind as you move forward.

Speak with an Experienced Workers’ Compensation Lawyer in Madison, WI

Are you entitled to workers’ compensation benefits for a job-related injury? If you have questions about protecting your legal rights, we invite you to get in touch. To schedule a free consultation with an experienced workers’ compensation lawyer in Madison, call 608-291-7609 or request an appointment online today.

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