When you get hurt on the job and you file for workers compensation benefits, you expect to receive the benefits you are owed. While this happens for some workers, for others, collecting benefits can be a challenge. If your employer denies your claim, you need to know what to do next. This starts with understanding why your claim was denied.
Employers (and their insurance companies) deny workers compensation claims for a variety of different reasons. Some of these reasons are valid, and some of them are not. If your employer denied your claim for an invalid reason, then you should still be able to collect benefits. If your employer denied your claim for a valid reason, whether you can still collect benefits depends on whether you can fix the issue that caused your denial.
7 Reasons Employers Can Deny Workers Compensation Claims
Here are seven valid reasons why employers can deny their employees’ claims for workers compensation benefits. Some of these issues can be fixed (as long as you address them in time), and some of them cannot:
1. You Waited Too Long to Report Your Injury
Under Wisconsin law, you have 30 days to report your injury or illness to your employer. This 30-day period runs from the date you knew, or “ought to have known” of your condition. For injuries sustained in falls, collisions, and other accidents, this generally means that you must report your injury within 30 days of the accident. For repetitive stress injuries and occupational illnesses, determining when the 30-day reporting period expires can be more complicated.
2. You Waited Too Long to File Your Claim
The deadline to report your injury or illness isn’t the only deadline that applies to your workers compensation claim. If your employer does not pay the benefits you are owed after you report your injury or illness, you then have two years (in most cases) to file a claim with the Wisconsin Department of Workforce Development (DWD). If you don’t file your claim within two years, this can justify your employer in denying your claim for benefits.
3. You Didn’t Provide Enough Information
An injury or illness only qualifies for workers compensation benefits if it occurs within the scope of your employment. In other words, you must have a job-related injury or illness in order to collect workers compensation benefits. If you didn’t provide enough information for your employer to determine whether your injury or illness qualifies, this could be the reason (or one of the reasons) why your employer denied your claim.
4. You Provided False or Misleading Information
Employers can deny claims for workers compensation benefits when employees provide false or misleading information regarding their injuries. This is true even if you provided false or misleading information unintentionally. Intentionally providing false or misleading information is considered workers compensation fraud, and it can provide justification for a permanent denial of benefits.
5. You Didn’t Seek Medical Treatment
When you suffer a job-related injury, seeking medical treatment isn’t just important for your health. It is also important for your workers compensation claim. If you haven’t seen a doctor, your employer isn’t going to pay benefits. If you waited too long to see a doctor, your employer might try to use this as a basis for denying your workers compensation claim as well.
6. Your Medical Records Don’t Indicate that Your Injury is Job-Related
When you see a doctor for treatment, it is important to tell your doctor that you suffered your injury or illness on the job. Your doctor should note this in your medical records. If your medical records don’t indicate that your injury is job-related, this could be why your employer denied your claim.
7. You are Not Eligible to Receive Benefits
Not all workers are eligible to receive workers compensation. If you are not eligible, then you are not entitled to benefits even if you got injured or sick on the job. If you are not eligible to receive workers compensation through your employer, you may have other options available.
3 Reasons Employers Can’t Deny Workers Compensation Benefits
As we mentioned above, in addition to denying workers compensation claims for valid reasons, employers will often deny claims for invalid reasons as well. Some examples of invalid reasons for denying workers compensation claims include:
1. You Have a Pre-Existing Condition
In Wisconsin, employers generally cannot deny workers compensation benefits on the basis of a pre-existing condition. For example, if you had a bad knee and you reinjured your knee at work or your pain got worse from doing your job, you are entitled to benefits under Wisconsin law.
2. You Caused Your Own Injury
Workers compensation is a “no fault” system. This means that you are entitled to collect benefits even if you caused your own injury.
3. Your Employer Wants To Avoid Paying
Finally, your employer cannot deny your claim simply because it wants to avoid paying. Unfortunately, this is all it takes for some companies to deny benefits. If your employer does not have a valid basis for denying your claim, then you should still be able to collect benefits with a lawyer’s help.
What To Do if Your Employer Denies Your Workers Compensation Claim
If your employer has denied your worker’s compensation claim, what should you do? At this point, you will want to speak with workers compensation attorney promptly. An experienced Wisconsin workers’ compensation lawyer will be able to determine why your claim was denied and what (if anything) you can do to collect benefits. If you have a valid claim, your lawyer can then fight to secure the benefits you deserve.
Schedule a Free Consultation with a Wisconsin Workers Compensation Lawyer
Has your employer denied your claim for workers’ compensation benefits? If so, contact us promptly for a free, no-obligation consultation. To speak with a Wisconsin workers compensation lawyer at Mays Law Office in confidence, call 608-257-0440 or tell us how we can reach you online now.
When you get hurt on the job, you need to find a way to cover your medical bills and other expenses. For most people, this means filing a claim for workers’ compensation benefits.
But, how do you know if you are eligible for workers’ compensation? If you are eligible, how do you file a claim and collect the benefits you deserve? We recently discussed the eligibility requirements for workers’ comp, and in this article we provide an overview of the workers’ compensation process.
How To File for Workers’ Compensation in Wisconsin
To begin, it is important to understand that filing for workers’ compensation benefits is not necessarily a straightforward process. While the process can be fairly straightforward if your employer’s insurance company treats you fairly and you don’t need to miss time from work, it can also be difficult, time-consuming, and very frustrating. As a result, while you can try to file a claim on your own, it is generally best to entrust your claim to an experienced Madison workers’ compensation attorney.
1. Report Your Injury at Work
The first step toward collecting workers’ compensation benefits is to report your injury at work. As the Wisconsin Department of Workforce Development (DWD) explains:
“An injured employee should give notice to the employer within 30 days of any injury. . . . However, if notice is not given within 30 days, it is still possible to give notice any time within two years of the date the injury occurred. . . . If the employer receives notice within two years and the employer was not misled by the fact that earlier notice was not given, benefits may be payable. The two-year limit does not apply if the employer knew or should have known of the injury.”
In other words, you should report your injury to your employer within 30 days if possible (and ideally right after you get injured). But, if it has already been more than 30 days, you may still be entitled to benefits, and you should consult with an attorney promptly.
When you report your injury, your employer may ask you to complete an incident report, and it is generally okay to do so. You just want to make sure you provide accurate information and do not make any assumptions about what may or may not have happened. Minimally, when reporting your injury you should include:
- The time and date you got injured
- Your type of injury (i.e. a broken bone or muscle strain)
- The part of your body that was injured
- The circumstances surrounding your injury
- Whether your injury requires medical attention
If you have any questions or concerns about reporting your injury to your employer, an attorney can help, and you should schedule a free consultation as soon as possible.
2. Seek Treatment for Your Injury
It is also important that you seek medical treatment for your injury as soon as possible. In Wisconsin, you have the right to see any doctor of your choosing, so you can seek treatment before or after you report your injury to your employer.
When seeking treatment, you should explain your symptoms with as much detail as possible. You should also be sure to tell your doctor that you suffered your injury at work. Try to get copies of your x-rays, scans, and other records so that you can provide them to your attorney.
3. Document Your Injury
As the Wisconsin DWD also explains, “Complications can arise in a worker’s compensation claim, and the amount of benefits is then determined by the specific facts of the case. It is important that the injured employee keep a record from the beginning.” In order to fully document your work injury, it is a good idea to make note of details including:
- All information you reported to your employer
- The names of any coworkers who witnessed your injury
- Your initial and ongoing symptoms
- How long each symptom has lasted
- Your doctors’ names and phone numbers
- Any bills you have paid for medical care or transportation
- The dates that you miss time from work
4. Calculate Your Benefits
When filing for workers’ compensation, it is extremely important to ensure that you accurately calculate your benefits. In addition to coverage for your medical expenses, if you are unable to work more than three days after your injury, you may also be entitled to temporary or permanent disability benefits. Disability benefits are generally calculated at two thirds of your weekly wage, although there are maximum coverage limits for high-earning employees.
In terms of how long you can receive disability benefits, the answer depends on the severity of your injury. For example, temporary total disability benefits are paid, “until the employee’s condition has become stabilized and treatment and convalescence are not likely to result in additional improvement,” while permanent total disability benefits can potentially be paid for life.
5. Negotiate a Settlement (if Appropriate) or Apply for a Hearing (if Necessary)
Once you have fully documented your injury and calculated the benefits you are entitled to recover, you can start focusing on resolving your workers’ compensation claim. In some cases, this may simply mean receiving medical coverage and weekly disability payments until you recover. However, it is also possible to negotiate a settlement, and this is an option that many workers prefer since it avoids the uncertainty of keeping your claim open.
If your employer’s insurance company refuses to pay the benefits you are owed, then you might need to apply for a hearing with the Wisconsin A hearing on a disputed claim is a legal process, and it will be strongly in your best interests to seek experienced legal representation.
Talk to a Madison Workers’ Compensation Attorney for Free
Do you need to file for workers’ compensation benefits in Wisconsin? If so, our Madison workers compensation attorneys can help you seek the benefits you deserve. Call 608-257-0440 or tell us how we can reach you online to schedule a free and confidential consultation.
For many workers in Wisconsin, recovering their losses after suffering a job-related injury involves filing a claim for workers’ compensation benefits. If you have been injured and are wondering if you are eligible to file, here is an overview of what you need to know:
5 Important Facts about Workers’ Compensation Eligibility in Illinois
1. Workers’ Compensation is a “No Fault” System in Wisconsin
In Wisconsin, workers’ compensation is a “no fault” system. This means that proof of fault is not required in order to file a claim with your employer. Even if you simply tripped going up the stairs, you can file a claim as long as your injury is “job-related” (more on this below).
This access to “no fault” benefits comes with a tradeoff. While you can file a workers’ compensation claim even if your employer is not at fault for your injury, the amount your employer has to pay is limited. Employers that comply with Wisconsin’s workers’ compensation law are immune from job injury lawsuits in most cases. As a result, while eligible employees can file claims regardless of fault, the benefits that are available through workers’ compensation are limited to:
- Medical benefits
- Partial wage replacement benefits (also referred to as disability benefits)
- Training and vocational benefits
However, many injured employees are still entitled to substantial workers’ compensation benefits. If you have been seriously injured, and if you are unable to work as a result of your injury, it will be important for you to work with an experienced Madison workers’ compensation lawyer to make sure you seek the full benefits you deserve.
2. Workers’ Compensation Benefits are Available to Employees
In order to be eligible for workers’ compensation benefits, you must be classified as an employee. Under Wisconsin law, independent contractors are not eligible to file for workers’ compensation. As explained by the Wisconsin Department of Workforce Development (DWD):
“All employees working for an employer (other than farmers) with three or more workers are protected immediately by the Worker’s Compensation Act. Employers with fewer than three workers come under the law if they pay wages of $500 or more in any quarter of a calendar year. . . . Farm workers are covered if the farm employer has six or more employees on 20 or more days in a calendar year.”
While most employees are covered, some are not. Specifically, Wisconsin’s workers’ compensation law does not apply to:
- Domestic servants
- Employees who do not work “in the trade, business, profession or occupation of the employer”
- Small farm employees
- Qualifying religious sect members
- Employees of Native American tribal enterprises
- Employees who are covered under federal workers’ compensation programs
What if you fall into one of these categories? Or, what if you are an independent contractor? If you are not eligible for workers’ compensation benefits under state or federal law, then you will need to seek compensation through other means. One option may be to file a personal injury lawsuit against your employer. You could also have a claim against another party (i.e. a property or vehicle owner, depending on how you got injured), and an attorney can assess your eligibility for other government benefits (i.e. Social Security disability) as well.
3. Workers’ Compensation Covers Most Causes of Job-Related Injuries
Since workers’ compensation is a “no fault” system, most causes of job-related injuries are covered. While your injury must be “job-related,” you do not need to be engaged in performing your specific job duties at the time you get injured in order to be eligible for benefits. For example, the following are all common causes of job-related accidents that can justify claims for workers’ compensation benefits:
- Slipping and falling while walking to the bathroom or kitchen
- Slipping and falling in the parking lot
- Hurting your back while squatting, twisting, or bending
- Accidents that occur while you are traveling for work
These, of course, are in addition to job-related accidents such as falls, collisions, tool and machinery accidents, and exposure to harmful substances or electrical currents. Regardless of what happened, if you have been injured on the job in Wisconsin, you should speak with a local attorney about your legal rights.
4. Workers’ Compensation Covers Most Types of Job-Related Injuries and Illnesses
In Wisconsin, workers’ compensation covers virtually all types of job-related injuries, and it covers most types of job-related illnesses. Eligible employees can collect workers’ compensation benefits for:
- Physical injuries from accidents and repetitive stress (including soft tissue injuries, nerve damage, broken bones, herniated discus, concussions, and other types of injuries)
- Impairment or loss of hearing, vision, or other bodily function
- Mental harm (including “nervous disorders, hysteria, and traumatic neurosis”)
- Occupational diseases resulting from “exposure over a period of time to some employment-related substance, condition or activity”
What about COVID-19? As the Wisconsin DWD explains, “[t]he short answer is maybe.” If a qualifying employee is able to demonstrate that his or her diagnosis is the result of exposure at work, then that employee should be able to file a successful claim for benefits.
5. Our Madison Workers’ Compensation Lawyers Can Determine Your Eligibility
Given the challenges involved with determining your eligibility and making sure you receive the full benefits to which you are legally entitled, it will be important for you to speak with a lawyer about your workers’ compensation claim. At Mays Law Office, we provide full-service legal representation for injured workers. We can assess your eligibility for all types of claims; and, if you are entitled to compensation, we can help you seek the maximum compensation available. To find out if you are eligible for workers’ compensation benefits, contact us for a free consultation today.
Speak with a Madison Workers’ Compensation Lawyer for Free
Were you injured on the job in Wisconsin? If so, our Madison workers’ compensation lawyers can assess your legal rights and help you fight for the compensation you deserve. To get started with a free, no-obligation consultation, call us at 608-257-0440 or tell us about your situation online today.
Even though the nature of business is strategizing to stay competitive and create a successful company, one goal that you probably have in common with your competitors is keeping your employees safe. As a workers comp lawyer
in Wisconsin, I want to inform all business owners that, you should spend adequate resources on protecting your workers is critical.
Focusing resources on safety protocols may help to enhance the efficiency and effectiveness of your employees, as well as your ability to adhere to legal guidelines.
Violations can derail your success
According to the Occupational Safety and Health Administration, there are many of the same citations they give out to companies each year including failure to have proper eyewear and face protection, poor respiratory protection, improper guarding of dangerous machinery and inadequate protection against falls.
Your awareness of these common citations can help you to implement sufficient guidelines to encourage adherence from your employees so they can stay safe. If you are visited by an official for an audit of your company and its practices and policies, you can have peace of mind with the knowledge that you have adequately addressed each of these “problem” areas.
Using training to combat risks
Developing informative training materials and providing educational instruction to your workers is arguably the most effective tool you can use to minimize their risk level. When your employees understand what dangers they are subject to and how to mitigate them with adherence to company guidelines, they may be incentivized to be vigilant and responsible. Additionally, proper training can prepare your employees to recognize discrepancies so they can properly report them to you before hazards turn into danger.
As a workers compensation attorney in Middleton
, Wisconsin, I want to clear one thing that you may think that work injuries only happen in dangerous professions, but the reality is that accidents can happen in every profession. Office workers may see more injuries than other fields but often they do not amount to enough to make a workers’ compensation claim. However, there are still many potentially serious injuries you could face when working in an office environment.
Fast Company explains that most office injuries are not those that appear right away but that happen over time. The cause is most often bad ergonomics and strain on the body, but accidents also can lead to office injuries.
Carpal tunnel syndrome
This condition affects the wrists and is usually a result of bad posture when typing. It also occurs due to overuse. It causes discomfort and pain in the wrists area. It may also lead to numbness and weakness.
Carpal tunnel occurs when the median nerve has too much pressure on it. You can use exercise to help improve the condition. In some cases, you may require surgery.
Sitting hunched over a computer can lead to chronic back pain. You can often relieve pain by adjusting your chair height or your desk height. You may also use stretching to help strengthen your back and supporting muscles.
Falls are common in all industries. In an office, loose papers on the floor, bad flooring or other debris in walkways can easily lead to a serious fall. Injuries can be minor bruises or serious bone breaks.
If you spend all day on a computer, then eye strain is a potential issue. It can lead to vision problems and headaches. You should take regular breaks and practice eye exercises to help relieve strain. You may also need physical therapy to help fix the issue.
Carpal tunnel syndrome is one of the most common office injuries. Also known as median nerve compression, it is a condition with symptoms ranging from numbness weakness and tingling in the hands.
The median nerve goes through a passage in your wrist along the length of your arm until it ends at your hand. This nerve controls the movement and feeling in all your fingers and your thumb explains WebMD. It does not include the pinky.
Carpal tunnel syndrome causes
There are a few different causes for carpal tunnel syndrome, but one of the most common culprits happens to be repetitive motion at a job. For instance, if you work in an office and type all day or a grocery store where you move your wrist over and over, you are more likely to develop carpal tunnel syndrome. Another risk factor includes repetitive movements when your hands are positioned lower than your wrist.
Carpal tunnel syndrome symptoms
If you have carpal tunnel syndrome, you may experience burning, itching or tingling in your thumb, palm or middle and index fingers. When you move your fingers, you may also experience shock-like feelings and a tingling that moves up your arm.
One of the first signs happens to be numbness in your hand at night due to how you fall asleep. You may wake up to numbness that tingles in your hands and then runs to your shoulder. These symptoms may flare up throughout the day, especially if you hold your wrist bent.
As the symptoms worsen, your hands may become weaker, you may lose grip strength and experience pain or muscle cramps.