You were injured on the job. Should you file for workers’ compensation? This is an extremely common question. On-the-job injuries happen all the time, and most workers are not familiar with their rights under Wisconsin law.

While the answer to this question ultimately depends on your specific circumstances, it will be a clear, “Yes,” in many cases. Most workers in Wisconsin are eligible to file for benefits when they get injured on the job. Keep reading to learn more about your legal rights in Wisconsin—and then contact us for a free, no-obligation consultation about your claim for benefits.

7 Important Facts About Filing for Workers’ Compensation in Wisconsin

What do you need to know about your legal rights if you were injured on the job? Here are seven important facts about filing for workers’ compensation in Wisconsin:

1. If You Are an Employee, You Should Be Covered

First and foremost, if you are an employee, you should be covered. In Wisconsin, employers are required to provide workers’ compensation coverage if they pay gross wages of $500 or more in any calendar quarter. This covers essentially all employers in the state. It covers out-of-state employers with employees in Wisconsin as well.

There is a distinction between employees and independent contractors—and, while employees are generally covered, independent contractors generally are not. If you are classified as an independent contractor, you may not be eligible for workers’ compensation benefits, although it may still be worth talking to a lawyer to make sure you have been classified appropriately.

2. If You Are Covered, You Have the Right to File for Benefits

If you are covered under your employer’s workers’ compensation plan, you have the right to file for benefits. The workers’ compensation system exists specifically to protect employees who get injured on the job, and your employer cannot try to prevent you from asserting your legal rights.

Importantly, this does not necessarily mean that your employer will accept your claim. In many cases, employers will dispute their employees’ claims in an effort to protect their bottom lines. The risk of facing issues with your claim is one of several reasons why it is important to have an experienced workers’ compensation lawyer on your side.

3. Your Employer Cannot Legally Retaliate Against You for Seeking Benefits

Just as your employer cannot try to prevent you from asserting your legal rights, it also cannot retaliate against you for seeking benefits. This is clear under Wisconsin law. If your employer retaliates against you illegally, your lawyer may be able to help you recover additional compensation.

Retaliation can take many forms; and, as an employee, it is important to know when you are (or might be) a victim. Firing you, demoting you, reassigning you, and reducing your pay are all examples of actions that could constitute retaliation. If you experience any of these after filing for benefits without a seemingly valid justification, you will want to discuss your options with your lawyer promptly.

4. Workers’ Compensation Covers Your Medical Costs Right Away

In Wisconsin, workers’ compensation covers your medical costs from the day you get injured. You have the right to choose your own doctor under Wisconsin law—your employer cannot tell you were to go. If you are not satisfied with the doctor you choose, you can change your doctor once without your employer’s approval. But, after the first change, “any further change may be made only by mutual agreement between the employee, employer and insurance carrier.”

A challenge that many injured workers face is deciding when to return to work. As the Wisconsin Department of Workforce Development (DWD) explains:

“If you have been advised by the doctor to return to work, an attempt should be made to return to the job even if you may not feel 100% up to it. By returning to work as directed by your doctor, you will be in a stronger position to obtain additional benefits if you attempted to return than if you refused an offer of work.”

Of course, returning to work too soon can be risky—as it can potentially lead to additional costs, pain, and complications that could (and perhaps should) have been avoided. If you have questions about whether you should return to work, your lawyer can help you make an infor

The recovery of workers compensation benefits in Wisconsin protects employees who suffer injuries on the job.  The system is intended to ensure that an injured worker will receive necessary medical treatment and wage replacement benefits. Unfortunately, many Wisconsin injured workers fail to file injury claims due to widespread misconceptions which can result in injured workers missing out on essential benefits they are legally entitled to. In this article, Attorney Lisa Pierobon Mays will debunk most of the misconceptions surrounding workers compensation in Wisconsin and clarify what the injured worker needs to know.

Misconception #1: If the Injury Was My Fault, I Can’t Get Workers Compensation

One of the biggest misconceptions about workers compensation is that an injured Wisconsin worker cannot receive benefits if they were responsible or “at fault” for their injury. Unlike personal injury claims, Wisconsin’s workers compensation system is No-Fault.  Injured workers can still get a remedy (through the payment of benefits) without concern of fault.  Monetary benefits are still available regardless of who caused the accident. There are, of course, exceptions, such as injuries that occur due to intentional self-harm or injuries caused by intoxication or drug use.  In essence, an injured worker can be distracted by their phone, slip and fall because they did not see a puddle of spilled oil on the floor and still recover workers compensation benefits for their injuries that stemmed from the slip and fall.

Misconception #2: I Can’t File a Workers Comp Claim If My Employer Wasn’t Negligent

Many workers think that they must prove their employer was at fault to receive benefits.  This is not the case in Wisconsin. Our workers compensation laws do not require an employee to prove employer negligence to recover benefits. Again, whether the injury resulted from employer negligence, a coworker’s actions, or the worker’s own mistake, the worker is still eligible for benefits.  Think of it as social insurance which attempts to maintain employer-employee relations.  The concept of negligence by both employers and employee plays no part in our Wisconsin workers compensation system. A Wisconsin injured worker is precluded from bringing a separate tort claim against their employer and co-employees. Many injured workers really struggle with this reality because they want the employer punished with a multi-million punitive dollar lawsuit for allowing or causing the worker to be injured. In worker compensation, it is the insurance carrier, not the employer, who plays the central role in the workers compensation claim.

Misconception #3: Workers Compensation Covers Only Major Injuries

Some Wisconsin workers think that only severe injuries, such as broken bones or traumatic injuries, qualify for workers compensation benefit. This is not true. Wisconsin workers compensation covers a wide range of injuries from head to toe, including repetitive stress injuries (such as carpal tunnel syndrome), back strains, cuts and amputations, and occupational illnesses, such as breathing disorders. Any injury that affects an employee’s ability to work may be entitled to benefits.

It is true, however, that smaller work injuries, if denied by the carrier for benefits, are difficult for the injured worker to find an attorney interested in representing them.  Why?  Consider a hernia injury.  It costs thousands of dollars to surgically repair a hernia, but once the surgery is done the worker is generally back to 100%.  Under the Wisconsin Workers Compensation Act, an attorney is not allowed to take more than a 20% fee on the recovery of benefits which EXCLUDES the recovery of any medical expenses.  So, what is left when the surgery is 100% successful and the injured worker only lost one or two weeks of work?  A 20% attorney fee on $1000 of lost wages makes it difficult for the injured worker to find an attorney willing to take on their claim.  Attorney Lisa Pierobon Mays continues to challenge this scenario with the Wisconsin Workers Compensation Advisory Board as the reality of our current law is absolutely devastating for injured workers who only have medical expenses at issue.

Misconception #4: I Will Lose My Job If I File a Workers Compensation Claim

Fear of retaliation prevents many injured workers from filing claims. Attorney Lisa Pierobon Mays hears stories from injured workers that they have witnessed other co-workers being harassed, ridiculed, punished, and ostracized not just by their employer, but their fellow co-workers for seeking workers compensation benefits.  This is truly unfortunate.  Wisconsin law prohibits employers from retaliating against employees for filing a legitimate workers compensation claim. If an employer retaliates against an injured worker, legal action can be taken against them through the Wisconsin Department of Workforce Development (DWD).  However, to be successful, the injured worker needs to thoroughly document such conduct, perhaps by audio recording harassing comments and discussions, especially with supervisors and management.  Also pictures of any documentation or overt behavior that can be memorialized is powerful evidence against the employer. Otherwise, such conduct becomes a “he-said, she-said” situation if not preserved.

Misconception #5: I Can’t Choose My Own Doctor

When an injury occurs, many workers experience their medical treatment being directed by their employer.  There are on-site or near-site employer medical clinics, such as Concentra, Access, DISA Global Solutions, Bellin Health, associated with the employer and its workers compensation insurance carrier.  The employer, insurance carrier, and clinic have a relationship previously established that is not necessarily impartial in treating the injured worker.  Often, these clinics try to return the injured worker back to work as soon as possible in order to keep the lost time benefit (called TTD) minimal.  However, returning an injured worker back to work too soon can be detrimental to their healing. Under Wisconsin law, sec. 102.42(1), injured workers have their choice of treating doctors. If an employer or insurer tries to restrict this right, the worker can challenge it.

Misconception #6: I Have to Be Injured at the Workplace to Qualify for Benefits

As we know from post-Covid, many Wisconsin employees are permitted to work off-site.  With this, not all work-related injuries happen at the office, warehouse, or job site. If a Wisconsin employee is injured while performing work-related duties—such as making deliveries, traveling for work, working at home, or attending a social company event—the injury may still be covered under Wisconsin workers compensation. Compensation is factually driven for injuries sustained during a regular commute to and from work (which are generally not covered) where the worker was performing a work-related task at the time of the commute, such as running an errand for the employer.

Misconception #7: Filing a Claim Means Suing My Employer

Many workers wrongly think that filing a workers compensation claim means that they are suing their employer. With this misconception, some injured workers fear that they are getting their employer in trouble if they file a workers compensation claim.  Moreover, some employers will take advantage of this misconception to dissuade their employees from filing the claim.  In Wisconsin, workers compensation is an insurance system designed to provide benefits without litigation. By filing a claim, an employee is not suing their employer but simply accessing benefits provided by the employer’s insurance policy.  In Wisconsin, businesses are required to have workers compensation insurance.  Attorney Lisa Pierobon Mays tells injured workers to think of it like any other insurance claim, such as car insurance.  Consider if your friend smashes into your car, most people will not think twice about filing the damage claim against their friend’s insurance company.

Misconception #8: Workers Compensation Benefits Last Forever

While some work injuries may lead to long-term benefits, the Wisconsin Workers Compensation System was not designed to compensate the injured for the true value of their financial and personal loss. Instead, it was generally designed to provide basic or temporary relief until the employee can return to work. The length of benefits depends on the severity of the injury, the employee’s recovery progress, and whether they can return to their previous job or need vocational rehabilitation.  The basic benefits available under the Wisconsin workers compensation system includes temporary total disability (TTD), medical expense and mileage  reimbursement, and permanent partial disability.  In fatal cases, benefits are recovered  by the deceased workers’ spouse and minors, along with funeral expenses.

Misconception #9: If My Claim Was Denied, I Have No Other Options

Way too many injured workers think that if their workers compensation is denied then all is lost. Absolutely not!  Workers compensation insurance carriers expect that a fair number of injured workers whose claim is denied will be intimidated and walk away from pursuing benefits. Sadly, many do! Many legitimate claims are initially denied due to paperwork errors, missing documentation, discrepancies in medical records, and insurance company tactics.  Insurance companies are looking for reasons to deny work injury claims.   Injured workers in Wisconsin have the right to appeal a denial through the Wisconsin DWD.  A workers compensation attorney, like Atty. Lisa Pierobon Mays, can assist in ensuring that the claim is being fairly handled.  Never accept that the denial of your work injury claim is correct.  At the very least, call Attorney Lisa Pierobon Mays for a free consultation.

Misconception #10: Workers Compensation Only Covers Medical Bills

While medical expenses are a major component of workers compensation, benefits often extend beyond just covering medical bills. Wisconsin workers compensation may also include wage replacement benefits for lost income, disability benefits if the employee is unable to work, and vocational retraining programs for employees who can no longer perform their previous job.

Misconception #11: If I Work a Desk Job, I Can’t Qualify for Workers Compensation

Many people associate workplace injuries with physical labor jobs, such as construction or manufacturing. However, even office workers can suffer injuries that qualify for workers compensation, such as repetitive motion injuries, back pain from prolonged sitting, and slip-and-fall accidents.  For instance, Attorney Lisa Pierobon Mays recovered workers compensation benefits for a data processor who suffered from carpal tunnel syndrome in both hands requiring surgery, substantial lost time from work, and medical treatment expense.

Misconception #12: I Can Wait to Report My Injury

Some injured workers delay in reporting their injury because they believe they have plenty of time or think the injury will heal on its own. While Wisconsin does not have a set deadline to report a work injury to the employer, it is advisable to give notice within 30 days.  In the case of an occupational disease, like repeated exposure to harmful substances which cause an injury, it is still possible to give notice anytime within two years of the date the injury occurred, the onset of the disease, or the date the injured worker first realized that such injury or disease was caused by his or her work.  Failing to report an injury timely can jeopardize a claim, making it crucial for workers to notify their employer as soon as possible. Insurance carriers are dubious of claims that are not timely filed and will likely be denied.  A Wisconsin injured worker should never be talked into waiting to complete an Incident Report of Work Injury to their employer.  Moreover, take a picture on your phone of the completed Incident Report for your records and preservation.

Misconception #13: Independent Contractors Can’t Get Workers Compensation

While it is true that independent contractors generally do not qualify for traditional Wisconsin workers compensation benefits, some workers classified as independent contractors may be misclassified as such. It is tempting for employers to describe an employee as an “independent contractor” to avoid premiums for workers, unemployment compensation, and Social Security taxes

In Wisconsin, under sec. 102.07(8) there is a nine-factor test for determining independent contractor status for workers performing services for employers.  All nine requirements must be met in order to be deemed an independent contractor so it’s worth consulting with a legal professional to determine eligibility.

Misconception #14: If I Return to Work, My Case Is Over

When an injured worker returns to work, it does not necessarily mean that their workers compensation case is closed.  If the injured worker continues to require medical treatment or experiences complications from the injury, they are still entitled to benefits.

In some cases, injured workers return to light-duty or part-time modified work while continuing to receive partial benefits (called TPD). An injured worker will always be entitled to medical mileage reimbursement (.51 cents/mile) for therapy, doctor appointments, and pharmaceutical prescription pick-ups. Injured workers that reach a point of healing (called a “Healing Plateau”), even if they were returned to work with or without restrictions, may have a permanent disability which will give rise to permanency benefits, called permanent partial disability (PPD).  This rating is assessed by the treating practitioner and the percentage of disability will equate to a particular sum of money.

Misinformation and misconceptions about workers compensation prevents way too many injured workers from seeking the benefits they deserve. Understanding the truth behind these common misunderstandings empowers workers to take the right steps after a workplace injury.

If you have suffered a work-related injury in Wisconsin, it is important to seek legal advice to ensure that your rights are protected. Mays Law Office offers free consultations and Attorney Lisa Pierobon Mays talks to every injured worker who calls her office. Mays Law Office has the authentic Google 5 Star Rating for client satisfaction. Don’t let misconceptions keep you from getting the benefits you are entitled to under the law.

When you have a workers’ compensation claim in Wisconsin, your employer (or its insurance company) is supposed to pay the benefits you are owed. You are supposed to be treated fairly, and you are not supposed to have to fight for the benefits you deserve.

Unfortunately, this doesn’t always happen.

Injured and sick employees routinely run into issues when filing for workers’ compensation benefits in Wisconsin. Issues can arise at all stages of the process—from when you try to file your claim to when you are going through the recovery process. If you are dealing with a work-related injury or illness, keep reading to learn more.

5 Potential Issues When You File for Workers’ Compensation

Here are five examples of issues that can arise when you file for workers’ compensation in Wisconsin:

1. Denial of Your Workers’ Compensation Claim

Many employees who have valid workers’ compensation claims nonetheless find themselves dealing with a denial. Some examples of common reasons for denying employees’ claims for workers’ compensation benefits include:

• Your injury or illness isn’t work-related
• The insurance company can’t determine the cause of your injury or illness
• You didn’t report your injury or illness on time
• You don’t qualify for benefits because you were intoxicated when you got injured
• You don’t qualify for benefits because you faked your injury or intentionally injured yourself

While all of these can potentially be valid justifications for denying a workers’ compensation claim, wrongful denials are far too common. With this in mind, if you have received a denial and believe that you are entitled to benefits, you should not give up on your claim. Instead, you should promptly consult with an experienced Madison workers’ compensation attorney who can help you make informed decisions about your next steps.

2. Delays that Leave You Without the Benefits You Need

Unnecessary delays are common as well—and, sometimes, it can be difficult to tell whether you are dealing with a delay or a denial. If you are like most people, when you are dealing with an injury or illness that requires medical attention, you cannot afford to wait any longer than necessary to receive the benefits to which you are legally entitled.

When you have a workers’ compensation claim, your employer (or its insurance company) is supposed to process your claim efficiently. It is supposed to investigate your claim in good faith, and it is supposed to inform you of any issues with your claim so that you can address them promptly. If you have been waiting weeks to receive benefits or have questions you can’t get answered, you should consult with a Madison workers’ compensation attorney in this situation as well.

3. Denial of Disability Benefits Because You Should Be Able to Work

In Wisconsin, there are two main categories of workers’ compensation benefits: (i) medical benefits; and, (ii) disability benefits.

Medical benefits cover the costs of treating a work-related injury or illness, and eligible employees are entitled to these benefits regardless of whether they need to miss time from work. However, disability benefits are only available to those who need to miss work for at least three days.

Sometimes, employees will receive medical benefits but have their claims for disability benefits denied. If your employer (or its insurance company) says you should be able to work but your doctor says otherwise, this is another scenario in which you may need legal representation for your claim.

4. Underpayment of Disability Benefits

Along with disability benefit denials, underpayment of disability benefits is a common issue as well. Employers (and their insurance companies) may underpay injured employees’ disability benefits for various reasons—some of which reflect honest mistakes and some of which do not.

Calculating disability benefits is complicated; and, depending on the severity of your on-the-job injury or illness, you may be entitled to various different types of disability benefits (including temporary partial (TP), temporary total (TT), permanent partial (PP), and permanent total (PT)). If you do not believe that you are receiving the full disability benefits to which you are legally entitled, an experienced Madison workers’ compensation attorney can determine if you are entitled to more.

5. Premature Termination of Medical or Disability Benefits (or Both)

Even if your workers’ compensation claim is successful initially, you could still find yourself facing financial challenges if your employer (or its insurance company) terminates your benefits prematurely. This is a common issue as well; and, as an injured or sick employee, it is critical to make sure you know when your workers’ compensation benefits should end.

So, when should they end? Generally speaking, you should be able to continue receiving medical benefits until you get better or reach your “maximum medical improvement.” You should be able to continue receiving disability benefits for as long as you are unable to work (or limited in your ability to work)—though there are additional steps involved in transitioning from temporary to permanent disability benefits.

How to Deal with These Issues and Seek the Workers’ Compensation Benefits You Deserve

Let’s say you have a workers’ compensation claim in Wisconsin. What can you do to make sure you receive the benefits you deserve?

If it’s not already too late, it’s best to work with an experienced Madison workers’ compensation attorney from the beginning of the process. Your attorney will be able to explain everything you need to know and handle your workers’ compensation claim for you while you focus on your recovery.

If you filed for workers’ compensation and are now struggling to obtain full benefits, this is also a scenario in which an experienced attorney may be able to help. Your attorney can work to determine what has gone wrong and why, and then your attorney can use this information to determine what next steps he or she may be able to take on your behalf.

Need Help With Your Workers’ Compensation Claim? Contact Us for a Free Consultation Today

Do you need to know more about your right to workers’ compensation benefits in Wisconsin? If so, we invite you to get in touch. To schedule a free consultation with a Madison workers’ compensation attorney at Mays Law Office, please call 608-291-7609 or contact us online today.

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 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.