Denied Workers Compensation in Wisconsin

Denied Workers Compensation in Wisconsin

Denied Workers Compensation?

In January 2022, an injured worker called Mays Law Office.  For privacy reasons let’s call this injured worker “J.C.”  J.C. visited our website Mays Law Office and saw that we offer free legal consultations with an attorney.  Immediately J.C. was connected to Attorney Lisa Pierobon Mays.  J.C. proceeded to tell Lisa that she got hurt at work back in November 2020.  J.C. stated that she started her workday symptom-free but while working repetitively on a machine containing a diecast mold, she felt and heard a horrible popping sensation in her right shoulder while aggressively scrubbing the mold with her outstretched right arm.   Lisa listened to J.C.’s story and then started asking some poignant questions, like did she report the injury to her supervisor?  Did she seek timely medical treatment?  What medical treatment had she received, and what was the diagnosis and prognosis of her right shoulder injury according to her doctors?    

Pretty quickly Attorney Pierobon Mays could see that J.C. had done everything right in reporting the injury and seeking medical treatment that same day, yet still the workers compensation carrier was giving her the run-around as to accepting her claim for workers compensation benefits.  J.C.’s claim had been bounced around to three different insurance adjusters, questions by J.C. to adjusters were often left unanswered, referral for medical treatment, like an MRI was delayed pending slow approval by the workers compensation adjuster, and then only one day before her pre-scheduled right shoulder surgery in August 2021, approval for the rotator cuff surgery was delayed by the workers compensation insurance carrier demanding that she first see their doctor, termed an “Independent Medical Examiner.”  J.C. had been suffering with pain in her right shoulder for almost 9 months and now, one day before her much needed surgery, it was being delayed!  Regardless, J.C. complied, cancelled her surgery, and saw the insurance company’s doctor.  Despite repeated calls by J.C. to the insurance carrier, she never heard anything more from the insurance company for another 2 months.  Then in November 2021, J.C. got a letter stating that the workers compensation insurance carrier was denying all benefits for any care, treatment, or disability related to her right shoulder.  J.C. was dumb-founded and angry as a whole year of pain had gone by and a very needed surgery was not going to be covered.  Moreover, her sore right shoulder was taking a toll on the rest of her body, specifically her left arm because it was trying to accommodate for her weak, dominant, right arm.   

Attorney Lisa Pierobon Mays heard enough and encouraged J.C. to come into Mays Law Office located in Middleton, Wisconsin.  An appointment was scheduled for the following day and J.C. was instructed to  bring all of her paperwork (correspondence, notes, medical notes) so that they could review it together and come up with a plan of attack.  The following day, J.C. met with Attorney Lisa Pierobon Mays and it was quickly discovered that the delay and denial of medical treatment by the workers compensation insurance company was erroneous and likely made in bad faith, which in Wisconsin is filed as a penalty claim and can be worth up to $30,000.  In reviewing the insurance company’s doctor report, it was clear that he believed that the right shoulder surgery was necessary and related to the work that J.C. had done while working on the machine back in November 2020.  Attorney Pierobon Mays told J.C. that quick measures had to be taken to hold the workers compensation insurance carrier accountable and responsible.  The goal was to get the surgery back on the calendar as soon as possible; J.C. hired Lisa to move forward in her representation. 

Attorney Lisa Pierobon Mays immediately filed the necessary paperwork, alerting the head judge for the State of Wisconsin Department of Workforce Development (termed “DWD”) that J.C.’s claim required special attention due to the alarmingly illegal decisions made by the workers compensation insurance carrier.  In turn, the State responded immediately by assigning the claim to an administrative law judge who within two days reviewed Attorney Pierobon Mays’ submissions and agreed that the denial was clearly erroneous.  The Judge ordered the insurance carrier to approve the surgery, based on their own doctor’s report that such surgery was reasonable, necessary, and related to the November 2020 work injury.  Fearing the repercussions of its error, the workers compensation insurance carrier quickly hired its own lawyer.  Yet, even the insurance company’s lawyer agreed with Attorney Pierobon Mays’ position that J.C.’s claim for benefits had been erroneously denied.  Attorney Lisa Pierobon Mays diligently worked with opposing counsel to get J.C.’s worker compensation injury claim back on track.  Surgery is now scheduled for right shoulder to be done in a few weeks and lost-time benefits for missing work will be paid to J.C. without issue or delay from the day of surgery forward.  All medical treatment will also be paid by the workers compensation carrier.     

While it is a happy ending that J.C.’s claim is now being handled properly, consider the cost it took to get it there.  J.C. suffered ongoing pain, delayed medical treatment, personal and financial stress, a fatigued body overcompensating for an injured arm, and now attorney fees of 20% deducted from her lost-time benefits.  All of this needless suffering because the insurance company failed to treat J.C. fairly and legally according to the laws of Wisconsin.  This story is tragic but not uncommon.  Workers’ compensation injury claims are often not handled properly.  Insurance adjusters come and go causing files to be regularly transferred to a new claims adjuster; attention to detail and accuracy is often lost when adjusters are changed.  Moreover, insurance adjusters are many times downright rude, demeaning, and condescending to injured Wisconsin workers.  Injured workers are made to feel like they have done something wrong in simply filing a workers compensation claim.   The injured worker’s credibility and integrity is regularly questioned and assaulted by adjusters who make them feel like they are only money-seeking.  The penalty claim in Wisconsin for Bad Faith rarely gives the injured worker back what they have lost as the award (up to $30,000) is not guaranteed because it is based on many more complicated factors.

Mays Law Office is proud of the work it did for J.C. and takes on every call and claim with an eye toward an aggressive and effective approach to keep workers compensation insurance companies responsible and accountableIn sum, never assume you are being treated fairly by an insurance company.  Call Attorney Lisa Pierobon Mays today at 608)257-0440.

 

 

10 Important Facts about Workers’ Compensation in Wisconsin

10 Important Facts about Workers’ Compensation in Wisconsin

You got injured or sick on the job. Do you qualify for workers’ compensation benefits? If so, what do you need to do to collect the benefits you deserve? Here are 10 important facts about filing for workers’ compensation benefits in Wisconsin:

1. Workers’ Compensation Covers “Employees”

The first thing you need to know about workers’ compensation is that benefits are available to “employees.” If you are an independent contractor, then you generally are not eligible to receive benefits.

Most workers in Wisconsin are employees. If you work for a company, receive a regular paycheck, and receive a W-2 at the end of the year, then you almost certainly qualify. If you receive 1099 instead of a W-2, this suggests that you are an independent contractor—although it is possible that you are being misclassified.

2. Most (But Not All) Employees Are Covered

Wisconsin law requires most employers to carry workers’ compensation insurance that covers their employees. But, there are a few exceptions. For example, farms are generally excluded, and some employers are subject to federal workers’ compensation laws instead of Wisconsin’s workers’ compensation statute.

The law also excludes certain types of employees from workers’ compensation eligibility. Domestic workers and volunteers are two examples. But, as the Wisconsin Department of Workforce Development (DWD) notes, “[n]early all workers in Wisconsin are covered.” So, if you have gotten injured or sick on the job, it is worth speaking with a Madison workers’ compensation lawyer about your legal rights.

3. The Uninsured Employers Fund Covers Employees Whose Employers Don’t Have Insurance

While Wisconsin law requires most employers to carry workers’ compensation insurance, not all employers follow the law. To protect employees whose employers don’t follow the law, the Wisconsin DWD has established the Uninsured Employers Fund (UEF). If you are entitled to workers’ compensation benefits and your employer doesn’t have insurance, you can hire a lawyer to help you file a claim with the UEF.

4. Workers’ Compensation Covers Physical and Mental Harm in Wisconsin

As the Wisconsin DWD explains, an “injury” for workers’ compensation purposes is, “any mental or physical harm due to workplace accidents or diseases.” The DWD provides the following examples of physical and mental harm:

  • Burns
  • Crushing injuries
  • Cuts and bruises
  • Dermatitis
  • Disfigurement
  • Emotional stress
  • Fractures
  • Hernias
  • Hysteria
  • Infections
  • Loss or paralysis of a body part
  • Loss of hearing or vision
  • Nervous disorders
  • Respiratory diseases
  • Sprains and strains
  • Stiffness
  • Traumatic neurosis

It is important to emphasize that these are just examples. Many more types of job-related injuries and illnesses are covered. If you have any questions about your eligibility you should talk to a Madison workers’ compensation lawyer promptly.

5. You Can (and Should) Choose Your Own Doctor

After suffering a job-related injury or illness, it is important to seek treatment promptly. Under Wisconsin law, you have the right to see “any physician, psychologist, chiropractor, dentist, physician assistant, advanced practice nurse prescriber or podiatrist who is licensed to practice in Wisconsin.” Your employer cannot tell you where to go for treatment; however, you may have to submit to an examination by a doctor who has been selected by your employer. If you receive a request for an “independent medical exam” (or “IME”), you should discuss the request with your lawyer before submitting to the examination.

6. Workers’ Compensation Covers Must (But Not All) Forms of Medical Treatment

If you have a workers’ compensation claim in Wisconsin, you are entitled to receive the treatment you need to get better or to achieve your “maximum medical improvement” (or “MMI”). However, not all forms of treatment are covered. For example, Wisconsin law specifically excludes physical therapy, massage, and pain clinic services from coverage, “unless the treatment is ordered by a doctor or . . . the employer or insurance company specifically agrees in advance to pay for such treatment.”

7. You Must Notify Your Employer of Your Injury or Illness

While you might be hesitant to tell your employer that you have an injury or illness, this is a key step in the process of filing for workers’ compensation benefits. The Wisconsin DWD recommends filing a report within 30 days, but you should generally report your injury or illness as soon as possible. Technically, you have up to two years to file a report with your employer. However, waiting this long can make it much more difficult to collect the benefits you deserve.

It is also important to understand that your employer cannot legally fire you or take other adverse employment action based on the fact that you decided to file for workers’ compensation benefits. Filing for workers’ compensation is your right, and you cannot be punished for exercising it.

8. You May Qualify for Temporary Disability, Permanent Disability, or Both

In addition to coverage for your eligible medical expenses, you may qualify for temporary or permanent disability benefits. You may also qualify for both. These benefits cover a portion of your lost wages while you are unable to work (or while you are only able to work in a limited capacity). Calculating your disability benefits requires a detailed understanding of Wisconsin’s workers’ compensation benefit schedule, and it is best to work with an experienced Madison workers’ compensation lawyer to ensure that you are seeking the maximum benefits available to you.

9. Workers’ Compensation Disputes are Common

From denying that employees’ injuries are work-related to underpaying employees’ benefits, workers’ compensation disputes are common. Hiring a lawyer will help minimize your risk of facing a dispute; and, if you encounter a dispute, your lawyer will be able to handle it for you.

10. You Can Hire a Madison Workers’ Compensation Lawyer at No Out-of-Pocket Cost

Finally, you can hire a Madison workers’ compensation lawyer to handle your claim at no out-of-pocket cost. At Mays Law Office, we help injured workers apply for benefits and deal with benefit denials. To discuss your workers’ compensation claim in confidence, contact us today.

Talk to a Madison Workers’ Compensation Lawyer for Free

Do you have a workers’ compensation claim in Wisconsin? If so, we can help. Call 608-257-0440 or contact us online to get started with a free and confidential consultation.

Hurt at Work in Wisconsin? What Happens Now?

Hurt at Work in Wisconsin? What Happens Now?

Now what happens?!  You have been hurt at work, you are scared and do not know what to do or who to listen to.   Mays Law Office hears this question every single day.

Attorney Lisa Pierobon Mays talks to injured workers on a daily basis – free of charge.  Every story varies but the emotions are always the same – fear, confusion, uncertainty, and even anger.  No one wakes up and thinks “Oh Boy, I sure hope I get hurt at work today.”  Accidents causing injuries at workplaces happen daily and fault, for the most part with certain legal exceptions, is not a factor in Wisconsin.  So, let’s say you slip and fall because a puddle of water was carelessly left on the floor, or you are walking too fast and miss a step running up the stairs and you blow out your knee.  In those kinds of situations, blame and fault is not a factor to be considered and not a reason to be denied workers compensation benefits.

So, what is the process once a Wisconsin worker injures himself?  The first question is whether the injury is serious enough that medical treatment is required?  Obviously, any injury involving broken bones, stitches, serious pain, difficulties with mobility and clear thinking should be medically treated immediately.  All work injuries should be reported to the employer so that an Incident/Accident Report can be timely completed by you and your supervisor.  Work comp claims can and have been denied for failure to report them timely to the employer; by not doing so raises suspicion and puts the injured workers credibility and honesty at risk.  With such information, your employer is responsible for notifying their workers compensation insurance carrier so that a claim can be opened, an investigation started, and benefits for lost time and medical treatment paid.

Once a workers compensation claim is filed, everyone has responsibilities.  The Employer is responsible to comply with any requests for complete, truthful and timely information made by the workers compensation carrier.  The Workers Compensation Insurance Carrier is responsible to diligently investigate the claim, respond to the employer’s reporting of the claim, talk to witnesses, get a statement from the injured worker as to the details how the work injury occurred.  The insurance carrier should also be reviewing medical records and sending out medical authorizations for the injured worker to sign for the review of their relevant medical records.  All of this is necessary for the workers compensation carrier to make a timely decision to either accept or deny, in good faith, the workers compensation claim.

The Wisconsin Injured Worker is responsible to give true and accurate statements as to how the injury occurred to their employer, the workers compensation insurance carrier, and their doctors.  Every statement of recollection must be consistent as to date, time, details, witnesses, and pain symptoms.  Any inconsistency can, and likely will, be used against the injured worker in an attempt to deny the claim.  The injured worker must maintain a good relationship with their medical providers.  Meaning, do not miss doctor appointments.  Do not disregard your doctor’s advice, treatment, and recommendations.  Keep in mind that your doctor will not be keen to support your claim if you have been a difficult patient.  Doctors like patients that follow their treatment, listen to their recommendations, and appear to want to get better.  Maintaining integrity with your doctors is of utmost importance because your comments and behavior is being documented in your medical records with every single communication that you have with them and their medical office, meaning their medical assistants, nurses, and even receptionist.  Also, the injured worker must keep their employer informed of their physical restrictions and availability to work.  Don’t just do this verbally.   It should be done by phone, text, email, and in writing so that the employer does not claim that you abandoned your job by failing to communicate after the injury.

Remember, an Injured Worker must never be seen doing anything that would be considered inconsistent with their injury.  Stay away from posting on social media as pictures can be damaging and misunderstood.  For instance, an injured worker suffering from a sore knee should not be posting pictures with their volleyball club team in a competitive setting.  It is only logical to assume that an injured worker with a knee injury would not be able to play volleyball.  Likewise, keep in mind that insurance companies hire investigators to conduct surveillance so be watchful as to how you appear to others, in public and even in your own yard, garage, porch, and deck!

So, now the Wisconsin injured worker says “Damn It, I’ve done all of this and I have still been denied Wisconsin workers compensation benefits!  What next….?!

If a Wisconsin injured worker’s claim for workers compensation has been denied, or even has a sense that their claim for workers compensation benefits will be denied, then they should immediately call Attorney Lisa Pierobon Mays at Mays Law Office.  Attorney Mays will provide a free phone consultation.  She will ask a series of questions to get to know you and your injury claim better.  She will review your communication with the workers compensations insurance carrier.  She will go over your medical treatment to understand your diagnosis and prognosis.  At the end of your conversation, you questions will be answered and suggestions offered as to how to proceed next.

Keep in mind that every work injury is different, unique, and requires it owns customized approach.  If the timing and circumstances of your claim calls for it, then Attorney Lisa Pierobon Mays will invite you to come to her Middleton/Madison office, if convenient, to discuss your claim further.  This in-person meeting is still part of the free consultation provided by Mays Law Office.  The meeting will last about an hour and half so that all the details of your denied claim can be thoroughly discussed and documented.  At the end of this meeting, a well-developed plan will be formalized as to how your workers compensation claim will be pursued.  Attorney Pierobon Mays will detail everything that you can expect and will be involved in the injury claim EVERY STEP OF THE WAY.  Your claim will NEVER be assigned to another attorney or a paralegal.  Every email, phone call, and correspondence will involve Attorney Pierobon Mays.

Attorney Pierobon Mays has been representing Wisconsin injured workers since 1997 – that’s 25 years of experience fighting and winning.  Attorney Lisa Pierobon Mays is not intimidated by any Wisconsin employer or workers compensation insurance carrier.  See her actual results by doing a simple Google review search.  You will see 5 Stars ratings from her actual clients who have found her effective, respected, and aggressive in achieving positive results for them.

Mays Law Office knows that suffering a work injury is scary and intimating but Attorney Lisa Pierobon Mays is only a phone call away from answering all of  your questions and easing your concerns.

What Should an Injured Wisconsin Worker Do After Their Injury?

What Should an Injured Wisconsin Worker Do After Their Injury?

There is no doubt that employers HATE work injuries. So what is an injured worker to do…? Stay quiet about her injury for fear that her employer becomes angry at her and in retaliation reduces her hours, changes her duties to something undesirable, or makes the work environment hostile. OR should the injured worker report her injury immediately regardless of her employer’s response because if the injury turns out to be serious and requires medical treatment and lost time from work then she will need to have it covered under workers’ compensation? 

Many injured workers wrongly take the wait-and-see approach. With this approach, they hope that the pain or symptoms are no more than a mere strain or sprain and will improve after a few days. If not then they will worry about reporting it later. 

While this wait-and-see approach may seem like a logical compromise, it will hurt the injured worker if the injury turns out to be more serious than originally thought. Not reporting the accident promptly, allows the employer to question the worker’s credibility which could lead to denial of medical treatment, benefits for missed time from work, and loss of a monetary award based on the permanent injury. Moreover, your private health carrier may also deny coverage of medical treatment if claimed as a work injury as such treatment is the responsibility of the worker’s compensation insurance carrier. Now the worker is in a Catch 22 predicament. 

What about if the employer has a policy requiring strict internal deadlines for reporting accidents, such as within 24 hours of the injury, which the worker deliberately did not follow? Now the employee can be reprimanded and her credibility and job security are jeopardized. 

Ultimately, the injured worker needs to report a work injury to avoid this Catch 22 predicament. When reporting the injury, always do it in writing and get a copy of your written report. Every reputable employer has an Accident Report Form. If no form can be found, draft your own report. Details such as who, what, where, when, how, and why are easily remembered when describing the injury. Details such as dates and times are always crucial. Keep a photocopy of what you report to the employer. If the employer refuses to provide a copy, use your smartphone to take a picture of it. When it comes to a workers compensation injury, document, document, document! Keep a journal with dates, times, witnesses, specifics as to how the injury occurred, and medical appointments because your memory will fade over time. Again, smartphones have lots of apps to keep details documented for you, such as voice recorders, cameras, note-taking, calendars, etc. 

Even if you are late in reporting an injury, you should still follow these recommendations. Remember, better late than never. 

Wisconsin law protects injured workers. Mays Law Office and Attorney Lisa Pierobon Mays are here for you. Call for a free and immediate consultation. Everything we discuss is confidential. We proudly represent the Wisconsin injured worker. See testimonials from our clients. 

 

After a Work Injury, do not Expect a Motherly Hug from the Workers Compensation Insurance Company

After a Work Injury, do not Expect a Motherly Hug from the Workers Compensation Insurance Company

While some injured workers are treated fairly in Wisconsin, most unfortunately are not. Most injured workers are treated rudely, even with skepticism as to whether they truly were hurt. One could even ask if Adjusters are trained to belittle the Wisconsin injured worker. Dont put up with it, call Mays Law Office at (866)257-0440 for a free consultation and tips on what the workers compensation carrier won’t tell you, such as 

You are entitled to 100% reimbursement for medical mileage to/from doctor and therapy appointments

If you are getting a lost time benefit (also called TTD benefit), is the average weekly wage calculated correctly – most are not; 

You can choose your own doctor/medical provider – never treat with the “company doctor

If instructed to see an IME or socalled “Independent Medical Examinerthere is nothing “independentabout this exam. You have rights on how to handle these insurance-paid exams

Nurses assigned to attend your medical appointments do not have the automatic right to come into your exams or guide your medical treatment; 

Employers have to offer you accommodating work that meets your physical restrictions while healing from a work injury, if not then a losttime benefit needs to be paid to you for missing work; 

If your injury is severe enough to cause permanent disability and you have lost your job, or an equivalent paying job, then likely you are eligible to pursue Retraining or a loss of Earning Capacity 

Claim; 

If your injury is severe enough that it leaves you disfigured, such as a serious scar, limp, amputation then you are entitled to an additional benefit called Disfigurement

Be cautious – don’t let the workers compensation insurance carrier stall, claiming week after week that they are “investigating” your injury. Likely, if the claim takes more than two weeks to investigate then it will be denied. Call Mays Law Office immediately. Never accept a denial of your work injury without calling or Emailing Mays Law Office first, Ipmays@mayslaw.net 

When Should I Call an Attorney after I Suffer a Work Injury in Wisconsin?

When Should I Call an Attorney after I Suffer a Work Injury in Wisconsin?

At Mays Law Office, Attorney Lisa Pierobon Mays is happy to talk to you at any time during the workers compensation process. However, there are crucial moments when you absolutely need to talk to us, such as: 

Call an attorney if the employer refuses to believe that you were injured at work or refuses to file the accident claim with their workers compensation carrier; 

Call an attorney if the employer fires you for reporting a work injury

Call an attorney if two weeks passes after your work injury and you have received no benefits for either lost time from work or payment of your medical bills; 

Call an attorney before going to any doctor appointment set up by the workers compensation carrier, especially if they claim it is an Independent Medical Examination.” This is false and nothing about it is independent or fair

Call an attorney if the workers compensation doctor disagrees with your doctor and the insurance company stops paying for your medical treatment or tells you to not follow the advice of your own doctor; 

Call an attorney if you cannot work and now the workers compensation carrier is not paying you a lost time benefit

Call an attorney if the workers compensation carrier wants you to sign a document in exchange for a money settlement; 

Call an attorney if you have physical restrictions and can do some level of work but the employer refuses to allow you back and now the workers compensation carrier is not paying you a lost time benefit

Call an attorney if your injury is so severe that you have concerns that you will never be well enough to return to the same type of employment. 

Lastly, always feel welcome to call Mays Law Office at any time you have questions. At Mays Law office, you will talk to a Wisconsin attorney who concentrates their practice in representing injured workers. At Mays Law Office you will work with an attorney, not just an assistance or paralegal. Have a question, Call (608)2570440 or Toll Free (866)2570440 or E-mail Ipmays@mayslaw.net 

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