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.



Injured on the Job in Wisconsin? Don’t Make These 10 Common Mistakes

Injured on the Job in Wisconsin? Don’t Make These 10 Common Mistakes

If you’ve been injured on the job in Wisconsin, you may be entitled to workers’ compensation benefits. But, even if you are clearly entitled to compensation, this doesn’t mean that it will be easy to collect the benefits you deserve. You need to take several steps to protect your rights, and there are also several costly mistakes you need to avoid.

Here are 10 common mistakes you need to avoid when filing for workers’ compensation benefits in Wisconsin:

1. Waiting Too Long to Report Your Injury

In Wisconsin, you only have 30 days to report a job-related injury. If you wait longer than 30 days, you could lose your right to workers’ compensation benefits.

However, while you have up to 30 days, you really shouldn’t wait any longer than necessary. Even if you report your injury within 30 days, waiting could make it more difficult to prove that you are entitled to benefits. Your employer may try to dispute that the accident happened, and your employer’s insurance company may try to argue that you can’t prove your injury is work-related.

2. Including Inaccurate Information on Your Injury Report

When reporting your injury to your employer, you need to be as accurate as possible. You do not want to say anything that isn’t true. Do not make any assumptions; if you don’t know something, state that you don’t know. Even if you inadvertently provide false or misleading information, this could create problems for your workers’ compensation claim.

3. Seeing a Company Doctor

Under Wisconsin law, you have the right to see a doctor of your choosing (this isn’t the case in all states). You should exercise this right—and you should not see a company doctor if one is available to you. If you needed emergency treatment and you saw a company doctor, that’s okay, but you will want to choose your own doctor going forward.

4. Failing to Follow Through with Your Medical Care

Once you receive a diagnosis and treatment recommendations, you need to follow through with your medical care. Ignoring medical advice is among the most common mistakes workers make after getting injured on the job. If you ignore your doctor’s advice, not only could this hinder your recovery, but it could lead to challenges with your workers’ compensation claim as well.

If you aren’t sure what your doctor has recommended, you should call the office to inquire. Make sure you get your prescriptions filled and make arrangements to be at all of your follow-up appointments on time.

5. Returning to Work Too Soon

As part of following your doctor’s advice, you need to make sure you do not return to work too soon. Even if you feel good enough to work, you still need to rest if this is what your doctor recommends. Broken bones, strains and tears, tendonitis, and other common types of work injuries can take several weeks or months to heal, and resuming work too soon could lead to setbacks with your recovery. If the insurance company says that you are responsible for these setbacks, your additional medical expenses might not be covered.

6. Letting the Insurance Company Calculate Your Benefits

Most employees who file for workers’ compensation on their own let the insurance company calculate their benefits. While the insurance company might calculate your benefits correctly, it also might not. To make sure you receive the full benefits to which you are legally entitled, you will want to double-check the insurance company’s calculation and raise any concerns you have.

This is especially important concerning disability benefits. Temporary and permanent disability benefits are calculated differently, and the amount you are entitled to receive depends on your individual circumstances. The insurance company might try to pay less than the full amount you are owed; and, if it does, you will need to know so that you can address the issue promptly.

7. Accepting a Denial of Benefits

Sometimes insurance companies will deny benefits outright. If you receive a denial of benefits, you should not let this be the last word on your claim. Instead, you should talk to a lawyer to find out if the denial was justified. If it weren’t (as is often the case), your lawyer would be able to deal with the insurance company for you and work to address any issues that may be responsible for your denial.

8. Failing to Prepare for Your Independent Medical Exam (IME)

After you file for workers’ compensation benefits, your employer’s insurance company may say that you need to attend an independent medical exam (IME). This is an exam conducted by a doctor who works with an insurance company. As such, it really isn’t “independent” at all.

Before attending an IME, you need to prepare. You need to know what to say, what not to say, and what to do once the exam is over. A lawyer can help you with this as well.

9. Giving Up on Your Claim

Given all of the challenges involved in filing for workers’ compensation benefits, some workers simply give up. They get tired of dealing with the insurance company, and they decide that the hassle isn’t worth any benefits they may eventually be able to recover.

However, you should not give up on your claim under any circumstances. Job-related injuries can be incredibly costly, and you deserve to collect benefits if you qualify. Down the line, you will be happy that you put in the effort to file a successful claim.

10. Trying to Handle Your Situation on Your Own

If you need to file for workers’ compensation, you don’t have to handle your situation on your own. A lawyer can help you, and you can hire a lawyer at no out-of-pocket cost. Legal fees for workers’ compensation claims are capped at 20 percent of the amount in dispute, and an experienced lawyer may be able to help you recover far more than you could recover on your own.

Schedule a Free Workers’ Comp Consultation at Mays Law Office

Do you need to file a claim for workers’ compensation benefits? If so, we encourage you to contact us for a free, no-obligation consultation. To speak with an experienced workers’ compensation lawyer at Mays Law Office in confidence, call 608-257-0440 or tell us how we can reach you online now.

How Do You File for Workers’ Compensation in Wisconsin?

How Do You File for Workers’ Compensation in Wisconsin?

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.

Are You Eligible to File for Workers’ Compensation in Wisconsin?

Are You Eligible to File for Workers’ Compensation in Wisconsin?

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
  • Volunteers
  • 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.