By Attorney Lisa Pierobon Mays · Updated September 2026
The short answer: A denial is not the end of your workers’ compensation claim. In Wisconsin, the insurance company (or a self-insured employer) must put a denial in writing, give the specific reason, and tell you about your right to a hearing. To challenge the denial, you file an Application for Hearing (Form WKC-7) with the Worker’s Compensation Division of the Department of Workforce Development (DWD), within the time limits in Wis. Stat. §§ 102.12 and 102.17(4). An administrative law judge decides the dispute. A party who disagrees with the judge’s decision can ask the Labor and Industry Review Commission (LIRC) to review it; the petition must be received within 21 days after DWD mails the decision.
In our experience, some injured workers stop at the first denial letter, and insurance companies know it. Attorney Lisa Pierobon Mays has practiced law in Wisconsin since 1995, and for more than 25 years she has represented injured workers against employers and insurance companies that deny benefits. This guide is verified against the Wisconsin Statutes and DWD’s rules as of September 2026. The date matters: since January 1, 2026, disputed claims are heard by DWD again.
What your denial letter must tell you
An insurance company or self-insured employer that denies a claim must give you written notice. The notice must state the specific reason for the denial and tell you about your right to a hearing, and DWD says the insurer must inform you within 7 days of deciding to deny.
A denial can cover the whole claim or only part of it. The insurer may pay your medical bills but refuse wage-loss benefits. It may stop benefits after an exam by a doctor it chose. It may accept your claim and still not pay a benefit that is due. Each of these disputes can go to a hearing.
Keep the letter and write down the date you received it. The stated reason tells you what evidence you will need. If your payments stopped and no letter came, ask the insurance company to put its decision in writing.
Why workers’ compensation claims get denied in Wisconsin
Some denials hold up; others can be challenged. The Wisconsin Department of Health Services publishes a workers’ compensation dashboard that shows the percent of claims each year that were paid, denied, or deemed not to have lost time. Common reasons insurers give for a denial include these.
Late notice to your employer
Under Wis. Stat. § 102.12, your employer must receive notice of a work injury within 30 days after it happens, or within 30 days after you knew or ought to have known the nature of the disability and its connection to your job. The second clock matters for a condition that develops over time, such as carpal tunnel syndrome. Late notice does not bar recovery if your employer was not misled by the delay. A separate two-year rule can bar a claim when no compensation other than medical treatment was paid and no application was filed, unless your employer knew or should have known about the injury within those two years. Our guide on how to file a workers’ compensation claim in Wisconsin explains these deadlines.
“The injury is not work-related”
To be covered, an injury must arise out of and in the course of your employment. Insurers often argue that your medical records do not connect the injury to the job, so tell every doctor, from the first visit, exactly how you were hurt at work. After an unexplained fall, some insurers call the injury “idiopathic,” meaning it came from a personal cause. See our article on the idiopathic defense.
“It is a pre-existing or degenerative condition”
The insurer’s doctor may say that your symptoms come from an older condition or from wear and tear, not from your work. Your treating doctor may disagree. When the medical opinions conflict, the judge weighs them at the hearing. One hearing win below was decided on this kind of disagreement.
The insurer’s independent medical examination (IME)
The insurance company can require you, by written request, to attend a reasonable examination with a doctor it selects, called an independent medical examination (IME). It must pay your necessary expenses, including travel, in advance; you can bring your own doctor and one observer, and you are entitled to a copy of the report (Wis. Stat. § 102.13(1)). An unfavorable IME report is a common reason for a denial, but when your doctor disagrees, the conflict is resolved at the hearing. Lisa explains what happens at these exams.
“You are an independent contractor”
Wisconsin decides contractor status with a strict nine-part test in Wis. Stat. § 102.07(8). Generally, a worker who does not meet all nine conditions is treated as an employee for workers’ compensation purposes. If you were denied as a contractor, check each condition against the way you actually worked.
Safety-rule, alcohol or drug defenses
Wisconsin workers’ compensation is a no-fault system, so ordinary carelessness is not a reason to deny a claim. Under Wis. Stat. § 102.58, compensation can be reduced by 15 percent, up to $15,000, when an injury is caused by a worker’s failure to use a required safety device the employer provided, maintained and reasonably enforced, or to obey a reasonable safety rule the employer adopted, reasonably enforced and told the worker about. When a violation of the employer’s drug or alcohol policy causes the injury, compensation and death benefits are barred, although the employer remains liable for medical treatment.
Inconsistent statements
Adjusters compare what you told your employer, the insurance company and your doctors. In our experience, even innocent differences can be used as a reason to deny, so give everyone the same accurate account.
What to do after a denial: step by step
- Keep every paper. Save the denial letter, your medical records and bills, pay stubs, the incident report, photos of the scene, and the names of witnesses.
- Keep getting treatment from a doctor you choose. In Wisconsin you choose your treating practitioner, and you have the right to a second choice on notice to your employer or its insurer (Wis. Stat. § 102.42(2)(a)). While the claim is denied you may receive bills, so keep every bill, receipt and mileage record, and use other coverage, such as group health insurance, if you have it.
- Get your doctor’s opinion in writing. Ask your treating doctor or other treating practitioner for a written opinion on what caused the injury and what your restrictions are. Doctors can testify, but most give their opinions in a written report, usually on DWD’s Form WKC-16-B, and the judge weighs those reports along with the testimony and the rest of the record.
- If you do not have a lawyer, DWD’s ADR Unit reviews the claim first. The Alternative Dispute Resolution (ADR) Unit of DWD’s Worker’s Compensation Division tries to resolve the dispute informally. If that does not work, the next step is a formal hearing. See DWD’s page for injured workers.
- File the Application for Hearing (Form WKC-7). You file it with DWD’s Worker’s Compensation Division, and there is no filing fee. Include medical documentation that supports the claim: DWD will not schedule a hearing until it receives that medical support. Filing pauses the § 102.17(4) time limit while the case is pending. Under 2025 Wisconsin Act 145, the pause adds no time: the deadline becomes the later of the date the case ends or the date it would have expired anyway, so if the original deadline passed while the case was pending, the claim can be barred once the case ends, for example when DWD approves a settlement or dismisses the application without prejudice.
- Prehearing conference and mediation. An administrative law judge may hold a prehearing conference, and DWD runs a mediation program to help the parties settle. A compromise settlement must be approved by DWD.
- The hearing. A hearing before a DWD administrative law judge is formal. Witnesses testify and can be cross-examined, and the judge weighs the medical reports. DWD schedules hearings only by written letter. In July 2026, DWD warned that email scammers were scheduling fake hearings to target injured workers, many of them Spanish-speaking. If a hearing notice arrives only by email, confirm it with DWD.
- Petition LIRC within 21 days. If you disagree with the judge’s decision, you can petition the Labor and Industry Review Commission for review. DWD or LIRC must receive the petition within 21 days after DWD mails the decision; a postmark inside the 21 days is not enough, and a late petition is accepted only if the delay was for a reason beyond your control (Wis. Stat. § 102.18(3)).
- Circuit court within 30 days. A party who disagrees with a LIRC decision can ask a circuit court to review it by filing a summons and complaint, naming LIRC and the other required parties, within 30 days after LIRC mails the decision; LIRC must receive the clerk-stamped, authenticated papers within those 30 days (Wis. Stat. § 102.23). A court can add 30 days only in narrow cases of exceptional delay in receiving the decision.
What changed on January 1, 2026
For years, disputed workers’ compensation claims were heard by the Division of Hearings and Appeals in the Department of Administration. 2025 Wisconsin Act 33 moved those hearings back to DWD, effective January 1, 2026. DWD now employs the administrative law judges, receives hearing applications, sets hearing locations, and runs the mediation program. A guide that sends you to the Division of Hearings and Appeals describes the old system.
A second law, 2025 Wisconsin Act 145, generally took effect April 1, 2026. It clarified how filing a hearing application pauses the time limit (step 5) and added traumatic injuries that cause the need for a shoulder or reverse shoulder replacement to the injuries with no time limit for filing.
Denials and unpaid claims Attorney Lisa Pierobon Mays has challenged
Every case depends on its own facts, and past results do not predict the outcome of any other case. These are cases the firm has described on this site:
- A surgery denied, then ordered. The insurer delayed J.C.’s rotator cuff surgery until she saw its examining doctor, then denied all benefits for her shoulder. Lisa found that the insurer’s own examiner had called the surgery necessary and work-related. An administrative law judge reviewed her filing within two days, agreed that the denial was wrong, and ordered the insurer to approve the surgery.
- A disk herniation called a “strain.” After an MRI showed a disk herniation, the insurer’s examiner called K.K.’s injury a lumbar strain, and all benefits were denied. Lisa pointed out that the report was written before K.K.’s surgery and missed the surgical findings. The case settled before the hearing.
- A hearing win on causation. The insurer’s examiner said that a heavy-equipment mechanic’s forearm condition was degenerative and not caused by his work. Lisa obtained a supporting report from his neurologist, and the judge credited the neurologist, awarding permanent disability, lost-time and medical benefits.
- A hearing win for an immigrant worker. Rosa, a housekeeper, was hurt in a fall at work. The insurer relied on an examiner’s report that ignored three MRIs and denied further treatment and compensation. The judge ruled in Rosa’s favor and awarded wage-loss and permanent disability benefits and her medical expenses.
- Accepted, but unpaid. M.M.’s knee claim was accepted, but his permanent disability benefits went unpaid for months. Lisa filed a hearing application with penalty claims for delay and bad faith, and the insurer’s own examiner later supported payment. The case resolved with payment of the outstanding benefits and medical expenses, reimbursement of attorney’s fees, and additional compensation.
- A late payment, penalized. When an insurer paid R.S.’s approved settlement after the deadline in the judge’s order, Lisa filed delay and bad-faith penalty claims. The insurer accepted the late-payment penalty and settled the bad-faith claim.
Do you need a lawyer after a denial?
You are not required to have one, and DWD’s ADR Unit works with workers who do not. But a hearing is a formal legal proceeding with written medical evidence and short appeal deadlines, and the insurance company often has its own lawyer. In a disputed case, the attorney’s fee is generally capped by statute at 20 percent of the disputed amount recovered (Wis. Stat. § 102.26), and DWD must approve it. Mays Law Office handles workers’ compensation cases on a contingency fee, so if nothing is recovered there is no attorney’s fee; costs are a separate question. See our guide to attorney fees in Wisconsin workers’ compensation cases.
Lisa concentrates her practice on workers’ compensation for Wisconsin injured workers. She is directly involved in each case from start to finish and communicates directly with her clients. She served on the Board of Directors of the Wisconsin Association for Workers Compensation Attorneys (District 7) from 2001 to 2025. Learn more about our Wisconsin workers’ compensation practice and about Attorney Lisa Pierobon Mays.
Frequently asked questions
Can I appeal a denied workers’ compensation claim in Wisconsin?
Yes, although strictly speaking you do not appeal the insurer’s letter: you file an Application for Hearing (Form WKC-7) with DWD’s Worker’s Compensation Division, and an administrative law judge hears the dispute. The first true appeal comes after the judge’s decision. A party who disagrees with the judge’s decision can petition LIRC, which (or DWD) must receive the petition within 21 days after DWD mails the decision, and can seek circuit court review within 30 days after LIRC mails its decision.
How long do I have to challenge a denial?
For most traumatic injuries that happened on or after March 2, 2016, Wis. Stat. § 102.17(4) allows six years from the date of injury or from the last payment of compensation, whichever is later; for an earlier injury, ask a lawyer which rule applies. Payments for medical treatment alone do not extend that period. There is no time limit for an occupational disease, or for certain serious traumatic injuries, such as one causing the loss or total impairment of a hand, arm, foot or leg, any loss of vision, a permanent brain injury, or the need for an artificial spinal disc or a knee, hip or shoulder replacement (Wis. Stat. § 102.17(4)(b)). Before either period applies, a separate two-year rule can bar a claim: if nothing other than medical treatment or burial expenses has been paid and no application has been filed within two years of the injury (or of when you knew or ought to have known it was work-related), the claim is barred unless your employer knew or should have known of the injury within that time (Wis. Stat. § 102.12). The deadlines after a decision are much shorter: a LIRC petition must be received within 21 days after the judge’s decision is mailed, and a circuit court action must be started within 30 days after LIRC’s decision is mailed.
Do I have to go to court to fight a denial?
No. If a denial is not resolved informally, the dispute can go to a formal hearing before a DWD administrative law judge once an application and supporting medical evidence are filed. That is an administrative hearing, not a court case. A court becomes involved only if a party asks a circuit court to review a LIRC decision.
The insurer’s doctor says I can go back to work. Can I still pursue my claim?
Yes. An IME report is the insurer’s evidence, not a decision. When your treating doctor disagrees, the judge weighs both opinions at the hearing. Your own doctor’s written report is the main medical evidence on your side, so ask for it early.
What if the insurance company denied my claim in bad faith?
Wisconsin law allows DWD to add a penalty when an insurer fails to pay because of malice or bad faith. Under Wis. Stat. § 102.18(1)(bp), the penalty for each event can be up to the lesser of 200 percent of the compensation due or $30,000. Whether a denial meets that standard depends on the facts. Lisa filed bad-faith penalty claims in the M.M. and R.S. cases above.
How much does a lawyer cost if my claim was denied?
In a disputed case, Wisconsin generally caps the attorney’s fee at 20 percent of the disputed amount recovered (Wis. Stat. § 102.26), and DWD must approve the fee. Mays Law Office handles workers’ compensation cases on a contingency fee, so if nothing is recovered there is no attorney’s fee, and the first consultation is free. Case costs may also be deducted from the recovery. See how attorney fees work in Wisconsin workers’ compensation cases.
Denied? Talk to Mays Law Office
If your workers’ compensation claim was denied, stopped or left unpaid, Attorney Lisa Pierobon Mays will review the denial letter and your records with you in a free consultation. Mays Law Office represents injured workers across Wisconsin from our office in Middleton. Se habla español. Contact us and tell us how to reach you.
This article provides general legal information, not legal advice. Reading it does not create an attorney-client relationship. Every case depends on its own facts.