Delays, Denials & More: Potential Issues When You File for Workers’ Compensation in Wisconsin

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.