What to do if Your Workers’ Compensation Claim is Denied

After filing for workers’ compensation benefits, you may find that your claim is denied. Remember: if you were injured on the job, you filed a claim for workers’ compensation and that claim was denied, you may dispute the denial.

Don’t be discouraged if you do receive a denial - continue to fight for the compensation you deserve.

If you have been injured on the job and believe you may qualify for workers’ compensation, you can learn more about how to file a workers’ compensation claim on our blog, here.

When you file, you should keep in mind the possibility that your claim may be denied. If this happens, it is not the end of the road. You have the option to file an appeal and prove you are entitled to workers’ compensation.

Determining why your claim was denied

Common reasons a workers’ comp claim can be denied:

●     Failure to promptly notify an employer of the injury;

●     Lack of medical treatment sought or received;

●     Location where the injury was sustained, for example in the commute to or from work, rather than onsite; or

●     Paperwork filed after a deadline.

Understanding why your claim was denied can help you take the appropriate steps to appeal that decision and rectify the situation. The denial letter you received will include an explanation and next steps on how to appeal a decision.

Understanding the dispute process

In Wisconsin, your dispute may be handled in either a formal hearing or through an informal alternative dispute resolution process. Either option can be complicated or convoluted, and it may be in your best interest to speak to a workers’ compensation attorney who can help you file an appeal.

The informal alternative dispute resolution process, utilized when a worker has not retained an attorney, includes a review of your claim by a specialist in the State of Wisconsin Department of WorkforceDevelopment’s Division of Workers Compensation’s Alternative Dispute ResolutionUnit. During that review the specialist will determine the issues in your claim and whether the medical information provided supports the claim for benefits.

If you do have an attorney, or if your first appeal is denied, you can pursue a formal hearing with an Administrative LawJudge. To request a hearing, you must complete an application for hearing form and provide medical information to support your claim. Your attorney can help you do so.

Having a workers’ compensation attorney can help you succeed

The dispute process to receive workers’ compensation can be an exhausting one, and having a knowledgeable expert in your corner can have a huge impact. Attorney Rachel Fitzgerald can help you file an appeal and navigate the process to receive the compensation you deserve.

Written by
Fitzgerald Law Firm