How To Appeal A Denied Worker’s Compensation Claim
When your worker’s compensation claim is denied in Wisconsin, it can feel like a dead end—but it’s not. We’ve worked with many injured workers who were wrongfully denied benefits they were legally entitled to. A denial doesn’t mean your injury isn’t real or that you don’t qualify for compensation. It just means the insurance company or employer has challenged your claim, and now you have the right to appeal. Wisconsin law gives you the opportunity to contest the decision and present evidence showing that your injury is work-related and that you deserve benefits.
Under Wisconsin Statutes Chapter 102, workers injured on the job have the right to file for benefits, including medical expenses, wage loss, permanent disability, and vocational retraining. But sometimes, employers or their insurance companies dispute claims, often arguing that the injury did not occur at work, that it’s not as serious as claimed, or that the employee didn’t follow proper procedures. If this happens to you, it’s important to understand your rights and take the proper steps.
Understanding Why Claims Get Denied
The first thing we do when a client comes to us with a denied claim is review the denial letter. The insurance company is required to state the reason for the denial. Common reasons include:
- The injury was not reported in time
- Medical evidence is lacking or inconsistent
- The injury did not occur during the course of employment
- The worker failed to seek timely medical treatment
- Pre-existing conditions were blamed instead of the job incident
No matter the reason, the denial can be challenged through the legal process set up by the Wisconsin Department of Workforce Development (DWD) and the Division of Hearings and Appeals.
How To File An Appeal In Wisconsin
If your claim is denied, you can file an application for a hearing with the DWD under Wisconsin Statute § 102.17. This application formally requests that an administrative law judge (ALJ) hear your case. You will be required to present evidence such as medical records, witness statements, accident reports, and wage records. This is your opportunity to show that your injury is connected to your job and that you meet the legal standards for compensation.
The ALJ will review all the evidence, hold a hearing, and issue a decision. If the judge rules in your favor, the insurance company may be ordered to pay benefits. If the judge upholds the denial, you still have the right to appeal to the Labor and Industry Review Commission (LIRC) and, from there, to the Wisconsin Circuit Court.
Why Legal Representation Helps
The appeals process is legal in nature and requires you to present evidence, respond to legal arguments, and comply with deadlines. We’ve seen many workers try to handle appeals on their own, only to have their claims dismissed or delayed. Having an attorney on your side ensures your case is handled properly from the start. We take care of the paperwork, collect medical opinions, question witnesses, and prepare you for testimony so that you have the best chance of success.
Wisconsin Worker’s Compensation Claim Frequently Asked Questions
Why Was My Worker’s Compensation Claim Denied In Wisconsin?
Common reasons include missed deadlines, lack of medical evidence, disputes over whether the injury happened at work, or claims that your condition is pre-existing. The insurance company must provide a reason in writing.
How Long Do I Have To Appeal A Denied Worker’s Compensation Claim?
You must file an application for a hearing within six years of the injury under most circumstances, according to Wisconsin Statute § 102.17. However, it’s best to act much sooner to preserve evidence and protect your rights.
Can I File An Appeal If My Injury Happened A While Ago?
Yes, as long as you are within the statutory timeline. If you previously filed a claim or received partial benefits, you may still be able to appeal a denial of additional benefits.
Do I Need A Lawyer To Appeal My Claim?
While not legally required, we strongly recommend having a lawyer represent you. Appeals involve legal rules, medical opinions, and formal hearings. A lawyer can increase your chances of getting benefits.
What Evidence Do I Need To Win My Appeal?
You’ll need clear medical records linking your injury to your work, witness statements if available, a detailed account of the incident, and proof of lost wages or permanent limitations from the injury.
Can I Be Denied Benefits If I Have A Pre-Existing Condition?
Not necessarily. If your job aggravated or worsened a pre-existing condition, you may still qualify for benefits. Medical evidence is key to proving the connection between your work and your current condition.
What Happens At A Worker’s Compensation Hearing?
You, your employer, and the insurance company will present evidence before an administrative law judge. Witnesses may testify, and documents are reviewed. The judge will then issue a written decision.
What If I Lose At The Hearing?
You can appeal the judge’s decision to the Labor and Industry Review Commission (LIRC). If LIRC also denies your claim, you can take your case to Wisconsin circuit court for further review.
Can I Still Work While Appealing My Denied Claim?
Yes. However, your ability to work may affect certain types of benefits, such as temporary total disability. Be honest with your medical provider and attorney about your work activities.
Will The Insurance Company Pay My Legal Fees If I Win?
Attorneys’ fees in worker’s compensation cases are generally limited by law in Wisconsin. If we help you recover benefits, our fees are a percentage of the amount recovered and are subject to approval by the state.
We Help Injured Workers Fight Wrongful Claim Denials
At Gillick, Wicht, Gillick & Graf, we believe that injured workers should never be left without the support they deserve. If your worker’s compensation claim was denied, we’re ready to help you challenge the decision and fight for your benefits.
Contact our Milwaukee worker’s compensation lawyer at Gillick, Wicht, Gillick & Graf by calling 414-257-2667 to receive your free consultation. We have offices in Milwaukee and proudly represent injured workers in Janesville and throughout all of Wisconsin.
