How To Appeal a Worker’s Compensation Claim Denial in Wisconsin

Were you hurt on the job in Wisconsin? If so, worker’s compensation benefits should provide medical coverage and wage loss benefits. Unfortunately, some injured workers struggle to get access to the financial support that they rightfully deserve.

This raises an important question:

Can you appeal a worker’s compensation claim denial in Wisconsin?

The answer is an unequivocal ‘yes’—you have the right to challenge an unfavorable decision. Here, our Wisconsin worker’s compensation attorneys explain what you need to do to file an appeal.

Start the Worker’s Comp Appeals Process By Requesting a Hearing

If your worker’s compensation claim was denied in Wisconsin, you should receive a written denial letter. The letter should include some basic information about the denial and your appeal rights. Most importantly, the letter should explain why your worker’s compensation claim was denied.

On appeal, you will have to address the reasoning for denial. To initiate your appeal, you must request a hearing from the Wisconsin Department of Workforce Development. You can request a worker’s comp appeal by completing and submitting Form WKC-7.

Your Worker’s Compensation Claim Will Be Assigned to an Administrative Law Judge (ALJ)

When you appeal a worker’s comp denial in Wisconsin, your claim will be assigned to an individual Administrative Law Judge (ALJ). Before you go before an ALJ, it is essential that you consult with an experienced Milwaukee worker’s comp lawyer. An attorney will review your denial letter and help you gather and prepare all of the supplemental evidence you need to support your appeal.

You Can Appeal an Unfavorable Decision From an ALJ

The Administrative Law Judge does not necessarily get to make the final decision in your case. If your worker’s comp claim is denied a second time by an ALJ, you have the right to appeal to the Wisconsin Labor and Industry Review Commission. However, there is a very strict deadline to appeal an ALJ decision. You only have 21 days from the date an adverse ALJ decision was rendered to appeal to the Commission.

Appealing a Worker’s Comp Denial to a Wisconsin Court

If your worker’s comp claim was denied by the Wisconsin Labor and Industry Review Commission, you may be able to appeal to a state circuit court. That being said, Wisconsin courts have somewhat limited authority to review worker’s comp denials. Wisconsin courts will only review so-called “questions of law,” not disagreements on “questions of fact.” If you have any questions about appealing a worker’s comp claim to state court, an experienced attorney can help.

Frequently Asked Questions About Appealing Wisconsin Worker’s Comp Claim Denial

If your workers’ compensation claim in Wisconsin has been denied, it’s important to remember that you’re not alone in this situation, and there are steps you can take to seek a resolution. This comprehensive guide addresses some of the most common questions regarding the appeal process for a denied workers’ comp claim in Wisconsin.

Why Was My Claim Denied?

Understanding why your claim was denied can help you prepare an effective appeal. Here are some common reasons for denial:

Insufficient Medical Evidence  – This occurs when the medical documentation provided does not adequately support your injury or illness as work-related, or when it lacks details about your diagnosis or treatment plan.

Missed Deadlines – Each stage of the claims process has strict deadlines. Failing to submit necessary documents or requests on time can result in a denial.

Disputes Over Whether the Injury is Work-Related – There may be disagreements about whether the injury occurred in the course of your employment, which can lead to a denial.

Employer or Insurer Disagreement with Your Doctor’s Findings – Sometimes, the insurer or employer may question the validity of your doctor’s assessment, resulting in a denial of your claim.

Can I Appeal the Denial?

Absolutely. The appeal process allows you to challenge the decision made by the insurance company. You can begin your appeal by filing through the Wisconsin Department of Workforce Development (DWD). If your appeal to the DWD does not yield a favorable outcome, you can escalate your case to the Labor and Industry Review Commission (LIRC). Should LIRC also deny your appeal, you still have the option to take your case to a Wisconsin Circuit Court.

What’s the Deadline to Appeal?

It’s crucial to adhere to the deadlines associated with your appeal. You have 30 calendar days from the date the LIRC decision was mailed to you to file a summons and complaint with the circuit court. Note that this deadline is based on the mailing date of the decision, not the date you actually received it. Therefore, it’s advisable to keep an eye on your mail to ensure you do not miss this critical deadline.

What Documents Do I Need?

To prepare for your appeal to the circuit court, you need to gather and submit the following documents:

Summons – This document officially notifies the defendants (the parties you are suing) that a lawsuit has been initiated against them.

Complaint – This is a detailed written statement outlining your case, including the reasons for the appeal and why the previous decision should be reconsidered and possibly reversed.

Authenticated Pleadings – These are court-stamped copies of all the documents you are submitting in support of your case. They must be properly authenticated to be accepted by the court.

Do I Need a Lawyer?

While it is possible to represent yourself in the appeals process, having legal representation is highly recommended. An attorney experienced in workers’ compensation cases can help you navigate the complexities of the law, prepare your documents correctly, and represent your interests effectively. Additionally, if you are an employer operating as a corporation or LLC, Wisconsin law mandates that you must be represented by an attorney during these proceedings.

Where Do I File?

When you are ready to file, you need to submit your appeal to the circuit court located in the Wisconsin county where you reside. If you are a non-resident, your filing should occur in the county where the work-related injury took place. Make sure to check the specific court’s filing requirements and procedures to avoid any potential delays.

How Do I Serve the Commission?

To complete the appeal process, you must serve authenticated pleadings to the LIRC in Madison alongside your circuit court filing. This must also be completed within the same 30-day timeframe. Keep in mind that delays in mailing or handling do not extend this deadline, so it is important to plan your submissions carefully to ensure compliance with the requirements. By following these guidelines, you can better navigate the appeal process for your denied workers’ compensation claim and work towards a favorable resolution. Remember to gather all necessary documentation, adhere to deadlines, and consider legal representation to enhance your chances of success.

Call Our Wisconsin Worker’s Comp Appeal Lawyers Today

At Gillick, Wicht, Gillick & Graf, our worker’s compensation lawyers in Milwaukee are focused on helping our clients maximize their financial benefits. If your work injury claim was denied, we can provide support. Call us at 414-257-2667 or send us a message online for a free review of your worker’s comp denial. With an office in Milwaukee, we handle worker’s comp appeals throughout the surrounding area, including in Appleton, Brookfield, Waukesha, Janesville, and Kenosha.