What To Do When Your Wisconsin Occupational Disease Claim Is Denied
As attorneys representing injured workers throughout Wisconsin, we know how difficult it is to be denied benefits after you’ve become ill from doing your job. Occupational diseases can affect your lungs, skin, joints, or even your mental health, depending on your work environment and the hazards you’ve faced. When you’ve done the hard work, followed the process, and still get denied, it’s frustrating and stressful. But under Wisconsin Worker’s Compensation Law, a denial is not the end of your claim.
Wisconsin law provides important protections for workers who develop illnesses from long-term exposure to harmful conditions at work. If your claim for an occupational disease was denied, you still have rights, and you can still fight back. The steps you take next are critical to preserving your claim and making sure you get the medical care and compensation you deserve. Here’s what we want you to know.
Understanding Why Occupational Disease Claims Are Denied
Wisconsin defines an occupational disease as one that arises over time due to conditions in the workplace, not from a one-time injury. This is different from an accidental injury and is covered under Wisconsin Statutes § 102.01(2)(c). Examples include respiratory problems from inhaling dust, repetitive stress injuries, chemical exposure, and hearing loss.
There are several common reasons claims are denied:
- The insurance company says your condition isn’t work-related
- Your employer disputes that your job caused or contributed to the disease
- There is insufficient medical documentation linking your illness to your work
- Your claim was not reported or filed on time
Even when your claim is legitimate, insurers often deny occupational disease claims because these illnesses build up slowly over time, making it easier for them to argue that your job didn’t directly cause your condition. That’s why it’s important to have strong legal and medical support.
What You Can Do After A Denial
The first step is to understand that a denial is not final. Under Wisconsin Statutes § 102.17, you have the right to file an application for a hearing with the Wisconsin Department of Workforce Development (DWD), and the case will be heard by an administrative law judge (ALJ).
Here’s what we usually recommend:
- Request A Copy Of The Denial Letter – This will explain the reasons the claim was denied and help us develop a strategy for appeal.
- Collect Medical Evidence – We work with your treating doctors and, if necessary, independent medical specialists to provide clear reports linking your condition to your job duties.
- File A Hearing Application – This starts the formal legal process. We prepare and submit this on your behalf to the DWD to move the case forward.
- Attend Mediation or Hearing – Some claims can be resolved through mediation. If not, we prepare your case for a formal hearing where an ALJ hears the evidence and decides whether benefits should be paid.
If the ALJ rules against you, we may appeal to the Labor and Industry Review Commission (LIRC) and even to the circuit court, if necessary.
Benefits You May Be Entitled To
Once your claim is accepted or approved through appeal, you may be eligible for:
- Medical treatment covered in full
- Temporary disability benefits while you’re unable to work
- Permanent disability benefits if you suffer lasting impairment
- Vocational rehabilitation if you can’t return to your prior job
Under Wisconsin Statutes § 102.42, your employer’s insurance must cover all reasonable and necessary medical treatment related to your work-related illness. You may also qualify for compensation under § 102.44 for permanent partial or total disability.
Frequently Asked Questions About Denied Occupational Disease Claims In Wisconsin
How Long Do I Have To Appeal A Denied Occupational Disease Claim?
You have twelve years from the date of injury or the last payment of benefits to bring a claim under Wisconsin Statutes § 102.17(4). However, it’s best to act quickly. If your claim is denied, you should contact an attorney right away to review the decision and begin building a strong case for appeal.
What If My Employer Says My Disease Is Due To Aging Or A Pre-Existing Condition?
This is a common defense, but it doesn’t automatically disqualify your claim. Under Wisconsin law, if your job aggravated or accelerated a pre-existing condition, it can still qualify as a compensable occupational disease. We work with medical professionals to prove how your work duties contributed to your condition.
Do I Need To See A Specific Doctor Chosen By My Employer?
No. Under Wisconsin Statutes § 102.42(2), you have the right to choose your own treating physician. If your employer or their insurer tries to pressure you into using their preferred doctor, you don’t have to agree. It’s important that your doctor understands your job duties and provides a thorough report that links your illness to your work.
Can I Still Get Benefits If I’ve Left The Job That Made Me Sick?
Yes. You can still file a claim even if you no longer work for the employer where you developed the occupational disease. As long as your condition is work-related and you file within the legal time limits, you are eligible for compensation under Wisconsin law.
What Can I Do If My Condition Has Gotten Worse Over Time?
If your occupational disease has progressed or caused additional problems, you may be entitled to more benefits. We can help you file for an amendment to your existing claim or pursue additional compensation based on the worsening of your condition.
What If The Insurance Company Offers A Settlement After Denying My Claim?
You should never accept a settlement without speaking to an attorney. Insurance companies often offer low settlements, hoping you’ll accept their settlement offer out of frustration. We review all settlement offers to ensure they reflect the full value of your medical expenses, lost income, and permanent disability, and we negotiate for a fair result.
Call Gillick, Wicht, Gillick & Graf If Your Occupational Disease Claim Has Been Denied
At Gillick, Wicht, Gillick & Graf, we’ve helped injured workers across Wisconsin fight back when their claims were wrongfully denied. If your occupational disease claim was turned down, we will review your case, gather the medical evidence needed, and stand up to the insurance company for you.
Contact our Milwaukee worker’s compensation lawyers at Gillick, Wicht, Gillick & Graf by calling 414-257-2667 to receive a free consultation. We represent injured workers throughout Milwaukee and across Wisconsin, and we’re here to help you get the benefits you’ve earned.