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4 Reasons for Workers' Compensation Claim Denials

Worker Compensation
The Workers' Compensation Division of the Wisconsin Department of Workforce Development requires any employer who has three or more employees, or an annual payroll of $2,000, to carry workers' compensation insurance or be self-insured. This ensures that an employee who is injured on the job will have access to workers' compensation benefits. To get these benefits, you just have to make a claim.

Unfortunately, not every claim is approved for coverage. Why could your claim possibly be denied? Here are a few of the most common reasons. 

1.  Your Paperwork Is Not Complete

When you get hurt on the job or become aware of an illness caused by your workplace, you are responsible for filing a report with your employer. The exact forms you need to fill out may vary from employer to employer. Report forms will require you to provide detailed information pertaining to your claim. This information includes:
  • Date
  • Time
  • Location
  • Description of your accident, injury, or illness
In addition to this information, you may need to provide any additional information relevant to your claim. 

Failure to completely fill out and file the appropriate paperwork within prescribed timeframes can result in a denial of your workers' compensation claim. If your claim is denied, then the insurance company must notify you within 14 days of the decision. The written decision will also include how to appeal the denial.

2.  Your Employer Disputes Your Claim

Once you file a claim for workers' compensation, your employer will have to sign off on or dispute your claim. Some of the common reasons that employers dispute claims are as follows:
  • Suspicion that your accident or injury was not work-related
  • Failure to follow through with mandated drug-testing or medical attention
  • Suspicion of malingering or fraud
  • Evidence of pre-existing conditions
  • Lack of supporting evidence
Even if your employer disputes your claim, you still have the right to go through the appeal process. Employers make mistakes, and disputes can be reversed. 

3.  You Failed to Follow Medical Advice or Treatment Plan

In Wisconsin, you have the right to choose your own treating physician for your workers' compensation covered injury. Once you make your choice known, the doctor will become your doctor of record and their recommendations or treatment plans will become a part of your workers' compensation record.

However, it is important that you follow the doctor's advice. Failure to do so could result in your claim being dismissed or denied.

If you disagree with the advice or course of treatment given by the first physician you choose, then you have the right to choose another. Just remember to notify your employer and the insurance carrier of your changes.

4.  You Were at Fault

Wisconsin is a no-fault state, which means that even if you contributed in some type of way to your accident, you may still be entitled to file a claim. However, if you were at fault, the benefits you are entitled to receive may be limited. For example, if you were improperly using equipment or messing around with the machinery that injured you, then your employer may have the right to reduce or deny certain parts of the claim.

Some employers will also require you to be drug tested following an accident. This testing ensures you were not under the influence of any substance that would have put you at an increased risk of having an accident. If your drug testing comes back positive, then it may also be grounds for a reduction of your benefits.

Unfortunately, some employers have a much higher percentage of disputes or denials than others. Sometimes this is on the part of the employer and other times it is on the part of the insurer.

If you feel your workers' compensation claim has been unjustly denied, then you need to call The Law Office of Meier, Wickhem, Lyons & Schulz, S.C. We will review your claim and do everything we can to help you obtain the coverage you deserve.