Why were you denied workers' compensation benefits?

No matter how careful you are, accidents happen; sometimes bones and joints just give out from the day-to-day stresses of heavy and repetitive work. Too often, my clients who were injured at work come to me after going weeks without income or medical treatment after having been denied benefits by the workers' compensation insurance company. The sad reality of our day is that many people, after their benefits are denied, have no other health or disability insurance and go weeks or months suffering from injuries that need surgery and they are without any income. Many of these people find themselves in pain, unable to go back to work, with mounting debts and faced with losing their homes and cars.

Why did you get denied workers' compensation benefits? Unfortunately, after an injury on the job, many people are sent by their employer's insurance company to a doctor they never met. This insurance company doctor, also called an independent medical examiner (IME), who has no legal responsibility to help you, will look you over for five or maybe ten minutes and then send you home. You may never meet the IME; he or she will simply look at your medical records. In a typical situation, one week to a month later, the IME will issue an opinion stating that your injury is not work related, blaming the injury on some other cause or a condition that you never had before. At this point, your workers' compensation benefits will stop. A lot of people ask me how can they do this and is it legal? The answer is yes. Your employer's workers' compensation insurance carrier can send you to an IME, and they can deny you benefits if the IME says the injury is not work related or if no future care is required. And yes, you must attend the IME; that is the law. Sometimes your benefits will be denied illegally simply because the insurance company adjuster, without any medical information, does not believe your claim is work related. On rare occasions, employers will lie and say that your injury did not occur at work.

What can I do after I have been denied benefits?

Wisconsin was one of the first states to adopt a workers' compensation program. You can fight the denial at a hearing, and we can help. Many people who are wrongly denied benefits seek the help of an attorney. There are many reasons for doing so. Some people hire attorneys because they are too injured to represent themselves, others have problems speaking in public, and some just find the process too confusing and time consuming. Many people are worried they do not have the skills to beat the highly skilled insurance company's attorney who has likely been involved in hundreds of such disputes. The hearing, which is similar to a trial, may involve complex issues of evidence or the presentation and questioning of witnesses beyond the knowledge and ability of the average person. You can go it alone, but unrepresented people frequently sell themselves short and miss out on benefits that the insurance company or your employer have no legal obligation to tell you about.

If you hire us, we will gather your records and other necessary documentation, prepare the paperwork, and represent you at the trial. About 90% or more of all claims settle before trial and based on the evidence of your case, we will advocate the best settlement on your behalf. By statute, we are limited to a 20% fee on any benefits and the allowable costs and expenses of litigation, except medical expenses, that you were denied by the insurance company. You pay nothing unless we win or settle your case.

A little bit about Wisconsin workers' compensation laws.

The laws are not flawless (you can be denied benefits based on the opinion of a doctor you never met), and are a trade off between the rights of injured people and the rights of employers. Besides payment of hospital bills, some of the benefits you can recover include weekly disability payments for time missed from work due to a work related injury; long term benefits such as retraining or compensation for loss of your ability to continue working for the same wages; payments to compensate you for the loss of function of a body part; and, in the worst cases, permanent total disability compensation for those who can no longer work due to a work injury. In the some cases, other benefits may be available. Wisconsin workers' compensation laws do not allow for pain and suffering from the injury by you, your spouse, or your children. The trade off is that you cannot recover for these non-economic losses, and your recovery is limited to statutory benefits.

Wisconsin workers' compensation is an administrative law system. This means your first hearing will be decided by an administrative law judge. An administrative law judge (ALJ) is not a publicly elected official like a circuit court judge, but he or she is hired by the legislative branch. In our state, our ALJs are highly skilled attorneys hired for their great level of knowledge of workers' compensation claims. Typically, they are so specialized in the law of workers' compensation that they know more about workers' compensation laws than the circuit court judges. Hearings usually occur at administrative buildings rather than at courts. If you do not prevail on your workers' compensation claim, you can appeal to the LIRC. The LIRC will issue an opinion either agreeing or disagreeing with the administrative law judge. If you are not satisfied with the opinion of the LIRC, then you have the right to have your case heard by a circuit court judge and, if necessary, appeal the decision to our state Supreme Court or beyond.

If you feel you have a claim, please contact us at Gagliardi Law LLP, at 262-843-3400.

Workers' Compensation

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Worker's Comp - Gagliardi Law - Photo © Larry Zamba 2012