What to Do if Your Workers' Compensation Claim Is Denied
After suffering an on-the-job injury, filing a workers’ compensation claim leads to valuable benefits that help you recover. For a variety of reasons, insurance companies deny some requests. Aside from hiring a lawyer, taking the actions below will help you get a decision in your favor if your claim is not approved.
A Guide to Workers’ Compensation Claim Denials
Two Options After Claim Denial
Wisconsin’s workers’ compensation process offers two options if your claim is denied in whole or in part. If you want benefits, you can request to resolve the dispute informally or seek a formal hearing. When individuals do not have lawyers, their claim denials are referred to the Alternative Dispute Resolution (ADR) Unit to start the informal process.
How Informal Review Process Works
The staff of the ADR unit reviews claims and medical documentation submitted to ensure it supports an injured worker’s position. They look at the disputed issues, and if they think you can resolve the claim through informal discussions, they will contact you and the insurer for a meeting. If there is no resolution, fill out a form to apply for a formal hearing and include your supporting medical information.
What Happens at a Formal Hearing
An administrative law judge (ALJ) presides over formal workers’ compensation hearings, which are legally binding proceedings similar to trials. The ALJ receives evidence from all parties and issues a written order that explains the decision for or against claimants. Due to the complex nature of the law and procedure involved in hearings, you should have an experienced workers’ compensation lawyer represent you.
If you face a denial of a workers’ compensation claim, representation by an experienced lawyer increases your chance of winning on review. The personal injury and workers’ compensation lawyers at Scott & Heenan serve the Platteville, WI, area, offering skilled representation throughout Grant County. Visit them online to learn more about their practice and call (608) 348-9506 to schedule a consultation today.
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