An Insurance Company’s “Closed File” Defense is Invalid in a Wisconsin Worker’s Comp Case
Injured workers seeking additional compensation, benefits or medical treatment are frequently confronted by a claims adjustor’s claim that the insurance carrier has “closed its file” and therefore cannot or will not pay any additional benefits. The so-called “closed file” defense is, in fact, no defense at all under Wisconsin law. Instead, under Wisconsin law, whether a worker’s comp claim remains open depends only on the applicable statute of limitations.
Statute of Limitations Timeline Depends on Traumatic vs. Occupational Injuries
Wisconsin law recognizes two types of injuries:
traumatic and
occupational. A
traumatic injury occurs when a worker is injured by a sudden, identifiable event occuring at a particular moment in time.
An occupational injury, by contrast, is one resulting from repetitive activities (for example, damage to the back, neck or other body part by performing the same or similar tasks over a period of months or years) or cumulative exposure (such as damage to the lungs through work in a dusty environment over a prolonged time period). With either a traumatic or occupational injury, a
12-year statute of limitations applies, although the date from which the 12-year clock begins to run depends on which type of injury is involved. With a traumatic injury, the 12 years begins to run on the date the injury occurred. However, because an occupational injury is occurring on every day the employee is exposed to the harmful activity in question, the date of injury is the first day on which the employee loses wages due to the exposure. Examples of an event that would establish a date of injury in an occupational injury case include:
• wage loss due a medical appointment related to the injury
• missed time because a doctor orders the employee off of work
• missed time due to physician-imposed work restrictions the employer cannot accommodate
Finally, in either a traumatic or occupational injury case, the statute of limitations begins again, and the 12-year clock is restarted, each time the insurance carrier pays either temporary or permanent disability to the injured employee (even if the carrier later denies the claim).
Wisconsin Worker’s Compensation Division Will Disregard An Insurer’s “Closed Workers Compensation File” Defense
In deciding whether your worker’s compensation claim remains open under Wisconsin law, an Administrative Law Judge (ALJ) will give no weight to the fact that an insurance carrier claims to have “closed its file” in your case. Instead, whether your claim is open is dependent on whether you have filed an application for hearing with the
Wisconsin Worker’s Compensation Division within 12 years of the date on which you were injured.
If any question exists regarding whether your worker’s compensation claim is approaching the end of the 12-year statute of limitations, the
worker’s compensation attorneys at Hawks Quindel will promptly file an application for hearing on your behalf after a free evaluation of the merits of the claim. Please
contact us via phone or email with any questions concerning your work injury or workers compensation questions.