How to Appeal a WI Workers' Comp Claim Denial
If you have received a letter from your employer’s workers' compensation insurance company telling you that your claim is denied, then you must appeal that denial in order to secure any benefits. While an injured employee has the right to appeal such a denial without an attorney’s assistance, the appeal process can be confusing. Hawks Quindel has more attorneys representing injured workers than any other law firm in Wisconsin, and we are very familiar with all of the ins and outs of our state’s appeal and hearing procedures. Here is what we will do to appeal the denial of your workers' compensation benefits if you retain us for representation in your work injury case.1. Obtaining All Relevant Records and Securing Doctors’ Opinions
The first and one of the most essential steps in preparing to appeal a workers' compensation claim denial is gathering all relevant records. These records include medical records and medical billings statements related to the work injury from all clinics and hospitals where you have treated, as well as your personnel file. After we have summarized and analyzed that documentation, we will write to the appropriate doctor(s) to secure a copy of the WKC-16-B report (“Practitioner’s Report in Lieu of Testimony”), which is necessary to prove the work-relatedness of your injury/condition. This record and report-gathering process is time-consuming, and often takes several months to finalize. However, it is the foundation of a successful appeal and, therefore, our attorneys will often not file a hearing application – the actual appeal step in your case – until several months after you have retained Hawks Quindel for representation.2. Hearing Application
The application for a hearing is the first step in appealing the denial of worker compensation benefits. This application outlines the central elements of the claims we pursue for our clients, including how the injury occurred, what body parts were injured, and what elements of compensation (weekly compensation, permanent disability, medical expense, e.g.) we are claiming on behalf of our client. Medical records and reports supporting the claim accompany the hearing application.3. Preparation of Medical Expense Summary
Before the hearing in your case, we will gather all medical and pharmacy billing records related to the work injury. Based on that information, we will then determine what (if any) amounts remain unpaid, how much you have paid for medical treatment and prescriptions, and what amounts have been paid by non-workers' compensation insurance carriers (including group health insurance). This is to ensure that all expenses are ultimately paid by someone other than you and that no insurance company seeks reimbursement from any amounts we might later secure for you in a settlement.4. Certificate of Readiness
When we have gathered and filed all relevant medical records, WKC-16-B reports (verified reports from treating doctors) and a detailed summary of all medical expenses, we file a Certificate of Readiness. This document advises the State that we are now prepared to present our case to the administrative law judge (ALJ) assigned to our client’s case.5. Settlement Discussions/Mediation
Over 95% of workers' compensation claims are resolved by voluntary settlement, either through direct negotiations between the attorneys for the parties or with the assistance of a neutral mediator. Hawks Quindel’s attorneys are expert negotiators and have secured millions of dollars in settlements for our clients over the past several decades.6. 15-day Pre-Hearing Filing Requirement
Fifteen days before the scheduled hearing, the Office of Workers' Compensation Hearings requires that the parties file and exchange all medical reports, records and billing records on which they plan to rely in support of their claims and defenses. Our firm assembles, organizes and files all of the required documents.7. Hearing
A Wisconsin workers' compensation hearing is much like a court trial with the exception of the fact that the case is decided by the ALJ rather than a jury. Witness are sworn, examined and cross-examined, documents are marked and offered into evidence, and the attorneys for the parties make legal arguments in support of their clients’ positions. A court reporter takes down all testimony and, as required, prepares a written transcript of all proceedings. The ALJ has 90 days from the close of the evidence to issue a written decision.8. Appeal of an ALJ’s Decision
Either party may appeal all or part of the ALJ’s decision to the Labor and Industry Review Commission (LIRC). LIRC is comprised of three commissioners appointed by Wisconsin’s governor, and serve staggered three-years appointments. The Commission typically decides such appeals within four months to one year following receipt of the parties’ written arguments.Contact Us
The Wisconsin workers' compensation hearing and appeal system is designed to review and decide appeals from insurance carriers’ denials of claims for benefits. Hawks Quindel has an entire team of seasoned attorneys, paralegals, and legal assistants experienced in navigating this appeal procedure. We are familiar with all of the ALJs who hear these cases and have an excellent reputation for preparation and professionalism in representing our clients in their efforts to secure the benefits owed to them.
Contact us if you would like to discuss your situation or legal rights with a Wisconsin workers' compensation attorney. Please call a Madison workers' compensation attorney directly at (608) 257-0040 or a Milwaukee workers' compensation attorney at (414) 271-8650, or email us via our Contact Page.