Workers comp closed my case according to a letter from the adjuster and Denied My Claim. Not accurate. The insurance company can deny paying more benefits and close their file, but they cannot close your case. Only you and the Wisconsin Worker’s Compensation Division Department can close the claim. The insurance companies write their denial letters so the injured worker is led to believe that once the adjuster denies the claim, that’s it, case closed. Actually, the denial letter is the first salvo fired in the battle to get the injured worker the worker’s compensation benefits due. Most worker’s compensation claims in Wisconsin are open for 12 years from the date of injury or the last date indemnity benefits are paid. With a serious head, neck or back injury, to get the best results it is advisable to consult with an experienced worker’s compensation attorney once the injured worker receives a denial or case closed letter from the insurance company. At [nap_names id=”FIRM-NAME-1″] we offer free consultation to help determine if there are more worker’s compensation benefits an injured worker is entitled to.
Say an injured worker has work-related neck or back surgery. The worker’s compensation insurance company pays for the surgery and temporary total disability (TTD) benefits while the worker heals. At end of healing, the doctor assigns a 5% or 10% permanent partial disability (PPD) rating. The insurance company writes a letter saying it will pay the PPD and that’s it, case closed. If the worker is returning to work at the same rate of pay, then that may be correct as far as benefits due now. But if the worker has permanent restrictions preventing a return to work at close to the same rate of pay as before the injury, then there may be additional worker’s compensation benefits, something the worker’s compensation insurance company does not tell the injured worker. Often the additional worker’s compensation benefits potentially available are loss of earning capacity and/or vocational retraining benefits.
There is nothing technically wrong with the worker’s compensation company not fully advising the injured worker of all the benefits available. The insurance company is in business to make a profit; not to look out for injured worker. The Wisconsin worker’s compensation process is adversarial. The injured worker and the insurance company must deal with each other in good faith, but each one is responsible for knowing their own rights.