After the workers compensation insurer issues a denial letter, denying any additional medical treatment or workers comp benefits a few things can happen. If the injured worker has health insurance, that insurance should cover his or her medical treatment for the work related injury because the workers compensation company is denying the claim. Next the injured worker can either drop it, file for a workers compensation hearing with the Wisconsin DWD, or talk to an experienced workers comp attorney.
When a person is hurt at work in Wisconsin, if the disability goes beyond the third day after an employee leaves work, insured employers are required to notify their insurance carriers within seven days of the accident or, for occupational disease, within seven days after the beginning of disability. See Wis. Admin. Code § DWD 80.02(1).
If missing work goes beyond the third day, self-insured employers and insurance carriers must also file a WKC-12 first report of injury with the DWD within two weeks after the accident or onset of disability. Wis. Admin. Code DWD § 80.02(2)(a).
Then the insurance carrier or self-insured employer is required to file a WKC-13 and a WKC-13-A, confirming the worker’s wage rate and showing the workers compensation benefits they are paying. See Wis. Admin. Code § DWD 80.02(2)(b), (c). These forms are due within 30 days after the accident or onset of disability. In addition, these forms must again be filed with the DWD, with a copy to the employee, within 30 days after any of the following events: (1) temporary benefits are changed to permanent benefits; (2) temporary benefits are reinstated; (3) temporary partial disability (TPD) benefits are paid, or (4) final payment is made. See Wis. Admin. Code § DWD 80.02(2)(e).
If payments are denied, the notice must give the reason for the denial. See Wis. Admin. Code § DWD 80.02(2)(g). If compensation payments are stopped for any reason, the insurance carrier (or self-insured employer) must give written notice, with a copy to the employee, within seven days after stopping payments or making the decision to deny liability for payments. See Wis. Admin. Code § DWD 80.02(2)(g).
An insurance company’s decision to deny liability for compensation payments because the insurer is still investigating the claim must be made by written notice to the employee within 14 days after the alleged injury or from the date the insurer received notice of the injury from any source.
McCormick Law Office attorneys in Milwaukee, Wisconsin file appeals on the insurance company denial letter, which are in essence an application for a hearing. We do this after assembling the necessary medical expert opinion and other facts in support of the case.