How to Avoid Worker's Compensation Denials

The Dos and Don’ts of Worker’s Compensation Claims:

Reporting the Injury:

• Report your injury to your supervisor or foreman as soon as it occurs.
• Carefully complete any forms required by employer.
• Obtain the name, address and phone number of all witnesses.
• Seek medical attention as soon as possible.
• If your injury occurs over time (for example, a back strain or rotator cuff tear), report your injury as soon as you begin to experience symptoms.  For these types of injuries:
  1. Describe the type of work you performed which you believe contributed to your condition.
  2. Don’t be pressured into giving a specific date. If injury occurred over days, weeks or months, say so.
  3. Seek medical attention as soon as you experience symptoms.

Seeing Your Doctor:

• You have the right to choose your doctor even if the company has its own doctor.
• See your doctor as soon as possible after the injury.  If he or she is not available, go to local emergency department or walk-in clinic.
• You are entitled to seek a second opinion from a different doctor if your condition is work-related.  But remember, the worker’s compensation insurance company is only responsible to pay the expense of a third choice if it approves the choice in advance.
• Referrals from one doctor to another don’t count as a new choice, and emergency treatment is counted as one of your choices
• Explain your injury to your doctor.  Don’t assume your doctor knows what happened.
• If you see another doctor, make sure to explain your injury to that doctor as well.  He or she may not have an accurate understanding of what happened without your explanation.
• If you are taken off work, provide the work release to your employer.
• If you are placed on lighter work, provide the restrictions to your employer.
• If your doctor doesn’t take you off work, and you don’t think you can work, tell your doctor why you can’t work.  Seek a second opinion if necessary.

Dealing with the Insurance Company Adjuster:

• Don’t agree to give a tape recorded or signed statement.  It is not required by law.
• The insurance company does have a right to investigate your claim.  You should informally explain what happened.
• You have an obligation to provide the insurance company with medical authorizations if requested.
• Don’t let the adjuster come to your house.
• Don’t allow the insurance company nurse to come to your house.
• Insurance companies do have the right to have you seen by a physician of their choosing (called an independent medical examiner).
• The insurance company does not have the right to have you seen by a second independent medical examiner, unless it is for a different part of your body or unusual circumstances exist.
• Let your doctor update the insurance company on your condition.

Seeing the Insurance Company Doctor:

• Don’t exhibit hostile attitude toward the insurance company doctor.
• You do not have to follow the treatment advice of the independent medical examiner - Consult with your physician before making your decision.

Returning to Work:

• If you are returning to work on the advice of your doctor, return to your physician and report your difficulties if you are unable to continue working.
• If you can no longer perform your regular job, or have been permanently placed on light or restricted work, find out if your employment or union contract allows you to switch to a new position with your company.
• If you are unable to remain with your employer, consider consulting with the Division of Vocational Rehabilitation for retraining.  If you are eligible for benefits, you will receive worker’s compensation benefits at temporary total disability rate.

Settling Worker’s Compensation Claims:

• Many worker’s compensation claims are paid on a conceded basis without a dispute.  You are not required to sign a release or other document to receive your benefits.
• Do not sign a release or “compromise agreement” without consulting with an attorney.

Rights of Workers

Under the Wisconsin Worker’s Compensation Act

• You have the right to be treated by your own doctor, and the right to refuse treatment by the company doctor or clinic.
• You have the right to second medical opinion.
• You have the right to refuse the assistance of the worker’s compensation insurance company’s rehabilitation nurse.
• You have the right to refuse to give a written or recorded statement. (However the insurer does have a right to investigate your claim and you should provide information verbally - but not recorded.)
• You have the right to return to work with restrictions if work is available.
• You have the right to seek vocational rehabilitation if no employment is available within your permanent restrictions.
• You have the right to make a safety penalty claim if your employer violates an administrative rule or state statute which causes your injury.
• You have the right to apply for Social Security disability even if you are receiving worker’s compensation benefits.
• You have a right to receive your benefits on a timely basis.  Worker’s compensation insurers are subject to a 10% penalty for delayed payments or a 200% penalty if the delay or denial was in bad faith.
• You have the right to pursue a third party claim against anyone who may have caused your injuries.  This right does not include claims against your employer or co-employees.