There is no pre-approval of medical treatment in Wisconsin worker’s comp claims. This is different from many other states’ worker’s compensation systems, and it is unlike your traditional health insurance. A worker’s comp carrier is not required to pre-approve any treatment, but they may do so as a courtesy.
Instead of pre-approval, Wisconsin’s system requires something of a “leap of faith.” You have the procedure and your medical clinic then sends the bill to the worker’s comp carrier. The carrier must pay unless they have a defense. You should always have health insurance as a backup in the event the carrier asserts a defense to your claim and refuses to pay the bill.
If your clinic refuses to schedule a medical procedure without pre-approval from the worker’s comp claims adjuster, you can attempt to obtain a courtesy pre-approval from the claims adjuster, but again they are not required to pre-approve any medical treatment. The clinic needs to simply schedule the procedure and bill the worker’s comp carrier if the claim is still being paid.
See the medical treatment section for further information on denial of medical expenses. Your clinics can also see our For Referring Professionals tab for further information. Contact us if you are having difficulty receiving treatment for a workplace injury, either from the Worker’s Compensation carrier or your health insurance carrier.