When you are injured at work, you need to understand the claims process for filing a claim for worker’s compensation benefits, or contesting a denial of benefits. While your employer is responsible for notifying the insurance carrier of your accident and/or injury, you must complete certain steps in order to ensure your claim is properly filed and to maximize the benefits you receive.
- The first thing you should do is report the work injury to your employer, whether it is a traumatic injury (workplace accident) or an occupational injury (work activities over time). Your employer must complete an injury report and submit it to their worker’s compensation insurance carrier.
- If your employer does not report the work injury to the carrier, you can find out who the carrier is here. You can contact the carrier and report the claim yourself, although it is always preferable for your employer to provide them with the injury report.
- Once the worker’s compensation carrier is informed of a work injury, they will contact you. If you miss work or have a wage loss due to a light duty assignment, the carrier must pay you benefits or set up an examination with a doctor of its choosing – called an “Independent Medical Examiner” or “IME” – within 30 days. If the insurance carrier does not follow through on your claim, a penalty may be assessed against the carrier by the Wisconsin Worker’s Compensation Division. If the carrier has a defense to your claim that does not involve an independent medical examination, it will not pay you benefits or schedule an IME. Contact us right away if your claim has been denied.
- You have the right to see your own doctor. The claims adjuster may tell you to see a certain doctor or clinic, but you do not have to go to that provider or facility unless it is an IME appointment. Your doctors can give you referrals to as many other doctors as necessary to treat your injury. You can go to one (1) other clinic system or doctor for a second opinion without a referral from your existing doctors, but you can only do that once during your claim. That other clinic system or doctor can also refer you to as many doctors as necessary to treat your injury.
- The claims adjuster may send a nurse case manager to go with you to medical appointments and talk with your doctors. You do not have to allow this person to be in the room at medical appointments, and you can instruct the nurse case manager to only communicate with your doctors in writing. You also do not have to tell the nurse case manager any of the details of your visit with the doctor.
- There is no pre-approval of medical treatment in Wisconsin worker’s compensation claims. This is unlike many other states’ worker’s compensation systems, and it is unlike health insurance. A worker’s compensation carrier is not required to pre-approve any treatment, but they may do so as a courtesy. See the medical treatment section for further information on the denial of medical expenses.
- You should provide your employer with all work and activity restrictions imposed by your doctor or medical provider. It is your employer’s responsibility to offer you work within your restrictions if it is available. If your employer offers you work within your restrictions, you must take it unless the offer is unreasonable. If you do not accept your employer’s reasonable offer of work within your restrictions, worker’s compensation benefits may not be payable to you for lost wages.
- Do not quit your employment following a work injury. If you quit and your employer later says it would have accommodated your restrictions but you chose to quit, benefits may not be payable to you for lost wages. Always let your employer make the decision on accommodating your restrictions or terminating your employment.