Workers Should Challenge Compensation Denials

Even if your claim is denied, it may be an error and you may still be eligible for workers' compensation.

Workers’ Compensation claims are down in volume nationally. My colleagues who represent injured workers indicate their inventories are diminished; my colleague adversaries representing insurance carriers and employers indicate their claims and case files are substantially down as well. In Wisconsin the industry is experiencing a decline in premium volume representing an absence of payroll. The only slight uptake is in the manufacturing sector, not representing new hires but merely increased overtime. Lower case volumes have produced a “race to the bottom” in hourly rates charged by firms to defend the claims, and all parties involved in the worker’s compensation arena, doctors, vocational experts, private investigators, surveillance companies, and insurance adjusters are experiencing a decline.

Some of the decline is attributable to the unfortunate phenomena of workers with meritorious claims not challenging the denial of the claim by “independent” medical examinations.

One unfortunate consequence of the troubled economy and decline in job opportunities is that workers are not challenging questionable denials of their worker’s compensation claims. Fear of termination, employer retribution, or other job opportunities is likely prompting workers to simply accept compensation denials by the worker’s comp insurance carrier. Those lucky enough to have group insurance are submitting medical expense to group insurance, and using either sick pay, vacation pay, or other non-worker’s comp alternatives to fill in their wage loss.

The Wisconsin Worker’s Compensation Division has experienced a decline in the number of claims made and the number of Hearing Applications, and this is a nationwide phenomena. Some of this decline is obviously due to the troubled labor market, but some of the decline is attributable to the unfortunate phenomena of workers with meritorious claims not challenging the denial of the claim by “independent” medical examinations or insurance adjuster denials based on “legitimate” doubt concerning the facts of the injury. Workers should challenge compensation denials. The system would be the better for it.

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