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Know the time limits in the claim process for workers' comp

If you have been hurt on the job, you may be eligible for workers' compensation benefits. This can help both you and your family, which may alleviate some stress and help to expedite your healing process.

Though accidents happen all the time, some individuals do not receive the compensation they deserve because they did not follow correct protocol or be their own advocates. After a workers' compensation injury, make sure that you understand the process and what time limits you and your employer must meet.

Reporting the Injury

No matter how minor, report the injury immediately to your supervisor or boss, not just a co-worker. If possible, make sure you complete an accident report or have something written down about the time, date, and nature of the injury. While some workers don't want to be labeled as "complainers" or get red-flagged, reporting an injury when it happens is the best way to protect your health and benefits. If the injury becomes severe and there is no report of injury, you face a much larger dispute down the road. Also, while some employers may discourage reporting injuries, terminating someone for getting hurt at work is unlawful (and subjects an employer to a one-year-wages penalty).

Filing a claim

As discussed, you must report the injury or illness to your employer as soon as you are aware of the condition. From a legal standpoint, you must report an injury within two years of the incident or when you become aware of the injury or illness/exposure.

Employers must notify the worker's compensation insurer of the incident within seven days after you inform them. The insurer then has 14 days to file the claim with the Department of Workforce Development (DWD). This report must include the WKC-13 Supplement Report and the WKC-13A Wage Information Supplement form, which denote all payments. If there are any additional time off or medical expenses to report, the insurer must submit a final medical report as well.

Is my claim denied?

For workers, one of the most important time limits is 14 days. Under the Wisconsin Workers' Compensation Law, the insurance company has 14 days to determine if they are accepting, denying, or investigating the claim. If you have been off work after a reported injury for more than two weeks and you have not received any workers' compensation benefits, the insurance company likely has denied your claim. At that point, you should explore seeking legal counsel to assist in disputing that denial.

Disputing a denial

If the insurance company disputes your claim, you need to file a Hearing Application with the DWD. An attorney generally is necessary to help you with the legal process for filing a Hearing Application.

The statute of limitations for filing a Hearing Application is six (6) years for traumatic injuries after March 2, 2016, and twelve (12) years for occupational exposure injuries. ("Occupational exposure" is arguing that your job duties over a period of time played a role in your work-related medical condition).

After a Hearing Application is filed (and generally after you are done healing), a formal court hearing can be set. The parties may attempt to settle without going to court, or if no settlement is reached, the matter proceeds to official litigation at the hearing.

An Administrative Law Judge is given the case and both parties are notified. At the hearing, both parties present their evidence and the ALJ makes a decision. The final determination may take up to 90 days,

If either party does not agree with the decision, either side may file a petition for review with the Labor Industry Review Commission within 21 days.

Missing a deadline can cost you compensation. A knowledgeable attorney can be a strong asset to help you fight for what you deserve.

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