The workers compensation claim process in a back injury case is best navigated with an experienced workers compensation attorney. Back injury claims are hotly contested by insurance companies due to the serious and expensive nature of a lumbar or cervical injury.
The workers’ compensation litigation process is described below but any general (not case specific) questions an attorney has can be answered with a telephone call to DWD. Questions having to do with your specific case should be directed to your attorney. Most attorneys will not give legal advice unless retained in writing. It does not cost up front money to retain a workers compensation attorney in Wisconsin, but it is a formal engagement that should not be taken lightly by either party.
Denial Letter
The litigation process usually begins with a denial letter from the workers’ compensation insurer to the injured worker. See DWD 80.02(2)(g)2. Applicant attorneys are often contacted by the injured worker after he or she receives the IME report or record review.
Medical Records
In addition to amassing the necessary jurisdictional facts, information about relevant employment, collateral benefit or subrogation issues, and relevant information, medical records must be collected. Start with a complete health care provider history, then based on factors such as the type of causation (traumatic and/or occupational), potential case value v. costs analysis, and whether there is a pending SSDI case, decide which, and how, to collect the medical records. Wis. Stats. Sec. 102.13(2)(b).
Application for Hearing
The application for hearing, Form WKC-7 is similar to a civil summons and complaint. To comply with process or fundamental fairness, the application should state with particularity the matters in dispute and the benefits claimed. See Bituminous Cas. Co. v. DILHR, 97 Wis. 2d 730, 734 , 295 N.W.2d 183 (Ct. App. 1980) and Theodore Fleisner, Inc. v. DILHR, 65 Wis. 2d 317 , 222 N.W.2d 600 (1974). A hearing will not be scheduled until the Certificate of Readiness is filed narrowing and illuminating the claims and denials.
Medical Reports
Physician opinions should be provided on the WKC-16B form itself or in a report or record attached to a 16B and filed at least 15 days before the hearing. See Wis. Stats. Sec. 102.17(1)(d).
Vocational Reports
The applicant is required to provide notice of and the identity of a vocational expert on loss of earning capacity claims at least 60 days before hearing. Wis. Stats. Sec. 102.17(7) and DWD 80.08. This potential problem is avoided by filing the vocational experts report with the hearing application when possible.
McCormick Law Office in Milwaukee, Wisconsin focuses in on the workers compensation claim process because settlement usually requires an impending hearing date.
