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What can happen when a workers’ compensation claim is disputed?

Wisconsin employers and employees generally interact in a positive way when a worker is injured on the job. Responsible business owners make sure workplace safety is a priority, regulations are properly followed and workers' compensation insurance is appropriately in place. When someone is legitimately hurt on the job, whether it be from a back or neck injury, degenerative condition or other accidental harm, he or she seeks the benefits needed to survive.

There are procedures in place, however, for those occasions when a dispute arises about a claim. The Wisconsin Department of Workforce Development website provides what is referred to as a workers' compensation claim flow. As it applies to a disputed claim, this information may be helpful as an overview of the steps available to either party.

For example, an injured worker may file with the WC Division an application for a formal hearing up to 12 years from either the date of an injury or when benefit payments stopped. This hearing will be held before an Administrative Law judge. Legal representation is not required, although a knowledgeable advocate with experience in these types of proceedings might be beneficial to a positive outcome. Hearings are assigned to an ALJ on a first-in, first-out basis and are usually held where the claimant lives.

At the hearing, evidence is presented by all parties. More than one hearing may be held. Many disputes are settled without a formal hearing actually taking place through compromise or agreement. Otherwise, a decision is made by the judge within 90 days. If either side disagrees with the decision, an appeal is possible within 21 days to the Labor Industry Review Commission. Subsequently, either party can proceed within 30 days of that decision to appeal to the circuit court of the county where the worker resides. That resulting judgment may be appealed to the Court of Appeals, whose ruling may, finally, be submitted for review to the Wisconsin Supreme Court.

Source: Department of Workforce Development, "Worker's Compensation Claim Flow" Jan. 01, 2015

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