Spencer Rule Archives

The Spencer Rule in Wisconsin's workers' compensation can in narrow circumstances get an injured worker weekly benefits even if the comp carrier denies a medical treatment.  Workers compensation insurance companies can deny paying for medical treatment for two basic reasons: A) the injury is not a work-related condition; or B) even if the employee has a work-related condition, the disputed treatment is not directed to cure or relieve the effects of the work-related condition.  While most disputed cases involve defense A, this article deals with defense B.  This dispute is usually raised by an independent medical examiner report (IME) who states for example, the worker has a herniated disc L5-S1 disc caused in part by an accident at work, but he doesn't need fusion surgery to cure or relieve the effects of the work-related injury to the disc.  The IME will claim a fusion is not necessary, and if it is done, it is for an unrelated pre-existing condition.  If its only saying not necessary, then TTD may be due.