How to Apply for Workers’ Comp in Wisconsin

The Short Answer:

In Wisconsin, you should notify your employer of a workplace injury within 30 days. This deadline can be extended up to 2 years if benefits are not paid. Longer deadlines may apply for occupational illnesses and catastrophic injuries. Your employer is responsible for submitting the workers’ comp insurance claim on your behalf. Once you report the injury, you should receive an approval or denial notice within approximately 14 days.

Key Takeaways

• Notify your employer of the injury in writing as soon as possible or within 30 days.
• Seek medical care immediately from a trusted doctor, and follow all instructions.
• Your employer must notify the workers’ comp carrier within 7 days of your injury.
• The insurance company is responsible for reporting accidents to the state.
• If your workers’ compensation claim is delayed or denied, you can and should file an appeal.
• If you received benefits previously, you have up to 6 years, and up to 12 years for certain occupational exposure claims, to reopen your claim.
• You can receive workers’ comp and SSDI together, but your workers compensation benefits may be reduced.
• Keep copies of all records and correspondence to protect your rights.

Learn How to Apply for Workers’ Comp in Wisconsin

The first step when applying for workers’ compensation benefits is to notify your employer of the injury. Your employer will alert their workers’ compensation insurance provider. Then, the insurance company will report the claim to the Wisconsin Department of Workforce Development. Here are a few things to keep in mind to expedite your workers’ comp application and prevent delays.

Step 1: Report Your Injury Immediately

While verbal reports are allowed, submitting an accident report in writing creates a paper trail that can protect your rights later. You can submit your injury report to your manager, supervisor, or HR department. Make sure your report includes relevant details, such as:

• The date and time of the injury.
• How the injury occurred.
• The type of injury and affected body part.
• Any physical symptoms or medical findings.

Step 2: Seek Medical Treatment

One advantage of Wisconsin’s workers’ compensation system is that you get to pick your own doctor or medical provider. You have the option to switch doctors once before requiring insurance approval, and specialist referrals do not count toward the 2-doctor limit. Tell the healthcare provider how your injury occurred, so there’s a record that it’s related to your work.

Tip: To protect your rights, make sure to seek medical care as soon as possible after the injury.

Step 3: Your Employer Files the Workers’ Comp Claim

Once you report your injury and seek medical care, your employer must notify their workers’ compensation insurance carrier by filing Form WKC-12, First Report of Injury. In most cases, the insurance company is responsible for submitting this document to the Wisconsin Department of Workforce Development.

Denials and Delays: Employers typically have 7 days to report the claim to their insurance carrier, or they face harsh penalties. If the injury will cause you to be out of work for 3 days or more, the insurance company must submit required forms to the state. A workers’ compensation attorney can help you request a hearing if your claim has been delayed or denied.

How Long Do I Have to Apply for Workers’ Compensation in Wisconsin?

Per Wis. Stat. §102.12, you must report your injury to your employer as soon as possible. Ideally, you should notify your employer within 30 days of the accident, even if your injuries are minor. If benefits have not been paid or if your claim was denied, you have 2 years from the date of the injury to request a hearing.

If you received workers’ compensation benefits previously and your symptoms have returned, you have 6 years from the date of the injury or your last payment, whichever is longer, to file an appeal. Filing deadlines changed in 2016, so different time limits may apply if your injury occurred before March 2, 2016.

Reporting Deadlines for Severe Injuries

There’s no time limit to seek workers’ compensation benefits for certain single-event traumatic injuries, such as vision loss and brain injuries.  However, most traumatic injury claims must be pursued within 6 years from the date of injury or last payment of benefits, whichever is later.  It is extended to 12 years for occupational exposure claims as outlined below.

Reporting Deadlines for Occupational Illnesses

Workers typically have 12 years to file a claim for occupational illnesses, such as silicosis, asthma, and hearing loss, as well as repetitive motion back or joint injuries. The deadline starts on the date of the injury, date of death, or date of the last workers’ compensation payment, whichever is most recent.

Understanding the Workers’ Comp Claims Process

1. Injury Occurs: To file a claim, you must have developed a work-related injury or illness during the course of your job.
2. Notify Your Employer: The first step is to report the injury to your boss or HR department.
3. Seek Medical Care: Visit a licensed doctor, nurse practitioner, or other medical provider. Attend all follow-up appointments, and let your doctor know that your injury is work-related.
4. Employer Reports to Insurance: Employers typically have 7 days to report claims to their workers’ compensation carrier. Fatal accidents must be reported to the state within 24 hours.
5. Insurance Review: The insurer has 14 days to approve or deny your claim or request more information, starting on the date of the injury or your last day of work.
6. Benefits Begin or Appeal Starts: If denied, your attorney can help you request a hearing with the Department of Workforce Development.

When Will My Workers’ Comp Benefits Begin?

If your workers’ compensation claim is approved, all necessary medical care is covered starting on day 1. Wage replacement benefits are subject to different waiting periods as follows:

• Insurance companies have 14 days to respond to claims, so you should receive your first check 2 weeks after the injury, if approved.
• Wage replacement benefits kick in on your 4th day off work.
• If you’re out of work for more than 7 days, you’ll be paid retroactively for the 3-day waiting period.
• Permanent disability is not available until you reach maximum medical improvement and your doctor assigns a permanent disability rating.

Regardless of where you are in the claims process, make sure to save all documents and correspondence related to your injury. You should keep the following records for at least 6 years in case you need to reopen your claim or file an appeal:

• Medical bills
• Doctor’s summaries
• Accident reports
• Time-off records
• Paystubs or tax returns
• Insurance notices
• Correspondence from your employer
• Benefits statements

Can I Apply for Social Security Disability While on Workers’ Comp?

Yes, but doing so may reduce your workers’ compensation benefits. Wisconsin follows a reverse offset system, so your workers’ compensation benefits will be reduced rather than your Social Security benefits if your total compensation exceeds 80% of your average current earnings. Here are a few things to consider.

SSDI Filing Requirements

To qualify for Social Security Disability Insurance, you must have a qualifying disability that’s expected to last for at least 12 months or result in death. It does not matter if the disability is work-related.

SSA Wage Calculations

Workers’ compensation reimburses you for 2/3 of your average weekly wages calculated over the past year. If you also qualify for SSDI, you can bring your total compensation up to 80% of your average current earnings. This can be calculated based on your highest annual earnings in the 5 years before your disability began, or you may average your earnings across your top 5 highest-earning years.

Tip: A Wisconsin workers’ comp lawyer may be able to help you structure your benefits to minimize the potential impact of offsets.

Have a Wisconsin Workers’ Comp Lawyer Help With Your Claim

Every year, over 22,000 employees file workers’ compensation claims in Wisconsin. While over 76% of claims are eventually paid, workers file over 3,000 appeals annually. Unfortunately, many valid workers’ compensation claims are unfairly delayed and denied.

If you’re having trouble accessing the workers’ compensation benefits that you need, contact a Wisconsin workers’ comp attorney at Sam Bomier Law LLC in Appleton, WI. We can review your denial notice and help you build a strong claim. With over 38 years of experience advocating for injured workers, Sam knows what to do. Request a free case review today.