Denied Workers Compensation?

In January 2022, an injured worker called Mays Law Office.  For privacy reasons let’s call this injured worker “J.C.”  J.C. visited our website Mays Law Office and saw that we offer free legal consultations with an attorney.  Immediately J.C. was connected to Attorney Lisa Pierobon Mays.  J.C. proceeded to tell Lisa that she got hurt at work back in November 2020.  J.C. stated that she started her workday symptom-free but while working repetitively on a machine containing a diecast mold, she felt and heard a horrible popping sensation in her right shoulder while aggressively scrubbing the mold with her outstretched right arm.   Lisa listened to J.C.’s story and then started asking some poignant questions, like did she report the injury to her supervisor?  Did she seek timely medical treatment?  What medical treatment had she received, and what was the diagnosis and prognosis of her right shoulder injury according to her doctors?    

Pretty quickly Attorney Pierobon Mays could see that J.C. had done everything right in reporting the injury and seeking medical treatment that same day, yet still the workers compensation carrier was giving her the run-around as to accepting her claim for workers compensation benefits.  J.C.’s claim had been bounced around to three different insurance adjusters, questions by J.C. to adjusters were often left unanswered, referral for medical treatment, like an MRI was delayed pending slow approval by the workers compensation adjuster, and then only one day before her pre-scheduled right shoulder surgery in August 2021, approval for the rotator cuff surgery was delayed by the workers compensation insurance carrier demanding that she first see their doctor, termed an “Independent Medical Examiner.”  J.C. had been suffering with pain in her right shoulder for almost 9 months and now, one day before her much needed surgery, it was being delayed!  Regardless, J.C. complied, cancelled her surgery, and saw the insurance company’s doctor.  Despite repeated calls by J.C. to the insurance carrier, she never heard anything more from the insurance company for another 2 months.  Then in November 2021, J.C. got a letter stating that the workers compensation insurance carrier was denying all benefits for any care, treatment, or disability related to her right shoulder.  J.C. was dumb-founded and angry as a whole year of pain had gone by and a very needed surgery was not going to be covered.  Moreover, her sore right shoulder was taking a toll on the rest of her body, specifically her left arm because it was trying to accommodate for her weak, dominant, right arm.   

Attorney Lisa Pierobon Mays heard enough and encouraged J.C. to come into Mays Law Office located in Middleton, Wisconsin.  An appointment was scheduled for the following day and J.C. was instructed to  bring all of her paperwork (correspondence, notes, medical notes) so that they could review it together and come up with a plan of attack.  The following day, J.C. met with Attorney Lisa Pierobon Mays and it was quickly discovered that the delay and denial of medical treatment by the workers compensation insurance company was erroneous and likely made in bad faith, which in Wisconsin is filed as a penalty claim and can be worth up to $30,000.  In reviewing the insurance company’s doctor report, it was clear that he believed that the right shoulder surgery was necessary and related to the work that J.C. had done while working on the machine back in November 2020.  Attorney Pierobon Mays told J.C. that quick measures had to be taken to hold the workers compensation insurance carrier accountable and responsible.  The goal was to get the surgery back on the calendar as soon as possible; J.C. hired Lisa to move forward in her representation. 

Attorney Lisa Pierobon Mays immediately filed the necessary paperwork, alerting the head judge for the State of Wisconsin Department of Workforce Development (termed “DWD”) that J.C.’s claim required special attention due to the alarmingly illegal decisions made by the workers compensation insurance carrier.  In turn, the State responded immediately by assigning the claim to an administrative law judge who within two days reviewed Attorney Pierobon Mays’ submissions and agreed that the denial was clearly erroneous.  The Judge ordered the insurance carrier to approve the surgery, based on their own doctor’s report that such surgery was reasonable, necessary, and related to the November 2020 work injury.  Fearing the repercussions of its error, the workers compensation insurance carrier quickly hired its own lawyer.  Yet, even the insurance company’s lawyer agreed with Attorney Pierobon Mays’ position that J.C.’s claim for benefits had been erroneously denied.  Attorney Lisa Pierobon Mays diligently worked with opposing counsel to get J.C.’s worker compensation injury claim back on track.  Surgery is now scheduled for right shoulder to be done in a few weeks and lost-time benefits for missing work will be paid to J.C. without issue or delay from the day of surgery forward.  All medical treatment will also be paid by the workers compensation carrier.     

While it is a happy ending that J.C.’s claim is now being handled properly, consider the cost it took to get it there.  J.C. suffered ongoing pain, delayed medical treatment, personal and financial stress, a fatigued body overcompensating for an injured arm, and now attorney fees of 20% deducted from her lost-time benefits.  All of this needless suffering because the insurance company failed to treat J.C. fairly and legally according to the laws of Wisconsin.  This story is tragic but not uncommon.  Workers’ compensation injury claims are often not handled properly.  Insurance adjusters come and go causing files to be regularly transferred to a new claims adjuster; attention to detail and accuracy is often lost when adjusters are changed.  Moreover, insurance adjusters are many times downright rude, demeaning, and condescending to injured Wisconsin workers.  Injured workers are made to feel like they have done something wrong in simply filing a workers compensation claim.   The injured worker’s credibility and integrity is regularly questioned and assaulted by adjusters who make them feel like they are only money-seeking.  The penalty claim in Wisconsin for Bad Faith rarely gives the injured worker back what they have lost as the award (up to $30,000) is not guaranteed because it is based on many more complicated factors.

Mays Law Office is proud of the work it did for J.C. and takes on every call and claim with an eye toward an aggressive and effective approach to keep workers compensation insurance companies responsible and accountable.  In sum, never assume you are being treated fairly by an insurance company.  Call Attorney Lisa Pierobon Mays today at 608)257-0440.