Wisconsin Workers' Compensation: How Lost Wages Are Handled When an Employee Doesn't Cooperate

What Happens to Lost Wages When Cooperation Is Lacking?

In Wisconsin, lost wages are a core component of a workers' compensation claim. However, if an employee refuses to cooperate—such as not following medical treatment, failing to submit required documents, or not providing a sworn statement—the insurer may deny the entire lost‑wage benefit. The state's statutes and the Wisconsin Department of Workforce Development's guidelines explicitly tie wage compensation to the claimant's compliance with all procedural requirements. Consequently, non‑cooperation can result in a total loss of lost‑wage payments, even if the injury is fully compensated elsewhere.

Legal Foundations: Wisconsin Statutes on Lost Wages

Wisconsin Statutes § 43.82(a)(8) mandates that lost wages be paid "to the extent that the employee is prevented from working." Yet, § 43.82(a)(8) also requires that the employee "cooperate in the investigation and treatment of the injury." If this cooperation is absent, the insurer may invoke the "non‑cooperation" clause, effectively negating the lost‑wage payment.

Typical Reasons for Non‑Cooperation

Employees often fail to cooperate for a variety of reasons:

• Uncertainty about the claim process
• Fear of retaliation or job loss
• Misunderstanding medical recommendations
• Inadequate communication from the employer or insurer

Calculating Lost Wages: The Standard Method

When an employee does cooperate, lost wages are calculated by:

Example: An employee earning $1,200 weekly who cannot work for 4 weeks would receive a lost‑wage payment of $4,800, assuming full cooperation.

What Happens When Cooperation Is Missing?

Without cooperation, the insurer may:

• Denial of the entire lost‑wage claim.
• Partial payment if the employee can demonstrate some compliance.
• Offer to pay a reduced amount based on the employee's partial cooperation.

In all cases, the insurer must provide a written notice explaining the denial and the employee's right to appeal.

Appealing a Lost‑Wage Denial

Employees can file an appeal with the Wisconsin Department of Workforce Development. The appeal process includes:

• Submitting a written statement detailing why cooperation was limited.
• Providing any medical or employer documentation supporting the claim.
• Attending a hearing before an administrative law judge.

A successful appeal may restore lost wages or result in a compromise settlement.

Practical Tips to Avoid Denial

To safeguard lost‑wage benefits:

• Respond promptly to all insurer and medical requests.
• Keep a detailed log of all communications and medical visits.
• Submit a signed, sworn statement within the required timeframe.
• Ask for written clarification if any instruction is unclear.

Key Takeaways

• Wisconsin's workers' comp law ties lost‑wage benefits to employee cooperation. • Failure to cooperate can lead to denial of all lost‑wage payments. • Employees have an appeal right that can restore benefits if cooperation is proven. • Proactive communication and documentation are essential to protect lost‑wage claims.