Francis G. Graef v. Continental Indemnity Company, 959 N.W.2d 628

On Nov. 1, 2012 Graef was gored at work, developed depression, and was prescribed duloxetine; Continental Indemnity, his employer’s WC insurer, paid for treatment.
On June 23, 2015 a pharmacy request for a duloxetine refill was initially denied by Continental and Graef left without the medication because he could not afford it; on Aug. 9, 2015 Graef attempted suicide by firearm.
In 2017 Graef sued Continental in circuit court for negligence in denying/withholding authorization/payment for the prescription refill, claiming the denial caused his suicide attempt and related damages.
Continental moved (in substance a motion to dismiss / summary judgment) arguing Wis. Stat. § 102.03(2) (the Act’s exclusive‑remedy provision) barred the tort action because the facts fit WC liability; Graef had not filed a WC claim with DWD.
The circuit court denied Continental’s motion; the court of appeals reversed; the Wisconsin Supreme Court affirmed, holding the Act supplied Graef’s exclusive remedy and directing entry of summary judgment for Continental.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Wis. Stat. § 102.03(2) bars Graef’s tort claim	Graef argued the causal chain was broken when Continental denied the refill, so WC exclusivity does not apply	Continental argued Graef’s allegations, if true, satisfy § 102.03(1) (initial work injury, subsequent treatment/relapse, second injury) so the Act is Graef’s exclusive remedy	Held: The alleged facts satisfy § 102.03(1); the attempted suicide is a subsequent injury tied to the workplace injury and the exclusive‑remedy provision applies; tort claim barred
Whether an exception should be created for negligent denials of WC benefits	Graef urged a new tort exception for negligent benefit denials	Continental argued such claims belong in WC; legislature addressed bad‑faith claims and intends exclusivity	Held: Court refused to create a negligent‑denial exception, citing Coleman and subsequent legislative response indicating exclusivity for denial‑of‑benefits claims
Whether Continental’s refusal to concede Graef would prevail in WC precludes applying exclusivity	Graef and the circuit court argued insurer ‘‘can’t have it both ways’’ and exclusivity should require insurer’s concession	Continental responded it may properly insist the claim be pursued in WC while denying liability there	Held: Court rejected conditioning exclusivity on insurer’s concession; insurer may challenge entitlement in the proper WC forum

Byers v. LIRC, 208 Wis. 2d 388 (1997) (historical background on Wisconsin’s workers’ compensation system)
County of La Crosse v. WERC, 182 Wis. 2d 15 (1994) (describing the workers’ compensation "grand bargain")
Mulder v. Acme‑Cleveland Corp., 95 Wis. 2d 173 (1978) (statutory scheme balances competing societal interests)
Jenkins v. Sabourin, 104 Wis. 2d 309 (1981) (secondary injuries during/caused by treatment of a work injury relate back to the original compensable event)
Brenne v. LIRC, 38 Wis. 2d 84 (1968) (suicide can be part of an unbroken compensable causal chain from a workplace injury)
Coleman v. Am. Universal Ins. Co., 86 Wis. 2d 615 (1979) (recognized limited bad‑faith exception; legislature later acted to address denial‑of‑benefits exclusivity)
Jenson v. Emps. Mut. Cas. Co., 161 Wis. 2d 253 (1991) (common‑law actions are barred if plaintiff otherwise is entitled to recovery under the Act)