2. Vocational Rehabilitation
3. Policy/Processes/Guidance
4. Laws & Legislation
5. Due Process and Appeal Rights Guidance

Due Process and Appeal Rights Guidance

Revised: June 2025

Purpose

To provide information and tips on providing appeal rights and due process information to consumers.

Under what circumstances should DVR provide appeal information?

DVR must provide appeal rights in writing to all applicants and eligible individuals at certain stages in the VR process, supplementing when necessary, via the individual’s preferred mode of communication (including email). DVR must also provide appeal rights any time a consumer or applicant’s request for a good or service is denied, reduced, suspended, or terminated by DVR.

For example, during a general conversation about services, if a good or service is requested and denied, DVR must inform the consumer of their appeal rights including the reason for the denial with reference to the specific policies or federal regulation citation(s).

Note: If an individual requests an informal review, mediation, or impartial hearing within 180 of the decision or denial of service, DVR will not suspend, reduce, or terminate services the consumer is receiving at the time they request their appeal unless they ask to end their services, or the consumer's services were obtained through misrepresentation, fraud, collusion, or criminal conduct.

When in a consumer case should DVR provide appeal information?

Appeal rights must be provided at the following points in every consumer case:

• Application
• Eligibility or ineligibility determination
• OOS category assignment
• IPE development and amendment
• DVR denies, reduces, or suspends services
• Case closure

In addition to the above, a consumer or applicant must be provided their appeal rights any time they request the information, including when requested by the individual's legal guardian or designated representative.

Note: Any time one of the above events takes place in a consumer case, provide the consumer with their appeal rights (English, Spanish, Hmong). (Internal, Staff Only)

What decisions can an applicant or consumer appeal?

Appealable decisions include, but are not limited to:

• Ineligibility, OOS placement, or case closure decisions
• Decisions regarding services requested prior to IPE development
• IPE service decisions
  • Denial of a service
  • Timeframe for the service – when a service will start or end
  • Length of the service
  • Service provider
  • Frequency of the service
  • Payment method
  • Service setting
  • Progress measures

What appeal options do applicants and consumers have?

If an applicant or consumer is dissatisfied with any decision made by DVR, DVR must let the individual know they have the right to appeal the decision, with options including informal review, mediation, and impartial hearing.

Definitions

• An informal review is a conversation with a DVR supervisor/manager to discuss the consumer's disagreement with a decision a DVR staff member made. A written summary of the informal review will be sent to the consumer within ten (10) business days of the completion of the review. If a consumer would like to request an informal review, please have them contact the supervisor listed on the provided appeal rights. Please make sure they state that they are asking for an informal review and why they are requesting the review.
• Mediation is a confidential process where an Administrative Law Judge (ALJ) will help the consumer try to reach a compromise or agreement with DVR. Both parties must agree to mediation. If a consumer would like to request mediation, please have them contact the DVR Hearing Coordinator listed in the provided appeal rights. Please make sure they state they are asking for mediation and the DVR decision(s) they want to mediate.

  Note: Both the consumer and DVR must agree to mediation.

• An impartial hearing is where an Impartial Hearing Officer: an ALJ from the Wisconsin Division of Hearings and Appeals will hear both sides of the case, the consumer's and DVR's. The ALJ will send a written decision to all parties no later than 30 calendar days after the impartial hearing. If a consumer would like to request an impartial hearing, they must contact the DVR Hearing Coordinator listed in the provided appeal rights. Please make sure to state that they are requesting an impartial hearing.

  Note: The consumer can request all of the above options at the same time.

If the consumer would like help with issues they are having with DVR or if the consumer would like to discuss their appeal rights, the appeal process, and request advocacy assistance, they can contact the CLIENT ASSISTANCE PROGRAM (CAP) at Disability Rights Wisconsin.

Disability Rights Wisconsin can be reached by calling toll free: 1-800-928-8778. Individuals may also visit the Disability Rights Wisconsin website at: How to Get Help - Disability Rights Wisconsin

What should be included in a denial letter?

• Date of the denial.
• Specific service(s) or finding(s) being denied, reduced, terminated, or suspended.
• The reason or basis for the denial, reduction, termination, or suspension.
• Reference to the specific policies and/or federal regulation citation(s).
• Consumer Rights/Appeals statement with correct supervisor's name and phone number.

Best practice is that a DVR Supervisor or WDA Director review each denial letter prior to sending to a consumer.

What happens if a consumer requests a good or service that was previously denied?

If a consumer requests the same good or service that was previously denied, DVR will review the request and determine if there is any change of circumstances since it was last requested and denied. DVR will case note the current circumstances and decision. Inform the consumer that the request was previously denied, and refer them to the original letter, providing a copy upon request. Additional letters do not need to be sent if circumstances have not changed since the original denial.

If circumstances changed since the original denial, review the request and consult with your supervisor as appropriate. Examples of changed circumstances include changes to disability or health status, changes in benefits (SSI/SSDI), switching schools (private to public), life changes such as a student moving out of a parent's home, or changes to Long-Term Care supports/funding.

Note: For more information on consumer due process rights, see the Consumer Rights and Responsibilities and Due Process sections of the DVR Program and Policy Manual