What Happens if My Workers’ Compensation Claim is Denied in Illinois?

When you are injured in the workplace, you can face a variety of challenges besides your physical pain and suffering, including medical bills, lost wages, and uncertainty about your future. While workers’ compensation can provide you with important benefits, it can be devastating to discover that your claim has been denied. Understanding your legal rights and options is crucial, so continue reading and reach out to a skilled Illinois workers’ compensation denials attorney today.

Why Would a Claim Be Denied?

Receiving a denial for your workers’ compensation claim is often an incredibly stressful experience, especially when you are already trying to manage the physical and financial repercussions of a workplace injury. Understanding why these denials happen is an important step in protecting your rights.

Employers cannot directly “deny” benefits themselves, but they can challenge the claim, provide conflicting statements or documentation, and pressure insurance carriers to dispute the injury. The workers’ compensation insurer will ultimately decide whether or not to approve benefits.

Common reasons why a workers’ compensation claim may be denied include insurance companies arguing that:

• The injury did not occur at work
• The worker failed to report the injury on time
• The injury was caused by a pre-existing condition
• The employee did not seek prompt medical treatment
• There is insufficient medical evidence connecting the injury to the job
• The worker was intoxicated or violating company policy at the time of the accident

The employer could also dispute the fact that the accident occurred at all. It’s important to note that denials are not uncommon and do not automatically mean that you will be unable to recover compensation.

What Happens if My Workers’ Compensation Claim is Denied in IL?

Immediately after receiving a denial letter, you should review the notice to understand the stated reason for the denial. Gather medical records, witness statements, accident reports, and any relevant communications you have had with your employer. It’s important to avoid giving recorded statements without legal advice and continue to follow medical treatment and doctor recommendations.

You have the right to challenge the denial through the Illinois Workers’ Compensation Commission. File an Application for Adjustment of Claim to initiate the legal process. This generally must be filed within three years of the injury or within two years of the last payment of compensation, whichever is later. If you are out of work and are not receiving medical or temporary disability benefits, you may be able to file a Petition for Immediate Hearing to get an expedited decision.

You should compile all supporting documents and medical records before attending the arbitration hearing. There, both sides will present evidence and arguments, and the arbitrator will typically issue a decision within 60 days of the hearing.

If the arbitrator denies your claim, you have 30 days to appeal the decision by filing a Petition for Review, which will move your case to a panel of three commissioners who will review the case and may hear oral arguments.

Securing workers’ compensation benefits is important for anyone who sustained harm in the course of their employment. For more information and legal advice, contact a skilled attorney at the Law Firm of Kevin A. Moore today.