Illinois Workers’ Compensation Denials

Were you injured on the job, but denied workers’ compensation benefits? If so, you likely feel frustrated and disillusioned, but this doesn’t have to be the end of the road–you are entitled to file an appeal for the benefits you deserve and need, and our legal team has extensive experience helping injured workers in Illinois through this process. Contact a knowledgeable and skilled Illinois workers’ compensation lawyer from the Law Firm of Kevin A. Moore for a free consultation today. We are dedicated to handling and reversing workers’ compensation denials, and we stand ready to fight for your benefits.

Workers’ Compensation Denials: Why Was My Claim Denied?

Having your workers’ compensation claim denied can feel like a devastating setback, especially when you’re already struggling with the pain and stress of a workplace injury. There are several common reasons why a claim might be denied–some of which can be challenged with the help of a knowledgeable attorney.

One of the most frequent reasons for denial is a dispute over whether the injury is work-related. If your employer or their insurance carrier argues that your injury occurred outside the scope of your employment, or that it happened off the clock or outside the workplace, they may attempt to deny your benefits entirely. In other cases, the denial may stem from inadequate or delayed reporting. Illinois law requires injured workers to report their injuries to their employer within 45 days, and failing to do so can jeopardize your eligibility.

Another reason your claim may be denied is a lack of sufficient medical evidence. If you did not seek immediate medical treatment, or if your medical records don’t clearly link your injury to your job duties, the insurer may use that as grounds for denial. Insurers may also challenge your claim if they believe you have a pre-existing condition, arguing that your injury is not new or not caused by your employment.

Workers’ compensation denials can also occur due to missed deadlines or incomplete paperwork. The Illinois Workers’ Compensation Commission (IWCC) process is technical and time-sensitive. Even a minor clerical error can be used as a basis to deny your claim. In more contentious cases, claims may be denied due to allegations of fraud or misrepresentation, particularly if the employer believes the injury was exaggerated or falsified.

On What Grounds Can I Appeal a Workers’ Comp Denial?

If your workers’ compensation claim has been denied, you have the legal right to challenge that decision–and there are several valid and compelling grounds on which to base your appeal.

You may appeal if your claim was denied due to incorrect or incomplete medical information. In many cases, workers’ compensation denials result from medical documentation that fails to adequately establish the relationship between your injury and your work. If additional records or testimony from your doctor can clarify this connection, you may have strong grounds for appeal.

You also have grounds to appeal if your employer disputes the nature or severity of your injury or claims it did not happen at work. Providing credible evidence–such as witness statements, incident reports, or surveillance footage–can effectively counter these disputes.

Additionally, if your claim was denied due to a procedural technicality, such as missing a deadline or failing to include a required form, but you can demonstrate reasonable cause or misunderstanding, an appeal may be appropriate. Courts recognize that injured workers are often navigating unfamiliar legal territory while in pain, and mistakes can sometimes be forgiven when properly addressed.

Claims denied based on pre-existing conditions can also be appealed, particularly if you can show that your job duties aggravated or accelerated your condition. In Illinois, even if a condition existed before your employment, you may still be entitled to benefits if your work contributed to your injury.

Finally, if you believe the insurance company or your employer acted in bad faith, misrepresented facts, or made an unjustified decision, an appeal allows you to present your case before an impartial arbitrator.

Appealing a denial requires strategy, evidence, and experience. That’s where we come in.

The Workers’ Compensation Appeals Process in Illinois

When your workers’ compensation claim is denied in Illinois, you are not out of options. The appeals process through the Illinois Workers’ Compensation Commission (IWCC) gives you the opportunity to present your case and seek a reversal of that denial. Here’s how the process typically unfolds:

1. File an Application for Adjustment of Claim: The first formal step is to file an Application for Adjustment of Claim with the IWCC. This form notifies the Commission of your intent to challenge the denial and begins the legal process. In most cases, this must be filed within three years of the injury or two years from the last compensation payment, whichever is later.
2. Status Call and Arbitration Hearing: Once your application is on file, your case will be assigned to a hearing location and arbitrator. Periodic status calls are held to manage the progress of the case. If the issue isn’t resolved during these preliminary stages, it will proceed to a formal arbitration hearing. This is similar to a trial, where both sides present evidence, witnesses, and medical testimony before an independent arbitrator.
3. Arbitrator’s Decision: After the hearing, the arbitrator will issue a written decision. If they rule in your favor, you may be awarded back pay, medical expenses, and other benefits. If they uphold the denial, you still have the right to continue the appeals process.
4. Review by the Commission: If either party disagrees with the arbitrator’s decision, a Petition for Review can be filed with the IWCC. A panel of three commissioners will then review the evidence and legal arguments and may affirm, modify, or reverse the arbitrator’s ruling.
5. Appeal to the Circuit Court and Beyond: If the IWCC panel denies your claim again, the decision can be appealed to the Illinois Circuit Court. From there, if necessary, the case can be taken further–to the Illinois Appellate Court and even to the Illinois Supreme Court, though such cases are rare and require strong legal justification.

Throughout this process, having a seasoned workers’ compensation attorney by your side is critical. Legal representation can mean the difference between another denial and the benefits you need to heal and move forward.

Contact a Workers’ Compensation Lawyer Today

Just because your claim was initially denied doesn’t mean that you’re not entitled to benefits. The Law Firm of Kevin A. Moore is here to be the aggressive advocate you need in pursuit of the benefits you deserve. Contact us for a free case evaluation so we can discuss the circumstances of your case and build a successful strategy going forward.