What Happens if I am Denied by Workers’ Compensation or an Insurance Company?

Under Illinois law, an employee who suffers an injury on the job is entitled to compensation for their injury. Compensation includes money for medical bills that stemmed from the workplace injury as well as for lost wages from work. You should not face financial consequences when you are unable to work due to a work-related injury.

However, paying out workers’ compensation benefits costs money, so employers and insurance companies may be unwilling to help you. You can be denied workers’ compensation benefits if your employer or their insurer makes the decision that your illness or injury was not work-related.

If you were denied workers’ compensation benefits, you need to determine why your claim was denied. The reason should be explained in the denial letter. Common reasons for a denial of workers’ comp benefits may include:

• Your Injury was not reported in a timely manner: You must report an injury to your supervisor, as soon as possible, typically within a few days.
• Your claim was not filed in time: Typically, the limit for filing a workers’ compensation claim will be between 30 and 90 days of the accident.
• The employer disputes your claim: Your employer may claim that the accident happened outside of the job, or use some other disqualifying reason to deny your benefits.
• Your injury may not compensable: Claims for work-related injuries due to stress may be difficult to prove.
• You did not receive medical treatment: To receive workers’ comp benefits, you must have received medical treatment.
• There is no evidence that injury is work related: It may not be clear if your injury happened at work, but additional medical exams and evidence may help to prove your case.

If your claim is denied, you need an experienced workers’ compensation attorney to fight for your rights to receive appropriate compensation and damages for your injuries. A lawyer from Spiros Law, P.C. can investigate why your employer denied the claim and help you gather evidence to help you file an appeal. This must be filed within three years of the date of injury. Afterwards, a trial date for an appeal will be set.

There are many levels of workers’ compensation benefit appeals, including:

• Arbitrator appeal: This appeal is filed with the Illinois Workers’ Compensation Commission for a hearing before an arbitrator.
• Commissioner’s appeal: This appeal is held before a panel of three commissioners on the workers’ compensation board to appeal an arbitrator’s decision.
• Circuit court appeal: A circuit court appeal is handled in the county where the injury took place. The standard of review is higher, which means you must demonstrate that the decision of the Illinois Workers’ Compensation Commission was incorrect.
• Appellate court appeal: All parties have the right to appeal before the workers’ compensation appellate court in Illinois, which could require an extensive briefing.
• Illinois Supreme Court appeal: This type of appeal is only granted with leave of the court.

If you need assistance with the denial of a workers’ compensation claim, contact Spiros Law, P.C. at (815) 929-9292 or online today for a consultation. We can help you with the appeals process.