It’s no joke being involved in an accident while at work or becoming sick while on the job. Fortunately, you should be covered by your employer’s workers’ compensation insurance which is designed to protect you while at work. A successful claim will pay for reasonable medical costs and a percentage of any lost wages. The fact that your employer is insured does not mean that compensation is guaranteed. Claims are denied for all sorts of reasons and you may find that you have to make an appeal against the denial decision. It pays to use a workers’ comp. attorney in the event that your claim is denied. Workers' Compensation Law in Illinois The Illinois Workers’ Compensation Commission is the state body that oversees the implementation of all workers’ compensation legislation as well as handling complaints if an insurer has denied a claim. In Illinois, all employers with at least one employee must take out workers’ compensation insurance. If you are injured or become sick while at work you must inform your employer within 45 days and make a claim within 3 years. Your employer is required to notify the Illinois Workers’ Compensation Commission if you have missed 3 days of work. A successful workers’ comp. claim should cover all medical costs as long as these are work related and are documented properly. Compensation for lost wages depends on whether the injury was temporary or permanent and whether you will be able to return to work at all. The compensation payment is never the full wages lost. The average is around two thirds of what you would have been expected it have been paid if you had been able to go back to work. Why Your Claim Could Be Denied The reasons for a denial are varied. Common reasons for denial include the following: The date of your accident or illness conflicts with information that the insurer has been given by your employer. Check what your employer reported as there could be a simple mistake. The insurer claims that your illness or injury was pre-existing, and so had nothing to do with your work. The insurer claims that you were deliberately inflicting injuries on yourself in order to gain compensation. You did not report your injury or illness to the employer on time or your claim was filed too late. You did not take any notice of safety equipment or safety rules while on the job. The Illinois Workers' Comp Appeals Process If your employer’s insurer denies your claim and you think that the denial is unjustified you must file an appeal with the Illinois Workers’ Compensation Commission within the workers' comp time limit of 3 years from the time of the accident or illness developing or within 2 years of your last compensation payment. The Commissioner will appoint an official to deal with the complaint. There is a formal procedure for this which will involve possible attempts at mediation and a formal hearing at which both you and the insurer will be able to present your point of view. You will need to have sufficient evidence to show to the Commission that your claim was originally justified. There are two levels of appeal beyond the formal hearing, which include a review of the hearing’s decision and an appeal to the state’s Court of Appeals. Why a Workers' Comp Attorney May be of Help If you are forced into making an appeal against a denial of your workers’ compensation claim by an insurer you may find that the process is quite complex. It is unlikely that you will succeed with a workers' compensation appeal unless you are very well organized and have sufficient documentation to support your claim. It’s wise to seek advice from an experienced workers’ compensation attorney who can guide you through the Illinois appeals process and represent you at any hearings.
