Workers in Illinois rely on workers’ compensation benefits when they suffer job-related injuries or illnesses. However, not all claims are approved. Insurance companies and employers frequently deny claims for various reasons, making it difficult for injured employees to get the benefits they deserve. Understanding why claims are denied can help employees take the necessary steps to strengthen their cases and improve their chances of approval.
One of the most common reasons workers’ compensation claims are denied is that the injury was not reported within the required timeframe. Under Illinois law (820 ILCS 305/6(c)), an injured worker must notify their employer of a workplace injury within 45 days of the accident. If an employee fails to report the injury in a timely manner, the employer may argue that the injury was not work-related or that the delay caused additional complications.
To qualify for benefits under the Illinois Workers’ Compensation Act (820 ILCS 305), an injury must have occurred within the course and scope of employment. Employers and insurance companies often deny claims by arguing that:
If an employer disputes that an injury is work-related, medical records, witness statements, and workplace incident reports can help establish a connection between the injury and job duties.
Medical documentation is critical to a workers’ compensation claim. Insurance companies frequently deny claims if they do not see sufficient medical evidence linking the injury to the workplace accident. Common reasons for denial include:
Under Illinois law (820 ILCS 305/12), an injured worker has the right to choose their own doctor, but employers may require an Independent Medical Examination (IME) to verify the severity of the injury.
Insurance companies often try to deny claims by arguing that the injury was caused by a pre-existing condition rather than a workplace accident. While pre-existing conditions do not automatically disqualify an employee from receiving benefits, the injured worker must prove that:
Medical documentation from a treating physician can help establish whether work-related activities were responsible for worsening the condition.
In Illinois, injured workers have three years from the date of the injury or two years from the last date of benefits to file a claim with the Illinois Workers’ Compensation Commission (IWCC) under 820 ILCS 305/6(d). If the claim is not filed within the statute of limitations, the worker loses the right to pursue benefits.
Employers sometimes dispute claims by arguing that:
If an employer disputes the claim, an injured worker may need to gather evidence, medical records, and witness testimony to challenge the denial.
A workers’ compensation claim may be denied if the injured worker:
Under Illinois law (820 ILCS 305/12), an injured worker must follow medical advice and attend treatment appointments to remain eligible for benefits.
If a worker files a claim after being terminated or laid off, insurance companies often question the validity of the claim. While workers can still file for benefits, they must prove that the injury occurred before their employment ended.
If a claim is denied, an injured worker can:
If your employer denies your claim, you have the right to file a claim with the Illinois Workers’ Compensation Commission (IWCC). You should also seek legal guidance and gather additional evidence to support your case.
Yes. If your workplace duties aggravated or worsened a pre-existing condition, you may still be eligible for benefits. You will need medical documentation proving that your work contributed to the worsening of your condition.
Under Illinois law (820 ILCS 305/6(c)), you must report your injury within 45 days of the accident. Failing to do so can result in a denial of benefits.
If your employer disputes the injury, you will need to provide witness statements, medical records, or other evidence showing that the accident occurred while performing job duties.
Under Illinois law (820 ILCS 305/4(h)), it is illegal for an employer to retaliate against an employee for filing a workers’ compensation claim. If you were fired for seeking benefits, you may have a wrongful termination case.
If you miss the deadline, you may lose your right to workers’ compensation benefits. However, some exceptions may apply, and you should speak with an attorney to discuss your options.
An IME is a medical evaluation requested by the employer’s insurance company to determine the extent of your injury. The doctor conducting the IME is chosen by the insurer and may not always provide a fair assessment.
Contact The Law Offices Of Robert T. Edens, P.C.
If your workers’ compensation claim was denied, we are here to help. At The Law Offices of Robert T. Edens, P.C., we have extensive experience handling workers’ compensation appeals and fighting for the rights of injured workers.
Contact our Illinois workers’ comp attorneys at The Law Offices of Robert T. Edens by calling us at 847-395-2200 to receive your free consultation. We proudly represent clients throughout Antioch, Waukegan, Woodstock, and the entire state of Illinois.
The Law Offices of Robert T. Edens, Personal Injury and Workers' Compensation Law Office, have offices in Antioch, Waukegan, Grayslake, Woodstock and Barrington. We represent clients throughout the communities of Antioch, Waukegan, Grayslake, Barrington, Woodstock, Buffalo Grove, Deer Park, Gurnee, Lake Zurich, Round Lake, McHenry, Cary, Crystal Lake, Libertyville, Lincolnshire, Mundelein, Vernon Hills, Wheeling, North Chicago, Zion, Inverness, Palatine, Wauconda, Island Lake, Fox Lake, Barrington Hills, Spring Grove, Lake Bluff, Lakemoor, Long Grove, Lake Villa, Kildeer, Wadsworth, Indian Creek, Fox River Grove, Lindenhurst and other cities within Lake and McHenry Counties Illinois.
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