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What are My Rights if My Workers’ Compensation Claim Has Been Denied?

When you file a claim for workers’ compensation benefits, there is a chance that your claim will be denied. Whether for legitimate reasons or due to bad-faith employment or insurance practices, workers’ compensation denials are common; and, if your claim has been denied, it is important to understand the options you have available.

1. Correcting a Deficiency in Your Benefits Claim

In some cases, insurance adjusters will deny claims simply because it is their job to do so. If a claim for benefits is deficient in any respect, it will likely be denied. Workers’ compensation insurance companies are not required to pay claims that do not meet the requirements for compensation; and, if you are entitled to benefits but you failed to submit appropriate documentation with your claim, this is a deficiency that should be corrected.

Oftentimes, addressing a minor deficiency can be a simple fix (although, you need to know what you did wrong and what you need to do to fix it). In this situation, your attorney may be able to work directly with the insurance company to get your benefit checks started.

2. Filing for Arbitration

If it is not possible to resolve your claim informally, your next step is to file an appeal with the Illinois Workers’ Compensation Commission (IWCC). The first stage of the appeals process involves arbitration before a single arbitrator who will hear evidence from both sides and render a decision. If you are dissatisfied with the arbitrator’s decision, you can request to have your claim reviewed by a panel of IWCC commissioners; and, if the commissioners rule against you, then you can take your case to court.

Workers’ compensation arbitration is somewhat similar to a simplified court proceeding. The timelines are shortened, and there are less formalities involved. However, your employer and its insurance company will have legal representation, and it will be in your best interests to hire an attorney who is experienced in handling workers’ compensation appeals.

3. Pursuing Other Sources of Financial Compensation

What if your workers’ compensation claim was properly denied? What if you were injured but you are not entitled to collect medical and disability benefits?

While most employees who suffer job-related injuries will be entitled to benefits, some workers are not eligible, and some types of accidents and injuries will fall outside of the scope of employment. If you are ineligible to receive benefits, other options you have available may include:

  • Filing a personal injury claim against your employer;
  • Filing a personal injury claim against a property owner, vehicle driver, contractor or subcontractor, or other third party;
  • Filing a claim for a product defect; and/or
  • Filing for Social Security Disability (SSD), long-term disability or other benefits.

Keep in mind, you may have these options if you are eligible for workers’ compensation as well. To ensure that you recover maximum compensation for your injury, you should discuss your situation with an experienced attorney.

Contact Us to Speak With an Attorney for Free

If you would like to speak with an attorney about your workers’ compensation claim, you can contact our Chicago law offices to schedule a free, no-obligation consultation. You can reach us 24/7, so call (312) 795-9595 or tell us how we can help online now.