Illinois Workers’ Comp Claim

Illinois Workers’ Comp Claim Date: Dec 5, 2018

If you work in Illinois and you are injured on the job, you are entitled to collect workers’ compensation benefits. Illinois’ workers’ compensation law is a no-fault. This means that you do not need to prove that your employer failed to provide adequate protection against possible injury. You only need to prove that you were injured at your workplace or as a result of working for your employer.

Illinois law mandates that all employers in the state provide workers’ compensation. They likely do this through a private insurance company as only the largest companies with hundreds of employees are financially stable enough to be self-funded. This insurance program will pay for your medical expenses, a portion of your lost wages or even help prepare you for a new job if your injuries prevent you from returning to your old one. If you suffer a permanent injury, workers’ compensation will often cover your medical expenses and lost wages even if you never work again.

How Do I Report an Injury?

You should immediately notify your employer if you suffer a work-related injury.

If you can’t notify them immediately — you need urgent medical care for instance — you have 45 days from the date of the injury to report it. You must report it to a supervisor, a management person, or a nurse in your workplace. Notifying a fellow employee or even your union does not count as properly notifying your employer.

If you fail to notify your employer within 45 days, you may lose your right to receive workers’ compensation benefits. You must notify your employer verbally or in writing. It is always best, however, to do so in writing because if you are forced to file a claim, having a written record of when you reported the injury will help your case.

When you give your employer notice that you have been injured on the job, be as honest and as accurate as possible. Do not exaggerate. Your employer’s insurance company can easily spot an exaggeration. Accurately and clearly describe what happened and the injuries you sustained.

There are some instances where you have longer than the 45-day limit to report a workplace injury. If the injury has slow developing symptoms or symptoms that occur over a period of time, such as a repetitive stress injury, you need to report it as soon you are aware that you have a problem. There are also extended reporting periods for incidents when you are exposed to radiation — 25 years after the last exposure — or to asbestos — 25 years — or some diseases that develop over time.

Seek Medical Treatment Immediately

Seek Medical Treatment Immediately

You should seek medical treatment as soon as possible after suffering a work-related injury. If your employer has a healthcare facility on site, you should go there as well. If not, go to the nearest emergency room. Make sure you tell the doctor that you were injured at work and how it happened.

We cannot emphasize enough how important it is to seek medical attention as soon as possible. Your employer and their insurance company will be skeptical if you delay medical treatment, and they will use your delay as a reason to either delay or deny your workers’ compensation claim. Solid medical evidence is one of the best ways to win a case if your employer denies your initial claim and you must file your claim with the Illinois Worker’s Compensation Commission (IWCC).

In Illinois, you have the choice of your own doctor for treatment. If your employer, however, is part of a preferred provider program (PPP), you may need to choose one of these in-network doctors. You should not give up the idea to see your own doctor, however. Insurance companies often choose doctors who are known to be favorable towards employers rather than employees. Even if you need to pay for it, it’s still a good idea to see your own doctor to get a fair evaluation of your medical situation.

What Happens After I Report My Injury to My Employer?

When you have officially notified your employer of the work-related injury, your employer must file an accident report within 30 days to the IWCC. The filing of this report does not result in any action from the IWCC. It serves merely to notify them that there has been an accident in your workplace.

Your employer is also obligated to inform their insurance company to process your claim. The insurance company will then investigate your claim. This will involve an examination of your medical records, any medical exams you have had as a result of the injury or any treatments you have received, an analysis of your work experience and evidence that the accident happened in the workplace.

Occasionally injured workers will receive a call from the insurance company asking them to make a written or recorded oral statement about the injury and what happened. You should always say no to this request. Remember, the job of the insurance company is to pay you as little as possible. The intent for the written or recorded statement is to help them find ways to trip you up. For instance, the insurance company looks for inconsistencies between the written report about your injury you gave to your employer and the statement you might give to them. Insurance companies will use any reason to deny your claim.

Your employer is also obligated to let you know as soon as possible whether they will honor your claim or deny it. If your employer denies your benefits, they must send you a written explanation of why they have denied workers’ comp benefits. If your employer does not send a letter of explanation, you need to ask why you were denied.

The primary reasons for the denial of a workers’ compensation claim are:

  • Your employer does not believe that your injury happened in your workplace or as a result of the activities of your job.
  • Your employer does not believe that your injury requires the medical treatment you say it does.
  • Your employer says that you did not tell them about your work-related injury within the 45-day limit.

What Should I Do If My Employer Denies My Workers’ Compensation Claim?

What Should I Do If My Employer Denies My Workers' Compensation Claim?

If your claim is denied, you will need to file an Application for Adjustment of Claim with the IWCC. You also need to file a Proof of Service with the application. The proof of service is a document that states you have notified your employer of your Application for Adjustment of Claim. You can mail your application to the IWCC or drop it off at any of its offices in the state.

Once the form has been filed, an arbitrator will be assigned to your case, and you will receive a case number. After this happens, every 60 days your case will be re-examined in what is known as a status call. When you receive notice of the status call, you can either request a hearing or tell the arbitrator that you and the insurance company are currently in negotiations on a settlement. You will continue to receive a status call every 60 days until you either request a hearing or tell the arbitrator that a settlement has been reached.

What Is the Time Limit for Filing an Application for Adjustment of Claim?

There are time limits on filing the application:

  • You need to file the application within three years of the date of your injury.
  • If your employer’s insurance company paid you some benefits but then stopped before you feel you had received fair compensation, you have two years from the date you received the last compensation payment to file the application.
  • You can also file a Petition for an Immediate Hearing. After you file this petition, you will receive a final judgment about your claim’s success or failure within 180 days. The judgment will let you know whether your employer needs to pay you wages for lost time or for medical benefits. If you have already returned to your job, however, and if you are owed fewer than a dozen weeks of temporary total disability payments, you cannot request an emergency hearing.

Medical Evaluation

Medical Evaluation

Before the actual hearing is held, your employer will likely request that you see a doctor who will evaluate your illness or your injury. If your employer requests an Independent Medical Exam (IME), you need to go. But you also need to be very careful. As we noted above, most insurance companies hire doctors to do IMEs because of their favorable record in denying workers’ compensation claims. Often these exams only last five to 10 minutes. Be aware that the doctor will be observing everything about you.

  • Bring a friend who can take notes on what happens in the doctor’s office.
  • Don’t spring up out of your chair when you are called into the doctor’s office.
  • Don’t jump up onto the examining table.
  • Don’t exaggerate your illness. Just be straightforward about how you’re feeling.
  • Don’t tell the doctor you are feeling “just fine” or that you don’t hurt as much as you use to. Everything you say can and will be used against you.
  • When you leave the doctor’s office, do not run to your car. The doctor will often be observing you out of the office window or have someone watching you.
  • Ask to see the doctor’s report if possible so you have a chance to correct any mistakes.

We know this all sounds a little paranoid, but we cannot emphasize enough that the insurance companies will pull any trick to deny you your workers’ compensation claim.

The Trial

Once you have made a request for a hearing, the arbitrator will set a trial date within 30 days of that request. During the hearing, the arbitrator will listen to both you and your employer state your cases about why you should or shouldn’t receive workers’ compensation benefits. After hearing all the facts, the arbitrator will send you a decision within 60 days.

If you’ve gone this far in a workers’ compensation claim, you should be working with an experienced workers’ compensation attorney. Even the IWCC recommends that both sides use attorneys for workers’ compensation settlements or for the trial process. When you work with an experienced workers’ compensation attorney, you greatly improve your chances of a successful outcome.

What Happens If the Arbitrator Denies My Claim?

If the arbitrator denies your claim or the IWCC panel denies it after an emergency hearing, and you don’t think a fair decision has been made, you can file a Petition for Review within 30 days of the decision. Your petition will be heard by a panel of three commissioners from the IWCC. This group will review the arbitrator’s decision.

You can submit a written argument before the appeal hearing on why the arbitrator’s decision should be overturned. At the hearing, you can present your side for five to 10 minutes. Your employer’s insurance company will have the same time limits to present their side of the case. The commission then has 60 days to issue a decision.

If you believe the commission was wrong, you can appeal that decision to the Illinois Circuit Court, and so forth even possibly to the state Supreme Court.

Only about a quarter of cases appealing the original arbitrator’s decision result in an increase of benefits for an injured worker.

Do I Need a Lawyer to Help Me With My Worker’s Compensation Claim?

Do I Need a Lawyer to Help Me With My Worker’s Compensation Claim?

Yes, working with an experienced workers’ compensation lawyer gives you the greatest chance of success for your claim. The entire process of making a claim, and then filing an Application for Adjustment, and then possibly appealing an arbitrator’s decision can be very confusing. This is especially true if you are still suffering from the effects of the injury that you suffered in the workplace.

You need someone on your side who has experience fighting the insurance companies. Insurance companies dealing with workers’ compensation claims have attorneys who fight these kinds of cases every day. They know many ways to deny your claim. An experienced workers’ compensation attorney knows the tricks and the methods that the insurance companies will use the deny your claim. Your attorney will make sure that you file all your claims on time, that all the paperwork is properly prepared and represent you at any hearing or trial.

Let the Law Firm of Argionis & Associates Help You With Your Illinois Workers’ Compensation Claim

Let the Law Firm of Argionis & Associates Help You With Your Illinois Workers’ Compensation Claim

If you have been injured at work and your employer has denied your workers’ compensation claim, let the experienced workers’ compensation lawyers at Argionis & Associates help you with your case.

As one of the most respected law firms in Chicago, we have the experience and the expertise to deal with your workers’ compensation claim. We understand how important it is for you and your family to make sure that you receive the proper benefits to which you are entitled if you have been injured on the job. We can help you negotiate the workers’ compensation process from the moment you suffer the injury through to the moment you receive your first benefit check. You can count on the fact that no one will outwork us on your behalf.

If you would like to talk to us about a workers’ compensation claim you can call us at 1-312-626-6294, or contact us online and a member of our team will get back to you as soon as possible. We look forward to working together with you to get you the compensation you deserve.