Navigating the Workers’ Compensation Appeals Process

Navigating the Workers’ Compensation Appeals Process Date: Apr 24, 2023

Workers’ compensation claims are critical for recovering money lost from a workplace injury. If your Illinois workers’ compensation is denied, you may be interested in appealing the decision.

Why Claims Are Denied

Worker’s compensation claims can face denial for several reasons:

• You did not report the injury in time: Claims often have a statute of limitations. For workers’ compensation, you must report your injury to your employer within 45 days of occurrence. You can also file a claim with the Illinois Workers’ Compensation Commission (IWCC) within three years of the injury if your employer denies your claim.
• The injury did not occur at work: Generally, your injury must occur at your workplace to qualify for workers’ compensation. You can also receive compensation if you were performing work for your employer outside the workplace when the injury occurred.
• Your employer or its insurer believes you were at fault: Many workers’ compensation claims are still paid if the worker is liable for the accident. However, if you were under the influence of drugs or alcohol at the time of the injury, your claim can be denied.
• Your employer or its insurer believes your injury is a preexisting condition: The entity may try to claim your injury relates to a preexisting condition and does not qualify for workers’ compensation.

Your employer or its insurer should provide a written description of your compensation denial pointing to one of these reasons. If you haven’t received this written explanation, contact your employer or the insurer following the claim denial. If you’ve received an explanation but don’t understand it, discuss the denial further with the entity.

While these reasons can justify a claim’s denial, they may not be accurate. For example, a working environment that makes a preexisting condition worse, often referred to as an “aggravation of a preexisting condition,” can qualify for workers’ compensation. If the claim denial doesn’t seem correct, you may feel inclined to appeal.

Probability of Being Overturned

Every case differs, and the likelihood of getting your denial overturned will depend on the facts surrounding your case. If you’re feeling uneasy about your claim denial, working with a legal professional can help you understand your case and whether the appeals process will lead to an overturned decision.

The Appeals Process

When seeking an appeal, start with requesting an adjustment to the claim by applying with the IWCC. Your case will receive an assigned number and arbitrator, who you can request a hearing with.

If the arbitrator agrees with the denial, you can request an administrative appeal. Submit two copies of a petition for your denial with a written explanation of your decision to appeal. You have 30 days following your denial to submit these materials to the IWCC. Within 35 days, you must submit a transcript of the arbitration hearing or a statement with the facts presented at the hearing.

Following your hearing, a panel of three commissioners will hear the arbitrator’s decision and review all evidence presented during the hearing — this is a commission appeal. This is only required if you wish to appeal the decision your arbitrator reached during the administrative hearing.

The workers’ compensation trial and appeal process involves the production of evidence, direct and cross-examination of witnesses and presentation of legal arguments. Deadlines are critical throughout. Therefore, it is highly recommended you have a legal professional in your corner.

Emergency Hearing

You may qualify for an expedited or emergency hearing if you meet the following conditions:

• You have not yet returned to work because of your injury.
• Your employer or insurance company has not paid lost-time benefits or medical benefits.

To request an emergency hearing, file a Petition for Immediate Hearing. The Commission must make a final decision within 180 days of your request.

Facing Workers’ Comp Claim Denial? Contact Argionis & Associates

In standard and emergency hearings, your employer will likely have attorney representation. Hiring an attorney can improve your chances of getting your denial overturned. At Argionis & Associates, LLC, we provide the representation necessary for your workers’ compensation appeal. We work in the greater Chicago area and specialize in injury cases, including workers’ compensation.

You only owe us fees if we win your case. Reach out today to discuss your appeal.

George Argionis

George Argionis has over 20 years of experience in handling cases involving auto collisions, premises injuries, medical malpractice, product liability, construction-related and work-related injuries. He has dedicated his career to helping restore lives both emotionally and economically.