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How to handle a workers’ comp claim denial in Illinois

On Behalf of | Jan 18, 2024 | Workers' Compensation |

Receiving a denial for a workers’ compensation claim can be frustrating and disheartening, but it’s not the end of the road. In Illinois, you have the right to appeal the decision and fight for your benefits.

Here’s what you need to know to handle a denied workers’ comp claim.

Understanding the denial

Your employer or worker’s comp insurer won’t deny your claim for no good reason. You should carefully review the denial letter, which should explain why your claim was turned down. Some of the more common reasons why an employer or insurer would deny a claim include:

  • Insufficient evidence that the injury is work-related
  • Missed deadlines for reporting the injury or filing the claim
  • Discrepancies in your medical records or employment history

Once you understand the reason for the denial, you can then take steps toward appealing the decision.

Appealing a denial

There are several steps involved in appealing a claim denial. The Illinois Workers’ Compensation Commission (IWCC) will administer the appeals process. However, the agency itself won’t automatically prepare a hearing over your case until you file the appeal.

The steps to appealing a denial are:

  • Collect more evidence: Whether your employer or insurer denied your claim due to insufficient evidence or disputed your employment status, it wouldn’t hurt to collect even more proof. Medical records, witness statements and employment documentation will all be useful for your case.
  • File an appeal: You must file a claim with the IWCC to start the appeals process. You only have 30 days from the date you received the denial letter to file an appeal.
  • Prepare for your hearing: Once the IWCC receives your application, it’ll assign an arbitrator to your case and schedule a hearing. Note that the burden of proof lies with the employee to prove that they’re eligible for benefits, so you should be ready to present your evidence and explanation.

A denied workers’ compensation claim doesn’t have to be the final word. Understanding the denial and taking prompt action allows you to navigate the appeals process and advocate for your rights as an Illinois worker. If you need guidance throughout the procedure, consider hiring a legal professional who can also fight for your right to benefits.