Why Could My Illinois Workers' Comp Claim be Denied?

 Posted on November 21, 2023 in Workers' Compensation

The purpose of the Illinois workers' compensation statute is to ensure that any employee who suffers a work-related injury or illness receives the medical care and financial assistance they need while they recover. Unfortunately, there are instances where a workers' comp claim is denied, leaving the worker in a difficult situation. The following are some common reasons why this can occur. If your claim has been denied, it is important to contact an Illinois work injury lawyer to find out what legal recourse you may have.

Late Reporting of the Injury

One of the most common reasons for a workers' comp claim denial is the late reporting of the injury or illness. Many states have strict reporting deadlines, and failing to notify your employer within the required timeframe can result in a denial. Employers must be informed promptly to investigate the incident and assess its validity.

To avoid this issue, report any work-related injury or illness as soon as it happens, even if the symptoms initially seem minor. Ensure your employer knows the incident and follows the company's reporting procedures. If you discover an injury or illness later, report it immediately to your employer and provide a detailed account of the incident.

Lack of Medical Evidence

Workers' comp claims require medical evidence to establish the validity of your injury or illness. Your claim may be denied if you fail to seek prompt medical attention or do not provide adequate medical documentation. Insurance companies often look for comprehensive medical records that connect the injury or illness to your work activities.

Seek medical attention promptly after a work-related injury or illness. Make sure that your healthcare provider documents the details of the incident, your symptoms, and any treatment or rehabilitation plans. Maintain a copy of your medical records, as these documents will be crucial in substantiating your claim.

Disputes Over the Cause

Another common reason for workers' comp claim denials is disputes over the cause of the injury or illness. Insurance companies may argue that the condition is unrelated to your job duties or occurred outside the workplace. If the cause is not clearly work-related, your claim may be denied.

To address this issue, provide a comprehensive account of how the injury or illness is related to your job duties. Document any workplace hazards or conditions that may have contributed to the incident. Collect witness statements, if available, to support your claim.

Failure to Follow Procedures

Workers' compensation claims have specific procedures and requirements that must be followed. Failing to adhere to these procedures, such as missing medical appointments, not cooperating with insurance company investigations, or refusing suitable work offered by your employer, can lead to claim denials.

It is critical that you comply with all workers' comp procedures and requirements. Attend all medical appointments and follow your healthcare provider's instructions. Cooperate fully with any investigations, and if your employer offers you suitable work within your restrictions, consider accepting it to maintain eligibility for benefits.

Contact an Aurora, IL, Workers' Comp Lawyer for Legal Assistance

If your workers' compensation claim is denied, an experienced Kane County, IL workers' comp attorney can help you navigate the appeals process and protect your rights. Call Kinnally Flaherty Krentz Loran Hodge & Masur P.C. at 630-907-0909 to schedule a free and confidential consultation and find out what legal steps are available to fight the denial of your claim.