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Workers compensation claim denied

What if My Workers’ Compensation Claim Gets Denied?

James P. Leahy Attorney At Law June 1, 2023

In Illinois, employees who suffer work-related injuries or occupational diseases may be entitled to pursue workers' compensation benefits through a claim. However, the insurance provider may deny your claims due to a different number of reasons, including late reporting, delayed filing, or inadequate evidence. Thankfully, you may be able to appeal your denied workers' compensation claim and recover your deserved benefits. 

At James P. Leahy Attorney At Law, I have the diligence and skill to advise and guide employees in their workers' compensation appeals. As an experienced Illinois workers' compensation attorney, I can investigate the reason for the denial and enlighten you about the next steps to take. In addition, I will advocate for your best interests and help you negotiate the maximum available benefits. My firm proudly serves clients across Elgin, Aurora, St. Charles, and Kane County, Illinois. 

Reasons a Workers' Compensation Claim May Be Denied

If your workers' compensation claim is denied in Illinois, the first thing is to identify the reason for the denial. Here are some common reasons why workers' compensation claims may be denied: 

  • Failure to report your injury or illness in time. 

  • Failure to file your claims in time. 

  • The accident occurred outside of work or due to horseplay. 

  • The accident occurred while you were under the influence of drugs or alcohol. 

  • Misrepresentation. 

  • You didn't meet the eligibility requirement for workers' compensation claims. 

  • Your employer disputes your workers' compensation claims. 

  • The insurer wants to carry out further investigation to validate your claims. 

  • No medical records or documentation to support your claims. 

  • Delaying for failure to seek immediate medical attention after the workplace accident or injury. 

  • You were not treated by an approved or qualified physician. 

  • Your injuries or illness are related to a pre-existing health issue. 

Furthermore, if the insurance provider or your employer denies your workers' compensation claims, you will receive a Notice of Denial. This denial notice indicates that the insurer has denied your benefits and the reason for the denial. This is also referred to as a "Notice of Controversion" for federal claims and in other jurisdictions. 

Notice of Controversion

A Notice of Controversion or Notice of Denial is a written notice that the insurance carrier or employer disputes an employee's right to seek workers' compensation benefits. Under the Illinois Workers' Compensation Act, the written notice must indicate: 

  • the reasons for the denial of your claim; and, 

  • a deadline for filing your appeal. 

If you have received a Notice of Denial from the insurance provider, you need to reach out to a skilled workers' compensation attorney immediately. Your lawyer can carefully evaluate the reasons for the denial and decide the best way to proceed with your appeal. 

What to Do If a Workers' Compensation Claim Is Denied

If your workers' compensation claim has been denied in Illinois, you're within your right to appeal the decision. Follow the steps below to file an appeal for your denied workers' comp claims: 

  1. Retain an experienced lawyer for proper guidance and to help file your appeal. 

  1. File an Application for Adjustment of Claim with the Illinois Workers' Compensation Commission (IWCC). 

  1. File a petition for an immediate hearing. Alternatively, you can seek a hearing with the arbitrator appointed by the IWCC. 

  1. If you're unsatisfied with the arbitrator's decision, file a petition for review within 30 days of the arbitrator's decision. 

  1. Upon appeal, a three-person panel of IWCC commissioners will assess your petition to decide if the arbitrator made a legal error. An IWCC hearing might be scheduled to hear your case. 

  1. At the IWCC hearing, the commissioners will listen to oral arguments, review evidence from both parties, then issue a verdict. It may take up to 60 days to know the outcome of your appeal. 

A knowledgeable workers' compensation attorney can help file your petition, prep you extensively for the hearing, and walk you through every legal phase of the appeal process. 

Accepting a Settlement 

Additionally, you may be able to settle your workers' compensation claim by negotiating a settlement with the insurer. Depending on the outcome of your claims or appeal, the workers' compensation insurance company might offer you a settlement—either a structured payment plan or a lump-sum payment. The settlement will cover your medical bills, lost wages, legal fees, and disability benefits. 

However, before accepting the insurer's settlement offer, be sure to consult with your lawyer. Your attorney can help review the settlement offer, ensures that it covers all your on-the-job injuries, damages, and losses, or attempt to negotiate an improved settlement. 

Speak With a Workers' Compensation Attorney Today

Unfortunately, not all workers' compensation benefits are approved by the insurance provider. Regardless, just because your claims were denied doesn't automatically mean that should be the end. At James P. Leahy Attorney At Law, I'm committed to offering experienced legal services and guiding clients through the complexities of filing workers' compensation appeals. 

As your legal counsel, I can evaluate the reasons for the denial, enlighten you about your possible legal options, and determine the best course of action. In addition, I will help file your appeal, provide substantial evidence to establish your claims and represent you diligently during the legal process. Above all, I will keep fighting for your appeal right and help you recover your rightful workers' compensation benefits. 

Contact me at James P. Leahy Attorney At Law today to schedule a simple case assessment with a reliable workers' compensation lawyer. I can offer you the personalized guidance and advocacy you need in your workers' comp appeals. My firm proudly serves clients across Elgin, Aurora, St. Charles, and Kane County, Illinois.