Appeal A Denied Workers’ Compensation Claim In Chicago

Injured workers in Illinois have a legal right to pursue benefits under the Illinois Workers’ Compensation Act. When employers deny a valid claim, the process can feel overwhelming and financial pressure can mount quickly. At Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca, our Chicago workers’ compensation lawyers guide injured employees and their families through every stage of the appeals process, from challenging an initial denial to representing them before the Illinois Workers’ Compensation Commission. Airline employees, construction workers and union-represented employees have all received skilled advocacy from our firm.

Why Workers’ Compensation Claims Are Denied

Insurance carriers and employers reject workers’ compensation claims for many reasons. Some of the most common include:

• Failure to prove that the injury arose out of and in the course of employment
• Failure to notify the employer of the injury within 45 days of the accident
• Disputes over whether a causal connection exists between the workplace accident and the diagnosed condition
• Arguments that the medical treatment received was not reasonable and necessary
• Disagreements over the extent of the employee’s injuries or level of disability
• Disputes over the employee’s average weekly wage

A denial is not the final word on your claim. Our attorneys review the employer’s stated reasons, investigate the circumstances surrounding the injury and work with medical professionals to build a thorough and well-supported response.

Appealing A Denied Workers’ Compensation Claim

When an employer denies a workers’ compensation claim, the injured worker may file an appeal with the Illinois Workers’ Compensation Commission. The first step is to review the denial letter and identify exactly why the employer rejected the claim. If the employer has not provided a written explanation, we can help you obtain one.

To formally begin the appeals process, the injured worker must file an Application for Adjustment of Claim with the IWCC within three years of the date of injury. The application must include proof of service confirming that the employer received a copy. Once filed, the Commission assigns an arbitrator who conducts service calls with both parties every three months to monitor negotiations. Either side may request a trial during those calls if a resolution cannot be reached.

Understanding The IWCC Review Process

After an arbitrator conducts a trial and issues a decision, both employees and employers may appeal that decision to the full Commission. The Commission, a panel of three commissioners, reviews the arbitrator’s decision and supporting evidence, holds a hearing and allows both parties to present arguments. The Commission then renders a decision within 60 days.

During a pending appeal, the employer does not have to pay benefits the arbitrator awarded. If the matter resolves in the employee’s favor, the Commission adds interest to the final award.

What Must Be Proven At Trial

If a settlement cannot be reached and the case goes to trial, the injured worker carries the burden of proving eligibility for benefits. This generally requires establishing:

• The employer was subject to Illinois workers’ compensation and occupational disease laws at the time of the injury
• The worker held legal employment with the employer on the date the injury occurred
• The injury resulted from a workplace accident or occupational disease exposure arising from employment
• The accident or exposure directly caused or aggravated the diagnosed condition
• The employee provided the employer with timely notice of the injury

Other issues that may come up at trial include the employee’s average weekly wage, the medical necessity of treatments and the degree of disability. Our attorneys prepare thoroughly for trial by gathering medical records and other documentation and working closely with medical professionals to present the strongest possible picture of the injury and its impact on the worker’s ability to earn a living.

Ready To Fight For Your Benefits In Illinois

A denied workers’ compensation claim does not mean an injured worker has no path forward. We guide employees through every stage of their claim, including all necessary appeals. Contact us online or call 312-724-5846 to schedule a free consultation. Se habla español.

Our workers’ compensation attorneys serve injured workers throughout Illinois, including residents of Rockford, Champaign, Springfield, Quincy and Aurora, as well as residents of Kane, Champaign, Cook, Sangamon, Winnebago and Adams counties.