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Workers' Compensation Claim Denials in the Auto Industry

Workers’ Compensation Attorneys Serving Chicago

As an auto worker, your job environment is full of hazards. If you were injured on the job in Illinois, you are entitled to workers’ compensation benefits. The workers’ compensation system was intended to make it easier for people injured at work to obtain the benefits they need to stay financially afloat. Unfortunately, wrongful workers’ compensation claims denials occur in the auto industry and many other fields. If you are an auto worker whose claim has been denied, you should consult a seasoned Chicago workers’ compensation lawyer to learn more about your rights and options.

Workers’ Compensation Claim Denials in the Auto Industry

In Illinois, all employers with an employee need to procure workers’ compensation insurance. If you are hurt while working or made sick by your job, you are supposed to provide notice to your employer within 45 days. You have three years to file a claim. Your employer must notify the Illinois Workers’ Compensation Commission (IWCC) once you miss three days of work due to a job-related injury. The IWCC handles workers’ complaints when an insurer denies a claim.

In some cases, an insurer begins paying benefits immediately and there is no need for further action by the injured employee. However, there are also situations in which an injured worker does not receive any benefits after providing timely notice to an employer of the work-related injury. And there are still other situations in which an insurer starts paying certain benefits, but then cuts them off and issues a denial.

If your claim is denied, you should be provided with a written explanation of why you are being denied workers’ compensation benefits. There are several different reasons your claim could be denied. For example, the insurer may believe your injury wasn’t work related, or it may not have received timely notice. It may believe your injury is not severe enough to warrant days off work or medical care. In some cases, the accident date conflicts with the information the employer provided. Denials may be issued when the injury wasn’t reported in a timely fashion to the employer. Denials may also occur when an insurer believes that your injuries were deliberately inflicted by you for purposes of defrauding the system. Finally, you may receive a denial because of a pre-existing condition; under these circumstances the insurer may argue your injury had nothing to do with your job as an auto worker.

If any of these scenarios happen in your case, you should not assume an insurer is right and the denial is valid. Workers’ compensation insurance carriers are businesses whose goal is to make a profit, and they may try to find ways to avoid paying even those benefits to which you are entitled. For instance, if you make a claim based on a ruptured spinal disc you suffered while lifting heavy objects, an insurer may look at your medical records and see that you were previously diagnosed with degenerative disc disease and issue a denial on the grounds that you have a pre-existing condition. However, this is not the correct analysis. Rather, the insurer must look at whether the disc rupture was an exacerbation of your pre-existing degenerative disc disease. If the aggravation of your spinal disc was work-related, your claim should not be denied.

Application for Adjustment of Claim

If you were injured on the job and anticipate needing benefits, you should file an Application for Adjustment of Claim with the IWCC. This must be served on your employer. Once this form is filed, you’ll get a case number and an arbitrator. There are status calls every two months; during the status call, if an attorney represents you, your legal counsel can say that you are in settlement negotiations or ask for a trial, as appropriate.

If your workers’ compensation claim is denied, you will need to ask for a hearing in front of an arbitrator of the IWCC. The hearing is conducted similarly to a trial. The arbitrator is a neutral third party who oversees the proceeding and hears each party’s arguments and evidence. The arbitrator will decide whether your employer and its insurer should accept your claim.

Consult a Dedicated Workers’ Compensation Lawyer in Chicago

If you have suffered a workers’ compensation claim denial in the auto industry in Chicago, you should talk over your situation with the seasoned attorneys of Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca. We are available to represent auto workers in Quincy, Champaign, Aurora and Rockford, along with Winnebago, Kane, Adams, Sangamon, and Cook Counties. Contact us at 312-263-6330 or 800-444-1525 or via our online form.