Steps to Take if Your Workers’ Compensation Claim Is Denied

 Posted on June 14,2024 in Workers' Compensation

Dealing with a work-related injury or illness is never easy, but it can become even more challenging when your workers’ compensation claim is declined. You do not have to give up if you are in this situation. You can take several steps to fight for the benefits you seek with an Illinois lawyer.

Find Out the Specific Reasons for Denial

The first step is to review the denial letter from the insurance company carefully. They are required to provide a clear explanation of why your claim was denied. Common reasons include:

• Missed deadlines for reporting the injury or filing the claim
• Insufficient medical evidence to support the injury or its work-related nature
• Disputes over whether the injury occurred at work or was pre-existing

Once you understand the basis for the denial, you can start gathering evidence to counter their arguments.

Gather Additional Evidence

If the insurance company claims insufficient evidence, it is time to build a stronger case. This may involve:

• Getting detailed medical records and doctor’s notes that clearly link your injury to your work duties
• Collecting witness statements from co-workers who saw the incident or can attest to the demands of your job
• Documenting the timeline of events, from the date of injury to when you reported it and sought medical treatment

The more comprehensive and persuasive your evidence, the better your chances of overturning the denial.

File an Appeal

In Illinois, you may appeal a denied workers’ compensation claim. The first level of appeal is usually through the insurance company itself. You need to submit a written request for reconsideration along with your additional evidence.

If the insurance company still denies your claim, you can file a formal appeal with the Illinois Workers’ Compensation Commission (IWCC). This involves filing an Application for Adjustment of Claim and attending a hearing before an arbitrator.

Consider Legal Representation

The appeals process can be challenging and time-consuming, especially while dealing with an injury related to your job. This is where a workers’ compensation attorney in Illinois can make a significant difference. An attorney can help you:

• Gather and present the strongest potential evidence for your claim
• Negotiate with the insurance company on your behalf
• Represent you at hearings and arguments before the IWCC
• Fight for the full benefits you may be entitled to under Illinois law

While you are not required to have an attorney, having legal representation can improve your odds of a successful appeal.

Stay Proactive and Persistent

Appealing a denied workers’ compensation claim can be lengthy, but you must stay proactive and persistent. Keep track of all deadlines, attend all required hearings, and continue to document your medical treatment and work restrictions.

Remember, the insurance company may hope you will get discouraged and give up. Do not let them wear you down. With the right evidence, legal support, and determination, you can secure the workers’ compensation benefits you need to recover and move forward.

Work With a Will County, IL Workers’ Compensation Lawyer

A denied workers’ compensation claim is not the end of the road. By understanding the reasons for the denial, gathering powerful evidence, and working on an appeal with a Joliet, IL workers’ compensation attorney, you can have hope that you can possibly receive your benefits. Call McNamara Phelan McSteen, LLC at 815-727-0100 to set up a free consultation to see if your situation has the potential to move forward.