Steps to Take if Your Workers’ Compensation Claim Is Denied

 Posted on September 15, 2025 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. A denial does not always mean the end of the road. Many valid claims are initially rejected but are later approved on appeal. This means you should not give up if you are in this situation.

Illinois law provides a clear process for appealing denied claims, but there are strict deadlines and legal requirements that make it crucial for you to act quickly. Understanding the necessary steps to take following a workers’ compensation denial can help ensure your rights to medical care and lost wages are protected. You can fight for the benefits you seek with a Joliet, Illinois workers’ compensation lawyer as your advocate.

What Are Some of the Most Common Reasons a Workers’ Compensation Claim Might Be Denied?

There are many reasons a workers’ compensation claim might be denied. Some of those reasons could be relatively simple, involving providing additional information or correcting a mistake. Other reasons can be more challenging to deal with and can benefit from consulting with an experienced workers’ compensation attorney. These reasons include:

• The injury was not reported within the 45-day window of time, causing a missed reporting deadline.
• The employer disputes whether the injury was work-related or occurred somewhere else.
• The employer and/or the workers’ compensation doctor believe the injury was pre-existing and was not exacerbated by a work-related accident or repetitive motions.
• There are gaps in treatment or a lack of medical evidence backing up the claim for workers’ compensation.
• There are allegations that misconduct was a significant contributing factor to the injury.
• The employer is claiming that the injury occurred "outside the scope of employment."

Carefully Review Your Workers’ Compensation Denial Letter

Your first step in the process should be to carefully review the denial letter sent to you from the workers’ compensation insurer. This letter will tell you why the insurer denied your claim. Identify whether the denial was procedural (like an error or a late filing) or substantive (a work-related dispute). Then make an appointment with a knowledgeable workers’ compensation attorney and gather all your documentation together in preparation for your meeting.  

If Insufficient Evidence is the Reason for Denial, Gather Additional Evidence

If the workers’ compensation insurer claims insufficient evidence, it is time to work with your attorney to build a stronger case. This may include obtaining detailed medical records and doctors’ assessments that will clearly link your injury to your job duties. If any co-workers or others at your place of employment witnessed your accident, collect statements from those individuals who saw the incident or who can attest to the physical or mental demands of your job.

If you have not already done so, fully document a timeline of events that includes the date and time of the injury, when you sought medical treatment for the injury, and when you reported the incident. The more comprehensive your evidence is, the better your chances are of overturning the workers’ compensation denial.

Filing an Appeal with the Illinois Workers’ Compensation Commission (IWCC)

In Illinois, you may appeal a denied workers’ compensation claim (820 ILCS 305/19). The first level of appeal is usually through the insurance company itself. You must submit a written request for reconsideration, along with any additional evidence. You must file an Application for Adjustment of Claim within three years of your injury, or two years from your last benefits. If the insurance company still denies your claim, you can file a formal appeal with the Illinois Workers’ Compensation Commission.

This involves filing an Application for Adjustment of Claim and attending a hearing before an IWCC arbitrator. Your attorney will present evidence, medical reports, vocational experts, and co-worker testimony on your behalf. If the arbitrator’s decision is not favorable, you may be able to appeal to a three-commissioner panel, and then to the Illinois Appellate Court and the Illinois Supreme Court.

Practical Ways You Can Strengthen Your Workers’ Compensation Appeal

It is extremely important that you seek consistent medical treatment for your workplace injury and always follow orders from your doctors. Keep detailed records of all communications with your employer, as well as missed work and expenses related to your workplace injury.

Never discuss your workers’ compensation claim on social media, as it may later be used against you. Work with an experienced Illinois workers’ compensation attorney to ensure all your evidence is complete and properly prepared, and that all deadlines are met.  

Always Consider Legal Representation Following a Workers’ Compensation Denial of Benefits

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 most substantial 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 for a workers’ compensation appeal, your odds of success increase exponentially when you do.

Stay Proactive and Persistent as You Challenge Your Workers’ Compensation Claim Denial

Appealing a denied workers’ compensation claim can be a lengthy process, but it is essential to remain proactive and persistent throughout. 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.

Contact a Will County, IL Workers’ Compensation Lawyer

A denied workers’ compensation claim is not the end, merely the beginning of a new stage in the process. By understanding the reasons for the denial, gathering strong evidence, and working on an appeal with a Joliet, IL workers’ compensation attorney from McNamara Phelan McSteen, LLC, your chances of receiving the benefits you need and are entitled to receive increase significantly.

We are a mid-sized, aggressive law firm with specific experience in different fields; the attorneys with appropriate experience in each area will handle specific cases. Call [[phone[[ to schedule your free consultation and move forward with your denied workers’ compensation claim.