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Dealing with a Denied Workers’ Compensation Claim

November 8th, 2018 at 9:44 am

Illinois workers compensation appeals lawyerInjured workers typically expect a payout from workers’ compensation, but claims are all too often denied. In fact, data from the United States Department of Labor shows that, out of the 4,104 Illinois workers’ compensation claims filed within the past year, more than half were denied. Thankfully, statistical analysis suggests that approximately 70 percent of all workers’ compensation claim appeals are successful, which means many injured workers could eventually receive a payout, even if their initial claim was denied. Learn more about how you can deal with a denied workers’ compensation claim, and discover what our seasoned workers’ compensation attorney can do to help with the process. 

Why Workers’ Compensation Claims Are Denied

Insurance companies are for-profit businesses, so their goal is to save as much money as possible. They do this mostly by denying benefits to injured workers for a myriad of reasons. Denied claims tend to make employers happy as well; fewer payouts mean lower insurance rates for them. In other words, the entire system is set up to benefit employers and insurance companies, and injured workers are the ones who are paying the price for corporate greed. 

Of course, that is not the reason they give for denied claims. Instead, they look for possible issues with either the claim itself or the claimant. For example, they might investigate into your medical history and find that you have a former back injury. If your work injury claim was related to a back injury, they may call it a “pre-existing condition.” Other reasons for denying a claim might include:

  • An injury that did not occur while working. Remote workers and employees who drive must also beware of this rule, as they are often working and operating in a gray area; 
  • Failing to promptly notify the employer about the injury. This is most often seen when a minor injury gets worse, so be sure to report even seemingly minor injuries to your employer;
  • Missing your filing deadline. Deadlines must strictly be adhered to, otherwise injured parties face an automatic denial of their claim;
  • Being intoxicated. Having a drug or alcohol substance in your system at the time of an injury, regardless of whether you were actively using it during working hours, usually results in an automatic denial of a work injury claim;
  • Your employer is disputing the claim. Perhaps they think you are lying, or maybe they say you had been laid off or terminated. Whatever the reason, expect an uphill battle and ensure you have legal protection during the appeal process; and
  • Injuries or medical condition is not covered by workers’ compensation. Fighting a claim that was denied for a pre-existing condition is one thing; these can ofte. Being denied because the insurance company does not consider your back injury “severe enough” can be an entirely different story. Here, victims may have to prove that their injury is impairing their life.

Appealing Your Denied Workers’ Compensation Claim

Insurance companies know that few workers have the time, knowledge, or resources to pursue an appeal on their own. Add in any financial struggles that they may be experiencing, and it is no wonder why so many injured workers simply give up on the idea of receiving compensation – but it does not have to be this way. Injured workers who obtain skilled legal representation to actively and aggressively pursue an appeal on their denied claim are often successful in receiving a payout from the insurance companies. 

The Law Offices of Francis J. Discipio can assist you or your loved one with the appeals process.  Trusted and backed by more than 25 years of experience, our skilled Oak Brook denied workers’ compensation claims lawyer offers free consultations. Schedule yours by calling 630-574-2288.

Sources:

https://www.dol.gov/owcp/energy/regs/compliance/statistics/WebPages/ILLINOIS.htm

https://www.revealnews.org/article/inside-teslas-factory-a-medical-clinic-designed-to-ignore-injured-workers/

https://www.9news.com.au/2018/11/06/13/14/allianz-refuses-injured-firefighters-insurance-claim

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