Most people don’t expect to be hurt on the job, but injuries can happen suddenly or, in some cases, develop over time. For the year 2021, the Bureau of Labor Statistics reports that 102,000 Illinois workers in the private sector suffered nonfatal injuries or illnesses on the job.
More than 67,000 of these involved missed days at work, a job transfer, or a working restriction.
If a similar workplace injury happens to you, your first thought may be to seek compensation through the workers’ compensation system. You anticipate that this no-fault system will pay for medical care and some of your lost wages while you recover – but what if it doesn’t?
Many workers’ compensation claims are denied for a variety of reasons, leaving injured workers with the choice to go to work in pain or take unpaid days off while trying to get medical care.
An Illinois Workers’ Compensation Attorney May Be Able to Help
If you have been denied after submitting a workers’ compensation claim or have concerns about filing one, a workers’ compensation attorney can assist you. Unlike the HR representatives at your company, your worker’s compensation lawyer will work for you and your interests.
They will keep track of deadlines, follow up with the workers’ compensation insurance carrier, provide additional information if required, and dispute a claim denial when necessary. If arbitration is needed – a standard method for dealing with workers’ compensation disputes in Illinois – your lawyer can also assist you in this process.
What Should You Do After an Accident At Work?
It can be challenging to know what to do next when you are hurt, in pain, and need help to recover from your injuries. Here are some steps you should take to protect your right to seek workers’ compensation benefits:
Look for Injuries and Seek Medical Care
First, check to see if you have any injuries, but remember that some injuries may not show symptoms right away. An accident that happens suddenly can be startling, and the adrenaline rush might blunt feelings of pain for a little while afterward.
If you initially feel fine but begin to experience pain or other symptoms later, don’t hesitate to seek medical treatment. This is also true if you recognize you have injuries but believe they’re minor – a doctor can ensure you’re not missing something more serious.
Report the Accident or Injury to Your Employer Right Away
Under Illinois law, you have 45 days after an injury or illness occurs to report it to your employer, although you should report it as soon as possible. Most employers have a process for reporting injuries or a person you should direct these reports to, but if you don’t know, the best place to find out is your HR department.
Ask for the contact info of the person who handles these reports, including their phone number and email address, and request a list of healthcare providers you can see for medical treatment.
If your company doesn’t have an HR department, report the injury to your immediate supervisor and ask them for the list of healthcare providers.
It’s critical that you report your injury in writing and in such a way that you can prove it later if your HR rep or supervisor claims they don’t remember receiving your report. Even if you explain the injury or illness to the rep or supervisor when you ask for the list of healthcare providers, be sure to follow up with an email from your personal address so you will always have access to it in your sent folder.
Include the date and time of the injury (to the best of your recollection). Let your supervisor know if you will not be in to work tomorrow due to your injury.
Wait for Your Employer’s Response
In Illinois, your employer is responsible for filing a workers’ compensation claim with their insurance carrier (or internally if they are self-insured). They have 14 days from the report to accept or deny your injury claim, but they should provide you with a list of healthcare providers sooner than that.
If they can’t get you the list within a day or two, follow up and remind the HR rep or supervisor that you are injured and need to see a doctor. If they continue to give you the runaround and can’t provide a simple list of providers, call a lawyer immediately.
You should also seek legal help if your claim is not approved or denied after 14 days or if it is denied. The Illinois Worker’s Compensation website allows you to check on your claim’s status.
If you can’t find any record of it a few days after you spoke with your employer, ask them if there’s anything else they need to file your claim. What if they promise they’re looking into it, and you still can’t find it a few days later?
This is concerning behavior from your employer, and you should speak with a lawyer.
Follow Up with Your Employer
Aside from medical care, workers’ compensation is meant to provide two-thirds of your usual pay when you’re injured and unable to work. Illinois law provides these benefits if you miss more than three days of work due to an injury, so if you are on your fourth day out of work, check with your employer about filing a claim for lost wages benefits.
If you’re off work for more than two weeks, you can also receive back benefits for the initial three days you missed.
Why Was Your Workers’ Compensation Claim Denied?
Your employer or their workers’ compensation insurance carrier can deny your claim for a long list of reasons. workers’ compensation is a no-fault system, so they generally won’t claim the accident is your fault like they might in a typical civil case.
But there are many other ways they can avoid paying your claim. Here are some common reasons the insurance company or employer gives for denying a claim:
They’re Not Convinced You’re Really Injured
The employer or insurance company doesn’t find your medical records convincing or believes you could be faking it. This often happens with soft tissue or other injuries that are difficult to prove with imaging or other tests.
If it happens to you, chances are you will feel angry or frustrated that your employer or their insurer doesn’t believe you. We encourage you to speak with an attorney rather than argue with your employer – we can investigate further, talk to medical experts, examine your medical records, and work to show your injuries are real
The Injury Didn’t Happen at Work
If there is clear evidence of an injury in your medical records, the employer or insurance company may instead argue that there’s no evidence your injury happened at work. This could be a problem if there were no witnesses to your accident or if you have a repetitive stress injury like tendonitis or back strain.
In a few cases, there may be a disagreement about when you were or weren’t working, especially if your job doesn’t use an automated time clock system. Essentially, the employer or insurance adjuster believes your injury happened elsewhere, and they may suggest your hobbies or other personal activities are to blame instead.
There are several ways your lawyer may address this issue. If your employer denies that a specific accident happened at work and caused your injury, we will assign an investigator to search for evidence.
In some cases, we may be able to locate a video of the accident or find a witness you and your employer may not have known about. The more time passes, the less likely we are to find such evidence, so we encourage you to contact a workers’ compensation lawyer immediately if your claim is denied for this reason.
Proving the cause of a repetitive strain injury can be difficult, but it may be easier if you seek medical attention for your symptoms right away. Be sure to tell your doctor about the kind of work you do and actions that make your symptoms worse – such as typing or lifting heavy objects at work.
Disputes about whether or not you were at work when a specific event happened can be complex, but sometimes, the employer has violated workplace law. For instance, if your employer asked you to perform work for them during an unpaid break, such as your lunch break, they might have violated federal laws by not paying you for your time.
Sometimes, we find that the employee is owed back pay and workers’ compensation if we can prove they were told to perform work off the clock. We may need to interview other workers who had similar experiences, but occasionally, a supervisor will actually admit the employee did work tasks off the clock in an effort to avoid a workers’ compensation claim.
Sometimes, there are situations where a worker has not yet clocked in and isn’t performing any work but still suffers an injury.
For instance, what if you were walking to the time clock when you slipped on the floor and hurt your wrist? Or, what if you were on a lunch break in the company breakroom when a ceiling tile caved in and injured you?
In these situations, workers are usually still covered by workers’ compensation as long as their injuries are caused by something in the workplace environment, like a wet floor or rotted ceiling tile. Your lawyer will work to show the problem in the workplace and how it directly led to your injuries.
The Injury Happened When the Worker Was Intoxicated, Engaging in Horseplay, or Intentionally Caused Their Injuries
While workers’ compensation can’t be denied because the worker is at fault in general, it can be denied in these specific situations where the worker is at fault. If it’s clear that you had real injuries that did occur while you were at work, your employer or their insurer may look for other excuses to deny your claim.
This is one reason why many workplaces require a drug test after any accident, regardless of fault. Proving that an employee’s actions were intentional can be more difficult – even if there were witnesses or a video, it can be hard to say for sure if someone slipped and fell on purpose versus accidentally.
It may be challenging for either side to prove their case, but the insurance company might deny your claim for this reason anyway. In some cases, they’re hoping the employee will simply accept the denial.
Your attorney will help you gather evidence to show your injury was not intentional and that you were not behaving recklessly.
A Preexisting Condition Caused the Injury
Sometimes, a preexisting condition complicates a workers’ compensation claim, but that doesn’t necessarily mean you have to accept a denial. Your lawyer will work to show that your injury would have caused your symptoms anyway or that it may have aggravated an existing condition rather than being caused by one.
We may interview medical experts and spend time recreating the accident to demonstrate that it would have caused injury to a previously healthy person.
How to Get Assistance From an Illinois Workers’ Compensation Law Firm
If you need help with a workers’ compensation claim or denial, please contact The Fakhouri Firm Accident and Injury Lawyers for a free consultation about your workplace injury. Our skilled legal team will review your case, answer your questions, and explain your options.
If we take your case, we can file the necessary paperwork to fight a claim denial and represent you in the arbitration process if needed.
Founder and lead attorney Robert S. Fakhouri graduated from the Chicago-Kent College of Law and soon became one of the youngest people ever to join the Illinois Bar. After working as a legal clerk and litigation associate, he founded the Fakhouri Firm and dedicated himself to protecting the legal rights of injured people.
When he’s not fighting for his clients in the courtroom or negotiating with insurance companies, you can find him discussing legal topics on social media. Work with his team at The Fakhouri Firm by calling (312) 999-9990.