Workers’ compensation in Illinois pays a portion of your salary until you heal from an injury. However, data shows that 25% of claims are denied on the first round. If you think you have been unfairly denied benefits, you may appeal the decision.
Learn the reasons claims get denied
Your workers’ comp denial letter should give a reason your claim was denied along with how to appeal. A common reason for denial is not reporting the injury within the time limits, which is 30 days in Indiana. You may get denied for not getting medical attention or not seeing the doctor the employer or their provider assigns you.
The injury must occur within the scope of employment, or the activities expected of you as an employee. For example, if you got injured while picking up a package for your employer, you will likely qualify for benefits. Workers’ comp does not cover intentional injury, injuries from being intoxicated or that occurred from reckless behavior.
How to appeal a denial
To begin the appeals process, file form 45422, which is an informal dispute called the Request for Assistance. This will initiate a mediation process with the Ombudsman Division to attempt to resolve a conflict involving suspended or denied workers’ comp.
If they can not help you or nothing is resolved, fill out the Application for Adjustment of Claim form. This form sets a hearing to give both parties the chance to present their case in front of the workers’ comp board.
Bring your medical records, proof a preexisting condition didn’t cause it, and pay stubs showing lost wages. If you do not agree with the judge’s decision, you may request a full review within 30 days after the hearing.
Denied claims can get carried to the state’s Supreme Court, so don’t think it’s impossible to fight denials. In some cases, you may be able to file claims against responsible third parties.