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Workers' Compensation: Denials


When a worker is injured on the job and the injury is work-related, its very possible they have a valid claim for workers' compensation benefits. Each state's workers' compensation system reviews claims and provides benefits to ensure that workers are covered in at least a limited way for injuries and employers aren't sued every time a worker is indeed injured.

Most employers are required to carry workers' compensation insurance. But that doesn't mean that every workers' compensation claim is a slam dunk. There are many reasons why a claim may be denied. If you are injured on the job, you should always keep in mind the following so that your claim may receive the consideration it merits.

Below are some common reasons workers' compensation claims may be denied:

Late Reporting: There is an expectation by the Illinois Compensation Board that an injured worker will file a claim immediately after an on-the-job injury. Likewise, an employer must notify the state of their compensation insurance shortly after any claim.

If you delay reporting the injury, that opens the door for the employer to another reason your claim might be denied, employer disputes.

Employer Disputes: Employers may dispute that the injury ever occurred in the workplace at all after filing your claim. When this occurs, this complicates your claim considerably. You will need to gather additional evidence and perhaps acquire witness support and physician statements attributing your injury or condition to your workplace.

For employers, denying a claim can decrease their own insurance expenses and liability. But insurers may deny your workers' compensation claim as well. So it's important to document everything and be prepared to substantiate your claim with as much supporting evidence as possible.

Severity of the Injuries: Some claims are denied simply because the injuries suffered don't rise to the level of what is considered compensable. If you cannot demonstrate injury severity, your claim may not be given the consideration it deserves.

In every case, a denial will be accompanied by a letter from your state's worker's compensation board explaining their decision. Review it carefully and consult an experienced workers' compensation attorney if you feel your claim was denied in error.

Appealing a worker's compensation claim denial can be a difficult process and appealing before deadlines stated in your denial letter is important for any reconsideration. You claim denial could actually be the result of paperwork or administrative error. So it is very important to contact an experienced workers' compensation attorney to review your claim and denial.

Your attorney will want to discuss your claim in detail with your employer or its insurer to ensure your claim was filed properly. Your appeal may have to be argued before an administrative law judge and there the evidence and documentation is of even more importance.

Your attorney can help you to appropriately document your injuries and ensure you have the evidence necessary to argue your claim. This is why it is extremely important to consult with a practiced workers' compensation attorney at the very outset. Many claim have been denied because a claimant failed to document their injuries or file a claim adequately.

If you have any questions about a workers' compensation claim, claim denial or possible personal injury damages resulting from an on-the-job injury. Panio Law Office attorneys have a wealth of experience and expertise in filing claims and recovering the widest array of damages for our clients, damages that go well beyond compensation available through standard workers' compensation claims.

Call us at (708) 928-8680. We can help.

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