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If you were recently injured on the job, you have probably considered filing for workers’ compensation benefits. Workers’ compensation is a form of insurance that provides compensation to employees who are injured on the job. The following provides some helpful information about the Illinois workers’ compensation claim process.

What Kind of Workers’ Compensation Benefits are Available in Illinois?

Illinois’ workers’ compensation laws are codified at 820 ILCS 305, also known as the “Illinois Workers’ Compensation Act.” This statute provides some of the following benefits for injured employees who file workers’ compensation claims:

• Temporary total disability (TTD) benefits: If you cannot work because you are recovering from a work injury, or if you cannot obtain light-duty work that accommodates your physical limitations, you may be entitled to TTD benefits. TTD benefits are two-thirds of your pre-injury average weekly wage and will continue until your doctor states that your condition has improved as much as feasibly possible under your current treatment plan (referred to as “maximum medical improvement”).
• Permanent total disability benefits: Once you have reached your level of maximum medical improvement, your doctor will determine if your injury has caused any permanent physical disability. You will be considered permanently and totally disabled if you are either unable to do any kind of work or if you have lost the use of both eyes, hands, arms, feet, or legs (or any two of those limbs). If so, you will receive permanent total disability benefits for life, at the same rate as your TTD benefits.
• Wage differential benefits: If you have returned to work since the time of your injury but are earning less than you were before your injury because of your permanent partial disability, you might be entitled to a wage differential award. These benefits equal two-thirds of the difference between what you are earning in your new position and what you would have been earning at your pre-injury position. These payments will terminate after five years or when you turn 67, whichever happens later.
• Disfigurement benefits: If your work-related injury resulted in a serious and permanent disfigurement to an body part that is commonly visible to the public (i.e. your face, head, neck, upper chest, arms, or lower legs) you may be entitled to receive an award amount equal to 60% of your pre-injury average weekly wage for up to 162 weeks (depending on the severity of the disfigurement).
• Medical benefits: Workers’ compensation typically covers all medical bills stemming from a work injury, so long as the treatment is authorized.
• Vocational rehabilitation benefits: If you are unable to return to work and need job counseling, training, or education to find another job, workers’ compensation will provide a maintenance benefit in the same amount as your TTD rate (as long as you are enrolled in an approved vocational rehabilitation program).
• Death/ burial benefits: If an employee dies as a result of a work-related injury, the surviving family members can receive certain death benefits. These benefits include an amount which is two-thirds of the employee’s average weekly wage, as well as up to $8,000 in burial expenses.

What is the Workers’ Compensation Process?

The workers’ comp process in the state of Illinois typically proceeds in the following manner:

You are required to notify your employer within 45 days of a workplace accident in order to preserve your right to collect benefits

• You must notify your employer of your injury. The first thing you should do after you suffer a workplace injury is to notify your employer. This is important because you are required to notify your employer (either orally or in writing, though providing a written notification is recommended) within 45 days of a workplace accident in order to preserve your right to collect benefits; a delay of more than 45 days may result in the loss of all potential workers’ compensation benefits. Make sure that you include the date and place of the accident in your notification, as well as the names of any employees who may have witnessed the accident.
• You should file an application for an Adjustment of Claim. After notifying your employer of your injury, you may also need to file a claim with the Illinois Workers’ Compensation Commission (IWCC). To do so, you must either mail or give to your employer an Application for Adjustment of Claim, along with a proof or service stating that you have either mailed or given a copy of the application to your employer. For most injuries, you must file the Application for Adjustment of Claim within three years after your injury. Please note that if your employer is paying for your medical treatment and temporary or permanent disability payments as expected, there is no need to file this form. However, if you need the IWCC to order your employer to pay benefits to you, you will need to file a claim. Additionally, if you anticipate that your employer may be required to pay you benefits in the future (such as permanent disability benefits), you should file this form.
• Your employer must take action on your claim. Once you notify your employer of your injury, your employer must provide you with a list of approved medical providers and must also inform the insurer to begin the claims process. If your injury has resulted in you missing at least three days of work, within 14 days, your employer must either accept your claim and start paying you temporary disability payments or send you a letter detailing the reasons why your claim is being denied or delayed. This letter may also request additional information or documentation from you for further investigation. Additionally, if your injury caused you to not be able to work for more than three days, your employer must also file an accident report with the IWCC within 30 days of being notified of your injury.

What are Some Reasons Why Workers’ Compensation Claims are Denied?

Sometimes, Illinois workers’ compensation insurance claims are denied. Claims can be denied for any number of reasons, some of which include:

• You failed to meet an applicable deadline. If you do not file your claim within the appropriate timeframe or fail to properly notify your employer of your accident, your claim may be denied.
• Your accident report and medical records are inconsistent. If the accident report that you provided to your employer does not match the information that is on file in your medical records, your claim will likely be denied.
• Your injury was not work related. In order for your injury to be compensable, it must have occurred within the course and scope of your employment.
• You failed to seek medical care for your injuries. If you failed to seek appropriate medical care for your injuries in a timely manner after you were injured, an insurance company may deny your claim, under the assumption that your injuries must not be significant.
• You were injured while under the influence of drugs or alcohol. If the injury you sustained at work was the result of being under the influence of drugs or alcohol, the health care expenses for that injury will not be covered under workers’ compensation.

What Should I Do if My Claim is Denied?

If your workers’ comp claim is denied, injured workers should consider taking one or more of the following steps:

• Review the denial letter: After receiving a denial letter, you should closely review the letter to ensure that you comprehend the reason(s) why your claim was denied. This is especially important because it might turn out that either you or the insurance company made a simple error that could be rectified by a simple phone call or email. If you happen to notice any errors on the denial letter, contact the insurance carrier right away in order to determine whether the error can be fixed.
• Contact an attorney: If, based on the details provided in the denial letter, there was some substantive basis for the denial of your claim, you may want to consider contacting a workers’ compensation attorney to help you determine what steps you should take next. This attorney will let you know whether you should file an appeal and will ensure that you meet any applicable deadlines. Alternatively, if you decide to opt out of the workers’ compensation process altogether and file a personal injury lawsuit against your employer instead, an attorney can provide assistance throughout that process, as well.
• Consider filing an appeal: If you notified your employer of your injury within 45 days, but your claim was denied, you may file a petition for review with the IWCC. The IWCC will then hold a hearing and make a determination on your claim.

Speak to an Illinois Personal Injury Attorney Today

If you have additional questions regarding the workers’ compensation process, the Palermo Law Group can help. Our firm is composed of knowledgeable and experienced personal injury attorneys who are ready to assist you with any questions or concerns you may have. Call us today at (630)-684-2332 or use our online form to schedule an initial consultation appointment.