Employees who receive injuries while on the job are legally able to file for workers’ compensation benefits. These benefits cover medical bills and lost wages as a result of the injuries.
In order to receive these benefits, an employee must fill out a claim form; however, this claim may receive a denial of payment. There are numerous reasons for a claim denial, and the employee may be able to appeal the decision.
Common reasons for claim denial
According to FindLaw, one reason for denial may be because the worker did not notify the employer about the work-related injury or did not do it by the deadline. Denial may also be due to the fact the employee did not file the claim in a timely manner according to the statute of limitations.
The investigator may deny the claim because the claimant injured him- or herself intentionally or there is no evidence the injury occurred at work. A denial may also occur if the employee was under the influence of drugs or alcohol at the time of the injury.
Other reasons may relate to the injury itself or the medical care. If the injury is not as severe as stated, or the worker does not appear for the medical exam, denial may occur.
Actions for denial disputes
The Illinois Workers’ Compensation Commission outlines steps an employee can take for a denied claim. First, the Commission recommends that the claimant hire an attorney, and the appeals process can take place through the Commission, but a trial typically does not occur until the worker reaches maximum medical improvement.
The employee must show evidence to an arbitrator that proves he or she deserves workers’ compensation benefits. After completion of the trial, the arbitrator must issue a decision within 60 days. This decision can go through an appeal process, which involves commissioners. Their decision is final for state employees, although other employees and employers can go through the appeal process if not happy with the result.
A faster way to resolve claim disputes is for the employee and employer to enter into a settlement contract, which the Commission must approve for it to be legally binding.