What to Do If Workers’ Compensation Denies Your Claim

Dodds Law Office, PC
shot of word worker's compensation

Illinois workers’ compensation law allows injured employees to seek benefits, including medical expenses, lost wages, and disability benefits via a claims process, which first begins by filing a notice of injury and a claim for benefits. However, not all work comp claims are approved. In the event that your claim is denied, benefits suspended or terminated, you may be eligible to file an appeal. An experienced Illinois workers’ compensation attorney can educate you about the next steps to take if your workers’ compensation claim is denied. 

shot of word worker's compensation

As an Illinois Workers’ Compensation Lawyer with his office centrally located in Bloomington, IL, I can investigate the reasons your work comp case has been denied, explore all available legal options with you, and help preserve your appeal rights. Just because your claim was denied does not mean that it is over. My firm proudly serves clients throughout Central Illinois, including Bloomington, Normal, Lincoln, Decatur, Champaign, Urbana, Pekin, and Peoria, Illinois.

Reasons a Workers’ Compensation Claim May Be Denied  

According to the Illinois Workers’ Compensation Commission, about 32,420 new claims were filed statewide in the Fiscal Year 2021. Of these, nearly 725 were dismissed. Here are some common reasons why workers’ compensation claims are denied: 

  • You failed to report your workplace injury or illness on time
  • You suffered the injury from an unrelated incident or during horseplay at work
  • You were under the influence of alcohol or drugs when the accident happened. 
  • You delayed filing or failed to file your claims on time. 
  • You didn’t seek immediate medical treatment after the workplace injury
  • There are no medical documents or records corroborating your claims 
  • Your injuries are related to a pre-existing medical condition
  • Misrepresentation
  • Your injury or illness wasn’t treated by a qualified or approved doctor
  • Further investigation needs to be conducted to corroborate your claims
  • No evidence or witnesses support the fact that you suffered the injury while on the job
  • Your employer disputes your workers’ compensation claims

When your workers’ compensation claim is denied by your employer or insurer, you will receive a Denial Notice or Notice of Denial notifying you of their decision to deny your claim for benefits. In other jurisdictions or for federal claims this might also be called a “Notice of Controversion.” An experienced and qualified lawyer can investigate the reasons for the denial and help preserve your claim as quickly as possible.

Notice of Denial 

A Notice of Denial or a Denial Notice is the denial of the workers’ compensation claim which is filed by an injured or ill employee. It is a written notice that the employer or insurance provider objects to an employee’s right to recover benefits under the Illinois Workers’ compensation Act. 

Employers that dispute or object to a workers’ compensation claim in Illinois are required to provide the employee with written notice identifying the reasons for the denial of the claim. If you receive a Notice of Denial or a Denial Notice, your attorney can carefully assess the reasons for the denial and determine the best course of action. 

What to Do If a Workers’ Compensation Claim Is Denied  

If your workers’ compensation claim is denied, you may be eligible to appeal the decision. Here are the steps involved in filing an appeal for workers’ compensation benefits in Illinois: 

  • Hire an attorney for detailed guidance and to help file your appeal
  • File an Application for Adjustment of Claim with the IWCC after the claim is denied
  • File a Petition for an Immediate Hearing or Request for Hearing with the Arbitration Judge assigned to your case
  • Following an Arbitrator’s Decision, file a Petition for Review of Arbitration Decision.
  • On Appeal three IWCC commissioners will review your petition to determine if there was legal error in the Arbitrator’s Decision. An IWCC hearing might be scheduled. 
  • During the IWCC hearing, you will be allowed to present an oral argument. The commissioners will listen to both parties and issue a judgment. You will know the outcome of your appeal within 60 days. 

A skilled attorney can help file your petition, coach you extensively for the hearing, and guide you through the appeal process. 

Accepting a Settlement  

Often it is possible to resolve your workers’ compensation claim through a settlement. After it is decided to appeal a denial of your work comp claim or an Application for Adjustment of Claim is filed, the employer or its insurer may offer a settlement, which may include a one-time lump-sum payment or a structured payment plan. Generally, the settlement must take the following into consideration:

  • Your medical expenses, including ongoing and future medical care and treatment 
  • Lost wages and benefits
  • Your degree of disability, and possibly your impairment rating
  • Attorney fees 
  • Temporary or permanent disability payments. 

Most importantly, before accepting a settlement offer, ensure that it covers all your work-related injuries, damages, and losses. An experienced work comp attorney can review the insurance company’s offer and help negotiate an adequate settlement amount. 

Compassionate Legal Assistance   

Finding out that your legitimate workers’ compensation claim has been denied can be devastating. Nevertheless, it is important to not lose hope. At the Dodds Law Office, PC, I fight for the interests of clients whose workers’ compensation claims have been wrongfully denied.

As your legal counsel, I can review the reasons for the denial and consult you regarding the best legal options available to proceed with your Illinois Workers Compensation Claim. I will also begin gathering substantial facts and evidence, help file your workers compensation claim, and guide you through the legal proceedings. I will continue fighting for your rights, help get the decision overturned, and do my absolute best to recover the workers’ compensation benefits you deserve.

Contact my firm – Dodds Law Office, PC – today to schedule a consultation with an experienced workers’ compensation attorney. I have the knowledge and experience you need in your workers’ compensation appeals. My firm proudly serves clients across Bloomington, Normal, Lincoln, Decatur, Champaign, Urbana, Pekin, and Peoria, Illinois.

Attorney Terry Dodds has been protecting the rights of the people of Bloomington, Illinois for over 20 years. Whether you were injured in an accident, or you have been charged with a crime, Terry Dodds can tip the scales of justice in your favor.

Years of Experience: More than 20 years
Illinois Registration Status: Active
Bar Admissions:Illinois State Bar Association Missouri State Bar Association McLean County Bar Association