What To Do if Your Workers’ Compensation Claim Is Denied

Getting hurt at work is stressful enough. Receiving a workers’ comp denial letter on top of that can feel like a debilitating blow when you’re already dealing with medical bills, missed paychecks, and an uncertain recovery. Thankfully, there is still some good news in this situation. A denial is not necessarily the end of the road.

If your workers’ compensation claim is denied, consider taking these steps to protect your rights:

• Gather and submit additional supporting evidence
• File a formal appeal with the Illinois Workers’ Compensation Commission (IWCC)
• Consult an experienced workers’ comp attorney for guidance

At Saks, Robinson & Rittenberg, Ltd., we’ve helped injured workers in Chicago fight for their workers’ compensation claims for over 40 years. Our team is ready to walk you through the workers’ comp process, including any needed appeals, in order to provide you with the compensation you deserve.

Why Are Workers’ Compensation Claims Often Denied?

Understanding why claims get denied can be your first step toward building a stronger case. Insurers typically deny claims for reasons such as:

• Late reporting: Illinois law requires you to notify your employer of a work injury within 45 days and file your claim within Illinois’ statute of limitations
• Disputed relation to work: The insurer argues your injury didn’t happen on the job or wasn’t caused by your work duties
• Pre-existing conditions: The insurer claims your injury stems from a separate, pre-existing medical condition

These reasons may seem significant, but they can often be overcome by presenting the right evidence.

Steps To Take After Receiving a Denial

1. Get the Denial Reason in Writing

Request a written explanation from the insurance company. This document detailing the denial is critical, as it tells you exactly what you’re up against and helps form the foundation of your appeal strategy.

2. Gather Additional Evidence

Once you know the reason for the denial, work to address it directly. Useful evidence can include:

• Medical records and physician statements linking your injury to your job
• Witness statements from coworkers
• Official incident or accident reports filed with your employer
• Photos, video footage, or documentation of the hazard that caused your injury

3. File an Appeal With the IWCC

In Illinois, denied workers’ compensation claims can be appealed through the Illinois Workers’ Compensation Commission. This typically involves filing an Application for Adjustment of Claim, a formal legal document that initiates the dispute resolution process. Deadlines apply, so acting quickly matters.

How a Disputed Workers’ Compensation Claim May Be Resolved

Once an appeal is filed with the IWCC, your claim will likely be resolved through an arbitration hearing. An IWCC arbitrator will review the evidence and issue a decision. If you disagree with the arbitrator’s ruling, you can request a review by the IWCC’s reviewing board, and ultimately appeal to the Illinois Appellate Court.

The process can be complicated and time-sensitive. Having an experienced attorney by your side significantly improves your chances of a favorable outcome.

Denial Need Not Be the Final Word

A denied workers’ compensation claim is a setback, but not inherently a dead end. By getting the denial reason in writing, building a stronger evidence file, and appealing your case to the IWCC, you still have some real options for relief.

The attorneys at Saks, Robinson & Rittenberg, Ltd. are experienced, aggressive, and ready to fight for the compensation you deserve. With decades of experience in Illinois workers’ comp claims, we can guide you through the appeal process and help your case be valued as it should. Contact us today to start discussing your case.