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What happens if I am denied by Workers’ Compensation or an insurance company?

A workers’ compensation claim denial can be incredibly deflating, and certain types of injuries won’t be covered under Illinois workers’ compensation laws. People who suffered injuries because of their own intoxication, involvement in criminal activity, or participation in recreational activities not directly related to work will not be covered by workers’ compensation.

Workers’ compensation insurance carriers often deny some claims for dubious reasons, but you should avoid getting into any arguments with an insurance company. Remember that what you say to insurers can and likely will be used against you, so you want to limit the number of conversations you have with an insurance company as well as what you say during those phone calls.

When your claim has been denied, you will have to apply for an adjustment within three years of the date of your injury or occupational illness, or within two years of the last payment, you received for workers’ compensation benefits. You will then be able to request a hearing with an arbitrator assigned to your case, and an arbitrator will dismiss a case when there is no hearing request within three years.

Under 820 Illinois Consolidated Statute 305/12, an employee entitled to receive workers’ compensation benefits can be required to undergo an independent medical examination (also known as an IME, but more commonly referred to as a Section 12 examination) at the request of an employer. You will want to be confident that you have an attorney before agreeing to any such examination, so you do not do or say anything that possibly jeopardizes your case.

Arbitrators will hear from both sides at hearings, and people can request expedited hearings when medical or temporary disability benefits have been cut off, and people need them restored because of an inability to return to work. If you disagree with an arbitrator’s decision, you will have 30 days to file two copies of a petition for review with the Illinois Workers’ Compensation Commission (IWCC).

An administrative appeal will involve three commissioners reviewing the evidence presented at your arbitrator hearing, and oral arguments can be presented when panel hearings are requested. The panel usually renders a decision within 60 days.

Any disagreement with an IWCC panel decision will mean that a person then must try to file a judicial appeal in the state court system. An appeal will usually begin in the circuit court for the county in which the employer or insurance company is located or the county in which the accident happened.

Circuit court decisions can then be appealed to Appellate Courts and possibly to the Illinois Supreme Court. State employees, however, cannot appeal past the conclusion of the commission.

Contact a Danville Workers’ Compensation Lawyer

You will want to get an experienced Danville workers’ compensation attorney on your side as soon as possible after any workplace accident to make sure that your claim isn’t delayed or denied. At Spiros Law, P.C., our attorneys have extensive experience helping injured workers get the compensation they need and deserve, and we’ll be ready to put our skills to work for you.