5 Mistakes to Avoid When Filing a Workers’ Comp Claim

5 Mistakes to Avoid When Filing a Workers’ Comp Claim

When a worker is injured or is exposed to an illness at work, he or she may be eligible for workers’ compensation benefits and should know what mistakes to avoid when filing a workers’ comp claim. Avoiding these mistakes can help the worker to receive all possible financial compensation he or she might be eligible to receive for the injury or illness. 

Carpenter building a home at construction site. Falling off ladder. Injured leg. concept of mistakes to avoid when filing a workers' comp claim

Over 100,000 workers were impacted by a workplace injury or illness in Illinois in 2021. Many of these injuries and illnesses left the worker unable to work for an extended period of time while accruing medical bills and other expenses. Worker’s compensation can help with medical bills, vocational rehabilitation, lost wages, and short and long term disabilities. 

When to File for Workers’ Compensation in Illinois

A worker should notify his or her employer at the time of the injury or illness if possible. The notification to begin the process of filing for workers’ compensation must be made within forty-five days of the accident or the diagnosis of the illness. If the worker waits to notify his or her employer past this timeframe, then the claim may be denied. There are some exceptions to this forty five-day rule, and a Chicago workers’ compensation attorney can help advise if any may apply to your claim.

In Illinois, all employers are required to carry insurance for workers in case of injury or illness, even if a company only employs one employee.  Workers should always report an injury or illness that can be covered under workers’ comp, or they might miss out on much-needed benefits and compensation to cover past and future medical bills, as well as other costs associated with the injury or illness.

It is best to notify the employer in writing, and the worker should keep a copy to prove that the employer was notified of the accident or illness in detail. This written notice should include the date, time, and the location of the accident. The worker should fill out any required paperwork in a timely manner. The employer will provide a list of doctors approved by the insurance company to examine the worker. Employees can choose to see their own doctor, but may be asked to undergo a second examination by an approved doctor.

For a successful claim, the worker must prove that his or her injury was caused by his or her job duties. If the underlying cause of the illness or the injury is not proven to be work related, then the claim will be denied. 

Worker’s compensation can include permanent total disability (PTD) benefits for workers that have experienced an injury which permanently leaves them unable to work. This can include disabilities that leave the injured worker unable to work at the prior skill level. The worker will be paid 66% of what he or she used to make, or a percentage to help cover any gap between wages. 

Steps for Filing Workers’ Compensation

In Illinois, filing workers’ comp is a multiple step process which begins after the injury or illness has occurred. First, the employer is notified of the injury or illness and an incident report is filled out and returned to the employer. Then, a doctor approved by the workers’ compensation insurance company must examine the injured worker. Keep any medical bills and receipts for treatment of the injury. It can also be beneficial for the worker to keep a journal of the recovery process, especially in regard to pain levels.

Once the insurance company has been notified of the injury, the company will review the claim. It is at this point that the insurance company will have thirty days to accept the claim or issue a denial and notify the injured worker of the decision. If the insurance company denies the claim, a workers’ compensation attorney can help the injured worker through the appeals process. 

Even if the insurance company does approve the claim, they may not approve all benefits that apply to the worker’s injury or illness. Workers’ compensation can cover not only medical treatment and vocational rehabilitation, but also partial and total disability benefits. When the injury is fatal, the family can be eligible to file for workers’ compensation death benefits. If any part of the claim is denied, the injured employee can fill out and file an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission.

If an injury or illness gets worse after a claim has already been closed, it can be reopened to request additional benefits for further treatment. The worsening condition must be able to be traced back to the original workplace injury for the request to be valid. The request to reopen the case must be made within 30 months of the injured worker receiving his or her workers’ compensation benefits.

To reopen a closed claim, the injured worker must have the doctor fill out a written statement that states the injury or illness has gotten worse since the claim was closed, as  well as a description of the additional required treatment. The doctor’s statement needs to be sent with a written request to the insurance adjuster to reopen the claim. A copy should be kept of both documents in case either are needed to file a petition with the court to reopen the claim for additional medical and rehabilitation costs. 

It is best to speak with a workers’ compensation attorney to review your claim to see if it is eligible to be reopened for additional benefits.

Most Common Mistakes Made When Filing for Workers’ Compensation

Insurance companies will try to avoid paying out claims whenever possible. This may include total denial of workers’ compensation, or if the claim was approved, a denial of some benefits. Although denials can be appealed, the insurance company will try to delay the process as much as possible to continue to avoid having to pay the injured worker the benefits he or she should receive. 

These delays could put a financial hardship on the worker and his or her family through the workers’ claim process. This can be especially difficult for families if the injured worker was the main or only financial provider. He or she may not have other financial solutions while waiting for workers’ compensation. A Chicago workers’ compensation lawyer can help navigate the claim process and avoid denials for simple reasons.

Five common mistakes that can lead to workers’ compensation denials are:

  1. Missing notification deadlines or failing to fill out any required paperwork. The injury or illness must be reported to the employer within forty-five days. If the injury is from repetitive stress or prolonged exposure, the impacted worker needs to report the injury or illness to his or her employer forty-five days after being diagnosed.
  2. Only going to see a doctor that is not on the approved list provided by the workers’ compensation insurance company. If the worker went to his or her primary doctor, and the source was identified as the workplace, he or she should be prepared to see a doctor requested by the insurance provider. If the worker misses the appointment, either because he or she refuses to go get examined, or because he or she was unable to make the appointment, the claim may be denied.
  3. Avoiding any offered work by the employer. An injury may leave a worker unable to do all the previous work at his or her previous skill level, but he or she may still be able to do some tasks. If the approved doctor has cleared certain tasks, then a worker should not refuse to do them if he or she is asked to do so. Refusing work that the injured worker is able to do can reflect poorly on the claim. 
  4. Going back to work too quickly. The worker should accept any work that he or she has been cleared to do, but only after the doctor says it is okay to work. If the worker’s body is not ready, going back to work can cause the injury or illness to get worse, which may require further treatment.
  5. Agreeing to an initial settlement. A settlement agreement might seem like a good way to avoid dragging out the claim process. However, this initial settlement offer may not cover all the benefits or costs that the injured worker might require for long term care or recovery. Some settlement offers might also include language that would not allow the injured worker to reopen the claim if the injury gets worse.

A workers’ compensation lawyer can help injured workers avoid these common mistakes that might get claims denied. In some cases, it might be best to consult with a lawyer prior to initiating a claim, but the forty-five-day deadline should be kept in mind when finding a workers’ compensation lawyer.