How Does Workers’ Comp Work?

How Does Workers’ Comp Work?

After a workplace injury, you may wonder – how does workers’ comp work? Workers’ compensation is an insurance program that provides financial benefits and medical care to employees who become ill or are injured due to their job. In a workers’ compensation case, fault is not assigned to any party. The claimant’s compensation is not reduced by his or her carelessness or increased by any fault on the employer’s part. Employers are the ones who fund this insurance.

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Workers’ Compensation Laws in Illinois

It is important to have a good understanding of how workers’ compensation laws can affect you. Here is a summary of the workers’ compensation laws in Illinois:

Statute of Limitations

In Illinois, the duration of workers’ compensation benefits can vary depending on the severity of the injury. It can range from a few weeks to several years, or even lifelong benefits in severe cases.

The statute of limitations gives you three years from the date of injury or two years from the last payment of benefits, whichever is later, to file. Reporting a workplace accident to your employer is not the same as filing a workers’ compensation claim. If your employer does not provide adequate or fair benefits, filing a claim may become necessary.

The statute of limitations is based on whichever option gives you more time to file your claim.

Important Deadlines

An employee must inform an employer of the injury within 45 days. The employee also has a 3-year time limit to file a claim with the Illinois Workers’ Compensation Commission.

What Is the Illinois Workers’ Compensation Act?

Illinois workers’ compensation insurance, also known as workers’ comp insurance or workman’s comp, is a system of benefits that compensates employees who suffer injuries or illnesses while performing their job duties. The Illinois Workers’ Compensation Act governs the state’s workers’ compensation laws and outlines employees’ and employers’ rights and responsibilities. The act aims to offer four types of workers’ compensation benefits:

  • Wage replacement
  • Medical care
  • Career rehabilitation
  • Wrongful death

What Are Your Employer’s Responsibilities Under Illinois Law?

In Illinois, employers must have workers’ compensation insurance for employees injured on the job. The benefits include medical and rehabilitative expenses, temporary total disability benefits, temporary partial permanent disability benefits, permanent total disability benefits, and job retraining.

Employers are also required to post a notice explaining workers’ comp rights and provide insurance details. They must report work-related injuries to the Illinois Worker’s Compensation Commission if they involve more than three lost work days. Employers cannot harass or discriminate against employees who exercise their rights under the law. Employers cannot charge employees for workers’ comp insurance.

How to Qualify for Workers’ Compensation in Illinois

To be eligible for workers’ compensation in Illinois, an employee must fulfill the following conditions:

Employment Relationship

For a claim to be valid, there needs to be an employment relationship established between the employer and the employee. In certain instances, independent contractors may be covered by workers’ compensation policies, while others might be excluded from coverage depending on their employment circumstances.

The Injury Was Work-Related

The employee must suffer the injury while performing a work-related duty. It may be difficult to prove that an injury occurred while the employee acted within the scope of his or her employment, especially if it happened outside the workplace or during non-working hours. It’s best to consult with a workers’ compensation lawyer for guidance in such cases.

Injuries resulting from pre-existing conditions or other accidents are not eligible for compensation.

Damages

Employees are eligible to receive workers’ compensation benefits for losses that they suffer, including medical expenses, lost income, and reduced ability to work, which can be paid through permanent or temporary disability benefits.

The Employer Must Be Notified

In Illinois, employees must report work-related injuries to their employer within 45 days by following the employer’s policies and procedures. An attorney can advise you on what to do if you failed to report your work injury.

What Is Considered a Work-Related Injury?

An injury or illness is work-related if it was caused or worsened by an event or exposure in the work environment, or work aggravated a pre-existing condition. This includes injuries sustained while performing job-related tasks, occupational diseases, and mental conditions developed or worsened due to work-related factors.

What Are the Reporting Requirements for Injured Employees?

You must report a work-related injury within 45 days of the accident. If the injury is caused by exposure or repetitive/cumulative use, you should report it within 45 days of becoming aware of the workplace cause for the injury or condition.

You can report the injury to your employer either orally or in writing. It is advisable to include your name, address, telephone number, Social Security number, and a short description of the injury or illness in the notice to avoid any possible delays.

Steps for Filing a Workers’ Compensation Claim in Illinois

The process of making a claim involves the following steps:

Report the Injury or Illness to Your Employer

In Illinois, report work-related injuries to your employer within 45 days to avoid losing eligibility for workers’ compensation. Prompt reporting helps you file a work injury claim and protects your best interests. Delayed reporting may result in the insurance company refusing to pay your claim, alleging that your injury happened after the accident, or worsened due to delayed reporting.

Seek Immediate Medical Attention and Document Your Treatment

Notify your employer and seek medical attention after an injury. A doctor can evaluate your injuries, determine when you can return to work, and when you’ve reached maximum medical improvement. Seeking medical treatment will link your injuries to the workplace accident. Collect evidence by documenting your treatment, medical expenses, and how the injury has affected your daily life. This will help in determining the value of your workers’ compensation claim.

File a Claim for Workers’ Compensation

You should work with an attorney to ensure the workers’ compensation application is accurately completed. Once the application is complete, you must provide a copy to your employer and submit the original to the appropriate state agency. You must deliver signed copies of the application to the Illinois Workers’ Compensation Commission in Illinois. You have a maximum of 3 years to file your workers’ compensation claim from the date of your injury.

Wait for Approval or Denial

If your claim is denied, you have the right to appeal. If your claim is approved, you will receive compensation in a lump sum or through structured payments over time.

Negotiate a Settlement

If you receive a workers’ compensation offer that is unreasonable, you are not obligated to accept it. You have the right to negotiate for a higher amount. You should hire a workers’ compensation attorney to ensure a fair settlement. If you cannot reach an agreement, you can take the case to trial.

Receive Payment for Your Injuries

In Illinois, workers typically receive their workers’ comp settlement check about 14 days after their claim is finalized.

Consult a Workers’ Compensation Lawyer

If you plan to file a claim, consulting workers’ compensation lawyers can streamline the process. They can help you file your claim, negotiate a settlement, find evidence, and represent your interests. A workers’ compensation attorney knows how to calculate the true cost of your injuries. These lawyers know how to fight for the best compensation on your behalf and can back their arguments with legal knowledge. Having a workers’ comp attorney increases your chances of maximizing your compensation.

Complications in the Claims Process

During workers’ compensation claims processing, problems may arise when reporting or due to employer or employee complications.

Employer-Related Complications

Delays or confusion in reporting worker injury claims can hinder investigations. Employers may not know who is responsible for submitting claims or what action is needed.

Invalid claims, such as when an employee is injured outside the scope of his or her work duties, are also a common issue in the workers’ compensation sector. These claims are often processed as if they were valid, which can lead to unnecessary expenses.

Employers may fail to monitor or review workers’ compensation claims, assuming that insurers have enough resources and knowledge to provide oversight. This hands-off approach can result in employers missing opportunities to improve their safety policies and prevent future workplace injuries.

Employee-Related Complications

Employees may make the following mistakes, causing complications in the claims process:

  • Reporting an injury after a delay, leading to a coverage denial.
  • Leaving out crucial medical information and accident details from the claim, or failing to submit the required information.
  • Making errors while filling out forms or neglecting to submit the necessary forms.
  • Having medical professionals’ submissions that suggest the injury was not a result of work-related activities.
  • Refusing to undergo medical testing, including mandatory drug screenings under many worker’s compensation policies.

Consider hiring a workers’ comp lawyer for help with your claim. A lawyer will assist you with building a strong case and securing a fair settlement, giving you peace of mind as you focus on your recovery.

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association