Workers’ Compensation Claim Checklist

Workers’ Compensation Claim Checklist

A workers’ compensation claim checklist offers guidance on the steps you should take after suffering a work-related injury and the documentation you need to navigate the workers’ comp system successfully. After a work-related injury in Chicago, it’s crucial to seek medical treatment, report your injury to your employer in a timely manner, seek legal guidance, keep detailed records, submit the necessary paperwork, update your employer on your progress regularly, and check the claim status. Get all the information you need to maximize your chances of successfully recovering compensation from the comprehensive workers’ comp claim checklist below.

Construction worker wearing safety harness and safety line working at high place. Workers' Compensation claim checklist concept

Who Is Eligible to File for Workers’ Compensation?

First and foremost, you should ascertain that you’re eligible for workers’ compensation. That will require you to have a basic understanding of what qualifies for workers’ comp in Illinois. Under Illinois law, employers are obliged to provide workers’ compensation to almost every person who is hired and his or her employment is based in the state.

Almost all employees in Illinois are eligible for workers’ compensation. According to estimates, 91% of Illinois employees are covered by the state’s Workers’ Compensation Act. Workers’ compensation may not cover you if you’re an independent contractor. However, employers can classify employees as independent contractors to avoid paying them workers’ comp benefits. Therefore, it’s essential to consult a workers’ compensation lawyer if you suffer a work injury and your employer labels you an independent contractor.

Employees are entitled to workers’ compensation if they sustain injuries or contract illnesses while acting within the scope of their employment. Injuries and illnesses that occur gradually as a consequence of your work duties or environment are also covered. You can also file for workers’ compensation if you have a pre-existing condition that’s worsened by your work-related duties.

Steps to File a Workers’ Compensation Claim

The steps you take after sustaining a work-related injury are critical to your claim. Certain actions will increase your chances of getting the full amount of workers’ compensation to which you should be entitled. Here’s a workers’ compensation claim checklist of the steps to take if you suffer an injury due to your work environment or job duties.

Seek Medical Attention for Your Injuries or Illness

You should seek medical attention as soon as possible after suffering a sudden work-related injury or discovering a cumulative injury that has developed over time due to your workplace. Prompt treatment for your injuries helps manage your health issues more appropriately, improves recovery, and generates medical records that prove the cause and nature of your injuries.

If you wait too long before seeking medical attention, your injury may start healing and reduce your workers’ compensation payout. Additionally, the longer you wait, the more challenging it becomes to connect your injury to a work-related incident.

Your employer may have a preferred medical provider to whom it will refer you. You’re entitled to choose another medical professional to receive a second opinion. Under Illinois work injury law, each employee can seek treatment from up to two doctors and any other medical providers to whom those doctors refer him or her. Emergency care and first aid won’t count as one of your two choices.

If your employer has an approved Preferred Provider Program (PPP) for workers’ compensation, the PPP network counts as your first choice of doctor. Therefore, if you choose not to receive treatment from a doctor within the network, you’ll only have one choice of doctor remaining. However, to opt out of the network, you’ll need to notify your employer in writing. You can also opt to choose any two doctors who are within the employer’s network.

If your employer doesn’t have a PPP, you can go to any two medical providers of your choosing.

Report Your Injury to Your Employer

You should notify your employer of your work-related injury as soon as you can. While you can inform your employer orally, it’s best to do so in writing to ensure there’s a formal record of the notice. You can prevent delays by including information like your name, contact information, and a brief description of your illness or workplace accident and the resulting injury in your notification.

In Illinois, a notice of a workplace injury must be given within 45 days of its occurrence. There are a few exceptions.

If you have an illness that has developed gradually over months or years due to your work or an injury resulting from repetitive job duties like typing, you should notify your employer as soon as you become aware of the condition and its relationship to your job. For an injury caused by exposure to radiation on the job, you’ll need to inform your employer within 90 days of you knowing or suspecting you were exposed to excessive radiation.

Employer Response

After being notified of your injury, your employer will need to give you the necessary information on the approved medical professionals in their PPN that can help in your treatment. Your employer will also start the claims process with the insurance provider.

If your injury causes you to miss work for more than three days, your employer will only have 14 days to accept or deny your claim. If your claim is accepted, your employer should start paying you temporary disability payments. If your claim is denied, the employer should give a written explanation of the denial. Employers are also required to file accident reports with the Illinois Workers’ Compensation Commission (IWCC) within 30 days of being informed about work injuries.

Document Everything

Write down everything you remember about the incident as soon as possible, including:

  • What occurred before the incident
  • Where you were
  • The exact time and date of the incident
  • Who came to assist you after the incident

Speak with witnesses and write down their statements, names, contact details, and job titles. Don’t share these notes with anyone else apart from your workers’ compensation lawyer.

Document your injuries carefully. Jot down the location of your pain and the things that increase the pain. Describe the sensation, how the injuries are affecting your life, and the changes you experience over time. Take clear photos of your injuries and where the accident that caused them happened.

These records can provide evidence and support your claim.

Seek Legal Guidance

You can schedule a free case evaluation with a workers’ compensation lawyer to help you understand your rights and what you should expect based on your exact situation. Although you don’t have to hire a lawyer when pursuing a workers’ compensation claim, the help of an attorney is often beneficial.

Navigating a workers’ compensation claim while nursing an injury can be a daunting experience. The claims process can be extensive, with the typical timeline of a workers’ compensation claim varying greatly. A workers’ compensation attorney has the knowledge to walk you through the entire process, help you file the claim form correctly to avoid unnecessary delays or denials, and take any other steps required to get the full amount of compensation to which you’re entitled.

Complete the Necessary Paperwork

Your employer will give you forms to fill out in relation to your claim. You should fill out and submit these forms in a timely manner. The employer should provide information on important facts about workers’ comp, such as the available benefits, your rights, and returning to work.

If your employer fails to give you workers’ comp benefits following your injury or you anticipate a dispute, you can file a claim with the IWCC. When filing the claim, you’ll need to provide proof of having given your employer a copy of your application. The Commission can order your employer to pay you benefits. A workers’ compensation attorney can help you prepare and file this claim while ensuring you comply with the state’s laws and regulations.

Update Your Employer Regularly

Employers and their insurance companies need to stay up to date with what’s happening with an employee’s work-related injury. Provide your employer with updates on your progress. That will help your employer know your current health status, when you may resume work, and prove that your injury is hindering you from working. You can use follow-up appointments, doctor’s notes, test results, and other medical documentation to show that your condition is preventing you from returning to work and that you’re making every effort to adhere to your treatment plan.

You won’t have to worry about updating your employer and the insurance carrier if you retain a workers’ compensation lawyer. Your lawyer will handle everything related to your claim, including keeping your employer and workers’ compensation insurer in the loop and providing supporting documentation.

Check the Claim Status

You can check the IWCC website for the status of your workers’ comp claim.

Appeal a Claim Denial if Necessary

Workers’ compensation claims can be denied for several reasons. Common reasons for denials include employers not considering an injury to be work related, employers believing an injury didn’t warrant time off work or medical treatment, and failure of an employee to notify his or her employer of an injury on time. You can request an arbitration hearing to appeal a claim denial.

A workers’ compensation lawyer can provide valuable assistance during the appeals process. Firstly, an attorney will review the reason for the denial and advise you on your prospects of success if you proceed with the appeal. An attorney will give you the best chance of having the decision reversed by gathering additional evidence, submitting the necessary paperwork, and complying with deadlines.

You can also appeal the arbitration decision by filing a Petition for Review within 30 days of receiving the arbitrator’s decision.

How Long Do You Have to File a Workers’ Comp Claim in Illinois?

There’s a difference between notifying your employer about a work-related injury and filing a workers’ comp claim. Remember — except for an injury resulting from radiation exposure or a slow-developing injury or illness — you must provide notice to your employer within 45 days of the date the injury occurred. Failure to notify your employer within that period could lead to you losing the right to receive workers’ comp benefits.

With regard to workers’ compensation claims, you must file your claim within 3 years of the date of your injury or 2 years of the date you last received workers’ compensation payment, whichever’s later. There are special time limits for claims for the following diseases:

  • Radiation exposure and asbestos-related injury: 25 years from the last exposure
  • Pneumoconiosis: 5 years from the last exposure
  • Berylliosis and diseases caused by the inhalation of silica dust: 3 years from the last exposure

Following a workers’ comp claim checklist can help you take steps that ensure you meet all the applicable deadlines in Illinois and successfully recover compensation for your workplace injury.