Common Disputes in Workers’ Compensation Claims
Workers’ compensation claims are commonly disputed by employers because of differences over the severity of the injury, prior injuries, or whether the condition is work-related. Workers should understand the reasons why issues about their claims might arise so they know how to handle disputes.
Failing to Notify Employer on Time
Workers who are injured at work are required to notify their employers about their injuries within a specified time period. If workers do not notify their employers within the time period, their claims may be denied by the workers’ compensation insurance carrier.
Getting Treatment From an Unapproved Doctor
Some employers have preferred providers that they may require workers to see for treatment. However, Illinois allows workers to opt out of their employers’ preferred networks. Workers are able to choose up to two doctors to treat their injuries. Choosing to opt out of the employer’s network counts as one choice, but employers can’t deny claims based on workers doing so.
Failing to Get Treatment
Workers who fail to get medical treatment for their work-related injuries may have their claims disputed or denied. It is important for people to seek treatment so they can prove that they suffered a work injury. Without supporting medical records, claims are more likely to be denied.
Employer Claims the Injury Isn’t Work-Related
Some employers may claim that the injury wasn’t related to the workers’ jobs. However, there are some instances in which people may still be able to recover workers’ compensation benefits for injuries that happened elsewhere such as a mandatory work-sponsored event or while traveling for work purposes.
Workers who suffer injuries to the same body part as where they have preexisting injuries may have their claims disputed. They will need to present evidence showing that the site was reinjured or that the previous injury was exacerbated.
When claims are disputed, workers may bring the case before an arbitrator. If they do not like the arbitrator’s decision, they may appeal to a three-commissioner panel. When workers disagree with the Commission’s decision, they can appeal to the Circuit Court, the Appellate Court, and sometimes to the Illinois Supreme Court.