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Mistakes That Hurt a Workers’ Comp Claim
What Is the Workers’ Compensation Claim Process in Illinois?
Although the workers' comp claims process may vary by state, in Illinois, your claim is likely to follow this process:
- Report your injury to your manager or employer within 45 days in Illinois. Any delay beyond this period may result in the denial of your claim by the insurance company.
- Seek medical care and evaluation, as your employer should refer you for these services after receiving notice of your injury. An evaluation will help determine the extent of your injuries, as well as when you can return to work and your maximum medical improvement.
- File your workers' comp claim, which involves filling out application forms, sending a copy to your employer, and delivering the application to the relevant state agency within three years of your injury in Illinois.
- Your claim will either be approved or denied. In the event of a denial, you can appeal. If it is approved, you will be offered a compensation amount; typically as structured payments or a lump sum.
- Negotiate a fair settlement with the help of a workers' compensation attorney if you feel that the first compensation offer is too low. If you cannot agree on a settlement amount, you can take your case to trial.
- Receive your workers' comp settlement check, which usually takes about 14 days from the time your claim is finalized in Illinois.
Why Workers Must Know Their Rights
Employers and insurers typically have greater resources and legal advice than employees. To balance out this disparity, it's crucial to understand your workers’ compensation rights. Knowing your rights can help you navigate the process of filing a claim more easily, as you'll know exactly what's expected of you and what you need to do to ensure coverage. Therefore, you should familiarize yourself with the workers' compensation system in Illinois to cover your bases.
Most Common Work-Related Injuries
Employees can suffer a variety of injuries due to workplace accidents in Illinois, ranging from lacerations to broken bones.
Repetitive Stress Injuries
Performing repetitive tasks, such as typing or working on an assembly line, can result in repetitive stress injuries. These injuries can cause immense discomfort and if not treated in time, they may even prevent an employee from working in the future.
Neck and Back Injuries
The spine is a complex structure that can be susceptible to various forms of damage, such as shifting, slipping, fracturing, compressing, or overextending. Heavy lifting, getting hit by falling objects, or sudden movements can cause damage to the neck and back. Some of the most frequent types of spinal injuries include herniated discs, muscle strains, pinched nerves, compression fractures, facet joint damage, and spinal cord injury.
Employees can suffer head injuries from accidents such as falls, getting struck by objects, or in incidents of workplace violence. Such injuries can lead to trauma to the skull or brain, which can cause a range of issues like physical limitations, vision problems, memory and concentration difficulties, as well as challenges in managing stress and emotions.
A bone fracture refers to a bone in the body experiencing a complete or partial break in its continuity due to excessive pressure, twisting, or sustained pressure. While broken bones can happen in any occupation, they are more frequent in physically demanding jobs that involve heavy machinery, such as construction. Accidents like slip-and-falls, vehicle crashes, or getting hit by moving objects or machinery can cause fractures.
Other common workplace injuries include:
- Ligament, muscle, or tendon sprains, tears, and strains
- Lacerations, punctures, and cuts from objects breaking or opening the skin
- Contusions and bruises
Common Mistakes That Can Negatively Impact a Workers’ Comp Claim
You should be aware of common errors people tend to make when filing a workers’ comp claim to avoid making them yourself:
Lack of Prompt Reporting
In Illinois, you have 45 days to report a work-related injury in writing to your employer to qualify for workers' compensation benefits. Waiting for more than 45 days can disqualify you from receiving benefits.
Failure to report promptly may also lead the workers' comp insurance company to assume that your injury was not serious or that you were not injured at all.
By reporting promptly and completing all the required paperwork, you can ensure that you comply with the workers' compensation rules and prevent any questions or disputes regarding your claim or injury.
Inconsistent or Inaccurate Documentation
It is crucial that you document any work-related injury and the events that led up to it. Inconsistencies in your statements or medical records could cast doubt on your version, leading to having your claim denied. To avoid this, it is best to write down everything you can remember about the accident, including what happened before and after the injury occurred.
Additionally, make sure to collect proof of all medical treatment, including bills, prescriptions, test reports, and scans. Keep a record of all injury-related costs, such as lost wages and medical bills, to save time, money, and energy. By following these steps and keeping detailed records, you can significantly reduce the chances of making errors in your claim and increase the likelihood of receiving your benefits.
Failure to Seek Immediate Medical Attention
Failing to promptly seek medical attention after an injury may lead to worsening of your condition due to overexertion. Additionally, avoiding medical help may create the impression that you do not take your health seriously, which could potentially harm your claim.
Why It’s Important to Follow the Doctor’s Orders
It's crucial to adhere to the treatment plan recommended by your doctor. Medical appointments should not be missed as they are necessary to alleviate pain, cure, or reduce the period of disability. It is essential to attend all appointments and only return to work when your physician deems it safe. Failing to attend medical appointments could put your benefits in jeopardy, implying that you may not believe your injury is as severe as you claim. It could also shift the blame of your injury to you if you do not take necessary steps to recover. The insurance company may use your early return to invalidate your claim. Therefore, make sure to follow your doctor's advice to the letter.
Inadequate Communication With Employer and Insurance Company
When filing a claim, you will be required to provide a detailed account of how the injury occurred and the symptoms you are experiencing as a result. To increase the chances of receiving compensation, you must advocate for yourself and include all relevant information, such as important dates, locations, any prior injuries or illnesses, and evolving symptoms. It is also recommended that you write down everything you remember about the event and any changes in the physical symptoms caused by your injury.
Effective communication with your employer and the insurance company is crucial to avoid delays in the process. You should attend to any extra information or steps required promptly and ensure that you are aware of all the necessary information. Failure to communicate properly can result in the insurance company not receiving important information or documentation related to your claim, which can jeopardize your compensation. Consistency is key, so keep your story the same throughout. It's essential to discuss the details of your case with your workers' compensation lawyer before communicating with insurance companies.
Seek Legal Advice to Help Avoid Mistakes in Your Claim
Workers' compensation attorneys can be helpful in handling your claim efficiently, as they are familiar with the process, know any potential mistakes to avoid, and can guide you through it. If you are injured out of state, your lawyer will know how to file a workers’ comp claim out of state. Your attorney will be responsible for ensuring that you avoid any potential mistakes and will handle much of the process for you, including:
- Gathering evidence related to your accident and injuries, including reaching out to witnesses and collecting their testimonies
- Determining the exact amount of compensation that you are entitled to receive
- Filing your claim and handle all communication with the insurance company
- Negotiating a fair settlement on your behalf with the insurance company
- Handling any disputes or legal proceedings, such as taking the matter to a hearing or trial
Your attorney will know the mistakes that hurt a workers’ comp claim, and how to avoid them. Your lawyer will be able to advise you on whether workers' comp is taxable in Illinois. Having legal representation may help improve your chances of a successful claim and obtaining a higher settlement amount.