4 Reasons for Denial of a Workers’ Comp Claim

Filing a workers’ compensation claim is hard. Denial of that claim can be devastating, both emotionally and financially. Some of the more common reasons for denial of a workers’ comp claim include actions the worker could have taken to avoid this issue. We will look at four of these reasons.

#1 – The Injury Did Not Occur at Work

If the worker’s injuries happened at home or someplace other than the workplace, the injury may not be covered. However, there are some situations where an employee who is injured offsite may still receive benefits. For example, a worker who is injured at an office party or work event being held away from the workplace may still be eligible for workers’ comp benefits.

Also, employers may claim your injury did not happen at work because you were not clocked in or had already clocked out. Talk to an attorney before deciding not to pursue your claim.

#2 – The Worker Was Intoxicated or Impaired

Employers may deny workers’ compensation benefits if a drug or alcohol test performed on an injured worker comes back positive. In fact, Illinois workers’ compensation law specifically states the conditions under which an employer does not have to pay benefits. However, the intoxication or impairment must have been a proximate (or primary) cause of the injury.

#3 – The Worker Failed to Report the Injury

Injured workers should tell their employers about the injury as soon as it happens. If not reported immediately, the worker must inform the employer within a certain time frame. The following deadlines apply according to the Illinois Handbook on Workers’ Compensation and Occupational Diseases:

  • 45 days from the date of the accident, if the injury occurred due to a workplace accident.
  • 90 days from the date of exposure if exposed to radiation.
  • As soon as possible after being diagnosed with an occupational disease.

Failing to report a work-related injury could result in loss of workers’ comp benefits.

#4 – The Injured Worker Failed to File a Claim on Time

Reporting the injury and filing a workers’ comp claim are not the same thing. A worker can file a claim with the Illinois Workers’ Compensation Commission if an employer fails to provide benefits. In most case, the injured worker must file the claim:

  • within three years of the injury, death, or diagnosis of occupational disease; or
  • within two years of the last payment of temporary total disability or a medical bill, whichever is later.

However, certain injuries or illnesses may have different time limits.

Avoid the Denial of Your Workers’ Comp Claim

Talk to Osvaldo Rodriguez, an experienced Illinois workers’ compensation lawyer, for an honest assessment of your case. To schedule your free initial consultation, or just ask a question, call us at 708-716-3441 or fill out the form on the Contact Us page.

At Osvaldo Rodriguez, P.C., we represent clients throughout the state of Illinois including Chicago, Addison, Bellwood, Bensenville, Berwyn, Cicero, Elmwood Park, Franklin Park, Maywood, Melrose Park, Northlake and Cook, DuPage, Will, and Kane Counties.

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