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Why Workers' Comp Claims are Denied

After sustaining an injury on the job, workers can seek help through the workers’ compensation program. If approved for workers’ compensation benefits, you may receive payments to make up for your lost wages while you recover. Your medical bills relating to the injury may also be paid by the workers’ compensation claim.

Unfortunately, in some situations, your workers’ compensation benefits are initially turned down. If this happens to you, contact an experienced workers’ compensation attorney. Here are some reasons why your claim may be denied and some ways your attorney can help you.

The Employer Has No Insurance

By law, most employers in the state of Illinois must purchase workers’ compensation insurance. Employers must also post a sign in the workplace. The sign informs workers of their rights and responsibilities under the Workers’ Compensation Act.

Experts say that around 91 percent of workers in Illinois are covered under workers’ compensation laws. If your employer is supposed to have workers’ compensation coverage for you and the other employees but doesn’t, they are subject to steep fines and jail time.

But that won’t help you if you’ve been injured on the job. If you find out after your workplace injury occurs that your employer is not paying for workers’ compensation insurance, contact an attorney as soon as possible. Your attorney will file a formal complaint against your employer and will help you prepare to file a civil suit. You may not be able to receive benefits through workers’ compensation, but you can sue your employer to try to recover your lost pay and medical costs.

The Injured Employee Did Not Give a Complete Report

When you’re injured at work, you have a duty to report your injury to your employer. If you don’t tell anyone that you’ve been harmed, how will anyone know? The Workers’ Compensation Act allows you to make an oral or a written report to your employer. The report should include (if known):

  • Date of injury

  • Time of injury

  • Location where injury occurred

Ideally, you should make your injury report as soon as you’re hurt. In reality, you may not notice every type of harm that happens to you in the workplace until some time has passed. For this reason, you’re allowed a generous window to report your injury

You’re allowed a 45-day reporting deadline after a workplace accident or acute injury and a 90-day deadline to report workplace radiation damage. If you acquired any type of occupational disease, you must report it as soon as you learn of the disease and it’s feasible for you to make your report.

Some employers try to stall a workers’ compensation request by claiming you’ve given insufficient documentation of your injury. The same employer may try to retaliate against you for making a claim. Both of these actions are wrong according to the law. Your attorney can file your claim with the Workers’ Compensation Commission and help protect your interests if your employer treats you unfairly.

The Injured Employee Was Under the Influence of Substances

In many workplaces, workers agree when hired to be tested for drugs and other substances if they have an accident or sustain an injury while on the job. You may be asked to give a urine or blood sample after your workplace injury. If you were drinking or on drugs while on the job, your claim for benefits can be denied. However, a positive drug-and-alcohol screen does not automatically rule out receiving workers’ compensation benefits.

Certain prescription and illicit substances, including some narcotics and cannabis, may stay in your system long after you’ve come down from the effects of the drugs. You may test positive, but your use of the substance in your private time may have no bearing on the injury you suffered at work. In other cases, a workplace hazard is so blatant, even a positive drug test on your part does not absolve your employer of negligence in causing your injury.

It you’ve suffered a workplace injury, and you tested positive for drugs, be honest with health care providers and your attorney. The circumstances of your workplace injury can have a far greater bearing on your workers’ compensation claim than the drugs in your system at the time of your accident.

The Other Reasons Why Claims Are Denied

There are several other circumstances where your workers’ compensation claim can be denied. These include:

  • Your injury was a preexisting condition

  • You are a contract worker, not an employee

  • You were injured away from the job site

In each of these cases, your attorney can argue on your behalf to have your claim approved. In the case of a preexisting medical problem, you can receive benefits if the workplace made the medical problem significantly worse. With the right evidence, your attorney can show how you were actually an employee, not a private contractor. Your attorney can also help you show that your injury was a work-related issue, even if the accident happened away from your normal workplace.

Contact Shay & Associates today if your workers’ compensation claim has been denied. We help you through the claim and appeal process and speak up for your rights every step of the way.

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