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Workers’ compensation pitfalls: Why good claims may get denied

On Behalf of | Feb 15, 2024 | Workers' Compensation

People spend a great deal of time at their workplaces, and accidents are bound to happen. When they do, workers’ compensation benefits are supposed to provide a critical safety net, and they do – when the system works as it is intended.

Unfortunately, a lot of valid workers’ compensation claims meet resistance from employers and insurers who are more concerned about their bottom line than they are injured workers. For example, the following are some common issues that can lead to a denied claim.

You didn’t report the claim quickly enough

One of the primary reasons for workers’ compensation denials in Illinois is the failure to report injuries promptly. According to state regulations, employees must report their injuries to their employers within 45 days of the incident – but any delay in reporting an accident can actually open the door to allegations that you are trying to pass an unrelated injury off as something that happened at work.

You had a pre-existing condition

Many times, employees have pre-existing conditions that make them more susceptible to injury, such as arthritis. Whenever a pre-existing condition contributes to a workplace injury, employers and insurers seem to try to use that as a reason to deny the workers’ comp claim. However, if the nature of your job or the workplace accident caused an aggravation or exacerbation of your pre-existing condition, then you are still eligible for benefits.

There are disputes over the cause of the injury

This can take various forms. Your employer may deny that your injury occurred at work simply because nobody witnessed your fall, for example. Or, your employer may deny your injury was even work-related because you were away from the office at the time – forgetting that you were picking up lunch for the office meeting. Finally, an employer may say that you violated some critical policy, were intoxicated at the time of the injury or were engaged in horseplay – all of which can justify a denied claim.

If your workers’ compensation claim was recently denied, make sure that you play close attention to your appeal rights. Taking definitive action can help you obtain the benefits you need and deserve.