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Five Most Common Reasons To Deny Workers' Compensation Claims

workers at a dangerous construction area, worker compensation

Governor Rauner's push for worker's compensation reform strengthened the power of the Illinois Workers' Compensation Commission to deny claims. The most common reasons for denial include:

Pre-Existing Injury

Workers claiming pre-existing injuries as workplace injuries is one of the leading causes of workers' compensation fraud. For example, an employee may hurt his or her back playing in a recreational softball league, but will claim the injury occurred at work on Monday morning. The presence of a pre-existing condition is not automatic grounds for denial, though some employers may try to convince an injured employee otherwise.

Unfortunately, this means companies will often go out of their way to uncover information that might indicate the injury was a pre-existing condition. Their investigation may include digging through social media posts for a mention of an injury outside of work, or by trying to tie the employee's hobbies to his or her injury.

Algonquin worker comp lawyers vigorously defend against this kind of attack by showing the link between workplace conditions and the injury or by proving outside activities played no role in the injury. Medical testimony from the attending physician and witness statements from employees who saw the injury go a long way in undermining the employer's claims of a pre-existing condition.

Missed Deadlines

The easiest grounds the commission has for denying a claim is the failure of the injured employee to meet the correct deadlines. The state of Illinois allows up employees to wait up to three years from the day of the injury or two years from the end of benefits. The deadline is firm, and there are very few exceptions.

A common question for employees is when the countdown begins on their injury filing. In most instances, the timer for filing paperwork begins with the first doctor's visit to treat the injury (for repetitive injuries) or the date the incident occurred (for singular accidents). The situation becomes more complicated when an employee makes a claim for a progressive condition, so it is advisable to file the paperwork as soon as possible.

When dealing with the pain of the injury, the stress of missed work, and juggling visits to the doctor, it is easy to miss filing deadlines. Algonquin worker comp lawyers take the pressure off of employees to file their paperwork and stay on top of the deadlines established by the commission.

Incomplete Documentation

A workers' compensation claim requires a tremendous amount of documentation. Once a case enters the arbitration process with the commission, it cannot move forward until all of the documents have been properly filed and reviewed at each stage along the way. The documents are all available online and the commission assumes employees will be responsible for filing the right papers at the right time.

Of particular importance is a full medical analysis of the injury from a qualified doctor, especially when the injury is due to progressive degeneration and not from a singular cause. Conditions such as hearing or vision loss, carpal tunnel syndrome, and lung damage are all potentially covered under existing workers' compensation laws; however, these conditions are as frequently caused by external factors as they are by work related factors. Without the doctor's assessment that the injury was directly or indirectly related to the job, the claim can be denied.

Intoxication and Employee Actions

For the most part, employers are responsible for the actions of their employees while those employees are on the job, but that responsibility does not always apply in a workers' compensation case. If an employee is injured because of their own misconduct, the employer is free to deny their compensation claim. The two most common examples of misconduct are:

  • Intoxication--Whether from alcohol or illegal drugs, intoxication is an immediate cause of disqualification from workers' compensation. Many employers require a drug test after a reportable accident, because instances of intoxication are so frequent.

  • Horseplay--Employees who are rough housing or joking around at work voluntarily put themselves in a position where they could be hurt. Often these employees are in clear violation of safety standards and company protocols, and when an injury occurs, the employer is not liable.

Algonquin worker comp lawyers can make arguments to combat denial of benefits on these grounds. The lawyers may claim a positive drug test was the result of allowable medical marijuana under SB 10, or they may argue the intoxication ended before the employee arrived at work. Claims of horseplay are very subjective, and with video evidence or witness testimony, Algonquin worker comp lawyers can make a counterclaim.

The Illinois Workers' Compensation Commission has strict rules in place to prevent fraudulent claims and abuse of the system. The commission may deny a claim based on a violation of any of their rules, but Algonquin worker comp lawyers can appeal the decision and potentially reopen the case.

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McHenry, IL 60050

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