A denied workers’ compensation claim can feel discouraging, but it doesn’t mean the process ends there. In Illinois, you have the legal right to challenge that decision through a structured appeal. Taking action promptly and understanding each phase can significantly impact the outcome.
Review the reason for denial
Begin by examining the denial letter carefully. It outlines why the claim was rejected—whether due to missed filing deadlines, incomplete medical documentation, or a dispute over how the injury occurred. Identifying the specific reason is essential because your appeal must directly address it. Keep copies of all correspondence and gather related medical and employment records.
File with the Illinois Workers’ Compensation Commission
To appeal, submit an Application for Adjustment of Claim to the Illinois Workers’ Compensation Commission (IWCC). This filing must occur within three years of your injury or two years from your last benefits payment, whichever comes later. Be sure to include accurate details about your injury and why you believe the denial was in error. Once submitted, your case is assigned an arbitrator and set for a status hearing.
Prepare for arbitration
During the arbitration hearing, both you and your employer’s insurer will present evidence. This may include medical records, physician testimony, and coworker statements. You’ll need to demonstrate that your injury is work-related and that you qualify for compensation. The arbitrator evaluates the testimony and records before issuing a written decision.
Appeal the arbitrator’s decision if necessary
If you disagree with the arbitrator’s ruling, you may file a Petition for Review. A panel of three commissioners will reexamine your case and issue a new decision. If you’re still unsatisfied, you have the right to escalate the appeal to the Illinois Appellate Court for further review.
Don’t let an initial denial discourage you. With persistence and a clear understanding of the process, you can continue pursuing the benefits you believe you’re owed.
