Workers’ compensation exists to protect both employer and employee. Employees can receive compensation and medical care for a work injury regardless of fault, while employers are protected from liability and huge damage awards. Workers’ compensation seeks to streamline the system when an employee is injured or contracts an illness at work, ensuring the livelihood of both parties.
However, employees must still submit a workers’ compensation claim and have it approved by a governing body. While many claims are approved and executed easily, many claims are rejected, preventing injured workers from receiving important benefits.
Across Missouri and Illinois, thousands of workers’ compensation claims are denied each year. In 2013, over 5,400 cases were dismissed in Illinois and over 1,800 cases were dismissed in Missouri. Learn more about how to avoid having a workers’ compensation claim denied in Illinois and Missouri with these helpful tips.
Common Reasons for a Claim Denial
Many of these failed claims share common characteristics, including:
Late filing of the claim. Workers’ compensation rules state specific time limits for filing a claim. In Illinois, injured workers must submit a claim within 45 days of the accident. In Missouri, employees have 30 days to report the illness or injury. Additionally, it can be difficult to have benefits approved if the claim is filed after a worker leaves or is terminated from a job. Filing the workers’ compensation claim as soon as possible is the best course of action.
Employee negligence. While workers’ compensation does pay benefits regardless of fault, there are a few key exceptions. If an employee was under the influence of drugs or alcohol at the time of the injury or displayed a willful disregard for company regulations, the claim may be denied.
Unwitnessed injury. In some cases, the injury occurs when no one else is around to see it. In this situation, it is important to report the injury quickly and share the story with supervisors and co-workers. Also, the injured worker should take notes to ensure he remembers the accident details clearly and reliably, as he will likely be asked to recount the incident many times over.
Medical record discrepancies. Medical records are available to insurers to prevent fraudulent claims. If the injuries do not match the employee’s recounting of the incident, the insurers will be suspicious and may deny the claim. Seeking medical treatment as soon as possible can help minimize these risks.
Statement or authorization dispute. Often, workers’ compensation insurers will ask injured employees to sign a statement or a medical authorization. Workers are under no obligation to do so. In some cases, however, this can disrupt the case. If an employee is asked to sign a statement or record, they should seek the advice of a knowledgeable attorney to protect their claim.
Whether you are just starting to pursue a workers’ compensation claim, or you’ve already had a claim denied, the experienced legal team at the Tapella & Eberspacher Law Firm may be able to help. If you’ve been injured at work, call the firm today at (217) 394-5885 for a free, no-obligation consultation.