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My Workers’ Compensation Claim Was Denied, Now What Do I Do?

Daniel Klosowski

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A number of my clients have found themselves in one of the following situations: In one scenario, the client has had an accident at work, reported the accident to their employer, and is now in need of medical care, but that treatment is being completely denied by the workers’ compensation insurance carrier. In the other scenario, the client has had an accident, reported it, has received some of the medical care that was being recommended by their treating physician, but now the workers’ compensation insurance carrier is denying a certain recommended course of treatment. This recommended treatment might be a diagnostic test like an EMG or MRI, or perhaps a surgical procedure that is needed to bring the client back to full health.

In both of the above situations, the individual may feel helpless and as though there is no recourse to dispute the insurance company’s denial of their treatment. However, there is a course of action that the individual can take in order to try and have the treatment approved by the workers’ compensation insurance carrier. The best course of action is to file an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission. This opens up several avenues that can lead to receiving the benefits that an injured worker is entitled to in Illinois.

Filing an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission begins a claim or case and allows an attorney to represent an injured worker. The attorney can speak with the workers’ compensation insurance carrier about the details of the worker’s injury and advocate for the benefits that the worker is entitled to under the law. In some instances, simply filing the claim will cause the insurance company to change their stance and approve the treatment that is being recommended.

In situations where the act of filing the claim does not result in the workers’ compensation insurance carrier changing their stance, the attorney can file an emergency motion to go to trial and argue for workers’ compensation benefits. These emergency motions can be filed every 30 days, assuring that not too much time passes before the matter can be set for trial. Simply setting the matter for trial will sometimes cause the insurance company to approve the recommended treatment.

When filing an Application for Adjustment of Claim and receiving a trial date does not result in treatment being approved, the attorney can proceed to trial and advocate on behalf of the client. The attorney will show why the treatment that is being recommended is necessary and related to the work injury and a judge will then issue an order awarding the treatment. The insurance company will then have to approve the treatment that was recommended by the treating physician.

It can be an intimidating situation when an insurance company has denied treatment that a physician is recommending. However, the Illinois Workers’ Compensation Act provides several remedies to the injured worker. Contacting an attorney who is experienced in workers’ compensation law is the best course of action to ensure that an individual receives the benefits they are entitled to under the law.

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