Illinois Workers Compensation Claims. Illinois Workers Comp Claim Process Explained.
In a nutshell, here is how the Illinois workers compensation claim process works:
1. Reporting A Work Injury or Accident to the Employer
When a worker is injured, the employee will typically notify their employer (either orally or in writing) that they were injured at work in an accident (including the approximate date and place of the work related accident). Generally, workers must notify their employer no later than 45 days after the work accident (there are some exceptions for occupation diseases and radiation exposure). In a typical year, about 200,000 to 250,000 workers in Illinois report injuries to their employers.
2. Steps An Employer Should Take After Receiving Notice of A Workplace Injury or Accident
An employer who is notified of a workplace injury should take the following steps: (1) provide all necessary first aid and medical services to the injured worker; (2) notify the insurance carrier or workers comp administrator of the injury or accident; (3) if the worker is unable to work for more than 3 days because of the injury the employer must either (i) begin paying TTD benefits; (ii) provide the employee a written explanation of additional information the employer needs before it will being making payments, or (iii) provide the worker a written explanation of why benefits are being denied by the employer.
Employers are then required to report work accidents to the Illinois Workers Compensation Commission that result in more than three days of lost work. The employer must report accidents on a form called “Employer’s First Report of Injury” also known as a Form 45. Job related deaths are required to be reported within two business days. All other job-related injuries, diseases or illnesses that result in loss of more than three days of work must be reported within a month. In a typical year, Illinois employers report about 65,000 to 80,000 injuries of more than 3 lost workdays.
The IWCC then mails a handbook letter to the injured employee and the parties typically try to resolve (i.e., settle) the injured employee’s workers compensation claim.
3. Filing A Workers Compensation Claim With The Illinois Workers Compensation Commission
An employee is not required to a file a claim in order to receive benefits. However, if there is dispute between the employee and employer about the payment of workers compensation benefits, i.e., an employer refuses to pay some or all workers compensation benefits (or if the employee is concerned about protecting his or her rights to receive future benefits) and a workers compensation settlement cannot be reached, the injured employee can file a workers compensation claim with the Illinois Workers Compensation Commission, by filing (either in person at the IWCC or by mail) three copies of an “Application for Adjustment of Claim,” along with a Proof of Service which states that a copy was served on the injured worker’s employer.
The IWCC is the State agency that is responsible for administering the judicial process that resolves disputed workers’ compensation claims between employees and employers and acts as an administrative court system for such claims.
4. Resolving A Workers Compensation Case Filed With The Commission
The workers compensation claim is then assigned a case number and an arbitrator is assigned to the workers compensation case. An arbitrator may try to settle the workers comp case, may issue a decision or dismiss the workers compensation case. Most Illinois workers compensation claims are settled.
It is an injured employee’s burden to prove that he or she is entitled to workers compensation benefits. An employee typically must show that: (1) there is jurisdiction (i.e., that on the date of the accident, the employer was subject to the Illinois Workers Compensation law); (2) there was an employment relationship (i.e., that on the date of the accident there existed a relationship of employee and employer between the parties); (3) there was an accident or exposure (i.e., that the employee sustained accidental injuries or was exposed to an occupational disease that arose out of and in the course of employment); (4) there was a causal connection (i.e., that the injury or medical condition was caused or aggravated by the accident or exposure); and (5) that the employer was provided notice of the accident or exposure within the applicable time limits.
If the workers compensation claim is not settled, the arbitrator decides these issues, along with other possible issues in dispute such as the extent of the employee’s injury or disability, the worker’s average weekly wage, whether the medical treatments and/or bills were reasonable and necessary, or whether the employee is entitled to penalties, etc. The arbitrator will conduct a trial (applying Illinois law, rules of evidence, precedent from other Illinois workers compensation cases, and the Rules Governing Practice Before the Commission). Such cases are usually cannot be resolved until the employee has reached maximum medical improvement. An arbitrator’s decision generally may be appealed to a commissioner panel and then through the Illinois court system, including an appeal to the circuit court, to an appellate court and occasionally, the Supreme Court.
Most employees and employers hire workers compensation attorneys and workers comp lawyers to handle disputed workers compensation claims. About 50,000 to 55,000 workers comp cases are filed each year in Illinois. There are time limits for filing workers comp claims, which if not followed, could result in a claimant losing his or her right to claim future benefits. Generally speaking, in most cases, an injured worker must file a claim within three years after an injury, death, or disablement from an occupational disease, or within two years of the last payment of temporary total disability TTD or a medical bill, whichever is later.
If you have been injured in an accident at work in Illinois, an Illinois workers comp attorney may be able to help you with your workers compensation claim.
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