I just had a somewhat sad phone call with an injured worker. She fell down the steps at work and injured her back. The Illinois workers’ compensation insurance carrier for her company sent her a letter that is really just a form letter. It stated that they had “investigated your case and have determined that your injury is not covered under the Illinois Workers’ Compensation Act.”
Unfortunately for this caller who has been disabled since this happened, it’s too late to do anything as the accident was in 2006. She just assumed that the insurance company was able to determine if an injury is covered or not. When they said no, she assumed that was that until recently when a friend suggested that she contact a lawyer. Unfortunately she waited too long.
Insurance companies make money by not paying out claims or reducing what they do pay. They send denial letters all of the time with the hopes that you, like this woman, will just go away. It’s not just work comp where this happens. I’ve talked to probably more than 100 people who were sitting at a stop light when they got rear-ended and then were told by an insurance adjuster that the person that hit them was not at fault. Every time they get you to believe they owe nothing or quit because you are frustrated they save/make money.
But please know that the insurance company is not a Judge and they do not have final say as to whether or not your claim is covered. They are of course motivated to not help you. So if you do get a letter denying your case, don’t freak out. Talk to a lawyer and get their independent and honest opinion about whether or not you do have a case. Often we can get a denial turned in to an acceptance right away.
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