Here is a fairly common scenario:
You are at work and lift something. You feel a pain in your back like you’ve never felt before. You report it immediately to your supervisor and try to treat the problem with rest and pain pills. Five days later it’s not better, it’s getting worse and you go to a doctor. Your employer files the claim with their insurance company and an adjuster calls you and asks a bunch of questions. A couple weeks go by, you haven’t heard anything and then you get a letter in the mail from the adjuster. It’s a form letter that says they’ve investigated your case and have determined that your injuries are not work related. They do wish you the best though.
Illinois work injuries get denied all of the time. Sometimes it’s for legit reasons, but quite often it’s without reason or for bogus ones like the one described above. Cases can get legally denied because evidence indicates you weren’t hurt at work. They can get denied because a medical doctor says your problems aren’t work related or that you are better. What can’t happen but does all the time is an adjuster to say your case is denied without any real reason.
They do this in hope that you will just go away or use your group insurance. So the question is, what do you do when your case is denied?
Whether the denial is valid (e.g. they sent you to an IME doctor who said you are fine) or not, the first step is that you have to formally file a case with a lawyer. This gets your claim assigned to an Arbitrator which allows you to have a hearing over the dispute if one is needed.
When they deny you without a real reason, often filing the case and threatening to file for penalties for a bad faith denial is enough to get them to do the right thing. If not then your attorney needs to subpoena your medical records, potentially take a deposition of your treating doctor who can testify that your problems are work related and then you would go to trial.
So it’s really a two step approach, either your lawyer is aggressive and gets your benefits reinstated with a phone call or your lawyer is aggressive and gets the case ready for trial ASAP.
The problem comes in when your attorney isn’t aggressive or is lazy and doesn’t like taking cases to trial or when they will handle the case, but half-ass it and aren’t prepared. That’s how winning cases end up as losers.
The bottom line is that if your case is denied, don’t panic. The law protects Illinois workers with legitimate cases. You just need someone who will advocate for you. Often a denial gets turned around the moment someone good is on the case and in your corner.
