Can An Illinois Work Comp Case Be Accepted And Then Denied?

A reader of our blog was injured on the job over a year ago. She sustained a knee injury and shoulder injury and since day one, all of her medical bills related to the case have been paid as has all of her time off of work.

Now a year later she got a letter in the mail from the insurance adjuster letting her know that due to newfound information, they were denying her shoulder injury but still accepting her knee injury. Apparently, they were told that she sought treatment for the shoulder problem a week before she said she got hurt at work.

The reader wanted to know if this was permissible. The answer unfortunately for her is yes.

Under Illinois workers’ compensation law, payment of benefits is not an admission of liability. In plain English, that means that just because they accept your case doesn’t mean they can’t fight it at a later point if new information comes available.

So even if they paid for surgery, physical therapy, or anything else, they can still fight the case. Even if they wrote a letter saying the case is accepted, they can go back on it.  That doesn’t mean they are right or that you can’t fight it at the Illinois Workers’ Compensation Commission. You can.  But while Illinois laws are very worker-friendly, that doesn’t mean that insurance companies and employers don’t have rights.

It may not sound like it, but if your case is first accepted, but then denied, that’s actually better than someone who gets denied at the outset for no good reason.

This happens all of the time quite honestly.  In most cases, it’s not like this one where it’s a year later and the denial is based on something that happens before the accident, but it can happen. Most of the time it occurs when an IME doctor gets involved and says what the insurance company wants to hear, giving them cover to deny your benefits.

In the big picture, if you are telling the truth about how you got hurt at work, you have to trust the process.  They have a right to a good faith denial and you have the right to have an arbitrator rule if that is a legitimate denial or not. So don’t stress, just educate yourself about your rights and go from there.

And as always, if you want to speak to a lawyer for free, you can contact us any time.