How to Appeal a Workers’ Compensation Decision

Suffering a work-related injury entitles you to workers’ compensation benefits, but in some cases, your employer may try to either reduce the amount you are entitled to or deny benefits completely. In these cases, you can appeal the decision by requesting a hearing from the Illinois Workers’ Compensation Commission (IWCC). Depending on the nature of the claim, appealing a decision can become a long and complicated process, so you will need to be aware of your options and the resources available to you.

Reasons for Denial

Before making an appeal, it’s important to know why your workers’ compensation was denied. Possible reasons why employers deny benefits include:

  • They feel the injury wasn’t work related
  • They think your injury doesn’t require time off work or medical treatment
  • You didn’t notify your employer within 45 days

In some cases, you may still receive benefits, but they will be far less than what you’re owed. In these cases, your employer likely believes your injury isn’t as severe as it actually is.

Grounds for Appeal

To appeal your employer’s decision, you’ll need to have a solid foundation for your case. In one way or another, you’ll have to demonstrate that your employer acted against the evidence surrounding your claim. This may mean proving:

  • Your injury warranted time off work
  • The medical treatment you received for your injury was necessary
  • You filed the claim on time
  • The injury resulted from the fulfillment of work-related duties

A doctor’s note, medical bills, eyewitness accounts, photographs of the accident or injury, and other evidence will be useful in establishing your right to workers’ compensation benefits. In addition, representation from an attorney will give you the legal clout you need to successfully appeal the decision.

The Appeals Process

The appeals process begins by filing an Application for Adjustment of Claim with the IWCC. This must be filed within three years of your injury or two years after your last compensation payment, whichever is later.

After filing an application, your case is assigned an arbitrator. From there, you are able to request a hearing with an IWCC arbitrator. During the hearing, you and your employer will present your cases along with evidence to support your claims. Since your employer will most likely be represented by an attorney, you will want to make sure you are likewise represented. After the hearing, the arbitrator will make a decision that is considered binding to both parties.

Appealing the Arbitrator’s Decision

If you are still denied benefits, then you have the option to appeal the arbitrator’s decision. To do so, you’ll meet before a board of three commissioners from the IWCC and relate why you deserve workers’ compensation. They will then give you a decision within 60 days.

If they still deny you benefits, you can take it to the Circuit Court, then to the Appellate Court, and finally (in some cases) to the Illinois Supreme Court. However, if you are a state employee, you must accept the Commission’s decision—no further appeals are permitted.

Again, the representation of a workers’ compensation attorney (such as us at Hart David Carson, LLP) will maximize your chances of a successful appeal. To discuss your claim, contact us today.

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