Whether you filed in Iowa or Illinois, understanding the reasons behind your workers’ compensation claim denial can help you sidestep potential pitfalls and take the appropriate steps to appeal. It’s equally important to note that a denial in either state doesn’t signal the end of your pursuit for work-related injury benefits.
At Winstein, Kavensky & Cunningham, our experienced Quad Cities workers’ compensation lawyers are dedicated to helping you overcome these challenges.
To help you better understand why your claim might have been denied and how to improve your chances of success, consider these four reasons.
Reason 1: Failure to Meet the Requirements for a Compensable Injury
For your workers’ compensation claim to be approved, your injury or illness must have occurred while performing job-related duties. Suffering an electrocution injury while performing a daily task at an employer’s factory or construction site could qualify for workers’ comp benefits.
Conversely, if your injury happened outside work hours or during personal activities, it may not be considered compensable. For example, injuries you sustained while commuting typically don’t qualify unless your commute involves a work-related task. Both Iowa and Illinois have specific requirements for determining whether your injury was the result of a workplace accident.
If your employer or the insurance provider believes your injury occurred outside your job duties, you may receive notice that your workers’ comp claim was denied. To avoid this, it’s crucial to thoroughly document how, when, and where your injury occurred. Gather evidence, such as witness statements or video footage, to support your case if possible. Clear, detailed documentation is critical to avoiding workers’ comp denials.
Denial Reason 2: Failure to Provide Timely Notice
Both Iowa and Illinois have strict time limits for reporting work-related injuries. If you fail to notify your employer or file your claim within the required timeframe, your employer may deny your claim.
- Iowa: Per Iowa Code Section 85.23, you must notify your employer within 90 days from the date that you knew or should have known that the injury was work-related
- Illinois: Per Illinois Statutes Chapter 820. Employment § 305/6, the deadline to file an Illinois workers’ compensation claim is shorter—you have only 45 days after the accident occurred to notify your employer.
Missing these deadlines can result in automatic claim denial. Timely reporting ensures that your injury is documented and helps prevent fraudulent claims. To avoid complications, notify your employer as soon as you are injured, even if the injury seems minor. Follow up in writing to keep a record.
If you missed the reporting deadline, contact the experienced workplace accident lawyer at Winstein, Kavensky & Cunningham. We can review your claim and explore options to appeal your denial.
Reason 3: Insufficient Medical Documentation Results in a Denied Claim
Medical evidence is essential to a successful workers’ compensation claim. Your employer may deny your claim if your medical records do not clearly support the connection between your injury and your job.
In Iowa and Illinois, seeking immediate medical treatment and following through with prescribed care is important. Skipping appointments or treatments could lead the insurance company to question the severity of your injury, which may result in a denial.
To avoid this, ensure that your healthcare provider documents every aspect of your injury, including how it occurred and how it affects your ability to work. Medical records are critical for proving your case.
If your employer denies your workers’ comp claim due to insufficient medical documentation, contact Winstein, Kavensky & Cunningham. We’ll help you gather the necessary evidence to support your appeal.
Reason 4: Pre-existing Health Conditions
If you have a pre-existing condition, the insurance company may argue that your current injury is related to that condition rather than a new, work-related injury. This is a common reason for claim denials.
In Illinois, you may still qualify for benefits even if a work-related injury aggravates a pre-existing condition. Proving this, however, can be challenging. Similarly, in Iowa, you need to show that the personal injury directly resulted from your job duties and not merely a flare-up of an existing condition.
If you have a pre-existing condition, ensure that your doctor clearly differentiates between your old injury and the new one. Detailed medical records are essential for proving your work-related injury claim.
Note that while our law office is located in Rock Island, Illinois, we serve the entirety of the Quad Cities area. This includes Davenport, IA, Bettendorf, IA, LeClaire, IA, Moline, IL, East Moline, IL, and the surrounding counties.
How to Take Action After Your Workers’ Comp Claim Was Denied
If your employer denies your workers’ compensation claim in Illinois or Iowa, taking immediate action is important. Consulting with an experienced Quad Cities workplace accident attorney is critical to ensuring that your claim gets approved. At Winstein, Kavensky & Cunningham, we have the knowledge and expertise to help you understand the reasons behind your denial and determine whether you have grounds to appeal.
A denial doesn’t necessarily mean the end of your claim. With the right legal guidance, you may still be able to challenge the decision and obtain the benefits you deserve.
Contact us today to schedule a free consultation, and let us help you navigate the workers’ compensation appeal process in Iowa or Illinois. Reach us by phone at (309) 794-1515, via LiveChat, or by filling out our contact FREE online form.