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What Happens to Medical Bills When Workers’ Compensation is Denied?

Written by Ankin Law Office

The worker may be required to pay for the cost of his or her medical treatment if the workers’ compensation claim is denied. If the worker has health insurance, then the worker’s insurer may pay for some or all the medical bills in accordance with the insurance coverage. If a worker’s claim for benefits is denied by the Illinois Workers’ Compensation Commission, he or she has the option of appealing that decision. Workers are encouraged to speak with workers’ compensation attorneys to discuss their rights under the law, including payment of medical bills due to a work injury.

What Is Workers’ Compensation?

Workers’ compensation is insurance taken out by employers to cover the cost of medical treatment, loss of wages, and other costs incurred due to work-place injuries. Under Illinois law, all employers are typically required to carry some form of workers’ compensation insurance, regardless of the number of workers employed. Unlike other states, workers seeking compensation under the Illinois Workers’ Compensation Act are generally not required to prove that the employer was at fault for or the cause of the accident or injury.

Police officers and firefighters who work within the city of Chicago are covered for work-place injuries under a separate Illinois law. Injured workers in this category are encouraged to reach out to a Chicago workers’ compensation lawyers to discuss the specifics of their injuries and available claims for benefits.

Bringing a Workers’ Compensation Claim

The Illinois Workers’ Compensation Commission oversees formally filed workers’ compensation claims. Workers are not required to file a claim with the Commission to receive benefits under the Illinois Workers’ Compensation Act; however, the worker may formally file a claim with the Commission if there is a dispute between the worker and his or her employer concerning payment of benefits. For example, if the worker falls from a ladder and suffers a head and shoulder injury, he or she must immediately notify the employer. The employer or the employer’s workers’ compensation insurance company may be reluctant to pay the medical costs and other benefits because of a dispute over whether the shoulder injury is from a fall from the ladder or a previous shoulder injury unrelated to the current job. In this situation, the worker may choose to file a formal claim with the Commission to resolve the dispute and receive the benefits that may be owed to him or her.

What are the Common Causes of Workers’ Compensation Denials in Illinois?

Common causes of workers’ compensation denials are the worker’s failure to timely notify the employer of the workplace injury, lack of objective witnesses to the accident, the existence of a pre-existing injury, and the injury that occurred offsite.

A worker is required to report the injury to his or her employer “as soon as practicable, but no later than 45 days after the accident.” In the case of radiological exposure, however, the worker must notify the employer 90 days after the worker knows or suspects that he or she has received an excessive dose of radiation. If the worker experiences an occupational disease, he or she must notify his or her employer as soon as practicable after becoming aware of the development of the disease. Delays by the worker in reporting the injury to his or her employer, this may cause payment of benefits to be delayed or the claim denied.

If, at the time of the current workplace injury, the worker had a pre-existing injury, the employer and the employer’s insurance company may resist payment of benefits, claiming instead that the pre-existing injury is the cause of the worker’s current symptoms. Workers can limit this by being transparent and open when communicating with the workers’ compensation doctor. If the worker is upfront about the pre-existing injury, then it may be easier for the worker or the worker’s attorney to distinguish between the pre-and post-work accident symptoms and what led to the current inability to work and claim for workers’ compensation.

What Happens to Medical Bills When a Workers’ Compensation Claim is Denied?

Typically, workers are responsible for paying the medical bills incurred due to a claimed work injury if the claim for benefits is denied by an arbitrator at the Illinois Workers’ Compensation Commission. If the worker has health insurance, then the worker’s health insurance may cover some or all the medical expenses. The payment of medical bills is subject to the fee schedule issued by the Illinois Workers’ Compensation Commission, based on the Illinois Workers’ Compensation Act.

A workers’ compensation attorney can explain to the worker what his or her rights are, what he or she is entitled to, and what he or she can do to make sure that the worker is only responsible for paying what the law requires of him or her.

What Happens if a Workers’ Compensation Claim is Denied?

If the worker believes that his or her claim for benefits was wrongly denied, then he or she has the option to file an appeal to a court of review. In Illinois, workers can appeal the arbitrator’s denial of benefits by first filing an appeal to a panel of three commissioners, who will review the worker’s claim. Within sixty days after holding a live hearing, the panel of commissioners issues a decision.

If either party is dissatisfied with the outcome of the initial appeal, then the party may be able to file an appeal to the circuit court, then to the Appellate Court. To appeal the Appellate Court’s decision, the party would need to ask the Illinois Supreme Court for permission to file an additional appeal. Typically, employees of the State of Illinois do not have the option to appeal decisions of the panel of commissioners but do have the option to appeal the decision made by the arbitrator. This limitation does not apply to cases involving employees of the Workers’ Compensation Commission.