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When Are Work Injuries Sufficient to Qualify for Workers’ Compensation?

Written by Ankin Law Office

An injury should be covered by your employer’s workers comp insurance if the costs are real, including whether or not you are able to return to work.

In Illinois, there is some uncertainty for the future of workers’ compensation claims due to efforts by the new governor to toughen requirements for workers to prove they are eligible for benefits. The state legislature is opposed to these proposed restrictions, which were already made more stringent in 2011, so it is unclear what will happen, if anything, in the future.

As it is, the workers’ compensation system has several hurdles that are designed to prevent fraudulent claims. This is unfortunate as it burdens injured individuals and their families with a bureaucratic, time-consuming process when, in most cases, everyone would prefer that life just return to normal: working, collecting a paycheck and to be free of medical and therapeutic bills.

This is why it almost always makes sense to engage a workers comp attorney, in Chicago as well as the rest of the state. The injured worker is required to prove several things about their injuries, including:

That your injury was caused by work. What’s clear-cut is when it happens in your workplace under normal working conditions. Where it might fall into dispute is if the injury occurred while traveling on company business, while traveling to and from work, if it occurred at a company social event (which you were required to attend) or when was alcohol or drugs were involved. If an accident aggravates a pre-existing condition, full compensation for the overall condition might be compensable (a possible exception is hearing loss).

That you have incurred medical expenses relating to the injury. Obviously, the greater the medical costs the greater the need for and size of the claim. Most important is that the injured worker seek and receive proper medical attention in a timely fashion.

That you are unable to work in a function that the company requires, due to your injury.  Attending medical personnel might determine that your injuries preclude the work you formerly performed, but that you might be able to work in less-rigorous functions. Your employer then needs to determine if you are employable elsewhere in their company. If there is a pay reduction, workers comp can make up the difference. Being rendered unable to work might make you eligible for full benefits.

The worker has to prove his or her case

What bears noting is that in a dispute on a claim, the burden of proof of eligibility is on the employee (as stated in the Illinois Workers’ Compensation Commission handbook ; section 4: Resolving a Dispute at the Commission). This is generally why workmans’ comp lawyers are frequently used by the injured parties – in Illinois, and most other states.