Filing a Workers Compensation Claim – Illinois
THIS PAGE CONTAINS INFORMATION ON HOW TO FILE A WORKERS COMPENSATION CLAIM IN ILLINOIS FOR INJURIES OCCURING ON 6/28/2011 AND LATER.
This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state’s law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I’m not happy with the determination, how do I appeal?
- I had an accident at work. How do I file a workers compensation claim in my state?If suffer an accident at work, you should notify your employer as soon as possible orally or via a writing. It is preferable to notify your employer in writing, specifying the date, place, description of the accident or injury as well as the employees personal contact information. You should aim to notify your employer within forty-five (45) days of the accident. Failing to comply with this deadline or time frame could result in a loss or denial of benefits. One caveat to this is if you suffer an injury as a result of radiological exposure, you may notify your employee within ninety (90) days of first notice.
After notifying your employer, your employer should provide you with all necessary information concerning medical treatment and services as well as contact either your employers insurance provider or workers compensation administrator. If you are unable to return to work for more than three days, your employer must begin paying temporary partial disability benefits or provide you with a written explanation of a denial of benefits or a request for more information.
- Should my employer have workers compensation insurance? How do I know if I am covered? Your employer is responsible for the cost of your workers compensation benefits. Most employers choose to become involved or purchase workers compensation insurance, where the insurance provider then pays the benefits on the employers behalf. Your employer is not required to purchase workers compensation insurance, but if chooses not to do so must obtain permission to be self-insured. If you cannot determine whether it is your employer or your employers insurance provider who is responsible for paying your benefits, you may contact the Illinois Workers Compensation Commission to get more information.
- What are the conditions that enable me or prevent me from claiming benefits under my state’s law?Workers compensation in Illinois is a no fault system that covers almost all employees who are hired, injured or whose employment is based in the state of Illinois. Illnesses and diseases that are work-related, in whole or in part, will be covered under this system.
- What benefits might I be eligible to receive?Under Illinois Workers Compensation system, you may qualify for the following benefits:
- Medical benefits reasonably related to the care and treatment of the work-related injury or illness.
- Temporary total disability benefits are wage replacement benefits paid to the worker while recovering from an injury or illness. These will be benefits paid if the employee is unable to attend work during recovery.
- Temporary partial disability benefits are wage replacement benefits that cover the difference of wages or hourly wage lost if the employee can return to work but not at the same capacity as prior to the injury.
- Vocational Rehabilitations are benefits provided to injured workers participating in vocational rehabilitation programs.
- Permanent partial disability benefits are paid to an injured employee who suffers some permanent disability or disfigurement, but can still work.
- Permanent total disability benefits are paid to a worker who is permanently unable to work.
- Death benefits are paid to survivors or dependents of workers who die as a result of a work-related injury or illness.
- How much time do I have to file my claim? What are the stages of the claims process? What should I expect?You must notify your employer within forty-five (45) days of your injury in order to best guarantee a receipt of benefits.
In order to dispute or challenge benefits or issues that may arise during your workers compensation claims process, a claim to the Illinois Workers Compensation Commission must be filed within three (3) years of the date or injury or illness or within two (2) years of your last payment of benefits. Depending on the nature and extent of your injury, or whether you suffer from an occupational illness as opposed to an injury, may alter the time limits in which you may file a claim.
If a dispute arises between you and your employer in regards to your claim, the Commission operates as a state court system to facilitate the process of resolving the dispute. A case is tried by an arbitrator, whose determination is reviewable by a panel of three commissioners.
- If I am not happy with the determination, how do I appeal? If your employer or your employers insurance provider denies your benefits and you are unsettled with the determination, you should file a claim with the Commission. To file a claim, you must file three copies of the Application for the Adjustment of Claim and a Proof of Service (which indicates you have given a copy of your application to your employer).
Once your claim if filed, you are assigned a case number, an arbitrator, and you are set on automatic three-month cycle. During these three months, you will be set on a status call, at which time you will be able to request a trial. It is your responsibility to pursue the course of the trial. If you or the other party (presumably your employer or employers insurance provider) does not pursue the trial, you will be placed on a continuous rotation of the three -month status call period for a maximum time of three (3) years. An arbitrator can dismiss your claim should you fail to bring a trial forward.
You are not required to hire an attorney to proceed with a claim at the Commission, but it may be to your advantage to do so as the claims process can be extensive.
An Arbitrator usually presides over a claims proceeding and conducts the proceeding similar to a trial. An arbitrator may not make any determinations concerning the claim until you, the employee, have reached maximum medical improvement. After this point, the arbitrator will issue his decision within 60 days of the trial.
If you remain unsatisfied with the arbitrators determination regarding your claim, you may appeal to a panel of IWCC commissioners. The commissioners will review the arbitrators decision, the transcript and evidence presented at trial, and will conduct a trial with both parties making their own arguments. The panel will report their decision within sixty (60) days of the hearing.
The Commissions decision is final when involving State of Illinois employees. All other employees may continue to appeal to the Circuit Court, Appellate Court, or Illinois Supreme Court.
Settlement or mediations are encouraged. All settlement agreements must be approved by the Commission. If not approved, the settlement does not close out the employees rights and the employees opportunity time to file a claim is extended indefinitely.