Illinois Workers Compensation Claims: Eligibility, Filing and Appeals

Almost all employees are covered by worker’s compensation. Exceptions are made for real estate agents or salespeople who work on commission only, and for domestic employees.

Employers purchase workers’ compensation insurance for their employees and the insurers fund worker’s compensation claims. In the event of a dispute, the Illinois Workers’ Compensation Commission enforces Worker’s Compensation laws and protects worker rights.

Injuries Arising from Employment

Illinois Worker’s Compensation laws provide benefits for injury, disablement or death arising out of and in the course of employment. Work injuries include repetitive use injuries, and strokes, heart attacks or other physical problems covered by work. Workers with pre-existing conditions are also covered if working conditions aggravated the condition. Occupational illnesses arising from working conditions are also covered.

If you are injured at a company recreational activity, including an athletic event, party or picnic, workers’ compensation will not cover the injury unless your employer required you to attend the event. Accidental injuries that were incurred while intoxicated are also not covered.  

How to file an Illinois Workers Compensation Claim

When you are injured at work, you should immediately notify your employer. You must also include the date and place of the accident in your notification. Although the notice can be written or oral, the Workers Compensation Commission recommends filing the noticed in writing and including the date and place of the accident, along with a brief description and your name and contact information. You must notify your employer within 45 days of an accident in order to preserve your right to collect benefits.

Your employer is then obligated to give you a list of approved medical providers, and inform their insurer to begin the claims process. This is done by filling out the Employer’s First Report of Injury, Form 45 of the Worker’s Compensation forms. Your employer must begin paying benefits, provide you with information on additional information you need to provide to get benefits, or deny your  benefits in writing once you are unable to work for 3 or more days.

Workers Compensation Claim Denials

Common reasons for denial include failure to notify your employer of an injury within 45 days, and failure to prove that the injury arose out of and in the course of work.

Appealing an Illinois Workers Compensation Denial

If your employer does not begin paying benefits in a timely matter or your benefits are denied, you must contact the Workers’ Compensation Commission. You can open a claim at the Commission by filing three copies of “Application for Adjustment of Claim” as well as “proof of service” demonstrating that you gave the application to your employer. You can file the claim by mail or in person to the Workers’ Compensation Commission office. You must file the claim within 3 years of the injury, death or disablement, unless the illness was caused by asbestos exposure or a death occurred. If the illness was caused by asbestos exposure, you have 25 years to file a claim. If death resulted, dependents must file a claim within 3 years of the death.

After you have filed a claim, you are assigned an arbitrator and case number. Every two months, the case is reviewed in a status call. During the status call, you can either request a trial or state that you are still in settlement negotiations. This bi-monthly review process continues for up tot here years, at which point the arbitrator may dismiss the case.

If you request a trial, a Commission Arbitrator will hear the case, using Illinois rules of evidence and procedure. Injured workers must be finished healing and their medical condition must be stable before a hearing. Workers must provide medical records, depositions by physicians, and other required proof of injury and wages. After the trial, the arbitrator will issue a final decision within 60 days.

If you still wish to appeal, a panel of 3 commissioners will review the evidence and the arbitrator’s decision, along with written arguments submitted to the commission. Another hearing will be called, and you or your attorney will have 5-10 minute to present your case. The commission will then issue a final decision within 60 days. This decision is final for State employees, but other employees can appeal to the Illinois Circuit Court, Appellate Court, or Supreme Court in certain cases.

Collecting Illinois Workers Compensation Benefits

Benefits include reasonable medical care required to cure or relieve the impact of the injury, temporary total or partial disability, vocational rehabilitation, permanent partial or total disability, and death benefits. Benefits are not taxable.

Medical benefits include all medical care that is reasonably necessary to resolve the injury. Employers pay medical bills directly to medical providers. You are entitled to choose two medical providers to visit, and then must get referrals to visit other providers. If you choose a third doctor, you may forfeit your right to benefits.

Temporary total disability benefits are paid at 66 2/3 percentage of your average weekly wage, up to state maximums. Temporary disability benefits are paid once three days of work are missed, unless more then 14 days of work are missed in which case the first three days of lost wages are paid as well.  Temporary partial disability is equal to 66 2/3 percent of the difference between your wages before the injury and your wages after.

Permanent partial disability is paid either by calculating 66 2/3 percentage of the difference in wages from before and after the injury, or by looking at a “schedule of injuries” which lists a weekly time limit for payments. Payments are made at 60% of the average weekly wages for the set number of weeks. For example, if you lose a thumb you are entitled to 76 weeks of benefits, paid at 60% of your average weekly wages. If the injury was not a scheduled injury, you are entitled to 500 weeks of benefits. If you are disfigured, you can obtain up to 162 weeks of benefits at 60% of average weekly wages.

Hiring an Illinois Workers Compensation Lawyer

Hiring an attorney is not required, but the Workers’ Compensation Commission advises that most employers and employees hire attorneys for contested cases. An attorney can help facilitate settlement and/or request a formal hearing. An attorney can also help prepare evidence when a claim is heard at a trial.

Illinois Workers Compensation Office Locations

Chicago office:
100 W. Randolph St. #8-200
Chicago, IL 60601
312/814-6611
infoquestions.wcc@illinois.gov

Peoria office:
202 N.E. Madison Ave. #201
Peoria, IL 61602
Teena Pitman
teena.pitman@illinois.gov
309/671-3019