An Easy to Read Guide About How to Apply for Workers’ Comp

March 18, 2021

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Brent Eames

According to the Bureau of Labor Statistics, there are around 2.8 million nonfatal workplace injuries and illnesses each year in the U.S.

The aftermath of workplace accidents can be stressful and frustrating, especially when you consider the intricacies of applying for workers’ compensation. Though most Illinois workers are covered by workers’ comp, navigating conversations with your employer and the insurance carrier can be difficult.

If you’ve been injured at work, it’s important to understand the basics of the filing process. Here’s what you should know about how to apply for workers’ comp, and what to do after your claim is approved or denied.

1. Make Sure You’re Eligible to Apply for Workers’ Comp

Before you jump into the next steps, it’s important to ensure that you’re eligible to apply. There are a few requirements you’ll need to check.

First, your employer must have workers’ compensation coverage. In general, most Illinois employers must have workers’ compensation—but not all of them. The state estimates that workers’ comp covers about 91% of all Illinois employees.

If you are part of the remaining number whose employer isn’t required to cover you, you’re not always out of luck. Some employers buy coverage even when there’s no requirement to do so. Check with your manager or HR representative if you’re unsure.

Next, be sure that you, specifically, have coverage. Some workers like freelancers and consultants aren’t entitled to benefits.

Another requirement is, of course, that you’ve sustained a work-related injury or related illness. Though this requirement is often clear-cut, the details here can sometimes be tricky, such as when you’re injured on a lunch break. If you’re uncertain, reach out to a workers’ compensation attorney to learn more.

If you meet all of these requirements, you’ll need to follow the next steps to receive your benefits by the state’s statute of limitations. For workers’ compensation, this is generally three years from the date of your accident or injury, depending on the circumstances.

2. Seek Medical Help for Your Workplace Injury or Illness

If you haven’t done so already, make sure to seek medical care as soon as possible. This does two things.

First, it has the immediate benefit of helping you understand how to manage and recover from your injury or illness. Second, it allows you to gather medical documents that you may need to prove your case. Be sure to keep these in a secure location for later use.

In the case of traumatic injuries in which you have already visited an urgent care or emergency room, be sure to find and keep any supporting documents. This may require a call to the medical center as needed.

In many cases, your employer may have a Preferred Provider Program for workers’ compensation cases, which may help you find a provider.

3. Notify Your Employer as Soon as Possible

Again, there are specific deadlines for notifying your employer about your workplace injury. Generally, you’ll have to do it within 45 days. However, it’s always helpful to report your injury as soon as it happens.

Your employer should give you specific forms to fill out and return to them. Once you have completed this, they will file the necessary claims on your behalf. If needed, be sure to follow up with your employer to make sure they’ve done this.

What Happens if the Insurer Approves Your Claim?

If your company’s insurance carrier approves your claim, you will have access to medical care through your insurer and/or workplace accommodations to help you get back to work. Be sure to follow the advice of the medical team your insurer pairs you with: the last thing you want is concerns that your negligence has had a negative impact on your injury!

During your recovery, you’ll need to report to your employer on a regular basis. If you miss work, you’ll have to submit claims for lost wages. Be sure to complete any documentation your employer requires.

What to Do if the Insurer Denies Your Claim?

If the insurance carrier denies all or some of your claim, you may want to fight their decision. This is also true if you’re dissatisfied with the workers’ comp settlement your insurer has offered.

Read your settlement or denial letter to understand the insurer’s reasoning. In the case of a denial letter, double-check that your injury does, in fact, satisfy the requirements listed above.

If you feel that the insurance company is in the wrong, you’ll want to fight their decision as soon as possible. In many cases, you’ll have only a limited time to fight back, so make sure to check the timeline listed on your denial letter.

From here, it’s a good idea to hire a lawyer, if you haven’t already. When companies deny an individual’s insurance claims, the aftermath can quickly grow complicated. In addition, the appeals process is complex, and it would require you to learn many legal nuances in a few short weeks.

Your work injury lawyer can help you find the correct documents you’ll need to fill out to fight back against the denial. They can also help you gather relevant evidence to support your claim.

In addition, a lawyer can help you through the trial itself, if needed. This can make you more likely to see success with the hearing process than you might by trying it yourself.

Know How to Apply for Workers’ Comp

If you’ve sustained a workplace injury or illness, it’s important to know how to apply for workers’ comp. When you have questions about the filing, settlement, or appeals process, speaking to an Illinois attorney at Eames Law Group can help.

Our team has a wealth of experience helping clients throughout the state through the Illinois workers’ compensation process. To learn what we can do for you, contact us today for a free case evaluation.

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