What To Do When Workers’ Comp Won’t Pay

March 5, 2021


Brent Eames

Each year, American workers suffer nearly three million nonfatal workplace injuries. These incidents can be devastating. They rob families of income, result in enormous medical bills, and can upend people’s lives. 

Workers’ compensation should be the safety net that helps injured workers handle their bills and get back on their feet. Too often, however, this isn’t what happens. Claims are denied, payments are delayed, and workers don’t get the help they deserve.

If that happens to you, there is hope. Here’s what to do when workers’ comp won’t pay.

The Big Problem With Workers’ Compensation 

The primary problem with workers’ compensation is that claims are handled by third-party insurance companies. Most employers required to offer workers’ compensation are not equipped to handle those claims in-house. Even when they are, it is not efficient to do so. 

Instead, employers purchase workers’ compensation insurance from a third-party insurer. That insurer then handles any claims that arise for them. 

But paying out claims cuts into insurers’ profits, so they don’t want to pay out any more than necessary. As such, they may:

  • Reject claims based on procedural or timing issues
  • Argue that you were not on the job or were doing unauthorized work at the time of your injury
  • Argue that you are not a covered employee entitled to compensation
  • Attempt to shift the blame for your injury onto you
  • Contend that your injury is not or should not be serious enough to support a claim
  • Dispute the fact that you sustained an injury at all
  • Dispute the fact that your injury occurred on the job and is the result of a workplace incident 

In each case, the results can be the same. 

  • You don’t receive the money you deserve
  • The insurer fails to pay for the necessary medical care you receive 
  • You struggle to get the care you need because you cannot pay for it
  • You face financial frustration and stress on top of your injury and loss of income 

Other Problems

Other common problems include the fact that the workers’ compensation system is complex. Innumerable rules and deadlines apply to each step of the process. Few workers are familiar with these steps and staying on top of all of them when injured can be hard. 

Simple errors like missing deadlines or misfiling paperwork can set your case back. To make matters worse, insurance companies are staffed by experts who look for and pounce on every such minor error to deny your claim.

Employers can also complicate matters. They may:

  • Miscommunicate important information
  • Fail to record or report your injury when you report it to them
  • Use hiring practices that cause your job to fall in a “grey area” that gives insurers room to argue that you do not qualify for benefits

Even when they want to help, employers can rarely combat workers comp adjuster tricks or help you get coverage when the insurer denies it.

Finally, in rare cases, you may not be eligible for workers’ compensation coverage. For instance, very small companies can be exempt from offering workers’ compensation coverage due to the overwhelming cost.

Similarly, if you are a freelance or contract worker you may not qualify for workers’ compensation coverage under the law. Fortunately, that doesn’t mean that you have no options.

What to Do When Workers’ Comp Won’t Pay 

When workers’ compensation won’t pay for your injury and related expenses, all is not lost. You do have options.

First, you can file an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission. This will allow you to push your claim for benefits forward with requests for hearing and demands for immediate payment. If the insurance company continues to refuse payment without a lawful justification, they can be sanctioned with monetary penalties and attorney’s fees for unreasonable behavior.

Second, you can explore the potential for third-party liability. This is when someone other than you or your employer is at fault for your injury. Third-party liability can be whole or partial, depending on the circumstances. 

For example, if your injury occurred as the result of using a defective tool, the tool manufacturer may be partially liable. You might be able to sue them for damages related to your injury even if you do not qualify for workers’ compensation for some reason. 

Or, if you were injured while doing work for your employer on the premises of another business, that business may have some liability for your incident. 

What Not to Do

What you should not do under any circumstances is attempt to negotiate with the insurer handling your case on your own. Few workers, if any, have to experience and legal knowledge to resolve their situations with an insurer in their favor. 

If you accept a settlement or terms from the insurer, you forfeit your right to future compensation. This is true even if the insurer settles with you for far less than you need or deserve. 

Why You Need an Attorney

The single most important open secret to how to win a workers’ comp case is to hire an attorney. Without an attorney, you are at the mercy of the insurance company. That is a deeply unfair fight because insurers:

  • Are more informed about the law
  • Have more resources with which to fight
  • Are not grappling with injuries, medical bills, loss of income, and other stressors at the same time

An attorney takes the burden of your claim off your shoulders. They free you up to focus on healing and taking care of other demands while they deal with the insurer on equal terms. 

Attorneys also understand the deadlines and filing requirements associated with workers’ compensation. They can help you work through the process and avoid denials due to technical or procedural errors. 

Moreover, attorneys have the experience to understand what you should expect for your case. They can prevent you from accepting terms that are not in your best interest. Insurance companies know this and many will stop trying to deny or undercut your claims as soon as they find out you have a qualified attorney on your case. 

As a bonus, in many cases, attorneys can inform you of additional funds for which you may be eligible such as penalty funds. 

Penalty Funds

When insurers don’t pay injured workers what they are due, workers suffer.

If workers’ comp delayed treatment by not paying medical bills, workers’ injuries can get more severe rather than healing. Also, what happens to medical bills when workers’ comp is denied? Often, they go unpaid and become sources of debt, stress, and credit score damage.

Lawmakers know that, which is why they built in penalties for insurers guilty of wrongfully delaying or denying claims. The penalty for  a late workers’ comp payment can vary depending on:

  • Your state
  • How late the payment is 
  • How many payments were late

Depending on the situation, penalties can be in the form of a set dollar amount or a percentage of the payment owed. In extreme cases, penalties can force insurers to pay workers twice the amount originally owed and cover the worker’s legal expenses. Insurers may also be required to pay:

  • Fines set by the state workers’ compensation agency 
  • Interest, fines, or fees charged to workers by health care providers over medical bills they were unable to pay on time
  • Other costs resulting from the insurer’s refusal to pay the claim on time

The exact amount of penalties that apply will vary by case. Only an attorney can help you:

  • Identify what penalities apply
  • Hold insurers legally accountable
  • Ensure that insurers pay all applicable penalties
  • Prevent future late payments or denials by insurers 

A Special Note for First Responders

Different workers’ compensation rules and deadlines can apply to first responders than apply to workers in other fields. For example, the Public Employee Disability Act (“PEDA”) offers first responders extended financial protections.

While every worker with a workers’ compensation case should contact an attorney, it is especially crucial that first responders do so. Otherwise, they will miss out on the important and unique benefits available to them.

Get the Help You Need

Now that you know what to do when workers’ comp won’t pay, don’t wait. Contact us today for a free consultation and let our skilled and experienced attorney help you map out a plan to get the compensation you deserve. 

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