According to the Illinois Workers Compensation Act (IWCA), employers with at least one full-time or part-time employee are required to have workers’ compensation insurance that would provide benefits when a work-related injury occurs.
The law is very expansive regarding the definition of employee, meaning that most people are covered. There are some people who may fall outside the definition of employee and are not eligible for workers’ compensation benefits. Others may not be eligible for workers comp because of the nature of their injury or how it occurred.
To learn more about whether you are eligible for workers comp coverage, or to appeal the denial of benefits, contact the experienced workers’ compensation attorneys at Rosenfeld Injury Lawyers today.
The Requirement to Carry Workers Compensation Insurance
The Illinois Workers Compensation Act requires an employer that has one or more full-time or part-time employees to carry workers’ compensation insurance.
The employer could self-insure themselves, where they are responsible for paying the benefits. Most employers purchase insurance from a for-profit company.
If an employer does not carry workers’ compensation coverage, there are two main consequences:
- They can be prosecuted for a misdemeanor under Illinois criminal laws
- They can be sued directly by the employee in a personal injury lawsuit, where the employer would need to pay all damages, including pain and suffering
Workers’ Compensation Laws Depend on Who Is an Employee
Illinois law requires that employers provide workers’ compensation coverage for everyone who is considered an employee under the definition of the law.
The IWCA defines an employee, in part, as follows:
“Every person in the service of another under any contract of hire, express or implied, oral or written, including persons whose employment is outside of the State of Illinois where the contract of hire is made within the State of Illinois.”
If an Illinois employer does not provide workers’ compensation insurance coverage for an employee, they can be criminally liable. In addition, you would be able to sue them in a negligence-based personal injury lawsuit that could pay you even more in damages.
In the meantime, there is a state program that can provide benefits for those whose employers did not pay for workers comp insurance.
Independent Contractors Do Not Receive Workers’ Compensation Benefits
The main category of workers who are not covered by workers comp insurance is independent contractors.
An independent contractor is defined as a person, business, or corporation that provides goods or services under a written contract or a verbal agreement. They are not considered regular employees of a business, and they are not on the payroll. They are paid as they work.
For example, an Uber driver would be considered an independent contractor because they deal directly with the rideshare customer, using Uber’s platform. If a retail store hires a plumber to do occasional work for them, they would also be deemed an independent contractor.
You Can Challenge Your Employment Classification
Employers can purposefully misclassify a worker. They want to avoid paying certain employee benefits that are required by law when one is an employee.
For example, employees are required to be paid overtime and a minimum wage. Employers must also pay premiums to ensure that their employees are covered by the workers’ compensation system.
Just because your employer says that you are an independent contractor does not mean that you actually are one. Much depends on your job duties and your relationship with the company that has hired you.
According to Illinois law, An individual performing services for someone else is deemed to be an employee of that person unless it is shown that:
- the individual has been and will continue to be free from control or direction over the performance of the service for the contractor, both under the individual’s contract of service and in fact;
- the service performed by the individual outside the usual course of services performed by the contractor; and
- the individual is engaged in an independently established trade, occupation, profession, or business
Your employer may be able to appeal a denial of coverage by arguing that you were entitled to benefits because you were an employee.
You Cannot Be Covered if You Did Not Sustain a Workplace Injury
The core legal principle is that workers’ compensation will cover you if you have suffered a work-related injury.
The first requirement is that you have suffered an actual injury. You would need to undergo a medical examination that would establish that you have been injured and are not able to work.
First, you will need to report your injury to your employer within 45 days of the accident occurring. Your employer would then send you to a doctor who would administer a medical examination. The results of this examination could determine whether you can get workers comp payments.
Coverage Depends on the Injury Being Work Related
One of the main reasons why insurance companies deny claims is that they believe that the injury was not work-related.
There could be several reasons for this. One is that the injury may have occurred off work time. They may claim that the injury occurred on your lunch break or when you were traveling to or from work.
The insurance company may also deny a claim because they do not believe that your injury was caused by your job.
For example, if you suffer from a foot condition called plantar fasciitis (which often results from standing on your feet for too long), the insurance company may claim that you developed the injury elsewhere.
Another reason for claim denial is that the insurance company may think that your condition was pre-existing. An example is when you are claiming workers’ compensation benefits for a back injury.
Your claim could be denied because the examining doctor believes that the injury occurred over time, as opposed to being from your job. This is in spite of what your own treating doctor believes.
Finally, the insurance company may not cover your workers’ compensation claim because they may argue that you have not tied your injuries to a certain job.
For instance, you may have been sickened by exposure to a toxic substance. You may not be able to prove the exact workplace where you were exposed because you worked in many locations over the years.
One thing that the insurance company cannot do is deny you benefits because they claim that you were negligent. Workers’ compensation is a non-fault-based system.
It does not matter whether you or the employer were at fault for the injury. The only way that your fault would be grounds for denying you workers’ compensation benefits is if you are found to have acted intentionally.
Coverage Depends on Work-Related Injuries Being Reported in Time
You have 45 days from the time that you were injured to report workplace injuries to your employer. There is no requirement to report your injury in writing.
However, you may want to notify your employer in writing, so you have a record that you followed the law. 45 days is a bright-line rule. If you miss this deadline, you will not be covered by workers’ compensation, even if your employer has a policy.
Then, you must also file your claim by the deadline to be covered. You have three years from the date of your injury to file the claim. In reality, there is no reason to wait this long to file for your benefits, even if payments are retroactive. You need the lost wages payments that you would receive from workers’ compensation.
You Are Not Covered if You Have Acted Intentionally
The insurance company may deny your claim because they may think that you acted intentionally when you were injured.
For example, if you deliberately broke a rule, and you were injured in the process, the injury company may deny your claim after an investigation.
What to Do if You Learn that Your Claim Is Not Covered by Workers Compensation
Your main option to fight a claim denial is to file a prompt appeal with Illinois Workers Compensation Commission. You have 20 days after the notice of the insurance company’s decision has been mailed to you to seek an appeal.
When you appeal your case, your legal arguments will be heard by an objective Administrative Law Judge who is employed by the state. They do not have the same profit motive as the insurance company, so you will get much more of a “fair shake.”
Your attorney will present both medical and factual information that supports your case. If your initial claim was denied because the examining physician believed that you were not injured, your lawyer would present medical evidence and testimony.
The Administrative Law Judge will issue a ruling on your case. If you do not win at that point, you can appeal to a panel of three Commissioners. If you still do not win, you can take your case to state court in the district where your claim was filed.
Most benefit denials are ultimately converted to benefits. The rate of conversions to benefits is roughly 68-72%. Your attorney may even be able to resolve your case by speaking to the insurance company and clearing up any misunderstandings that caused your claim to be denied in the first place.
Your Compensation for Work Injuries
If your workers’ compensation claim is successful, you can receive the following benefits:
- Two-thirds of your lost wages, up to the average weekly wage in Illinois (as of this writing, the AAW in Illinois is $1386)
- The reasonable cost of medical care to treat your injury
- Vocational costs in case you need to be retrained because you cannot perform the job duties of your current position.
If you have suffered a permanent injury, you can negotiate a settlement with the insurance company that will pay you benefits upfront in a lump sum payment.
You would need to know whether you would have future medical costs, and how much they are because the settlement releases the insurance carrier from any future liability in connection with your claim.
Some people do not opt for a lump sum settlement when there is considerable uncertainty about their future medical outlook.
Contact an Illinois Workers Compensation Attorney Today
If your claim has been denied, or if you anticipate that you may run into issues with your claim, you should contact a workers’ compensation attorney immediately. The attorneys at Rosenfeld Injury Lawyers have a track record of getting results for injured workers who have been hurt on the job.
We know how to stand up to insurance companies to get you what you deserve under the law. First, you need to reach out to us to schedule your free initial consultation.
You can send us a message online or call us today at (888) 424-5757 to schedule your free initial consultation. We will provide you with a comprehensive analysis of your case and explain your legal options.