If you receive a denial for your workers’ compensation claim in Illinois because it is believed that your injury stems from a pre-existing condition, it is essential to know how to proceed. Many workers face this challenge and may need clarification about their next steps. However, taking informed action can help address the denial effectively.
Gather your medical records
Your first step should be to collect all relevant medical documentation, including records that document your condition before and after the injury occurred at work. Ensure these documents differentiate between your past medical issues and your current injury.
Accurate and comprehensive medical records are your best defense against a claim denial based on a pre-existing condition.
Request a written denial notice
Ask for a written explanation of your denial from workers’ compensation insurance, specifying why they believe your injury is not compensable. A written denial is crucial as it will guide your subsequent actions and help your healthcare provider address specific concerns the insurer raises.
Consult a medical professional
Consult a healthcare provider who can assess whether your current injury is new and related to work or aggravation of a pre-existing condition. A detailed report from a medical professional can strengthen your position when you appeal the denial.
File an appeal
You have the right to appeal the decision. This process typically involves submitting your claim to a review board or a court in Illinois. Include all relevant medical assessments, your written denial notice, and additional evidence supporting your claim of a work-related injury.
Seek help from a workers comp representative
Consider consulting with an attorney who understands Illinois workers’ compensation laws. This professional can guide the procedures for appealing a denial and what additional steps you may need.
Navigating a workers’ compensation denial can be complex and often requires patience and persistence. Stay informed about your rights under Illinois law. Acting promptly and following these steps can help you manage the appeal process more effectively.
