Oak Lawn, IL asked in Workers' Compensation and Appeals / Appellate Law for Illinois

Q: Workers' comp coverage dropped for delayed treatment appeal

I was injured at work in March 2024 and initially managed the injury with self-care at home as advised by workers' compensation. In May, I visited urgent care but did not seek further treatment until December due to worsening hip pain. When I reached out to workers' compensation in December, I was informed that my coverage had been dropped because I waited too long between treatments. I did not receive any formal notice about being dropped. How can I address this situation, and what steps should I take to appeal or resolve this issue?

2 Lawyer Answers

A: That's not how it works. As long as you reported your work injury within 45 days, you have 3 years to file the claim with the Illinois Worker's Compensation Commission. Until the claim is filed with the Commission, YOU HAVE NO RIGHTS TO ENFORCE. As I stated, you are required to formally report your injury and most employers will initially refer you to their designated work comp provider for assessment. Beyond that, you have a right to be seen by any doctor of your choice and all of the doctors who that Dr. may send you to. Additionally, you have a right to choose a 2nd doctor and all of the providers who that Dr. may send you to. When you were initially injured, you should have consulted an experienced Workers' Compensation attorney. We accept these claims on a contingency basis which means that you pay us nothing upfront. Moreover, state law caps our fee at 20% of your recovery. Even if everything went smoothly for you, once your injury was healed, Workers' Compensation would offer you a settlement. You would have no idea whether that was a fair settlement or not. Worse still, if you thought it was unfair, you would have no idea what argument to raise to make them increase the offer. It is a very rare exception that individuals represented by an experienced attorney do not recover well in excess of 20% more than they would be offered. If you are following me, you understand that hiring an attorney results in no cost to you and potentially far greater recovery. Whether you hire an attorney the day you are injured or the day before you settle the claim, THE FEE IS THE SAME. Why not have someone guiding you, all along? There are a number of things that you can do to weaken your case and reduce your recovery. Delay is among the worst. You suffer longer and you give the other side ammunition against you, especially if no formalized testing was done and no formal diagnosis was made.

In 2015, a client came to me for a knee injury. In discussing his case, he told me that 4 years earlier, he sustained an injury to his wrist. He had filed a claim and hired an attorney. That attorney recommended that he accept $6000.00 to settle this claim. He asked me if it was fair and I said "NO." In 2022, we settled his claim for $750,000. I'm not telling you that happens every day, to that degree but it does happen every day to some degree. Consult with more than one attorney before you decide to hire one because it is hard to change attorneys when you hire them on a contingency basis. Before you commit yourself, make sure that you have access to the attorney, not just a paralegal or secretary but someone who can answer your questions, definitively. If you have any difficulty reaching an attorney before you engage them, just imagine the difficulty you will have after you have committed yourself to hire them. All Worker's Compensation attorneys offer no-cost consultations. You owe it to yourself to seek representation immediately. Good luck.

A: I just wanted to clarify that you are not seeking to "reopen" your case because you DO NOT HAVE ONE. You need to hire an attorney OR file an Application for Adjustment of Claim with the Illinois Workers Compensation Commission (IWCC). The claim No. you have is with the insurance company. As I indicated in an earlier answer, until the matter is before the IWCC, there is NOTHING you can do.

Justia Ask A Lawyer is a forum for consumers to get free answers to basic legal questions. Any information sent through Justia Ask A Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between Justia and you, or between any attorney who receives your information or responds to your questions and you, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask A Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises, or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.