In Illinois, when an employee gets a work-related injury or an occupational disease and the impairment is work-related, the exclusive legal remedy. Many people do not know how a workers’ compensation claim begins or the options for review and appeal should the claim be denied.
Employee sustains an injury or becomes ill
An injured Illinois worker should immediately give notice of the injury to their employer. For an occupational illness, the employee should give notice as soon as possible after becoming aware of the diagnosis.
After the employer receives notice, certain duties kick in if the employee misses at least three workdays. Within one month, the employer must report the injury or illness to the Illinois Workers’ Compensation Commission, the agency that enforces the state’s workers’ compensation laws. (The employer must report an employee death within two days.)
The employer must also do any one of these:
- Begin to pay the employee temporary total disability (TTD) payments or
- Ask in writing for information from the employee needed to pay benefits or
- Deny benefits with a written explanation
Employer refuses to pay benefits
The employee may file the claim with the Commission, which will assign an arbitrator (decision maker) to the claim. (There are other good reasons to preserve the claim by filing it with the Commission, generally three years from the date of injury.)
For up to three years (normally), the parties may try to negotiate a settlement contract, which is a frequent solution in which the employee accepts a lump sum to close the claim. During those three years, the case remains on the Commission docket, and every three months, there will be a status call with the arbitrator and the two parties, during which the employee or employer may ask for a trial before the arbitrator.
Once maximum medical improvement (MMI) is reached, a settlement conference can occur. MMI means that the employee has healed or recovered from the work injury or illness as much as they are likely to.
The employee has the burden of proving the all of the elements of their claim at trial. But if the parties are far apart, a formal pretrial conference is possible upon consent of the parties. If the parties do not reach agreement, the arbitrator may make a pretrial recommendation for resolution. If that does not work, a trial is needed.
Should the arbitrator deny the claim, however, either party may appeal to a panel of three commissioners within the agency. After a hearing and written arguments, the Commission has 60 days to decide the appeal.
In part 2 of this post, we will explain the rights of the parties to appeal further to the Illinois state court system.