How workers’ comp benefits are determined in Illinois

According to the U.S. Bureau of Labor Statistics, workers in Illinois suffered more than 154,000 job-related injuries and occupational diseases in 2012. Employees who become ill or injured on the job have the right to apply for workers’ compensation benefits. To maximize the chance of a successful claim, it is important to know how these benefits are determined.

Workers’ compensation depends on multiple factors

The Illinois Workers’ Compensation Commission considers all of the following factors when deciding each case:

• Was the injury or illness caused exclusively by work-related activities?
• Was the injury or illness reported in a timely manner?
• Is the worker partially or totally disabled by the injury or illness?
• Does the employer carry workers’ comp insurance?
• Is the worker legally considered an employee? 

Each workers’ comp claim is evaluated with these questions. If even one of the necessary criteria is missing, the claim and any further appeals may be denied. If the claim is successful, compensation will be granted in proportion to the severity of the injury.

Documenting the situation

Employees who file claims will be required to show proof that their worker injuries are genuinely job-related. They will also need to prove that the injury or illness has interfered with their quality of life and their ability to work. Testimony from co-workers, notes from doctors and medical test results can all help make the case for compensation. If an employee plans to claim Temporary Total Disability coverage during the recovery process, it is especially important for the employee to work with doctors and supervisors to document the full extent of the illness or injury. When there is a pre-existing medical condition, employees need to prove beyond reasonable doubt that a work-related incident or situation has made it worse.

Determining employee eligibility

Not all people injured on the job are eligible for workers’ compensation. Farm workers and domestic workers are often considered independent contractors rather than employees.. Furthermore, some small employers are not legally required to hold workers’ compensation insurance, and their employees may not be able to make a claim for an on-the-job injury or illness. Employees of small family-owned businesses should document their situation carefully and find out which rules apply to their particular case.

According to the IWCC, 11 percent of workers’ comp claims made in Illinois are denied each year. This number can be decreased through better education and information. By knowing how to prove their eligibility, employees can make the strongest possible case for workers’ compensation.