Reasons Naperville Workers’ Compensation Claims Could Be Denied

by | Jul 26, 2023 | Attorney

Workers’ compensation benefits are essential for employees who experience work-related injuries or illnesses. Most Illinois employers are required to participate in the state’s workers’ compensation program. However, sometimes an insurer or employer questions or denies a claim. They may be skeptical and believe there’s a possibility of fraud. An employee dealing with this situation may want to consult with Naperville’s expert workers’ compensation attorney.

Suspected Fraud

In some instances, the insurer or employer suspects the worker of faking or exaggerating the severity of an injury. The insurer scrutinizes all medical documentation to identify inconsistencies or other evidence of fraudulent behavior. Insurance agents may use surveillance techniques and gather testimony from co-workers and supervisors.

Suspected Malingering

After a certain amount of time, the insurer may end payments because agents believe the recipient is malingering. The term refers to a person claiming their symptoms continue even though this should no longer be the case. A Naperville workers’ compensation lawyer can help the client with any required extra medical evaluations. At least one exam might have to be with an independent physician and not the patient’s own doctor.

Responsibility for the Injury

When a worker is responsible for the injury, the insurer is still required to pay benefits except in limited cases. If the employee was negligent regarding safety, that is not an appropriate reason to deny the claim. However, evidence that the worker was intoxicated because of using alcohol or other drugs is a valid reason.

Employees dealing with situations like this may want to learn about Wilson Law Office, LLC today.

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