When an employee is injured or ill on the job in Illinois, it is comforting for them to know that workers’ compensation insurance is available to them. This provides coverage for any damages related to the workplace incident, including wage replacement and medical benefits. In order to recover this compensation, the injured employee must file a claim. The process in doing so is as follows:
Claims Classifications
In the state of Illinois, workers’ compensation claims are classified into two categories. This includes:
- Medical-only: This claim means that the injured worker missed seven or fewer days of work because of the workplace injury. The employee can receive treatment and/or benefits for the injury while they can still report to work.
- Lost-time: This claim means that the injured employee missed more than eight days of work.
Filing a Claim
It is important to know that not only the injured worker can file a claim. An interested party, such as an employer or spouse, can also do so. In addition to this, the doctor that is treating the injury or illness can file as well. If the injured party or another interested party files the claim, they can submit it online, through a First Report of an Injury (FROI) form, or by phone. If the doctor files the claim, they can submit it to the Bureau of Workers’ Compensation (BWC) or the managed care organization (MCO) within 24 hours of the employee’s visit.
Appealing a Claim Decision
After a claim is filed, it is reviewed and either approved or denied. Once a Claims Service Specialist (CSS) issues an initial written notice of a decision regarding the claim, a 14-day appeals period begins immediately. This means that if the injured employee or the employer disagrees with the decision, either party can file an appeal within 14 calendar days from the date of receiving the decision. This must be done with the Industrial Commission of Ohio through a Notice of Appeal form.
When this happens, the Industrial Commission of Ohio will hear the dispute in an administrative hearing. Once an appeal is filed, the Commission will notify all parties of the date, time, and location of the hearing two weeks before it occurs.
Contact
If you have become the victim of an on the job injury, it may be beneficial to speak with an attorney and the doctor that is treating you to determine how to make the process as easy as possible. AllianceMeds understands that a workplace accident can be challenging and is here to help. We will deliver your medication to your door using overnight delivery and cover any out of pocket expenses that may arise. If you have any questions about how we can help, contact AllianceMeds today.