If you’re hurt at work, and instructed not to return to work by a doctor or hospital, when will you get a check from the insurance company?
Under the statute, which is called the Illinois Workers’ Compensation Act, the insurance company would have 14 days to issue a check from the date that your disability began. This would likely be from the date you stopped working, and sought medical treatment, and were authorized not to return to work, either by the emergency room physician, the occupational clinic physician, or your own personal physician. This payment is known as TTD, or temporary total disability.
If you don’t receive a check within 14 days, you should at least receive a letter from the insurance company explaining why they are not going to pay you. This is usually after some type of investigation has been conducted. First, the insurance company would need to know that you gave notice of the injury. The law provides that you have 45 days to give notice of your injury to your employer.
They may also ask you to submit to questioning and to give a recorded statement. Most lawyers are of the opinion this should be avoided. These recorded statements are rarely, if ever, taken to help you receive benefits; however, it does allow the insurance company to ask you anything they want, including any injuries you sustained before this one, which may form a defense to your claim. The recorded statement is mainly done to help the insurance company build a defense to your claim, as they want to reject your claim and protect their money. The adjuster will try to tell you otherwise. Do not trust the adjuster, as we discussed in this post: “I was injured at work. What things should I NOT do?”
The insurance company has several ways that it can verify your accident. One would be obtaining an accident report that you gave to your employer in writing. Another would be obtaining the occupational clinic record of your visit, which should contain the history of the accident that you sustained. In the case of a visit to the emergency room, a report would also indicate a history that would contain how and where you were injured.
One would think that this information from the employer and one or more medical providers that you’ve seen would suffice to give notice to them that they owe you a check within the 14 days.
If you don’t receive the check, they will be required to send you a letter with the reason that you will not receive a check. The letter should contain the reason the claim is being denied. Typically, the letter will state that you have not sustained an injury in the course and scope of your employment.
All of this would occur in a perfect world; however, it rarely does. In reality, claims are simply denied because, as it is, the nature of an insurance company is to want to protect its shareholders. Unfortunately, your physical well-being will take a backseat to such desires.
If the claim is disputed, you are not likely to have contact from the insurance company, unless and until you retain competent experienced representation from an attorney.
In the case of a disputed or denied workers’ compensation claim, you should hire an attorney as soon as possible, for you will not be paid until someone forces the insurance company to take action.