Multiple Back Injuries Workers’ Compensation – $290,000 Settlement

Work Injury Sustained While Digging A Hole

While working for the public works department of a Chicago suburb, our client injured his back while digging to repair a water main break. About a week later, he slipped and fell on the job injuring his back even more severely with resulting spinal and nerve damage that required multiple surgeries including a laminectomy revision. Our attorney filed a claim with the Illinois Workers’ Compensation Commission and we were able to secure an appropriate award in the amount $290,000 to assist this injured worker with his financial affairs and with his continued medical treatment.

Why Workers’ Comp Insurance Companies Sometimes Deny Claims

Most people assume that if you’re injured while at work, your claim automatically qualifies as a worker’s compensation case. Although it’s generally true that most on-the-job accidents and injuries are in fact valid worker’s comp claims, this isn’t necessarily the case.

The insurance companies that insure employers for these claims are no different than other types of insurance companies like auto insurers. They’re big businesses that make more money for their stockholders the less money they pay out in claims. So it’s always in their best financial interests to avoid (or at least limit) pay outs on these matters. As such, they’ll often look for almost any reason to avoid settlement. Some of these reasons are completely legitimate and others are less so. Among the most common reasons are:

  • Not job-related: In order to be compensable, an injury must both “arise out of” and “in the course of” your employment. This basically means that the accident needs to happen while you’re actually on the job and doing something that is specifically work-related. These requirements are some of the most hotly contested reasons that an insurer might challenge your claim.
  • Detour: Although you may in fact be doing something completely work-related, the insurer may claim that you took a detour or deviated from your employment to do something else (no matter how short) that was more of a personal matter. It could be stopping at Walgreens on the way to a job site, or walking out to your car to make a personal phone call.
  • Horseplay: Although you might be on the job, if you get injured while taking a break to toss a football around and get injured, they will say that this is not covered.
  • Misconduct: If your job requires you to wear safety glasses or a harness but you purposely refuse to, any injury that results from that failure will likely be challenged.
  • Independent contractor: A worker’s compensation claim requires an employer-employee relationship and if the insurer can show that the injured party is really an “independent contractor”, the claim will be denied.
  • No coverage: Some very small companies may have no insurance for this at all and other larger companies may violate the law and fail to secure the proper type of insurance.
  • Time limit: In Chicago, and across Illinois, there is a statute of limitations which is a time limitation that restricts when a claim must be filed with the Illinois Worker’s Compensation Commission. If the claim is not filed within that time, a worker will forever lose his/her right to pursue compensation. A very common mistake that some injured workers make is that they assume their employer has filed this important paper for them, which is almost never the case.

Even if your employer begins to make payments to you for a work injury, the insurance company may still deny your claim or fail to pay all the benefits that you’re entitled to. Contact Mitchell S. Sexner & Associates LLC for free help to make sure you receive everything that you should.

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