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Documenting & Proving a Workers Comp Claim

When you make a claim for workers compensation, it’s your responsibility to prove that you should receive benefits. That’s similar in principal to the burden of proof applied to plaintiffs in civil lawsuits. Essentially, you’re asking for something and the law says that you should have to establish why you deserve what you’re asking for.

A workers compensation claim is different from a civil lawsuit in that you don’t have to prove negligence or fault. The workers compensation system is a no-fault system, so what you have to establish is that you meet the requirements under the Workers Compensation Act, 820 ILCS 305, to be eligible for benefits.

Generally speaking, these are the major things you have to prove:

  • Jurisdiction — You have to demonstrate that at the time of your accident, your employer was subject to the workers compensation laws in Illinois. In other words, you have to prove that your employer was engaged in business in Illinois at the time you were injured.
  • Employment — You have to show that you had an employment relationship with your employer at the time of your accident. This may not be as straightforward as it sounds if your arrangement with your employer is relatively loose. Your employer may claim that you are an independent contractor, and proving that you were an employee may be challenging if you work at home, set your own hours, use your own vehicle or equipment to do your job, and your employer doesn’t take taxes out of your wages.
  • Injury — You have to prove that you were hurt in the course of doing your job, and that your injuries are of a type for which you can receive benefits.
  • Causation — You have to show that your injuries were caused or made worse by the accident and not some unrelated incident or medical condition.
  • Notice — You have to show that you notified your employer about your accident by the deadline set by the Workers Compensation Act.

Evidence You’ll Need

To prove the elements outlined above, you’ll need evidence. Evidence usually is in the form of documents and testimony. You’ll gather and present your evidence when your claim goes to arbitration, or your workers compensation attorney may use it to negotiate a settlement of your claim beforehand.

Types of evidence you’ll typically need to support a workers comp claim include:

  • Medical Records — This is the meat and potatoes of your claim. Perhaps the most important part of your case will be demonstrating that you were injured, so you’ll need your medical records to show how you were hurt and what treatments you had to undergo during your recovery.
  • Accident Reports — You’ll want to get copies of any accident or incident reports related to your injury. That would include written reports provided to your employer or a police report in the event you were hurt in a work-related car crash.
  • Employment Records — Employment records can establish that you did in fact have an employer-employee relationship at the time of your accident. Pay stubs can show that you were on your employer’s payroll and that taxes were being taken out. If you got a written offer of employment when you started your job, that could demonstrate your employment relationship. Copies of performance reviews also can demonstrate your employment relationship.
  • Witness Testimony — Anyone who saw your accident and can give a statement or testify about what happened may be able to help prove that your accident caused your injuries. Your medical providers also may be witnesses to support your claim.
  • Expert Witnesses — If your employer is disputing that your accident could have caused your injuries, an expert or expert witnesses may be helpful. Experts can include physicians (other than the doctors who actually treated you), engineers, accident reconstruction specialists, or anyone with specialized knowledge who can offer independent evaluations and opinions about your case.

How a Lawyer Can Help

If your employer is disputing your workers compensation claim, you may need to perform an independent investigation into the circumstances of your accident. An experienced Chicago workers comp attorney can help you with the investigation phase of your claim, and once the evidence is gathered can use it to make an argument in your favor. A lawyer can negotiate on your behalf to try to settle your claim, or represent you through the process of making a formal claim to the Illinois Workers Compensation Commission.