If you are an injured employee you must complete Form 110 and file a claim with the Department of Industrial Accidents (DIA). After completing the form and gathering your attachments, you must make 3 copies of your Form 110 and add any/all documents that support your case. You then need to send these copies to your employers’ workers’ compensation insurance carrier. It is crucial that you attach any copies of medical bills, reports, and anything else that may help your case. If any of these documents are not attached, the insurer’s attorney will have the DIA withdraw the claim if it is not filed properly.
Next, the DIA will examine the claim and react in 2 ways:
- They can deny the form for many different reasons and return your documents back to you. In this case, the DIA will attach a rejection letter revealing what information was missing or incorrect.
- If the information is wrong, the DIA will send a notice to you, the insurance company, as well as your employer with a date, time, and place where a meeting will be held. This meeting will take place with a conciliator to talk about the claim that was filed. This encounter is a conciliation.
- Your employer will get notified if you file a claim. They do not need to be present at the conciliation unless the insurance company wants them to be. If your employer has no workers’ compensation insurance on the date of your injury, they need to be present at the meeting.
If a claim gets rejected by the DIA, it is usually because you have the wrong insurance carrier. Another reason may be that you have no checked off what types of benefits you are seeking. Lastly, if you do not enter a 1st or 5th day of disability, then you will receive a letter of rejection. If for any reason you do not know the name of your employer’s insurance company, you can find it on any of the insurance forms they have sent over to you, especially on Form 104 (Notification of Denial). You may also lookup your employer’s insurance carrier online. If your employer does not have workers’ compensation insurance, you need to file a claim against the Workers’ Compensation Trust Fund, which is part of the DIA.