Your Rights Under Worker’s Compensation
If you are injured at work you have the right to obtain various benefits under the Illinois Worker’s Compensation Act, which is described below.
1) Temporary Total Disability: – If you miss more than three (3) days of work as a result of a work-related injury, you have the right to receive a weekly payment of two-thirds (2/3) of your average weekly wage, computed on the basis of the last 52 weeks of work for that employer before the accident if offered on a regular basis. Overtime is used in calculating your temporary total disability, but not at full values. Wages from a second job will impair you too. This is known as “temporary total disability” or “TTD.” Most people simply refer to this as their “worker’s compensation”, but it is not the only benefit available under the law.
2) Medical Services and Treatment: – Your employer, or the worker compensation insurance carrier, must pay all medical bills for your treatment, which are “reasonable and necessary.” You have the right to select your own doctor, plus one other doctor. Any referrals these two (2) doctors make do not count as additional doctors. There is no limit to the claim of referrals for medical treatment, as long as the treatment is reasonable and necessary and a result of your injury at work.
What happens if my bills are not paid?
The worker’s compensation carrier may decide not to pay for your medical treatment. The reasons are many: a dispute that your injuries are work-related; that the treatment you selected is not reasonable or necessary as connected to the injuries from the accident. If this happens, there are alternatives:
1) Pay the expenses yourself and try to get worker’s compensation to reimburse you later.
2) Try to get your health insurance carrier to pay for them. They may not be willing to do this at all or in the alternative you would sign a statement saying that the treatment is not work-related. This statement would be untruthful and presents problems, and should be avoided. If neither of these alternatives is available, then with your permission to guarantee bills, the doctor, if he agrees, may wait for payment.
What if my temporary benefits are cut off?
At some point during your treatment, the worker’s compensation carrier will probably send you one of their doctors to examine you and decide if you can return to work. This is called an Independent Medical Examination. Since these doctors are hired by the insurance companies, they often have a tendency to ignore your complaints and release you for work before your treating doctor does.
The Industrial Commission has procedures available for situations such as these. Unfortunately, it can take anywhere from four (4) months to four (4) years to obtain a final decision from these ‘immediate hearings,” depending on how many appeals are taken by the losing side. A petition for an immediate hearing may be filed to enforce your rights to reasonable and necessary medical treatment, your right to temporary total disability payments or other rights.
Obviously, this is not very helpful to you if you need your benefits. We will try and convince the insurance company that you are entitled to benefits. This is done through obtaining medical reports and records (unfortunately the cost of these reports and records is an expense you ultimately must bear). If the insurance company does not respond favorably, then we will file the petition for an immediate hearing.
3) Permanent Partial Disability: – If your injury is serious enough to leave you with some type of permanent restriction or limitation of some kind; you are entitled to receive additional compensation. This is called “permanent partial disability” or “PPD.”
The amount of money you receive for permanent disability depends upon many factors, such as, wages before the accident, the part of the body that was injured, the severity of the injury, the ability to return to work, and the wages you made when you return to gainful employment.
What if my injury was caused by the fault of my employer?
The Worker’s Compensation Act is a “no-fault” law. It does not matter whether the accident was the fault of your employer, your fault, or no one’s fault. The only thing that matters is that your job “increased the risk of injury” occurring. For example, if you have to do lifting at work, the risk is increased that you will injure your back doing so. If your job requires you to make deliveries in a motor vehicle, you are increasing the risk of being involved in a motor vehicle accident. It does not matter whether or not your plant is “unsafe,” or whether or not there are a lot of accidents there. Virtually all types of jobs increase the risk of injury due to some degree and, therefore, most injuries, which occur at work are compensable.
Can I sue my employer?
Even if the accident was caused by gross negligence on the part of your employer, you cannot sue fellow employees or employer. Under the Worker’s Compensation Act, all employers are immune from suits by their employees for work-related injuries or occupationally caused disease. Your only remedy is under the Worker’s Compensation Act.
If however, your injury was caused by fault of some “third party”, other than your employer, you can sue that “third party” for your injuries in court. This is something to discuss thoroughly with our firm.
Can I be fired for filing a Worker’s Compensation claim?
Section 4(h) of the Worker’s Compensation ACT states:
It shall be unlawful for any employer, insurance company or service or adjustment company to interfere with, restrain or coerce an employee in any manner whatsoever in the exercise of the rights or remedies granted to him or her by this Act or to discriminate, attempt to discriminate, or threaten to discriminate against an employee in any way because of his or her exercise of the rights or remedies granted to him or her by this Act.
It shall be unlawful for any employer, individually or through any insurance company or service or adjustment company, to discharge or to threaten to discharge, or to refuse to rehire or recall to active service in a suitable capacity an employee because ofthe exercise of his or her rights or remedies granted to him or her by this Act.
Numerous employers have been successfully sued for violating Section 4(h) of the Workers’ Compensation Act. There have been verdicts in the millions of dollars in civil suits against certain employers for violating this part of the Act. This part of the Act is one of the few times you can sue an employer if your rights are violated under Section 4(h).
Processing a claim
The first thing our office will do if you retain our services is to file an Application for Adjustment of Claim with the Industrial Commission, which starts the claim process and offers you protection for past, present, and future rights and benefits under the Illinois Worker’s compensation Act. Your employer will receive a notice of the claim.
After your medical treatment is completed, you will return to work. After you have been working at your regular job for a few months, we will contact you and verify any bills for unpaid medical treatment and to insure all of your temporary benefits have been paid. Finally, we may or may not send you to a physician for an independent medical evaluation. We will usually advance the funds for this examination. (The cost for this will ultimately be charged to you at the time of the settlement for your case.)
The worker’s compensation insurance carrier will probably send you to one of their doctors for a similar examination. (When going to the insurance company doctor it is very important that you be accurate in explaining the extent of your injuries.)
Once the reports from both sets of doctors are in, the process of evaluating your claim begins. If an agreeable settlement can not be reached, we will take your case before an Arbitrator at the Industrial Commission. You will be notified and will have to come to court to testify. (Sometimes it may be necessary for your doctor to testify.) The expense of providing testimony of your doctor will be charged against the proceeds of the case. After hearing all of the testimony and presentation of evidence, the Arbitrator will issue an opinion.
If your case goes to arbitration, your rights to future medical care and additional benefits, if your condition gets worse, are preserved. These rights are usually given up in any settlement.
After arbitration both sides have the right to appeal to the Industrial Commission. Due to the extreme backlog, it is now taking 2-3 years for these appeals to be decided after the arbitration decision has been entered. Your employer does not have to pay the arbitration award while the case is on appeal.
Under certain circumstances the decision of the Industrial Commission may be appealed to the Circuit Court and then to a special Industrial Court of Appeals. It is not unusual for this process to take one or two years.
How long will my case take?
As you can see by the above discussion, there are many variables to determine the length of time your case may take. The most important thing to remember is the legal process will not begin until you have reached maximum medical improvement. We cannot, however, even begin to discuss settlement of your claim until you have returned to work and completed all of your treatment. In addition, since any settlement will almost always close out your rights to future medical care and any additional compensation for any worsening of your condition, we must be sure that your condition has completely stabilized before commencing any settlement discussions with the insurance carrier.
If it is appropriate, and we have received a settlement offer that you accept, the terms of settlement and a complete breakdown of our fees, costs and the amount you will receive will be sent to you in the form of a settlement contract. Always read the term of a settlement contract carefully. Your rights to future benefits will be given up and as well as the the right of reimbursement for medical bills incurred, and left unpaid or agreed upon. All settlement proceeds are completely TAX-FREE.
The insurance company may at anytime after you file a claim, send an investigator to video tape your activities. This evidence can be used at your hearing before the Arbitrator to dispute any issues with your case. Contact us for a free consultation of your specific needs at (847) 244-0690 24 hours a day.