Illinois Workers Compensation Claims
Who is Covered by Illinois Workers’ Compensation?
When a person is injured simply from going about their daily duties on the job, Illinois law believes they should not be punished for it, and instead should be eligible to recover compensation.
The majority of the population depends on a healthy body just to get to and from work, and most of us rely on our health to perform our jobs correctly. When we suffer from a muscle strain, a sprain, or any other injury, our work performance takes a turn for the worst.
When a person is injured simply from going about their daily duties on the job, Illinois law believes they should not be punished for it, and instead should be eligible to recover compensation. Out of this theory, the system of workers’ compensation was developed. Workers’ compensation arose from the idea that employees owe a duty to their employers to perform their jobs, and employers owe a duty to their employees to provide a safe work environment. When accidents happen, the workers’ compensation system is there to protect employees and their families.
Just about every employee who works in Illinois is covered by this system of insurance. The Illinois Workers’ Compensation Act provides that if a person is employed in the State of Illinois, other than by a small family-run business, or if their employment is “centralized” in Illinois, they are covered by Illinois’ system of workers’ compensation. Any injury that arises “out of and in the course of employment” is protected under the Act. This basically means that whether you slip over a piece of equipment or strain a muscle through a repetitive motion, your injury falls under the Act.
How Do I Get Coverage?
The key to receiving coverage is reporting the injury in a timely fashion. As soon as you’re medically able to give notice to your employer, you need to report the accident that led to your injury. In fact, by not reporting to your boss, you run the risk of forfeiting any right to recovery at all. The Act allows all employees a 45 day window to make their initial report to their employer; however, the sooner the better. Even if you don’t know how serious your injury is, it is better to make an initial report and then revise it later. Keep in mind that any sort of retaliation by your employer is strictly prohibited by law, which means it is better that you speak up rather than wait until the injury gets worse.
Do I Need An Attorney?
There is no requirement in Illinois that you seek legal counsel before filing a claim for workers’ compensation. However, having an advocate will serve your interests for several reasons. First, the workers’ compensation system can be complex. You can be pressured into accepting partial payment or less than you deserve simply out of fear of missing too many paychecks. Second, you will most likely need to see a doctor who works with the insurance company. This may not always work in your favor. Thus, having an attorney who understands the medicine behind the treatment is in your best interest. Third, your injury may worsen. If you accept less than you deserve now, you may be sacrificing any chance of receiving compensation if the injury worsens in the future. Without understanding exactly how seriously you have been injured or how it will affect you in the future, you may be placing your physical and financial future in jeopardy.
Illinois Workers Compensation Claim Process
It can be very complicated, and if your employer is trying to dispute your claim or you have a dispute with the Illinois Workers’ Compensation Commission (IWCC)
In theory, the workers’ compensation process is relatively simple… The company you work for has purchased workers compensation insurance from a carrier. You report your injury, get treatment, make a claim, and get paid. In practice, it can be very complicated, and if your employer is trying to dispute your claim or you have a dispute with the Illinois Workers’ Compensation Commission (IWCC), you may have significant difficulty in getting compensation for your injury.
Reporting an Injury
If you suffer a workplace injury, you should report it as soon as possible to your employer If you are unable to report your injury immediately because you are unconscious or have to seek emergency medical care, or are simply unable to get in contact with them, you can report your injury to your employer within 45 days of the incident (or up to 90 days for radiological exposure). For occupational diseases, you should give notice as soon as possible after diagnosis.
In general, you have to get primary treatment for your workplace injuries at the care facility designated by your employer. The exception is if you need emergency care, in which case you are allowed to get it at the nearest facility or the one where you can get the most immediate care.
In Illinois, your employer cannot tell you which doctors to see. However, if your employer does have a Preferred Provider Program (PPP), you must choose a doctor from within the network or risk not getting workers’ compensation.
Filing a Claim
To file your claim, you must provide three copies of the Application for Adjustment of Claim and the Proof of Service. There are no fees to file the claim.
After your claim is filed, it will be assigned an arbitrator. Claims in Chicago are assigned to a different pool of arbitrators than those in the rest of Illinois. It remains your responsibility and that of your employer, to try to resolve the case.
It is your responsibility to prove that you are entitled to workers’ compensation benefits. The most common disputes include:
- Were you eligible for coverage at the time of the accident?
- Were you an employee when injured?
- Did you actually suffer an accident or exposure to occupational disease?
- Did the accident or exposure cause your injury or illness?
- Did you give notice to your employer about the injury or exposure?
We have experience helping workers overcome all these disputes.
Note: you can take payment for workers’ compensation benefits without limiting your rights to dispute findings. So can your employer. They may one day decide to deny a claim they’ve been paying and ask for repayment.
Every three months, you are given the option of moving your case to trial rather than continue negotiating with your employer over disputed benefits. Trials are conducted before an arbitrator, and decisions can be appealed if either party is unhappy with the outcome.
Your compensation will depend on the severity and type of your injury. In general, compensation is based on your average weekly wage before the injury and limited by the state’s average weekly wage figures.
How Much do Illinois Workers Receive in Workers Compensation?
Today, workers in the U.S. enjoy incredibly more job protection than workers did a few decades back. However, even today, filing a workers compensation is not as easy as one may think. Considering this, it would be good to know how Illinois workers compensation fees compare to other states.
Recently, the Workers Compensation Research Institute released a report on 2015 workers compensation fees in Illinois compared to other states’ fees and Medicare payment rates. The report provides useful information for both injured workers and anyone who wants to learn about workers compensation rates in Illinois. In this post, Chicago worker injury lawyer will discuss the key findings of this report.
Findings of the Workers Compensation Research Institute report
- Since July 2011, Illinois has moved down in the state rankings, however, the state still remains on the upper end of the spectrum
- The workers compensation fee schedule rates for the state workers varies wide according to the type of injury sustained and care needed
- In 2011, the average workers compensation schedule rates were 69 percent higher than Medicare rates over the same time period and for same medical services
Key workers compensation statistics
Workers who have been injured in the workplace have to deal with paperwork, bureaucracy and the laws surrounding workers compensation. All this can be extremely stressful, particularly when the worker is already struggling with his injuries.
Many workers are left wondering whether the rules were designed to help workers or be complicated enough to discourage common people from seeking workers compensation. Chicago workers compensation believes that it is important for workers to arm themselves with the best possible information when it comes to their rights. Studying the Workers Compensation Research Institute report can provide you with enough information.
The report is based on workers compensation fee schedules for common medical services from the State workers compensation commission. The report examined the services provided by hospital outpatient and ambulatory surgery center, Hospital inpatient services and professional medical services.
In simple language, the report states that the workers’ compensation benefits amount you receive in Illinois depends on the type of injury you have sustained. For example, for routine medical services, compensation fee rates are similar to standard medical rates. This means, workers hardly receive anything more than what would with basic Medicare coverage. However, when it comes to major surgeries, the rates were 339 percent more than Medicare rates.
For serious injuries as well, workers compensation rates are much higher than Medicare rates. In 2015, workers receiving outpatient services for shoulder and knee surgeries were 110 percent and 157 percent higher than Medicare rates for shoulder and knee surgery on average.
Third-Party Workers Compensation Claims
Filing a Lawsuit Against Accountable Parties In Addition to Receiving Workers’ Compensation
There are many instances in which an employee can be injured while on the job by a negligent third party. In such cases, the victim is able to receive workers’ compensation from his or her employer and may also see compensation from the negligent third party as well. Consider the following example: a truck driver is involved in an automobile accident with a negligent third party while making a delivery for his or her employer. The truck driver can obtain workers’ compensation from his or her employer and may further seek compensation from the negligent third party for other damages, such as pain and suffering.
What is Workers’ Compensation?
When a worker suffers from a work-related injury or develops a disease from his or her occupation, the employee may need to take time off to recover, but is still entitled to receive benefits and pay through workers’ compensation, regardless of fault. The Illinois Workers’ Compensation and Occupational Diseases Acts prescribes the rights and obligations for employees who have experienced work-related injuries or diseases, and also lays out the rights and obligations of the employers. The Act provides the following benefits to injured employees: medical care for the injury, temporary total disability benefits, temporary partial disability benefits during recovery if the employee is working light duty for less compensation, vocational rehabilitation for eligible programs, permanent partial disability benefits, permanent total disability benefits, and death benefits.
Under the law, the employer is responsible for the cost of workers’ compensation, and most employers opt to purchase workers’ compensation insurance for their employees. If an employee suffers an injury at work and reports that injury to his or her employer, yet the employer fails to pay enough benefits to the employee for the injury or fails to pay any benefit whatsoever, the employee may file a workers’ compensation claim with the Illinois Workers’ Compensation Commission, which is the State agency responsible for administering the judicial process to resolves workers’ compensation disputes between employees and employers.
Injured Employee Can Also Pursue A Negligence Claim Against Third Party
Even though an injured individual may be receiving workers’ compensation from his or her employer, he or she is still permitted to seek compensation from negligent third parties. The third party is not relieved of his or her accountability merely because the victim is already receiving some form of compensation for the accident from an employer. There may be damages from the accident that are not covered by workers’ compensation, and the victim is entitled to recover those damages from accountable third parties. A victim may seek damages such as pain and suffering, disability and disfigurement from the third party.
Contacting An Experienced Attorney
If you have been injured on the job and are in need of an experienced workers’ compensation attorney to resolve a disputed claim against your employer, or if you wish to seek personal injury damages from an accountable third party, you should contact the experienced attorneys at Willens & Baez today for a free consultation. We can be reached online or by telephone at (312) 957-4166.