The Illinois Worker’s Compensation Commission website is at IWCC.IL.gov. On the website, you will find in a menu, down the left side, that there is a handbook on Workers’ Compensation and Occupational Diseases. It’s in three different languages: English, Spanish and Polish. The handbook answers many questions about benefits and the workings of the Commission, and is available for download from any one of a number of websites. Here I will answer some of the unanswered questions.
Illinois’ workers’ compensation system basically provides three benefits for those injured or killed in the line of duty, and they include: TTD, or temporary total disability, payment of medical expenses—as long as they fall within the 2011 fee schedule—and vocational rehabilitation and maintenance benefits, in the event the injured worker cannot return to his former occupation. These benefits are supposed to be paid regardless of fault.
The Industrial Commission acts as an industrial court to resolve disputes between employers and employees that arise out of a line of duty injury, whether it’s a single accident, or what’s known as a repetitive trauma injury. Approximately 50,000 claims are filed each year, but only a far less number are reported as either lost time or non-lost time accidents, so obviously, there is much controversy involved in a great number of these 50,000 cases. Sometimes, this is due to the amount of compensation that may be due to the injured worker, but more often, the claims are disputed either because of the lack of an accident, denial of repetitive trauma, or any one of a number of other reasons, for which the Industrial Commission becomes the final answer. Even things as simple as paying weekly benefits or providing needed medical care are subjects of dispute.
The benefits that are proposed to be paid for by the employer include medical care and temporary total disability pay, known as TTD, while the employee is off work recovering from an injury. Fortunately, after February 1, 2006, an employee may be entitled to receive what’s called TPD, or temporary partial disability, if he is unable to work at full duty or eight hours a day, or he is paid at a lesser scale than the job previously paid, as long as he has not reached maximum medical improvement, which is known as MMI.
In addition to the above benefits for vocational rehabilitation, maintenance may be provided to an injured employee, and once he has reached maximum medical improvement and either returned to work or not, he might be entitled to receive permanent partial disability, known as PPD, as long as there is some residual disability to the employee as demonstrated typically by medical findings or the inability to perform at a previous level.
Finally, there are two remaining benefits. If the employee is rendered unable to return to any type of employment, he would be entitled to what’s known as PPD, or permanent partial disability. And for the employee that is killed in the line of duty, his family is entitled to death benefits for the surviving family members, as well as burial benefits.
The benefits an injured worker receives for lost time are not taxable income under either state or federal law and need not be reported on the return filed by the injured worker. These lost time benefits are typically paid by either the employer’s insurance company or through a third-party administrator that handles self-insured employers, or employers who have what’s known as retentions; in other words, deductibles under a bond issued by the state of Illinois.
Employers’ duties include the purchase of workers’ compensation insurance or permission to act as a self-insured from the Illinois Industrial Commission, posting a notice in the workplace that contains the information on who the workers’ compensation provider is and their contact information on a poster, which is provided by the Illinois industrial Commission. An employee may not be charged for workers’ compensation insurance, and they cannot harass or discharge an employee for exercising his or her rights under the Act.
Employees must report an injury within 45 days of the event, and specify the date and place of the accident. The notice can even either be given verbally or in writing. If the employer fails or refuses to pay either lost time or medical benefits, it would be wise for the injured employee to obtain the services of an experienced workers’ compensation attorney. This is especially true for accidents that have occurred after June 2011.
Once you hire an attorney, the entire matter of filing your claim with the industrial commission should be performed by him, and any matters relating to the nonpayment of benefits will be handled by him directly with the employer or the insurance carrier or third-party administrator, known as a TPA. An injured worker does not have to hire an attorney, but it should be kept in mind. In disputed cases, most employees and employers do hire attorneys.
An attorney may only charge a client 20% of the amounts that are obtained through the attorney’s efforts, and then, only if they are collected, the fee is called a contingent fee, and nothing is paid if nothing is recovered. The case of an employee who has a written offer is to never pay more than 20% of the entire matter; most attorneys will charge a percentage of the amount over the offer.
The state provides the forms for which claims are filed, called Applications for Adjustment of Claims, and also a form for attorney’s fees, which is called an Attorney Representation Agreement.
Disputes regarding benefits are handled first by an arbitrator at the Commission. This should never be attempted unless the injured worker has an attorney; the arbitrator cannot act as an attorney, and may advise the injured worker that he should obtain one.
There are provisions in the Workers’ Compensation Act for filing emergency petitions that become expedited in the case of denials by the employer.
If either party, the employer or the injured worker, is dissatisfied with the arbitrator’s decision, an appeal may be filed before the Illinois Industrial Commission within a specified period of time.
From a commission’s decision, an appeal may also be taken to the circuit court of the county in which the accident occurred, following that there is a third appeal, as a matter of right, to the appellate court of the state industrial commission division.
In the great majority of cases, disputes are handled by settlement agreements between the employer and the injured worker and his attorney. These settlement agreements must be approved by an arbitrator, a commissioner, or the chairman of the Industrial Commission. Settlement agreements typically will close out the injured workers’ future rights, unless the specific language included maintains certain rights, like the right to future medical care at the expense of the employer.
In the case of a hearing, the hearing officer will issue a decision. Once this decision becomes final and the employee does not enter into a settlement agreement based on that decision, the injured worker is entitled to medical care at the expense of the employer for his lifetime regarding the effects of the accidental injury occurred at work. He may also return to the commission within 30 months if his disability has returned and/or increased, but often both of these rights are waived in a settlement agreement. However, in the case of a decision payable for a wage differential, both parties’ rights will remain open until 60 months after the decision has become final.
There is a flowchart of dispute resolution process before the commission and through the court system. You can find this flowchart on page 13 of the industrial commission handbook. It indicates that a completely disputed case can take up to 1 to 5 years to resolve; some cases go back and forth several times.
Medical benefits for injured workers may include care that is reasonably necessary to cure or relieve the employee from the effects of the injury, including but not limited to: first-aid emergency care, doctor visits, hospital care, surgery, physical therapy, chiropractic treatment, pharmaceuticals, prosthetic devices, and prescribed medical appliances. Injured workers may choose who they would like to be treated by emergency care. First-aid is not included as a choice; however, the choice is limited to two physicians or any physicians to whom they refer you or recommend you to for further treatment, unless your accident occurred after 2011, and your company is involved in a Preferred Provider Program, known as a PPP. You will have two choices within that PPP; however, the PPP is considered your first choice if you decide to go outside that program, so you will have only one choice left.
Injured workers will be entitled to medical care at the expense of their employer as long as they did not exceed the specified number of choices. Doctors who provide services under the Workers’ Compensation Act are restricted by the fee schedule, which they accepted for payment of their bills, and you may not be subject to what is known as balance billed for any of the services.
It is always important to receive immediate medical care once you are injured, and I recommend patients go to the nearest emergency room, as opposed to being seen in an occupational clinic, where all of their complaints may not be listed in their history, and they may also not receive necessary diagnostic testing. Occupational doctors are typically cost-containment personnel, even though they bill for medical services.
Injured employees should never be required to give a recorded statement to the insurance company or third-party administrator. Recorded statements are used more often against the employee than in their favor. The other thing to look out for is the nurse case managers, who can be a two-edged sword, both assisting in arranging your medical care, as well as being a conduit to the claims person handling your case. Nurse case managers will ultimately want to be with you after you see the doctor, so that they can recommend to the doctor that you should return to work, at least on light duty, or that you have reached maximum medical improvement, and should be released to return to work. This by no means should suggest that nurse case managers are not helpful; in many cases, they can be.
This is by no means an exhaustive discussion of the intricacies of the Workers’ Compensation Act. Many other questions are answered in the Industrial Commission handbook. My goal here was to highlight on the ones that I feel are most important.