Who will pay your medical expenses if you’re injured on the job?

Your employer or its insurance carrier is obligated by the Illinois Workers’ Compensation Act to pay all medical expenses that are reasonably required to relieve and cure you from the effects of the accidental injury.

Although not always but frequently, they may refuse to pay medical expenses because the claim is being denied.  In this case, the group health insurance carrier will accept responsibility and pay the bills, if:

  • You have group health insurance through your employer or through a spouse, and
  • The claim has been denied in writing.

You should, in those circumstances, present your group health insurance identification card when you see a healthcare provider if your claim has not been accepted by the workers’ compensation insurance carrier.

If your employer’s group health insurance carrier is used, and is contributed to in part by your employer, they will receive credit for the payments, if your case is eventually paid for by the work comp carrier.

This type of situation should be a signal to you that you need legal assistance to pursue this claim.  Even if you retain an attorney, you may end up receiving your medical care on your group health insurance until such time as you are able to return to work.  The only problem is that you will not be receiving weekly compensation benefits from the workers’ compensation carrier.

You may be entitled to receive short-term and/or long-term disability benefits from a plan you may have with your employer.

Such a scenario may reduce the pressure that’s placed on you by any denial from the workers’ compensation carrier, until such time as you have reached what is termed your maximum medical improvement.

The workers’ compensation system is not a do-it-yourself program.  It is governed by laws and rules, and you should seek counsel who is familiar with both the laws and the rules, and who has had sufficient experience experience representing injured workers.

Illinois Workers’ Compensation Act, Maximum Medical Improvement (MMI), Medical Care