What your employer is supposed to do when you get hurt at work

A work injury should always be addressed sooner rather than later. For your part, this means getting medical attention right away. It can preserve your health, as well as a claim for benefits should you need them. You also need to notify your employer, and you should file a claim. As for your employer’s part, they need to file a Form 45 to report your injury.

Form 45 is called Employer’s First Report of Injury, and it requires them to list the details of what happened when you got hurt. It’s not an incredibly complicated form, yet many employers fail to fill one out. This is especially true in a small company that doesn’t have procedures in place to deal with workplace injuries and accidents.

Failure to fill out the form isn’t always an honest mistake, however. Some employers simply don’t care, or they don’t want an official record of your injury because they’re hoping to avoid a claim. If they don’t file this form and they say you didn’t tell them you got hurt, they can try to get your claim denied by the insurance company. The law requires you to give them notice within 45 days after an injury on the job. Form 45 is further proof that you have complied with this rule.

Even if you have a great employer, it doesn’t hurt to be extra cautious and document everything yourself. You never know. When giving notice to your employer of your injury, make a record. Send an e-mail, or write a letter (keeping a copy), that has the date and a brief explanation of what happened. Your notice doesn’t have to be overly formal, and it doesn’t have to be on an official form. Just make sure you give the notice and make a record of it. If you face the frustrating issue of your employer denying that there was notice, you’ll have proof.

Not all work injuries are catastrophic. Some injured workers think their injury is too minor to require going through any process or giving notice. They assume they won’t need medical benefits or payment for lost wages. Some people are embarrassed, or afraid of being fired if they make a big deal out of it. Notifying your employer is a small task, it can be done with a quick e-mail, and it could save your claim if you end up having one. As they say, it’s better to be safe than sorry.
 

Tags:

What a good lawyer can do for you

If you are feeling hesitant about hiring a lawyer, you aren’t the first. We talk to people all the time who are unsure of whether they really need legal help. The thing is, hiring a lawyer isn’t that big of a deal, and it can make a world of difference if you’ve been injured at work.

The immediate benefit you’ll get is answers to your questions from someone who knows what they’re doing and who has helped hundreds of injured workers before (make sure this is true of anyone you hire). All of the lawyers we work with share our philosophy of giving clients honest and straightforward answers.

Next, your lawyer will make sure your case is on track. There are deadlines to be aware of, and it’s your lawyer’s job to make sure those deadlines are met. Have you notified your employer? Filed a formal claim requesting benefits? Are you nearing the statute of limitations, after which you are no longer allowed to make a claim at all?

Your lawyer, if they have the experience we’re talking about, will know how the insurance company operates. They’ll know their common delay tactics, how they might attempt to deny your claim and what to expect from them when it’s time for settlement or even trial.

And speaking of trial, your attorney shouldn’t be afraid to go there if necessary. Many, many cases settle, with the injured worker taking a lump sum in exchange for ending their claim. But if the other side isn’t giving you what you’re entitled to, a good lawyer will have the experience and desire to take your case to trial (with your approval, of course).

And finally, a good lawyer will communicate with you throughout all of these steps. Their fee is set by law and is lower than the fees for most other types of injury cases. And you shouldn’t have to pay a fee on your regular benefits payments, only when your lawyer has to work to get you past benefits or a settlement, or a win at trial.

It’s fairly likely that your lawyer will have handled cases similar to yours, which puts you ahead of the game. Honestly, we can’t think of any good reason to not hire an attorney, unless your injury is minor. In our experience, workers who hire attorneys end up with larger settlements than those who go it alone.
 

Updated benefits rates for Illinois work injuries

The Illinois Workers’ Compensation Commission just released new minimum and maximum benefits rates, which they do twice a year. These are the upper and lower limits on the amount you get if you can’t work because of an injury.

You get wage loss benefits called Temporary Total Disability (TTD) if you can’t work while you recover. You also can get TTD if your doctor has given you restrictions and your employer doesn’t have any appropriate work for you. These checks are equal to 2/3 of your average weekly wage. If you earn $600 a week, you would get $400 a week according to Illinois workers’ compensation law. The exact amount varies from person to person, unless the minimum or maximum rate applies to you. 

If you are injured on or after July 15, 1014, the maximum TTD rate is $1,341.07. So, if 2/3 of your average weekly wage is more than that, you don’t get the full 2/3. The current minimum TTD rate is $220. The minimum increases if you have a spouse and children and can go up to $330. If you are below the minimum amount, you will get TTD based on what your actual weekly wages are.  If 2/3 is less than the minimum, then you get the minimum. The exception is that no matter your wage, the minimum for permanent total disability or death applies as the lowest you can receive.

Here is a list of the updated rates as of July 15, 2014:

Temporary Total Disability (TTD)
Maximum = $1,341.07
Minimum = $220.00 (up to $330 if spouse and children)

Permanent Partial Disability (PPD)
Maximum = (will be posted Jan. 2015)
Minimum = $220.00

State Average Weekly Wage
 = $1,005.80.

Permanent Total Disability (PTD)
Maximum = $1,341.07
Minimum =  $502.90

Mileage Rate = $0.56

The mileage rate is what you get if you have to travel to see one of the insurance company doctors, for an IME for example. They need to send you a check for the mileage amount ahead of time. If the insurance company doesn’t pay you, then you don’t have to attend the exam.

It’s important to make sure your average weekly wage is correctly calculated and that you are getting full benefits under Illinois law. Don’t rely on your employer’s calculation or even that of the insurance company. Talk to an experienced Illinois workers’ compensation attorney who knows wage calculations and is familiar with the ways in which insurance companies attempt to get away with paying less than they should.

Tags:

A sure sign your case isn't going to trial

Illinois workers’ compensation claims get denied all of the time for the most ridiculous reasons or often without a reason at all.
 
When your case is denied, you have no choice other than getting a lawyer.  If they know what they are doing they will get your case ready for trial which usually means subpoenaing all of your medical records and possibly taking a deposition of your treating doctor.
 
Once that happens the case can go to trial (with the exception being if there was an IME and we need to take that doctor’s deposition). This stuff isn’t rocket science.  Sure, occasionally you have to arrange a witness to attend or have other issues to address, but if you aren’t being paid your benefits, this is what happens.
 
I am writing this post though because recently I got a call from an injured worker who hurt her back after a day of heavy lifting.  It’s a pretty straight forward case on paper.  She has no history of ever treating with a doctor for back trouble.  She went to work and lifted items for four plus hours and at the end of the day she had terrible back pain and told her supervisor about it.  The next morning she couldn’t move so she went to the doctor.  Her doctor stated that she has a work related back injury.
 
The insurance company denied the case because there was no specific injury.  That of course does not matter because back injuries as the result of repetitive lifting are covered under the Illinois Workers’ Compensation Act.
 
My caller called a lawyer which was a good decision.  The lawyer filed a 19(b) petition which is a request for an immediate hearing and the right thing to do.  A trial date was set.  That’s when it got weird.
 
According to the caller, her lawyer said she doesn’t have to show up for the trial.  Uhm, that means the case isn’t going to trial because if the injured worker isn’t there then there is no case at all.  You as the injured worker will always be the first witness as it’s your job to paint a picture for the Arbitrator as to what happened to you.  Nobody can do that but you.  A lawyer isn’t allowed to testify on your behalf.  An Arbitrator needs to judge your credibility and the defense attorney is allowed to ask you questions.
 
The caller insisted that her attorney told her a trial would happen without her.  Again, that’s possible.  I think he probably meant to say that the case was not ready for trial yet, but they got a court date to put pressure on the insurance company.  Sometimes that happens because it forces the other side to agree to deposition dates.  When they are in the wrong they will often delay.
 
Nobody is more important to the result of any case other than the person that was hurt.  What I told this caller is that she needs to get back in touch with her attorney.  And quite honestly, even if I knew the case wouldn’t go to trial that day, I’d still want you there so we can discuss the case together. It’s also not unheard of for you to give your testimony and then for the lawyers to complete the doctor’s depositions at a later date.  This is your case and your life.  Not having you at the hearing location is a mistake.

When lawyers lie and can't back it up

We were recently contacted by an over the road truck driver who is based out of Georgia, but hurt in an accident in Illinois. Since it happened downstate we referred him to a lawyer down there that has a great track record and in my opinion gives him the best chance for a good result. He also has a long history of success working with truck drivers.

What makes this case a bit different is that before he contacted me the injured worker called and hired a law firm in his town in Georgia. His wages are pretty high, but apparently down in GA the weekly TTD benefit checks are capped at a little over $500. He asked his lawyer if he could get higher benefits in Illinois and was told that he could not.

That was lie number one. While we do have a weekly cap, it’s more than double what it is in GA. Fortunately this man was smart enough to not take his lawyer’s word for it when it came to legal advice in a state he isn’t licensed in. I let him know that in Illinois he could get higher benefits and the fact that he filed a case in his home state doesn’t prevent him from filing here.

I then referred him to the downstate lawyer who had a few conversations with him. The worker is a very smart guy and realizes that he stands to immediately get a higher benefit in IL for TTD payments, both retroactively and in the future. But he was hesitant to switch his case here for one reason. He asked us how much the settlement might be and we told him we weren’t sure yet because he’s still treating and we don’t know what the ultimate outcome will be. He then relayed that his current lawyer told him that the case was worth $150,000.00.

Well, that was lie number two. My partner advised him to go back to the lawyer and demonstrate how he arrived at that figure. He did and of course the attorney couldn’t back up his bravado. We see that in Chicago all of the time where firms will tell you what you want to hear instead of the truth. They expect you to be dazzled by the big numbers and not question the process itself. It must work because it happens time and time again.

The GA lawyer may have told a third lie because he told the client it was important to go to a hearing ASAP. I’m not licensed in Georgia so perhaps it’s true, but when a client is receiving all of their medical and lost time benefits, the only reason to go to a hearing is to lock the case for a lawyer who is trying to earn a fee.

I have always operated under the theory of do what’s best for the client and things will work out, even if we don’t make a penny on the case. Often that means helping you realize that your current representation is doing a great job. Other times it means telling you the hard truth even if it will turn you off and make you look elsewhere for representation.

This liar will live to see another day and b.s. other clients. But I wonder if he ever thinks that his business and karma would be so much better if he was just honest.

Tags:

Is your workers' compensation lawyer hurting you?

A Chicago work comp defense attorney I am friendly with shared the following snippet from an e-mail she got from a lawyer on a case she is defending:


Petitioner is recommended surgery and yes you will pay it because I will visit justice upon your client.  While you consider this email and remain aghast at its utter bravado I'll retire to east bank club pool to savor another impending victory over your firm.

For lack of a better term, the lawyer representing this injured worker appears to be an utter douche bag.  I had never heard of him so I looked him up and noticed that he’s only been licensed to practice for less than three years and has his own firm.  That leads me to believe that he was never properly trained on how to handle a case or communicate like a professional.  That’s not to say that a younger lawyer can’t successfully handle a case, but in this matter he’s doing it in a way that will not only harm the current client, but future clients.
 
If we represent you, our job is to look out for you and not be buddies with the defense law firm.  But pissing them off by acting like a jerk is not going to make them suddenly turn reasonable.  Think of your own life experiences.  When someone puts you on the defensive with their actions, it makes you defensive right back to them.  The last thing that will happen in this case is for the insurance company to roll over and pay for a surgery because someone is acting arrogant.  In fact, if it’s a close call it will be the motivation needed for them to deny the case altogether.
 
And this doesn’t just hurt the current client who appears to be badly injured, it will hurt his future clients.  This e-mail is being passed around because it’s so ridiculous.  As a result the lawyer is going to get a bad reputation.  So the next time he has a case with this defense firm or anyone else that has seen it, they are going to have a biased view of the case and the innocent worker is going to suffer.
 
Clients want lawyers that show they are fighting for them, but this type of letter is actually harming them. There are so many better ways to write this, mainly to lay out the supporting evidence, file a trial motion and petition for penalties (which actually requires the insurance company to respond to you with their reasons for denying the case) and follow up with a phone call.  Attaching a medical report that supports your position would help too.  That’s actual toughness because it shows that you have a strong case and will go to court with evidence that will punish them for not doing what they are supposed to do under the law.
 
I’ll give this younger attorney a pass personally.  Maybe he was having a bad day or maybe he just doesn’t know any better.  But he looks like an ass and certainly is not anyone I’d recommend to represent anyone that I cared about.
 
As a client you can protect yourself by simply asking your attorney to cc you (or blind carbon copy) on any correspondence that they are sending.  They should feel great about this because it can prove to you that they are actually trying to get stuff done on your case.  And if they don’t want to do it, it may be a sign that they are doing nothing at all.

Illinois work comp: When a "voluntary" event isn't really voluntary

There are many companies that have summer events to try and boost morale or simply reward workers for a job well done.  That is a good thing of course.  Most of these events are voluntary which means that if you don’t go that is your prerogative and it won’t affect your employment in any way.  You know it’s voluntary if it doesn’t cost you any pay or retaliation if you don’t go.
 
If you do go to the company picnic or other event this summer and get hurt somehow (you’d be stunned by the number of people that call me who were hurt in a friendly game of volleyball) then it’s not covered under Illinois work comp laws if it’s truly a voluntary event.
 
But what happens sometimes is that you are told that it’s not mandatory for you to attend, but you and everyone else at the company knows that is not true.
 
Case in point, I was recently called by a nice man who was asked by his boss if he wanted to go on the company paintball outing.  He didn’t want to go, but had a built in excuse of having a doctor’s appointment. The higher ups sent out an e-mail about the event and said it was voluntary.  But his direct boss didn’t feel that way and asked him multiple times to change the doctor’s appointment, letting him know that it would be “good for his career” if he attended.
 
That doesn’t feel like an optional event to me.  It’s not a slam dunk case by any means.  If he would have been docked pay, demoted or fired for missing then it would be a no-brainer.  That said, it certainly sounds to me like this was not an optional event for him, especially when his boss asks him multiple times to go and tells him it would help his career.
 
So he did go and badly injured his knee, tearing his ACL.  The case has been denied by the insurance company because the higher ups said it was voluntary.
 
He may win his case, he may not.  But this case shows that you have to look deeper as to what’s really going on to make a proper analysis as to whether or not there is a case.  This case, like many others, is not black and white.  It’s not much different when your employer says you are an independent contractor, but treats you like a true employee in every way.
 
So my advice to you is no matter what your case is about, don’t take the insurance company’s word for it when they tell you that you have no case.   Talk to someone independent – we will always talk with you for free and in confidence – and get a true, full analysis. It might not mean you have a case, but you’ll know for sure.

Is your union telling you which workers' compensation lawyer to hire?

There is no special skill required to represent a member of a union who is hurt on the job as compared to a regular employee who is hurt on the job.  This is especially true if you have real experience in representing injured workers.  Once you’ve represented one City of Chicago employee, you know that they will be sent to Mercy Works for care by the City for their initial treatment.  If you get a call from a United Airlines flight attendant or pilot, you should know that their contract allows them to bring a case in Illinois no matter where they are based out of or where their injury took place.
 
None of this is rocket science and there are many other examples we could give.
 
Yet there are unions out there that are overly aggressive as to who their members should hire and even worse, don’t make the recommendations based on the quality of the lawyers.
 
That’s not to say that some of the firms they recommend don’t do a good job, but if part of the reason you are suggesting a firm is because they took you to a Bears game or golfing or to Vegas or gave you a flat screen TV for Christmas or will take you to the nicest steak house in town whenever you want or got you a stripper (and yes these are all things I have been told about) then something is wrong.
 
It’s a rather open secret that the firms on the preferred lists at many unions get there or stay there because they do this sort of entertaining which is a disguised as a “get to know you” type of event.  It’s one thing to take someone to dinner and talk about your business.  It’s something else to give away trips or merchandise or even cash which are motivation to make someone recommend you and illegal under Illinois law which prevents an attorney from providing a non-lawyer with compensation in exchange for a referral.
 
I know this behavior will never stop just as I know that politicians will never stop getting arrested for taking kickbacks either, at least not in Illinois.  But you as the injured worker, the only one that really matters, need to look out for yourself.  I don’t say this as a plea to get you to hire me or anyone in my network.  It just makes me cringe when people get rewarded for unethical behavior and it’s worse when a worker suffers as a result.
 
When a caller to my office tells me that the lawyer they are working with is terrible, the first thing I ask is “how did you decide to hire them in the first place?”  If they tell me the union told them to do it, I ask if they’ve asked the union’s help in getting better results with the case.  More than half the time the answer is yes, but not one time has anyone told me that the union rep who made the recommendation was willing to intervene.  The most common answer I hear is that they are told that it’s not their problem.
 
Of course the complaints by the union members don’t impact who gets recommended in the future.  In one recent case, the union recommended a Chicago firm for a claim in southern Illinois.  The worker that called me was upset because it’s been over a year since he was told that the case would go to trial and it hasn’t.  Of course the reason is because nobody from the Chicago firm wants to drive five hours to take a case to trial.
 
So it’s up to you to figure out why a firm is being recommended.  If you ask me why I’m suggesting someone for you, I’ll tell you and the answers will be because it’s in your best interests.  But don’t take my word for it or the union or anyone else.  Get a recommendation from the union, from me and from another source and interview all three.  Let that decide who is best for you.  What is their service like?  Are they rushing you off the phone?  Have they handled similar cases?  How much work do they handle in your area?
 
No matter the issue, nobody should look out for you more than you.  If you don’t then you should not be surprised when things don’t go your way.

Sometimes you just have a bad attorney

We are a unique Illinois workers’ compensation law firm in that we’ve created a statewide network of like minded attorneys that fight for their clients and get good results.  This doesn’t guarantee you anything, but having someone experienced in your corner can only help.
 
If you already have a lawyer and it’s not going well, we’ll talk to you about why and hopefully help you salvage that relationship.  If you need to switch law firms, that happens all of the time and we’ll talk to you about taking over the case.
 
When you do switch, it should be to get the case on the right track and have confidence that you are giving yourself the best chance for a good result.
 
I was recently talking to a downstate lawyer we work with.  He had settled a case that we referred to him for approximately $150,000.00 which is a lot of money for a work injury.  When the client came to me, he had an attorney and his benefits had been denied.
 
The attorney that took over the case told me that there was nothing wrong with the client or the case. “Sometimes they just have a bad attorney” he said to me.  That sounds so simple to say, but is so true.
 
If you do have representation that doesn’t know what they are doing, the insurance company will walk all over them.  If they are just lazy, they’ll never put the work in that’s needed to get you the result you deserve.  Most attorneys in Illinois do a good enough job in my opinion, but some of course do not.
 
You can’t know if you’ve hired a bad one until you are working with them or more correctly stated, seeing them not work for you.  In this case, we and the worker were lucky that he came to us before it was too late.
 
The bottom line is that if you do have a bad attorney then you need to get a good one.  Like I said, that doesn’t guarantee anything, but at least it gives you the best chance of winning.

Tripping on a cracked sidewalk can be a work injury

An Illinois court of appeals awarded workers’ compensation to a woman who tripped on a cracked sidewalk on her way into work. She was a county employee, entering the county courthouse after a work meeting elsewhere. The door she normally entered through was locked, and she was on her way to the front steps of the building when she tripped and fell on a cracked sidewalk. She was wearing heels, and one of them caught in the broken and cracked sidewalk. The employee fractured her wrist and developed a condition that later required a fusion of the wrist.

The arbitrator in the case, as well as the Illinois Workers’ Compensation Commission and the circuit court, ruled that the wrist injury was not related to her employment for purposes of workers’ compensation and benefits were denied. The appellate court disagreed, and she ultimately received workers’ compensation benefits for her injury.

In order to fall under workers’ compensation, an injury must arise out of and in the course of one’s employment. For an injury like this one, the question becomes whether her employment put her at a greater risk than the general public. If your risk as an employee is no greater than the risk faced by the general population, it’s not going to be considered a work injury.

The arbitrator and lower court said she was at no greater risk for tripping and falling than the general public, and therefore it was not a work injury. The appeals court, however, said she was at a greater risk and labeled the sidewalk condition a “special hazard.” The court said the employee was entering the building because of her work, and using that entrance because the usual employee entrance was locked. Her risk was greater than the general public because she had to attend meetings at another location and she was therefore exposed to this special hazard because of her job.

Had this employee tripped over her own feet, the case likely would have been different. However, it’s difficult to know what other circumstances might have arisen under another set of facts. The point is that each case is different. You have the general rule, which is usually fairly set and certain. However, when you apply that rule to a specific instance or injury, it becomes much more complex.

Don’t assume your injury isn’t a work injury because you weren’t doing your specific job duties when you were hurt, or because you weren’t at your place of employment when you were hurt, or because of any other reason. Many times, the outcome is not what you might think. Talk to an experienced Illinois workers’ compensation attorney.  We are always happy to speak with you for free and in confidence.
 

Falling during work while running out to your car

We talk to a lot of people about parking lot injuries at work and whether they’re covered under Illinois workers’ compensation law. It tends to be a grey area. The law says that injuries that arise out of and in the course of employment are covered. When an employee is hurt in the parking lot, it raises the issue of whether it falls into those categories. The basic question is whether the injury is related – or related enough – to the individual’s employment. Injuries that are completely unrelated are not covered under Illinois law.

We recently heard of a case where an employee was given permission to run out to her car and grab her sweater. It was raining and the lot was wet. She slipped and fell on her way back in. Does it count as a work injury?

We believe that it does. In parking lot cases, one consideration is whether the lot is owned and operated or maintained by the employer. Also, it matters whether the employees are told where to park. The gist is that the more involved the employer is in the parking situation, the more likely it is that an injury is going to be considered work related. In this case, the employer did own and maintain the lot and told employees to park there.

Another important aspect is something called the personal comfort rule. When you do something at work for your own comfort – a trip to the bathroom, a walk to the vending machine – it doesn’t mean you completely step outside of your employment. This might apply to the employee who went out to her car to get her sweater. Just because she wasn’t performing an official job duty doesn’t mean her injury didn’t relate to her employment.

When an injury is in a grey area like this, the employer and their insurance company see an opportunity to save money and deny the claim for benefits. It’s your lawyer’s job to argue otherwise. If your claim is denied, you can bring your case before an arbitrator and ask them to make a final decision on the matter.
 

Teachers: How to calculate your average weekly wage

If you are injured on the job and unable to work as a result, you can qualify for temporary total disability benefits. These benefits are checks for 2/3 of your usual pay. The way they are calculated is by determining your “average weekly wage” and then paying you 2/3 of that amount.

The calculation of your average weekly wage (AWW) is important, since it’s the basis for determining the amount of your disability benefits. If the insurance company comes up with an AWW that is low, then you are missing out on benefits. It can really add up over the weeks, and maybe months, that you are out of work recovering.

There are a couple of different ways to calculate an employee’s AWW in Illinois. For someone working full time, year-round, with an annual salary, you basically take their salary and divide by 52. (There might be issues that affect this formula, but it’s the basic idea.)

The issue for teachers is that they often work fewer than 52 weeks. Their salary is based on the school year – 40 weeks, for example. Yet, many opt to get their pay spread out over 52 weeks. So do you divide their salary by 52 or 40? It makes a big difference.

Illinois law favors the employees in these situations. It says that you divide the total earnings (salary) by the actual time worked. For most teachers, this is the school year. For example, if we are talking about a teacher whose contract requires them to work 40 weeks of the year and who earns $40,000. Their average weekly wage ($40k divided by 40) is $1000. Even if they don’t actually get paid $1,000/week because they opt to be paid over 52 weeks, this is the correct calculation for benefits.

If the $40k is divided by 52, then the teacher’s average weekly wage drops to approximately $770. This calculation is incorrect, but it’s often up to the employee and their attorney to catch the mistake.

The same rule applies to seasonal workers and potentially others who didn’t work the whole year before their injury. Even if you just took a few weeks of unpaid vacation or leave, look into how it affects your AWW calculation. You could be leaving a lot of money on the table, especially if you end up getting temporary total disability payments for an extended period of time.

 

Tags:

The risks of your employment might not be obvious

If someone asked you to name the health risks of being a cashier, you’d probably name the physical injuries that can come from standing for long periods of time, or using a cash register all day long, or repeatedly bagging customer purchases.

The fact that a cashier might be at risk for an injury caused by an out-of-control vehicle smashing into the store probably doesn’t come to mind. But that’s what happened in a recent workers’ compensation case. The question was whether the cashier had suffered a work injury under Illinois workers’ compensation law and would be entitled to benefits.

The legal issue is whether the injury was related to her job as cashier. The rule is that injuries that could happen just as easily to any member of the general public at any time don’t count as work injuries (for purposes of getting workers’ compensation). So was the cashier at greater risk for getting hit by a runaway car because of her job?

The cashier won her case and it was determined that she was at a greater risk than members of the general public for that type of injury. The reason was because she was required to stand in the front of the store for most of her time at work and the front wall of the store was a large glass window. 

These cases tend to be very fact specific. While the law is important, it really comes down to the situation of each injury and each employee. Examples where employees were not eligible for benefits include falling on gravel in the parking lot, tripping for no apparent reason, and bending over to pick something up. In these cases, no compensation was awarded because the arbitrator or commission determined that the employee was at no greater risk than the general public when it came to their specific injuries. That said, there are situations in which these cases would be compensable. A single detail can make a big difference.

The bottom line is that you can’t rely on the general rule when determining whether workers’ compensation should be awarded in a particular case. There are so many exceptions and nuances. Honestly, it’s what makes our job interesting. And it’s also one reason why the help of a good Illinois attorney can turn your case around.

 

You have recourse if the insurance company acts in bad faith

Insurance companies aren’t known for being easy to work with, or helpful to those seeking coverage, or honest and straightforward when explaining what you’re entitled to or how it all works. And that really stinks for an injured employee. You’re basically on your own. Actually, it’s worse than being on your own because the other side (the insurance company) is literally working against you.

The good news is that Illinois law allows you to punish bad behavior by seeking penalties, which is extra money they have to pay you on top of any benefits you are owed. Two sections of the Illinois Workers’ Compensation Act provide for penalties to injured workers when the party responsible for paying benefits denies them unreasonably. So if your TTD benefits aren’t getting paid, or your medical bills aren’t getting covered, and there is no good reason for withholding those benefits, you can file a petition for penalties.

In a recent case, an injured employee wasn’t getting the TTD payments he was entitled to. There was no written notice of the denial as required, and the worker had to repeatedly file petitions to try and get compensation. And when the worker finally filed a petition for penalties, the defendant didn’t even respond, even after the arbitrator gave them more time to do so. What’s most important is that the defendant’s arguments as to why benefits were withheld had no merit. So there was no excuse.

In that case, the defendant was ordered to pay 77 weeks of TTD, plus about $16,500 in penalties and a couple thousand more in attorney fees. So the injured worker got the payments he should have received all along, plus penalties.

Penalties aren’t appropriate in every case, because not every case is that blatant. For all the stuff in the gray area – low-ball settlement offers, horning in on your medical treatment, and all the other ways they try to save money on your claim – get a lawyer. Not only will an experienced Illinois workers’ compensation attorney know how to play the game in your favor, but the insurance company will know that they won’t be able to get away with all their little tricks.
 

Employee gets benefits despite eight-month delay in getting treatment

We always say that you shouldn’t delay after a work injury. Don’t delay in getting medical treatment. Don’t delay in reporting your injury to your employer. And don’t delay in filing a claim. We still believe all these things, but want to point out that if you do delay, don’t assume you’re out of luck. In a recent Illinois workers’ compensation case, an injured employee waited a long time before seeking benefits for his work injury. And he won.

The guy worked for a packing company, loading and wrapping pallets of shrimp. He had to reach overhead to wrap the pallets in plastic. One day he felt a pulling sensation and pain in his shoulder while doing this work. That was in March. He continued to work, even as the injury worsened, until December when he finally sought compensation.

It’s not surprising that they tried to deny his claim due to the lapse in time. When a lot of time goes by, the question becomes whether it’s truly work related. The connection is harder to prove. The employer or insurer will argue that it happened outside of work while the employee was doing something unrelated. And if there’s no accident report or witnesses who remember, you can lose.

In this case, however, the guy self-medicated during the eight months and was unaware that he could file a claim for benefits. Apparently, this was enough to justify his delay in seeking treatment. Also, his doctor and the doctor for the other side both attributed his injury to his work duties, which is very important to any case.

His doctor recommended physical therapy, which didn’t work. The next step was surgery, and the arbitrator ruled that it should be covered. The guy’s credibility seemed to matter a lot, which is true in our experience, as well. So while we would never recommend waiting eight months, if you have waited, you might still have a valid claim.

Illinois law entitles injured workers to full coverage of their medical bills, as well as payment for a portion of lost wages if they are out of work while they recover. If you need surgery or are unable to work, these benefits can make all the difference. If the insurance company or your employer tells you that you aren’t eligible, get a second opinion from an experienced Illinois workers’ compensation attorney.
 

Tags: