Chicago Medical Provider Accused Of Fraudulent Billing

I’ve written a lot before that when it comes to your Illinois workers’ compensation claim, credibility is key. You need to be credible which means don’t embellish your injuries or change your story.  Tell the truth about how you got hurt even if it doesn’t seem like a perfect story.  Don’t get caught on surveillance video doing things that you told your doctor you can’t do. Basically don’t lie.  That’s simple enough, right?

The credibility of your lawyer also matters.  If they are known for filing bogus claims, you may be looked at as a faker too even if your claim is legit. Your are guilty by association.

You also need to have a credible doctor in your corner.  In most cases you need a medical doctor to state what your injuries are and how they are related to your job duties.  The insurance company will surely hire their own doctor to state that you either aren’t injured or weren’t hurt at work. If you don’t have a good doctor in your corner you could lose your case.

I mention this because a high volume medical provider, Marque Medicos of Chicago and other locations, was just accused of billing fraud in a lawsuit by Liberty Mutual insurance company.  See: http://cookcountyrecord.com/stories/510997776-liberty-mutual-accuses-back-clinic-marque-medicos-of-workers-comp-insurance-fraud-demands-17-million#.V7tVCtIIQsU.email.

This is an outfit known for treating a large amount of patients and in my opinion doesn’t have the best reputation.  This lawsuit kind of backs up my feelings as they are accused of billing for work not performed and other allegedly fraudulent billing practices.

Whether they are guilty of this or not, this suit will not help their reputation in the legal community and with Illinois Workers’ Compensation Commission Arbitrators.  Fair or not, it’s possible that some patients who have legitimate injuries and are getting real care from them will have their treatment looked at more closely and in a skeptical way as compared to patients getting treatment from clinics that don’t have these allegations.

There are plenty of other facilities that have a bad reputation too although this is the first time I can recall one of them getting sued. You can bet that if the lawsuit is successful, more claims will follow, especially if Liberty Mutual gets anywhere near the $17 million that they are asking for.

My advice to you as a patient of any doctor is to make sure that once a month you are getting a copy of your bill.  You want to make sure that it’s getting paid and if it isn’t you want to find out why not and/or have your attorney do what is necessary to get the bill paid so those treatments don’t come out of your pocket.  You should also, as this case shows, make sure that you are being charged for the treatment that you are actually receiving.  If a medical provider is doing one thing and then billing the insurance company for something else then it can be a sign that they aren’t the right facility for you.  If they get caught it can hurt them, but it can also hurt you.  And you have to look out for you.

If you have any questions about anything related to Illinois work comp law, call us at (312) 346-5578 or fill out the form to the right and we’ll call you ASAP.

Should The Insurance Company Pay Your Travel Costs To The Doctor?

A common question we get, especially from callers who are downstate or in more rural parts of Illinois is, “Should the insurance company pay me for mileage expense for going to and from the doctor?”

It’s a good question and it makes sense because if it wasn’t for the work related injury you wouldn’t have this additional expense.

Generally speaking though, you don ‘t get reimbursed for your gas expense for going to and from your doctor for an Illinois workers’ compensation claim. But like with many “generally speaking” rules, there are exceptions.

There is an exception if your employer is directing your medical care.  If you are going to a doctor of their choosing for an independent medical exam, not only do they have to pay you for your travel costs, they have to do so in advance and if they don’t, you do not have to go to the exam.

The more important scenario though is when you have to travel a great distance to see a doctor of your choosing.  To get compensated for mileage, you have to show that it’s “reasonably necessary” for you to travel outside your area to see a medical specialist who can help with your problem.  In other words, if you live in Chicago and have the choice of hundreds of doctors, it’s not reasonable for you to go to Rockford or Peoria to see a doctor.  You can do it and while the insurance company would have to pay your medical bills, they wouldn’t have to pay your travel costs.

On the other hand, if you live in Carbondale or Quincy or somewhere more remote and there isn’t a neurologist or pain management specialist or some other sort of needed doctor in your area, if you choose to drive to Springfield or St. Louis or some other area for treatment, it would likely be seen as reasonable and you should certainly fight for mileage reimbursement. We’d certainly do that for you because it can add up to a lot of money over time.

There’s one more exception that isn’t as obvious, but came up in a case which was decided in favor of the injured worker.  He was living in Mt. Vernon, but had always treated with a physician who was located in Wood River, Illinois which is just outside of St. Louis. That was approximately 90 miles away from his home. While there were other doctors in his area, he had been with this one for over seven years so the Court felt that it was reasonable for him to continue to go to this doctor after the work injury and awarded more than $1,500.00 in travel costs.

If you take anything away from this post it should be that it doesn’t hurt to ask and that every case is different so don’t just accept it if someone tells you that the law in every case is one thing.  That’s often not true and your unique situation should be looked at.  If you’d like us to do that for you, get in touch any time for a free consultation.

I’m One Of The 10 Best Work Comp Lawyers In Illinois (If I Pay $275)

I’ve said for a long time that there is no such thing as the “best” workers’ compensation lawyer in Illinois.  Instead you need to find the best lawyer for your case.  That is why we created a state wide network of experienced attorneys with the goal of our law firm getting you the right lawyer for you.  Just because one attorney was good for your cousin doesn’t mean that the same lawyer is the best fit for you.

Apparently I was wrong because I just got this:

It’s a letter from some bogus lawyer ranking group like you see in airline magazines and other places where they list the ten best doctors or ten best steak houses.  Now I don’t know if I was nominated by a client or fellow attorney as they list in their criteria, but I doubt that happened because I don’t know anyone who has heard of this organization.  I can tell you that their requirement that I have achieved the “highest degree of professional achievement” is b.s. because there is no way or measuring that nor is there a way to measure whether or not I have an “impeccable client satisfaction rating.”

So why do these things exist?  Two reasons.

  1. They can get lawyers who don’t know how to market themselves to get excited about this because they can now put on their website that they were chosen as a top 10 lawyer by an organization that sounds really official, but could just as easily be run by you, me or a teenager out of their garage.
  2.  This organization is trying to make money.  To be listed I have to complete their registration form and pay a $275 membership fee.  See below.

Of course if I do this I can be a big phony and claim that I’ve been selected to something that isn’t peer reviewed at all.  On the flip side it comes with a plaque and gets me discounts to Starbucks and The Red Roof Inn among other places.

This of course isn’t the only “Best Lawyer” list place out there.  There are a bunch of them as well as bogus lawyer rating websites.  To me they are all phony and only work because lawyers want to either feel special or mislead clients about their qualifications.

I think we are great because we are straight forward, experienced and treat anyone we talk to like a family member or friend.  There are plenty of great firms out there as well that you can choose from.  But if you are choosing them because you see they got an award on their website then you are making a bad decision.

If you want to talk about a case at any time for free call us at (312) 346-5578 or fill out our form to the top right of this page and we’ll call you.  We help everywhere in Illinois.

Chicago Work Comp Lawyer Allegedly Stole From Clients

It’s only allegations at this point so take this all as such.

I don’t get how a reputable, successful lawyer can one day just start stealing from or lying to clients, but that is what allegedly happened.  Chicago workers’ compensation lawyer, Joel Bell, was accused by the Illinois Attorney Registration and Disciplinary Commission (ARDC) recently of failing to deliver settlement money to his clients and using that money for his own personal use.

Bell isn’t someone I recommend, but he’s also not someone who I would have said before now is a bad lawyer.  Certainly there are many others who seem to do a much worse job than he does.  I had cases against him years ago when I started off as a defense attorney and I thought he did a good job.

He’s accused of taking amounts as low as $391 and as high as $95,000.00.  In all he’s accused of taking $364,000.00!  I don’t get how anyone could do this.  It’s not as if the clients are going to just go away or accept that the money was stolen.   Yet he’s accused of telling the son of a client that the money would be paid soon when he had already taken it for his own use.

While I’m not aware of his personal finances, this is a lawyer who had/has lots of clients.  He seemed to have a great career having been involved in thousands of cases.  These again are just allegations, but this is of course a huge red flag.

I’ve had people call me over the years and tell me that their settlement contracts were signed months ago, but they haven’t received anything yet.  They tell me that they think their attorney stole the money and I usually think that is crazy.  Because as a lawyer you’d have to be crazy to steal your client’s settlement.  Not only is it potentially a major felony, it could cost you your career and the chances of getting caught are very high.  Especially when you take large amounts like is alleged here.

It will be interesting to see where this goes, but it doesn’t look good.  As a FYI, once settlement contracts are submitted and approved by an Arbitrator, your lawyer usually receives the settlement check within 30 days.  One week after they get it they should be able to pay you.  If it takes months and you get nothing but excuses or no answers, you should probably file a complaint with the ARDC.  One of the reasons people like working with us through our state wide network is that we are more accountable and if for some reason a lawyer was pulling this type of nonsense, I can personally intervene and find out what is going on.

Does Your Lawyer Love What They Do?

Let’s be honest, no little boy or girl has ever written in school that when they grow up they dream of being an Illinois workers’ compensation attorney.  If they did they are quite odd.

This job certainly isn’t what I dreamed of as a child. But I quickly learned that there weren’t many six foot power forwards in the NBA so that dream went aside.

When I was in college and trying to figure out what to do with my life, one of the reasons that I went to law school was because a law degree gives you a lot of options. When I got to law school, a professor talked about how having a law degree gives you the ability to help people more than any degree out there.  That’s what clicked with me.

I’ve always loved helping others and have been volunteering my time since high school although it was really college when I picked up the volunteering bug.  Since then I’ve worked as a tutor at St. Joseph School in Cabrini Green, served meals at Inspiration Cafe and now with my family will regularly make meals and deliver them to the homeless.

I don’t say that to brag, I say it because a good lawyer has to want to help others.  While I didn’t know anything about injured workers as a kid, as an adult I know that I, and the state wide network I’ve created, can do a lot of good for those who need us.  Our job isn’t rocket science, but it does take some work.

I love the feeling of knowing that we solved a problem for someone. I love the feeling of competition when a case is being wrongfully denied or we know that we are on the right side of a contested issue. I get a rush from clients who write us notes offering their thanks. I love getting a settlement that makes a big financial difference in the life of someone who came to us broken.  I love knowing that we helped someone get healthy.  I love hearing that a client can pick up their kid for the first time in years because their back pain is gone.

And so while this job was not my childhood dream, I do LOVE it and that’s why we return phone calls in a timely manner, give honest advice and do what we can to win any case we are involved in.

You’ll know that your lawyer doesn’t love his job based on how he or she treats you.  If they do a good enough job there is good money in it for them.  If they are still miserable even though they are getting paid, it’s a red flag for you.  It may be a sign that you should switch lawyers.

If you want to talk to someone who LOVES what they do, call us at (312) 346-5578 or fill out our contact form and we’ll call you.  It’s free and confidential.

The Illinois Workers’ Compensation Commission Has Changed – For The Better

In June, former Illinois Workers’ Compensation Commission Arbitrator, Al Preibis, passed away at the age of 93.  He was the first Arbitrator who I ever appeared before and was affectionately known as “Big Al The Workingman’s Pal.” Before you went to trial on a case he had a speech that he gave to injured workers letting them know what was going to happen.  I can still after all of these years almost recite it word for word.

I started my career at a defense firm before I opened my own practice representing injured workers.  You knew back then that if the case was before Arbitrator Preibis (who I liked) that it favored the injured worker.

There were other Arbitrators back then who were known as equally friendly to insurance companies no matter how good the claim appeared.  Attorneys would settle the case for way less than what it was worth because they knew if they went to trial they could end up with nothing.

There were other characters that had been around for a while when I started practicing.  Some were sweet (Arbitrator Brown used to handle all the pro se settlements and was just a super nice guy who worked in to his 90’s), some were mean (one guy in particular you felt like you were in the Soup Nazi episode when you went before him) and some you just knew that if they were buddies with the lawyer you had no chance.

My favorite (and worst) memory is when I was trying a case and the Arbitrator fell asleep while the injured worker was testifying. I can only imagine what the worker was thinking as they were surely expecting more from the legal system only to look over and see the person in charge of their fate was snoring.  I know it made me question what I was doing with my life.

It’s not that there weren’t competent Arbitrators 20 years ago when I got started.  There were and some of them are still around.  It’s just that there were also a cast of old timers who basically did whatever they want.

I can’t guarantee you a result if you get hurt at work, but I can promise you that the Workers’ Comp Commission in Illinois is better, fairer and while not every Arbitrator is perfect, I do believe that in most cases you get a fair shot at justice which is really all that you can ask for.

So I raise a glass to the fond memory of Arbitrator Preibis.  He was a nice guy and quite the character.  And he certainly helped me get training to become a better attorney.

We LOVE helping injured workers in Illinois. If you want to discuss you situation, fill out our contact form to the right or call the number at the top of the page.  Our state wide network of attorneys helps everywhere in Illinois.

How I got started in Illinois workers’ compensation law

When you go to law school, you think you might have an idea of what you want to do with your degree, but the truth is that you have no clue.  Many of my classmates wanted to practice “environmental law” until they discovered that the only jobs that exist in that area are helping big corporations get away with polluting the environment.  The truth is that most people kind of fall in to their career.  When you are desperate for that first job, you’ll deal with any area of law that you are assigned to.  And once you get experience in that field you usually stick with it because otherwise you’d have to start at the bottom of the ladder at a new place.

Because of this, many attorneys are stuck in careers they hate, but they feel trapped.  That’s why you see such bad service at some firms.

I was fortunate in that during law school I got connected with a very good workers’ compensation firm that was run by fun lawyers who taught me a lot about the law and how to treat people.  I ended up working for them for a bit until I went out on my own.  They are still great friends of mine to this day.

But for me, the reason I was happy going in to Illinois work comp law wasn’t because I found a great place to work at.  I remember being a waiter at Bennigan’s in high school many years ago.  One day I was walking back to the kitchen and I slipped on the wet floor, landing hard on my back.  I was pretty invincible in my own mind up until that point, but suddenly I had throbbing pain.

What happened next was the general manager trying to screw me over.  I needed to go to the doctor right away, but he didn’t tell me that workers’ compensation was an option. I missed two weeks of work and wasn’t paid a penny.  It didn’t bother me then because I didn’t know any better.  I was lucky that I had insurance through my parents to get medical treatment and while I missed the money I was making, it wasn’t the end of the world as I didn’t have a family to support.

Years later though when I worked on my first few cases and learned the law, it occurred to me that I was really screwed over and it could have been worse if my injury dragged on or if I really needed the money.  My boss didn’t care at all about me, but instead was only worried about himself.  He would have received a negative review for any employees getting hurt.  That’s all he cared about which is why he never told me about my rights and options.

I was lucky, but I think of that experience any time I hear of a worker that is getting screwed over.  I can certainly relate to what they are going through and it motivates me to not let what happened to me happen to anyone else on a larger scale.  I haven’t gone through even close to what 99% of my callers and clients have dealt with, but I tasted it enough to really have the fire to help people.  And if that desire ever fades I’ll find something else to do.

Go To Your Doctor, Not Theirs!

If you get hurt while working in Illinois, your company has the right to send you to a company clinic.  One issue I’ve seen a lot this summer is that for whatever reason, injured workers are only treating at that clinic and it’s hurting their health.

As you can imagine, a company clinic makes a lot of money from the company.  If they keep the injured workers off of work, the company will look for a new medical facility that will say what they want them to say.  As a result, we constantly see these doctors sending severely injured employees back to work when they should be getting rest and treatment.

So what’s the solution?

It’s a simple one.  You do not have to treat at this company clinic even if the insurance company says they won’t pay for you to see your own doctor (that’s a lie). Under Illinois workers’ compensation law, you have a right to see a doctor of your choosing and treat with them.

If you have a serious injury it is really important that you exercise this right.  You need a physician who is unbiased telling you what is wrong with you and what treatment you need.  You need someone who will not send you back to work too early when that can make your injury much worse.

I can’t emphasize enough how important it is for your health that you don’t end up with one of their “hired guns” as your treating doctor.

Bonus tip. If you have a back, neck, leg or arm injury that goes beyond a strain, you should have your doctor refer you to an orthopedic doctor as those are the physicians who specialize in treating those injuries.  Company clinic doctors will often tell you that an x-ray is normal so you are fine.  The reality is that ligament injuries as well as herniated discs can only show up via an MRI and that is a common test which an orthopedic will order to determine what is truly wrong with you.

This is all true even (and especially) if your wish is to just be fine and get back to work. Too often a company doctor sends you back to work too soon and ends up making a mild injury one that results in months of lost time and a surgery when a few weeks of rest and physical therapy could have solved everything.

If you have any questions about this you can always call us for a free consultation at (312) 346-5578.

One Thing Leads To Another (And That Should Be Covered)

You should be glad that you can’t hear my terrible singing voice, but maybe you remember the song by The Fixx, “One thing leads to another.”

I thought of that after reading about a recent Illinois work comp case that was decided against the City of Chicago and in favor of an injured worker.  The original case was rather straight forward.  The worker, a lineman, injured his foot and as a result was given a CAM Walker boot and placed on limited duty.  Two months later while leaving his doctor’s office and still wearing the boot, he slipped on ice and fell, injuring his head.

The issue was could the injured worker prove that wearing the walking boot was at least a part of the reason why he fell.  He testified that it was his right foot that slipped and that was the foot with the boot.  He also testified that he was being extra careful due to the conditions, but the boot still slipped.

The Illinois Workers’ Compensation Commission felt that it was more likely that he could slip because of the boot so even though the original injury was to his foot, they awarded benefits for his injury to his head.

This is actually pretty well settled case law in Illinois. If your compensable work related injury leads to another injury or accident, that is all covered too.  The most common example we see is when someone who is on crutches for a leg injury ends up with an elbow or shoulder injury from using the crutches too much.

It’s also seen a lot with overuse situations. In other words, if you hurt your right arm and suddenly have to use your left arm for everything then when your left arm has an injury, that would be covered too.

The other really common example is similar to the case we discussed.  I can’t tell you how many injured workers have called me after falling at home.  It can be that a leg gave out or they had a shooting pain in their back that caused them to lose balance or their knee buckled.  If the reason for the fall traces back to a work related injury then the additional problems are covered under the Illinois Work Comp Act.

Just remember, if one thing leads to another, you win.

Is this confusing? It can be.  If you have any questions about this or anything else, fill out our contact form to the right or call the number at the top of the page. It’s always free and confidential and we help injured workers everywhere in Illinois.

You Won’t Get Punished For Being A Good Worker

While I know that insurance companies and not employers are usually the ones making the ridiculous denials of Illinois workers’ compensation cases, I’m still surprised when an employer goes along with it.

The most recent example was a case that was rightfully decided in favor of an injured worker.  A custodian at a school was instructed to move furniture, desks and other items from one side of a classroom to the other so the carpets could be cleaned.  After it was cleaned and dry, naturally the items had to be moved to the other side of the room so the other half of the carpet could be cleaned.

The custodian attempted to move a file cabinet with a dolly and while doing so he hurt his leg.  He denied being told not to move any of the heavy items, but two other custodians testified that they were instructed not to move the file cabinets.  In essence, the insurance company took a position that this worker was violating a safety rule when he got injured and took an unreasonable risk.  When you do that you are not performing your job duties and don’t get work comp benefits if you are hurt.

The Illinois Workers’ Compensation Commission saw through this nonsense and rightfully awarded benefits.  Their reasoning was common sense.  The custodian was clearly performing an activity that was for the benefit of his employer and in no way for his own benefit or convenience. He had been tasked with moving furniture in classrooms throughout the school so carpets could be cleaned. Even if he wasn’t asked to move the file cabinet, it was him trying to help that lead to him moving it.  You don’t get punished for being a good worker.

This is way different than him goofing off or not doing his job. If he rode the dolly like it was a vehicle or swung it around in a playful manner, that would be different and likely not a case.  This was just him doing his job as best he could.  In a country where so many don’t work hard are we going to punish those who have a good work ethic?

To me, it’s ridiculous that this case was fought, but this is the system you deal with as an injured worker. Obvious cases aren’t always accepted and even when cases are paid at first, they are always looking for a reason to cut you off.  Fortunately though the laws in our state mostly make sense and the Judges usually do a good job.  So it sucks that this guy had to go to trial, but the system did its job.

If you have questions about this post or any possible case, call us for free any time at 312-346-5578.  We help everywhere in Illinois.

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