There are lots of insurance company tricks out there as well as bad employers who will lie to you.
An example of this came up recently with a gentleman that I consulted with on an accident. He didn’t need the help of me or any lawyer in my network because fortunately his injuries were very minor. His normal job involves working on an assembly line. He took a break and went to the locker room to relax for ten minutes. As he got up, he stumbled on some loose carpet and reached out to catch his fall. In the process he cut his hand.
The good news is that it could have been much worse. As he was telling the story, I assumed that he was going to tell me that he tore his rotator cuff or hurt his back because we see that a lot when it comes to these types of accidents. So fortunately there wasn’t much of an injury. The bad news is that when he asked to go to the hospital they said no because he wasn’t hurt while working, as if that should matter when it comes to his health.
But the reality is that even though his job duties don’t involve being in the locker room, it’s reasonably expected that he will go in there so any accident that happens there is covered under workers’ compensation laws in Illinois.
I’ve seen similar nonsense with insurance companies telling workers that since they weren’t doing their normal job, they aren’t covered. That’s pure baloney. If your normal job is to sit behind a desk and the boss tells you to go make a delivery, well then you better do what the boss says or you’ll get fired. So if you get hurt while doing what the boss says to do, you receive Illinois workers’ compensation benefits.
The exception to this is if you are engaged in horseplay. For example, if your company has a golf cart at the warehouse and you go for a joy ride in it and crash, that wouldn’t be a work comp case that we could win for you. But if you are operating it normally and it’s for the benefit of your employer then any injury you get would be covered.
In this case, the break the worker took is for his benefit, but also for that of the employer as it allows him to work better when he returns to the line. He did end up going to the ER and just wants his bill paid. He hasn’t actually talked to the insurance company yet, so I’m optimistic that will happen.
But don’t let anyone tell you that you have no case or can’t make a case, especially when that result benefits them, not you. Talk to a lawyer. It’s free and will help you make an educated decision or in this case, figure out what you can do on your own to get the benefits you are entitled to.
There are lots of insurance company tricks out there as well as bad employers who will lie to you.
A serious work injury is impossible to predict, and if it happens to you, it can seem like there are a million unknowns. What happens from the time of your injury, legally speaking, can differ based on your particular circumstances, but there is a general timeline of a typical workers’ compensation claim.
Work injury. A slip and fall, or something more serious, is usually the start of a workers’ compensation case. Whether it’s a sudden injury or something that develops over time, you shouldn’t just wait it out. One of the best things you can do, aside from seeking medical treatment, is to be proactive about your claim for benefits. Gather all the information you can.
Medical treatment. If your injury is sudden and severe, medical treatment is a given. But even if it seems like you might be able to work through it, go see a doctor if there’s any doubt. An injury can worsen quickly. If you wait, things might get worse. You could put your health, and a potential claim for benefits, at risk.
Notification deadline. You have to notify your employer of your work injury within 45 days of the date of the injury. If your condition or injury doesn’t have a specific date on which it occurred, then your deadline is 45 days from the date you knew your injury was work related.
Talk to an attorney. There’s no such thing as doing this too soon, especially if your injury is serious. If you’re unsure of whether you need legal help, at least get a free consultation and get all of your questions answered.
File a claim for benefits. You might start getting benefits regardless, but make sure to get this paperwork filed in case a problem comes up down the road and you need to request a hearing with an arbitrator. The form is called an Application for Adjustment of Claim and is filed with the Illinois Workers’ Compensation Commission.
Your arbitrator. Every claim is assigned to an arbitrator, who acts like a judge in your case. They will put your case on their docket regularly for status hearings to monitor any progress. If there is a dispute in your case, the arbitrator will make a decision after a hearing. They’ll also oversee your trial if you have one.
Your benefits. Ideally, you should start getting benefits fairly quickly. Temporary Total Disability benefits are available four days after you get hurt and you can expect TTD checks every two weeks. These are if you are unable to work. Your medical benefits should start right away, and you should be covered 100%. This includes doctor visits, medication, tests and even surgery.
Status call. These usually happen every three months to monitor the progress of your claim. If your case is moving along normally, then nothing much will happen and your case will be put on the calendar for another three months. If you want a trial, your attorney can request one at your status hearing.
Hearings on a dispute. As we mentioned, your attorney can request a hearing if there is a dispute in your case. A common reason is because benefits aren’t being paid. Your attorney will argue that you are entitled to benefits and hopefully the insurance company will be forced to pay.
Settlement. The majority of workers’ compensation claims in Illinois settle at the end. This means that you receive a lump sum in exchange for ending your case (no more benefits in the future). It’s important to understand what rights you are giving up in a settlement. It’s also important to go through this process with an attorney who understands the value of your case. You won’t get a second chance.
Trial. If a settlement agreement can’t be reached, the case can go to trial. Attorneys for both sides will present their cases, and the arbitrator will make a final decision. Make sure your attorney is willing to take your case this far if it’s necessary in order to get you a fair outcome.
Lawyers aren’t always good at explaining the big picture to clients or letting them know what to expect step by step. We try our best to give straightforward information to people. We hope this answers your questions, but if it doesn’t, just give us a call.
These two types of injury cases often get confused. They are different areas of law for the most part. But it’s worth knowing the differences, because if you don’t have a valid workers’ compensation claim, you might be able to pursue a personal injury lawsuit instead. One main difference between the two is how you prove your case. In a work injury situation, you have to prove that your injury arose out of and in the course of your employment. In other words, you have to show that it was job related. If you can do this, you should be entitled to benefits. You don’t have to prove that anyone was at fault or caused your injury. In a personal injury lawsuit, much of it rides on your ability to prove fault and causation. You usually can’t win unless you prove negligence, for example. In a work injury, it doesn’t matter whether it was your fault, or your employer’s fault, or no one’s fault.
A work injury case is an insurance claim, not a lawsuit. If you have a work injury, then you are not allowed to bring a lawsuit against your employer. The whole workers’ compensation system was set up as a trade-off of sorts. Employers are protected from lawsuits, and employees are entitled to benefits as long as an injury was related to the job.
There are some circumstances in which an injured worker would still have the option of a lawsuit. If an injury is caused by a third party – someone other than the employer – then the employee may be able to file an injury lawsuit against that third party. For example, if you are injured at a job site because the property owner was negligent, then you can sue the property owner for damages.
Another example of a third-party lawsuit is a lawsuit for a defective product. A defective piece of equipment or a tool that malfunctions can cause serious injury. There might be a lawsuit against the manufacturer in such cases.
Get a lawyer who understands the big picture and how these two areas of law work. And don’t wait too long. If you plan to go after workers’ compensation benefits, you have just 45 days to notify your employer. Other deadlines apply, as well. Benefits in Illinois include coverage of 100% of your medical bills (with no out-of-pocket expenses), as well as payment of lost wages if you are unable to work due to your injury. You can get 2/3 of your average weekly wage while you recover.
In Illinois, workers’ compensation law gives workers certain benefits if they are injured on the job. One major benefit in many cases is payment of 2/3 of your average weekly wage until you’re well enough to return to work. But many people have more than one job. What happens if you get hurt at one job and it prevents you from working at your second job? Can you expect any additional help from workers’ compensation to cover those lost wages, as well?
If you are working more than one job, you are still entitled to the same help to get you back on your feet. Illinois law says that employees can collect lost wage benefits for a second job, even if the injury didn’t occur at that job. There is a catch, however. You can only collect wage benefits related to your second job if your employer at your first job, where you were hurt, knew about your second job.
Let’s say you work overnight on a loading dock and you have a second job during the day driving a delivery truck for a different employer. One night you get hurt while unloading boxes. It’s a back injury and your doctor says that you can’t do any lifting, and you can’t drive. You rely on both jobs to pay the bills but your injury prevents you from doing either, at least until you recover. If your boss at the loading dock knew about your second job as a delivery driver, then you can include those wages for calculating your benefits checks. If that employer didn’t know, you probably won’t be allowed to collect benefits related to the delivery job.
There are a few other things to keep in mind. For one, part-time employees are covered under workers’ compensation laws in Illinois, and there is no rule that requires you to work for your employer for a certain amount of time before qualifying. Independent contractors, on the other hand, are not entitled to benefits. Make sure you are truly an independent contractor before giving up on any benefits, however, because employers don’t always properly label their workers. And volunteers generally aren’t entitled to benefits under Illinois law.
Benefits are paid out by your employer, or their insurance company in many cases. Don’t rely on them to accurately calculate your average weekly wage. It’s in their best interest to pay you less, which is obviously not in your best interest. They might try to avoid paying based on wages from more than one job, for example. Other issues include bonuses and overtime and whether those get included, as well. The good thing about hiring an experienced workers’ compensation attorney is that they should know all the little tricks the insurance company tries to get away with. You need someone on your side who knows how the game is played.
It’s not uncommon for us to hear about an employee who got hurt on the job because they weren’t following proper safety precautions. An employer might have various consequences for employees who don’t follow safety rules, but they can’t take away your right to workers’ compensation benefits. Illinois law decides who can and can’t get these benefits, which include payment for lost wages and coverage of medical expenses. The law in Illinois says that you are eligible for benefits, even if you broke safety rules, as long as you were doing your job. This surprises some people, but the idea is that you were still doing something for the benefit of your employer when you got hurt. Just because you were doing it wrong, doesn’t mean you weren’t doing your job. If you were doing what you were hired to do, then you should be eligible for benefits in the event of an injury.
On the other hand, if you were doing something for your own personal benefit, you might be out of luck. Illinois law doesn’t extend benefits to employees who get hurt while doing something completely unrelated to their job. Of course, there are a million different scenarios and many of them end up in some gray area between these two rules.
If you were running a machine for your employer and suffered an eye injury because you weren’t wearing protective eyewear like you were supposed to, you should still be entitled to benefits. The same is true if you were driving to a job site and got in a vehicle accident because you were in a hurry to get there.
At the other end of the spectrum is a worker who is goofing around and riding on the back of a forklift for fun when the employer has a rule that they aren’t supposed to do that. If they get hurt, they probably won’t be eligible for workers’ compensation benefits because they were doing something for their own benefits – horsing around with their co-workers – and not doing anything for the benefit of their employer.
Along the same lines is the issue of fault in any work injury. Just like violation of safety rules doesn’t disqualify you, neither does the fact that an injury is your fault. Again, as long as you were doing your job, you should be covered. Fault is not an issue in workers’ compensation law. You are covered no matter what, as long as it’s work related. The same is true for the employer. Regardless of their fault, you are entitled to benefits.
Taking fault out of the equation is meant to simplify the process for getting benefits to workers and getting them back on the job. Employees give up their right to sue (lawsuits are not allowed in a work injury) and employers pay benefits regardless of fault.
An important note of caution: Don’t let the insurance company or your employer convince you that you are not entitled to benefits because you are at fault or because you violated company policy. It’s in their interest to make your claim go away. It’s in your best interest to talk to a lawyer and assert your rights. So just keep in mind that your employer is not necessarily on your side, and the insurance company most certainly isn’t.
If you have been seriously injured and can’t work, the benefits you get under Illinois workers’ compensation law can be vital to your health, financial stability and the well being of your family. Hiring a lawyer to handle your work injury case can be a leap of faith, but it’s one of the best things you can do to ensure a good outcome. Of course, you need to make sure the attorney you hire is excellent at what they do and how they do it.
If you suspect that your lawyer is acting unethically, don’t ignore your suspicions. Even if they aren’t violating the specific rules of ethics that attorneys are required to follow, they may have other faults that are detrimental to your case. Here are some red flags:
Directing your medical care. Your attorney definitely should be aware of, and interested in, your medical care. It’s a major part of your case. However, they should not be telling you which doctors or therapists to see. Some lawyers have arrangements with doctors to refer cases back and forth. The problem with this is that it puts their interests ahead of yours. It should be the other way around. Also, it makes your case less credible.
Ignoring your calls, emails, etc. There is a range of bad behavior in this category, from attorneys who simply aren’t good communicators, to those who are too busy to handle your case or too lazy to care. You should expect your attorney to keep in contact about all major updates in your case. You should expect them to get back to you in a reasonable amount of time if you reach out to them, which in our opinion means they should get back to you within a couple of days at the most.
Promising you a certain amount on your case. It’s misleading to tell a client that their case is worth “x dollars.” There is no way to know at the outset. Some attorneys make promises in order to get clients. If your attorney does give you a number, they should also be explaining that it is a ballpark amount based on other cases they have handled in the past.
Passing your case off to another attorney at the firm. You might meet with one of the firm’s partners when you first go in to hire them but then later find out they have passed your file on to a younger associate. This is common, but you don’t have to agree to it. If you aren’t confident in the ability of the younger attorney to handle your case, speak up and ask about their experience. You certainly don’t want your case to be used to train a newly licensed attorney.
Offering to also handle your child support problem and write up your will. The point here is that an attorney who focuses on one area of law (or a small number of related areas) is going to get more experience in that type of case. If your attorney handles workers’ compensation cases day in and day out, they will probably be better equipped to handle your work injury case than someone who handles a few of these cases a year.
Like we said, not all of these things are technically unethical, but we wouldn’t put up with any of them if we were a client.
Holding a law license allows you to practice law but it doesn’t say anything about your character or how hard you work for your clients. Some lawyers are caught and disciplined for bad behavior. You can check whether your attorney has ever been disciplined or had their license suspended by looking them up on the Illinois Attorney Registration and Disciplinary Commission website. Most of the time, unfortunately, it’s up to the client to use their judgment. It’s not too much to expect your attorney to work hard to make sure you are getting all the benefits you’re entitled to and stand up to the insurance company if they aren’t paying you. It’s not too much to ask that your attorney communicate with you. If you have questions about any of this, give us a call.
An injury is considered a work injury under Illinois workers’ compensation law if it “arises out of” an individual’s employment. What this essentially means is that your job has to cause your injury in order for you to receive benefits such as medical coverage and payment of lost wages.
Sometimes, the work obviously causes the injury. If you hurt your back doing physical labor on the job, then it’s pretty clear that your work caused your injury. However, not all cases are that simple. One tricky issue is when you suffer a secondary or aggravating injury on top of your original injury. Are you still covered?
In many cases, the answer is yes, if there’s still a link to your original work injury. The idea is that if your work injury leaves you less than 100%, and you are later hurt because of that vulnerability, you should be covered for that later injury, too. Let’s say you suffer a back injury on the job and then many months later get in a car accident that makes your injury much worse. Your additional medical costs should be covered. If you weren’t vulnerable in the first place, then that second incident would not have affected you like it did. So it all relates back to the work injury and proving causation, even if it seems indirect.
Another example is when someone gets injured doing physical therapy or rehab after a work injury. They’re obeying their doctor’s orders and following a regimen to improve their strength and ability to get back to work, but then it causes another injury. Are they covered? They weren’t at work when it happened – they were at the gym. They probably weren’t doing their work duties. But the causation is still there because the injury would not have happened had they not had a work injury in the first place. They would not have been doing the rehab program, or physical therapy session, if they hadn’t been suffering from a work injury. In this case, there is still a link between the job and the injury, and it should be covered under workers’ compensation.
We see this type of case with professional athletes, although it’s a bit different due to the nature of their job. An athlete who is injured playing their sport almost always has to do physical rehabilitation to get back to where they were. It’s similar to your average work injury in that the therapy is related to the work injury, so a re-injury or second injury should be covered. But it’s different in that an athlete is technically doing a version their job while doing the rehab program. The causation in these cases is perhaps even more clear.
All of this comes down to proving that your job caused your current injury. There are many nuances in the law that make this a deeper issue than it might seem. Get an attorney who knows how the law works in your situation.
Not only should you be a partner with your lawyer, but you should be the most active participant in your case. Consider this e-mail that I got from an outstanding workers’ compensation lawyer in Chicago.
I filed a case for this guy in June. It was a low rate case, but he claimed to have a herniated disc and was not getting paid. I motioned the case up for a 19(b) hearing and notified the claimant to meet me in Wheaton. On the day before the hearing, I spoke with him and confirmed that he would be there. The next day, he did not show up, nor did he respond to my many phone messages and emails. I wasted an entire half day waiting for him (to say nothing of the prep time, etc) and my opposing counsel had 4 witnesses present for the hearing to testify about their accident defense. He never did respond. I filed a motion to withdraw as counsel which was granted.
When the lawyer says it’s a low rate case, that means the injured worker wasn’t earning very much money. That will effect how much the case is worth. So he was clearly busting his butt for the client, but not going to get a huge financial return out of it if he won. That’s ok, unless your client doesn’t care about their case at all. I understand why the attorney was upset. He got a case ready for trial in less than three months and the client doesn’t even bother to respond to a call.
Beyond that, it’s very disrespectful to the other attorney. We aren’t worried about being friends with them, but if you tell them you are going to trial and that you’ve prepared your client, it makes you as a lawyer look bad. That could impact future clients or cases.
I talk a lot about being honest with your attorney. I’m very straight forward with anyone that contacts me about how I’ve created a network of great lawyers that I work with on cases to try and get the best result possible for you. We are also extremely direct and honest when you call and ask us questions. Any attorney we’d refer you to can not promise a result, but can show a great track record of success and customer service.
All that anyone can ask in return is that you be honest and work with us to make your case a success.
Now I’m sure most of you would say that you’d never not show up for court if a trial was scheduled. I’ve been handling these cases for 17 years and it’s the first time I’ve ever heard of this happening But I still encourage you to be actively involved in your case. That doesn’t mean that you let it dominate your thoughts and life. But instead, no matter who you hire, ask them what you can do to help or what information they need. Every time you go to the doctor, e-mail what happened and make sure to send them your off work slips. If you go back on light duty to work and are experiencing issues with your boss, communicate with us. But when you stay silent, it’s the sure fire way to harm your case because knowledge is power when it comes to handling these claims. If we don’t hear anything from you we assume all is well.
Have you ever been to Herrin, Illinois? Neither have I. I’m sure it’s a lovely place and I’ve worked with many injured workers from down in that part of the state. But it’s more than five hours from my office and the only practical way of getting there is to driver, so I’ve never been there. When I do get calls from that part of the state, I refer them to various law firms that are part of our state wide network of lawyers. For those downstate firms, getting to Herrin or anywhere else in that region is not a big deal because they live near by. So if you are hurt downstate, I can help you, but that’s by connecting you with someone good for your case.
Beyond that, they regularly appear at those courthouses and know the local doctors who often have to give depositions in workers’ compensation cases. They know the good ones, the bad ones, the evasive ones and the helpful ones. All of this information is helpful for you, the client.
Recently I was contacted by a worker who is living in Chicago, but was working way downstate when he was injured. He hired a very reputable law firm in Chicago for work injuries and if the case was in this area, it would have been a great choice. But the problem was that the case was in a place that they don’t ever go to and certainly don’t want to go to for just one case.
So now that the worker’s benefits are being denied, instead of fighting for him, they’ve told him to put all of his treatment through the group insurance carrier from his wife’s employer. Otherwise they’d have to make two trips downstate for depositions and one or two more trips for a trial.
In my opinion, unless you are a lawyer who has a huge amount of cases downstate, you shouldn’t accept those clients. Refer the case out instead as it’s in the best interests of the client.
What often happens is an established firm will hire a young associate to travel to these far off places and pay their dues by spending the night at bad hotels or waking up at 4 a.m. to make it on time for 30 minutes of court time. So you might think you are hiring a top notch firm, but the reality is that some kid is getting an education off of your case.
This actually happened to me when I first started working, way back in 1997. I was sent to Alton and was really in over my head because I didn’t know anyone at the court, certainly not the Arbitrator who was buddies with all of the local lawyers. I didn’t have a say in the matter as I wasn’t the boss, but it was not in the best interests of our client. I vowed never to make the same mistake when I had my own firm.
In the same vein, every now and then these downstate lawyers find their way up to Chicago for a case. Sure they are happy to visit our great city, but again it’s not in the best interests of the client.
As a FYI, the location of your case will be based on where the accident takes place. So you could live and work in northern Illinois, but if you get sent down to southern IL for work and get hurt, any hearing in your case will be down there. That’s because the evidence as to your accident is down there and the Illinois Workers’ Compensation Act rules that determine where your hearing will take place. So keep that in mind before you make a hiring decision.
When I was young, I was taught never to ask a woman how old she is or how much do you weigh. I teach those lessons to my children now. But while I’m working, I ask those types of questions all of the time.
I’m not trying to be rude, but rather it’s very relevant for properly analyzing a workers’ compensation and figuring out if it’s compensable and how much it might be worth.
If you are diagnosed with carpal tunnel syndrome, we wouldn’t be doing our job if we didn’t ask you how much you weigh. Obesity is a knows cause of carpal tunnel. That doesn’t mean if you are overweight that you have no case, but it does mean that we are trying to be prepared for any possible defenses that we might have to fight. Any good work comp lawyer would also ask you if you are diabetic or pregnant as those are two known risk factors as well. You could have all three of these issues and still win your case. But most cases aren’t perfect and have some possible defense. Your attorney needs to be prepared to respond to those defenses. If the first time they learn that you are diabetic is when you are on the witness stand then they haven’t done their job.
Knowing your age is important too. First off, we can’t formally file a claim without listing your date of birth. That’s a requirement for the Application for Adjustment of Claim that must be filed with the State of Illinois. Beyond that, knowing how old you are plays a role in determining what your case is worth, especially if you are not going to be able to return to your old job and have a loss of future wages as a result. Knowing your age allows to get a proper range of what your case may be worth.
To be fair, I’ve never heard someone respond that they were offended by these questions. Of course, I ask the weight question in a delicate, polite way and explain why I am asking. So hopefully my grandmother, who taught me the importance of being polite and NEVER asking a woman her weight or age, is proud of me still, knowing that I have a good reason for asking.
For you as a client, you should be nervous if your attorney isn’t asking questions about you. They should get to know you and your case, otherwise how are they going to have a full picture of what you are going through and be able to best represent you?
A reader of my blog called in with a good question. He regularly works at a school from Monday to Friday. On a Thursday afternoon, right before he was going to leave for the day, he slipped on a wet floor and hurt his back. He went to the doctor that day and had extreme pain. The doctor gave him some pain medication, told him to follow up with him the following Wednesday and said he could not perform any work until that time. He did go back on that date and let the doctor know he was feeling much better so he was released to return to work, full duty.
The law in Illinois says that if you are hurt and can not work, you are supposed to begin receiving temporary total disability benefits (TTD) on the fourth day that you miss. The first three days do not get paid until you have missed 14 calendar days. After that happens, the first three days are to be paid retroactively.
The key word here is “calendar” days. So for my caller, he missed Friday, Monday, Tuesday and Wednesday. He called me wanting to know if it was worth it to get a lawyer over the one day of work lost that he thinks he is owed. I let him know that he’s not owed one day, but instead three days. He was kept off work for six calendar days total. So based on Illinois law he’s owed three days of TTD benefits. It doesn’t matter that he never works on the weekend because the TTD pay rate is based on a seven day work week.
Whether or not it’s worth it to get an attorney for three missed days probably depends more on the extent of the injury than anything else, but that money is his and he is owed. Why should the insurance company keep it and he go without pay for those days? He’s already not getting paid for the other three days that he’s not entitled to under the law and the amount he’s going to receive will not equal what he could have gotten if he wasn’t injured and could work his normal job.
This caller didn’t ask, but I also get asked a lot about when the TTD checks should start to arrive. If it’s obvious right away that you are going to be off work for some time – e.g. you drive a bus and shatter your right let in a bus accident – then you have a right to expect that within two weeks of the accident date the checks will start coming. Some insurance companies send the checks weekly, others do it every other week.
The times that you don’t get paid in a timely manner like this are when it’s not obvious that you’ll be off work for a while or they haven’t been provided copies of your off work slips. If we or any lawyer in our network was representing you, as soon as you go to a doctor’s visit we’d tell you to get us a copy of your off work slip. We get it to the insurance adjuster right away so there can be no excuse about paying you.
The only other time you can’t expect a TTD check within two weeks of the accident is if there is a legitimate dispute as to whether or not your injuries are work related. The problem here which often leads to workers getting an attorney is that it’s not unusual for an insurance company to send a letter that says, “We’ve investigated your injuries and have determined that they are not work related as covered by the Illinois Workers’ Compensation Act.” Often this letter is just a tactic to hope that you won’t pursue the case any further and will be discouraged. If it’s a bogus denial, the proper thing to do is hire a lawyer and have them file a 19(b) petition for immediate hearing and a petition for penalties and fees to punish the insurance company for their bad behavior. Too often they will play games and your life of course is not a game.
We have four new Arbitrators and we lost one as Arbitrator Brandon Zanotti resigned in order to become a State’s Attorney. Below are the biographies of the new Arbitrators per the IWCC. Somewhat odd in that three of the four are more insurance company oriented per their background. But until we see them in action as Arbitrators, we of course can have no real opinion on them. Best of luck to them all.
Governor Pat Quinn appointed four new arbitrators to the Commission:
• Maria Bocanegra is an attorney at Katz Friedman, specializing in workers’ compensation. She previously worked as a judicial assistant to the Honorable David Furman and as a case administrator for the United States Bankruptcy Court in the District of Colorado. Ms.Bocanegra was also appointed to the Illinois Department of Labor’s Labor Advisory Board in 2013. She holds a J.D. from DePaul University and a B.A. from Quincy College.
•Stephen Friedman is currently a Managing Partner of Rusin, Maciorowski & Friedman, Ltd., specializing in workers’ compensation defense. Previously, he was an associate and a partner at Rooks, Pitts and Poust practicing workers’ compensation and personal injury defense. He earned both a J.D. and a B.A. from the University of Illinois.
•Steven Fruth is currently a trial attorney at the Chicago Transit Authority. Previously, he served as a Circuit Judge in the Circuit Court of Cook County and as the Staff Counsel at Allstate Insurance Company. He holds a J.D. from the John Marshall Law School and a B.A. from Southern Illinois University.
•Michael Nowak is an attorney at Becker, Paulson, Hoerner & Thompson, P.C., focusing primarily on workers’ compensation law. Previously, he was a partner in his own firm, representing injured workers. Mr. Nowak has served as an arbitrator for the St. Clair County Arbitration Center as well as a member of the Judicial Nominating Committee for the U.S. District Court, Southern District of Illinois. He holds a J.D. from Northern Illinois University and a B.A. from Eastern Illinois University.
Please join us in welcoming these new arbitrators to the Commission.
A reader asked us the following:
I was injured three plus years ago. I was 35 on date of injury and am now 39. I underwent six surgeries ending with a total knee replacement. I am no longer able to have employment in law enforcement and was approved for and am just now receiving medical disability pension. In your opinion, what is a reasonable amount I can anticipate from a W/C settlement?
I know everyone wants to know what their case is worth. But your goal isn’t really to find out what your case is worth, your goal is to get the most money you can get under Illinois law for your case. If I tell you that I can settle your case for $100,000.00, that might sound awesome to you. Who couldn’t use that money? But if you knew that the case was really worth up to $300,000.00, you’d be furious if you resolved the claim for a low amount.
For this reader, I couldn’t possibly tell him what his case is worth without knowing more information. First off, if he can’t go back to his old job, what job can he go back to? Why can’t he return to that old job? What did his doctor say? Does the insurance company doctor agree or say something different? What was he earning when he got hurt and how much would he be earning right now under that job? How does that compare with what he’s currently able to earn? Has he been offered vocational rehabilitation? Is this a wage differential situation or is he realistically permanently disabled from returning to any meaningful sort of work?
All of these things matter. I would love to make this person happy and give them a settlement figure, but doing so would be a lie and certainly not in their best interests. When you have a life altering injury, a detailed analysis is needed to determine what the case is truly worth on a low end as well as on the high end. A case like this isn’t going to have a set value, but instead will have a range that it could be worth. Our job is to determine that range for you and then get as close to the high end of that range as possible.
There are plenty of law firms out there that will let you call them and give you an answer that makes you feel good in the moment, but they are just selling you a bag of magic beans. Nobody could possibly know what your case is worth without most or all of this detailed information.
And while nobody wants to hear it, you’ll never get close to what your case could be worth without legal representation. There is no requirement that the insurance company even make you a settlement offer at all and if they do, they are always going to try to hit the lowest possible range of fairness for you. And in many cases they try to make you believe that the AMA (American Medical Association) rating that a doctor will give you is controlling when in fact it is not.
Like anything else in life, the more information you can get and we can get, the more accurate of an analysis that will take place and the more likely you are to get the best result possible for you. And that’s what it’s really all about. Not the fastest answer you can get, but the best answer.
Illinois law says that workers who suffer a job-related injury or illness are entitled to benefits. Sometimes, workers have to go after these benefits themselves (ideally, with an attorney), and other times benefits are awarded fairly routinely. A denial of benefits is not the final word – an arbitrator will make the decision in a disputed case.
Many companies in Illinois are required to carry workers’ compensation insurance. The employer’s insurance company should pay the following benefits, according to Illinois law:
Medical: All reasonable and related medical expenses should be covered 100%, with no out-of-pocket costs or co-pays. This includes prescription medication, diagnostic tests, treatment, surgery and even physical therapy. Your medical benefits generally continue until you reach what’s called maximum medical improvement, which basically means you are as good as you are going to get.
Lost wages: If you have to miss work while you recover, whether it’s a few weeks or many months, or even more, you are entitled to get paid for a portion of what you would have been making if you were still working. These benefits, which are equal to 2/3 of your average weekly wage, should be paid out regularly. If they stop, or if you are denied, you can request a hearing in front of an arbitrator.
Settlement: When a claim comes to an end, the insurer might make a settlement offer. This is a lump sum that is meant to compensate the worker for the permanency of their injury. In exchange, the worker gives up his or her right to future medical benefits for that injury. Not all cases end in settlement, but many do. If your case ends with a trial, the outcome could be different, with future medical benefits available.
Death benefits: When a worker is killed on the job, his or her surviving spouse, minor children and other dependents are eligible for death benefits.
Other: The law also considers how difficult it can be to re-enter the workforce. You might be eligible for job re-training if your injury makes it so that you can’t return to your old career.
In order to have the best shot at getting your benefits, file a claim as soon as possible. Technically, you have three years from the date of the accident to file a claim for benefits, or two years from the last payment of benefits, whichever is later. But sooner is better. Also, the law says that you must notify your employer of your injury within 45 days.
Don’t let your boss or the insurance company tell you that you aren’t eligible for benefits. Always check with an attorney. An initial consultation should be free.
Delay, in the legal system, is an unfortunate reality in some cases. But there should always be a reason for it, not just the fact that your lawyer is lazy or the insurance company is waiting to see if you’ll just go away. If there’s been a delay in your case, find out why. If you haven’t heard from your lawyer in a while and you don’t know the status of your claim, you should check in. It’s completely reasonable expect a prompt response.
Potential reasons for a delay in your case:
The insurance company is denying benefits. If the insurance company can find a way to deny your claim, they will. Once that happens, the ball is in your court. Many times, the injured worker can successfully get their claim approved by asking for a hearing in front of an arbitrator. Don’t do this without an experienced attorney who knows how to make your case and understands the strategies used by the insurance company. Note that you won’t get this hearing automatically; you have to submit a petition.
You are still in the middle of your medical treatment. If you are still injured and still going through treatment or therapy for your injury, then not much will be changing in your case. You should continue to get benefits, but your claim won’t settle until you are as good as you’re going to get. This is called maximum medical improvement, or MMI.
The insurance company is delaying settlement. If your medical treatment is complete, you might be waiting for a settlement offer from the insurance company. The insurance company doesn’t have to offer you a settlement. Many times they do, because they want to close your case and ensure that you won’t come back later asking for more benefits. However, it’s not unheard of for an insurance company to ignore you and hope you give up and go away. Your attorney should be doing what they can to move things along.
You need a new lawyer. If you aren’t getting benefits and your attorney has not petitioned for a hearing or given you a good reason why they haven’t, then it’s time to have a serious conversation. If you have trouble getting in touch with your lawyer and can’t even set up a face-to-face meeting, it might be a sign that your case is being ignored. You can always get a second opinion, and in some cases, switching attorneys is the only way to solve the problem. The sooner you switch, the better off you’ll be.
Don’t sit around and wonder what’s going on in your case or stress about a lack of benefits. Call your attorney or set up a meeting so you can get your questions answered.