Illinois Workers’ Comp – Think Of Animal House

One of the funniest movies ever is “Animal House” and the best scene is when Chicago’s own John Belushi gives a speech at the end.  He says, “Over? Did you say “over”? Nothing is over until we decide it is! Was it over when the Germans bombed Pearl Harbor? Hell no!”

I thought of this great scene the other day when a woman called me, not for help with her Illinois workers’ compensation claim, but to get my thoughts as to whether or not she could get social security disability benefits following a knee replacement surgery.

I asked her how she hurt herself and she told me at work.  I then asked why she wasn’t getting work comp benefits and she told me that she tried, but the case was denied.  “So I figured that was that and the case was over” she said to me.

Over? When it comes to your Illinois work injury case, nothing is over until we decide it is!

Injuries get denied every day.  Insurance companies don’t just give money away, even when they are clearly in the wrong.  So when they deny you, you have to go through the Illinois Workers’ Compensation Commission and file for a trial.

Sadly in this case, she already has a lawyer and a doctor who said her need for surgery is due to the work injury, but for some reason her attorney hasn’t done anything.  The good news is that she can easily switch law firms.  The bad news is that she’s been without money coming in for no reason other than hiring a firm that doesn’t appear to know what they are doing.

No matter your case facts though, just remember that a denial letter from an insurance company is not the be all end all.  It may mean that you have a fight on your hand.  It may mean you really don’t have a case.  It might mean they’ll roll over once a lawyer who knows what to do is involved.  Whatever the situation, make sure you get an opinion from an attorney, don’t just take the insurance company at their word.  I know this will be shocking to you, but they aren’t always honest. :)

And of course a consultation with an attorney should be free.  If you’d like to speak to us about a case, call us at (312) 346-5578 or fill out our contact form and we will call you.  We cover all of Illinois.

Ridiculous Insurance Company Strategy That Is Easy To Beat

Insurance companies try all sorts of dumb things with one goal in mind.  They want to frustrate you in to either giving up or using your own health insurance.  If you are injured at work in Illinois it’s a terrible idea to use your own insurance for two reasons.  1. There will be co-pays and out of pocket expenses which you wouldn’t have if you went through work comp. 2. If your personal health insurance company found out that they improperly paid for benefits that they shouldn’t have, they can/will withhold future payments until they are reimbursed.

So if you get Blue Cross to pay for your work related shoulder injury, they could later refuse to pay for cancer treatments or your appendix or something else.

All that said, the work comp insurance will still try to deter you.  Recently I got a call from guy who badly injured his shoulder when he fell out of his truck.  It’s clearly a case, but he hasn’t been able to get much medical care.  Why?  Because the insurance company has refused to give him a claim number, stating that they don’t do that while they are investigating the case.

There is really nothing to investigate and it’s a phony excuse.  They are really hoping to discourage this truck driver and get him to use a different medical insurance policy. Unfortunately for them, he’s too smart to do that, knows why work comp exists in Illinois and was smart enough to call for help.

All we need to do is file your case and/or pick up the phone.  We’ll typically have a case number and approval for benefits right after that because they know there is no avoiding the case once you officially file with an attorney.  And if that doesn’t work we’d file a trial motion and a petition for penalties due to an unreasonable delay in benefits and that should solve everything.

Big picture is that you are up against people who get paid to try and find a way to either not pay you or minimize what you are owed.  It’s ruthless and often ridiculous, but they are banking on you being a pushover. So their strategy only works if you let them get away with it.

 

They Paid My Medical Bills and TTD, Now What?

Illinois workers’ compensation law typically provides three things in every case, payment of medical bills, payment of lost time from work (TTD benefits) and a settlement (PPD or permanent partial disability) when you are all better.

Only the medical and TTD are mandatory by law unless the insurance company has a good reason to deny them.  This is why we get a lot of calls from people who tell us something like, “I got hurt at work.  They paid for my medical care and lost time, but when I called asking about a settlement they told me my case was closed.”

This is a trick by insurance companies, hoping that you will be thankful your bills are paid and move on so they can save some money.  You see, if they don’t pay your medical and lost time they can be punished by the State.  But nothing happens to them if they don’t make a settlement offer.

As insurance companies don’t like to give away money, more and more we see that they’ll either make a low ball offer or none at all.  So what are you to do?

While having an attorney for the entire case is a good idea as in the least it’s a security blanket if something goes wrong, if you are hoping for a settlement offer and they lie and say your case is closed, you have to get an attorney.

We would formally file your case (as long as the statute of limitations for doing so hasn’t passed) and “magically” your case would no longer be closed.

In 99% of the cases the insurance company will then agree to negotiate a settlement because it’s worse for them usually if the case goes to trial.  Either they will offer something fair and you’ll settle or if not, we’ll tell you it’s not a good offer and take your case to trial.

At trial, in cases where everything has been paid, it’s usually just a matter of arguing before an Arbitrator what your case is worth. Often they’ll recommend a dollar amount before trial and that will get the case resolved.  If it doesn’t, a trial like this would probably take a few hours and then the Arbitrator would order the insurance company to pay a certain amount.

Lawyer fees are 20% of what is recovered and in almost every situation you’ll end up with more by getting an attorney.

Bottom line is don’t listen to the nonsense of them telling you the case is closed or that you aren’t entitled to a settlement.  It’s insurance company nonsense that simply has to be pushed back against.

Questions on settlements?  Want to talk to a lawyer for free?  Call us any time at (312) 346-5578.  We help everywhere in Illinois.

Heart Attacks By Firefighters, EMT’s and Paramedics

I try to talk in plain English when I write and when you call.  Phony lawyers who use big words to try and seem smart are not my cup of tea.  That said, I want to talk about first responders and heart attacks and it’s not all “plain English.

As we all know, firefighters, emergency medical technicians and paramedics have particularly hard jobs.  Because of their unique job environments, there are special conditions in place in Illinois to ensure they are covered by the Workers Compensation Act.  Those in the emergency responders’ fields are particularly prone to heart disease. In fact, 45% of on duty fire fighters deaths are caused by cardiovascular events.

The Illinois Workers Comp Act says that anyone who has worked in this field for more than five years, who is diagnosed with any blood borne pathogen, lung or respiratory disease or condition, heart or vascular disease or condition, hypertension, tuberculosis, or cancer, who is also deemed disabled due to their condition, will be covered by workers comp. If a person has worked in the field for less than five years, but is still exposed to the conditions, and diagnosed due to the exposure, will still be covered, but an adjustment to the coverage may take place.

This doesn’t mean it’s a slam dunk win. What it means is that there’s a “rebuttable presumption” that your job duties contributed to you getting these diseases/conditions.  The insurance company can try to prove that your job had nothing to do with it. For example, if you are a firefighter (not in Chicago, they are the exception to the rule) and have a heart attack, it’s presumed that you should get Illinois workers’ compensation benefits.  However, let’s say you weigh 350 pounds, smoke two packs a day, don’t exercise and have a family history of heart disease while working mostly a desk job.  The insurance company can argue that those are the reasons you had the heart attack and that the job had nothing to do with it.

The bottom line is that in these dangerous, challenging jobs, the law is in your favor and if the rest of your life is relatively healthy, you should win your case. Too few people know about this law (it’s from Section 6(f) of the Illinois Workers’ Compensation Act) and as a result many workers are leaving money on the table.

If you are an emergency responder who has been injured on duty, or has one of the above medical conditions due in part to your work environment we can help you. Contact us today for a free consultation to review the facts of your case.

When You Become Addicted To Pain Drugs Due To A Work Injury

You typically think of workers’ compensation benefits in Illinois as being payment for medical bills or time off of work or the settlement you get in the end.   That is how most cases work.  Every now and then there are unique benefits that are part of your case.  One example is if you get addicted to pain pills or other opioids that are prescribed to you because you got hurt on the job.

It’s not uncommon for an injured worker to get a prescription for pain medicine.  In most cases it’s just part of the normal recovery process. But when you have a long term injury like RSD or a spinal fusion or the need for a pain pump, it’s certainly possible that you can become addicted to these medications.

There’s a rule under Illinois work comp law that basically states that if a problem can be traced back to the original injury, it should be covered.  So if you use crutches for a leg injury and as a result develop arm pain, that’s covered.  In the same manner, the need for addiction care would be covered under our laws.

It’s not really a unique benefit, but rather part of your medical care that is 100% covered because you were hurt at work.  It’s unique in that we don’t see it more than a handful of times a year.  If you were an addict before you got hurt then you might have a fight on your hands.  But if you didn’t have a history of drug abuse and your doctor recommends a treatment plan, the work comp insurance company can be forced to pay for rehab, detox or whatever is appropriate for you.

And as this is your life, you get a say in the treatment process.  Most importantly, if you need help you should be able to get help.  Insurance companies don’t like to spend money and these treatments can be expensive.  Too bad for them.  I don’t care that they don’t like it.  This can literally be a life or death situation for you.

There was a recent case where detox was ordered by the Illinois Workers’ Compensation Commission because the dosage rate of medication was so high. The only one against it was the doctor who was making a lot of money by pushing all of these meds.

Please don’t be afraid to stand up for yourself and ask for help. You must do it before your case is settled.  Any questions or if you want to talk to someone who is experienced with this situation, call us any time at (312) 346-5578 for a free, confidential consultation.

The Danger Of Using The Doctor Your Lawyer Insists You Go To

I’ve written before on this blog that we are lawyers, not doctors.  We have a lot of experience with all sorts of medical issues, but we’d never try to give you medical advice.  I might say, “That sounds like carpal tunnel” if you tell me your wrists are numb and hands are tingling.  If you have shooting pain going down your leg from your lower back, I’d likely tell you that it sounds like a herniated disc and I’d recommend you see an orthopedic doctor ASAP.

What I wouldn’t do is expect you to assume my medical opinion is right and while I’m always happy to recommend a physician that I think is reputable, I’d never insist you see a certain doctor.

Unfortunately there are a lot of doctors and physical therapists who have built their businesses by reaching out to lawyers and getting them to send their clients to their facilities in exchange for referring patients to the lawyers.  It’s a tit for tat situation that does not benefit the clients at all.  When a lawyer has 50 clients seeing the same doctor, he’s going to look out for the doctor over the client, especially when the doctor is a referral source.

I recently heard about a Chicago workers’ compensation law firm that gets involved with this shady practice. A defense firm noticed that on most of their cases, the workers were being sent to a certain medical facility. It’s not as if they were going to Rush or Northwestern or a place like that, it was a facility that none of the lawyers had ever heard of.  They put two and two together and now are looking at fighting many of these cases based on the assumption that the opinion of the treating doctor can be proven to be not credible.

This isn’t the first time something like this has happened.  When I first started practicing law there was a doctor who essentially was a professional testifier on behalf of injured workers.  His medical reports all looked the same and he lost all credibility at the Illinois Industrial Commission (now known as the Illinois Workers’ Compensation Commission). Eventually that doctor was arrested for Medicare fraud because he wasn’t just (allegedly) being dishonest with work comp cases.

The point is that if your attorney is insisting you see a certain doctor it’s often a really bad sign and I’d question why they care who you are going to for care.  Most attorneys, even the bad ones, are well intentioned and wouldn’t do this, but a handful operate this way.  It’s dangerous for you and your case.  You could end up losing or having benefits delayed just because it appears something shady is going on.

IL Work Comp – Per Diem and Travel Expenses and Your Average Weekly Wage

One reason that one case could be worth way more than someone who works a different job but has the exact same injury is your average weekly wage.  The higher your wages, the more your case is going to worth.  That’s because your lost time (TTD) and settlement (PPD) benefits are based on how much you were earning at the time of the accident.

Insurance companies like to make money and one way they do that is by trying to keep your wage down. Some examples include telling you that overtime doesn’t count or saying you worked 52 weeks in a year when you really only worked 49.  These little savings can hurt you and really add up for them.

Another way they do it is by denying some of your fringe benefits that are really a financial gain for you.  By that I mean if you take a client out to lunch and pay for it, the company reimbursing you isn’t really giving you a financial gain.  On the other hand, if you get a per diem where they give you a certain amount of money per day to do with as you please, that’s a financial gain.

This law was established in a case involving a United Airlines employee. In that case a flight attendant was given $100 a day that was included in her pay checks along with her hourly wage.  What it came down to was how much was this woman spending per day out of the per diem and how much was she pocketing?  If she spent $40 and saved $60 on average then her average weekly wage should be increased by $60.

Of course some per diems are even larger and many people pocket almost the entire thing, so this can be a very big deal.  The same can be true for things such as housing allowances or if they give you a certain amount of money to purchase health insurance if you want. All of these fringe benefits matter to you and when they are real money in your pocket, they matter to your work comp case.

My wife used to work at a place where they paid for her meals and cab ride home if she stayed past 7 p.m.  It’s not currently the law, but I’d argue that those things also should be considered an economic benefit because it saved her money on train and food expenses four nights a week.  She still would have had to travel home, but instead of going home and making dinner and paying for it, she had the bonus of free meals.

Bottom line is that you should think of everything you are getting beyond your normal pay check and your lawyer should be asking you this too.  If you want to know if something should be included, call us any time for a free opinion.

The Number One Cause For CNA Injuries In Illinois

In 20 years or so of being a lawyer, I’ve probably talked to more certified nursing assistants (CNA’s) than any other profession.  That’s because there are so many of them and since they are lifting and moving all of the time, they have a high risk of injury.  A common call is that they were helping lift a patient when someone let go and they hurt their back or they tried to catch a falling patient and hurt their back or arm.  Of course there are plenty others who slip on wet floors, often due to patient spills of all sorts.

One thing has changed about our CNA calls in recent years.  In the last decade many facilities are getting bought up by big national groups.  There is less of a focus on the patient experience and more of a focus on maximizing every last dollar.  It’s resulted in these companies having many shifts understaffed which has become the number one cause for CNA’s getting injured at work in Illinois.

You don’t become a CNA unless you have a heart of gold and like helping people and the ones I’ve met also have great work ethics.  So if there are 70 residents and only three people staffed for a shift, you’re not going to ignore someone because it’s more work than you are supposed to do.

As a result, when you are running around like crazy, not taking a break and doing extra work, it’s no surprise when an accident happens. It’s really just a matter of time quite often.

So what can you do?  Depending on the type of facility, there are different requirements as to the amount of care each patient is required to receive and the staff members needed to comply with that law.  We’ve had callers tell us that they had a 40/1 patient to nurse ratio at times which is insane.  Call the Illinois Department of Labor as you should be able to report your issues to them anonymously.  You can also call the Illinois Department of Health.

And if you are unfortunately injured, do know that the Illinois Workers’ Compensation laws will protect you.  Report your injury right away, get medical care and make sure you don’t treat with their doctors.  And like anyone, call us at (312) 346-5578 or fill out our contact form if you need help.  There are no up front costs and we will give you free advice and protect you.

Illinois Workers’ Compensation Questions

We are Chicago workers’ compensation attorneys who help with cases anywhere in Illinois.  We’ll talk to you for free and in confidence.  Call us at (312) 346-5578 or fill out our contact form.  We of course blog every couple of days.  Sometimes we get good questions that aren’t enough for a blog post, but I thought it would be good to share them with our readers in case they apply to your situation.  In no particular order …

I work for an not for profit company and broke my leg on the job.  My boss said non profits don’t have to carry workers’ compensation insurance in Illinois.  Is that true? No, it’s not true.  They are like any other business.

My husband tore his rotator cuff working for the Chicago Transit Authority. My cousin is a Chicago cop and doesn’t get regular work comp benefits.  Is it the same for the CTA? No, CTA employees get Illinois workers’ compensation benefits.  Chicago police officers do not, but any other City of Chicago employee is eligible for benefits.

Is it true that there is a cap on what you can get for a settlement if you have carpal tunnel syndrome? Yes and no.  Yes if you make a full duty recovery. If so it’s limited to 15% of each hand. If you don’t then that is not necessarily the case.

I read the Illinois budget debate has something to do with workers’ compensation benefits.  How is that true? I have no idea.  It’s political theater by Governor Rauner and the special interest groups he supports.

My neighbor tore his ACL at work and got a $70,000.00 settlement offer.  Same thing happened to me and they are offering $40,000.00.  Why the difference? It’s likely because he had a different recovery and or higher wage than you. It also could be that he didn’t have as good of a lawyer.

I work for United Airlines as a pilot, but came to them through the merger with Continental.  I’m based out of New Jersey.  Can I bring my case in Illinois since United is headquartered there? United pilots who were originally hired by United can always file their case in Illinois.  Same for flight attendants.  If you were part of a merger, current case law says that you have to be hired here, hurt here or primarily work out of Illinois.  That case is being challenged but for now it’s a no go.

I read what you wrote about some Chicago work comp firms hiring kids just out of law school and you said it’s a bad idea.  That happened to me where I thought I was hiring an experienced lawyer, but instead got his new associate who always had to get back to me with answers to questions because he had no clue.  Why do law firms do that? We don’t do it, but some firms hire young kids to save money.  It’s kind of dumb because they must spend a ton of time dealing with the problems they create and then they often just quit. And of course it’s terrible for the clients.

Do people really get arrested for work comp fraud? Not often, but it happens and I bet it starts to happen more.  Hopefully companies that knowingly go without insurance get in trouble too because it’s a felony to do so.

I’m a teacher, usually in history class, but one day I subbed for gym and broke my ankle playing dodge ball.  They want to deny me benefits because the gym teacher isn’t supposed to participate. I didn’t know that.  Can they do that? Any case can be denied, but when push comes to shove I think you’ll win because it doesn’t sound like you were goofing off when you got hurt. Doing something you aren’t supposed to do does not end the claim if it’s not reckless and is a benefit to your employer.

We settled.  How long until I’m paid? The key to answering this question is knowing when settlement contracts have been signed by all parties, submitted to the Arbitrator and approved by the Arbitrator.  Once your attorneys has a copy of an approved settlement contract, stamped by an Arbitrator and sends that to the insurance company, you’ll typically get paid in 30 days or less.

 

If you have any questions, get in touch any time.  We are happy to talk to anyone and it’s a free service.

What Happens When You Get Fired While On Work Comp?

First point, it’s illegal to fire someone for pursuing a workers’ compensation claim in Illinois.  We’ve seen cases where that’s happened and the fired worker has sued and won millions.  But that’s not what this post is about.

What I’m talking about is when you are hurt at work and get let go because the company is so small that they need to replace you or they are downsizing or you are back at work and screw up somehow that gives them reason to let you go.  In other words, firings that would have happened with or without the work injury.

If you are receiving medical care for a work related injury and get fired, even if it’s for a big screw up on your part, you don’t lose your benefits.

You also can’t lose your right to a settlement down the road.

The biggest issue is when you are back at work under restrictions from the doctor and get let go from work.  If this happens, you are supposed to be paid TTD benefits until you have no restrictions at all.  This is true even if you have been working for them with restrictions for a long time.

If your restrictions are permanent then you would have to start looking for a new job within your restrictions and/or get assistance from the insurance company in finding new work (vocational rehabilitation).   During this time they’d have to pay you maintenance benefits which is the same thing as TTD essentially.

Big picture point is that if you do get let go, don’t freak out.  It shouldn’t hurt your case and in some matters it actually makes it worth more because there’s no job for you to return to and the insurance company isn’t worried about a re-injury if you go back to work.

Did we explain this well?  Are you confused?  Questions about something else?  Call or e-mail us at any time to talk to a lawyer for free.  We handle cases everywhere in Illinois.

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