It’s generally the rule under Illinois workers’ compensation law, that in order to receive benefits, you need to cooperate with all reasonable medical treatment that has been recommended. If your doctor suggests a treatment or therapy plan, and you don’t follow it, your benefits could be suspended or terminated.
Surgery, though, is looked at differently under Illinois law, and gives workers more freedom to just say “no.”
The ability to reasonably refuse surgery is unique in the world of workers’ compensation. Because usually under the system you put your benefits at risk not only for failing to follow a medical plan, but also for doing things that make your health worse. These are called “injurious practices.”
One example of an injurious practice is smoking, which has been known to cause surgeries like lumbar fusion to fail, in addition to all the other health risks. An Arbitrator may tell you that as long as you are still smoking, your benefits will stop.
A lot of times surgery is the only chance that a worker can get better and recover from an injury. To the insurance company, it seems clear—no choice about it: you have the surgery and have a chance to return to work, or else they shouldn’t have to continue to pay.
But Illinois law has said that even if there is an additional cost to the insurer if the worker doesn’t have the surgery, that’s not a reason to deny benefits. As long as refusing the surgery is reasonable, your benefits shouldn’t be affected.
Because surgery is an invasive procedure, if you are fearful to do it, that’s generally enough to show your decision is reasonable. Whether it’s fear of the procedure itself, or the possible outcomes of the surgery, workers are usually given a lot of freedom to have their own beliefs and fears about it.
If your choice about surgery is made in bad faith, that may be viewed differently. But otherwise, you should not have to give a medical or scientific argument about what harm might come to you from the surgery in order to keep your benefits.
Even where there could be serious harmful consequences in refusing the surgery, your decision not to have it can still be reasonable, even if it is based on fear of the procedure. You cannot generally be forced to choose between surgery and workers’ compensation benefits.
We are workers’ compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.
