In Illinois, workers’ compensation law requires your employer or their insurer to pay for all reasonable medical treatment that is related to your work injury. They’re also required to pay you a portion of your lost wages if you are unable to work as a result of your work injury. Frequently, the worker and the insurance company disagree on these issues.
When the insurance company disagrees with your doctor’s stated medical opinion, they will try to dispute the opinion with one of their own. They do this by having an “independent” doctor evaluate you and go over your medical records. While technically it’s independent, it’s not always the reality. While some IME doctors remain impartial, others tend to say what the insurance company wants them to say.
You have to go to this appointment. It’s usually brief. While this is good for your convenience, it shows how silly it is that a doctor looks at you for five minutes and makes a decision about your injury and treatment. If you refuse to submit to the exam, then your benefits can be cut off.
Sometimes, you might have to go to more than one IME during the course of your claim. Often, it happens after a change in your condition or because your case has gone on for a long time. While multiple IMEs are allowed in Illinois, the insurance company can’t use them as a way to harass you. We’ve seen that happen. It’s not the norm, as it’s expensive for the insurance company because they pay for it, and your attorney should notice if there are any red flags there.
Try not to worry about an IME. If you have a credible doctor and you’ve been honest and straightforward with everything, there’s no reason the IME opinion should overrule a reasoned opinion of your own physician or specialist in the end. Hiring a good Illinois lawyer can make a difference. The arbitrator will hear both sides, but the opinion of the doctor who has seen you routinely and has much more experience with you carries weight. And many times, the IME simply confirms what your doctor has said all along.
In Illinois, workers’ compensation law requires your employer or their insurer to pay for all reasonable medical treatment that is related to your work injury. They’re also required to pay you a portion of your lost wages if you are unable to work as a result of your work injury. Frequently, the worker and the insurance company disagree on these issues.
You can get workers’ compensation benefits in Illinois even if you get hurt doing something outside of your job description. Don’t let your employer or the insurance company tell you otherwise. There are some exceptions, but for the most part you are covered for any injury that arises out of and in the course of your employment.
If a cashier stops to help a stockroom employee move some boxes and hurts their back, it’s most likely covered. It comes down to whether they were doing something to the benefit of their employer. The cashier was, even if they weren’t supposed to be doing it. The cases in which an employee can’t get benefits is when they are doing something so far outside their work duties that it’s no longer considered work related. Examples: Goofing off at work, doing something dangerous just for fun, etc.
Don’t let your employer tell you that your injury is your fault and therefore you can’t file a claim. Even if it’s partially your fault, because you lifted the box wrong, or whatever else, it doesn’t matter. Workers’ compensation in Illinois is a “no fault” system. You are entitled to benefits regardless of fault.
And don’t simply accept a denial by the insurance company. They deny claims all the time, even when it’s a long shot. They hope you’ll get frustrated and go away, or that you’ll fail to hire an attorney and learn that you really do have a good case.
As an employee, it’s your job to do whatever your employer needs. You can’t just stand there and refuse to do something because it’s not in your job description. And most people help their co-workers out if they need help. It would be crazy to not allow benefits to these employees, who were simply being good employees. And the law doesn’t deny benefits in these cases. The insurance company might try to, but you can fight back.
It’s not ideal that you have to hire an attorney and request a hearing before an arbitrator in order to receive the benefits the law entitles you to, but that’s the reality. Hire someone who knows what they’re doing so that you can get your case on track quickly, get your benefits, and hopefully get better and back to work.
We get a lot of calls from people in a frustrating situation: They’ve been injured for months, their doctor says it’s work related and is recommending surgery, but the insurance company’s doctor says they don’t need surgery or that their injury was from a old accident many years ago.
These people can’t move forward and get the surgery, and they aren’t getting benefits, which means no workers’ compensation checks despite the fact that they are unable to work. They’re stuck, and they’re running out of money. They’re also in pain because of their injury. The insurance company is hoping they get frustrated and don’t do anything about it, and that eventually they can say it’s too late to file a claim at all.
So what can you do? It’s going to take a few months, but you can get out of this. If you hire an experienced Illinois workers’ compensation attorney, they will do the following:
- File a formal claim if you haven’t already done so
- Gather all of your medical records
- Schedule a deposition (to get testimony) of your doctor and the insurance company’s doctor
- Argue your case at a trial with the arbitrator assigned to your case
It’s a pretty basic formula, and it shouldn’t take years to resolve. If your attorney can’t inform you about the progress of your case and what they’re doing to move it forward, that’s a red flag that they may not be the best attorney for you. For an experienced attorney who handles these cases day in and day out, this is not that difficult.
Delay is often caused by the insurance company, but it can be made worse by not hiring a lawyer or not hiring the right lawyer. You can switch attorneys. The most important thing to do, however, is get started.
Dealing with a work injury can be overwhelming. You don’t have to solve everything all at once, but there are a few things you should do right away so that you are in a good position to get workers’ compensation benefits if you need them and to get back to work – and your life – as soon as possible.
One of the things that you should do right away is get medical treatment. If your work accident was serious, you likely had emergency care right away. If that wasn’t the case, then get to your doctor as soon as you realize that you have an injury that is related to your job. A delay here can impact many things down the road.
Seeing a doctor or receiving initial treatment for your injury is essential, but don’t stop there. Make sure your treatment continues. If it’s not working for you, or if there are delays, consider having a conversation with your doctor or even getting a second opinion.
There are two main reasons why it’s so important to be on top of your medical care. One is your health. Delays in treatment can cause an injury to worsen and even become permanent in cases where a full recovery could have been possible. The other reason is your workers’ compensation claim. If you are injured on the job, then workers’ compensation in Illinois pays you some of your lost wages while you recover. And all of your medical treatment should be covered 100%. These benefits are significant, and if you delay treatment, they could be at risk.
Workers’ compensation benefits are usually paid by your employer’s insurance company. The insurer’s ultimate goal is their own bottom line, not your health. So you have to look out for yourself. If they see an opportunity to deny your claim and refuse benefits, then they’ll take it. For example, if you wait six months to get treatment for a job injury, they can try to deny your claim by saying that your injury could have been caused by anything that happened in the last six months. If you had seen a doctor right away, there would have been documented evidence that you were hurt on a certain day and in a certain way.
After a work injury, you should notify your employer, see your doctor and file a claim for workers’ compensation benefits. Delaying these steps will work against you, and if your injury worsens, you’ll be in a particularly bad position. Talking to an Illinois workers’ compensation attorney can help, too. They should not charge you anything to go over your case and file a claim.
A reader asks:
I'm currently in the settlement process of my case. I have a T8 disc herniation and went to pt, then had an injection, then more pt since September. The Hartford is trying to settle, but I dont have much interest in the money, because it feels like the injection is wearing off. Instead of a cash settlement, is it possible to settle for open medical benefits for the injury. I'm worried that I will be getting many injections in the future as one wears off after the other and will be stuck with the bill, because I would have settled the case. My lawyer told me that this can't be done, but I know a carpenter that settled for cash and open medical benefits about five years ago. Who is telling me the truth?
So the question is who’s telling the truth. In this case it’s probably both people.
It is incredibly rare for an insurance company to offer you a settlement and agree that if you ever need to see a doctor about the problem in the future, they will pay for it. Their motivation for settling is in part based off the fact that they get to close out your medical rights. Even by giving you money, they know what the total costs will be and can put your case to bed. If you’ve truly made a recovery it’s usually a win-win situation.
If you will likely need medical treatment, Federal laws require the insurance company to give you money to manage to pay for that care. This is called a Medicare set aside. Basically it’s money given to you that you have to use for medical treatment for the problem in the future. This amount is determined by companies that view your medical records and what anticipated medical treatment you will have. For example, if you have a rod put in to your leg because you broke it, chances are that it will need to be replaced some day.
If you want an assurance that if a problem ever does pop up that you can get it paid for, instead of settling, you take your case to trial. Assuming you win, you will keep your medical benefits related to the injury open for life. That means that if you hurt your back now and have problems with it in 20 years, if your future doctor relates those problems to your work injury then the work comp insurance company will have to pay for that medical treatment. I am a big proponent of every NFL player filing for work comp over concussions the day that they retire. That is one way to make sure you can get the care that you need without the NFL having to approve of it.
Even if you do go to trial, you will still get paid and it will likely be a similar amount of money as to what you could have settled for. The biggest difference is a trial offers no guarantees and the process takes longer. But if your health is the most important thing to you then you should go to trial or consider it if you had a serious injury.
I doubt the carpenter got a big fat settlement and the rights to see a doctor whenever he wants. I guess it’s possible, but not probable. I’ve never seen that happen in 17 years of being involved in cases.
You’re in a lot of pain, but the insurance company is arguing that you’re not. They’re basically saying that you’re lying. It’s an argument they sometimes win because proving pain is difficult. We know how frustrating this can be. Your pain is real and it’s preventing you from living your normal life. So how do you prove it?
Pain is different for everyone. We have different pain thresholds and different experiences with pain. Some of us just deal with it better than others, and sometimes it literally feels different to different people. It’s hard to measure objectively. Two workers with similar back injuries might have different experiences, with one returning to work in a couple of months and the other feeling significant pain for years.
The best thing you can do is back up your claims with good medical testimony. If your doctor is reputable and testifies to your level of pain, it can go a long way. In order to do this, be honest and communicate thoroughly with your treating physician. If they don’t hear it from you, they won’t know how bad it is.
Don’t suffer and keep quiet. If you don’t talk to your doctor about the changes in your condition, including your level of pain, they can’t help you. Also talk to your doctor about how you were injured and what you were doing at the time. Explain your job duties to them and what you do on a typical day at work. They also need to support your claim that your injury was caused by your job. They won’t know if you don’t tell them about your work. The insurance company wants to deny your claim, and saying that your injury happened outside of work is one way they might try to do that.
Also, follow your doctor’s orders. If he or she gives you restrictions, follow them. Don’t push yourself to do things that hurt, either at work if you’re still working or at home on your days off. The insurance company might hire a private investigator to follow you and try to catch you doing something they can use to prove that you aren’t in pain. Even if you are being honest, you can get caught in this trap by pushing yourself despite your pain. Be consistent and careful.
It’s unfortunate that you might have to fight hard for benefits just because your pain can’t be proven. But that’s the reality and your case depends on it. Your credibility is a related issue and an important one. If all of this seems overwhelming, talk to an experienced attorney who focuses their practice on helping injured workers. If they have the right experience, they’ll know how to prove your case, even if the insurance company is working hard to disprove it.
By Michael Helfand
We always tell people to worry about their health first if they have a work accident or are involved in a similar incident that ends in an injury. It’s so important to get medical attention and not ignore the pain. It’s equally important to follow your doctor’s advice and go back to them if things change or you get worse.
All of these suggestions are especially important if you have a neck injury. A neck injury can get significantly worse if left untreated, and in the worst-case scenario your injury can become permanent as a result of not being treated. Nerve injuries to the discs in your neck can require neck fusion surgery, after which the nerves have about a year to regenerate. After that, the extent of your recovery is over, meaning that at that point you’re as healed as you’re going to get.
Unfortunately, we’ve seen cases where injured workers don’t get the treatment they need for a neck injury and end up with a permanent impairment, including constant pain and the inability to ever work again. We’re not trying to scare you, but we want you to learn from what we’ve seen. These cases can be serious. Even those with treatment can leave a worker with a permanent disability.
If you are having trouble getting treatment approved through the workers’ comp insurance company, don’t give up. Talk to a lawyer right away. Your attorney, if they know what they’re doing, can force the insurance company to pay what they’re supposed to. Judges don’t oversee these cases. Instead, they are handled by arbitrators who have a similar role. Disputes that can’t be resolved are presented to the arbitrator at a hearing. If the arbitrator agrees with your doctor they can order the insurance company to cover your treatment. The key is getting one of these hearings as quickly as possible.
Any time there is a serious injury with the potential of permanent disability, we suggest hiring an experienced Illinois workers’ compensation attorney to look out for you. Because of the seriousness of a neck injury, we don’t suggest settling the case on your own. When a case settles, medical coverage is closed. You don’t want to settle for too little or too soon, and the insurance company certainly won’t be giving you any tips on how to get all the benefits that are available.
There are several reasons why the date of your injury matters in an Illinois workers’ compensation case. One is that the deadline for filing a claim is based on this date. You have three years from the date of your injury to file a claim for benefits, or you lose your chance, which means missing out on benefits such as payment of medical bills and a portion of your lost wages. If you have received some benefits, then your deadline is two years from the last payment of those benefits.
You have 45 days from the date of your injury to notify your employer, or benefits could be denied. It’s important to know the date of your injury for this purpose, as well. Although we wouldn’t recommend cutting it close and waiting until the last day.
You’re probably thinking that this sounds pretty straightforward and that a seriously injured worker is not going to forget the date of his or her job accident. It can be less clear, however, when someone suffers from an injury – or illness – that occurs slowly over time. If this has happened to you, you might not know the date when it all started.
The date of injury in these cases, which are usually repetitive stress injuries, is the date on which you knew or should have known that you were injured and that the injury was related to your work. Sometimes, this is the date you saw a doctor and he or she told you that your job was likely causing your pain or other health issues.
The date of your injury also matters when the law changes, as it often does. You’ll want to know whether a recent law applies to your case. When there is a change to Illinois workers’ compensation law, it generally only affects claims going forward. But it’s based on the date of your injury, not your claim. So the date of your injury will tell you whether a new or recent law applies. For example, a new law might say that it affects injuries occurring “on or after June 28, 2011.”
Always check with your attorney if you have questions about dates or deadlines, because a mistake can mean the end of your case.
There are many reasons to file a claim for Illinois workers’ compensation if you can, one of which is coverage of your medical bills. If your work injury qualifies for benefits, then your treatment, including recommended surgery, should be covered 100%. There should be no co-pays or out-of-pocket expenses for you to worry about.
The insurance company isn’t going to agree to cover every type of treatment out there, of course. Your treatment has to be reasonable and related to your work injury. This should include emergency room visits, medications, doctor appointments, lab work, physical therapy, and surgery, among others. Even if the law says it should be covered, however, the insurance company is going to look for a way to not cover it. That’s their job.
For example, the insurance company might deny coverage in cases where the treatment is unconventional or alternative, or where it’s particularly expensive. Your fate lies in the opinion of your doctor. It’s important to have a doctor you trust and who has a good reputation. It’s also important that you communicate well with your doctor about how you got injured and what your symptoms are and how they progress.
If the insurance company disagrees with your doctor, they can make you get an Independent Medical Exam from another doctor. If that doctor has a differing opinion then you might have to go to a hearing, with an arbitrator who is similar to a judge, to argue for your treatment. It’s highly recommended that you have an Illinois workers’ compensation attorney represent you at that hearing.
Along these same lines, you should never feel that you are being forced into a certain type of treatment or pushed into having surgery that you don’t want to have.
Unfortunately, the medical benefits that seems guaranteed under Illinois law are not always easily obtained. Get a good doctor, follow their advice and don’t talk to the insurance company (have your lawyer do that).
We get a good number of calls from people who have suffered foot and other related injuries from being on their feet all day. This type of injury affects cashiers, machine operators, teachers, construction workers, and pretty much most workers out there. And that’s the problem. If you get hurt doing something that most people do – like standing all day at work – then it’s not considered a work injury for the purposes of workers’ compensation.
We realize this isn’t good news, since an injury caused by standing can prevent you from being able to work, but we want to be upfront about your chances. If you have suffered an injury along these lines, and you think there is something unique to your particular job that caused the injury (more than just standing), it could make a difference.
If you can prove that your injury was caused by something specific to your job, such as being required to wear certain shoes, walking long distances during the work day, standing on uneven ground, or anything else, you should be able to argue that your injury is a work injury.
If you can prove that your injury is work related, then Illinois law entitles you to benefits. Your medical bills and treatment should be covered 100%, with no out-of-pocket expenses or co-pays. If you are unable to work while you recover, workers’ compensation law says that you get checks for 2/3 of your average weekly pay while you’re out. If your injury ends up being permanent, you can usually get a settlement for that.
While these benefits are clearly stated in Illinois law, you might have to go after them. Your employer and their insurance company (who pays these benefits) aren’t looking out for you above their own interests. The insurance company makes money when it denies claims, so don’t take their word for it if they tell you that you can’t get benefits because your injury doesn’t count as work related.
Also, don’t wait to file a claim for benefits. There are deadlines in Illinois and even if you have a legitimate claim, waiting too long could mean that you’re out of luck.
Let’s say you’ve been injured on the job, and you are unable to work as a result. You are collecting TTD (temporary total disability) payments while you recover. Your doctor believes that you need surgery in order to fully get back to normal, but that you aren’t healthy enough to undergo that surgery due to hypertension. Naturally, you are worried about your benefits.
First of all, the law in Illinois says that you should continue to get TTD until you are at “maximum medical improvement,” which means you are fully recovered or as good as you’re going to get. This is true even you don’t have surgery. If there is another treatment option, you should be allowed to pursue that one instead. You can’t be forced to have surgery, even if your doctor recommends it.
When an unrelated condition affects your work injury, it doesn’t mean you will lose your workers’ compensation benefits. Let’s say your hypertension, which is not work related, makes your work injury worse than it would be otherwise. You still should be covered by workers’ compensation. If you have a work-related back injury and then get into a car accident that makes it much worse, you still should be covered.
Pre-existing conditions, secondary injuries and other complications can make your case more difficult. If your benefits are denied outright or stop after they’ve started, you might need an attorney who can request a hearing in front of an Illinois workers’ compensation judge (called an arbitrator) and argue your case.
But remember that the insurance company “takes you as they find you.” This means that you don’t get punished for having other problems that make your work injury worse. The most common example is someone who is overweight and takes longer to recover from a back injury. They don’t lose their benefits because they might be pre-disposed to have back trouble.
That said, even if you get cancer while rehabbing a knee injury, you only lose your lost time benefits if a doctor will state that your knee is good enough for you to work full time. If the doctor instead says that your cancer is preventing you from fixing the knee then they will have to keep on paying you, even if that lasts for months or years.
If you are working and get killed in an accident, your family would have a claim for death benefits. But what happens if you have a work related injury and then months later you die of unrelated causes?
I thought of this recently when I got a call from someone whose husband had died of cancer months after a work related accident. Somehow their attorney allowed the case to be dismissed and didn’t file for a reinstatement on time. And when they did file to get the case re-filed, they made a huge error.
After a death, the application for adjustment of claim –this is the initial paperwork used to start any case – must be amended to show that the case is now the estate of the injured worker. If you don’t do that then you don’t have a case to pursue. And if the case has already been dismissed and you don’t do that, boy did you mess up. In fact, I suspect my caller will have a legal malpractice lawsuit on their hands (wasn’t our mistake, but some firm I’ve never heard of).
Once the application is properly amended, you need to show some sort of dependency which would be a spouse, child under 18, child in college, etc. After that happens, you can pursue getting all of the medical bills and time off work from the accident paid.
On top of that you can likely get a settlement depending on the actual injury the deceased person had and where they were in their treatment.
But there is a process you have to go through. It’s not a complicated one, yet before an insurance company is going to pay you or anyone else any money they want to make sure they are paying the right people who are entitled to that compensation. They certainly don’t give away money on a whim or by mistake.
Much like most Illinois work comp claims, it’s not very complex if you know what you are doing. That’s of course why people get attorneys in these situations, because they don’t want anything to be screwed up. Someone who is experienced should be able to make the case go smoothly.
Losing a case is of course no where near as bad as losing a loved one. But that doesn’t mean you should not take a case seriously. Handle the process the right way and it will be one less thing to worry about.
A person can get hurt just about anywhere and at anytime. Nursing home employees, however, are at a higher risk according to some studies. The dangers they face are due in part to the physical nature of the job, the unpredictable behavior of residents and the illnesses commonly found in a group home setting.
Overall, it can be a demanding job. Nursing home employees are at a fall risk if the floors aren’t kept clean and clear of water and other spills. They are required to lift patients to move them in and out of bed, and lift equipment. The behavior of some of the people these employees are caring for is violent or at least resistive. And then there’s the risk of getting sick from a contagious disease or illness.
The amount of injuries sustained by nursing home employees is greater than some of the most physically demanding jobs out there, including construction and coal mining. Specific injuries caused by the increased risks include shoulder, neck and back injuries, as well as knee and head injuries. Because of the repetitive and physical nature of the job, repetitive stress injuries are common, as well. These can be caused by continual lifting, bending, reaching, etc.
As with any work-related injury, getting prompt medical attention is the best thing you can do. It puts your health first. Once you know what your injury is and understand the extent of the injury, you can file a claim for workers’ compensation to get coverage of all medical treatment. If your injury is severe enough to prevent you from working, you can seek payment for lost income, as well. All of these benefits are provided by Illinois workers’ compensation law if your injury was caused by your job.
Death benefits through workers’ compensation in Illinois
In the devastating cases where a worker is killed on the job, benefits may be available to the surviving family. Illinois workers’ compensation law calls these death benefits. In addition to a claim, each case should be analyzed for a potential lawsuit against a third party who may have been responsible for causing the death. A good attorney will investigate all possibilities.
At least some amount of death benefits should be available in every case where a worker is killed at work while performing duties that were part of their job. The law specifically says that benefits are available for injuries that “arise out of and in the course of” one’s employment. What this means is that benefits are not for every injury/death that happens while someone is at work. If the employee was doing something for their own benefit and completely outside of their job, such as horsing around with co-workers, it might not count as a work injury or death.
Another hurdle could be proving that the deceased worker was actually an employee and not an independent contractor. Generally, workers’ compensation is only for employees. However, employers aren’t always correct when they label those who work for them. Just because someone was referred to as an independent contractor and paid as an independent contractor, doesn’t mean they were one. A closer look at the relationship between the worker and the employer could show that they were actually an employee. It comes down to how much control the employer had over the worker’s schedule, work methods, equipment, clients, etc.
The employer’s workers’ compensation insurer is the one paying out benefits. In every death case, the insurance company has to pay any related medical bills, as well as funeral expenses. In those cases where there is a surviving minor children or a surviving spouse or someone else who was dependent on the deceased worker, the company also has to pay out death benefits, which can be more than $500,000. In the case of a dependent who is not a minor child or spouse, you have to prove dependency and benefits likely will be based on how dependent that person was on the person who died.
You suspect that your foot pain is caused by standing while you work day after day. Does that mean that you can file a workers’ compensation claim if it gets so bad that you can no longer work or to cover any necessary treatment? The answer is that it depends whether your job put you at a higher risk for your foot injury, which might be plantar fasciitis.
Lots of people stand for long periods of time during the day. The act of standing is not job-specific, and therefore an injury caused by standing is not generally covered by workers’ compensation. However, there are exceptions. Look closely at what your job requires of you. If you have to wear shoes that may have caused the injury, then it would be related to your job. If you have to stand on uneven surfaces, or in a manner that is different and more strenuous than regular standing, you should be able to argue that the injury was job related.
If your heel injury was caused by a single incident, such as a fall at work, then there will be less of a question as to whether it’s covered under workers’ compensation. Most likely, you’ll be covered, because it’s easy to point to your job as the clear cause.
Plantar fasciitis can be caused by age, obesity and diabetes. Even if you suspect one of these non-work causes is behind your injury, you might be eligible for workers’ compensation if your job aggravates or accelerates your condition. The fact that you have a pre-existing condition does not automatically disqualify you from getting benefits.
It’s always a good idea to report your injury and then file a claim if you believe your job is to blame. Foot injuries can be serious and last for years. If it turns out that you need surgery, or you can no longer do your job, you’ll want to know you did everything you can to get paid through workers’ compensation. You might be able to get 100% medical coverage as well as missed pay. Most workers with permanent injuries get some sort of settlement, as well.
Your employer and their insurance company are focused on their bottom line rather than your health or financial stability. Consider hiring an attorney to get the right advice.
Two injuries can be exactly the same, yet treated quite differently under the law. Consider a serious injury caused by a fall. In one case, a man falls off his neighbor’s roof while helping the neighbor with repairs over the weekend. In another case, a man falls off the roof of a customer’s home while doing his job as a roofer.
Work injuries are covered under workers’ compensation law and its unique set of rules, one of the most significant being that lawsuits are not allowed. The man who is injured while working can file a workers’ compensation claim with the Illinois Workers’ Compensation Commission. His employer most likely carries insurance, which will pay him (assuming his claim is approved) for medical bills, lost wages and a settlement amount if his injury is permanent.
The man who fell off his neighbor’s roof while lending a hand can sue his neighbor. He would have to prove fault – that his neighbor was at least negligent in causing his fall. His case would go to court to be decided by a judge or jury. In order to get medical bills covered, he would have to prove his case, including the amount of his financial harm. He may be able to win pain and suffering damages, as well. Pain and suffering damages are not available in a work accident.
Fault doesn’t matter in a workers’ compensation case. If the roofer made a careless mistake, causing his fall, he will still get benefits. If his employer’s equipment was old, and that was the cause of the fall, he cannot sue his employer. A claim for benefits is the only option in most cases. An employer can dispute a claim, not because it’s not their fault, but based on the argument that it wasn’t actually a work injury or that the injury is not what the worker claims. If there is a dispute, an arbitrator (similar to a judge) hears arguments and makes a decision
We are workers' compensation attorneys who 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.
Illinois law provides workers’ compensation for work-related injuries, regardless of whose fault it is. Workers in Illinois often fare better than those in other states because Illinois law tends to be more worker-friendly. However, there are limitations, and the insurance companies deny claims, or try to deny claims, where the injury is not clearly work related.
If you get injured on your lunch break, it may or may not be covered by your employer’s workers’ compensation insurance. It comes down to where you were and what you were doing. It will work in your favor if you were still at your place of work, if you can prove that you were doing something for your employer at the time, or if you were exposed to a workplace hazard that the general public is not exposed to. It might not matter if you were actually clocked out or taking a personal break at the time.
On the other hand, if you clocked out, left the building, got in your car and went to pick up a pizza, then a car accident on the way back would not be a work injury in most cases. If your boss asked you to go pick up a pizza, that would be a different story, with the key being the fact that you were doing something for the benefit of your employer. However, if you are out on your own lunch break, you aren’t accountable to your employer and they can’t be held responsible for any injuries that result.
Another exception to be aware of is whether you’re considered a traveling employee. This status isn’t just for employees to drive around to different places all day. Traveling employees are more likely to get workers’ compensation for injuries outside of the workplace.
When it comes to lunch break injuries, whether you had physically punched your time card is not the main consideration. Individual circumstances are taken into account. This makes more sense than a hard and fast rule, but it also makes the outcome of each case difficult to predict. Let us know if you have any questions.
We are workers' compensation attorneys who 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.
The insurance company will try to deny your claim if they can. It’s their job. Plenty of people don’t have a problem getting benefits, but for those who do, it often comes down to the details of how they got injured and whether it was “in the course of” their employment. In other words, the insurance company argues that the injury could have happened anywhere, anytime and that the job did not put the worker at any sort of increased risk.
The Illinois appellate court recently ruled in favor of an employee who was facing this argument from the insurance company. Her job was to provide care for people in their homes. One day she was helping someone get into the shower when she noticed a soap dish in the way. She held the person with one arm and reached to move the soap dish with the other arm, and felt something pop in her neck. She had a herniated disc, which eventually required surgery.
The insurance company tried, and failed, to argue that moving a soap dish was not a particular risk of the job, but the employee won. The Illinois Workers’ Compensation Commission, as well as the courts, said that her job required her to keep people safe while getting in the shower and that’s what she was doing when she was injured.
It seems fairly clear that this employee should have won. After all, she was doing her job when this happened, and her job duties caused her to reach awkwardly and hurt her neck. Not all injured employees win this argument, however. For example, if you trip on your shoelaces at work, it’s not going to necessarily be considered a work injury. It depends on whether there was any increased risk because of the type of job you have or what you were doing at the time. If you were required to rush somewhere and tripped, you might win. If you were required to wear special shoes that caused you to fall, you might win. But anyone, anywhere can trip on their shoelaces at any given moment. So the argument is that the job didn’t put you at an increased risk of tripping.
It all comes down to the very specific facts of your injury. This is one reason why it’s important to write down what happened, explain to your doctor what you were doing when you were injured, notify your employer, file a claim and talk to an Illinois attorney if you have questions or doubts.
We are workers' compensation attorneys who 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.
We are workers' compensation attorneys who 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.
If you have a neck fusion, it’s often the result of a nerve injury in the discs in your neck. If that happens and there is a delay in medical treatment, the nerve damage can be permanent. You can go from injury free to feeling like your life is ruined forever.
If you end up having a neck fusion, typically the nerves have one year to regenerate after the surgery. Once that time passes, you are usually as good as you are going to get. If you have pain every day, that’s probably how it will be for the rest of your life. Epidural steroid injections, nerve blocks and pain medication can help, but they can only do so much.
We are not doctors and aren’t trying to give anyone medical advice. That said, we deal with neck injuries all of the time. I just finished a heart breaking phone call with a trucker who is in great despair because his doctor explained to him that he’s as good as he’s going to get. Unfortunately for him, that means constant pain, no sleeping and an inability to return to his old job.
Part of the reason this trucker ended up this way is because his medical care was delayed for six months due to some b.s. insurance adjuster that was playing games with his life. So I’m writing this post to encourage anyone with a major injury to get the medical treatment that they need and do whatever they can to avoid delays. He had a lawyer who didn’t file any trial motions or do what was needed to get him the proper care and now his life is ruined forever.
Often a work comp insurance company will try to get you to put your medical care through your group health provider. This is to save them money. Typically we tell our clients not to do this, but if you have a nerve injury, you can’t mess around. Get the treatment that you need, even if your group insurance has to pay for it initially. We’ll make sure that the work comp people reimburse them and that all out of pocket expenses are paid back to you as well.
It’s not an ideal way to handle things and we still do whatever we can to make the insurance company responsible right away. But nothing is more important than your health and since once these problems exist to a while they can’t be fixed, we really encourage you not to mess around.
Neck injuries can be really frightening. Like anything else, you have to look out for you. If you let the adjuster play games, they may ruin your life.
We get a lot of calls about carpal tunnel syndrome (CTS), along with questions about finding the “best” attorney for this particular work injury. The answer is that we don’t believe that there is a single “best” attorney for CTS, or for any injury for that matter. It’s a title that doesn’t mean much, given the unique nature of each case and the individual strengths of each attorney. More important is looking at the big picture and knowing if an attorney is the best one to handle your particular carpal tunnel claim.
Here are some things to consider:
- Experience. You want an attorney who not only has many years of experience in workers’ compensation cases, but many years of experience in carpal tunnel and other repetitive stress injury cases.
- Practice focus. You want an attorney who handles mostly workers’ compensation cases, so you’ll want to ask what percentage of their practice is devoted to this area.
Experience and focus are the two most important things to start with. Other important things we will ask or find out include:
- Which arbitrator will hear your case
- Whether there are unique aspects to your case, such as whether your employer is claiming you are an independent contractor and not eligible for benefits
- If your case is likely to go to trial
- If you prefer, or would be better matched with, an attorney with particular personality traits
- If you need anything specific, such as an attorney who speaks another language
- The urgency of your claim, especially if your benefits have been cut off or are in dispute
Only after really listening to your situation can we give our opinion on the best attorney for your CTS injury.
There was a recent case where a Chicago area UPS worker was walking down the stairs and his knee buckled causing an injury that led to a surgery. He hired a lawyer (not our firm or anyone in our network) and went to trial because his claim for benefits were denied. He lost the trial and based on what we know about the case, it was the correct decision.
To have a winning case for a fall on the stairs at work, you have to show that something about your job increased your risk of getting hurt. If the stairs are wet and you slip, you win. If you are carrying a bunch of work materials and lose your balance, you win. If you are running late to a meeting and are sprinting and trip, you win. If the stairs are carpeted and your foot gets stuck on a loose piece, you win.
In all of those examples, the worker would be able to point to some reason as to why he fell.
The UPS driver, unfortunately, just had his knee gave way. The Arbitrator that ruled against him noted that there was no defect in the stairs, he wasn’t carrying anything and he wasn’t in a hurry. Basically there was no explanation as to why he fell. That’s called an idiopathic fall which is fancy legal jargon for “who knows what happened?”
If you do sustain a fall at work, you need to figure out why it happened. If you don’t have any explanation that relates to your job, you will lose.
On a side note, you should never, ever give a recorded statement to an insurance company, especially if you fell while working. It’s a great chance for them to deny your benefits by getting you to say you don’t know why you fell. If they trick you in to saying that, you will lose your case. So be careful.
A meniscus tear is an injury to part of the cushion in your knee. A meniscus tear is a fairly common injury and can happen easily at work. If you hit your knee against something hard or twist it in an awkward way, you might feel a pop or a burning sensation. These are clues that you may have a torn meniscus.
The first thing you should do is get medical attention. Left untreated, this type of injury to your knee can lead to early onset of arthritis. Your doctor will likely recommend that you see an orthopedic surgeon to assess the extent of your injury and suggest a treatment plan. You may need surgery to repair the tear.
You’re probably wondering whether your insurance will cover all of this, and how you can possibly afford to miss work. Maybe you are considering toughing it out. This is where Illinois workers’ compensation comes in. If you injured yourself at work – even if it was your fault and not your employer’s – you can and should file a claim for workers’ compensation benefits. Most employers in Illinois are required to carry insurance to cover things like this, so you won’t be asking your employer to directly pay for your medical bills. There is no need to tough it out.
The first steps are notifying your employer that you were injured on the job and filing a claim for workers’ compensation with the Illinois Workers’ Compensation Commission. If your injury is covered (it happened at work and was related to your job) then you are entitled to the benefits set by law, which include 100% coverage of your related medical costs, as well as checks for lost wages while you’re out of work due to your injury. These checks are generally 2/3 of your regular pay. If your injury is serious or permanent, you may also get a settlement once your injury is stable.
Sometimes the insurance company denies a claim. Many times, their reason is flawed. An Illinois work injury attorney can help you sort it out.
Of all the tricks the insurance companies use to deny claims, discredit injured workers and reduce benefits, this can be one of the most frustrating. Imagine getting a serious injury on the job and then seeing that the insurance company listed it as a minor strain.
There are a few reasons why the insurance company wants to downplay your injury. It all comes down to money and the amount that they have to pay you in benefits. If your injury is minor, it will cost them less. And if your injury is minor, you can make a full recovery (at least on paper). So this trick allows them to handle your claim cheaply and close your file quickly.
Unfortunately, this trick works and people who are seriously injured end up getting cheated out of benefits that they need. The insurance companies are pretty good at appearing to be on your side. They’ll call you up to see how you’re feeling, etc. For someone who has never dealt with workers’ compensation before (which is most people), it may seem like things are going well.
If you have an attorney, on the other hand, you are more likely to get full benefits. First of all, an attorney who has experience with Illinois work injury cases and workers’ compensation knows what the insurance company is trying to do, and they know how to push back. Second, insurance companies often treat you differently if you are represented by an attorney. In our experience, you’re less likely to get a very low settlement offer if you have an attorney with a good reputation. It might still be low, but the insurer knows it can’t completely take advantage of you.
If you see that your employer’s insurance company has listed your injury as something that it’s not, don’t assume that’s just how the system works. Seek help from an attorney and get your real injury recognized.
For the purposes of workers’ compensation, arthritis and degenerative disc disease usually fall into the category of what’s called a “pre-existing injury.” In other words, your job didn’t cause these conditions. However, that doesn’t mean they don’t count as work injuries.
The law in Illinois says that if your job aggravates a pre-existing condition, it is considered a work injury and you are entitled to benefits. These benefits include payment of medical bills (100%), payment for a portion of lost wages (usually 2/3 of what you were earning before your injury made it impossible to work), and other benefits.
Arthritis is a broad term that is often used to describe joint conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, gout, lupus, etc. Symptoms commonly include stiffness, swelling, pain and redness around the joints, which include wrists, hands, knees, hips, etc. These symptoms can affect other parts of the body, as well.
Degenerative disc disease is common as you age, as the discs in the spine age and lose the ability to absorb shock. It happens to everyone. However, a specific injury can make the degeneration worse or accelerate the condition, causing significant pain. A back or neck injury often sets this off. Slipped, ruptured, herniated, and torn discs are other terms you may hear.
There are certain types of jobs that put extra strain on the neck and back. In these jobs, workers may be more likely to aggravate or accelerate a condition such as arthritis or degenerative disc disease. Jobs in this category include those that require repetitive motions (typing, assembly line work), high impact activity (construction, other manual labor), or those that require workers to remain sedentary for long periods of time.
Despite the fact that pre-existing injuries can be covered by workers’ compensation, the insurance companies sometimes try to deny this type of claim. It’s their job to deny claims that don’t meet the criteria, and they tend to push the limits. After all, they make money by paying out less to injured workers.
If your claim for aggravation of a pre-existing injury is denied, you might just have to request a hearing and tell the arbitrator (basically a judge) why your injury should be covered. This is what Illinois workers’ compensation attorneys do for their clients. Many times, they are able to prove that benefits should be paid.
A good workers’ compensation attorney understands that your actual injury is just one part of what you’re going through. While it’s technically not within their expertise to look after your mental health or your finances or your family, they can’t adequately represent your legal interests if they’re blind to the rest of the issues in your life. Most of these may be occurring as a result of your work injury, so they’re certainly related.
A serious work injury can weigh on you. You aren’t feeling well physically, you can’t work and earn the living you had been earning, you have bills and debts to pay, your family is counting on you, and the future is uncertain. These are common side effects of a work injury, or any serious injury. Additional injuries, setbacks and depression aren’t uncommon either.
For an Illinois workers’ compensation attorney, all aspects of the injured worker’s life are relevant. For example, your attorney should help you figure out how to deal with collections agencies, if you’ve been unable to pay your bills. Also, your attorney should negotiate your settlement with your entire situation in mind. Some people can afford to negotiate at length and wait for the “full” amount that they feel their case is worth; others need the money from settlement as quickly as possible and might settle for less. This doesn’t mean they didn’t win, just that they worked with their attorney to get the best outcome for them, in their unique set of circumstances.
They don’t teach you this stuff in law school. It’s an additional set of skills that a practicing attorney develops over time. We generally recommend Illinois attorneys with many years of experience, and this is one reason why we do that. Your workers’ compensation attorney should not only be aware of your stress and confusion at a difficult time, but they should be prepared to help you deal with it.
Imagine you are up on a scaffold at work and doing some painting when suddenly the scaffold collapses and your ankle gets crushed. It’s witnessed and your employer and the insurance company agree that your injuries are work related and the insurance company says they will pay for all of your medical care. So how can they get away without having to pay all of your doctors?
The answer is, they can screw you if you screw up. Let me explain.
Under Illinois law, when you are hurt on the job you are entitled to see a doctor of your choice. If you don’t like what that doctor recommends or has to say you can see a second doctor. Any referral you get from either of these physicians is considered part of their treatment. So if the first doctor order a MRI and then some physical therapy and then suggests a surgeon, that’s all part of your first opinion.
The problem develops when you don’t get a referral to a new doctor. Once you are on your third choice, you have to pay for that treatment out of pocket, no matter what.
The insurance company isn’t going to warn you about this. They aren’t going to tell you to get a referral to make it happen. And if you don’t, you will get screwed over, especially if you like this third doctor and want them to take care of you.
It can get even trickier because for accidents after September 1, 2011, the insurance company can pick one of your doctors for you. You don’t have to see them, but if you don’t it will really limit your options.
So the bottom line is to make sure that you always get a referral. If you don’t it could cost you a ton of money. And there won’t be anything you or the best lawyer in the world can do about it.
There are nerves in your neck that are connected to other parts of your body, such as your arms. An injury to your neck can affect many things. If you have numbness or tingling in your arm, for example, it could be the result of something you did to your neck. Nerve injuries like this can be serious, so get medical attention as soon as possible if you think you might have this type of injury.
If your neck injury happened while you were working, Illinois law says that you are entitled to workers’ compensation benefits. This means that you can file a claim and get your medical bills covered (100%). You also can get checks to cover some of your lost wages if you are unable to work because of your injury.
The first step is always seeing a doctor. Next, you would file a claim for benefits. Your employer does not pay workers’ compensation – it’s handled by their insurance company. Most employers in Illinois are required to carry workers’ compensation insurance. If the insurance company accepts your claim, they will start paying benefits. If your claim is denied, you can request a hearing to prove that you should be getting benefits (an attorney is very helpful if your claim is denied because they know how to prove your case and how to do so as quickly as possible).
Workers’ compensation covers injuries that occur suddenly, such as when a worker slips and falls, or lifts something heavy, and it also covers injuries that occur slowly over time. These are called repetitive stress injuries. The basic rule is that if your injury was caused by your job then you are entitled to benefits. Even an old injury that is re-injured at work should be covered. If you have questions, talk to an Illinois work injury attorney.
It’s important to not rush back to work after an injury. We understand that you need to get back to your pre-injury income, and back to your routine, but if you return too soon you risk re-injury or a related injury. Further injury could set back your recovery and keep you out of work much longer.
So how soon can you return to work? We recommend following the advice of your doctor. Talk to them about the job duties you perform and whether you are ready to go back. They may advise you to return to work but with certain restrictions. These restrictions might limit the tasks you can perform, and you might not be able to go back to your full job. In some cases, your employer might offer you a completely different job to do during this time.
If you don’t follow your doctor’s restrictions, and you re-injure yourself, your benefits could be at risk. If it’s determined that you purposely ignored the doctor’s recommendations, you could lose your wage loss benefits. In some cases, your employer may not have a job available that complies with your medical restrictions. You do not have to return to that job if that’s the case. However, if a job is available, and you do not take it, then you can lose benefits.
If the job you can do with restrictions pays less than the job you had pre-injury, there are wage loss benefits you should be able to collect. This is called wage differential, and it’s for a portion of the difference between your current wage and your pre-injury wage.
Going back to work after an injury is a step that you shouldn’t take lightly. Talk to your doctor and your attorney to protect your health and your benefits.
Workers’ compensation is for employees who are injured while doing their jobs. For hotel room cleaners, these injuries range from physical strain to contagious illness. When someone is injured on the job they can make a claim for benefits, which include 100% coverage of medical expenses, as well as payment of a portion of lost wages. In other words, if you are unable to work while you recover from a work injury, then you can still get some of your pay through workers’ compensation.
The hotel industry is large, with hundreds of thousands of workers cleaning rooms daily. The responsibilities of the job vary widely and often are physically demanding. In any given day, a hotel room cleaner vacuums, cleans bathrooms and changes bed linens countless times. All of these activities involve repeated lifting, bending and reaching.
In the hotel industry, those who clean rooms are at the greatest risk of work-related injury. In addition to physical injury, these workers are at risk of illness. Cleaning products can cause respiratory illness and skin irritation. Contact with various waste products can expose them to infectious disease. It’s also a stressful job because of the constant physical demands.
Hotel workers are entitled to workers’ compensation benefits if injured on the job. The first step is getting medical treatment. Next, talk to a workers’ compensation attorney about the benefits you’re entitled to, as well as the best way to go about getting those benefits, particularly if you have filed a claim and it has been denied. An attorney can request a hearing and get your claim back on track.
A caller to my office wanted to verify what a lawyer told him. The caller had been stung by a bee which caused him to fall and break his ankle. The lawyer he had previously called had told him that the law says that bug bites and bee stings are never covered under the Illinois Workers’ Compensation Act.
Well, that’s not true.
No matter your injury, you have to look at the context of how you got hurt. This is certainly true with insect cases.
For example, let’s say you work for the cable company and have to go and repair a customer’s TV. You head out to the back of their house to look at a cable and all of the sudden discover that there is a bee hive right next to it. Before you know it, a swarm of bees is on you and you are stung multiple times. In my opinion, that case would be covered as a work related injury.
On the flip side, if you show up to a customer’s house and while walking to the door you get stung by a single bee, that probably wouldn’t be covered. The first example is a case because you are at an increased risk as compared to the general public because you have to deal with the bee hive. In the 2nd example, it was just a random act that could have happened anywhere.
You could also get a spider bite just sitting at your desk. That’s probably not a case because there is no increased risk of spider bites in most offices. But if you have to work in a warehouse and it could be shown that the work environment leads to more spiders being there.
Of course you need an actual injury too which doesn’t always happen, but in almost no scenario can you say something is a case or isn’t a case without having the full picture.
A final example would be getting Lyme disease from being bitten by a tick. If your job requires you to work in a forest or place with tall grass, then getting Lyme disease is an increased risk of your job. On the flip side, if the tick bite occurs while you are giving a presentation in your office, nothing about your job would appear to increase the chances of tics being there.
Again, a good lawyer will always look at the context of how the injury occurred. Failing to do so is just lazy.
I saw this question posted on a different website and thought it would be of value to my readers:
My mother-in-law was injured at work and needs to have surgery. She will not be able to bathe/dress herself after surgery. Will they provide a home healthcare nurse to assist her with this?
The answer is yes if a doctor says that it’s medically necessary. You can certainly expect that the insurance company will fight a request like this because they don’t like to pay anything that isn’t typical. But what they want to do shouldn’t matter. If it’s reasonable and medically needed then you should get it.
We’ve seen cases where family members acted as home health aids for injured workers and were entitled to some compensation. But that’s not always available and you certainly shouldn’t risk your long term health by taking un-needed chances.
What a lot of our clients don’t recognize is that their medical restrictions may require some benefits that aren’t traditional. For example, we’ve seen cases where the insurance company had to pay for a gym membership to help in rehabbing an injury. One of our clients became paralyzed from a job accident and the insurance company has had to buy him a special van that he can drive. They also had to pay for major structural changes to his house in order to accommodate his wheel chair.
If an interpreter is needed, that can be provided. If you need to take public transportation to get to an appointment, you can argue that the insurance company should have to pay for your fare card. And certainly if you need home health care, they should cover that too.
We try to get our clients what they are entitled to under the law. And as the old saying goes, if you don’t ask for it, you’ll never know if you can get it. But we don’t make things up. We ask for what our clients need.
We are investigating the possible work related death of a man that died of cancer. For many years he worked at a factory where he breathed in particles that came out of the machines. The factory also had very bad ventilation. It’s possible that his cancer is related to his years of chemical and particle exposure.
If he does have a case, it will fall under what is called occupational disease. Those cases are for the most part handled like any normal work injury, but they are more difficult to prove and usually involve a catastrophic injury or death.
To bring an occupational disease case, you have to not only prove that the exposure lead to your illness, but also that your exposure was in the last three years. In other words, if you are claiming an illness today based on something that happened to you at a place you stopped working at in 1977, there is nothing we can do for you.
Sometimes there is more than one case to pursue. The most common example is if you have an asbestos exposure injury. You might have a lawsuit for that (we work with a Chicago asbestos law firm on those cases) on top of a claim for benefits for workers’ compensation.
In the sad case that someone does pass away from an occupational disease, the family can bring a case if they left a surviving spouse, child under 18 or someone else who was financially dependent on them. There might also be a case for the estate if there was some permanent injury before the person died.
These cases are pretty niche. A lawyer who dabbles in work comp claims would not be qualified to handle them. Of course we have a state wide network of attorneys who have handled hundreds of these cases, so we are happy to help if you need it. But please be careful. There are strict deadlines for filing cases and you truly need someone that can demonstrate past success with these claims. Nobody “specializes” in exposure cases, but there are certainly a handful of work comp lawyers who can show great success with past cases.
An attorney I’m friends with related a story about a case he was working on. The injured worker was getting injections in to his back for a chronic injury. He went to his doctor and said, “If this doesn’t work I’m going to come back and kill you” and apparently he didn’t say it in a very joking manner.
The cops were called and of course the doctor fired the patient and barred him from the office. Yes, a doctor can fire you if they want.
As someone who has a torn rotator cuff and has had back and knee injuries over the years (none of them work related), I can certainly understand how frustrating it is when an injury does not heal. But threatening a doctor is going to do nothing, but land you in jail. Same is true if you threaten the insurance adjuster, other lawyer or anyone else. And even if you don’t land in jail, it makes you look crazy to the Arbitrator. I’ve seen plenty of cases lost because armed security was needed because people were scared that the worker would hurt someone (no one I’ve represented fortunately).
Personally, I would fire any client that did this and every lawyer I work with would too. It’s just not worth the hassle. We fight for our clients, but don’t want clients who fight.
So even if it will make you feel better to vent, don’t do it in a threatening way. Feel free to tell your doctor how frustrated you are. Feel free to tell me. I’ve had days when my job isn’t to be an attorney, but to just be a friend and listen. We are happy to do that. But we’ll also tell you when you are wrong. And if you threaten anyone you are not only wrong, you are ruining your case.
There are things you should do, and things you really shouldn’t do. Unfortunately, some people don’t stop to think about this after they get hurt at work. Here are some basic things to keep in mind when deciding how to handle your workers’ compensation case.
- Notify your employer. If you get hurt at work, tell your boss or supervisor as soon as possible. Do this in writing and include the date. Consider keeping some notes or a journal for yourself on what happened, who was there, etc.
- See a doctor. Your health is the most important thing in all of this. Seeing a doctor right away also helps your case.
- Be honest with the doctor. Tell your doctor how you were injured. They need to know it was work related.
- Listen to the doctor. If the doctor gives you restrictions or tells you not to do certain things, like yard work or golf, obey the doctor’s orders. If you get caught by the insurance company doing what you supposedly can’t do (and they do check), you could ruin your case.
- File a claim. Even if your case is straightforward and you begin receiving benefits without a formal claim, file one anyway. Just because your case started out smoothly does not mean it will continue that way. If the insurance company cuts off your benefits unexpectedly and you need to request a hearing, having a claim on file will give you a head start.
- Talk to an attorney. If you have a serious injury, if you aren’t receiving benefits or you believe you aren’t getting all the benefits you should be getting, get the advice of an experienced workers’ compensation attorney. They will meet with you for free.
- Keep talking to your attorney. Keep your attorney informed of any changes in your case, including your health and medical treatment. Do not speak with the insurance company.
- Follow through. If your benefits stop, if your pain gets worse, if your employer threatens to fire you because of your inability to come to work, don’t be discouraged or frightened. You are entitled to benefits if you are injured at work and your employer is not allowed to fire you for seeking those benefits.
Workers’ compensation in Illinois provides benefits, such as coverage of medical expenses and payment for lost wages, for workers who are injured on the job. You do not have to file a lawsuit and go to court or prove anything against your employer to get these benefits – they are yours according to Illinois law.
Many different types of injuries that happen at work are considered work injuries for the purposes of qualifying for benefits, including repetitive stress injuries such as carpal tunnel syndrome. These are different from one-time injuries such as a fall off a ladder. Repetitive stress injuries occur over time from doing the same motion over and over. Carpal tunnel is commonly known to be caused by excessive typing, but assembly line work can result in the condition, as well. Similarly, repeated lifting and/or twisting motions can cause repetitive stress injuries to the neck or back.
As soon as you begin to suspect that you have work related repetitive stress injury, see a doctor. Not only does early treatment benefit your overall health, but it can help you establish your claim for workers’ compensation benefits. If you are unable to perform your job, if you need surgery or if you are permanently disabled as a result, you should be compensated.
Your medical bills should be covered 100%, so long as your treatment is reasonable and related to your injury. If you have a pre-existing condition, such as a prior back injury, you are not disqualified. If your job made your condition worse or made it flare up again you still should be eligible for workers’ compensation payments.
Your employer or their insurance company may deny your claim. Don’t worry – this happens all the time. It’s in their best interest to avoid paying out benefits, because it costs them money. So if you get a denial, don’t give up. Talk to an experienced workers’ compensation attorney about getting your claim approved and your benefits started.
Some employers are jerks. But most aren’t and the great majority of people that call us are happy to have a job and like where they work.
No matter how you feel about your job, there is one thing that we never do if we are representing you following a work related injury. And that is we don’t have contact with your employer.
This is a big fear for some clients. Some don’t want the employer to know their business. Others are worried about pissing off their boss. Others are just paranoid.
Whatever your concern, please know that other than sending a copy of the application of adjustment of claim to the employer, which we have to do by law, we don’t contact them any other time without your permission. And in 99% of case we don’t even need to. All of our dealings are with the insurance company and their lawyers. That’s it.
We are big on respecting your privacy and we know that you have a future after your case is done. We want your case to go as smoothly as possible and we want your future to be as comfortable as possible.
So don’t decline pursuing a case because you don’t want your employer to be involved. That will never happen with us.
More than 10 years ago I started a state wide network of like minded, experienced Illinois workers’ compensation attorneys. I am a lawyer who helps you find the right work injury attorney for your case, be it me or someone else in our network. That gives you the best possible chance of success.
While we don’t promise a result, we do promise that everyone we suggest is experienced and will be the lawyer that directly handles your case. Unfortunately there are a bunch of law firms where this isn’t true.
There is one Chicago workers’ compensation attorney in particular (not part of our network) who ends up having his clients call us a lot. The story with him is usually the same. It’s some version of: “I was impressed by his website and brochures. He personally told me that he would handle the case himself. After I signed up, I got a letter from their firm, but it was from someone I’d never met who turns out to be a young associate at their office with no experience. The partner I talked to originally said that this was just a form letter, but I’ve only dealt with this young guy since.”
There are a bunch of law firms in town that are headed by very seasoned lawyers. Some of these hire young, inexperienced associates to actually handle some or all of the cases. For these older lawyers, they don’t have to deal with the clients or the actual work that goes in to handling a case and they can pay these young lawyers way less than what they’d pay someone who knows what they are doing or has an actual track record of success.
The person that suffers of course is you. These young attorneys are using you as a guinea pig to figure out how to handle a case. That doesn’t mean they will screw up for sure, but given that the cost is the same, don’t you like your chances better with someone who has 15-30 years of case experience than you do with someone who has 1-3 years of experience or even worse, just got out of law school? You get one shot to win your case. You better believe that the insurance companies and defense lawyers know that they can push around young attorneys.
If you are hurt on the job, you should be able to focus on your health and getting better. The last thing you need is an attorney to give you a headache because their service is terrible or they flat out lie to you.
Before you hire a firm, check out how many of the attorneys on their roster have been practicing law for less than five years. If it’s about half of the attorneys that work there, don’t be surprised if one of them is really your lawyer. If this is your first case, the two of you can figure out how things work together. Or better yet, keep looking around for an experienced law firm that has veteran attorneys that will actually do the work themselves.
When you get hurt on the job, the insurance company is allowed to hire a private investigator to follow you around. Their goal is to see if you are really as hurt as you say you are or to see if you are doing things that your doctor says that you should not do.
I used to represent insurance companies (still wiping the scum feeling off me from that, although it is great training to learn how they think and operate) and I’d say 49 out of 50 surveillance videos were a complete waste of time. Most people are honest and if they tell their doctor that their back hurts, you won’t catch them doing the bench press at their gym or working on their car or playing tackle football (although I did see those three things happen on video tapes from cases I handled).
Hiring an investigator isn’t cheap so they are very selective on the cases where they use it. It’s usually when they have an injured worker with a long term injury or receive a tip that you aren’t being honest. They aren’t going to do it right after a surgery (because they’ll never catch you doing anything wrong), but will definitely do it before a surgery so they can avoid that big bill. It’s also really common at the settlement stage of a case when you can’t return to your old job. That fact often makes a case worth more money and they want to make sure you are being legitimate.
Like I said, most of the time surveillance shows nothing, but when they catch someone it’s often a doozy. But a Wheaton workers’ compensation lawyer I know sent me this article that discusses the most blatant case of work comp fraud caught on video that I’ve ever seen.
I’ll let you read it yourself and enjoy a good laugh. But the bigger picture is knowing that it’s people like her that cause insurance companies to go after honest people like you and in some cases, screw over honest people like you.
The best thing you can do of course is just continue to be honest. I’ve never had a client that throws down their crutches after they leave the doctor’s office. But when I say that you should be truthful, that means don’t embellish your injury or exaggerate your symptoms. Just tell the truth and let the doctor take care of the rest.
Some clients are uncomfortable with the idea that someone might be following them around or sitting outside their house with a camera. We fight like heck for our clients, but this is something that we can not prevent from happening. But I can tell you that after a few days of them seeing you do nothing out of the ordinary, they will stop following you. And I know this from experience and because insurance companies are all about not spending money. They only do surveillance with the hopes that they can stop paying you. They will not spend thousands of dollars a week extra once they realize that you are legit. And in that regard, the surveillance will actually help your case in the long run.
Spinal stenosis is a type of spinal injury that can result from a work injury. It can result from a sudden trauma or develop over time. It’s also a condition that can occur naturally with age, but if your job contributed to the problem or aggravated it, you should be able to get workers’ compensation benefits regardless of whether you had a pre-existing injury.
Spinal stenosis can occur when the space between the spinal vertebrae narrows and compresses the nerves. A few specific work injury scenarios that can lead to spinal stenosis include:
- a fall or other trauma at work that injures the neck or back
- a vehicle accident on the job that injures the neck or back
- job-related repetitive motion, such as heavy lifting or repeated bending, that puts strain on the neck and/or back
Symptoms of spinal stenosis can include: pain, numbness and/or weakness in your legs or middle of your body; pain in your neck; and pain, tingling or weakness in your shoulders or arms. People suffering from spinal stenosis may have trouble sitting or standing without pain, and in some cases it can affect your balance or your ability to walk.
There is a wide range of back injuries that can happen on the job. Listen to your body and get medical attention if you are in pain. Don’t let anyone tell you that because you hurt your back in a car accident ten years ago you will not be able to get workers’ compensation. As we mentioned above, workers’ comp law allows you to get benefits even if you have a pre-existing condition. You are eligible so long as your job in some way accelerated or aggravated that condition.
If you have questions about a back or neck injury at work, feel free to contact us.
Your pain is real, but it’s hard to prove. People react differently to pain. Our thresholds are different and pain can affect us in varying ways. It’s not easy to measure in any objective way. We’ve seen two people with similar injuries have very different pain reactions. One worker with a shoulder injury might recover in a few months and get back to work, while another might never recover.
One key to proving pain is having medical testimony that backs up your claims. Your treating physician’s opinion on your pain can make all the difference. Being honest and communicating well with your doctor is important. One of the worst things you can do is try to suffer through the pain and not follow up with your doctor.
A related issue is talking to your doctor, in detail, about how you were injured. If you don’t explain what you do at work (heavy lifting, for example), they aren’t going to be able to connect the dots and realize that you have a work injury. Again, their opinion on how you were injured is essential to the success of your case. The insurance company would love to argue that your injury was caused by skiing on the weekends and not your job duties.
Another key is respecting your pain. Follow your doctor’s orders and obey any restrictions. Don’t push yourself at work or at home on the weekends. Some insurance companies hire private investigators to follow injured workers and catch them doing something they claimed they couldn’t do. Even honest people get caught in this trap because they push themselves to do things despite the pain. Your daily activities need to be consistent with what you’re claiming. Be honest about your pain, and make sure to act accordingly, even when you’re off duty.
Because pain is subjective, you have to work hard and be careful when proving it. If you fail to get a solid medical opinion or get caught doing something that would indicate you’re not actually in pain, you could lose your case. Your credibility is extremely important in a work injury case, especially if your case ends up before an arbitrator.
There are two important things to know about attorney fees in workers’ compensation cases. The first is that Illinois law limits an attorney’s fee to 20% in these cases. This is lower than your typical injury case fee. The second thing to know is that the attorneys we recommend do not take 20% out of your weekly checks for lost wages or your medical bill payments unless they have to do significant work and fight for what you’re owed. In other words, if you have a routine case, they should not charge you a fee to help you file your claim.
Workers’ compensation attorneys are paid a contingency fee, which means they only earn a fee if they are successful in your case. If they get you a settlement or award after trial, they get paid. If you lose, you don’t pay. In typical injury cases, the contingency fee is 33%; in a work injury case, it’s limited to 20%.
Many cases settle, and in our experience having an attorney negotiating on your behalf results in a higher settlement amount. A fee would be earned in this situation, but also in one where the insurance company has refused benefits. Your attorney can request a hearing and argue your case in front of an arbitrator. If you win, and the arbitrator says that the insurance company owes you for past benefits, then your attorney earns a fee on that. If the arbitrator rules against you, there is no fee.
Don’t hesitate to ask your attorney about how their fee works. You deserve to know – and understand – the details. Even if you have to switch attorneys, your fee should not exceed 20%. If you want to know more about legal fees in workers’ compensation cases, feel free to contact us.
In a post the other day, I talked about not settling a case too fast. That’s true, but ironically we just were involved in a case that settled within 24 hours of the first call.
A client called us on a Monday. We referred her to a partner of ours in her area. Signed up that day, gave us her medical records from a five year old injury that was ready to settle. The insurance company had previously refused to make an offer. We valued the case at $50,000 and the attorney we recommended was able to get the insurance company to agree to that the same day.
In all my years of handling workers’ compensation cases, this is the quickest turn around I’ve ever seen. And I don’t expect I’ll see one that ever beats it. But I’d love to try.
In every Illinois workers’ compensation claim, there is a possibility for a settlement. They don’t have to offer you a settlement, although they do have to pay your medical bills and time off work as long as you have a work related injury.
But sometimes the insurance company will offer you a very quick settlement. For them, if they settle your case it means that they don’t have to pay any more of your medical bills or for any of your time off of work. Other times if they settle for a low amount it will allow them to avoid paying you for the difference of what you were able to make before the injury and what you are able to make now.
They are making these offers because it’s in their best interests, not yours. We always try to settle our cases for as much as possible and as quickly as is sensible. Note that I didn’t say as quick as possible because once you settle your case, your right to benefits are done. If you have hardware in your body from a fusion surgery and it needs to come out, you’d have to pay for it. If you return to work and can’t do your job because your boss is not honoring your lifting restrictions, you are out of luck. If you need more physical therapy, it’s on you. If your case was really worth $100,000.00 more, you can’t go back and re-open the claim to get what is fair.
So when we settle a case, we go for the most possible for our client, but also at the right time. What good is a $50,000.00 settlement if the case is worth twice that or if you have $40,000.00 in medical bills that haven’t been paid?
I caution you to look at every action by the insurance company with a questioning eye. Assume they have an ulterior motive for what they are doing. They might not be bad guys, but I promise that they are not looking out for you. And if they are really eager to settle your case, it can be worse than if they don’t want to settle at all.
Finally, don’t listen to their b.s. about an offer expiring if you don’t accept it in time. I can only think of one time that has ever truly happened and about 200 times that threat was made and low and behold not only was the offer not only still there, but usually we got our client much more and on their time table, not the insurance company.
The value of every Illinois workers’ compensation case is different. What your case is worth depends on a ton of factors. The most generic are your average weekly wage and the extent of your injuries. Your ability to perform the same work as before, the need for future medical care and your personal goals also help us determine what you should get. Of course for any client, we try to get the most amount possible. Mostly we do that because we have pride in our work, but of course the more that we get for you, the more we get for us.
When we discuss settlement with our clients, we talk about a range of value. In other words, we’ll tell them that on the low end the case is worth $x and on the high end the case is worth $y. We also take in to consideration that if the insurance company has a defense to the case, it could be worth $0. So the only way we’d suggest to a client that they consider settling toward the lower end of the range is if we think there is a real chance that they could go to trial and get nothing.
We are so proud of this recent settlement of “only” $26,290.85 because when we figured out the high range of value of this case it came to 35% loss of a leg for our client’s knee injury which equaled $26,290.85. In other words, we got our client the most amount that we felt that the case could ever be worth.
Of interest in this case is that the client came to us only after the insurance company offered him 15% loss of the leg. We felt the lowest the case was worth is 20% of the leg. The insurance company agreed because they offered him that less what attorney fees would have been if he had an attorney and then rounded it down. You won’t always get a settlement offer without a lawyer and they don’t have to give you one, but if they do, you can bet it will be at the very lowest range of value. The problem is that once an offer is made, most attorneys (us included) won’t get involved because we can only get paid if we get the offer increased so usually it’s not worth it for us. The injured worker is usually forced to settle and ends up with a few thousand less than they would have.
In this case, the offer before we got involved was so low that it was worth it to get involved. Eventually we were able to get every last penny out of them and our client was thrilled. And while it may not look as impressive on paper as some of our six figure case results look, in this case we are proud because we know that there was no way to get any more out of this case than we got. And most importantly we have a happy client.
There is a Chicago work injury lawyer who is famous amongst his peers for being the laziest, slowest moving guy out there. He has a marketing shtick that gets him clients based on the prestigious school he went to. Even with that, when you look at him, you wonder how anyone can feel comfortable hiring him and having him in their corner. He’s kind of poorly groomed and sloppy and he talks very slowly. I remember when I started off as an insurance defense lawyer in work comp cases way back in 1997, I was assigned to handle a case against him. The case was over 10 years old and the very nice Arbitrator was screaming at him because almost every case he had in front of her was old. The case I was working on was four years old and we had a settlement offer on the table that was never responded to in the two years before I took it over. His client wasn’t getting treatment and apparently he never even told him that there was an offer. We ended up paying him the same amount that we had been offering for 24 months.
Yet somehow this guy keeps on getting clients. I really don’t get it, but it’s not my problem. As a client, it’s up to you to decide if the lawyer you are thinking of hiring is a good choice for your case. If you think I suck, don’t hire me. If you think the attorney I recommend is awful, don’t hire them. But if you see a guy whose got mustard on his shirt or smells of alcohol (one lawyer in town is notorious for that) or is screaming at their secretary and you still hire them, then it’s on you.
I bring this up because I was called by a guy who hired the lawyer I wrote about and he of course was not happy with his choice. He told me that the lawyer always tells him what he wants to hear, but never actually does anything. He only hired him he said because his buddy had used him on a case. “But then I remembered that my buddy’s case had taken years and he didn’t like the guy.”
That made me laugh both because it was funny how he said it and it’s pathetic about how the customer service is with this attorney.
When you are hurt on the job and have a serious injury, it’s as if your life is on the line. There are a ton of good lawyers out there. There are also a bunch of crappy ones that yell, don’t return phone calls or like this guy, don’t actually do anything at all even when minimal effort would get a result. If you see red flags then you need to take note of them. If your case gets screwed up to the point of no return there will be nothing that anyone can do for you.
A reader asks:
I was hurt on the job and worked for two different employers at the time of the accident. The company where the accident occurred has agreed it is a undisputable workers compensation claim at no fault of mine. I saw a lawyer who told me I MUST file a worker's compensation claim against both employers because I was working at more than one employer at the time.
A story like this makes me cringe. Basically this attorney has no clue what they are talking about and is asking a potential client to start off with a lie. File a claim against anyone possible and hope that something sticks. The problem with that approach is that the injured worker has to sign a legal document that they know is false. Then they have to send this to their 2nd employer who doesn’t know anything about a work injury. You think that will piss them off? I obviously fight for the rights of injured workers in Illinois, but if my secretary knowingly filed a b.s. case against me I’d be mad.
Then there is the problem of the credibility of the worker. Let’s say that this case ends up going to trial some day. If the worker is on the witness stand, they will have to admit that they lied. That of course will make them look not very credible and could be the reason they end up losing the case.
Beyond all of this, there is no benefit to filing a 2nd case. If anything it will delay the matter because the two insurance companies will point fingers at each other. It would be much more logical (not to mention moral) to just file one case against the employer that agrees is the cause of the injury.
This is what happens when you hire an attorney that doesn’t just handle work injuries all day every day. Whether you hire me, someone I recommend for you or another firm that you find on your own, if the lawyer is handling work comp, plus divorce, DUI, traffic, etc it’s a really bad sign. It’s impossible to keep up on all areas of the law. And when you don’t know what you are doing, you end up giving awful advice that can kill a case.
The greatest compliment that an attorney can receive is when they get a call from someone new who tells them that they were referred by a past client. That shows that the client thinks you did a good job. We get a call like this 1-2 times a week and it’s always my favorite call of the week.
Because Illinois workers’ compensation attorneys count on their current clients for future business, I’m always confused when I get an e-mail like this one below. This is from a woman downstate who clearly won’t be recommending her lawyer (not our firm or anyone we work with by the way) in the future.
I was injured on 2010 and was recently released from my doc. I fell and broke my lunate bone in my left wrist, because the insurance company waited so long to do anything about it the bones started to break down. I had all the small bones in my wrist removed because it took so long, after the surgery the pain didnt go away and they ended up fusing my wrist a few months later. I have a lawyer and they are working on my settlement and I am being told different things now than I was told when I hired him. I am told the amount I am looking at is a lot less and that because of the new laws I wont recieve any pain and suffering, (I didnt think the new laws had anything to do with my case) I dont know what to believe and am stressing out. Can you please help me understand all this?
The explanation to all of this is that his lawyer is a liar and said something at the start of the case that they couldn’t back up at the end of the case. If you read my blog you will know that there are a lot of attorneys for work comp that tell their clients what the case will be worth the minute they sign them up. There is no way to do this at the beginning of an injury because we don’t know what your recovery will be. So to cover up for that first lie (which is really a used car salesman type tactic) they lie again at the end of the case and say that new laws have caused the values of cases to drop. It’s a total crock as the new laws can not change the value of injuries before September 1, 2011 and even then, the new laws haven’t really hurt the value of injuries after this date.
If this was a good attorney, they would have been honest from the get go. As any child can tell you, once you start one lie, you usually have to cover it up with another lie.
I have no idea why some of these attorneys feel the need to b.s. their clients and how they look themselves in the mirror knowing that they are really the stereotype of the scummy, sleazy lawyer.
We don’t ever promise a result because you never know what will happen. At some time we sit down with our clients and figure out what the case could be worth with them. I’m sure there are people that haven’t chosen us or the law firms we work with over the years because we don’t tell them what they want to hear, but instead tell the truth. And I’ll always be happy with that because I wouldn’t want a client to ever tell me that I promised them one thing and am delivering something else.
Just when I think I’ve heard it all, . . . .
A caller reached out to me. He hurt his knee when he tripped over a TV cord. He was moving the TV because he’s a trash collector and the TV was with the trash.
The insurance company told him that this was not a workers’ compensation case because he should have known better than to try and lift a heavy television set. Since this was “his fault”, they told him that he was not eligible for work comp benefits.
That is of course a ridiculous argument and it holds no weight. But insurance companies will say these things with the hopes of discouraging you from going forward.
I’m not saying that everything an insurance company says is total b.s. But when they try to give you legal advice, especially when that advice is in their best interests, don’t assume that they are telling the truth or correct. They have a big motivation to discourage you.
When you have an injury, no one expects you to be a work comp expert. But you do have your common sense and if something doesn’t seem right or you just are curious, call a lawyer. No work comp attorney in Illinois should ever charge you a penny for a phone call. And at least after having that call you should be able to make an educated decision about what you want to do.
A caller reached out to me because his lawyer told him that his case would take about one year and here he was on year three of the case. The caller was understandably frustrated because he wanted to move on with his life. I think what was really going on is that the lawyer set up a false expectation and now this worker is mad because he’s still under a doctor’s care and he needs to vent. It’s easy to vent against the lawyer because that guy fed a line of b.s. to him in order to make him feel good at the get go.
The worst thing (ok, maybe not the worst, but it’s bad) a lawyer can do is to tell the client what they want to hear even if it’s not true. Too many Illinois work comp lawyers practice this way, mostly because they have no business or customer service sense even if their legal skills are ok. To them, it’s easier to temporarily tell the client something to make them feel good and then worry later about the fact that it’s a lie.
The reality is that there is no way for a lawyer to tell you for certain how long a case will take. We can make a prediction, but there are too many variables to know for sure.
So what are these variables? Well, there’s the following:
- We can’t tell you at the get go what sort of medical recovery you are going to have. Most people with carpal tunnel surgery for example are as good as new within 4-6 weeks after surgery. But sometimes they get worse and need another surgery. We aren’t going to settle your case if you aren’t 100% physically as nothing is more important than your health.
- Other times you have one work injury and then get back to work. Before your first case is settled, you injure a different body part. No insurance company that we know of will settle one case while another claim is still open. So even if the first injury is minor, you’ll have to likely wait until the second one is over too.
- Sometimes insurance companies don’t make a fair offer or won’t make a settlement offer at all. In that case we need to go to trial. Some cases can be tried as soon as we have all of your medical records. Other times we need to take depositions of doctors. We can’t tell you at the beginning of the case that this will happen so there is no way to tell you what sort of delay there could be. We always try to get a case done when it’s appropriate to do so, but also don’t rush a case at the risk of a good result.
- If the case goes to trial there could be an appeal. That alone can delay the case by one year or more. Again, no way to predict that at the outset.
- At times our clients don’t want to settle because they are waiting to retire. In those cases we will do what we can to delay the outcome until the client is ready.
I could probably list 5-10 more reasons for a possible delay, but you get the idea. Big picture is that if a lawyer tells you how long a case will take, just know that it’s an estimate that could be way wrong. If they tell you it’s for certain or guaranteed, they are simply full of it.
Insurance companies hire private investigators to follow injured workers and basically try to catch them in a lie. The investigators are gathering evidence that you aren’t really injured or that you are less injured than you say you are. They might snap a picture of you carrying something heavy when you have a claim for a back injury, or take a video of you playing sports despite a shoulder injury. Their goal is to use this evidence to cut off your benefits.
Surveillance isn’t used in every claim. For small injuries, it’s generally not worth the insurance company’s time, not to mention the expense of hiring a private investigator to follow you around. But if your claim is contested or your injury is going to cost the insurance company a lot of money, then be prepared for the possibility of surveillance.
Even if you are being honest about your injury, you can get in a situation where you’re hurting your claim. Follow your doctor’s orders and take care of yourself. We all do things when we’re injured that we shouldn’t do, simply because life is busy and it’s hard to stop doing things like lifting your kids or carrying stuff in from the car. Even these honest mistakes can end your benefits. It’s not worth the risk.
Sometimes we hear from people who are worried because the insurance company says they have them on video doing something against doctor’s orders or something that shows they aren’t really that injured. They swear they weren’t doing whatever the insurance company claims they were doing. Mistaken identity does happen, or maybe you don’t remember doing what they claim. Unfortunately, they aren’t required to hand over the tape, so sometimes the only way to settle the issue is to go to trial.
In addition to being careful and following your doctor’s restrictions, we always say that honesty is key. Be honest with your doctor and with your attorney. It will give you the best chance of success.
In September of 2011, the Illinois Workers’ Compensation Act was changed. Among the new rules is the following:
Intoxication Defense: An employee is not entitled to workers' compensation benefits if involved in an accident that is a direct cause of drugs or alcohol use. Also an employee may not be awarded workers' compensation benefits if he or she fails a drug or alcohol test. If there is evidence of a blood alcohol level of .08% or if there is evidence of impairment as a result of the use cannabis or other drugs, then it will be presumed the employee was intoxicated and intoxication was the proximate cause of the injury. To overcome the denial of benefit, the employee has the opportunity to present admissible evidence that indicates intoxication was not the sole cause of the accident. The statute provides that a drug or alcohol test should be taken immediately after the accident.
In plain English this means that if you get hurt on the job you can be given a drug test and that if you fail the test your benefits can be denied.
This is a ridiculous rule. The old rule was that if there are drugs or alcohol in your system and you get hurt on the job, if being intoxicated led to your accident your claim could be denied. That’s common sense. So if you are drunk at work and cut your hand with a saw, you lose the case.
The new rule says that even if you smoked pot on a Friday night, if you get hurt at work the following Tuesday and marijuana is in your system, the insurance company can deny your benefits. That makes no sense as clearly in that example, your drug use would have nothing to do with you getting hurt. It’s just a cheap way for insurance companies to screw workers.
All is not lost under this new rule. The bad news is that your benefits can be denied. The good news is that you can still go to trial and credibly testify that your drug use had nothing to do with you getting hurt. If there are any witnesses that say you were acting erratically you are screwed, but otherwise if the truth is that you hadn’t used for days, you should be ok.
Many lawyers will turn down these cases because they know off the bat that they will have to go to trial and a dirty little lawyer secret is that many attorneys don’t want to go to trial because they don’t like to do work. We are happy to go to trial if need be as are the lawyers in our statewide network.
So if you do fail a drug test, don’t panic. It will make your case much harder, but it’s not impossible to win. It just will take longer and require some work.
A caller who fell off a ladder reached out to me for some advice. In early 2011 he fell about five feet and landed on his side. He was bruised up pretty badly and went to the doctor with hip pain. That has been his only medical visit for hip problems until he went to the doctor in July. What he told me was that it bothered him since it happened, but he doesn’t like doctors so he put it off (for about 15 months) until the pain was too much to bear and his wife made him get it checked out.
So what the caller wanted to know was, is it too late to bring a case for the treatment he needs for his hip?
The answer is that there is no law on this, but there is generally a rule that the longer you wait to get medical treatment, the harder it is to prove that your condition is related to a work injury.
Now it’s certainly not impossible. You would need a credible doctor in your corner and how you come across when testifying would be relevant too. But on the flip side, you can bet that the insurance company will have a doctor that says your current problems couldn’t possibly be related to the work injury. If they get that, the only way you win is at trial and you can certainly imagine that their lawyer would try to pick apart your credibility. It would go something like this:
Mr. Smith, you hurt your hip on the job in March of 2011, correct?
But you didn’t see a doctor in April of 2011, right?
How about May?
Is it correct to assume that you didn’t see a doctor of any kind for any reason until 15 months after you fell?
Well, I did see a doctor for a colonoscopy in December.
But you didn’t mention a hip injury to that doctor, did you?
This is an abbreviation, but it’s how you can bet that your cross examination would go and it would certainly hurt your credibility. It’s not impossible to overcome, but it’s difficult.
So while there is no set time limit for going to the doctor, the best advice we can give you is to not be a tough guy/girl. If you aren’t feeling well, get medical help. There is nothing more important than your health. Often getting medical treatment can solve your problems and prevent an injury from being long term. Legally it also gives you a much greater chance of success if you choose to pursue benefits. But generally speaking, we tell our clients that if they are not feeling well they should go to the doctor. If they feel fine then don’t. It sounds like common sense, but a lot of people have trouble with this concept and it’s not because they have bad intentions.
Finally, don’t ever not see a doctor because you don’t have health insurance. If it’s a work related injury in Illinois, the work comp insurance has to pay for it all. And even it’s not a work injury, we’ve seen tons of cases where what could have been a minor problem with a small bill, blew up in to a need for surgery and a huge bill. The sooner you deal with a problem the better.
There are both federal and state laws that allow someone with black lung to obtain benefits. A coal mine worker in a recent case had gone the federal route and filed a claim with the U.S. Department of Labor. He was denied benefits. Next, he filed a claim with the Illinois Workers’ Compensation Commission under the Illinois law that allows for benefits. This time, he won benefits.
The main issue in this case became whether he was allowed to try again after losing the first time. It brings up the legal concept of collateral estoppel, which basically says that if there is a final decision on an issue, you don’t get a do-over. In the federal claim, the decision maker said miner did not have black-lung disease. So was he permitted to then go through the workers’ compensation commission in Illinois and ask them to determine whether he had the disease?
The case turned out in the miner’s favor. Collateral estoppel only applies if there is that final decision. The appellate court who finally settled the issue said that the federal decision (that he did not have black lung) was too informal and that the nature of the federal process limits the evidence a worker is allowed to present. Because of these limitations, the appellate court said that the decision was not a “final adjudication” of the issue.
The final outcome in the case was that the worker’s Illinois claim was perfectly legal and he was allowed to keep the benefits he was awarded in that claim. All this procedural stuff can be confusing. The main thing to take away from this that if you had a federal claim that was denied, you still might have a valid state claim for benefits. So if you are a coal miner or any other worker that has black lung disease, make sure that you explore all of your options, including workers’ compensation benefits. We have, through our state wide network, helped many coal miners in the past and would be happy to help you.
Insurance companies are not required to offer you a settlement, but often they do. The decision whether to take the settlement is complicated. Your other option is to go to trial, generally with the hope of getting more that way. But trial is a risk – you might end up with a lot less. Here are some of the things you and your attorney should consider.
It might be time to settle if…
- The amount is fair and reasonable. If you reject the offer and go to trial, you might get more, but you might get a lot less.
- You need money now, in a lump sum. Often, work injuries cause significant financial distress. A settlement is going to be over and decided more quickly, plus it comes in a lump sum. Awards at trial generally are paid out over time.
- Your future medical needs are clear. When you sign a settlement agreement, you give up the right to come back later and ask for more money. If your condition worsens and you need surgery later on, you can’t get the insurance company to pay for that. So a settlement may not be the best idea if your future medical needs are unclear.
- Your success at trial is uncertain. If you settle, you get something. If your case isn’t strong, or the evidence isn’t in your favor, trial may be too big of a risk. Your attorney will help you weigh these factors.
- You need to avoid the stress of a trial. If it would put your health in danger to go through an emotional ordeal, such as a trial, then settlement might be a smart move.
It might not be time to settle if …
- The settlement offer isn’t enough to cover what you’ve lost and what you might lose in the future. If the amount doesn’t compensate you for all your medical bills and lost wages, plus future lost wages, you might want to consider going to trial.
- Your future medical needs are uncertain. After a trial, the medical portion of your claim is left open. If you require future medical care because of your injury, you can get the bills covered. In settlement, you end your right to future medical coverage.
- Your chances at trial are good. Your attorney can help you weigh the strength of your case against the risk of going to trial.
If you are offered a settlement, we hope you talk to an attorney about it. Injured workers who do not have an attorney are offered notoriously low settlement amounts because it’s assumed they have no experience to tell them how much they should be getting.
We got a call from a guy that hurt his shoulder while lifting a patient at the hospital he works at. He did all of the right things. He was honest. He got medical care right away. Reported the injury to his supervisor. He actually went to their doctor right away. That doctor recommended that he get a MRI and said he probably tore his rotator cuff. This was four months ago. He’s still waiting for that MRI.
What happened is the insurance company assigned a nurse manager to the case. She didn’t like the MRI recommendation and got the case assigned to a new doctor at the company clinic who hasn’t ordered the test. See, MRI’s are expensive and the company clinic depends on the insurance company and employer for business. So everyone was happy to play ball and screw the worker because you know, it’s just his arm.
The bad news is that he’s been in pain and it’s possible that the delay in getting the right care will screw up his arm or lead to a surgery that could have been avoided.
The good news is that he has the right to stop seeing their doctor and go see an independent, reputable doctor that will look out for his best interests.
I can’t imagine that a MRI won’t be ordered and there would be no basis for the insurance company to deny paying for it. So now that he’s been told his rights, he’s on his way to making a medical recovery. And shouldn’t everyone involved want that? You’d think that they would, but the reality is that the only person you can count on to look out for your health is you.
As someone who tore their rotator cuff, I know a little about this injury and I’m optimistic that our caller can still make a good recovery. But I’d have felt a lot better for him if they took good care of him from the beginning. He did all the right things. They did everything wrong.
We got contacted by a salt of the earth, hard working guy who’d been with the same employer for over 30 years. He does repetitive work with his hands and in the fall was diagnosed with carpal tunnel syndrome.
Instead of formally filing an Illinois workers’ compensation case like most people would, this trusting man asked his boss what he should do. He sent him to HR who told him that he needed to see a doctor to confirm whether or not the injuries were in fact work related.
They are allowed to do that and you’d assume that they would send him to someone local to take a look at his hands. They didn’t do that though. Instead they sent him five hours south to St. Louis to see a hand doctor that apparently sees many of their workers. I guess they couldn’t find a qualified hand surgeon in Illinois to take a look at this guy.
You can probably guess what happened next. The doctor told him that his job was not the cause of his problems and in fact they were related to something 20 years ago. He was out of luck they said as it’s too late to file a case on something that old.
Of course this is a bunch of nonsense. It’s not too late and no credible doctor would state that the job didn’t play a role in his problems. If we get that opinion, he wins.
You are not stuck with the opinions of these hired guns. They make life a little harder, but that’s not something a good lawyer can’t overcome. Don’t let them discourage you or make you believe your case is a lost cause. It’s not and there are options for you if a credible doctor is in your corner.
We are attorneys who have created a state wide network of experienced, customer service focused attorneys that fight for their clients in Illinois work injury claims. We created this network because we recognize that getting the right lawyer on the case for the client is the best thing for them. And the happiness and success of the client is all that really matters.
For example, we were called by a family who lost their father when he was electrocuted on his job. We know one lawyer who has handled a lot of electrocution cases, but this family only speaks Spanish and insisted on a Spanish speaking work injury lawyer in Chicago. That is a need for them and it’s in their best interests. So hooking them up with a Spanish speaker in our network was best for them.
In this same case, the family also needed a personal injury attorney that speaks Spanish to investigate that claim. So we had to make sure that the lawyer we recommended fit that need, but also would work well with the work comp lawyer.
Other times a caller wants someone that speaks Polish. In many cases, the location of the job or where the worker lives really matters. Often we want to connect you with someone who understands your complex injury like a RSD case or a spinal fusion where a pain pump has been put in place.
Above all else, anyone we work with is someone we’d have a family member or friend hire if they were hurt. That doesn’t guarantee a result, but hopefully it speaks to our integrity.
Whether you go with us or some law firm that you find on your own, remember that you need to do what is best for YOU. You are the only one that matters in your case. If you aren’t happy or the lawyer isn’t the right fit for you, keep looking until you find the right fit.
When you sustain a serious injury on the job in Illinois that requires more than a few doctor visits, it’s very common for an insurance company to assign a nurse case manager to your case. We call them NCM’s for short.
A NCM is a nurse that helps out the insurance company by gathering medical records and updating them on your medical care. But they really make their money by saving the insurance company money as they attempt to limit your medical care. This is of course good for the insurance company bottom line and bad for your health. We, of course, only care about your health.
A NCM, if allowed, will talk directly to the doctor and at times will discourage certain medical procedures. Other times they will try to get doctors to take away physical restrictions that are put in place for a worker’s safety. If a doctor is weak willed, they will basically ignore the best interests of the client so they aren’t hassled or bothered. Other times still we have seen a NCM cancel your appointments because it doesn’t fit their schedule. And worse yet, many of them try to sit in on your appointments which of course invades your privacy and can make you feel very uncomfortable.
Other than gathering medical records and bills, all of these things we described are against the law. Yet they happen anyway. The good news is that a competent attorney can easily stop them by simply making clear that permission is not granted for them to have any communication with the doctor. We as lawyers almost never allow it and if we do, it’s because it is in our client’s best interests. Even then we set very clear ground rules such as making sure they are never in the exam room. But it’s usually just easier and better to take them off the case.
We get a lot of calls from distressed workers who are having their lives ruined by these NCM’s. Some have attorneys who tell them there is nothing they can do. That’s a sign that the lawyer doesn’t know what they are talking about.
If you don’t want a NCM on your case, take control of your life. If you hire us, getting them off the case is the first thing we’d do.
A caller contacted me the other day and said that he wanted me to take over his case from his current lawyer. I asked him, as I always do, what was the problem with the lawyer that he was currently working with. He said that attorney was not answering questions and as a result he went looking on the internet for information. He came across my site and when he did finally get to talk to his lawyer, he asked about some things that he read.
Well this apparently set the attorney off and he yelled and screamed telling the client (who had a great case by the way) that he felt that he couldn’t trust the client and he was insulted and wahhh, wahh, wahh!!! And after that he told the injured worker that he should find a new law firm to represent him.
Really? I love it when a client becomes educated. I’ll tell them when what they are reading is incorrect and when what their reading makes sense. But usually I try to provide that education first so if they do read it elsewhere they’ll realize that 1. I know what I’m talking about and; 2. I’m looking out for their best interests.
I completely do not get why any lawyer would be so over-sensitive like this. If they just delivered good service in the first place, their client wouldn’t be looking around for answers elsewhere.
I promise you that you will never meet a lawyer that cares more about the success of your case and your life than you do. It’s your job to look out for yourself. Hopefully you find an attorney that really is in your corner. But if they are insulted and can’t have an adult conversation with you, then you know that they are not right for you and don’t care about you.
I’ve seen a lot of Illinois work comp attorneys give bad service. But I’ve never, until now, seen one quit a case, a really good case, because the client was looking out for themselves. There truly is always a first time for everything.
A reader asks:
I used to work as a police officer and made $25 an hour. I hurt my back and had a fusion and now I can’t work that job anymore. They apparently found me a job as a security officer making $10 an hour. My village has lots of other jobs that would be available that I can work. Isn’t there a law that says they have to find me some sort of employment working for them? Or can they make me find a job on my own which is what they are telling me?
Unfortunately for this reader, there is no law that makes them have to find a job with them. If they have such a job it will save them a ton of money, but we can’t make them accommodate his restrictions. The worker does have to search for jobs on his own to see if he can find anything within his restrictions.
So if he can only make $10 an hour and would make $25 an hour at the old job, the employer/insurance company has to pay him 2/3 the difference of his $15 an hour loss or $400 a week tax free. That would be a little more than $20,000 a year. Even if he ends up finding a job later on that pays more money, he’d still get this payment.
An employer has a duty to offer vocational rehabilitation when you have permanent restrictions and no job. This is designed to get you in to a position where you can earn as much money as possible. There is unfortunately no law that says they have to employ you, but the beauty of vocational rehabilitation is that it can protect you from any wage loss you suffer.
This reader had a lawyer so I don’t know what happened to him. But if he has a good one in his corner he should get weekly benefits for years or a lump sum settlement that is probably worth a couple hundred thousand.
A reader asks:
I had a left knee replacement in August of 2011. I have had an IME for my right knee injury. The replacement was not to take place on my right knee until after my retirement due to osteoarthritis. The injury to my knee took care of that plan. They said I aggravated my OA. I am to retire in another year. Can Workmans Comp hold my osteoarthritis against me?
The e-mail from this reader wasn’t clear, so to clarify for you, here’s the back-story. He has a history of bad knees, mostly from old age and general wear and tear. The right knee was going to need surgery one day, but he wasn’t getting active treatment for it other than taking pain meds. He fell at work and his orthopedic surgeon said that they right knee replacement had to take place now.
In other words, the work injury accelerated his need for the surgery. Under Illinois law, even if you have a pre-existing injury or problem with a body part, if a job accident aggravates or accelerates that injury then workers’ compensation insurance is supposed to cover all of your medical care from there on out.
So the insurance company can try and hold the osteoarthritis problem that already existed against the reader, but it sounds like his surgeon is in his corner. If the company hack, er I mean IME doctor, says that the accident played no role in speeding things up then we go to trial and let an Arbitrator decide. But I’d love to cross examine the IME doc about how he thinks the accident didn’t accelerate the injury when the previous plan was to wait for retirement for surgery. I can’t guarantee that we’d win this case, but I’d be shocked if we didn’t.
To sum up, pre-existing problems can matter, but if you aren’t under active care or your job accident makes things clearly worse, it shouldn’t cause you to lose your case. Especially if your own doctor is in your corner.
In most Illinois work comp cases, you hurt your leg and when the case is over you can pursue a settlement for a percentage loss use of the leg. For example, 20% loss of the leg or whatever your true disability is. If it was a foot or hand or any other part of the body, you’d receive a percentage loss for that too. But some times you can hurt one body part and get a settlement for that body part and others.
This probably sounds confusing so hopefully I can explain it. Let’s assume that a worker in Illinois hurts their knee and has surgery for a torn ACL. When they are all better they will likely get some settlement for their leg based on how strong their recovery is.
But let’s assume that after surgery they are on crutches and they hurt their elbow from repetitively using them. Or they fall down the stairs because they have to hop on one leg and they break their hand. Those injuries would also result in settlements even though they weren’t a part of the original work injury.
The law is that any problem that can be traced back to the original injury should be covered. So using crutches clearly traces back to hurting your knee. Falling down the stairs does as well. On the flip side, if you are out with a knee injury, but get hit by a car, that would likely have nothing to do with the original injury and would not be part of your work comp case.
This is actually a really common occurrence. Not just the stuff I described, but it’s common to have a neck fusion and then injure your shoulder. Many clients who have major injuries also get depression and we can get them treatment and a settlement some day for that problem even though it’s not a part of the original accident.
Our advice to clients and callers is to make sure you are detailed and honest, to a fault, with both us and your doctors about all the problems you experience.
I pride myself on speaking in plain English, but I don’t always succeed. In fact I failed just the other day. A caller who fell down the stairs at work wanted to know if he had a case. I let him know that we had to show that there was a defect in the stairs to win. That was a poor word choice as he quickly said, “That’s too bad, I don’t think there was a defect, I just slipped on some water on the stairs.”
And this shows that I wasn’t speaking in plain English. I should have said that to win the case we need to show that something made you fall other than tripping over your own two feet. A defect (which is how lawyers refer to it) can include the stairs being wet, something sticking out from the stairs or wall or even a poorly lit stairway.
The bottom line is that you need an explanation as to why you fell. Running to a meeting you were late to and you fall? That’s a winner. Carrying materials for work that make you lose your balance? That’s a winner too. No idea what happened? That’s a loser.
So the bad news is that I did a terrible job at first communicating with this caller. The good news is that they do have case and we should be able to help them.
If you fall down the stairs at work and are physically able to do so, please try to figure out ASAP why you fell. Get medical attention first of course, but when you come back to work, take a photo if you can. Above all else, don’t give a recorded statement to the insurance company. A lot of times people fall and they don’t know why, but they slipped on something. I’ve seen insurance companies only focus on the “I don’t know why I fell” part and use that to deny a case. If you slip on the stairs and break your leg or wrench your back or whatever, you don’t have to crawl up the stairs to look at the liquid or item that caused you to slip. If you know that something made you slip, that’s usually enough to win the case and we don’t want the insurance company to twist your words to deny you your benefits.
A big mistake a lawyer can make is to assume that their clients or perspective clients know something that may seem obvious, but really isn’t. Just because we have dealt with an issue for decades and know it backwards and forwards, we can never assume that the client does.
I thought of this recently as I heard the same thing from three callers to my office. They all said some variation of, “My family does not have the money to hire a lawyer so I don’t think you will be able to help me.”
In Illinois workers’ compensation cases, whether you hire a good law firm or a terrible one, there should never, ever be any money paid by the client to get the lawyer to handle the case. We work on a contingency basis which means that there is never an up front fee and we only get paid if we make a recovery. That fee can not exceed 20% of the settlement if there is one. If we recover nothing, you owe us nothing. Now some shady firms will try to take money out of medical bills or lost time (TTD) payments, but we and the lawyers we recommend do not do that unless we go to trial on a case.
I have mistakenly assumed that every injured worker would know that they don’t need money to get an attorney, but obviously that was a mistake by me. So it’s worth repeating that you’ll never lay out a penny to hire us or anyone we know. One caller was jerked around for six months on a great case because he didn’t think he had a choice as he could barely pay his rent, much less a lawyer.
No matter your situation, we’ll talk to you for free and while we are selective in the cases we get involved in, you at least will be able to get a legal opinion whenever you contact us. And it won’t cost a thing.
I recently had a conversation from someone who asked me if I though that they had a workers’ compensation claim. Under Illinois law, you have to report an injury to your employer within 45 days of when you knew or should have known an accident was work related. He readily admitted that he hadn’t told anyone at the company about the accident which occurred more than 90 days prior to the call. I let him know that was a case killer for me and that I couldn’t help. Usually that’s the end of these conversations.
But he carried on that he really liked what I had to say on my blog and wanted me to get involved. I reiterated that I wouldn’t based on the facts. He then said, “Well another lawyer told me that if I testify that I told my former supervisor about the accident then I’d win because that guy doesn’t work there anymore.” He wouldn’t tell me the name of this lawyer, but stuff like this drives me bonkers.
If he’s truly a fan of what I say on this blog then he’d know that honesty in our clients is the most important thing to us. I will never represent a liar and what he’s asking me to do could cause me to lose my law license. No client is worth that and I would never consider that. Neither would just about any lawyer that I know. But apparently some scum bag attorney told him to make stuff up.
That’s just wrong on so many levels and it made me want to puke. Most callers and clients are honest, hard working people. A few bad apples like this guy cause insurance companies to fight claims that shouldn’t be fought because they have their “suspicions” that something isn’t true.
If you call us looking for an opinion, you will get our full attention and a blunt, honest evaluation of your case. Hopefully good or bad you can accept what we have to say. But if you are looking for someone to help you change the facts of your case to make it a good case you are at the wrong place.
In order to be eligible for workers’ compensation, your injury needs to be related to your job. A big factor in determining whether an injury was work-related is where it happened. An injury on your employer’s property is pretty clear, but what if you drive around instead of working at a desk all day?
The good news is that you’re still covered if you have to drive around to do your job. If you have to meet clients or customers in other towns, for example, and you get in a car accident on your way to an appointment, then it should be considered a work injury under Illinois law. (Commuting to and from work usually isn’t covered, although it can be in certain situations.)
But there are some gray areas, such as running personal errands during your work day. Let’s say you have a meeting in Park Ridge, then run to the store for a few things, then have a meeting in Evanston, then meet a friend for lunch and then drive down to Homewood for another meeting before heading back home. If you are a traveling employee, it’s expected that you would run errands, eat meals and stop for gas during your work day, but you might not be covered the entire day.
It comes down to whether you were still considered “in the course of” your employment when you were injured. This usually depends on how far you deviate from your path. You might not be covered for a car accident on your way to run a personal errand, but coverage might kick in again once you’re headed back toward a work appointment. In other words, you might exit and re-enter the course of your employment during the day.
If you’re not a traveling employee, and you leave work to run a personal errand that has nothing to do with work, then you probably wouldn’t be covered under workers’ comp for any injuries you suffer while you’re out.
The bottom line is that each situation is different, so don’t make an assumption.
Five years ago Brett Favre was thought of as either the best NFL quarterback or certainly in the top 3. I know I as a Bears fan would have gladly taken him over Rex Grossman or anyone else that we threw out there. Two years ago he was terrible and last year he was out of the league altogether.
I thought of this recently when I received a call from a woman asking me to take over the case of a lawyer who is really highly regarded amongst fellow attorneys. Five years ago, if you asked me who I would hire to handle my case it would have been this guy. He was even tempered, well prepared, respected and a straight shooter.
Something has happened to him because in the last year I’ve received about 10 calls from his clients that were looking for new lawyers. I had never received one call prior and would have previously assumed that anyone that wanted to fire him had a problem because he only took strong cases.
But of the ten calls I’ve gotten, eight have said essentially the same thing: he’s smug, short tempered and not very nice.
I have no idea what happened to this lawyer. But it proves the point that just because someone was great five years ago isn’t necessarily great now. They might be better, they might be worst. There is one work comp defense lawyer that was at the top of the game five years ago and last year was arrested for exposing himself to young girls.
The point is that you don’t know who’s best for you now. If it’s a new injury where you are going back to an old attorney of yours, make sure as best you can that they still have the fight in them. Verify who in their office will handle your case. If you are going to a lawyer that someone recommended to you (including me) actually interview them. If they won’t give you ten minutes of their time to talk to you then they probably aren’t the best fit for you.
This whole post may be reflective of my natural type A, anal approach, but when you see so many changes in people it’s a red flag and people should be aware of it.
The other morning I had a long consultation with a woman who was looking out for the best interests of her brother. He had worked in construction for his whole life and was having tremendous pain in his shoulder. He is a classic “tough guy” who has always treated aches and pains with Advil, but now he was having trouble sleeping because of the pain and could hardly lift his head above his head.
He didn’t think he had a case and his foreman told him the same thing because he couldn’t pinpoint a time and place when he got hurt. But not every Illinois work injury has to have a specific accident. Many injuries are the result of what is called repetitive trauma which is an injury caused by doing the same thing over and over.
In this case, the worker on a regular basis is lifting heavy materials and working with his hands over his head. His sister told me that he does that on average of an hour a day and has pretty much worked five days a week at least for over 20 years.
He told his foreman that he needed to see his doctor and now he’s been taken off the schedule which of course has him freaking out because he has a family to take care of. The silver lining is that if his doctor will state that he needs any restrictions and that his injuries are work related (I can’t imagine the doctor won’t say this) then the insurance company will have to continue to pay him until there is a job available within his restrictions.
This is a story we see all of the time and realistically speaking, this guy probably has a torn rotator cuff and is headed for surgery. All of his medical bills and time off work should be covered by workers’ compensation. It wouldn’t surprise me if he is never able to return to his regular job and while that would not be a good thing, again the silver lining is that they’d have to pay him until a new job within his restrictions is found.
The moral of the story which I tell people all of the time is that while no one wants to be hurt on the job, the law is there to protect workers. And this is true even if your injury is a result of doing the same types of activities over and over and over.
One of the reasons we created a state wide network of like-minded workers’ compensation attorneys is to make sure that the people that contacted us got connected with the right lawyer for their case. It’s an evolving list and if we don’t feel that a lawyer is delivering the type of good service and work that we and you expect, we stop recommending them.
There are a lot of unhappy attorneys out there. I LOVE what I do, but even I feel burned out some days. When I do I go hang out with my kids, work out, watch a ball game or take a vacation to charge the batteries. Fortunately, the days I feel run down are few and far between. Unfortunately, many lawyers (none that we recommend or work with) are really burned out and their clients are the ones that suffer. Usually you don’t realize that they don’t care until it’s too late. But there are some warning signs. If you see too much of the following, your attorney might not be in to their job anymore.
- Phone calls aren’t returned or are done only after many days.
- You can usually only talk to their assistant.
- They tell you that they are doing something on your case like write a letter or file a motion and it never happens.
- They yell at you or otherwise belittle you in some way.
- Your benefits get cut off and even though your doctor is in your corner, your attorney never files for a trial hearing.
- You show up to meet them and they look all disheveled. Not saying an attorney needs to be in a suit, I almost never wear one outside of court, weddings and funerals. But if they are unshaven and wearing a baseball hat when you see them, they might have just given up.
- There is a lot of turnover on their staff. Sometimes it means it’s just a bad place to work. Other times it means that the employees see the warning signs and are jumping ship.
These are just a few examples. We tell callers to stick with their attorney if they can, but you are allowed to switch if you realize that it’s best for you. It doesn’t cost you any more in attorney fees and if it’s the best thing for your life then you should at least consider it and/or confront your current lawyer about your unhappiness with them.
If you are lifting a box at work and feel a pop in your back, you know for sure how you hurt yourself. Same thing is true if you slip on a wet floor or fall off of a ladder. But sometimes you have physical injuries that you believe are from work, but you don’t have an actual accident.
These are called repetitive trauma claims and they are quite common under Illinois workers’ compensation law. The most common repetitive use injury is carpal tunnel, but we have helped people with injuries to almost any body part including the back, knees, shoulders, feet and neck.
I recently received a call from a woman who was seeking the opinion of a Chicago workers’ compensation law firm. She is an auto technician who rotates tires and performs oil changes all day. She’s been on the job for two years and has had on again off again problems with her elbows and wrists. She mostly has taken care of it with Advil and trying to rest when she can, but the problems have gotten worse as of late. She called her doctor’s office and they asked if the injury was work related and she answered honestly that she didn’t know and was hoping the doctor could tell her.
Her honesty (which we always advise) actually caused a problem because the doctor wouldn’t give an appointment without knowing who would pay. She asked my advice and while I’m no doctor, it seems clear that her problems were caused or worsened by her job activities. So I told her to tell the doctor that the problem is work related. If she does this, as long as the doctor doesn’t disagree with her she will be fine. I don’t know how anyone can say that all the turning and twisting of her arms and wrists hasn’t played a role in this happening.
I haven’t heard back, but I’d be really stunned if things don’t work out for her. For you as a worker, the best advice you can get is to tell your doctor everything that you do on the job and the pain that you notice while working or right after. Be very descriptive as to the actual activities you are performing and how often you do them. Once you know or should know that these activities are work related, that is your accident date and you have to report this to your employer. After that happens, the normal Illinois work comp process plays itself out.
The moral of the story is that you shouldn’t freak out if you can’t determine the injury date or if there is no injury date. You just need some good guidance and medical care and everything else should take care of itself.
About once a week I get a call or a letter from a doctor or chiropractor that goes something like this. I’m writing what they mean, not what they directly say:
Dear Mr. Helfand:
I am a board certified pain specialist. I just opened up a new clinic and I need patients. I know nothing about you, but I’d be happy to refer my patients to you so you can be their lawyer if you are willing to refer your clients to me so I can be their doctor. I realize that might not be in our clients best interests, but you and I both know that it’s going to make us a lot of money. So what do you say? Let’s do it!!!
Doc that needs clients.
I know that this what they mean because when they do call, it’s very obvious. When I ask why they would recommend me when they don’t know me, they tell me that it’s because we can help each other.
I politely decline all of these invitations and always will. To do otherwise would make me feel like a scummy real estate agent that tells you to buy a house so they can get a commission when they know that there are 20 things wrong with it. I like to go to bed at night with a clear conscience and I always will because I’ll never tell you who you have to see for your medical care.
Plenty of Illinois workers’ compensation attorneys sleep fine at night while still telling their clients to see a doctor who helps the attorney and not the client. If you ask me an opinion of a doctor, I’ll offer it, but I’ll never tell you that you have to see Dr. so and so. It’s just wrong.
Aside from being morally wrong, going to the doctor your lawyer picks could blow up your case. If you are ever on trial and the insurance company attorney asks you how you chose your doctor and you answer honestly that “my lawyer told me to go there” then you both look bad as does the doctor. If an Arbitrator has any reason not to find that the doctor is credible, he can toss out the case. To me, knowing that the doctor who is testifying on your behalf has a motivation to help you and me would cause most Arbitrators to wonder how honest he is.
Fortunately, for most of Illinois there are plenty of great and honest physicians and thanks to the internet you can usually find them on your own. But if you are with a work comp lawyer that insists that your medical care be with a certain group, it’s a huge red flag and you should probably avoid it.
I received a phone call from a woman the other day who injured her leg as a flight attendant while working for United. Her call was prompted by a lack of return phone calls from the insurance carrier, Gallagher Bassett. While I was on the phone with her I got an e-mail from a United pilot. Wouldn’t you know it, that pilot was contacting me because the insurance adjuster didn’t call him back. And an hour after that I received another call from a United Airlines injured worker who was not able to get an insurance adjuster to speak with them.
We do get a lot of United phone calls and any United Airlines employee in the US can bring their claim out of Illinois. But to get three in an hour is very unusual. It is beyond interesting that they may be changing their strategy of how they deal with workers, especially since it seems to be backfiring on them. But a lot of insurance companies are trying to “act tough” with workers these days. I guess they assume that if they ignore you, you’ll go away. That’s just dumb, but they aren’t looking out for you, they’re looking out for their own bottom line.
We’ll see if this was a one time occurrence or a new trend. United does have a lot of injured workers as many of their jobs are high risk. We’ve helped a lot of these callers over the years and of course would be happy to help you.
We had a sad call the other day. The adult son of an injured worker called us. His father was a widower who had gone back to work after his wife died and injured his knee. He tore his meniscus, had surgery and made a recovery. He had hired a lawyer who agreed to a settlement and the paperwork to process that settlement was taking place.
Unfortunately, this worker died of a heart attack while waiting and that heart attack had nothing to do with his job injury. The adult son was his only heir and the son was not financially dependent on his Dad in any way.
The caller wanted to get the settlement, but had been told by his Dad’s lawyer that the case was over since he wasn’t financially dependent on him in any way.
Regrettably the lawyer is right. Even if the Dad had signed the contracts, if they weren’t approved by an Arbitrator, the case would still be over. This guy had a knowledgeable attorney who gave the right answer, even if it’s not what the client wanted to hear.
For you as a client, just know that until an Arbitrator approves a settlement, it’s not official. Even if you verbally agree to something, it doesn’t matter until the ink is dry on the Judge’s pen that signs off on a contract.
Every now and then I’ll get a call or e-mail like I did the other day. The caller was hoping I knew of a good labor lawyer. She had broken her ankle on the job, had surgery and could not make a return to work because she had restrictions that the employer could not accommodate. She told me that her boss said that she wouldn’t bring her back because she filed for workers’ comp. That, of course, is incredibly illegal.
I’m certainly no employment law attorney. That said, I do recommend them for our clients. Those can be hard cases and often you have to pay a lawyer by the hour. For work comp we never charge a fee and the cases aren’t as challenging. As a result, sometimes callers think they need a labor lawyer when an Illinois workers’ compensation attorney can solve your problems.
In this case, the caller was upset because she was told that she wouldn’t be receiving additional pay and she didn’t believe that she could find a new job that would hire her given her work restrictions. She wanted to sue for discrimination. That would take years. With work comp, we could get an order right away for maintenance (which is a continuance of her work comp benefits) and vocational rehabilitation (which would make them help her find a job within her restrictions). While it’s possible that she could get additional damages from a discrimination lawsuit, in the short term, work comp is going to solve her problems. The caller had no idea about any of this and was thrilled with her options.
Big picture is that you should keep an open mind, explore all of your options and then make an informed decision. And the good news is that sometimes the answer to your problems are just under your nose.
A reader asks: I’m trying to get workers’ compensation for carpal tunnel. When I applied in 2011 for the job, I did not mention that I had a carpal tunnel problem back in 2002. The application question was “have you had prior injuries to your neck, back, arms, legs, hands, etc.” I simply forgot about it because it was so long ago and I haven’t had any problems since. Does this disqualify me for workmans comp?
It’s never a good idea to lie, but in this case it doesn’t appear that the worker lied, but instead just forgot. Either way, it should not at all disqualify you from receiving Illinois workers’ compensation benefits.
The real question is did your job cause, aggravate OR accelerate your medical problem. Even if there was something pre-existing, it doesn’t matter. If this guy was treating for carpal tunnel when he got hired, he’d have a hard time winning his case. But if you are healthy and then get worse from doing your job, that should be a case that you win every time.
Now I’m not a labor lawyer and maybe they can fire this guy for lying on a job application (although that would be really weak). But there is no way this case should be denied and I suspect that if he hires a lawyer who knows what they are doing, the problem will soon be solved.
A recent reader of my blog said: “I feel like I need an attorney for my work injury. But I’ve never sued anyone and don’t want to sue my boss as he’s been good to me. What should I do?”
Good news, you can hire a lawyer if you are injured on the job and not sue anyone. That’s because Illinois workers’ compensation claims are a claim for benefits similar to trying to get health insurance or any other benefit. These cases don’t go to court. There are no juries. It’s a benefits claim, plain and simple.
What most people mean when they say that is they don’t want to rock the boat. We don’t want to do that either as we know you (hopefully) have a job to go back to and people to deal with. So we never talk to the employer and instead only deal with the insurance company and their attorneys. And usually that’s all that happens. Believe it or not, most insurance companies and defense lawyers don’t talk to the employer very much either.
Our goal is always smooth sailing for you, be it at work or on the case itself. No boat rocking whatsoever, at least not with the employer. We’ll fight for you if need be, but that’s between us and the insurance people.
For some reason I’ve received a bunch of calls lately involving Illinois workers that were exposed to asbestos on the job. Whether or not we can help these callers with an Illinois workers’ compensation claim depends on when they last worked, when they were last exposed to asbestos and of course whether we can prove that the job caused the problem. Asbestos claims are tricky because usually an injury doesn’t show up for around 15 years or more after you were exposed. But we’ve been involved in these claims and had some success.
One thing to know though is that you may also have what is called a third party lawsuit against one of these employers or buildings where you worked. There are really only a handful (maybe 3) of law firms in Illinois that in my opinion have a great history of success with these cases. We of course work with them to help our clients get what ever they are entitled to. Asbestos related injuries can unfortunately be awful.
For you as a worker or former worker, it’s usually advisable that you have a lawyer investigate these cases ASAP as there is a much bigger chance of you losing your rights due to time limits passing.
Whether it’s asbestos injuries in Illinois or any other problem that is possibly caused by negligence or product liability, it’s important that you have an experienced lawyer look in to it. The most common situation is a car accident while working, but we’ve helped others that have been beat up, raped, hurt by asbestos, exposed to chemicals, slipped on wet floors, etc. We aren’t the right law firm to take on those cases except for the work comp part of it. But we do know the best personal injury attorneys in Illinois and have gladly and successfully directed our clients to them.
Bottom line is that if you need help with any legal issue, we pride ourselves in customer service and would be happy to talk to you. We don’t promise anything other than an honest opinion and that if we do recommend you to someone, it will be a lawyer we know, trust and would be willing to hire ourselves.
The main reason for performing an autopsy after a fatality on the job is to help prove that the job caused the death. If the cause of death isn’t certain, it can be difficult to link it back to the person’s employment and establish death benefits for the surviving family.
A recent Illinois case demonstrates this. The worker, a custodian, was loading a van with a co-worker. They were putting equipment in the vehicle to take to another location. The worker went to use the bathroom, and when he didn’t return, his co-worker went to check on him and found him unresponsive. The cause of death on his death certificate was a heart attack, but no autopsy was performed.
At first, death benefits were approved. But after the insurer challenged the decision, it was reversed. The arbitrator agreed that the cause of death wasn’t certain. Benefits were ultimately denied. The death certificate gave a cause of death, but in the end, it was speculative. The claim failed on a lack of evidence.
An autopsy isn’t necessary in every fatal work injury case, but in some it can make all the difference. It won’t automatically establish that a death was caused by work, but if the cause of death is determined, then other evidence can be used to make that connection.
We get that if a loved one dies on the job that an autopsy isn’t necessarily the first thing you are thinking of. But even if you have to pay for it, it really is important to know. It will give you some closure and might possibly help you win a workers’ compensation claim.
We’ve written before that your claim can be denied if the risk that caused your injury is one that the general population faces, rather than one you uniquely face because of your employment.
A classic example of this rule is the insect bite case. If you get bitten and injured by a poisonous spider at work, your claim can be denied unless you prove that you were at a greater risk for the spider bite because of your employment. A typical office worker would have trouble proving this. Someone who leads tours through a wooded area with lots of spiders, however, would have an easier time showing that they were more at risk than the general public.
A recent slip and fall case in Illinois brought up this same point. A worker filed a claim against her employer after falling on an uneven gravel surface in the parking lot of the medical center where she worked. She was on break, but that wasn’t an issue because she remained on-call during her lunch break and could be called back at any time.
Her claim was denied because falling on the uneven surface in the parking lot wasn’t related closely enough to her employment. In order for an injury to “arise out of and in the course of” the employment, a worker has to be at a greater risk from the dangerous condition than the general public. The arbitrator ruled that she was not at a greater risk of tripping on an uneven surface than the general public. Also, any member of the public could walk through or park in the lot.
Not every parking lot injury would be denied like this one. If you can prove that you were at greater risk – because the parking lot or specific spots were reserved for employees, for example – you might get a better outcome. This is just one example, which goes to show how much the facts of each individual case can affect the end result.
In another recent case, a child welfare worker was injured in the restroom while on a bathroom break. Someone called her name, and in reacting to being called she ran into a garbage can and fell. Her job required her to answer urgent phone calls and the office was understaffed that day. She testified that she assumed she was being called by her co-worker to take an urgent call. In this case, the worker was awarded benefits because the situation she found herself in was closely related to her employment.
Yet another recent case was about a cashier who worked in the front of a business next to large windows. She was injured by an out-of-control vehicle that smashed into the building. Because she was required to work in the front of the store near the large windows, she was at greater risk of being hit by an out-of-control vehicle than a member of the general public. She was awarded benefits, as well.
The Illinois Workers’ Compensation Commission recently sided with an employee who was injured while on break. This doesn’t mean every worker on break is covered, but it confirms that it depends on the specifics and benefits might be available depending on the circumstances.
In this case, an Illinois police officer fell and suffered an injury in his driveway. He was on lunch break at his home and slipped on snow or ice on his way back to his squad car. His claim was challenged, but he ended up getting workers’ compensation benefits. The key was that he was on-call the entire time, even though he was at home.
One of the key facts that made his injury a work injury was that he was on call throughout his lunch break. (Officers were permitted to have lunch breaks at home if within city limits.) Also in his favor was the fact that there have been similar cases in Illinois in the past, where the arbitrator sided with the injured worker. These cases not only mention the fact that the officers were on-call, but the fact that they were in uniform and could have had to return to their squad cars to answer a call at any time during their breaks.
These cases confirm that a work injury doesn’t need to happen at work and can even happen during a break if you’re still on call or providing a similar service to your employer. Generally, if you are doing something for your own benefit, even if during work hours, it’s not necessarily covered. It’s important to consider whether, during a break, an employee is still “in the course” of their employment. The same is true for location. If you are running an errand for your boss, you should be covered for an accident that happens while you’re out running the errand. If you decide to take a detour to run your own errand, it likely won’t be covered.
It’s a gray area, and if you find yourself in this type of situation, don’t be surprised if the insurance company denies your claim for benefits. Don’t give up if you believe your injury was caused by your employment. Request a hearing and let the arbitrator decide.
If you read our blog, you will notice that we aren’t big on using legal jargon. This is a blog for clients, not attorneys or insurance adjusters. That said, someone forwarded me a memo recently about when a psychological injury is compensable in Illinois and when it isn’t. The words below are not mine, but I think it does a good job of explaining what is covered and what isn’t and why that is so. I probably won’t do this much again and if it’s too wordy just go on to the next post of ours. Otherwise, I hope it helps.
In Pathfinder Company v. Industrial Commission, 343 N.E.2d 913 (Ill. 1976), the petitioner was instructing a coworker how to operate a machine press when the coworker severed her hand in the press. The petitioner then “pulled the severed hand from the machine and fainted at the site of it.” Id. at 915. She was taken to the hospital and remained there overnight after suffering an anxiety reaction. This included a variety of symptoms such as headaches, numbness in her hands and feet, and nervousness. Id. The petitioner eventually quit her job due to her psychological injuries. She spent time in the hospital as a result, and her physician believed that the accident which she had been exposed to had “a tremendous impact on her consciousness and that the memory is still there.” Id.
In determining whether the petitioner’s psychological injuries were compensable, the court reviewed case law from other jurisdictions. It concluded that under the liberal construction of the Illinois Workers’ Compensation Act, an employee that suffers a sudden, severe emotional shock traceable to a definite time, place and cause which causes psychological injury or harm has suffered an “accident” within the meaning of the Act, though no physical trauma or injury was sustained. Id. at 917. The court reasoned that it would be illogical to allow compensation for psychological injuries when accompanied by a minor physical injury, only to deny benefits for a similar psychological injury when brought about when a petitioner experiences sudden and severe emotional shock but was fortunate enough not to sustain physical injury. Id.
The Pathfinder decision, however, was limited in its scope by the case of General Motors Parts Division v. Industrial Commission, 522 N.E.2d 1260 (Ill. App. Ct. 1988). In that case, the petitioner attempted to recover benefits for psychological injuries sustained when “his supervisor verbally assaulted him with profane, racial slurs.” Id. at 1260. The court, however, denied compensation as the evidence indicated the petitioner’s mental stability was brought on by a series of events over time and not a single traumatic incident like that in Pathfinder. Id. at 1256-66. Moreover, the court stated “we do not read Pathfinder to permit recovery for every nontraumatic psychic injury from which an employee suffers merely because the employee can identify some stressful work-related episode…” Id. at 1266. In ruling so, the court limited Pathfinder by stating it “only authorizes an award of benefits only when the employee suffers a sudden severe shock which produces immediate disability and is caused by an uncommon non-traumatic work-related experience out of proportion to the incidents of normal employment.” Id. at 1267.
The Pathfinder standard was further limited by the case of Chicago Board of Education v. Industrial Commission, 523 N.E.2d 912 (Ill. App. Ct. 1988). In that case, the petitioner sought compensation under the Workers’ Occupational Diseases Act for psychological injuries from a series of traumatic events over time ranging from being robbed to generally poor working conditions. Id. at 913-14. The court found, however, that due to the potential for abuse by employees making fraudulent claims, recovery could not be allowed for psychological injuries which gradually come to fruition over time within the normal course of employment. Id. at 917. Thus, the court found the applicable test was that mental disorders which are a result of gradual deterioration over time are only compensable when: (1) the disorder arose from a situation greater than the day to day emotional stress all employees endure; (2) the conditions existed from an objective standpoint, not merely in the eyes of the injured employee; and (3) the employment conditions were greater cause to the disorder than non-employment conditions. Id. at 918.
Pathfinder’s limitations have been applied to cases involving police and paramedics. These case have generally found that while these employees may be exposed to a shocking event which would normally meet original Pathfinder test, they are continually exposed to similar types of traumatic events and thus to do meet the tests stated in General Motors. See Ushman v. City of Springfield, 05 Il.W.C. 08480 (2008); Burney v. Jersey Community Hospital, 04 Il.W.C. 41965 (2006). In addition, benefits have also been denied when a petitioner delays seeking medical treatment for the alleged psychological or mental injury, as this does not satisfy the “immediate” requirement of General Motors. See, e.g., Turrentine v. Springfield Park District, 97 Il.W.C. 61559 (1999).
It is also clear that the IWCC and Illinois courts are reluctant to extend the Pathfinder doctrine for fear of opening the floodgates of litigation. For example, in Board of Education of the City of Chicago v. Industrial Commission, 538 N.E.2d 830 (Ill. App. Ct. 1989), the court denied benefits to a school teacher for psychological injuries allegedly sustained as the result of being slapped by a student. In holding so, the court distinguished Pathfinder, stating that the employee had been developing emotional depression over the course of the past year and the slapping incident “was a risk connected with the claimant’s employment that could or might occur in the ordinary course of events to a person engaged as a school teacher.” Id. at 832-33. Thus, this event did not concern a situation of greater dimension than the experience encountered by teachers in the Chicago school system.
Generally speaking, while Pathfinder does allow for compensation for psychological injuries even though no physical injury is actually sustained, the development of its doctrine over time has severely limited the impact of the original decision.
The vast majority of workers’ compensation cases in Illinois settle, meaning you and the insurance company reach an agreement about how much your injury is worth. The insurer pays you the agreed upon amount, and in exchange, you waive your right to a trial. You also usually waive future medical coverage.
If you’re waiting for a settlement offer from the insurance company, it might never come. Although it often happens this way, they are under no obligation to settle your claim and sometimes might choose to wait it out. Certainly, closing cases is a priority, but so is not spending money. So if the insurance company thinks you’ll just go away, they might use delay tactics.
Another scenario is when you call to check on your claim and the insurance adjuster tells you that your case is closed. They can’t just do that. It’s another tactic to scare you off.
The bottom line is that a settlement offer is usually possible, but you might need to put some work into it, especially if you want to get a fair amount. Insurance companies consistently give low offers, especially to those who don’t have an attorney. The reason we feel the need to remind people that insurance companies are not looking out for them is because they often act like they are. We hear from people who say they didn’t think they needed an attorney because the insurance adjuster was so “nice” or “helpful.”
Hiring an attorney who has experience negotiating with insurance companies can make a huge difference in your claim turns out. The insurer’s goal is to save the insurance company money. Their priority is never your health or financial security.
Fresh off the Illinois Workers' Compensation Commission presses. Three new Arbitrators were appointed. I know Doug McCarthy very well. He is a great guy and is the son of a former State Senator who helped write the Illinois work comp laws in the 70's. He is exactly the type of attorney who should be appointed Arbitrator in that he is experienced, fair and easy to work with. Here is the press release.
CHICAGO - January 26, 2012. Governor Pat Quinn today announced the appointment of three additional arbitrators to the Illinois Workers' Compensation Commission (IWCC) to review workplace injury claims. The arbitrators will join the 27 arbitrators the Governor appointed in 2011, all of whom were appointed following a rigorous vetting process by the Workers' Compensation Advisory Board and the Office of the Governor. The appointments were part of a package of comprehensive reforms to the workers' compensation system that the Governor signed into law last year.
"The vetting and appointment of arbitrators was a critical step in our overhaul of Illinois' workers' compensation program, and I am pleased appoint these additional arbitrators to the IWCC," Gov. Quinn said. "These arbitrators bring years of professional experience to judge workers' compensation cases, and are an important part of the reform process that will help improve Illinois' business climate."
The workers' compensation reforms called for the Governor to make appointments to fill arbitrator positions, considering recommendations from the Advisory Board, which comprises six members representing employers, and six members representing workers. Arbitrators rule on claims filed under the state's Workers' Compensation Act.
Before last year's reforms, Illinois had some of the highest workers' compensation premiums in the nation. The reform package is projected to decrease compensation costs for employers by nearly nine percent, based on a filing with the Illinois Department of Insurance by the National Council on Compensation Insurance. Illinois employers are expected to save at least $500 million annually in premiums as a result of the overhaul.
The new law requires that all newly-appointed arbitrators must be attorneys and that both arbitrators and commissioners follow the rules and ethical practices of judges. Arbitrators and commissioners must also take at least 20 hours of training every two years while in office regarding professional and ethical standards, detection of fraud, evidence-based medical treatment, and Coal Workers' Pneumoconiosis.
Governor Quinn has appointed the following arbitrators to the IWCC:
Brandon J. Zanotti of Jackson County comes to the Commission from private practice. At Feirich/Mager/Green/Ryan, Mr. Zanotti worked as an attorney specializing in workers' compensation cases representing both petitioners and respondents. In addition to his time in private practice, Mr. Zanotti was a congressional clerk to Sen. Richard Durbin in Washington, D.C. and clerked for Judge Joseph M. Leberman in the First Judicial Circuit County of Illinois. Mr. Zanotti graduated summa cum laude from Southern IllinoisUniversity with a B.S. in Finance and also has a J.D. from Washington University School of Law. Mr. Zanotti has been appointed to a one-year term as an arbitrator.
D. Douglas McCarthy of Macon County brings more than 30 years of legal experience to the Commission. At McCarthy, Rowden and Baker, Mr. McCarthy specialized in workers' compensation and social security disability law. He has appeared before the Commission, state circuit and appellate courts and in federal administrative hearings. Mr. McCarthy graduated from Illinois State University with a B.A. in Communications, received an M.A. in Public Affairs Reporting from Sangamon State University and a J.D. from Southern Illinois University. Mr. McCarthy has been appointed to a two-year term as an arbitrator.
William R. Gallagher of St. Clair County brings 35 years of legal experience to the Commission. Mr. Gallagher most recently worked as a solo practitioner, specializing in workers' compensation law in Illinois and Missouri. Mr. Gallagher has also worked as In-House Counsel at the Kemper National Insurance Company, specializing in workers' compensation and products liability cases, and as an attorney at the Harry J. Nichols Law Office, working on workers' compensation claims in Illinois and Missouri. Mr. Gallagher has a B.A. in Political Science and Economics and a J.D. from Southern Illinois University. Mr. Gallagher has been appointed to a two-year term as an arbitrator.
You’ve had a work injury; you’re home recovering from the accident, and unable to work. You get the feeling that someone’s watching you. It may not be your imagination--you may be under video surveillance by your employer’s insurance company.
While it may seem unsetting, it is legal, and fairly common. Unfortunately it happens that people fake injuries, or exaggerate their pain or limitations. Insurance companies, to protect themselves particularly where a big payout is expected, will hire private detectives to follow you or watch you and videotape your movements. They want to have proof if you are one of those dishonest people trying to cheat the system.
Sometimes though, honest people are caught on video surveillance doing things that look bad, but really are not. For example, a worker may push himself to shovel snow when he thinks it is necessary, even though he has a back injury restricting all bending and lifting. He may be in horrible pain doing it, and may have possibly injured himself worse. But on the video it could appear as though he was not telling the truth about the extent of his injury.
We’ve had this happen to a bunch of clients. Most of them tell us that they were feeling well on that particular day and wanted to see if they could push their body further in hopes of getting back to work. That’s what people with a good work ethic do.
In some cases treating physicians have changed their opinions about their patient’s injuries based on seeing the video of the patient doing things like mowing the lawn, running, and other activities that they should not be able to do if they were in as much pain as they described during the medical exam. Particularly in cases where much of the evidence of your injury comes from what you report to the doctor about your pain, and can’t measured or seen on tests, the surveillance can sway the doctor’s testimony.
Though you can attempt to explain what is on the surveillance video, you don’t want to put yourself in that position. It is better to just listen to your doctor, and follow the restrictions that you have been given. It is better for your case and importantly it is better for your health and recovery.
But you don’t have to worry too much about being followed and taped, especially if you are following doctor’s orders and being honest. You can just go about your business, and what shows up on tape will most likely be fine. Being disabled from work doesn’t mean that you can’t do anything. It just means that you shouldn’t be unreasonable in what you are doing. And while there is no limit on how much surveillance a company can perform, it is really expensive. If they watch you for five days and see nothing, they will probably stop following you.
Some break-time injuries may be covered under Illinois workers’ compensation insurance, just as though you were in the middle of a job task. Under certain circumstances, even where you are doing something that is for your own personal needs, like eating or using the restroom, an accident could be considered employment-related.
Generally to be covered under workers’ compensation, you need to be engaged in the work of your employer at the time of the accident. But when you are taking a break for some expected activity that involves your own personal comfort or health, you are still actually serving the needs of your job. In order to properly perform your job duties, it is necessary to eat, use the bathroom, warm up or cool off, and other such activities. For this reason, these are not necessarily considered to be off-the-clock.
A recent Illinois workers’ compensation case is a perfect case for showing how personal comfort activities can be covered as work time. It involved a firefighter who was required by his job to complete paramedic training at a particular hospital. The employer paid for the training and any expenses. He was able to take this course during his regular shift time. The firefighter was injured while hurrying to the cafeteria for a quick breakfast break while he was at the hospital for the training. He was moving fast so he would not miss any ambulance calls. Also, he slipped, because the stairway was littered with spilled food from other workers rushing from the cafeteria for emergency situations.
All the parts of this fact situation fit well within the considerations for a break-related accident being counted as a work-related accident for workers’ compensation coverage. The firefighter was where he was because he was required to do the training; and he was required to do it at that particular place. His employer was paying for the activity as well. He was taking a brief break for eating, which is a necessary act of personal comfort. The actual accident was caused by two things, both which were related to the emergency nature of the job: his rushing quickly down the stairs; and the spilled food that he slipped on.
If he had done something to cause the accident that was unusual or not expected by his employer, the outcome might have been different. But here, everything that the firefighter did before and during the accident was expected and related to his job duties. In situations like these, even activities that are part of a break, do not necessarily break the chain from being work-related for workers’ compensation coverage.
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.
Not all Illinois work injuries happen at work. Having a fall while you are walking in or out of the office can also be a work injury that is covered by Illinois workers’ compensation in some circumstances. Further, if your fall happens when you are not even on your employer’s premises, you still may be able to have your injuries covered.
If your fall happens while walking to or from work, when it is not a company walkway or company parking lot, or some other employer-controlled property, the general rule is that it is not a work injury. But sometimes there are other facts about your situation that bring your fall back within the reach of workers’ compensation. It basically comes down to how much control and influence you job has on which way you walked, and what caused the fall.
Here is the difference. If you park your car, and have a choice of which path to take into the building, or which door to walk through, then you may be on your own. But if your employer or something about your job controls which way you walk into or out of work, then it may become a work-related walk.
Many companies will have rules like this that control which way their employees come in the door. There may be a specific employee entrance, or there may be task to be performed on the way out that requires a certain path. However it happens, if you are not freely choosing your way, and your employer or job duties dictate the path, then even though you are not at work, and not on work property, you still may have a work injury if you fall.
So if you are in fact walking in your employer’s path to work and you fall, the next question is what caused the fall? Was there something about your job that made the risk of falling greater than someone else that did not work there? Often, if there is a defect in the pavement or icy conditions, your exposure to these dangers would be higher because of your job, so it could likely be covered.
There was a recent Illinois workers’ compensation case that went a bit further in deciding whether the path was controlled by the employer or employee. This was a case involving a delivery driver for a company. His employer had a designated place to park and entrance way, but the driver instead parked and walked where it was closer and safer. He slipped on ice and injured himself.
Even though he was not walking a path specifically chose by his employer, he was walking a way that was dictated by his job and the conditions that were present as he made his way into work. His fall was covered by workers’ compensation insurance.
Cases like these show that just because you are not at work yet, or on company grounds, you should not necessarily assume, that you would not be able to recover workers’ compensation benefits for your injury, without exploring your situation further.
If you think that exposure to a chemical at work caused your illness or condition, you may have a case under the Occupational Disease Act. This is similar to the Illinois Workers’ Compensation Act. Both reimburse you for your medical bills and lost wages if your injury is work related.
In cases of chemical exposure, though, it can be very challenging to prove that your current health problems are related to your work environment. The exposure is more difficult to investigate. And because the symptoms can develop over a long period of time, it can be hard to show that other health conditions you may have are not the real reason for your illness.
If you are suffering from an illness that is related to your work, keep in mind that the chemical exposure at work does not need to be the sole cause of your illness. You do not need to give up the idea of getting insurance benefits for your injury just because, for example, you are a long-time smoker.
Frequently the insurance company will point to other conditions or risk factors that do not related to work, such as smoking or other prior conditions. And they will try to make the claim that because of these other factors, the chemicals at work are not to blame for your current condition. Though the other complications may make your case for a work injury more difficult, you do not automatically lose your case.
What you do need though, is more medical proof to make a convincing case that the exposure in the work environment contributed to your disease or illness. Cases have been won and lost on the amount and quality of the medical backing for the claim.
For example, testimony from experts that a worker’s condition is the same at work and outside of work, and that others on the job site have similar issues can help to show a work cause. Even if others at work only have very mild symptoms as compared to yours, that fact that your health makes your reaction more severe should not prevent you from proving a work injury.
On the other hand, a worker in Illinois recently lost a case because of the lack of medical evidence showing that the work chemicals caused the health condition. Even though several experts pointed to the worker’s smoking as the cause of his illness, that alone would not necessarily have ended the case if there had been other strong evidence showing the chemicals made his health worse.
Because these illnesses can develop over time, you should not waste time in pursuing a claim if there is a chance that your health problems may have been affected by a chemical exposure on the job. Most important of all of course is your health so above all else, head to the doctor ASAP no matter what is causing your problem.
Workers’ compensation may cover a rehabilitation plan that will help you prepare to find a job, when your work injury has prevented you from continuing what you used to do. This vocational rehabilitation can be a great opportunity to help you develop your skills and prepare for your future. But the opportunity can be blown if it is not handled reasonably and diligently.
Vocational rehabilitation can provide you with services, such as job training, education, and job searching support. But if you do not cooperate with the rehabilitation company, then you could lose your benefits, including your maintenance. What can get in your way? If you are not following through with the recommendations, you could be risking your benefits. But also, your follow- through has to be reasonable and realistic.
The rehabilitation program is not necessarily going to completely change your career path altogether. You can learn some new skills, and complete some education, and receive other supports. But a worker recently in a case in Illinois, lost his maintenance benefits partly because his unrealistic job search efforts.
He had been a meat cutter for a grocery chain, and did not have much of an academic record. Yet on his job applications, he specified an unreasonably high salary request, and he was attempting to pursue management positions, for which he was not qualified. On the other hand the rehabilitation company wanted him to pursue a literacy program that they thought would help him, and he did not do that. He also did not make as many job contacts as was expected of him.
In other cases, benefits have been terminated where the vocational rehabilitation program recommended obtaining a GED and to research appropriate job sites, as well as for not handling interviews properly.
What is generally expected to not run into a problem is to put out reasonable efforts at cooperating with the program. But also, it should be done in a meaningful way to help the plan succeed. Otherwise, your efforts at rehabilitation might not seem sincere, and you could risk losing your right to your benefits for the vocational rehabilitation and maintenance. Even if your job search is not a success, your part in the retraining and applying should be genuine and reasonable. If it’s not, it could literally cost you tens of thousands of dollars if the Arbitrator doesn’t like your approach to looking for work.
If you sustain an injury on the job, there is a chance some day that you will have to appear before an Arbitrator that will decide whether or not to award you work injury benefits and/or how much your case is worth.
For you it will probably/hopefully be a once in a lifetime experience. For your attorney it will probably/hopefully be an almost every day occurrence, at least in terms of dealing with a case. While you are likely testifying for the first time, they should be going to trial for a countless time. If you know how many cases you’ve tried you probably haven’t handled that many. Every reputable lawyer I know has lost count.
Because lawyers go through the trial process over and over again, they repeat many of the same steps. How they organize their file, what they do for preparing questions, talking to witnesses ahead of time, going over testimony with a client, reviewing medical records, etc.
Unfortunately, many lawyers also do one thing over and over that can destroy an otherwise good case. They send their client to a doctor who can testify about the client’s injury. There is nothing wrong with that in general, but many lawyers use the same doctors over and over and over again. Because they handle so many cases, the doctor gets a reputation as a whore for the lawyer whose opinion is not credible. The lawyer is paying the doctor with money that will eventually go to you, so essentially you are paying for something that doesn’t help your case.
The case can get ruined when an Arbitrator knows the doctor is a whore and not only doesn’t give that opinion any value, but also slams the worker for hiring an attorney that made a bad choice. We hear about this a lot from our defense attorney friends. There is one downstate doctor who really isn’t a doctor anymore, but rather is a farmer. He does work still with one lawyer on lots of cases. When he gives a deposition it’s not in a medical office, but rather in his living room. That is so un-normal that it makes insurance companies suspicious and in our opinion looks really bad to the Arbitrator. Not all of these doctors are that odd, but even the otherwise good ones who have a real medical practice can harm a case if they are showing up as witnesses on case after case.
Of course insurance companies make similar mistakes by using the same types of doctors for their “independent” medical examinations. But who cares if the insurance company doesn’t look credible. We are only worried about the workers just as you should only be worried about yourself. So if your lawyer is sending you to a hired gun that you are eventually going to be paying for, you should ask your attorney why they made that recommendation and how often they work with the physician. If the answer is a lot, it may be a bad sign.
Clearly not everyone feels pain to the same degree, and the same injury may produce more pain in one person than another. It would make sense, then, that treatment for the injury would be specific to each person. Two workers with the same lower back strain from heavy lifting could take different periods of time to recover and be able to get back to work, if at all.
When you need to prove your case for workers’ compensation benefits to reimburse you for the full extent of your recovery, you want to be sure to not make some simple mistakes that could blow your case. Since pain is real, and needs to be treated, yet it is subjective and needs to be proven somehow, the way you go about it can make all the difference. In a case decided recently in Illinois, a mechanic who injured his back at work made some of these mistakes.
First, he did not have medical testimony from his treating physicians that backed up his complaints of ongoing pain. The physician’s reports lacked any medical basis for continued treatment, or for his current reduced functioning based on the pain he claimed to be suffering.
In contrast, another very similar Illinois case where a mechanic suffered back strain and chronic pain, the medical testimony was specific and supported the worker’s claims. He had two treating physicians that gave medical opinions that his injury was likely caused by heavy lifting on the day of the accident, and testified about his current limited functioning. Also, the worker had continued to receive additional treatment to try to relieve the pain, including acupuncture and massages.
The second mistake the worker made in proving his case, was not conducting himself within what he claimed his own physical limitations were. If you are in pain, and need further treatment and work limitations, then you have to limit your activities accordingly. This worker did not. When the insurance company used video surveillance to check on his activity, what they saw on the video was that he was doing things that were outside of his work restrictions, and that were inconsistent with his claims of pain.
When you are trying to prove this kind of a case, credibility is critical. Any support you can bring in the form of medical testimony can help to show that you are not inventing your pain. And you are only hurting your case if you try to push yourself too far and do activities that are not the type someone in your condition should do. You lose the credibility of your own testimony about your pain, if you say you cannot bend and lift at work, and then you are out shoveling your snow---regardless of how much pain you are in when you do it.
Workers’ compensation insurance covers injuries that happen when you are on the job, but with some jobs, it is not so clear when you are working and when you are not. Employees that are on call for their employers are waiting to be called into action, but not exactly working. When and if an on-call employee is back on duty and back within the workers’ compensation coverage, is a question to be determined in each case.
Typically, an employee that is on call for the company is standing ready to work, but is not necessarily working during the periods of time that he or she is waiting. The employer has to actually call the employee into action, for the status to change. If you may be called to work, and you have your cell phone by you to get the call, that is likely not enough for an injury to be covered under worker’s compensation.
But when you are specifically called into action by your employer, at that point there is a shift in your status. When you are once again under the control of your employer, then an accident that happens is more likely to be considered a work accident.
Police officers face a different situation when they are on call or even when they are off duty. They can be called into action to perform job duties by more than just a call from their employer. They can observe situations out in public that create a need to spring into action and perform their duties as an officer.
Whether the police officer is off duty and sees a troubling situation, or whether he or she is on call and monitoring the radio in case a scenario arises that should be responded to, the result may still be the same. If a police officer’s job duties provide for vigilance and action whenever necessary, then the officer does not necessarily need to be specifically called to action in a particular situation for the situation to be covered by workers’ compensation insurance in the event there is an injury.
It is really the same analysis as other on-call employees. Did the employer have authority over the employee at the time of the injury? If the answer is yes, then you are more likely to have your injuries covered as job-related. Your employer could have authority because you were specifically summoned back to work while you were on call.
Or your employer could have authority over you because, in the example of the police officer, your job contemplates you will act when needed to help others.
Mean boss, bad work environment, cruel coworkers: a recipe for job-related stress. But psychological stress injuries, even if caused by your job, are not generally covered under workers’ compensation in Illinois.
Sometimes the stress and pressure from your job can cause you to suffer emotionally and psychologically, as it builds up over time. This type of injury, though, without more, usually will not trigger workers’ compensation benefits. There are a few additional factors, that if part of the picture, could change the result and allow compensation.
Instead of the cause of the psychological injury being stress that wears at you over time, if there was a sudden event that you could point to as the cause, you’re likely to have your injury covered. This type of event could either be something physical or emotional.
An example of a physical event that could trigger benefits, would be if your boss inappropriately hit or touched you in a way that caused you to suffer panic attacks. In proving your case, you could point to specific incidents on specific days that began your psychological injury.
An emotional event that could trigger benefits for a stress injury, would be witnessing something sudden, severe, and shocking that occurred at work, such as the death of a coworker. If, for example, you work in a factory and saw your coworker violently injured or killed by the machinery, you could suffer serious psychological injuries from this specific event.
Another type of stress injury that could be covered under workers’ compensation, that may seem psychological, really is, for the most part, physical in nature. If your job stress has caused you to suffer a physical injury such as hypertension, then this is a different scenario. Here you are not suffering from a psychological injury, but instead, you have a physical injury that may have been brought about by the emotional stress of your job. Even though there is a psychological aspect to your injury, your body itself can suffer and deteriorate as a result.
Each of these stress-related job injuries has some other element to it other than a lousy job making you feel lousy. That’s not to say that the way you feel from a stressful job isn’t significant. Stress injuries can be very real and make it difficult to work--but Illinois workers’ compensation does not usually cover it. That does not mean that you should ignore injuries that are related to stressful work situations. Just as these examples show, there are those cases where, when you look at the total picture, you can justify getting benefits for your injury.
I recently spoke to a potential client who I declined to represent even though he sustained a major, life altering injury while sitting at his desk. He had a stroke and suffers from partial paralysis now. The reason I rejected his case is because there is no proof that his job contributed to the bad result.
In order to win an Illinois workers’ compensation claim, you need to show that your injuries arose out of and in the course of your employment. In the course of means while working for your job. He met that burden, but doesn’t prove that his injuries arose out of his job which means the job somehow contributed to the problem.
For example, if you are lifting a box at work and your back gives out, the injury is directly related to the job duties. But for a stroke, it’s usually not the job duties that cause the problem to happen. It would be different if he had a stroke while performing heavy labor, working in extreme heat or cold or doing something else unusual. He did say that he had been working long hours and feeling stressed, but that alone is not enough to win a case.
We don’t enjoy turning away clients, especially nice ones with good injuries. But we always tell the truth and the truth in this case was that the client couldn’t prove his job contributed to his problems. Without that you have nothing.
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.
Weather-related emergencies are a reality of life, and injuries from these events may be unavoidable. When you are at work, and nature strikes, there is a possibility that your injuries could be covered by workers’ compensation insurance. But you’ll need more than just being on the job at the time, to turn an act of nature into a compensable injury.
Here in Illinois we experience our share of lightning strikes, tornadoes, and other violent storms. When these events happen while you are on the job, any injuries you suffer could be covered under workers’ compensation insurance if there was something about your experience and your injury risk that made it unique to your job.
If you were working in a field where there were trees, and you were struck by lightning, you may not be covered. The only connection to your job, was that you happened to be in a physical location that is susceptible to lightning strikes. But the general public that is in the same area experienced basically the same risk that you did. Workers’ compensation would likely not cover your injuries.
It could be a different result, though, if there was something unique about your work environment or circumstances that made the risk of a lightning strike more dangerous. If some other factor specific to your job enhanced the severity of the situation, then your injuries might be covered. For example, in one case an employee was working in a greenhouse during a major storm that involved thunder and lightning. The worker injured in the storm had an expert testify about the unique nature of the climate and soil in the greenhouse, and how it increased the likelihood of injury beyond what others would experience. These facts make a better case for the injury to be covered.
Similarly, there are situations where employees working in severe weather conditions are hit by debris or other objects. Even though they were on the job when they were injured by the storm, if there was not some other factor related to a risk of the job, they may not be covered. But in a case where a store manager was hit by a sign falling through the roof, there was a strong showing for it being a work injury. There was evidence specific to the sign itself that made it particularly susceptible to wind damage. Because of this heightened risk, an accident like this one may come within the coverage for workers’ compensation.
The outside elements can be unpredictable, especially in Illinois. But we all share that risk together. Where your job environment and situation create a unique risk, then you may have a workers’ compensation claim if you are injured.
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.
A client who had been in a car accident during work hours wanted to know which way to go to recover money to compensate him for his injuries. The other driver caused the accident, so he likely had a claim against him. So should he file a workers’ compensation claim or file a lawsuit against the other driver?
Actually, Illinois law does not force you to choose between the two. The Illinois Workers’ Compensation laws have provided a system for injured workers to be able to pursue both claims, while ensuring that the money received is distributed appropriately.
Here is how it works:
If you are in an accident during work hours, you first want to determine whether you were covered by workers’ compensation at the time. Were you driving for work-related purposes, or were you driving for your own personal reasons? If this was a work-related trip, and you are covered by workers’ compensation insurance then you should be reimbursed for your medical expenses and missed work time.
But if the accident itself was another driver’s fault, then you may also have a claim against him or her. The other driver could also be responsible for paying for your injuries and other damages from the accident, in a personal injury lawsuit. These damages could include not only your medical expenses and lost wages, but also other measures such as damage to your car, and your personal pain and suffering from the accident which are not part of workers’ compensation benefits.
So now you have two insurance companies involved with this accident, each being asked to compensate you for your loss. The workers’ compensation insurance can reimburse you according to the workers’ compensation law, and the other driver’s auto insurance carrier is involved in defending the personal injury lawsuit.
To be sure the money that is paid for your injuries is not paid twice to you—once from each claim--your employer’s workers’ compensation insurer will have a lien on any money you recover from the driver in your lawsuit. This means that they have a case to be reimbursed for what they have paid to you in workers’ compensation benefits, if you are paid from the 3rd party for the same injuries. The employer can be reimbursed for up to 75% of what they have paid in workers’ compensation benefits, with attorneys’ fees and costs taken into account. This amount is often negotiable.
Bringing both claims gives you the possibility of recovering an amount that is larger than what you would get with workers’ compensation alone, because of the additional damages allowed in personal injury lawsuits that are not allowed in workers’ compensation cases. Our philosophy is to explore everything and then decide what is best from there. But as workers’ compensation immediately pays your medical bills and time off work, I can’t think of a time when we told a client not to at least pursue that claim.
Workers who have been exposed to the chemical Diacetyl, which is used to increase butter flavor and taste in products and is largely found in microwave popcorn, may be at risk for the disease known as Popcorn Lung.
Popcorn Lung, or Popcorn Workers' Lung, is a disease where the bronchioles (small airway branches) are plugged with granulation tissue, causing lung usage to be as low as 16% to 21%, as opposed to the normal 80%.
Symptoms include severe shortness of breath, a dry cough and wheezing. Since these symptoms are similar to other respiratory diseases such as asthma or emphysema, a misdiagnosis can occur, and a second opinion is strongly encouraged.
The severity of symptoms varies from a mild cough to a severe cough. Also, the onset of symptoms can range from gradual to sudden onset. That is why it is important to see a doctor if you have been exposed to Diacetyl even if you feel fine.
By reducing exposure to Diacetyl, you may believe you are in the clear. However, Popcorn Lung is irreversible once it has developed and reduced exposure will not improve your condition. Patients may even require a lung transplant in severe cases.
Exposure to Diacetyl has been found to be one of the main causes of Popcorn Lung. However, exposure to polyamide-amine dyes and thionyl chloride fumes may also cause the disease. Also, it is not just popcorn manufacturers that use Diacetyl. It is also used in ice cream, candy, cakes and other products.
If you have been exposed to Diacetyl or any of the other possible inhalants that cause the disease, you should see a doctor to be tested for Popcorn Lung. Again, do this even if you feel fine and regardless of your role or the product produced in the plant.
If you continue to be exposed to Diacetyl or any of the other possible inhalants that cause the disease in the workplace, you should obtain and read the National Institute for Occupational Safety and Health (NIOSH) Booklet "NIOSH ALERT: Preventing Lung Disease in Workers Who Use or Make Flavorings" as well as see a doctor to be tested for Popcorn Lung.
In Illinois, injured workers can receive workers compensation benefits for a variety of injuries. Just because you were hurt at the job in Illinois does not mean that you will receive workman's compensation benefits. Below are some examples of injuries that are covered by Illinois workers compensation laws.
Workers can recover benefits for injuries that result from repetitive movements when those movements are required for the completion of work related tasks. One of the most common types of repetitive trauma injuries is carpal tunnel syndrome, which usually results from constant computer use. Additionally, repetitive hammering with a heavy tool over time can eventually result in repetitive trauma injuries to the arms. Even standing for prolonged periods of time can constitute repetitive trauma to the legs if the standing is required to perform a job related task.
Traumatic Physical Injuries
An employee can receive benefits for a traumatic physical injury if it occurs while performing a specific work related activity. For example, when a worker falls off of a ladder and breaks a leg, that worker can receive benefits because the injury occurred simultaneously by a specific work related incident. Likewise, a worker can recover workers compensation benefits for hyper extending his or her arm while reaching up to restock a shelf at work. Work related traumatic physical injuries represent the most common claim in Illinois workers compensation law.
When workers are diagnosed with diseases that result from exposure to elements at work that they ordinarily wouldn't have exposure to outside of work, they can recover workers compensation benefits. For example, a coal miner can sue for a lung disease that is caused by inhaling coal dust at work.
Workers can receive benefits for mental injuries that arise out of employment. There are two types of mental injures, those that arise out of emotional strain and those that arise out of physical injuries. An example of a mental injury that arises out of a physical injury is when a worker is hit on the head with a piece of equipment and suffers memory loss. An example of a mental injury that arises out of emotional strain is when an employee witnesses a hand amputation at work and suffers insomnia as a result of witnessing the event.
In our opinion, the best lawyers for work injury cases almost exclusively handle workers compensation matters in Illinois. Because they are focused on one area we believe that they are best suited to know the Arbitrator's and the laws and achieve the best results for their clients. Because these attorneys are focused on workers compensation, they are familiar with the laws and more likely to maximize the compensation awarded to their clients.
Reaching out to help a coworker in need is admirable, but if you are injured while doing it, you may not be covered under Illinois Workers’ Compensation. A recent case involving two coworkers on a lunch break highlighted that situation.
The two went out to a local restaurant for lunch while on a break from work, when the truck they were riding in wouldn’t start. One of them got out to help work on the battery, when the truck lurched forward and hit him. Because he was injured while trying to help a coworker during their work break, he tried to claim benefits under workers’ compensation, but was denied.
The act of helping someone else could fall within the category of the “good Samaritan” doctrine, which would allow for workers’ compensation benefits to cover an injury. But it is not enough to be just a good and helpful person coming to someone’s aid. For the purpose of workers’ compensation claims, your actions have to be the kind that your employer could foresee or anticipate; otherwise you were acting on your own and not in the course of your employment.
In this case, though it was a work-day lunch break, and he was aiding a fellow worker, there was no other connection to his employment. Their employer did not have any reason to anticipate that he would be trying to jump-start another’s truck. Also, they were on their own to choose the restaurant, they were parked in a parking lot that was open to everyone and not the employer’s property, and they were not in the process of doing something for their employer.
The argument was rejected that since the employer did not have a policy against helping with a coworker’s vehicle, and had not told employees not to do it, there must be some level of acceptance for what he did. Instead, it is basically the opposite: if there had been a policy saying that employees are expected or required to come to the aid of their coworkers; then the result may be different. In that scenario, the company policy would show that the employer anticipated and even expected that this could happen.
Similarly, if there was something special about the job or its location, that made it reasonable to expect that employees could need to come to someone’s rescue, the injury could be covered by workers’ compensation. In these situations, a departure from your usual job duties to help someone could be expected or foreseeable.
But in a situation where the good deed is done without any direction or control or expectation by your employer, likely it is also done at your own risk, and may not create an entitlement for workers’ compensation benefits.
Insurance companies are allowed under Illinois workers’ compensation rules, to send injured workers for an Independent Medical Evaluation (IME). This may happen when you are receiving benefits for your injury and the insurance company wants to have another medical opinion about your injuries, your treatment, and the compensation for your injuries.
Even though you are required to go the IME appointment or risk losing your benefits, you aren’t required to have to pay for it yourself. Not only are the time and place of the appointment supposed to be reasonable, but the costs associated with the appointments for the IME are required to be given to you in advance. The notice of the time and place for the IME should include the costs for travel, meals, and lost wages if work will be missed.
A recent Illinois case highlighted the significance of the costs being paid in advance. A worker got the IME notice, but instead of the money for costs, there was a statement that the travel expenses would be paid at the exam. This is not what the law requires though. Payment for travel for the IME should be given along with the notice. And if the costs are not included, the worker does not have to go to the IME appointment.
In this case, when the worker did not show up for the appointment, her benefits were terminated. The insurer’s position was that benefits could be terminated because the employee did not fulfill her obligation to go to the scheduled IME. But in fact it was the notice for the IME that didn’t stand up, and excused the employee from keeping the appointment.
The failure to prepay the travel expenses made the notice for the IME invalid, so the fact that benefits were cut off because the employee missed the IME date was unreasonable. This can end up costing the employer more money. If benefits are not paid in a timely way, and there is no reasonable justification for it, then they can end up owing you more money than just the original benefits you were entitled to. So where they rely on the workers’ failure to go to the IME to stop benefits, this decision is not reasonable if it is based on their failure to send a proper notice with prepaid costs.
If you have any question about whether you can miss a scheduled appointment, it is better to discuss it with an attorney to be sure you won’t be hurting your case. But if you are asked to go for an IME, you should not have to risk losing money on a promise to reimburse you later.
The new Illinois workers' compensation laws include a pretty big change in how injured workers choose their doctors.
Under the old law, an injured worker was entitled to two choices of doctors. Each choice included any additional health care providers that your doctor referred you to (surgeons, specialists, therapists). This is known as a chain of referrals, and you were entitled to two chains.
You still technically get two chains of referrals, but there is a catch. The new law allows employers to set up preferred provider networks, which is basically a list of doctors you have to choose from.
You can opt out. The law says you are entitled to reject the preferred providers of your employer, but there is a penalty. If you opt out of the network, you only get ONE choice of doctor. Opting out of the network costs you one of your picks. Your one choice still includes that doctor’s referrals, but that’s it.
So the new law limits the doctors available to you, and restricts your ability to change doctors. Employers aren’t required to have preferred provider networks, but they certainly have incentive to enroll in the program – it saves them (and their insurance company) money to have contracts with select doctors.
Like most of the recent changes in the workers’ comp laws, this one helps businesses and insurers and hurts injured workers. Having two choices is important because not every doctor-patient match is a good one. If it becomes clear that they aren’t the right doctor for you, you might not have any recourse.
Some exceptions to the rule: If your injury requires a specialist that is not available in your employer’s preferred provider network, you may be able to argue for an exception. Also, the workers’ compensation commission can approve a third choice of doctors if you file a petition and can show that the treatment you are receiving in-network is improper or inadequate.
The bottom line is that if your employer has a preferred provider network, you will have a list of doctors to choose from. If you choose to go outside of the network, it counts as one of your choices, and you will have only one left. So be careful in order to avoid getting stuck with a bunch of medical bills.
Sometimes a situation that starts our clear can end up muddy. You are injured at work. Workers’ compensation is providing you benefits while you are out of work and going through medical treatment to recover. But then…another non-work incident happens which affects your work injury. The question arises: will workers’ compensation continue to cover your original injury, or has the new accident gotten in the way of your benefits?
In Illinois workers’ compensation, once it’s been determined that your injury was work-related, you are generally entitled to benefits to compensate you for that injury. And the Illinois courts are not so quick to take those benefits away from you, just because some other accident or event happened while you were trying to recover.
After all, sometimes a second injury is more likely to happen, because of the weakened condition you were left in from the work injury. There is some expectation that, even if you’re being very cautious, your first injury makes you more susceptible to experiencing some event which can either aggravate your old injury or cause a new injury.
Sometimes, though, the second incident that happens is not a consequence of your work injury at all. Some other random event happens, such as a car accident, that affects your recovery from your original injury. Even where the car accident was not caused by the work injury and the accident made your injury worse, workers’ compensation benefits have not been cut off.
In cases like the unrelated car accident, the important question is whether the chain has been broken that links the work accident to the most recent injury status. If there is an unrelated event in the chain while you’re recovering, it may shake the chain around a bit, but not necessarily break it. You have to look at whether the current injury would not have happened the way it did, if there hadn’t been the original work injury.
In the case of the unrelated car accident, even though the injured workers’ condition was made worse by the accident, had he not had the original injury, the car accident would not have had the same effect as it did. He hadn’t fully recovered from his work injury, so he was more susceptible to the complications to his health that happened after the car accident.
In other words, but for the fact that you had the first injury that was work-related, the second accident or event wouldn’t have caused the same harm to you that it did. The non-employment event won’t break the chain of the employment injury, as long as your employment is still a factor in causing your current injury.
You should, therefore, be able to continue to receive your workers’ compensation benefits for your work-related injury, even if you have had a subsequent injury—whether or not the second injury was caused by the first. If there is a connection between your current condition and your original employment injury, then the intervening incident shouldn’t cut off your benefits.
So the other day I got a call from a woman who was looking for help in regards to the torn rotator cuff she sustained from a job injury in Chicago. It was a pretty typical call in terms of her describing the accident, how she was sent to an IME doctor and the disagreement she was having with the insurance company. Her case had issues, but it was nothing we don't see on a daily basis.
I was just about to discuss a meeting with her when she added one fact that shocked me. It was something I haven't heard in my 14+ years of doing this. Her case had gone to trial, the day before, and now she realized that she hired the wrong attorney and wanted a new one.
Uhm, I don't know who the best lawyer ever is, but even that person wouldn't have been able to do something for this woman. Once your case goes to trial, that is it. You wait for the Arbitrator's decision and go from there. No new evidence can be presented and you don't get a do over.
I was honestly shocked because she casually mentioned it as if it wasn't a big deal. I never blame a client for being naive about the process - I certainly am naive to many of my client's jobs - but this was really shocking.
The moral of the story is that if you are feeling un-easy that the lawyer you hired won't fight for you, if you don't switch before the trial (or even depositions) takes place, it is probably too late.
Injuring your back or neck should never be taken lightly. Getting the proper medical care for your best recovery is vital. When your injury was work-related, safeguarding your right to getting workers’ compensation benefits for that injury can be an important piece of your recovery puzzle. With the high costs of medical care, you want to be sure you receive all the benefits you are entitled to, so you can afford to have all the treatment you are entitled to.
With this in mind, it is important to have a strong medical record detailing the extent of your injury, and any evidence that it was connected to your work. Often the strongest and most credible testimony and evidence for these injuries comes from medical doctors, as opposed to chiropractors. That is not to say that chiropractors don’t perform a valuable healing function; but being under the care of a medical doctor that focuses on neck and back injuries can make a significant difference for you both medically and legally.
In an Illinois workers’ compensation case that was recently decided, the worker showed that merging the two practices proved to be the best of both worlds. She received chiropractic care which helped her condition, and yet sought the opinions and treatment of several other specialists as well.
In this case, the woman performed cleaning services, and had two work injuries in one year. Each time the pain began in her back and neck. She was treated by a chiropractor after each incident. The first time, the treatments allowed her to return to work as usual. After the second injury, she continued the chiropractic care, because it relieved her symptoms, however she saw several other specialists as well.
Wisely, this worker knew, and was advised by her chiropractor, that she should get the care and opinion of medical specialists. She was then able to get pain medication, physical therapy, injections, and an evaluation for surgery. She had a detailed medical record, and several physicians that were able to testify about her condition and that it was related to her work.
The court upheld her workers’ compensation benefits, including the costs of her chiropractic care. The judge supported the workers’ claim that the ongoing chiropractic treatments, while not curing her, were necessary to relieve the pain temporarily.
Neck and back injuries can be very serious, and lead to other complications. It’s very important to get the medical care necessary to be sure you are receiving all the treatments that will lead you to your best recovery. It is also important to help yourself to be able to get the benefits you are legally entitled to, in order to help you get that treatment
In most instances, if you want to receive workers’ compensation benefits for your injury at work, you need to follow doctors’ orders. You can’t disregard the medical opinions and still expect your employer to pay. But when it comes to having surgery, the choice is still yours to exercise. In Illinois workers’ compensation cases, you don’t have to subject yourself to surgery just to receive your benefits.
A caller was facing this issue and asked what his rights were. He had gone through one surgery already, and it did not go well, so he didn’t want to risk a second surgery. The insurance company was giving him pressure to have the surgery. For the insurer, it seems like a bottom-line issue. If you have the surgery, you could likely get better and get back to your job. It could save money in future benefits.
But for the worker facing the decision, it’s more complex. Surgery involves risk, pain, recovery, and an invasion to your body. You don’t want the insurance company dictating that you have to have surgery; even if it saves them money. And fortunately, in Illinois, you can refuse the surgery, as long as your decision was reasonable and not made in bad faith.
In deciding whether your choice to refuse surgery is reasonable, it doesn’t matter if it could make your condition worse, or cost more money down the road if you don’t have the procedure. It is reasonable to refuse surgery even if you are avoiding it out of fear: fear of the consequences; fear of the pain; or any other legitimate fear. Our Illinois courts have pointed out that the workers’ compensation system is there to support workers with varied beliefs and fears. As long as the decision not to have surgery was based on a personal belief, reason, fear, or other good faith justification, you shouldn’t lose your benefits for exercising your freedom of choice.
For the caller facing this dilemma, the fact that he had experienced one bad surgery already, made it perfectly reasonable to choose not to try it again. Even though surgeons can give their opinion that a surgery would likely produce a successful outcome, there are no guarantees.
As long as there isn’t any indication you are making your surgery choice out of bad faith, but instead it is based on reasonable personal choice, your decision should be supported by the workers’ compensation system. If you have questions about this, just give us a call at (312) 346-5578.
We get a surprising number of calls from people who are told by their employer or the union that they have to hire a certain attorney. Or they are told that being in a union somehow alters how a workers’ compensation case is handled. Neither of these is true.
Being in a union does not change how this works. You file a claim, you are entitled to benefits. And you get to pick your own attorney. This is important because you want to hire someone whom you know is 100% on your side. The union officials might have relationships with certain attorneys, and maybe they get something out of referring cases. If they are insisting on making this choice for you, we see it as a red flag. That said, there’s nothing wrong with asking them to suggest an attorney or firm. It’s when they try to force you that you should be concerned.
This can be confusing, because union agreements do affect employment law, such as your hours or how disputes are resolved. But it’s not the case when it comes to a work injury.
When looking for a workers’ compensation attorney, focus on experience and familiarity with the arbitrators at the Illinois Workers’ Compensation Commission. An attorney who knows these key people, and who has been practicing in this area of law for many years (and who handles mostly work injuries rather than a wide range of cases), is your best bet, in our opinion. There are no guarantees, but it certainly can’t hurt.
- Occupational diseases are illnesses or conditions caused by exposure to something harmful on the job. In order to be eligible for benefits, an employee’s exposure has to be related to the job. Examples include dust, fumes, chemicals, radiation, etc. These cases fall under the Occupational Disease Act, rather than the Workers’ Compensation Act, although they are very similar.
- Practically speaking, the main difference between occupational diseases and typical work injuries is the timeline. Exposure to chemicals can cause health problems years, even decades, after exposure, whereas a slip and fall at work is pretty straightforward. In occupational illness cases, extra effort is required to gather evidence, as exposure can be difficult to quantify.
- In these cases, investigators can be used to gather evidence. OSHA investigates dangerous work conditions and can be a good way to get the evidence you need. Other times, an employer will cooperate, or an attorney will hire a private investigator to do some of the work. Whatever the method, the goal is to link your condition to your job.
- If your doctor links your disease to your work, you are eligible for benefits, which include 100% of your medical bills, 2/3 of your average weekly wages if you are out of work because of your condition, as well as possible compensation if your injury is permanent. Even when a job is not the only cause of an illness, benefits should be available. The job just needs to be a contributing factor to the worker’s condition.
- There are deadlines for filing claims for workers’ compensation. As soon as you suspect you have an occupational illness, get medical attention, and then talk to an attorney about how long you have to file a claim. Missing the deadline can end your case.
Plantar fasciitis is a type of heel injury. The cushion can get injured or wear down. A common question from workers who develop this condition is: How do I know if my heel pain was caused by my job?
If your heel injury was caused by a single accident or fall, and it happened while you were working, then it’s likely covered. The trickier case is when your heel pain is caused by excessive use. If your job requires you to walk an excessive amount, or if you have to walk on uneven surfaces or wear specific shoes that caused the problem, then you are likely eligible for benefits.
On the other hand, simply standing to do your job is not enough, even if it did cause pain in your heel or foot. In order to get workers’ compensation benefits, you need to show that your job put you at a greater risk for the injury.
Plantar fasciitis also can be caused by age, obesity and diabetes. In these situations, your injury would still be covered if your job aggravated or accelerated the condition. If not, then it’s probably not considered work related.
Each case is different, but foot problems can last years, if not forever. Surgery is sometimes required. It’s possible that you may not be able to do your old job anymore. It’s especially important to file a claim and pursue benefits in these cases. Illinois law protects you and says that you are entitled to medical coverage, as well as compensation if you have to miss work (or can’t return to work) due to your injury.
Finally, consider hiring an attorney. You will get plenty of advice from your employer and their insurance company, but ultimately, they are going to be more worried about their bottom line than about your health.
Because this type of injury develops over time, it’s not always clear when it starts or when it gets to the point where you should do something about it. Here are some quick tips:
- Make an appointment with your doctor. It can’t hurt, and it’s the best first step to take. A common example of a repetitive trauma injury is carpal tunnel from typing. If your wrists start hurting consistently, it’s probably time to look into it.
- Be completely honest, and clear, with your doctor. Explain what hurts, how it hurts, when you first noticed it, etc. Also explain your job duties and daily activities. Your doctor needs all this information in order to link a possible injury to your work. And without this link, you aren’t going to get worker’s compensation benefits.
- You must tell your employer. You’re required to notify them within 45 days of the injury. Don’t wait until the last minute, and make sure to put it in writing. If you don’t notify your employer, or don’t do it by the deadline, your claim can be denied. In repetitive trauma cases, the deadline isn’t always clear because the date of injury isn’t clear. A good rule of thumb is to notify your employer as soon as you realize that your injury is related to your job.
- If your doctor gives you specific instructions on what you can and can’t do at work – called work restrictions – follow them closely. You can hurt your case if you go against your doctor’s recommendations. You can even lose your claim altogether.
If your work injury leads to a secondary injury – infection after surgery, for example – it should be covered by workers’ compensation. If you hadn’t received the initial injury, you wouldn’t have the related injuries, so Illinois law allows the worker to receive benefits for both.
The range of secondary injuries is broad: bad reactions to medication, injury to another body party during physical therapy, hurting your arm from having to use crutches, contracting an infection or other illness during a hospital stay, surgical errors, etc.
Initially, you shouldn’t be surprised if the insurance company denies responsibility for your secondary injury or condition. It’s going to cost them more money, so it’s in their best interest to say it’s not covered. Don’t take their word for it. The law in Illinois says that anything arising from your work injury also should be covered. In our experience, this ends up happening, but sometimes you have to fight for it.
If your employer suggests using your group health insurance for a secondary injury, or the insurance adjuster suggests using Medicare, check with a workers’ comp attorney before following their advice.
Working around warehouses or storerooms where boxes are stacked, you know there’s always that chance that something will fall. If a heavy box lands on your foot, you may develop a Lisfranc joint injury. That’s the bony area on the top of your foot. When you injure the Lisfranc, you can have a sprain, fracture, or dislocation.
In addition to dropping something on the top of your foot, you can also have a Lisfranc injury from a car accident, or a running or twisting incident. The result can be very painful, causing your foot to swell or bruise. In more serious cases, you can have difficulty bearing weight on your foot.
If you suspect you may have a Lisfranc injury, you’ll want to get to an orthopedic specialist for a proper diagnosis. This can be critical for two reasons. First, it’s an injury that is often hard to diagnose. It may not be apparent from a typical x-ray, and a further scan may be ordered. Second, these injuries can lead to further complications like arthritis. Treating it early and properly can be a big help to your overall recovery.
For a more minor injury, rest and pain medications may be enough. You may need to wear a cast and avoid putting weight on your foot. Exercises could be used later to help rebuild strength and motion in your foot. Sometimes, in more severe cases, surgery is needed. Following your doctor’s treatment recommendations can help to avoid a prolonged recovery time or developing arthritis.
During this healing time, you should be entitled to Illinois workers’ compensation benefits to reimburse your medical expenses, and to recover lost wages. We recommend lawyers with Lisfranc experience who understands the complicated medical issues involved. Please contact us if you have any questions or would like to find out what you may be able to recover for your injury.
If you work at a job that involves frequent bending of you wrist or grasping with your hands, you may be at risk for developing carpal tunnel syndrome (CTS). This is an injury to the nerve that goes from your forearm to your hand.
CTS causes pain, numbness, or discomfort in your wrist, and can even travel up your arm to your shoulder. You may experience loss of control of your hand, and have trouble handling objects.
More than eight million people are affected by CTS across the country. And since it’s most frequently caused by the stress of repetitive movements on the job, workers are turning to the workers’ compensation system in large numbers to recover what they’ve lost because of the injury. In addition to repetitive motions, CTS symptoms can also be triggered by a single trauma to the hand or neck.
If you experience pain or numbness in your hand, arm, or shoulders; or if you’re having difficulty grasping objects, you should see a doctor that’s very knowledgeable about CTS. Sometimes even the tests that are run to diagnose CTS can be wrong, and miss a case. So it’s important that your doctor is experienced in seeing the signs and is able to properly diagnose and treat your CTS.
Treatment is focused on reducing the swelling and relieving the nerve pressure. Catching the condition in its earliest stages can be very helpful in treating it more easily and quickly, and without surgery. If it has not gotten too severe, your doctor may prescribe a splint, and/or anti-inflammatory medications to help reduce swelling and relieve pressure. More severe cases can require cortisone injections or surgery. The surgery is fairly common and not too invasive.
Regardless of the treatment plan, if your CTS is related to your work activity, workers’ compensation benefits should reimburse you for your medical costs, including co-payments and out of pocket expenses. You should also be able to recover lost wages for the missed work time your treatment requires.
Hiring a lawyer who is highly experienced in workers’ compensation law and in particular hand and wrist injuries, will help you be sure that you are getting the maximum benefits that are allowed under Illinois law for your injury. If you would like to find out more about what may be due for your injury, or have any questions, please contact us. Our lawyers are highly experienced in this area and would be happy to help you.
In some states, injured workers don’t get to choose their doctor. The employer – and the employer’s insurance company – gets to pick. Illinois law, on the other hand, leaves the choice up to the injured worker, for the most part.
If your employer tells you who you must see, you do not have to agree. In fact, it’s usually in your best interest to see your regular doctor, whom you already know and trust, rather than a physician chosen by the insurance company. Your priority is your health and recovery. The insurer’s priority is quite different.
Although Illinois law allows the worker considerable choice, there are limits. The law says that an injured worker can choose two doctors. If they decide to see a third after that, it must be approved by the employer, or it won’t be covered. The two-doctor rule does not include referrals. You basically get two chains of doctors – each chain being the doctor you choose and anyone they refer you to. Seeing a doctor for emergency care shouldn’t count as one of the two.
Another thing to keep in mind about medical benefits and treatment in Illinois is that anything related to your injury should be covered 100%. There should be no co-pays or out of pocket costs.
The insurance company may assign you a nurse case manager. This person is not in charge of your medical treatment. They should not attend your doctor appointments – and you should refuse if they ask. And they don’t get to talk to your doctor about anything except requesting medical records.
If you are injured at work, and you notify your employer (which you should always do as soon as possible), your employer is supposed to file a Form 45. This form, called Employer’s First Report of Injury, requires them to list the details of what happened when you got hurt.
It’s not uncommon for an employer to fail to do this, especially in a small company. Some employers don’t care, or they aren’t aware of the form in the first place. In other cases, the employer doesn’t want an official record of your injury because they’re hoping to avoid a claim. Illinois law says that an injured employee must notify their employer within 45 days after a work injury. When an employer files a Form 45, it shows that they had notice. If they don’t file this form, they could later try to say that you didn’t give them proper notice and that your claim should be denied because of it.
The best thing to do is make your own record of the notice. Send an e-mail, or write a letter (keeping a copy), that has the date and a brief explanation of what happened. It doesn’t have to be overly formal, and it doesn’t have to be on an official form. Just make sure you give the notice and make a record of it somehow. If your employer later tries to argue that you didn’t tell them within the deadline, you’ll have proof that you did.
Some injured workers think their injury is too minor to require taking any action. Some people are embarrassed, or afraid of being fired if they make a big deal out of it. Notifying your employer is a small task, it can be done with a quick e-mail, and it could save your claim if you end up having one. Try to think long term.
For carpal tunnel claims after June 28, 2011 and all other injuries from September 1st on, new laws are in place for workers’ compensation claims. One of the new rules is that the AMA settlement guidelines, which screw workers, have to be considered as part of the settlement process. It’s not the only factor or the main factor, but some attorneys have been worried about how this will effect the value of claims for their clients.
We don’t really know the answer, but according to a national insurance company organization, the NCCI, the value of cases in Illinois should not go down much, if any. They recently produced a memo on the topic. Here is a summary from the Chamber of Commerce.
The NCCI has provided its analysis of savings on HB 1698, the legislation signed into law by Gov. Quinn on June 28th. Their analysis found an average overall system savings of 8.8% or approximately $264 million annually.
Medical Fee Schedule (8.2) (effective September 1, 2011)
Wage Differential Benefits (effective September 1, 2011)
Permanent Partial Disability (PPD) Benefits for Carpal Tunnel Syndrome claims (8e) (effective June 28, 2011)
Overall Impact on Illinois WC System Costs
As you can see, while they expect payments to doctors per case to go down by a bunch, they do not expect the permanent partial disability payments to be dropped very much and it’s our contention that they should hardly drop at all as well, if any.
Again, we’ll find out for sure soon enough, but considering that insurance companies aren’t expecting a big drop behind closed doors, I don’t know how they make a different argument to the Illinois Workers’ Compensation Commission. But of course, that has never stopped them before.
Many jobs involve exposure to fumes in the workplace that can make you sick, and can even cause an injury or damage to your health. You can have a claim for workers’ compensation benefits for your injuries caused by these fumes in many cases. Even where the exposure is not typically the kind that you would expect would harm you, you may still be able to recover benefits.
Not all fumes affect workers the same way. Sometimes co-workers are not bothered, but you may be more sensitive and experience health problems from the fumes. Or perhaps you have another, unrelated health condition which makes you more susceptible to the fumes causing you harm. Either way, your entitlement to workers’ compensation benefits in most cases should not be affected.
For one Illinois worker who was a smoker and a diabetic, inhaling fumes at work was found to be a cause of his severe pneumonia. Even though the smoking and diabetes had lowered his ability to fight infection and made him more susceptible to getting pneumonia, the result was still the same. The fumes at work made the health condition a work-place illness.
The reason for this is that the Illinois workers’ compensation system deals with the injured worker as a whole: preexisting conditions and all. A worker with a health condition that is made worse by inhaling fumes at work isn’t penalized just because of the prior condition. Likewise for the worker that is particularly sensitive to the fumes. If the workplace is a cause of the health condition, then benefits should be available.
There are some limitations to this rule though. For it to be a workplace injury, the exposure that you’ve had needs to be related enough to your job that someone in the general public wouldn’t experience the same thing. Even if the fumes in fact caused your health problem, if they weren’t different than someone who did not have you job duties would experience, then benefits may not be available.
For example, a worker had a reaction to fumes while involved in a remodeling project. But the same reaction occurred by that same worker outside of the workplace as well. So it was fair to conclude that there was nothing special about the workplace that caused the condition.
Also, recently in Illinois, a worker was denied benefits when she claimed that workplace fumes made her preexisting condition worse. The fumes, though, were determined to be from ordinary products that anyone outside this work environment could also be exposed to. This particular worker had an unusual reaction. But it was not a workplace condition, because the worker wasn’t exposed to something that was unique to her job.
When you’re hurt by fumes in the workplace, you can still get compensation for your health problems if your preexisting condition made it more likely for you to be affected than another worker. But if you reacted in a severe way to an ordinary and common exposure that was not unique to your workplace, you may not be able to recover benefits.
You’ve had an injury at work, and you’re trying to heal. But a painful condition can add injury to injury and complicate your recovery. This syndrome—Reflex Sympathetic Dystrophy is also known as “Complex Regional Pain Syndrome” (CRPS). It’s a chronic neurological condition, where the nervous system has abnormal functioning after an injury.
While you’re trying to recover from your injury, if it doesn’t seem to be healing properly, you should notify your doctor. This is especially the case, if you have severe burning pain, changes to your bone or skin, excessive sweating, swelling, or extreme sensitivity to the touch. You may be experiencing CPRS, and early detection and treatment can be critical for combating the condition.
Your doctor will examine you and take a detailed medical history. If you have an injury that isn’t healing normally, and a lot of pain, it is likely to be diagnosed as CRPS if you also have swelling, movement disorders, abnormal nervous system functioning, or changes in tissue growth. There is no specific test for CRPS, but your doctor may ask for additional bone scans or x-rays to help in the diagnosis.
Unfortunately, there is no cure for CPRS, but treatment is still important, because it can help to reduce the pain and prevent future complications. The most likely treatment options are:
· • Medication: There are many different types of medications, depending on what kind of pain you have, such as cramping pain, shooting pain, constant pain, etc. Also, whether the pain affects your sleep or is related to a recent injury will relevant.
Your doctor may use several medications at once, or may try some in a sequence to achieve the best result.
· • Physical Therapy: Various types of therapy programs may help relieve the pain. Your doctor may recommend physical therapy, hydrotherapy, massage therapy, or pressure techniques. Physical therapists are also excellent sources for working with you on strategies for using the injured body part in different ways that would be less painful.
· • Sympathetic Nerve Blocks: Often chronic pain such as CRPS is caused by the sympathetic nerves that are not properly regulating the blood flow, sweating and other functions. If those nerves are blocked, pain may be relieved.
· • Surgical Sympathectomy: When the blocks don’t relieve the pain, this surgery may help in cases where the pain is being caused by the sympathetic nerve functioning. During the procedure, a permanent block is inserted. This is a fairly drastic option of last resort, because there are complications that could occur
From a legal standpoint, not every attorney understands these injuries or has experience with them. We certainly do as does every attorney we work with. If you have questions or need help finding a lawyer please contact us.
Just got notes from a seminar on the changes to Illinois workers' compensation laws that happened in June. We have all been operating on the assumption that these laws don't go in to effect until September 1st. That's true for most cases except for carpal tunnel claims.
For carpal tunnel, as of June 28th the new laws apply when it comes to your settlement. So the most you can get for an injury after that date is 15% loss of use of your hand or 30% if you have permanent restrictions. The payment is also based off of 190 weeks of disability instead of 215 weeks as was the law before.
We just signed up a new carpal tunnel case the other day that will have a July accident date so these new rules will apply. It remains to be seen how Illinois insurance companies are going to play this out, but it is our position at this time that cases where surgery is performed should be worth 15% loss of the hand if a full recovery is made.
You can bet that insurance companies will try to low ball claimants. Not everyone needs an attorney, but if you want full value for your case, we think the only way to get it will be with a lawyer who is threatening trial if the insurance company doesn't do the right thing.
Stay tuned. We will provide more comments on the law as it develops.
It’s not just the sudden accident at work that can cause a workplace injury. Many workers in Illinois are able to recover workers’ compensation benefits related to repetitive work injuries. These types of injuries develop over time as a result of constant twisting, flexing, bending, etc. while performing job duties.
According to a published report, one Illinois worker recently found out that it’s not enough to simply list your job duties, and hope that it will be understood what the duties entailed, and how they caused your injury. When proving a work-related repetitive trauma, the specifics are key.
In that case the Workers’ Compensation Commission said that the worker just listed off her job duties, including typing, filing, and using and filling the copy machine. What were missing, were specific details about the motions she performed, including the body parts affected and the amount of time she did each movement in a day or week.
Illinois courts have cautioned that it’s not necessary to present proof of each separate movement with exact numbers and quantity of pressure involved. But you do need to be able to show that your injury was related to your job duties particularly, and not just the ordinary wear and tear our bodies go through anyway.
The cases where repetitive trauma was found to be work-related generally contain a solid level of detail. They show what the tasks were, and that the movements were performed on a daily basis for a significant period of time. Medical records should show that there is evidence that your injury was caused or made worse by the repetitive hand, arm, or other body movements in performing your job.
For example, a treating physician can testify that you suffered trauma from: consistently pushing and pulling with your upper body; consistently manipulating objects with your fingers; consistently grasping and twisting with your hands; and other such movements throughout the course of your workday.
While specific mathematical proof may not be necessary to establish this kind of a workers’ compensation claim, a specific detailed showing of your work activities and their medical result may in fact be key.
The Illinois workers’ compensation system protects employees from being fired because they are filing claims for benefits.The law is clear, that in order to protect workers’ rights to receive workers’ compensation benefits, employers are not allowed to fire an employee for exercising his or her rights. This is considered a "retaliatory discharge."
But proving that you were fired because of the workers’ compensation claim is not as easy as it may seem. It is not enough to merely argue that you filed a claim, and then you were fired. If it was that simple, then filing a claim for benefits would always give you complete job security, because your employer could never terminate you.
Instead, the responsibility rests with the worker to show that the firing was connected to the workers’ compensation claim. If your employer has a valid reason to fire you, and it’s not just to cover up for firing you because of your claim for benefits, then you have not met your burden to prove a retaliatory discharge.
Often these situations arise where an injured worker doesn’t return to work after a period of recovery. If your treating physician continues your restriction from working, but an Independent Medical Exam (IME) physician hired by the insurance company gives the opinion that you should be able to return to work, then what?
If there is a disagreement among physicians as to whether you are able to return to work, you are allowed to rely on your treating physician’s opinion, and not go back to your job at that time. If your employer fires you solely based on relying on the IME opinion, when it’s known that you have a different opinion from your doctor, this could be considered a retaliatory discharge.
The Illinois workers’ compensation system has a process for resolving those issues. If you can’t agree, you take it to the Illinois Workers’ Compensation Commission to make a ruling. But your employer cannot just decide that the IME is correct, and rely solely on that opinion to fire you for not returning to work, when you have an opposing medical opinion.
Sometimes, though, these situations can get even trickier to prove. In some recent Illinois cases where a worker was fired when there were conflicting IME and treating physician opinions, the argument for retaliatory discharge was rejected anyway. In each case, the court found a valid reason for the firing, separate and apart from the IME opinion.
Even in a case like this, where you could argue that your employer relied on a different IME opinion and fired you for not returning to work, you still have to show that there wasn’t some other valid reason you were fired. For example, in one case, the employer had attempted to contact the worker to return to work, even after the workers’ compensation claim was filed. This showed that there wasn’t necessarily a motive to retaliate for the claim.
The right to file a claim for workers’ compensation benefits is secure from any backlash for exercising that right. But employers remain able to decide to fire an employee for a legitimate reason, even after a claim for benefits is filed.
Back injuries are very common among workers, whether or not they are in a physically demanding job. There are many causes of back injuries, and they range from sudden, single events to long-term degeneration. Regardless of the way it developed, if your work activity caused your back injury or if it worsened a pre-existing condition, Illinois workers’ compensation benefits should be available to you.
Back and spinal issues can come from obvious activities like heavy lifting, car accidents, or other traumatic events. They can also come from degenerative conditions which are affected by injuries, aging, and other health issues. Regardless, a back or spinal injury can leave you in a lot of pain, and unable to do your job.
One of the common spinal injuries is a herniated disc. This happens when the hardened outside layer of the disc tears, and the soft inside pushes out. If this happens to you, you’ll likely notice pain, weakness, and numbness in places such as your lower back, legs, and feet. The pain may feel like shooting pain down your leg.
If you notice these symptoms, or you have an injury to your back and the pain isn’t going away after a few days, then it’s time to see a doctor that is very experienced in diagnosing and treating back injuries. You don’t want to just dismiss it as something that will pass. A medical doctor such as a neurosurgeon or orthopedic surgeon would be best. They are better equipped than a chiropractor to diagnose and treat your injury. Their opinions are also generally given more weight by the Workers’ Compensation Commission.
When you see your doctor for your injury or pain, you will likely be asked many questions about your medical history and the recent events that caused your injury. Giving your doctor a complete and accurate picture of what happened, and doing it as close in time to your first symptoms as possible, can help your odds in treating your injury, and can also help you to prove that your injury was caused by or aggravated by your work activities.
Treatment for back and spinal injuries often begins with pain medications and physical therapy. The two can work well together. Physical therapy helps to strengthen your back over time to be able to hopefully return to full strength and full function. Pain medications can help you tolerate the process of healing and strengthening.
If that treatment doesn’t work, surgery may be necessary. There are different kinds of surgeries that can be recommended, depending on your specific injury. Some surgeries are more invasive than others.
Back injuries can be very painful, and very debilitating. You don’t want take an injury like this lightly, and put off seeing a doctor. That can only lead to complications in treatment, and possibly in proving your case for workers’ compensation benefits. You should be able to recover your medical bills and lost time from work, if your injury was related to your job. If you have any questions about a back injury, please contact us. Our attorneys are very experienced in workers’ compensation benefits for these injuries.