When The IME Doctor Disagrees With Your Doctor

By Mike Helfand on Posted in Tips if Injured

Under Section 12 of the Illinois Workers’ Compensation Act, your employer has a right to send you to an independent medical examination which is known as an IME. This is a one time medical exam by a doctor of their (usually the insurance company) choosing. You have to go to this exam. If you don’t you could automatically lose your right to any work comp benefits.

This doctor isn’t your doctor. They aren’t looking out for you. They don’t owe you confidentiality or even a duty of care. They are paid to examine you and write a report. Often these “exams” last less than five minutes, they review your medical records and offer an opinion. Many of them are hired guns who make hundreds of thousands of dollars doing these exams or even millions. There are some doctors who dedicate one day a week to doing nothing but IME’s. It’s a cash cow for them.

Because it’s a cash cow, don’t be surprised if their report is a bunch of bullshit and they disagree with what your doctor has to say about your injury. They might say you are fine when your doctor thinks you need surgery. They might say your injuries aren’t work related. They may say you can work full duty when your doctor has you on lifting restrictions. They can and will say anything even if it puts your health at risk.

Some people worship money and can sleep at night without thinking about the people they are harming. I couldn’t do that and I think you need to be a little bit psychopathic to know that what you are writing about someone’s health or case is nonsense.

It of course can be really frustrating for an injured worker when the IME disagrees with your doctor. It can mean all of your benefits are cut off and you can’t get the medical care you need, at least not right away. It can also seem insane that they can derail your care in a five minute exam when you’ve treated for hours with a treating doctor who knows you and your injury really well.

So what do you do if/when this happens?

First off, this is why we always advise injured workers to have a case officially on file ASAP. It will allow us to prepare you for the IME and with some doctors, anticipate how to respond. After that, we will get the deposition of your doctor and the IME hack, err doctor, scheduled ASAP. Following that will be a 19(b) petition for immediate hearing which will get your case before an Arbitrator.

At that time you will testify and then an Arbitrator will make their ruling. But before that even happens, we can also do a pre-trial with the Arbitrator and each side can state what they expect the evidence to show. Sometimes the IME report is so ridiculous or the doctor has such a bad reputation that the Arbitrator will make clear to the defense attorney that they will lose if this goes to trial. Other times we can get settlement advances to put some money in your pocket while we are getting the trial ready.

And when the IME is truly indefensible, we can also file a motion for penalties and fees which will punish the insurance company for their bad behavior and unreasonable denial of benefits.

In other words, an IME can hurt your case and in some cases cause you to lose if you don’t have a credible doctor in your corner. But it’s also a common thing that good, aggressive lawyers know how to overcome. So don’t freak out if that doctor disagrees with your doctor, even if it makes no sense at all. The fact that it doesn’t make sense is probably why you will win in the end.

Hurt At Work In Illinois But You Have No Insurance

By Mike Helfand on Posted in Benefits

The best thing about Illinois workers comp law, in my opinion, is that you don’t need to have insurance in order to get medical care. If your employer has work comp insurance, that insurance is essentially your health care for any work related injury. Better yet, it pays for everything. Meaning 100%. Meaning no co-pays or out of pocket costs to you.

As long as the care is reasonable (e.g. not experimental) and related to your accident, it should be covered. That means if you tear your ACL, they should pay for your knee surgery at a doctor of your choosing. And if after surgery using crutches causes an elbow injury, they should pay for that too. It’s all reasonable and related. But if you are pregnant or have cancer or slam your hand in your car door, that treatment is on you.

It’s really the best part of the Illinois Workers’ Compensation Act, but unfortunately not everyone knows about it. Your employer is supposed to post signs that advise you of your rights under Illinois law. Those signs make clear that you don’t need medical insurance. Unfortunately some employers break the law and don’t post these signs and others do, but not in an obvious place. And some workers don’t read them which can happen especially if you work in the field versus the same place every day.

As a result, I get a lot of phone calls from injured workers who were hurt on the job, but delay getting medical care because they have no way to pay for it since they have no insurance.

Some delay by a few days before learning the law. That’s not a huge worry for the case as once they learn the law they get into a doctor right away. Others will self medicate for weeks or months because they don’t want to get a big medical bill. Unfortunately often when they do learn the actual law it’s either too late or has at least created a big issue in their case. The longer you go without seeing a doctor, the harder it is to prove your problem is related to a work accident.

If it’s a repetitive trauma situation like a back injury from continuous heavy lifting, the delay might not matter a ton. On the other hand, if you were physically attacked or hit by a forklift or have some other one time accident, the longer you go without seeing a doctor, the harder it is to prove there’s actually a work related injury. There’s no specific delay that bars you from having a case, but generally speaking more than a month will create a problem.

I encourage everyone to make sure that there co-workers are aware of this law. Even some union members we meet and help aren’t aware of it which is a bit shocking to me. Not having health insurance doesn’t mean a thing when it comes to work related injuries. Get to the doctor and know that if you have a legitimate case your company’s insurance will have to cover all of it.

Illinois Work Comp Laws Are Great, Why You Should Care

By Mike Helfand on Posted in Benefits

My son had a great English teacher who made everyone in the class do a presentation on various topics once a month. It helped him be comfortable with public speaking and made him a good writer as well. There was only one guiding principle in doing these presentations. You had to answer the question, “Why should I care?”

I love that concept. It’s something I try to remember in my daily life. Often it gets me to not say anything because I think to myself that nobody would care.

When it comes to Illinois workers’ compensation law, you definitely should care. Illinois has the best laws in the country for workers who get hurt on the job. There are a lot of politicians and others who are trying to gut those laws. It’s incredibly important that that doesn’t happen.

As we all know, life is really expensive these days. If you get hurt at work and don’t have the protections of the Illinois Workers’ Compensation Act, you could quickly be homeless or bankrupt. States like Indiana, Kansas, Texas and others limit what you can get from a work related injury and make it very difficult to find a lawyer to help you if your benefits are disputed. And there are either caps or low benefit amounts in many states where the rights and needs of workers aren’t considered.

People that don’t care don’t envision themselves getting hurt on the job or needing work comp benefits. It’s obvious a heavy duty laborer, truck driver or factory worker should care about these laws. Those jobs are high risk and have injuries all of the time. But why should a low risk job like teacher, business person or bank teller, you might not think this will ever effect you.

Aside from the fact you should have empathy for others, I can tell you that we have helped thousands of teachers, bank tellers, business people and others who are in seemingly “low risk” jobs. Any job can and does lead to an injury. Stuff happens that is often beyond your control. Bank tellers get robbed at gun point or have a cabinet fall on them. Teachers slip on wet floors or fall while breaking up a student fight. Business people get into car accidents while traveling or fall in the hotel shower.

I remember a call from a supervisor at a big Chicago area warehouse who told me that he used to hate his workers who filed for work comp, but now that he was hurt, he got it. His benefits were denied for about six weeks. During that time he was in tremendous pain and ended up being late on a mortgage payment because he didn’t have any money coming in.

Beyond the financial reasons you should care, if you are injured while working, without work comp benefits you could be facing tens of thousands of dollars in out of pocket expenses even with great insurance. But with work comp on your side, 100% of your bills are paid for and you don’t have to worry about a medical provider being in network. In other words, you don’t get punished because you were injured in a way that benefited your job. In fact, these great laws give you the best chance possible at getting all of the treatment you need and a full recovery.

Beyond all of this, if your injury is so serious that you need to change careers and suffer a wage loss, Illinois work comp laws account for that. You could be making $125,000 today, but find yourself two years from now only able to make $30,000. You don’t lose out in that situation. Even if you have no income change, you can also get compensated for how the injury will affect you later on in life.

The bottom line is that a work related injury could be life altering to you, someone you care about or a fellow human being. Someone who is legitimately hurt at work shouldn’t be made to suffer or have their life turned upside down. The Illinois Workers’ Compensation Act helps prevent that and gives workers remedies to fix it. It’s important and we all should be glad that it’s this way and not like states where injured workers get cast aside with welfare as their best resource.

Can You Get Work Comp If You Work From Home?

By Mike Helfand on Posted in Do I Have a Case?

One of the big work changes that has happened since Covid is the common concept of remote working. It’s still crazy to me when I’m in the Loop how less crowded the trains are and how less crowded it is to walk around. That said, I often work from home and get the appeal behind it for many workers.

I’m actually working from home as I write this blog and before I did this, I took two phone calls, but also went to my kitchen to grab a banana. I also loaded some dishes from last night’s dinner into my dishwasher. In other words, I’m doing my job, but also doing other things that aren’t necessarily a part of my job.

When I’m in my Loop office in downtown Chicago, I mostly meet with people, talk on the phone, review emails, etc. But I also go into the office kitchen and grab a banana, cereal or some water just like I do at home. If I see a mess, I will clean it up. Those also aren’t part of my core job functions, but not unusual things to happen at work.

So if I slipped on a wet floor at home and got hurt or at the main office and got hurt, what’s the difference? Not much really, at least as it comes to Illinois workers’ compensation law.

And more so, if you type all day at home for your job and get carpal tunnel, that would be a work related injury. If you lift a box at home as part of your job and injure your back, that would be a work related injury.

Generally speaking, your home office isn’t different than your actual office where you would have worked in 2019 before remote working was a common thing. Working from home doesn’t take away any of your rights under the Illinois Workers’ Compensation Act. Like any other claim, whether or not you have a case is fact specific. If your employer is benefiting from your activities and you get injured, it should be a work related injury and a workers comp case. That means you should get all of your medical bills paid for, compensated for any time where you can’t work and eventually get a settlement for the permanent nature of your injuries.

Of course insurance companies don’t like to make things easy or always follow the law. In my experience, if you do claim to be hurt while working from home, they will delay or deny your case even without good cause. It’s likely because there are no witnesses in these situations and people have trouble conceptualizing getting hurt at home being part of the job.

This is one of those “don’t overthink it” situations. You as the injured worker need to report the injury/accident to your employer, get medical care (and relate to the doctor how you were injured) and focus on your health.

I explained all of this to a worker the other day. He had tripped on his carpet while walking to the bathroom before a conference call. He was told that because it was his carpet that there was no case. The truth is that is not correct. The employer benefits from you going to the bathroom and it’s expected that you would do that during your work day. The fact that you own the carpet is irrelevant. That’s the work environment they put you in. They don’t get a break because it was beyond their control.

Bottom line is that most injuries during the work day at home will be an Illinois work comp case. Call us any time for help anywhere in Illinois at 312-346-5578 if you have questions about a case or want to discuss representation.

My Employer Went Out Of Business. Can I Still File For Workers’ Comp?

By Mike Helfand on Posted in Do I Have a Case?

All things considered, the economy is doing really well in America. But of course that doesn’t mean that every business is successful. Some go under because they are poorly run. Some go under because they are no longer relevant or weren’t a great idea to begin with. Others it’s because they were part of a trend that is no longer around (hello cupcake stores). It could be because they aren’t making enough money.

Whatever the reason, when it comes to Illinois workers’ compensation law, a recent caller wanted to know if he could still file a case even though his employer shut their doors. He worked for a restaurant that ended things with no notice to anyone. About a month prior to that happening, he had slipped on a wet floor and tore a muscle in his shoulder trying to catch himself on the fall. He was still able to work up until the day they let everyone go.

The answer is that your employer going out of business has no affect on you being able to file for workers comp benefits. You still have to do everything to prove a case such as report an accident within 45 days of it happening, get medical treatment, etc., but them being open or closed isn’t really an issue.

In fact, sometimes them going out of business can help you get benefits. In this case, the worker had restrictions of no lifting with his injured arm more than ten pounds. He was in a managerial role so he could do that job still. Now that no job is available, he is entitled to weekly TTD benefits until he no longer has his restrictions.

But how can he get paid if they are out of business? That’s because even though the claim is against them, payment is made by their insurance company and that insurance is based on your accident date, not the date that they close up their business.

For lawyers, sometimes when your employer goes under it actually makes our job easier. The insurance company loses leverage in saying a light duty job is available for you with the employer because there no longer is an employer. The insurance company also loses the ability to investigate some claims because tracking down witnesses becomes much harder for them. And even if they can find someone, those people might not volunteer to testify which means they’d have to be subpoenaed to do so. And it also means that the defense attorney can’t prepare them and don’t know what they will say. So it ends up often being your word versus nobody.

Beyond that, losing your job can make the case worth a lot more money. We also see that insurance companies are motivated to settle because it’s their goal to close out all of the claims related to a customer they no longer have. They might pay more than a case is worth just to get it done. They also don’t worry about you going back to work and getting re-injured since you are no longer with the employer they insured.

Bottom line is that unless your employer committed a felony and didn’t have insurance, them going under is nothing to worry about for most Illinois work comp cases. And in many of those claims it actually makes your case stronger. As long as you are honest and can prove your case, you’ll likely end up with more money in the long run.

Is any of this confusing? It can be. If you have any questions, please call us at 312-346-5578 to speak with a lawyer for free.

Murder And Illinois Workers’ Compensation Law

By Mike Helfand on Posted in Injuries

This is a grim post, but the reality is that murders do happen in the workplace. In fact, according to a CNN article, between 2018 and 2023 there were over 2,700 murders in the workplace in the US. Many of those of course took place in Illinois. Just a month ago, a man was sentenced for killing a DCFS worker.

This post is being written for the family members of those who are killed on the job. We try to be a resource for every Illinois work comp issue there is. Murder is one of them. This post is being written solely from the perspective of how you can access IL work comp benefits if this tragedy happens.

There are a few things to know about work comp after a murder. The first thing an attorney would look at is, was the murder a risk of the job or work related? Just being at work doesn’t make it a case. You have to show something about the job contributed to it happening.

For example, if you work at a store and are killed in a robbery because you didn’t respond to demands fast enough or the scumbag just decided to shoot someone, that would be a case. A DCFS worker killed by an angry client would be a case. If your co-worker shoots you because they don’t feel you are doing a good job, that would be a case.

On the other hand, if your co-worker shoots you because you hit on his girlfriend, that wouldn’t likely be a work comp case even if it happened at work. If you work on Michigan Avenue and there’s a shooting on the street and a stray bullet makes its way into the store, that probably wouldn’t be a case. On the other hand, if you worked in a dangerous neighborhood it might be. That’s because the job location increased the risk of something bad happening.

Assuming you can prove the death was related to work, then comes the benefits that you get under the Illinois workers’ compensation Act. Even if the worker wasn’t married and had no kids, the employer (or more realistically their insurance company) would have to pay the medical bills for any treatment. They’d also have to pay for the funeral, up to $8,000. So if the funeral cost $10,000, the family would be on the hook for $2,000. This is a benefit that will hopefully increase at some point.

The biggest benefit is the survivors benefit. A surviving spouse would receive 2/3 of the average weekly wage of the person who was killed, tax free. The minimum rate is currently $715.42 and the maximum rate is $1,907.79. You’d receive that amount every week for 25 years. This is subject to cost of living increases. Note that these rates increase every six months. Note that if a widow remarries, the benefits will get cut off after an additional two years or payments.

If there is no widow, but there are children, they receive these benefits until the age of 18. If that dependent child is enrolled in school, the benefits can continue until they reach the age of 25. If a child is otherwise dependent because they are mentally or physically handicapped, the benefits shall continue as long as the child is incapacitated. Even if a child doesn’t continue with school, they are guaranteed a minimum of six years of payments.

If there’s no child or spouse, but the killed worker supported their parents, they can make a claim for benefits too. Their payment shall be based on the proportion of their income that was dependent on the child. Those cases are always hotly debated and require someone that understands accounting. It also requires a lot of records to show how money was given and used. The same formula can be used for adult children that were still financially dependent on a parent. This can even extend to grandparents or grandchildren for up to five years.

Whether or not you need a lawyer in these tragic cases comes down to if there is a dispute or not. These benefits should be paid immediately and without delay. Sometimes insurance companies just don’t pay or say they are investigating. Other times they pay at the wrong rate or make you jump through a lot of unnecessary hoops.

My strong advice is to consult with an attorney to see what your right are and if a lawyer is needed. It’s free and they won’t take any of the benefits if things are being paid properly. In fact, State law limits attorney fees in these cases to $100 if there is no dispute. If there is a legitimate dispute or delay, attorney fees are capped at 20% of 364 weeks of benefits. Basically a lawyer would get every fifth check for seven years and after that 100% would go to the survivors.

If you have questions about any of this and want to talk to a compassionate and experienced lawyer, call us any time at 312-346-5578.

Are You Standing All Day At Work Or Is There More To It?

By Mike Helfand on Posted in Injuries

While I think Illinois work comp law is great for injured workers, not every injury is a case. I don’t agree with all of the laws and case rulings that have come down. One area where that is true has to do with the act of standing.

We get contacted by a lot of bank tellers, cashiers, teachers and others who are on their feet for all or most of the day. Generally speaking, if the act of standing injures your feet or legs, it’s not a compensable work comp case in Illinois. There are some exceptions such as if you are working on uneven ground or have to wear special footwear like high heels or steel toed boots.

We don’t dismiss these cases right away when we get asked about them. That’s because even if your job requires you to stand for a lot of the day, that is not likely all that you do. Take for example a cashier who recently contacted us. She has a knee injury and needs surgery.

She said that her legs are usually in pain after standing for an eight hour shift. But when we asked her what else she does, she told us how she bags groceries, often has to carry them and bends and squats a lot for various duties related to being a cashier.

In my opinion, the job activities beyond just standing are the ones that give her a chance of successfully receiving Illinois work comp benefits. If you are squatting while carrying heavy things or even just bending your knees a bit to pick up a heavy bag, that will put stress on your lower limbs. And if you are a cashier at a busy grocery store like Jewel, Whole Foods, Trader Joes, Mariano’s, etc., you are doing that over 100 times in a day. So it would make sense that your body might break down a bit.

So the moral of the story is that it’s really important to be detailed with your doctor and any lawyer you talk to about a possible case. It’s more so important to be detailed with the doctor. I say that because I think it’s the lawyer’s job to ask you the right questions. If we just hear “I stand all day” and don’t ask any follow up questions that means we aren’t doing a good job. It’s not your job to know what we need to hear or should be asking.

Her case isn’t a slam dunk. We will need to get a statement from an orthopedic doctor that her injuries are caused, aggravated OR accelerated by her job duties beyond just standing. But she should prevail as should anyone else that does more than just stand in comfy shoes all day at work and gets hurt.

A Tip For Southern Illinois Injured Workers

By Mike Helfand on Posted in Tips if Injured

We created a state wide network of Illinois work comp attorneys. Our feeling is that there’s no one best lawyer for every case, but rather each case is unique. If you work for United Airlines, we want to make sure the lawyer you hire has taken on cases against them successfully many times in the past. That’s because there can be unique factors when it comes to cases with them. Same for Jewel, Walmart and many other companies.

In other instances, the location of the case determines who you should hire. For whatever reason, a lot of Chicago work comp attorneys are trying to take on cases in southern Illinois. They can, but I personally don’t think that’s a good idea in most circumstances. A recent chat I had with a great Madison County work comp attorney shows why.

He had taken over a case from a Chicago attorney and it was all screwed up. The reason that is true is that the doctors in the case were heavily favoring the insurance company. Although the accident was in Illinois, the medical care happened in Saint Louis.

Long story short is the injured worker unknowingly went to an orthopedic doctor who regularly handles work comp cases for Missouri insurance companies. As a result he likes to curry favor with them. This lawyer told me that the reputation of this doctor is well known by the local attorneys.

Of course this reputation was not well known by the Chicago lawyers. So they didn’t warn their client against seeing this doctor and now their case is upside down.

This wasn’t just a one off unlucky situation. This attorney tells me there are a lot of Saint Louis doctors who are really tied to insurance companies as they make a lot of money off the MO work comp system. He said that while he doesn’t make his clients see any particular doctor, he does warn them of ones to steer clear of.

This is just one example, but it really shows that you can have a great case and lose due to the dumbest of reasons that aren’t your fault. It’s something an attorney who regularly practices in your area would know. It’s always a good idea to ask your lawyer what they know about your doctor. If the answer is nothing then they should ask around and find out.

The reality is that there are a ton of amazing orthopedic doctors in Saint Louis. You don’t have to avoid all of them. You just need to know which ones to avoid. And that takes someone in the know.

If you’d like our recommendation of a great southern Illinois work comp law firm, call us any time at 312-346-5578.

When Is The Right Time To Get A 2nd Opinion?

By Mike Helfand on Posted in Tips if Injured

I got a call recently from someone who had been seriously injured on the job. He had an attorney and wanted to know if it was OK to get a second opinion. The first thing he said to me was, “I don’t know if this is the right time or not.”

Turns out it was not the right time as he had signed settlement contracts already that had been submitted to the Arbitrator. It’s too bad as it appears that his case was worth at least $75,000 more than he agreed to settle for.

So when is the right time to seek a second opinion from an attorney on an Illinois work comp case?

Every case is different, but the best time is certainly before a settlement offer has been made. Attorney fees in Illinois work injury claims are capped at 20% of the settlement. If you hire a new law firm, the two firms will have to split that 20%. It doesn’t cost you more. But if an offer has been made, the first lawyer is entitled to 20% of that offer and the new lawyer would likely get 20% of any increase they can get.

So if an offer has been made, it makes it harder to take over unless it’s woefully low. Usually what we see is that the offer is low, but a lot of work needs to be done. So we’d end up doing a ton of work and the other attorney would get the majority of the fee. It’s hard to take over a case like that.

If there’s no offer, this issue doesn’t exist. But even then, it’s best that you get a second opinion and switch lawyers (if that’s what you want) sooner versus later. The other day I got a call from someone whose lawyer is doing a terrible job and there isn’t an offer. But we can’t get involved because the case is 12 years old. The old attorney would have a claim to most of the fee.

On the other hand, when we get called by people who realize in the first six months or so that they hired the wrong lawyer, it’s easy to take the case over. There’s one Chicago work comp law firm in particular whose clients tell us the same story all of the time. Namely that they can’t get a call back and the attorney doesn’t seem interested in helping. We’ve been involved in taking over a lot of their cases because most people are smart enough to expect better service.

Of course a second opinion doesn’t always mean talking about getting a new attorney. We will answer questions for free and in confidence, but within reason. One person called me because “my lawyer yells at me whenever I call and I don’t want to bother him.” It felt like a Stockholm Syndrome situation to me as they wouldn’t even consider switching. We won’t do the job for shitty lawyers, but we will honestly tell you if what’s happening in your case seems to make sense or not. A lot of attorneys do a great job with the case, but don’t communicate that to their clients well enough.

If at any time you want to talk to us, call us at 312-346-5578. You will usually immediately speak with a lawyer.

Your Employer Doesn’t Have To Help You Get Workers Comp

By Mike Helfand on Posted in Benefits

I was reading an article about an actress who was injured on a set. She had complaints about how the director treated her and was mad at the production company because “they didn’t help me get workers’ compensation benefits.”

In a moral world, your employer would always do right by you. The reality is that we aren’t in a moral world. Their job isn’t to look out for you. They are typically going to look out for their own best interests and that is legal.

Now they are supposed to post information about what to do if you are injured on a job including who their insurance carrier is. They are also supposed to fill out an accident report if you get hurt at work. The reality is that thousands of employers violate these requirements and nothing happens to them. And it would be ideal if they called the insurance company for you and advocated for you. It would also be great if they helped you get medical care and I don’t mean the company clinic, but an actual good doctor. But those things also rarely happen.

The truth is that it’s up to you to look out for you when you get hurt on the job in Illinois. Quite honestly, it’s the number one reason to get a lawyer. It gives you as close to a guarantee as possible that you won’t get taken advantage of or be punished because you didn’t know certain things like a nurse case manager isn’t allowed to talk to your doctor.

Otherwise, it’s up to you to report an accident. It’s up to you to call their insurance company (or have the lawyer do it for you if you hire one). It’s up to you to know not to give a recorded statement to the insurance adjuster so your words don’t get twisted (also a great reason to have an attorney do the talking for you). It’s on you to seek out medical care with a doctor who will look out for you and is qualified to treat your type of injury.

Hoping that your employer will do right by you is a terrible idea. And it’s especially bad if you work for a large company where they clearly only care about the bottom line or a small one where your employer tries to get you to lie about how you were hurt and “promises” to take care of everything for you.

Illinois workers’ compensation benefits are a right that every employee in the state of Illinois has. They are there to protect you and they really can. But you still have to prove a case. If your plan to prove it is to rely on your boss or company, you are greatly reducing the chances of a good result in the case.

This doesn’t mean you are alone. Our job is to take care of you from the moment you hire a law firm and it’s what any good attorney wants to do. We’d be happy to do that for you and it’s a sign that you are looking out for your own best interests.

LexBlog