Should You Work If The IME Doctor Says You Can?

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One of the best pieces of advice for any injured worker in Illinois (or anywhere really) is to get a good treating doctor and listen to them. Usually with a work injury this means a good orthopedic doctor, but it could also be a neurologist or a pain doctor. You are looking for someone who specializes in the injury you are dealing with.

Unfortunately, what happens a lot in a workers compensation case is that you’ll have a great doctor who knows you well and has spent a lot of time with you. The insurance company will send you to an IME doctor for a one time exam. This is their right under the Illinois Workers’ Compensation Act. That doctor might spend five minutes with you and then write a report which completely contradicts what your doctor is saying.

So you may be faced with a situation where your great doctor says you can only do work with significant restrictions (e.g. 20 pound lifting restriction) and the hired gun insurance company doctor says you can work your normal job.

As a result, you may be faced with a situation where if you don’t put your health at risk, you’ll have no income coming in. How should you handle a situation like this?

As work comp attorneys, we can solve the problem, but it won’t be overnight. In most cases, an Arbitrator is going to favor the opinion of a reputable doctor who knows you well over an IME doctor who briefly saw you. But to get to that point, we will need to take the depositions of both doctors first. That can take a few months. Your lawyer can then file what is called a 19(b) petition for immediate hearing, but even then there’s no guarantee you’ll get to trial right away.

After the trial happens it can be weeks to many months before a decision is rendered. And if you win, the other side can appeal which usually means another year of delays.

Before a trial can happen we can have a pre-trial where we can discuss the evidence with the Arbitrator. They might lean on the insurance company to do the right thing or recommend an advance against any settlement which could put some money in your pocket. They might also do nothing. It depends on who the Arbitrator is and how strong the case facts are.

You can try to return to work based on what the IME says. If you make a good faith effort to do that, but can’t physically tolerate it, technically your TTD benefits are supposed to start again. That doesn’t always happen, but it varies case to case.

If your restrictions are permanent, you can look for a job within those restrictions while your lawyer gets the case ready for trial. If you do this and show that you are suffering a significant wage loss, you could end up receiving wage differential benefits. That would be 2/3 the difference of what you could make in the old job vs. what you can make now.

There is no right answer. It’s something you should discuss with your attorney. Your case facts and life circumstances should dictate your decision. What you shouldn’t do is consider settling until you are working a job comfortably for at least a few months. If you settle and then things get worse, you likely will be on your own at that point.

ACL Surgery Paid For By Work Comp, But Not The Physical Therapy

Here’s an inquiry we received that I thought people might find interesting.

I hurt my knee at work and was eventually diagnosed with a torn anterior cruciate ligament, ACL injury. I had surgery that the workers’ compensation insurance company paid for. I’m half way through my post surgery physical therapy process. I showed up to PT today and the therapist told me that the adjuster said they were no longer going to pay for my sessions. Any idea why and what I can do?

The answer I gave was that I needed to talk to them to learn more, but even before that happened, there were a variety of reasons this could have happened. Here are some of them:

  1. The insurance company got new information that gave them a reasonable belief that the injury wasn’t work related. That could be something like a tipster calling up and saying that you actually hurt yourself when you slipped on ice in your own driveway, not at work. Or it could have been a social media post that indicates you are lying.
  2. They came across medical records that contradict how you got hurt.
  3. An IME or records review doctor stated that additional physical therapy isn’t needed. That would be odd as in most cases PT starts within two weeks of the surgery and is expected to last 4-6 months. That said there are plenty of doctors for hire who would state whatever the insurance company wants.
  4. They don’t think the physical therapy office is legit. Most places are, but there are some doctors who run it out of their office schedule more therapy than is medically necessary or even get caught billing for work that doesn’t take place.
  5. The insurance company is messing with you. They will do this. If they think that you won’t do anything about it or that you’ll just put the treatment through your own insurance, they’ll cut off your benefits to save some money. It’s gross, but it happens a lot.
  6. They made a mistake. Believe it or not, this could have been someone at the PT office calling for treatment approval and somebody mistakenly saying it’s not authorized.

If you watched the most recent season of “True Detective,” Jody Foster’s character frequently says, “You are asking the wrong question.” That’s what’s happening here. The right question is, “How do we solve this problem so the injured worker can get the physical therapy they need and get healthy?”

The first thing a good workers’ compensation attorney would do is pick up the phone and call the insurance adjuster. Many of the possible reasons for this happening can be solved in a five minute phone call by an attorney who knows what they are doing.

If that doesn’t work or as sometimes happens, no adjuster will actually answer the phone, a good attorney would force their hand by filing a petition for immediate hearing. That can get your case in front of an Arbitrator relatively quickly and would force the insurance company to either do the right thing or disclose how they made a decision that defies accepted medical practices.

In other words, this is annoying and frustrating, but we are goal focused people and there is a solution. So it’s important to find out why benefits get cut off in work comp cases, but even more important to figure out how to fix it.

Chiropractors And Illinois Work Comp

My job as an Illinois workers comp attorney and hopefully as a good guy is to tell people the truth. I’m really direct even when I know I’m telling someone something they don’t want to hear.

A great example of this is when talking about chiropractors and treatment for job related injuries in Illinois. Now full disclosure, I’m not a chiropractor fan. The thought of someone grabbing me by the neck and quickly twisting it freaks me out a bit. Plus I’ve heard too many stories of patients having strokes from being adjusted negligently.

I’m not really a fan of any doctors though. I hurt my knee back in the 90’s, explained to the orthopedic doctor that my #1 goal was to return to marathon running and he told me, “Why don’t you just not run any more?” And while I’ve been lucky to not have any major surgeries, the thought of going under also freaks me out.

But when it comes to chiropractors, the truth is that they are not viewed as very credible at the Illinois Workers’ Compensation Commission. This is especially true when you put their opinion about your injury and need for care versus a respected orthopedic doctor.

Part of this is because medical doctors have much more training and their treatment is much more accepted in the medical community. Part of it is because there are a lot of chiropractors who over treat their patients and run up huge bills. Whatever the reason, the blunt and honest answer is that if you get hurt at work in Illinois, if you treat with a chiropractor instead of an orthopedic, it will likely harm your case.

In one case we worked on, but withdrew from, the worker could not find an orthopedic doctor to state his injuries are work related and wanted us to rely on the chiropractor’s opinion. This would be put up against the IME doctor who while they are a hired gun, is an orthopedic. We explained to the client that we did not believe they’d win at trial.

This belief is based on 27 years of experience as well as statements by Arbitrators who have unanimously made clear that most chiropractors aren’t viewed as credible in their court rooms. That might not be fair. That might take away a treatment option you are comfortable with. But again, it’s my job to be 100% honest and not tell you what you want to hear. So even though I think it medically makes much more sense to see an orthopedic doctor in most situations, it also makes way more sense for your claim itself.

The big exception could be if your orthopedic recommends you see a chiropractor as part of your therapy. It almost never happens, but it’s certainly possible.

We don’t ever force clients to certain doctors, but are always happy to give opinions on who would be a good one if we know who you are considering. If you want to discuss that or any part of your case, please contact us any time.

When To Hire An Illinois Work Comp Lawyer? Here’s Why Earlier Is Better

Sometimes I feel I’m in the middle of a Dr. Seuss book when I hear the variety of bogus reasons that an injured Illinois worker has had their case denied. I’m not the best ryhmer, but it could be:

We are looking for more information. We are doing an investigation. We heard a different story. We are just going to ignore ya. We have a doctor who is a hired gun. Wrongly denying your case is lots of fun.

I won’t quit my day job.

In all seriousness, every day I hear from injured Illinois workers who have clearly compensable work comp claims and are getting jerked around by the insurance company. The latest was a guy who has never treated for knee problems until he twisted his knee stepping off a forklift. He needs surgery, but his case was recently denied by an IME doctor who said that his need for surgery is not due to the torn meniscus the MRI shows, but instead due to arthritis which is pre-existing.

It takes a lot of balls to write something so ridiculous, but some IME doctor did it. The problem is that this worker was hurt six months before the IME and got a surgery recommendation four months ago. He never hired a lawyer so he allowed the insurance company to convince him to try ice, rest and therapy even though he was in terrible pain and his orthopedic doctor said that they wouldn’t fix the problem. And then eventually they found their hired gun and cut him off.

The point of all of this is that whether you realize it or not, the insurance company is playing games. They may seem nice (not usually). They may approve your case and seem to be doing everything right. But behind the scenes they are not worried about your health, but instead are trying to make sure that they can limit what they pay on your claim.

In this case, had the injured worker gotten a lawyer sooner, they would have had surgery a while ago. The insurance company likely wouldn’t have even wasted their time on such a non-sensible IME and even if they somehow did, a case would already be on file and the worker could get their day in court much faster.

There were other issues in this case. A nurse case manager was talking to his doctor which is a big no no and is designed to interfere with his medical care. It wouldn’t surprise me if they were doing surveillance on him. They took a recorded statement of him which he didn’t have to agree to. All of these things are issues lawyers would have given him a heads up on and protected him from which is the best thing an attorney can do.

A good lawyer, whether you find it here or elsewhere does just that. They protect you. And as it costs nothing up front and they don’t take a penny of your TTD or medical that is already being paid, it’s honestly a no brainer to hire an attorney as soon as you realize you have a significant injury. It’s not too late when a problem has occurred, but the whole idea is to avoid problems in the first place.

I don’t say this to try and get us more business. I say it because it’s simply the truth. If you want a free, confidential, no commitment consult, call us any time.

Why This Illinois Work Comp Attorney Didn’t File The Case For Two Years

To me, the worst thing a lawyer can do is focus on what’s best for them over what is best for their clients. In almost every case that means they worry about money and how they can get more even if it’s not the best thing for the injured worker. The most common way this happens in Illinois workers comp law is when your attorney insists you see a certain doctor. They do that because the doctor refers them clients and they want to scratch each others backs.

But this terrible behavior happens in other ways. I came across one example recently and man did this attorney screw their seriously injured client over.

In this case, a worker sustained a major back injury in 2022. They were referred to a lawyer who used to represent injured workers at a firm whose focus was on injury cases. That lawyer wasn’t in that job in 2022, but instead had joined a large corporate law firm that focuses on things like representing local governments, commercial litigation and defending insurance companies in major lawsuits.

In other words, the attorney’s practice is no longer focused on helping people, but instead on helping big companies and cities. Those clients would be pissed if they knew that their attorney was handling injury cases, so the lawyer did something awful. Or more accurately they didn’t do anything.

By that I mean that when they were hired in 2022, they didn’t file the case with the Illinois Workers’ Compensation Commission. That’s the first step in every case and important to do. The reason you do it is it assigns you to an Arbitrator which gives you an outlet to solving a problem if one develops. It also moves your case farther along if you need a trial to get a settlement. And it formally notifies the insurance company that you have representation that is looking out for you.

Instead this attorney tried to do this case on the side. They did make calls to the insurance company, but when an IME cut off the medical benefits, they didn’t do anything for many months. That is despicable! It is their job to file the right trial motions in situations like this. Of course you can’t file a trial motion if the case itself hasn’t even been filed.

It’s for this reason I strongly recommend that you Google your lawyer before hiring them and see what they are telling the world about their legal practice. If it doesn’t say work comp is their main focus, you should not hire them. Had this injured worker done so, they would have seen an attorney who mainly deals with securities issues before the SEC and commercial litigation. They might know how to handle a work comp case given their prior experience, but it hasn’t been something they regularly handle for almost four years!

When they got the call to handle this case, the attorney should have either declined or referred this worker to someone else. While fortunately the case is still salvageable, this worker has suffered and had their case delayed for no reason other than their attorney was looking out for themselves. I honestly don’t know how these attorneys live with themselves or justify their actions.

Illinois Work Comp Tip, Don’t Quit Your Job

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Everyone’s work situation is different. Some people work at great places that treat them really well. Other people have employers who are nightmares. And for a lot of people the job is just a job and they don’t feel strongly about it one way or the other.

When you get hurt on the job, you can receive work comp benefits for your time off of work due to the injury. This includes when you have restrictions that your employer can’t accommodate. You get paid until they can accommodate you or your doctor returns you to work.

The exception to this is if you quit your job. When you do so, unless your doctor has you fully authorized off of work, they can usually stop paying your weekly work comp checks. That’s because they can lie and say they would have a job within your restrictions had you not quit.

Now this is often bs. We’ve seen situations where restrictions couldn’t be accommodated, a worker quit, and then miraculously the employer, through the insurance company, said a job would have existed. They know it’s a lie of course, but just saying it is usually enough for them to get away with it. That’s because it’s really hard to prove it’s not now true.

I’ve unfortunately seen a lot of workers lately hurt by this law. People get frustrated with how their employer is treating them or think they might have another opportunity. Or in one case, a worker knew they’d never feel safe returning to their job, so they just quit because they decided they’d never go back. Doing so ended up costing them over $10,000 in lost pay. The better/smarter thing to do would have been to keep the desire to not go back to themselves until they were in a situation where they had to go back such as a full duty release.

And often when you don’t want to go back, you might find that there will never be a job for you. This could be a good thing as it can greatly increase what your work comp settlement is worth. So you can get your goal of not having to go back to the job and get more money out of it in the end.

While some people will ultimately decide to quit even if it lowers the amount of benefits they receive, our #1 piece of advice is don’t do it until you talk it through with an attorney so you can make a fully educated decision that you won’t regret.

Bonus tip. If you do quit, know that isn’t the end of the case. You can still get your medical bills paid and a settlement when you are all better.

CCMSI Won’t Tell Me If My Claim Is Covered!

Here’s a comment I got from a chatter recently. This one has to do with CCMSI and his Illinois workers’ compensation case, but it really could be with any work comp insurance company:

I was injured on the job and it has been over 6 weeks and Ccmsi has still not determined if my claim will be covered.

This like I said is not unusual for CCMSI or anyone else. You see it with Travelers, Gallagher Basset, Sedgwick, ESIS, etc.

They aren’t telling you no and they aren’t telling you yes. They say things like, “It’s under investigation,” or “We are gathering records,” or “We are gathering information,” or maybe they just blow you off and don’t get back to you. Let me tell you that it’s all nonsense and BS.

Your work injury isn’t a murder case. It’s a simple investigation. Typically talking to a supervisor and/or looking at a medical report is all that they really need to do. It’s almost always a pretty straight forward situation. A worker types all day and has been diagnosed with carpal tunnel. A worker was hit by a forklift and broke their leg. A worker lifts heavy objects all day and has a back injury.

Certainly it’s possible that there are other causes for these injuries. But it’s not probable and they can’t delay and delay until they find something. If they follow the law, they are supposed to begin providing work comp benefits. They can always stop payments if new information arises and seek to be reimbursed what they paid. Of course they don’t follow the law.

And if you don’t have a case filed with the Illinois Workers’ Compensation Commission, they can screw around with your health and life by not approving benefits. They get away with it because if you don’t have a case filed, there is no way to hold the insurance company accountable for their bad behavior.

You’d be shocked at how quickly benefits can be approved and delays end when you actually put pressure on an insurance company and file a case. There are motions a lawyer can file that can punish their bad behavior. Insurance companies quickly decide the cost of having to pay for a lawyer and penalties on your case, outweighs just doing the right thing and approving your claim.

That doesn’t mean that they won’t still try and deny your case at some point. They’ve already made their intentions clear. They do this stuff all of the time. It’s not personal to you, it’s just business to them.

The bottom line is that good cases are supposed to be covered. Delays can greatly harm your health and your life, especially if you have no money coming in. By waiting them out, you actually reward them and hurt yourself. It’s shameful how these insurance companies can act. But the great news is turning around a denial or no response is usually not that hard.

How Soon Should You Return to Work After A Workers’ Comp Injury in Illinois?

A lot of the questions I get about Illinois workers comp law happen because employers put crazy thoughts into the heads of their employees. One recently didn’t think he could go to the ER without a co-worker driving him because his boss said so. Another thought that if you got injured on the job it was a requirement that you sit out for two weeks. He thought that because it’s what his foreman said.

So how soon should you return to work if you get injured on the job in Illinois?

The answer is relatively simple. Listen to whatever your doctor says. If they say you can’t work due to your injury then you don’t. That could be days, weeks, months or with terrible injuries even years. Usually they’ll initially authorize you off work for 2-4 weeks and then re-evaluate you. If you’re in physical therapy or receive a steroid injection, they’ll probably take you off work for another 2-4 weeks and see where you are at after that. If you have a surgery, there’s usually a minimum period for your body to heal. So if you have a back surgery, it wouldn’t be unusual for your doctor to state that you have to be off work for three months.

In other words, even if you end up being off work for many months or years, your doctor won’t state that at the beginning and the hope of course is that you’ll get healthy sooner rather than later.

In some cases, you can do work, but not your full duty job. You might have a restriction that says no lifting over 20 pounds for example. If you are a teacher, secretary or (gasp) a lawyer, you can probably do your normal job still. But professions like nursing or construction usually will prevent you from returning to work. If your employer can’t or won’t accommodate your work restrictions, you won’t be able to return to work, but you should continue to get work comp TTD benefits as you recover.

Other times your doctor will tell you that you can return to work full duty, but your body is telling you otherwise. In those situations, you should express your concern to your doctor and have a hopefully thoughtful discussion about it. You need to make clear the pain you are experiencing and what your job duties are. If they still want to send you back to work, you don’t have to go, but if you don’t, you also won’t get TTD benefits and could lose your job. We usually advise people in those situations that if they can to give it a shot and see what happens. If the pain is too great you can then you can go back to your doctor and discuss it from there.

The bottom line is that every case is different and your health should be priority number one. Beware an employer who tries to pressure you to return to work or one that says they’ll accommodate your restrictions, but doesn’t. Those are the ones that make a short term injury into a serious, life altering one.

And as always, if you have any questions, please call us to speak with a lawyer for free any time. We cover all of Illinois.

Degenerative Disc Disease Doesn’t Mean You Don’t Have A Work Comp Case

A great piece of advice for anyone who may have an Illinois workers’ compensation case is to not take every medical term that you hear literally or to assume what one means. A lot of medical terms can be confusing or not apply to work comp law in Illinois the way you’d think they would. A great example of that is degenerative disc disease.

In general, as you get older your joints will wear down a bit. That can happen in your knees, your arms and of course your back. It’s basic wear and tear that results in a form of arthritis which can cause pain. Sometimes the pain is minor and other times it’s life altering and requires significant medical treatment.

This type of wear and tear arthritis in the back is called degenerative disc disease (DDD). There is no one cause of this problem, but it’s often just from acts of living. Over the course of your life, you do a lot of lifting, you could be in an accident or have a fall, you could sleep wrong, etc. All of these activities together can cause arthritis and your spine to break down.

Because it says “degenerative” and is a breakdown of the spine, I’ve seen work comp insurance adjusters and employers tell their workers that this problem isn’t part of work comp. It most recently happened to a nurse who called me and had been told she couldn’t file for work comp.

Of course this is a lie and anyone can file for work comp. And for people like this nurse who have been lifting patients on a regular basis for 20+ years, it of course is common sense that part of the breakdown of her body that has been diagnosed as DDD is caused by her job.

Now the job isn’t the only factor of course as she’s done lifting in other parts of her life and was in a car accident as a teenager. But the job has clearly been a contributing factor and under Illinois law, that is all she needs to show in order to be eligible for work comp benefits. Your job doesn’t have to be the only cause or even the main cause. It has to just play a role.

In this case I’d argue that her work has been the main cause and she also first noticed pain when lifting a heavy patient without help. But even without that, her job involves so much lifting and has been going on for such a long time that it would be absurd for anyone to claim it had nothing to do with her back breaking down.

We love these cases as they are ones that can often be turned around quickly and where we can help injured workers. If you’d like a free consult, please call us at 312-346-5578.

College Athletes And Illinois Workers’ Compensation

We are attorneys for injured Illinois workers in Illinois. We believe college athletes should be getting work comp benefits. If you are an injured athlete from a division one school, please call us any time at 312-346-5578 for a free, confidential consult.

A lot of companies try to get away with not paying Illinois work comp benefits by claiming workers aren’t actually employees. The most common way they do that is by calling workers independent contractors. If they don’t actually work for you, then you don’t owe them work comp benefits, right? That’s actually wrong if we can prove the company has control over you and treats you like an employee.

I think of this control test any time I see a college athlete get hurt while playing. I’ve often thought that if you really know the schedule of a college athlete, you’d realize they are really employees even if they don’t get paid beyond the scholarship. From limiting what classes they can take, to threatening to take away a scholarship, to forcing athletes to play through pain, pumping players with drugs, barring studying abroad, etc., the college coaches and universities have always had control over them.

The schools also provide uniforms that the players have to where and make them follow a certain schedule. These are all hallmarks of actual employees.

But now more than ever it’s clear that college athletes, especially football and basketball players are about to really become employees. Due to the settlement of an anti-trust lawsuit over the NCAA taking away money making opportunities, players in the top conferences are going to begin receiving upwards of $20 million a year as soon as the fall of 2025. And that number can go up.

While scholarships aren’t taxed, I see no way this money could possibly avoid taxes. It’s no different than the NIL money that many of these great athletes are fortunately receiving now. Speaking of which, it’s very common for the schools themselves through their NIL collectives to broker deals for players to entice them to play for their team.

So this fall when you see a football player tear their ACL on a tackle or miss a game with a shoulder injury or medically retire due to a neck or back injury, those players, in my opinion, are owed Illinois workers’ compensation benefits.Same will be true this winter when you see a basketball player get hurt. And I’d argue it holds true for even non-revenue athletes who are on scholarship or receiving other financial consideration due to their participation.

These benefits of course can really be significant for these young men and women. Not only would they get 100% of their medical care related to the injury taken care of, it can potentially happen for life and they’d get to choose their own doctor. A lot of injured college athletes get forced onto the school doctors and they often get pressured to release an athlete to play before they are truly ready.

Beyond that, if compensation was taken away due to the injury, these athletes could make up some of that money through Illinois work comp benefits. And they could eventually be entitled to a settlement. If they have a career ending injury, that settlement could be worth well into the mid six figures.

It’s going to take one athlete willing to be the first to come forward and file a claim for benefits to prove we are right that they deserve these benefits. If you are willing to discuss being that person, we’d love to speak with you.