
Here is an Illinois workers’ compensation situation that comes up a handful of times a year. We don’t like to see anyone have their benefits denied, but we like this situation because the law is incredibly crystal clear and it is an easy problem to solve. Here is what happens.
A worker at ABC Company hurts their back on February 1st. There is no dispute that it is a work-related injury. They receive three months of physical therapy and an epidural steroid injection to their lumbar spine. They miss six weeks of work. Everything is paid for. Come May, they are feeling really good, and their orthopedic doctor says that they can work full duty and do not need any more care. That case was handled by the X insurance company (it could be Travelers, ESIS, Hartford, or anyone else).
They return to the ABC Company and in June they hurt their back again while lifting a box. They go to the orthopedic doctor again and he wants the worker to have a MRI. This case is being handled by the Y insurance company.
What typically happens next is the Y insurance company refuses to pay for the MRI. They say that the back injury is really from the first accident that is the responsibility of the X insurance company. They are not disputing a new situation occurred or the need for the MRI, but it is their opinion that it all traces back to the February injury.
So who pays for the MRI and continuing treatment?
The answer is we do not care. Your case is not filed as you vs. the insurance company. It’s filed you vs. the employer. Whether the February or June accident is the reason you need to see a doctor now, it all falls under the responsibility of the ABC company.
As a result, their is no defense to not paying. The two of them can argue it out, but someone has to pay. And if they do not pay then a motion for penalties and fees will be granted that will punish them both for their unreasonable denial.
Typically in this situation an Arbitrator will recommend that they each pay half until they can get opinions as to which accident is responsible. It may end up meaning that eventually the case is forced to trial when it is time to settle so an Arbitrator can determine if the June situation was a new injury or a temporary aggravation of the old one. It’s likely that the MRI will help paint the picture, especially if there is an earlier one to compare it to you.
But the bottom line is that you as the injured worker should not have benefits delayed in any way while this gets sorted out. It is one employer. The case might be different if you switched jobs. In this case there is no dispute that the ABC Company is responsible. So their insurance has to pay or they do.
In one case that came to us, a worker waited over a year for this to get solved. That is beyond unacceptable. If a client came to us, we would immediately file a petition for immediate hearing and penalties and fees. Unless there is a defense that you were not hurt at work or do not need the treatment (highly unlikely), I do not believe that there is an Arbitrator in Illinois that would find against you. Even the most employer friendly Arbitrators would rule in your favor.
So if this happens to you, know that you are in a great position and your case is very winnable. Call us any time for immediate help anywhere in Illinois and a free case review.








