Tyson Foods Closing And Illinois Workers Compensation Cases

By Mike Helfand on Posted in Tips if Injured

Over the weekend it was reported that the Tyson Foods plant in Joslin, Illinois would be closing. With it comes the loss of around 2,500 jobs at the plant which has been operational for over 40 years. Allegedly they are doing it due to cattle shortages across the country.

These jobs were, at times, dangerous and led to a lot of work related injuries. We have helped dozens of injured workers at this facility over the last 25+ years. These workers see just about every injury you can imagine with back injuries being the most common along with a lot of repetitive trauma injuries to the arms, shoulders, and wrists.

What Happens To The Workers’ Compensation Claims Of Injured Tyson Workers?

Since the plant closure announcement, we have already received calls from concerned injured workers who are wondering what will happen to their case and how the closure affects things. Here is what you need to know and this applies to not just Tyson, but any plant that closes down.

  1. Your case is still active. You can and should continue to receive medical care at their expense.
  2. You also should continue to receive TTD benefits if your injury has you off of work.
  3. If you have restrictions from a work injury that they were accommodating, the day that they close down, they should put you back on TTD benefits until you have no restrictions.
  4. If your restrictions end up being permanent, that could greatly increase the value of your case. Them not having a job for you any more will make your case worth much more money.
  5. No matter the case, you are entitled to a settlement when you are all better.

Another thing to know is that when these shut downs happen, the company and their third party company that they use to process these cases, want to close all claims ASAP. You need not feel pressured to do so and should never settle before you are ready. And when it does come time to settle, a good lawyer can usually get you maximum dollars because of the extra incentive they have to be done with these cases. Let their greed work to your benefit.

You also do not get punished because there are not as many high wage jobs in the area. So if you have restrictions and suddenly have a $15 an hour wage loss compared to what you’d currently make at Tyson, a case that would have been worth $50,000 could suddenly be worth $300,0000 or some other large number depending on your age and other case factors.

So while it is certainly stressful and a bit gross that they are closing, I do want any injured worker from Tyson to know that their case will not be harmed.

Bonus tip. If you have hesitated to bring a work comp case in the past even though you are injured, you absolutely must do it now if you ever want to go that route. Trying to bring a case months after the closure or your last day worked will be very difficult and could cause a winning case to be a loser.

We are here to help if you want that help. Call us any time at 312-346-5578 for a free consultation with an attorney who knows how to handle Tyson claims.

Shoulder Replacement Surgery and Illinois Workers’ Compensation

By Mike Helfand on Posted in Injuries

When most people think of workers’ compensation claims, they picture a sprained back or a broken bone or some other injury that heals with rest and physical therapy. Shoulder replacement surgery is something else entirely. It is a major, life-changing procedure that signals a severe and permanent injury. If your job has left you needing a shoulder replacement, you deserve serious legal representation to match the seriousness of your condition.

Jobs Where Shoulder Injuries Are Common

Shoulder injuries happen at work because of the physical demands certain jobs place on the body day after day. Workers most at risk include:

  • Construction workers — lifting heavy materials, working overhead, operating heavy equipment
  • Factory and assembly line workers — repetitive arm motions and awkward positions over years
  • Warehouse and logistics workers — loading, unloading, and carrying heavy loads repeatedly
  • Nurses, CNAs, and healthcare workers — lifting and repositioning patients puts enormous strain on the shoulder joint
  • Painters and drywall workers — constant overhead work degrades the shoulder over time
  • Mechanics and auto body workers — reaching, pulling, and working in tight spaces
  • Firefighters and first responders — physical exertion under high-intensity conditions

The reality is that almost any job could lead to a major shoulder injury, even something low risk like lawyer, secretary or teacher. If your job involves any of these types of activities (even if your role or your title is different) and your shoulder has given out, your injury may very well be work-related.

Symptoms of a Serious Shoulder Injury

Shoulder problems often start small and get worse over time. Warning signs that something serious is happening include:

  • Persistent pain that doesn’t improve with rest or medication
  • Deep aching or throbbing in the shoulder, especially at night
  • Severe limited range of motion, difficulty raising your arm or reaching behind your back
  • Grinding, clicking, or popping sensations in the joint
  • Weakness in the arm that makes daily tasks difficult
  • Swelling or tenderness around the shoulder joint

Many workers push through these symptoms for months or years before getting a proper diagnosis. By that point, the damage can be severe enough to require surgery.

Why Shoulder Replacement Is a Much More Serious Surgery

Most shoulder injuries are treated conservatively with rest, injections, physical therapy, or rotator cuff repair. Most of those surgeries are short and recovery only takes a couple of months.

A shoulder replacement (also called shoulder arthroplasty) is recommended only when the joint has been destroyed to a point where those options no longer work. This happens with severe rotator cuff tears, advanced arthritis caused by workplace trauma, or fractures that have compromised the entire joint.

This is major surgery. The damaged parts of the shoulder joint are removed and replaced with artificial components. Recovery takes many months. Physical therapy is intensive and lengthy. Many patients never fully return to the type of physical work they did before. Some cannot return at all. The long-term impact on your career, your income, and your quality of life is enormous, and your workers’ comp claim needs to reflect that reality.

Why You Need an Experienced Workers’ Comp Attorney

A shoulder replacement claim is not a simple case. The higher the stakes, the harder insurance companies fight to minimize what they pay out. Here is why having an experienced lawyer in your corner matters:

The value of your case is significant. Between surgery costs, months of lost wages, long-term therapy, and potential permanent disability, a shoulder replacement case can be worth a substantial amount. An experienced attorney knows how to calculate the full value of your claim.

Insurance companies will look for any reason to deny or reduce your claim. They may argue your injury is pre-existing, not work-related, or not as severe as your doctors say. A skilled attorney anticipates these tactics and builds a case that counters them.

You may never return to your previous job. If your shoulder replacement limits the kind of work you can do, you may be entitled to vocational rehabilitation or additional compensation for loss of earning capacity. Most injured workers don’t know to ask for this, but an attorney will.

Workers’ comp attorneys work on a contingency fee basis. This means you pay nothing out of pocket. Your attorney only gets paid when you win or settle your case.

Contact us today for a free consultation. We have a state wide network of attorneys who have had success in representing workers with severe shoulder injuries. They literally can make your case worth tens or hundreds of thousands of dollars more. Fill out our contact form, start a chat, or call us at 312-346-5578. We will treat you like a family member.

Social Security and Illinois Workers’ Compensation

By Mike Helfand on Posted in Benefits

I recently had a phone call from an injured worker. He had actually already settled his workers’ compensation case, but wanted to sue Gallagher Bassett. He is also on social security and said that the insurance company did something in the contract that caused him to lose six years of benefits.

I had some thoughts right away:

  1. The first was that you can not sue the insurance company. It is not their job or that of their lawyer to look out for you.
  2. The person who should look out for you, other than you looking out for yourself, is your lawyer.
  3. Based on what this person described, I assumed he would need a legal malpractice attorney.

But then I looked his case up and discovered that he represented himself on what was a very serious injury. And that explained a lot.

Spread Language and Illinois Work Comp Settlements

When you settle a workers’ compensation case and either are on social security disability or you anticipate you might be, the social security administration looks at your settlement as income. As a result, it can greatly reduce your social security benefits. That is what happened to the person who called me.

The way an experienced Illinois workers’ compensation attorney protects their clients is by adding something called spread language to the settlement contract.

What spread language does is take your life expectancy and have the contract reflect that the payment is being spread out over your life expectancy. You still get the settlement in a lump sum, it just greatly reduces how the Government views it and in most cases will only cause your social security to go down by a very low amount.

If this person had hired an attorney and they did not do this, it would likely be an Illinois legal malpractice lawsuit. I have seen that happen on other cases, but it did not happen here. As a result, not having a lawyer cost him a lot of money.

To make matters worse, my quick assessment of his case was that it was probably worth more than $200,000 than he got. In other words, even with a 20% lawyer fee, which would have actually been less as the fee would be capped, he would have netted way more money.

It is a sad case all around and one that could have been avoided. The only hope now is that the insurance company would be willing to re-write the settlement contracts. That is not likely.

If you have a large money settlement or might be or are on social security, make sure that spread language is part of the contract. The insurance company will never fight it and it will protect you and save you money.

Attendant Care and Illinois Workers’ Compensation

By Mike Helfand on Posted in Injuries

One of the great things about Illinois workers’ compensation law for workers is that it covers 100% of all reasonable and related medical care. Most people think of this as meaning that there will be no co-pays and no out of pocket expenses. And that is correct.

What a lot of people do not consider is what medical care actually is. Medical care under the Illinois Workers’ Compensation Act could be a gym membership. It could be a modification to your home or the insurance company having to buy you a vehicle. One man I represented for almost 20 years was paralyzed and got multiple vans.

It can also mean that if needed, you can get attendant care.

What Is Attendant Care?

Attendant care is a person who comes into your home at the order of your doctor to help take care of you. They are called a “non-skilled” worker, but that is nonsense. They provide a lot of services to help someone who is significantly injured and can not fully take care of themselves. This includes:

  • Helping with baths or showers
  • Preparing meals
  • Getting you dressed
  • Assisting with taking medication
  • Housekeeping and laundry
  • General grooming
  • Transportation
  • Companionship and supervision
  • Anything else needed in your acts of daily living

If your doctor orders it and it is medically necessary, then the workers’ compensation provider must pay for it.

Illinois Work Comp Cases

Attendant care does not come up in most Illinois workers’ compensation cases. It is reserved for those who are significantly injured. As a result, not every Illinois work comp attorney has experience in making sure that if it is ordered that you can actually get it.

It is possible that attendant care will be provided for life and in other cases it may be temporary. For example, if you had a spinal fusion due to a work related injury and you live alone, it is likely that you will need someone to come into your home to help you with your acts of daily living.

If you are paralyzed or permanently disabled from working, it is possible that you will need attendant care for life.

And even if you live with someone, if they have to take care of you and your doctor has ordered attendant care, it is possible your spouse, friend or other family member could be paid for helping you out.

It is something an attorney should suggest for most people who have major injuries. And it is certainly something you should bring up to your doctor if you feel you need it.

The Role Of Your Doctor and Tips For The Provider

It is important that your physician be detailed about why you need attendant care and what that should involve. His prescription and official records should indicate things like:

  • Times when care should be provided
  • What needs to be done
  • How long care should last

As for the attendant, especially if it is a friend or relative, make sure they know to keep detailed logs of what they are doing including tasks completed and how long it took. They also should report this to the doctor as well as any other progress that occurs or relevant observations.

Free Case Review

The key points in all of this are that attendant care is available, but you might have to ask for it and there are very few attorneys with a track record of handling cases that need attendant care. If your injury is that serious, the right law firm can make your life much better.

We have a state wide network of experienced, successful work comp attorneys who care about their clients. If you would like a free case review, please call us any time at 312-346-5578. All calls are confidential and no commitment.

This Chicago Work Comp Lawyer Made His Client Feel Terrible

By Mike Helfand on Posted in Tips if Injured

Illinois workers’ compensation attorneys do not see each other much anymore because most hearings and court appearances are on Webex which is comparable to Zoom. As a result, you do not get the small interactions very often that help foster relationships which can make cases operate more smoothly.

I have vivid, not necessarily fond, memories of going to the Illinois Workers’ Compensation Commission at the Thompson Center before Covid when hearings took place there. You would see gross things like older, married male attorneys hitting on young female lawyers. You would get a sense about how various firms practiced. One firm in particular would make almost all of their clients show up even though they knew the cases were not actually going to trial that today.

You would also see some great attorneys in action and see some acting like total assholes.

It has been a decade or more since I have seen in person one particular Chicago work comp lawyer who had a major anger problem. It was never directed at me, but I saw him act out toward defense attorneys and his own clients.

Well he appears to still be at it because one of his clients, who has a great case worth a lot of money, called me crying. She had a question about her case and said when she called her attorney he screamed at her, called her stupid and made her scared. She told me that she felt like a kid who had been sent to the principal’s office.

There is absolutely no excuse for a lawyer to treat a client that way, ever. You can not say you are having a bad day. That does not mean an attorney should be perfect or can’t get argumentative. That can happen and sometimes it is appropriate.

But to call your client stupid and make them afraid to call you is just gross. She told me that whenever she calls she gets ridiculed and this was not a one off event.

So sadly nothing has changed for this lawyer and given that he’s been doing this for over 30 years, it sadly means he will probably escape accountability.

Your work comp attorney does not need to be your best friend or even your friend at all, but it would be nice if they are patient and compassionate with you. If they have a problem with anything you do, they should be able to say it calmly. For example, if a client is calling 10 times in a day and yelling at staff, the attorney should call that out.

But if you are calling occasionally when you have questions and you are courteous, they should try to help you.

What makes this case worse in my opinion is that when benefits got cut off, he made no attempt to solve the situation and did not provide any real legal advice from what she shared.

The good news for this person and anyone else is that you can switch firms and it will cost nothing to do so. The only hindrance to that would be if there was a settlement offer. Often at that point you are stuck unless the offer was woefully low.

On the same day this worker called me, another injured worker who hired a different terrible firm reached out as well. He too had been screamed at by his lawyer, but his case went to trial and they lost so there was no way to help him unfortunately.

Again, the lesson is you do not have to take it and if you are thinking about switching, do it before it is too late.

What to Say and Not Say to an Adjuster

By Mike Helfand on Posted in Tips if Injured

When an Illinois worker gets hurt on the job, it is common for an insurance adjuster to reach out quickly. The adjuster may sound friendly and concerned, but it is important to understand who they work for. Insurance companies are businesses focused on their bottom line. Their goal is to limit how much they pay on claims, and they are often looking for reasons to deny or reduce benefits. They are not there to protect your interests.

What you say to an insurance adjuster can have a big impact on your case. It is important to be polite, but also careful. You do not have to talk to them and often shouldn’t. If you do, you should stick to basic facts about your injury. This includes when and where the accident happened and the body parts that were injured. If you have already seen a doctor, you can confirm that as well. Keep your answers short and accurate. If you do not know the answer to a question or are unsure, it is okay to say that you do not know or that you need to check your records.

At the same time, there are things you should avoid saying. Do not guess or speculate about what caused the accident. Do not downplay your injuries by saying things like, “I’m fine,” or, “It’s not that bad,” especially early on. Many work injuries get worse over time, and those statements can later be used against you. You should also avoid giving recorded statements. Adjusters are trained to ask questions in a way that may lead you to give answers that hurt your claim, even if that is not your intention. They are well known for twisting words or misinterpreting them.

It is also important not to discuss unrelated medical history or prior injuries. While some prior conditions may be relevant, insurance companies sometimes try to blame your current injury on a pre-existing issue in order to deny benefits. Treatment not related to your injury is none of their business. It is why we recommend to never sign a broad release form for your medical records. Also avoid talking about your activities outside of work or posting about your injury on social media, because this information can be taken out of context.

One of the most common mistakes injured workers make is assuming the adjuster is there to help them through the process. In reality, the adjuster’s job is to protect the insurance company. That is why having a lawyer on your side who understands how the system works can make a big difference.

An experienced Illinois workers’ compensation attorney can guide you on exactly how to handle communications with the insurance company. A lawyer can speak to the adjuster on your behalf, help you avoid common pitfalls, and make sure your rights are protected. They can also ensure that your injury is properly documented, that you receive the medical care you need, and that you are paid all the benefits you are entitled to under the law.

If you have been injured at work, you do not have to deal with the insurance company on your own. We can connect you with a reputable Illinois workers’ compensation attorney who has a strong track record. We have a state wide network of experienced, top work injury attorneys. There is no cost to speak with a lawyer, and you will not pay any fees unless there is a recovery in your case. Contact us today through our contact form or by calling 312-346-5578.

Do Not Let The Work Comp Insurance Do This

By Mike Helfand on Posted in Tips if Injured

We notice trends in Illinois workers’ compensation claims. By that I mean we will hear the same sort of thing from injured workers in bunches. Usually it is in response to an insurance company strategy. They will often try the same thing over and over as long as it is effective. An example would be an insurance company not paying benefits without any reason or lying about which doctor you can see.

Lately we have seen a different type of pattern. It is no secret that the world is more expensive than ever and the US economy is not great unless you are ultra wealthy. While Illinois workers’ compensation claims are worth more than ever, if your case gets denied and you do not have pay coming in, it also puts more pressure on you than injured workers before you have faced.

The new insurance company strategy, which you can not let them do can be summed up in one word.

Frustration.

I hear from more injured workers who have been dealing with workers’ compensation on a long-term basis. I am talking about injured workers with big injuries who have had a case for a year or more. Many of these people have had claims for five or more years.

These are often people who will never get back to their old job and have had multiple surgeries and may need more. What will happen is the insurance company will get a hired gun IME or conduct surveillance that gets taken out of context and cut off all benefits. So now the worker is in pain and looking at six months or more until money starts coming in again.

A lot of these workers have also hired terrible Illinois work comp law firms. By that I mean that the attorney does not communicate well and does not fight for them. That makes it worse because the insurance company is frustrating you and so is your lawyer.

The goal of the insurance company is to make you give up. They will want you to settle your case. They do this for a few reasons:

  1. It ends your right to medical care at their expense.
  2. It allows them to get away with no longer paying you weekly TTD checks.
  3. Any settlement you get will be MUCH less than what your case could be worth.

In other words, if the maximum value of your work comp claim one day would be $350,000, they might offer you 100k right now. If you are frustrated, you just might take that. It would be a huge mistake.

In other cases, we have seen injured workers call their lawyer and say, “I just want this to be over with.” Unless you have a terminal illness, that is also a huge mistake.

It is the job of your lawyer to fight for you and not take the easy buck. Any attorney who encourages you to settle while you are still off work per your doctor or still getting medical care for your injury, is not fighting for you.

The insurance company benefits if you settle. The lawyer does too because they get paid. You on the other hand, even if money comes in, get screwed. Because once that settlement money is gone, that is it.

Most Illinois work comp cases run smoothly, but not all. The insurance company is always looking for a way to minimize what a claim costs them. You have to think long term, not short term. That can be hard, but it is really in your best interests.

My litmus test for people is, if we settle today, will it cause you problems five years from now? Will you be happy then? If the answer is no, then do not settle.

Illinois Employer Tries To Gaslight Injured Worker

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

One thing that surprises and occasionally frustrates me as an Illinois workers’ compensation attorney is when injured workers are blindly loyal to employers who treat them like absolute garbage. I get that people need to keep their jobs or don’t want to “make waves” or whatever. But I am not talking about that.

What I am talking about is employers who do things that are clearly in their interest and not the workers. Such as:

  • Trying to get you to work “just a little” off the clock instead of paying you for all actual hours worked.
  • Telling injured workers to lie to the doctor and say they were not hurt at work.
  • Promising to pay out of their own pocket for bills and lying about that.
  • Pressuring an injured worker to ignore doctor’s restrictions after an injury.

Companies like this do not care about you. They certainly are not worried that if they torpedo your work comp claim that it can have lasting damage are your physical and financial health.

The most recent gross employer behavior I saw was a Chicago area company that had a worker who hurt his back on the job while moving some heavy materials. He reported the injury, saw an orthopedic doctor and has a recommendation for surgery. He is in tremendous pain and has shooting pains going down his leg. It is hard for him to stand.

When he let his boss know what his doctor said, the boss accused him of “being in cahoots” with the doctor. He essentially implied that this worker was running a scam. Mind you that this worker has been there for almost a decade and has never filed a work comp claim in the past despite multiple injuries.

The boss sent him to a doctor friend who stated that no surgery was needed and he is fine. That doctor is not an orthopedic one and is apparently a close friend of the boss. That doctor’s opinion is in no way credible. Yet the boss is trying to gaslight his worker into thinking that the back specialist is making things up or the two of them are running a scam. In fact it is the opposite.

Despite all of this, the injured worker was hesitant to go forward. He is worried about hurting the company and making his boss mad.

As best I could, I explained how he could become permanently disabled from ever working again if he does not get the care that he needs and that hiring a work comp attorney is the only way to make that happen. I have seen workers end up crippled and homeless because they were “not the suing type” or let their boss pressure them into not pursuing a claim.

This happens at huge fortune 500 companies, small companies and everything in between. No matter where you work, you have to look out for you. A lawyer’s job is to protect you and advocate for you, but they can not care about what happens to you more than you do. There will always be another client. Another case. But you have one life and one body. And it is up to you to worry about that more than anyone.

Illinois Work Comp When You Own The Company

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

An injured worker with a big back injury came to me for advice recently. He got hurt on the job and needs surgery. The catch is that he owns the company and didn’t know if he could do anything about it because in his mind, he would be suing himself.

First point is that an Illinois workers’ compensation claim is not a lawsuit, but instead a claim for benefits. That is an important difference. If you are driving your own car and crash, you can not sue yourself for negligence. But if it is a job injury, since it is not a lawsuit, you do not have to prove negligence. You are claiming benefits just like if you pursued treatment under the company health insurance policy.

Now that that is out of the way, there is one key question any time an owner of a company is hurt on the job in Illinois. And that question is, do you carry work comp insurance on yourself?

Every employee in Illinois is covered by work comp, with one big exception. An owner (meaning someone who owns at least 5% of a company) can exclude themselves from work comp claims. That often happens because an owner is likely to be a higher wage earner. So excluding themselves lowers their insurance premiums and since they are the owner they can likely pay themselves for any time off work unless them being out of work kills the company.

So if you are an owner and get hurt on the job AND have not excluded yourself from work comp coverage, you are supposed to be treated like any other employee. That said, these cases are not always straight forward. That is because:

  1. Typically an insurance company is dealing with claims about employees, not the owner.
  2. As a result, investigating a case is harder because there is often nobody independent to talk to about what happened when you got hurt.
  3. So at times the insurance companies will take longer than they should to approve and process a claim. Basically they will often assume you are lying even without any evidence that shows that.

The reality is that Illinois law does not allow an insurance company to delay paying lost time benefits or approving medical bills just because they are “investigating.” They have to have a reasonable excuse for any delays. Being suspicious just because it is the owner who made the claim is not reasonable.

So often an injured owner has to act faster and more aggressively or they risk getting screwed over. That means hiring an attorney to immediately file the case and file the right trial motions to put pressure on the insurance company.

The key point is that you have the same rights and benefits as any other injured worker. They can not deny or delay just because it is your company.

Bottom line is that if you own the company and work a heavy duty job or if you getting hurt and being unable to work would cause you big financial harm, you should not exclude yourself from insurance.

And if you have any questions or want a free case review, please call us any time at 312-346-5578.

Work Comp When You Do Not Want Surgery Now, But Might Later

By Mike Helfand on Posted in Benefits

Under Illinois workers’ compensation law, if you refuse reasonable medical treatment, that could result in your case being denied or ended. In other words, if you hurt your back on the job and your doctor suggests physical therapy, if you refuse to participate, it could end your case.

There is a BIG exception to this rule.

You Can Not Be Forced To Have Surgery If Hurt At Work In Illinois

One thing an insurance company (or anyone else) can not make you do is have surgery. This is true even if it is a relatively quick and likely successful surgery like for carpal tunnel. It is also true if having surgery could get you back to work full duty and not having the surgery will leave you with permanent restrictions.

The reason for this is because surgery is invasive and even the safest surgeries have risks. It is your choice as to what to do or not do with your body. This is all pretty sensible.

Reasons Why People Refuse To Have Surgery

Some people refuse surgery because they are scared or had a bad experience previously. One former client refused to do anything with anesthesia because they are convinced that is why their father developed Alzheimer’s.

And a recent caller to my office did not want the surgery because he had a lot of family events coming up. One child was getting married, another was going to graduate college and he and his wife had a big safari anniversary trip planned. He had a torn rotator cuff and while he could do regular day to day activities, he can no longer work his heavy duty labor job. That is because without surgery his restrictions are no lifting overhead more than ten pounds. A ton of his work is overhead lifting.

A rotator cuff repair takes about 45 minutes, but will require six months of recovery. It is absolutely his right to turn down the surgery even if the reasons are so he will be able to enjoy some fun outside of work. I would not want to be in an arm sling for wedding photos either.

When You Do Not Want Surgery Now, But Might Later

Because he does not want the surgery, his doctor has declared him to be at maximum medical improvement (MMI) and has discharged him from his care with permanent restrictions. Because he has a job within his restrictions that pays the same as he used to make (he got very lucky), the case is ready to be settled.

His question to me was about having surgery at a later date. He doesn’t love his new job and is worried about limited arm mobility as he gets older. He wanted to know if he could settle, but get them to pay for the surgery at a later date.

While everything is negotiable, most Illinois workers’ compensation settlements close out your medical rights. Insurance companies want certainty. But he has two options to get what he wants:

  1. He can take his case to arbitration. When you win an arbitration (and this case is not disputed, so he would win), you still get the equivalent of a settlement, but you keep your medical rights open as relates to that injury. So if in two, five, 10 years or whenever he wants to have rotator cuff surgery, the insurance company would have to pay for all of it as long as he can prove the need for surgery is related to the work accident.
  2. He can settle and request a Medicare Set Aside. Any time you settle an Illinois work comp case, you are supposed to take into consideration the rights of Medicare. Basically that means that if it is anticipated that you might need future medical care, you and the insurance company can not make Medicare pay for it. So what happens is that the insurance company has to fund a surgery now and give that money to you. This is separate from the settlement dollars.

The great part of this is you can put that surgery money in your pocket and control it. If you ever do have the surgery, if you want to use Medicare, you will have to contribute these dollars first. Otherwise if they catch that it should have been part of work comp, you’d have to pay them back. And if you never have the surgery, the money is just yours.

The Bottom Line

The TL/DR version of this post is that you can not be forced to have surgery if hurt on the job. And if you might want surgery down the road, there are options for you even if you settle your case.

And if you have any questions or want a free case review, please call us any time at 312-346-5578.

LexBlog