IL Work Comp – When A Meniscus Tear Becomes A Knee Replacement

By Mike Helfand on Posted in Injuries

We have been involved in hundreds if not thousands of knee injury cases over the years. Many of those have involved meniscus tears. For most injured Illinois workers, a meniscus tear case will go something like this:

  • Hurt your knee at work
  • Go to the doctor
  • Get referred to an orthopedic doctor
  • Have a MRI
  • Discover meniscus tear
  • Have surgery
  • Return to work in 2-8 weeks depending on what type of job you do

Meniscus tears are serious and can keep a professional athlete out for a season, but most workers can recover to their normal jobs pretty quickly. The exception is some heavy duty laborers who may need a longer period of light duty work. So these are serious injuries, but in our experience, most injured workers recover pretty well. After that it’s get a settlement and move on with your life. Given the choice, you’d much rather have this injury than an ACL or MCL tear.

But Not Every Injured Worker In Illinois Makes A Full Recovery

In some cases, the surgery does not fix things. Either the doctor discovers the injury is much worse than the MRI showed or you are unlucky and the surgery does not make you feel better. That could be in part because of years of wear and tear on your knee or other issues,

When that happens, the direction of your case could vary. Some things that could happen include:

  • Physical therapy
  • Occupational therapy
  • Another surgery
  • Steroid injections

For some people, the meniscus surgery is the last straw in a badly deteriorated knee. It is possible you were feeling fine and walking around on it without pain until you tore your meniscus. But now from either unknown problems, old problems or complications of the first surgery, you need a knee replacement.

That is a major upgrade in injury significance and can require a long recovery. Most knee replacements require a short hospital stay and many people spend time in a rehab center to get them on their feet again and be watched for side effects such as blood clots.

From there, there will certainly be a lengthy period of physical therapy and then it really comes down to what type of work do you do. For many jobs, it will be difficult to return to your old work after a knee replacement.

What Happens To The Work Comp Case?

Because the need for a knee replacement traces back in part to your meniscus injury, it will be considered all one case. That means all of your medical bills will be paid whether you have your own insurance or not. You also should be compensated for all of your time off work. It is not unusual for a worker to miss six months or more of work after a knee replacement.

If you are unable to recover and return to your old job, you will be eligible for vocational rehabilitation. That would be assistance in looking for a job within your medical restrictions. You would continue to get paid during this time.

If you get back to your old job or find a new one making a similar amount, you will be eligible for a settlement based on how your leg has been impacted. Every case is different, but most of these settlements are significant. If you can only do a job making much less money, you could get wage differential benefits. Having an attorney at this point is incredibly important and can literally be the difference of hundreds of thousands of dollars.

And if you can not do any work any more because your injury is so serious and your background does not qualify you for a new job, you could receive permanent disability benefits for life. Depending on your age, those benefits could be in the seven figures.

Of course insurance companies will argue that your knee replacement is not their problem. We know how to push back on that and protect you. If you would like a free case review with an experienced lawyer, we have a great state wide network than can help you. Contact us any time at 312-346-5578.

Everything To Know About Illinois Workers’ Compensation Law

By Mike Helfand on Posted in Tips if Injured

If you are injured on the job in Illinois, I thought it would be helpful to have a road map. I have put together a list of common terms, what typically happens in a case and other things you should know. Some may be obvious, others will not be. And while every case is different based on its own unique facts, here are things injured workers in Illinois should know.

And as always, please contact us any time for a FREE case review with an experienced attorney at 888-705-1766.

The Stages Of Illinois Workers’ Compensation Litigation

Illinois workers’ compensation claims are not lawsuits, they are claims for benefits. That said, if your benefits are denied or delayed, there are hearings with attorneys present for you and the insurance company or employer. There can be up to five levels of hearing if your case goes to arbitration.

  1. Arbitration – This is the most common. The Illinois Workers’ Compensation Commission employs arbitrators to hear cases. Before an arbitration can happen, you have to have a pre-trial in which each lawyer will tell the arbitrator what the case is about and then the arbitrator makes a recommendation. If that does not resolve your issue, an arbitration will take place where you will testify. It is nothing like TV beyond there being a court reporter and lawyers. Most arbitration hearings take less than one day and then the arbitrator makes a ruling usually within a few months.
  2. The Commission – After the arbitrator issues their decision, each party has the option to appeal. If that happens it gets assigned to a panel of three commissioners at the Illinois Workers’ Compensation Commission. You as the injured worker will no longer be involved. Instead, your lawyer will write a brief (legal memo) that outlines the case and how they think it should work out. There will then be an oral argument where your lawyer and the other lawyer will tell the commissioners about the case and get asked questions. After that, the commissioners will issue a decision. That whole process takes 12-18 months on average.
  3. Circuit Court – Each party can then appeal the case further, but doing so typically only makes sense if you are appealing because you think the law has not been interpreted correctly. This will assign your case to a Judge who again will receive legal briefings and hear oral arguments before making a decision.
  4. Appellate Court – Much like the Commission, this is an elevated appeal before multiple Judges, but instead of three, it is five. The same process with a brief and argument plays out.
  5. Illinois Supreme Court – It is highly unusual for an Illinois workers’ compensation claim to make it this far, but it happens maybe once every other year. If it does it would be because there is an argument that could potentially create new law or change how the Illinois Workers’ Compensation Act has been interpreted previously.

The Key Point – Most Illinois work comp cases settle and if they do go to Arbitration, they are usually not appealed farther than the Commission level. In other words, do not worry about this, just make sure you have an understanding of how things go.

Bonus Tip – Some lazy lawyers will discourage clients from going to trial by telling them the process will take years. That is theoretically true, but not likely in most cases and not a good reason to give up your rights.

Proving Entitlement To Illinois Workers’ Compensation Benefits

In every case, an injured worker has a burden of proof to show two things. That there injury arose out of and in the course of their employment. It is important to understand what that means.

Arising Out Of Your Employment

This means that your injury is connected to your job duties and it is from a risk that is associated with your job. For the most part it is a common sense test. If you were lifting a box as part of your job and hurt it, that meets the requirement. If you are goofing off and tear your leg while showing someone what a great dancer you are, then it would not be covered.

The main thing to know is that if your employer is benefiting from your work, it meets the test. In other words, if your normal job is to work on an assembly line, but you slip and fall while taking out the trash, that would be a case.

What we as lawyers do is ask “How did it happen?”

In The Course Of Your Employment

For this you should think of the time of the accident and the circumstances. We also again think did your employer benefit from you being there and doing what you are doing.

For example, let’s say you are supposed to clock in at 9 a.m. and show up to the company parking lot at 8:45 a.m. If you slip on ice and break your leg, your employer benefited from you being there so it would still be a case.

And of course injuries during normal working hours when you are doing your job should be covered. This can also be extended to injuries while walking to a bathroom break or things that are not actually a job activity, but reasonable for a worker to do.

The Importance Of Telling Your Employer About An Accident

The most frustrating thing we deal with as attorneys who represent injured workers is when an insurance company or employer gets away with not paying benefits due to some loophole. The biggest one involves your obligation to notify your employer about an accident.

Under Illinois law, you have to tell your employer about an accident/injury within 45 days of when you knew or should have known that you had a work related injury. Some workers do not do this because they are worried about their job or do not want to make their boss mad. This is a huge mistake. Once those 45 days passes, you lose your rights forever. That means no payment of your medical bills, no compensation for time off of work and no settlement when you are better.

Telling them about an injury does not mean you are bringing a claim. It just means you are protecting your rights. So as Nike says, just do it.

Bonus Tip – If your boss witnesses an accident, it is notice. If they become aware of it from someone else, it is notice.

Bonus Tip #2 – The best way to give notice is in writing. Text or email makes the most sense and prevents them from saying that you never told them about it.

Eligibility To File For Workers’ Compensation In Illinois

To bring an Illinois work comp case, you have to show that Illinois has a right to hear the case. This is known as jurisdiction. It is shown in three ways. You only need to show one of them

  1. You were hurt in Illinois– Even if you work for an out of state company, if the injury takes place in IL, you get to bring a case here. That is huge as Illinois has the best benefits for injured workers of any state.
  2. You primarily work out of Illinois – This could mean you are a truck driver or flight attendant whose home terminal is Illinois. It could mean that you work in multiple states, but mainly Illinois.
  3. Your contract for hire was in Illinois – This means that the last act to hire you occurred in Illinois. Often that is a physical exam or interview taking place in Illinois. Sometimes it means you were hired over the phone in Illinois before you went to work for an out of state company. If they sent all your paperwork here and then started you working, you can bring your case here.

Important Point – If you were hired in Illinois and then transferred with your company out of state, if you continued to work for them the whole time, you can bring your case here.

Pre-Existing Conditions and Illinois Work Comp Law

A very common insurance tactic is to state that your injury is pre-existing so you do not get benefits. This is simply a lie. Every case is different and the law in Illinois is very clear. In fact it states:

A pre-existing condition does not prevent recovery under the Illinois Workers’ Compensation Act if that condition was aggravated or accelerated by the workers’ job. To win compensation, a worker has to only show that the job was a “causative factor.” It does not have to be the only cause or even the primary cause.

In other words, if your job duties make a problem worse, you get work comp benefits. As lawyers, what we look for is were you treating for this problem right before your job made it worse. In other words, if you have been going to a doctor for two years for a back injury that happened at home and now want to say it is due to the job, we would need to have clear evidence, usually from a MRI, that something happened that made the problem worse.

On the other hand, insurance companies will say the fact that you were dealing with a problem 10 years ago is why you have trouble now. They will even say that when you have a clear accident. That is total nonsense.

The Key Point – Facts matter and how your job made your problem worse is what we care about and the most relevant issue in winning benefits.

Medical Rights For Injured Workers

As an injured worker, you have a right to have 100% of your medical care paid for. In other words, you do not have to worry about having health insurance in order to get treatment. As long as the treatment is reasonable (not experimental, medically accepted) and related (due to your work injury) then it should be covered.

You have a right to a 2nd opinion as well. That said, if one doctor refers you to another, even for a 2nd opinion, that is considered part of one chain of medical choices. You are usually entitled to two chains of medical choices. After that, any payments would be your responsibility.

So if you get hurt and go to the ER who tells you to follow up with your doctor who then sends you to an orthopedic doctor who recommends a MRI and physical therapy, that would be one chain of referrals. If that orthopedic doctor wants to do surgery and you seek a 2nd opinion without a referral, that would start your 2nd chain of referrals. Anything beyond those two chains would be your responsibility.

Key Point – Get a referral from one doctor to another. Do not doctor shop.

Bonus Tip – Your employer might send you to a company clinic or IME. You usually have to go to these appointments, but these doctors are not looking out for you. Always get someone who has no allegiance to your company to look at your injuries.

Calculating Your Average Weekly Wage

Determining how much you make your week is an important part of how Illinois workers’ compensation benefits for lost time (TTD) and settlements (PPD). It is also the main way that insurance companies steal from injured workers.

Your average weekly wage is often the amount you made the last year divided by 52 weeks. If your salary is $104,000 a year, your average weekly wage is probably $2,000.

But if in the past year you had time that you did not work and were not compensated, that changes how your average weekly wage should be calculated. If there were three weeks you did not work or get pay, instead of dividing by 52, we would divide by 49. If you are a seasonal worker it would be a much lower number.

We also use all of your jobs in calculating your wage. As long as your employer for the job you were hurt on was aware of the 2nd job and fine with it, both jobs should be included in the calculation. That greatly increases what your pay will be.

And overtime benefits are included too (at the straight time rate) when it is mandatory and consistent.

Key Point – A lot of things can affect your average weekly wage and getting it wrong can cost you thousands of dollars or more. It is usually one of the first things an attorney will look at.

Bonus Tip – If your wages were underpaid, they can be paid retroactively. So not all is lost if it was done incorrectly.

Illinois Workers’ Compensation Settlements

Almost every Illinois work injury case has some settlement value. A broken tooth or sprained finger might be worth a few hundred dollars. A major injury could be worth over $1 million. Most cases fall somewhere in between.

There are some key factors in determining what your case is worth. They include:

Your average weekly wage – The more you earn per work, the more your case is going to be worth compared to similar injuries for workers who make less.

Your medical treatment – Having a surgery usually makes a case worth more. Injections can make a case worth more.

The body part injured – Severe injuries to your shoulder are going to be worth more than those to your thumb. A bad back injury is usually worth more than a bad foot injury. Each body part is assigned a certain value. “Man as a whole” injuries are worth the most.

Your recovery – This is a huge factor. If you make a full recovery, you are still entitled to something, but not as much if you had restrictions. And if you can no longer work the same job, a case worth $50,000 could suddenly be worth ten times that if you have a significant wage loss.

How the injury will impact your future – This varies from case to case, but if you will have arthritis or other issues in the future, that can increase the case value.

Future medical care – This is a part of many settlements on top of the normal settlement. It is called a Medicare Set Aside. It is possible the insurance company will have to fund a medical account for future medical needs like additional surgery. That could be an additional large sum on top of the settlement itself.

These are not every factor, but the major ones.

Bonus Tip – Every case is different. Just because a co-worker got something for their injury that does not play a role in what your case is worth. It may be worth the same, less or a lot more.

This is hopefully a great resource for anyone who has an Illinois workers’ compensation case. We have helped tens of thousands of injured Illinois workers and would love to help you. Our state wide network of experienced attorneys is unmatched and allows us to serve all of Illinois. Please reach out any time for a free case review.

Illinois Work Comp When You Have A Felony On Your Record

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

We believe in second chances. A lot of people make mistakes, especially when they are younger. Fortunately many employers are willing to work with people who have felonies on their backgrounds. This is especially true when those violations are old or for drug offenses that might not even be illegal now.

If you have a felony on your background and get hurt at work in Illinois, you have the same rights as any other injured worker. But if we are being honest, your case will likely be handled differently by the insurance company.

Fair or not, they are going to look at your case even harder than they do others and be very suspicious that you are lying. If your story changes, it might be hard for you to prevail. That is because when it comes to trial testimony, evidence of you being a felon can be used against you to argue that you are not trustworthy.

Again, this may not be fair, but it is the reality. It can especially be a problem if your conviction was related to fraud. That said, it’s just one factor used in assessing credibility. The older the case and the tighter the facts of your claim, the more likely it is, in our experience, that an Arbitrator will favor you.

For example, if you are claiming a back injury from being hit by a forklift on the job, if there is video of this accident and you have no prior back problems, your felony record should not matter much.

Recent Case Shows How Insurance Companies Act Toward Felons

Within the last year there was a case at the Illinois appellate court involving an injured worker with a prior felony. This case gives insight as to what you can expect. Below is a summary. Note that we did not handle this case.

Jerry Conner, a 52-year-old commercial truck driver, was injured at work when he tripped while placing a wheel chock, fell forward, and struck his shoulders and head. Following the accident, he experienced significant shoulder injuries, including a full-thickness rotator cuff tear, severe joint degeneration, and impingement. Despite surgery and other medical interventions, his shoulders did not improve, and he underwent a functional capacity evaluation, which showed he could not perform his previous heavy-duty job duties, especially tasks requiring work above shoulder height.

He also participated in vocational rehabilitation, where assessments revealed limitations in education, computer skills, and age-related barriers to employment. Over a period of two years, Conner diligently searched for alternative employment, applying to more than 1,500 jobs, but he was unable to secure work. His vocational counselor, Dave Patsavas, testified that given Conner’s physical restrictions, age, and experience, there were no suitable and stable jobs available, and fast food or retail work would require physical activity beyond his capabilities.

The arbitrator found Conner credible, noting that while he had a prior felony conviction unrelated to his work, it did not affect the validity of his medical or vocational records. The arbitrator concluded that Conner’s efforts to find work were diligent but unsuccessful, and considering his age, work restrictions, and lack of suitable employment opportunities, he qualified as permanently and totally disabled. The Illinois Workers’ Compensation Commission affirmed the arbitrator’s decision without modification, and the circuit court of Macon County confirmed the Commission’s judgment.

On appeal, the employer argued that Conner could have pursued fast food or retail jobs, but the appellate court held that the employer failed to show any suitable work was available, and the Commission’s finding was supported by the evidence. The appellate court concluded that the award of permanent and total disability was not against the manifest weight of the evidence and affirmed the decision.

What This Means

Basically there was no dispute as to how this worker got hurt and what the injury was. The employer tried to argue, it seems, that being a felon hurt his chances for finding work. That argument was rejected because of the severity of the injury and because it is not relevant. They hired him knowing he was a felon. They can’t avoid Illinois work comp laws now that he is injured.

The reality is that the evidence shows that his injury was honest, his job search was honest and him being a felon is completely irrelevant to his ability to find work. And in any Illinois work comp case, when the facts are on the side and we can show you are honest, you are likely to win.

Hand-Arm Vibration Syndrome (HAVS) and Illinois Workers’ Compensation

By Mike Helfand on Posted in Injuries

Many jobs require workers to use power tools or vibrating equipment every day. Over time, that constant vibration can cause a serious medical condition known as Hand-Arm Vibration Syndrome, or HAVS.

Hand-Arm Vibration Syndrome is a condition that affects the nerves, blood vessels, and muscles in the hands and arms. It develops after repeated exposure to vibration, usually from handheld tools. HAVS does not happen overnight. It builds up slowly, often over months or years of doing the same type of work.

One of the most common symptoms is numbness or tingling in the fingers. Some workers notice that their fingers turn white in cold weather. This is sometimes called “vibration white finger.” Others experience a loss of grip strength, clumsiness, or difficulty picking up small objects like coins or screws. As the condition gets worse, the damage can become permanent.

How HAVS Develops at Work

HAVS is most often caused by regular use of vibrating tools such as jackhammers, grinders, sanders, drills, impact wrenches, and chainsaws. The vibration from these tools travels from the hand into the arm and can damage small blood vessels and nerves.

The risk increases when workers use vibrating equipment for long periods without breaks, in cold environments, or without proper protective equipment. The longer and more often a worker is exposed to vibration, the higher the chance of developing HAVS.

Because the condition develops slowly, many workers do not connect their symptoms to their job right away. They may think their hands are just tired or that numbness is temporary. By the time they seek treatment, the condition may already be advanced.

Jobs That Are Higher Risk

Certain professions are more likely to lead to HAVS. Construction workers frequently use jackhammers and power drills. Factory and assembly line workers may use vibrating hand tools every shift. Mechanics often use impact tools. Landscaping and tree service workers may operate chainsaws and other vibrating equipment. Even some warehouse and manufacturing jobs involve long-term exposure to vibration.

Diagnosis and Treatment

There is no single test that proves HAVS, but doctors can diagnose it based on your symptoms, work history, and physical examination. Nerve testing and other studies may be used to rule out similar conditions.

Treatment usually focuses on stopping or reducing vibration exposure. This may mean changing job duties or using different equipment. Doctors may recommend medications to improve circulation or physical therapy. In more serious cases, permanent nerve or vascular damage can occur. The earlier HAVS is diagnosed, the better the chances of preventing long-term damage.

Illinois Workers’ Compensation and HAVS

Under Illinois workers’ compensation law, you are entitled to benefits if your job caused or contributed to Hand-Arm Vibration Syndrome. This includes 100% payment of medical bills, wage benefits if you cannot work, and compensation for permanent damage to your hands also known as a settlement. What your case is worth depends on a lot of factors including your wages and how severe the injury is.

HAVS cases are often disputed by insurance companies that argue that your symptoms are due to aging, diabetes, or another non-work-related condition. They may also claim there is not enough proof that your job caused the problem.

That is why it is important to speak with an experienced Illinois workers’ compensation attorney. A lawyer can help gather evidence, make sure your claim is properly filed, and represent you if your case needs to be heard before the Illinois Workers’ Compensation Commission.

If you would like us to help you find the best attorney for your case, please call us at 312-346-5578. There is no fee to talk to a lawyer and everyone in our state wide network has a track record of success.

Great Example of How Insurance Companies in Work Comp Operate

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

This is a new case, decided by the Illinois Appellate Court. Below is a summary. Note that this case was not handled by our office. But it really is a great example of how insurance companies in Illinois work comp claims will try to do anything possible to fight your benefits.

The Case Facts

Julie Bulow worked as a rental representative for AIM National Lease. One of her duties was performing “360 inspections” of rental trucks, which meant walking around the trucks and climbing in and out of them. On August 13, 2019, while inspecting a truck, she tripped over a parking block and fell. After the fall, she had pain and injuries in her left leg, ankle, and foot.

Bulow received medical treatment shortly after the accident and was diagnosed with sprains and bruising in her left foot and ankle. But her problems did not go away. She continued to have pain, swelling, numbness, and tingling in her leg and foot. Over time, several doctors evaluated her condition. Some believed she was suffering from Complex Regional Pain Syndrome (CRPS), a painful nerve condition that can develop after an injury. Others thought her symptoms were related to conditions such as tarsal tunnel syndrome or that her original injury had already healed.

The “Intervening” Event

During her recovery, Bulow attended a breast cancer charity event called the “Pledge the Pink” walk. The event involved walking long distances over three days. Her employer later argued that this event caused her later foot and ankle problems. Bulow testified that she had recently undergone breast cancer surgery and did not actually walk the full distance. Instead, she said she spent most of the time riding in a golf cart and did very little walking.
Bulow continued to receive treatment for her pain and eventually underwent pain management procedures. She later had a dorsal root ganglion stimulator implanted in her spine, which helped reduce her pain and improved her ability to function.

The Court Decisions

An arbitrator with the Illinois Workers’ Compensation Commission found that Bulow’s ongoing leg, ankle, and foot problems were caused by her workplace fall. The arbitrator believed the opinions of her treating doctors and found her testimony to be credible. The employer appealed, but the appellate court mostly agreed with the Commission.

The court ruled that the charity walk did not break the connection between her work accident and her medical condition. It also confirmed that the employer was responsible for reasonable medical treatment related to the injury. However, the case was sent back to the Commission to remove medical charges related to shoulder therapy and to determine the correct amount of medical expenses that were actually paid.

My Take

Basically this woman had a very bad leg/ankle/foot injury. It was so bad that she really should not have been doing any walking on it. But that does not mean that she did not have the right to live her life.

She is a breast cancer survivor and wants to support a breast cancer charity. So to me it sounds like she is a good person. The insurance company appears to assume that by going to that event, she must have ignored doctor’s orders and made her problem much worse.

This is what insurance companies will do. They will make assumptions or throw things against the wall to see if it sticks. All of this is done without care for what is best for the injured worker. Fortunately she had a credible excuse. She was there supporting the event and mostly was riding in a golf cart.

In the end, she deservedly won the case. It is a shame that her benefits and care got delayed in any way because the insurance company was playing games. I can only hope that the case results in a humongous settlement or court award to compensate her for everything she has gone through.

Post Surgery Complications and IL Work Comp Law

By Mike Helfand on Posted in Injuries

I was in a year round Christmas store recently. They had a lot of fancy Christmas ornaments and other items. Many or these were made of glass or otherwise appeared very fragile. In every section of the store was signage that said, “You break it, you buy it.” Some of these items were really expensive and I walked very gingerly throughout the store. It was almost a relief to get outside unscathed.

You break it, you buy it can apply to a lot of areas of life. That includes Illinois workers’ compensation law. A recent caller to our office is a great example why.

Long story short is that she had a lifting injury resulting in a hernia that required surgery to repair it. That part of the case and surgery went fine. The problem was that there were post surgery complications including blood in her urine, diverticulitis, and severe intestinal pain.

The work comp insurance company is balking at paying for additional treatment for her for these post surgery complications. The problem for them is that the saying of “you break it, you but it” applies to Illinois work comp cases too.

In other words, any injury that stems from the original injury is part of the work comp case. That means that any post surgery complications that would not have happened without the surgery are part of the work comp case.

So all of the medical care that is related to this should be covered by work comp insurance. They are trying to argue that she had diverticulitis before this, but the reality is that it was not something that required any medical care in any way for years for her. This surgery triggered the need for additional care. It’s just as much a part of the work comp case as the hernia injury itself.

And if for some reason this becomes a permanent, life altering injury, they will have to pay for that too. As long as your problem can be traced back to the original work related injury, it is all a part of one case.

This scenario is a lot more common than you think. It might not always be an intestinal injury, but could also be PTSD, arm injuries from being placed in a weird way during surgery, foot drop from a spinal surgery, sepsis from infections during surgery or even death.

The job of the insurance company is to look out for their bottom line. That is why they fought this case and will usually fight any similar situation. They are hoping that you as an injured worker will not know your rights. But the reality is that they do not usually have much to stand on when push comes to shove. They will need a credible doctor to state that the surgery did not result in these other problems needing medical care. That is a huge hill for them to climb.

So if this happens to you, do not stress. It is a solvable problem and one we would love to help you with. Please call us any time for a free case review at 312-346-5578.

Amazon Vendor Tries To Deny Injured Worker (and Loses)

By Mike Helfand on Posted in Tips if Injured

One thing we do as Illinois workers’ compensation attorneys is constantly read case law on newer cases. Every month there are new decisions at the Illinois Appellate Court. Sometimes these decisions change what the law is, or at least how it is interpreted. Other times these cases provide a road map on how similar cases should be decided in the future.

I do not always agree with these decisions, but most of them make sense. That is certainly the situation on a case that was decided this year for an injured worker who was hurt in August of 2023.

Side note. A lot of Illinois work comp attorneys lie to their clients and claim that if you go to trial it will take forever. I often hear that some attorneys tell injured workers that just going to trial will take 2-3 years. In this case, the worker got hurt, went to trial, won within a few months of getting hurt and the appeal was decided a few months after that. There were two more appeals which is why the case was not finally resolved until this year, but a normal trial does not take very long to happen if your attorney fights for you.

Here is a summary of the case:

Jose Avila was working as a delivery driver for I Deliver Logistics, delivering Amazon packages. While driving in Aurora, another driver cut him off. Avila honked and made gestures. The other driver got out of his SUV, approached Avila’s truck, and punched him. A short scuffle followed.

Avila got back in his truck and drove a few blocks away to make his next delivery. About four minutes later, the same men followed him, jumped him from behind while he was delivering a package, badly beat him, and stole his chain. He suffered facial injuries, broken teeth, a broken nose, headaches, and PTSD. He needed medical treatment and was taken off work.

An arbitrator awarded him workers’ compensation benefits, finding the attack was a “street risk” of his job as a traveling employee. The employer appealed, and the Workers’ Compensation Commission reversed, saying Avila was the aggressor and caused the fight.

The circuit court disagreed and reinstated benefits. The Appellate Court agreed with the circuit court.Even if Avila acted angrily at first, the video showed the other driver threw the first punch. More importantly, the second beating happened minutes later, after Avila had driven away and returned to work. The attackers chose to follow and assault him again, which broke any connection to the earlier argument.

The court reinstated his benefits and sent the case back to the Commission to decide whether penalties and attorney’s fees should be awarded against the employer. Eventually this case settled because the insurance company had no other choice.

My Thoughts On This Case

This is clearly the right decision. It can be expected that if you drive around for your job, you will encounter other drivers. Some of these drivers will be assholes or criminals.

These crazy drivers attacked him. He was injured. The argument against him was that he started it by making gestures. That is nonsense. The attack happened after he left the scene and these people chased him down. They clearly were the aggressors.

What is nuts about this case to me is that aside from it being so clearly a compensable case, his injuries were not that big. They likely spent almost as much on fighting the case as they paid for the settlement. They probably thought that an attorney would not spend time fighting a case like this and fortunately they were wrong.

The key point is that you need to have an attorney in your corner who is both aggressive and willing to go to trial. The attorney could have given up after the original decision was reversed, but they kept fighting because they knew their client was in the right.

Reddit Legal Advice On Illinois Workers’ Compensation

By Mike Helfand on Posted in Tips if Injured

Although a lot of people are going to ChatGPT for legal advice and getting bad information. This isn’t a new phenomenon. People have always gotten legal advice from friends, family, neighbors, co-workers, etc.

And in the last few years, getting legal advice from Reddit has become very popular. Makes sense because an injured Illinois worker can be frustrated and has nothing to lose by reaching out online. Or at lease they do not realize they do because these non-lawyers are very often wrong.

You can look through these posts here. Here is a random one that was posted that I picked.

I spent 14 months in physical and emotional limbo after my body took a beating as a ramp agent, and I’m beginning to wonder if reporting my injury was a mistake given how I’m being treated. Despite undergoing a major left shoulder surgery involving a biceps tenodesis and four anchors, and struggling with a second shoulder injury that the company is trying to dismiss, the IME has hit me with a “0% permanent restriction” rating that feels like a bad-faith setup to force me back and fire me. My own doctor warned me to get legal representation because the system is treating me like a criminal rather than an injured employee. This has completely stalled my life; I’ve been married for three years but remain stuck in a long-distance relationship, unable to move or even feel like a husband because I am so physically and financially limited.

It’s not that the responses to this person are awful. Some are offering prayers. Some are discussing their cases which doesn’t really help this guy, but at least it makes you feel like someone understands. But there are two problems that stick out.

First is that he mentions getting a 0% impairment rating. That is completely irrelevant in Illinois and does not impact what the case is worth at all. Years ago Illinois work comp law was changed to make impairment ratings a factor that could be considered in settlements. In reality it is not used and has not changed what cases are worth in any way.

In other words, do not lose sleep over a hack IME doctor giving a fake rating. It won’t hurt you.

The second issue is that the obvious solution, which even his doctor mentioned, is to get a lawyer. It is free and will solve his problems. With all respect to the commenters, the reality is that is the best advice a non-attorney can give. It sounds self serving for me to say that, but it is true.

If you were pregnant, I’d tell you take advice from an OBGYN. If your pipes are leaking, I would recommend you seek out a plumber. And if you have a legal issue, getting with a lawyer makes sense.

And for Illinois work comp cases, not having an attorney is crazy because it literally costs you nothing and can prevent so many problems. So if your goal of going to AI or Reddit or a friend is to get free advice, why would you not do it with someone who handles these cases every day?

The only risk in getting an Illinois work comp attorney is hiring a bad one. That is one reason we created a state wide network of top attorneys. We connect you with lawyers that other lawyers respect and that we as attorneys know have a great track record of success.

If you have questions and want a free case review or to discuss representation, please contact us any time. We will do whatever we can to help. I can’t guarantee a result, but do promise that the answers will be more accurate than Reddit.

Fractured Diaphragm and Illinois Workers’ Compensation

By Mike Helfand on Posted in Injuries

A fractured or ruptured diaphragm is a serious internal injury involving the large muscle that separates the chest cavity from the abdominal cavity and plays a critical role in breathing. This type of injury usually results from major blunt force or crushing trauma and is often associated with other internal injuries. It is not the most common Illinois work comp injury, but is one that we have helped with multiple times.

Because the diaphragm is essential to normal breathing, a rupture can quickly become life-threatening and often requires emergency surgery. When a diaphragm fracture happens because of a job-related accident, the injured worker qualifies for benefits under Illinois workers’ compensation law.

This post covers how these cases happen and work. If you want a free case review, please contact us any time. We help everywhere in Illinois.

How Do Diaphragm Fractures Happen at Work?

Diaphragm ruptures almost always stem from high-impact events. In the workplace, these injuries are typically linked to severe accidents involving force to the torso. Workers in construction, manufacturing, warehousing, transportation, and heavy industry face higher exposure, but any worker can suffer this injury if subjected to major trauma.

Common job-related causes include:

• Heavy equipment or forklift accidents
• Crushing incidents involving machinery or materials
• Falls from height with torso impact
• Vehicle collisions during work duties
• Structural collapses or explosions

It can also happen to people who drive for work from a car accident. What makes it unique is that it is almost never from a repetitive activity unlike most other Illinois work injuries.

Symptoms and Medical Complications

A diaphragm rupture is often difficult to diagnose at first because it can occur alongside other big injuries. Symptoms can include chest pain, abdominal pain, shortness of breath, and signs of internal bleeding. In some cases, abdominal organs can shift upward into the chest cavity, creating other complications involving the lungs and heart.

Diagnosis usually requires advanced imaging like CT scans and specialized radiology studies. Treatment commonly involves surgery to repair the tear, followed by hospitalization and careful monitoring. Recovery time can be substantial, particularly if there are related lung or organ injuries.

It is incredibly important for your health, not just your case, that you get to a doctor right away. Going to a local emergency room usually makes the most sense if you have these symptoms.

Medical Treatment Under Illinois Workers’ Compensation Law

If the injury happened while at work, workers comp should cover all necessary medical treatment connected to the injury. This generally includes emergency care, surgery, hospital stays, diagnostic testing, follow-up treatment, medications, and rehabilitation. The goal of the system is to ensure that an injured worker gets appropriate medical care without paying a cent out-of-pocket.

Because diaphragm injuries are severe and costly, insurance companies sometimes dispute medical the extent of “necessary treatment” or whether later complications are related to the original accident. Detailed medical documentation as well as an experienced attorney on your side are especially important in these complex cases.

Temporary Disability Benefits While You Recover

Most workers with a diaphragm rupture cannot return to work for a significant period of time. While you recover, you may qualify for temporary total disability benefits. These payments are designed to partially replace lost wages while your doctor keeps you off work. The amount is based on a percentage of your average weekly wage. Benefits should continue as long as you remain medically unable to perform your job duties or your employer can not accommodate your restrictions.

These payments are called TTD benefits and are 2/3 of your average weekly wage. They are also tax free.

Permanent Effects, Long-Term Disability and Vocational Rehabilitation

Some workers recover well after surgical repair, but others are left with lasting damage. Ongoing breathing limitations, reduced endurance and stamina, chronic pain, or complications involving the lungs or digestive system can interfere with a return to full-duty work. Whether you make an amazing recovery or have long term problems more compensation is available through a permanent disability award or settlement,

Long-term effects may include:

• Reduced lung capacity
• Chronic respiratory symptoms
• Permanent activity restrictions

If your restrictions prevent you from returning to your former job, work comp should provide vocational rehabilitation benefits. These services help injured workers reenter the workforce in a position suited to their current abilities.

Legal Representation Matters

Diaphragm rupture claims tend to involve extensive and expensive medical care. Because of this, insurance carriers are more likely to closely review these claims and often dispute them. An experienced workers’ compensation attorney can help coordinate medical evidence, address any questions brought up by the employer or insurance company, and handle all hearings and settlement negotiations.

Contact us for a FREE case review with an attorney who has substantial experience representing workers with serious internal and diaphragm-related injuries. An attorney with an understanding these injuries can literally make your case worth tens of thousands of dollars more. Call us at 312-346-5578 or complete our contact form.

Illinois Work Comp, Your IME May Be Rigged

By Mike Helfand on Posted in Benefits

I am a part of a group chat that hundreds of Illinois injury lawyers from across all fields are a part of. It is really helpful as we share information, discuss cases and how to best win them and generally work toward helping clients.

As part of this group chat, there was a conversation about who is the biggest hired gun IME. A lot of names were said, but there were three in particular that were heavily discussed.

If you are not aware, IME stands for independent medical examination. It gives the insurance company/employer the right to send you to a one time exam with a doctor of their choosing. That doctor is not there to give you medical treatment. They are there to offer an opinion as to what your injury is, is it work related and what future treatment and time off work you need if any.

For an overview of IME’s, here is everything we have written about it. Illinois IME Overview

In theory, this doctor should just give an honest opinion. Doctors are supposed to “do no harm” according to their oath. In reality, it is a big business for many of them. Some make more than seven figures every year from these exams.

Who Is The Worst IME Doctor In Illinois?

Most of the doctors who do IME’s are orthopedics. That makes sense because most work injuries involve treatment by orthopedic doctors. There is one in particular who was described in a bunch of colorful ways by various lawyers on this chat, including:

  • “He is a Whore with a capital W. Worst one around.”
  • “He does around 200 of these exams every year. I have seen around 75 reports from him and they all read the same. Only one time did he agree with the treating doctor.”
  • “I’m convinced he uses AI to generate these reports. They are so similar and have common mistakes associated with AI like messing up the actual surgery date.”

There were a bunch of other interesting comments to say the least.

The most relevant is that he pretty much never agrees with the treating doctor. If you ever have an injury and go for a second opinion, you will find that doctors tend to agree with each other’s findings over 90% of the time. That is because the treating doctor usually gets it right. And those doctors are only motivated to help you. IME doctors are motivated by their pocketbook. If they hurt hundreds of people along the way, they have their yacht and multiple homes to make them feel better.

So Am I Screwed If I Get Sent To One Of These Doctors?

The good news is that not only do lawyers know who the hired gun IME doctors are, but so do the Arbitrators who make rulings on Illinois workers’ compensation cases. They are not dummies and even ones that tend to lean toward favoring the insurance company do not usually give any credibility to these bad faith physicians.

The bad news is that an IME like this could be used to deny your benefits. It can take 3-6 months before you can get a trial hearing because your attorney has to take a deposition of your treating doctor and the IME. So it is certainly possible that your claim will be wrongly denied for a bit before you get a ruling in your favor.

And that is why insurance companies continue to use these doctors. They know that they have no credibility, but it gives them cover to act badly and put pressure on you. Their hope is that you will be financially desperate and need to settle your case too soon or forgo medical treatment that you need.

It is why having an attorney file the case BEFORE the IME is so important. We can be prepared to strike back quickly so any delay has minimal effect on your life. We also often have pre-trials before the Arbitrator if we know they are aware of how bad the IME doctor is so they can make clear to the defense attorney and insurance company that they are fighting a losing battle.

A good lawyer can also prepare you for the IME, including properly documenting what happened which will aid in taking that doctor’s deposition.

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If you have any questions or concerns about an IME or want a free case review, please call us any time at 312-346-5578. We have a state wide network of great lawyers and would love to help you.

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