A Warning For Injured Jewel Food Workers

By Mike Helfand on Posted in Benefits

For most injured Illinois workers, you get to choose your own physician if you get hurt on the job. If you don’t like that one you have a right to a second opinion. The work comp insurance company has to pay for both of these medical providers as long as the treatment is reasonable and related to your job injury. If you seek out a third opinion without approval or a referral from one of the first two doctors, you have to pay for that.

A few years back the law was amended to allow an employer to create a preferred provider program. Basically this states employers can create an exclusive list of medical providers if their program is approved by the Illinois Department of Insurance.  An injured worker can choose to treat with a medical provider who is not on the list. But doing this constitutes one of the two choices of medical providers. Their doctor is essentially your second opinion.  There aren’t too many companies who have created a preferred provider program in Illinois, but they are out there.

But even before that, a law was passed that until recently hadn’t been used and presents a warning for Jewel workers in Illinois.  The Illinois Workers’ Compensation Act has a big exception to workers choosing their own doctor in the “Panel of Physicians” provision. If a “panel of physicians” is in place by an employer, workers hurt on the job only treat with medical providers from this list, unless there are extenuating circumstances or a panel physician makes a referral to a provider not on the list.

The good news is that these panels can only be created if there is an agreement by the representative of the employees (e.g. a union) and it’s approved by the Illinois Workers’ Compensation Commission.

Why the Jewel union agreed to this is beyond me.  It really is not in the best interests of their workers.  That said, it’s there.  There are two major problems with it in my opinion:

  1. It can take away your choice as to which doctor you are treating with.  You might have an established relationship with a physician you think is great and know cares about you.  If they aren’t on that list, you can’t see them.
  2. If you don’t know about this agreement and get medical care outside this panel, you will get stuck with the bills even if your injury is work related.

Imagine if you hurt your right knee a year ago in a car accident and had surgery.   The surgeon did an amazing job and you made a quick and complete recovery. They checked up on you, got you the best room at the hospital, gave you their cell phone number for emergencies and were available for any questions. If you then hurt your leg again at work, doesn’t it make sense that you’d  want to see this doctor and they’d be the best choice for you?  Of course.  But if they aren’t a part of this panel, the only way you can see them is if a panel doctor turns down your business and gives you a referral.

Not all the doctors on this list are bad, but it doesn’t change the fact that you should have a choice over who cares for your injury. So if you are a Jewel worker, be careful. You don’t want to be hurt and stuck with a bill.  This agreement certainly puts you at risk.

If you have any questions about this or anything else related to Illinois work comp law, please contact us any time for free at 312-346-5578.

How Your Work Comp Case Can Be Accepted For A Year And Then Denied

By Mike Helfand on Posted in Benefits

We are Illinois work comp attorneys who care about our clients. Call us at 888-705-1766 to speak with a lawyer for free any time, or fill out our contact form.

Often in workers’ compensation claims, things happen that don’t seem to make sense or seem like they might be against the law. Often that is true such as when the insurance company tries to have a nurse case manager attend your doctor’s appointments.  That’s not allowed, but some of them act like bullies and will do this if you don’t stand up for yourself.

Other times something happens that seems wrong, but is actually allowed. The most common example is when you get hurt at work, your case is accepted, your benefits are paid, often for a long time and then they get denied. It’s not unusual for your claim to be accepted for a year or more and then suddenly you get a letter saying you have no case.

This usually happens when someone is hurt at work and the insurance adjuster takes their doctor’s word that it’s work related. Eventually a certain amount of money gets paid out on the case which in the insurance company triggers a review by a more senior person.  They do this because they don’t want to pay a lot on any case. This senior person will come up with a strategy which often involves sending the worker to an IME which is an appointment with a company chosen doctor who will evaluate you and offer an opinion on what treatment you need and if your injury is work related.

This doctor often is a hired gun who makes a ton of money by writing reports that benefit the insurance company.  If they do, the insurance company can deny your case.  They are not your doctor and they aren’t looking out for you.

So how is this legal if they’ve paid out benefits for a year or more?

Under Illinois work comp law, payment of benefits is not an admission of liability.  If they discover new evidence on your case such as you posting on social media that you really weren’t hurt at work, they can cut you off.  And as shady as it may seem, their IME is new evidence which can be used to deny a case even after it was initially accepted.

A recent caller to our office had been receiving benefits for about 18 months when his shoulder injury got denied after an IME who said the injury was from something that happened ten years prior.  It’s a ridiculous reason to deny a case, but it is allowed under Illinois law.

The good news is that it’s a solvable problem. Arbitrators at the Illinois Workers’ Compensation Commission aren’t stupid.  They know who the hired gun doctors are and they don’t usually give much weight to their opinions, especially when your treating doctor is reputable.

Quite honestly, this is one big reason to have a lawyer even when the case is accepted.  You’ll have someone who can prep you for the IME and if your benefits do get cut off, getting before an Arbitrator will happen much faster.  Prepare for the worst and hope for the best is our motto.

Do I Even Need A Workers’ Compensation Lawyer?

By Mike Helfand on Posted in Tips if Injured

One thing about our law firm that makes me proud is that people who read this blog seem to feel that we are approachable. I want you to know that you can always call us to speak with a lawyer for free.

We are experienced and honest and will bluntly tell you what we think about your situation, if you have a case and what you should do.

A common statement we hear from people that “Everyone is telling me that I should get a lawyer.  Do I even need one?”

I’m probably one of the few attorneys who will tell you when you don’t need a lawyer.  If it’s a minor injury then a lawyer likely won’t add a ton of value for example.  On the other hand, with bigger injuries it’s usually a good idea to at least have a conversation about it.  Here are some of the reasons:

  1. It costs nothing up front to hire an attorney. So waiting until something seems to go wrong doesn’t save you any money.
  2. You might think the insurance company is being nice or that everything is alright because you are getting paid, but you might getting taken advantage of and not know it. Some shady things the insurance company will do that shouldn’t happen are to ask for a medical release of all of your medical history, have a nurse case manager talk to your doctor directly, record conversations with you or ask irrelevant questions about old injuries. They are essentially doing whatever they can to come up with a reason to cut you off even when they seem nice.
  3. If you wait until your benefits are cut off before getting an attorney, you will likely delay justice by a couple of months as the lawyer has to gather records and investigate your case.
  4. Insurance companies sometimes cut off benefits for no good reason at all. Sometimes when you have a lawyer on the case they don’t play games because they know they can’t get away with it, especially if your attorney has a reputation for fighting for their clients.
  5. Getting a lawyer isn’t bringing a lawsuit.  Work comp is a claim for employee benefits and we make sure you get what you are legally entitled to under the law.
  6. In almost every instance, you will get more from a settlement with a lawyer than without even after their 20% fee.
  7. Experienced Illinois work comp attorneys know the right doctors for your injury and who are insurance company hired guns.  You’d never think that choosing a doctor could destroy your case but it happens.
  8. If your injury is serious, at some point the insurance company will send you to an IME which is a doctor of their choosing. Not having a lawyer prep you for that is a huge risk.
  9. There is no requirement that an insurance company make you a settlement offer but if you get a lawyer they will.
  10. Having an attorney in many ways is a security blanket.  You are protected if something goes wrong, you have someone to ask questions or and you don’t get taken advantage of.

I get why people wouldn’t want a lawyer. Most sane people don’t want any situation in their life when they need an attorney.  It would be nice if insurance companies did the right thing at all times and followed the law, but the reality is that doesn’t happen. They are in it to make money and they do that by paying as little as possible to you.

So is it required by law to get an attorney when you are hurt on the job in Illinois?  No. Is it safe and smart?  Absolutely.

If you aren’t sure what to do or just have questions, fill out our contact form or call us at 888-705-1766 to talk with a lawyer for free.

Bonus Compensation And Average Weekly Wage For Work Comp

By Mike Helfand on Posted in Benefits

Under Illinois workers’ compensation law, the amount you get paid for your time off work and your settlement is based on your average weekly wage (AWW).  If you make $20 an hour and work 40 hours a week, your average weekly wage is $800. It’s not usually complicated. If you are salaried, we divide your salary by 52 weeks.

The goal is for your AWW to be is high as possible.  We want you to get every penny you are legally entitled to.  While the wage calculation is straight forward in most cases, in others it’s not.  This is true when there is bonus compensation.

The good news is that the lines on this issue are getting less blurry thanks to a recent court case.  Ironically it’s all thanks to an insurance adjuster for Zurich Insurance. In her job as a claims handler, she was injured while attending a mediation when a door hit her shoulder and back.  As part of her claim she argued that her bonus compensation should be included in her average weekly wage.

At trial she testified that she had job duties which included a diary management system that measured performance. Every month she met with her manager to discuss how much money they had recovered versus their goals. How well she did or didn’t do affected her compensation.  Failure to complete a diary on time had negative financial implications for her. Her work was clearly part of an incentive-based pay program.

When part of your bonus is a result of incentive payment, it should be included in your AWW calculation.  This case made me smile because work comp insurance companies like Zurich spend a lot of time and effort trying to limit how much compensation injured workers receive. In this case it was one of their own insurance adjusters they were trying to screw over and ultimately their improper actions have helped clarify what the law is.

For you, as an injured worker, if your bonus is at all a result of your performance (as compared to everyone getting the same holiday bonus for example) then we’d argue that your work comp payments should be based on that money.  This means more money in your pocket so it’s important to get it right.

The lesson is that if an insurance company will not do the right thing for one of their own adjusters, you can’t expect them to do the right thing for you.  If you’d like a free consultation with an attorney to discuss what your wage should be or anything else about your claim, please fill out our contact form or call us at 312-346-5578.  We cover all of Illinois.

When You Know You Will Fail A Work Comp Drug Test

By Mike Helfand on Posted in Tips if Injured

Even though marijuana use is legal now in Illinois, it hasn’t changed the fact that if you test positive for drugs or alcohol after getting injured on the job, it can cause problems for your workers’ compensation claim.  You still have a right to bring a case, but you have to prove that you weren’t impaired when you got hurt. In some cases that is easy in others it isn’t. It all comes down to the facts of how you got hurt.

Most people know that they are going to fail a drug test given how long marijuana, cocaine and other drugs stay in your system. So most of the calls we get are from recently injured workers who are worried the drug test will take away their rights.  The good news is that it  won’t in most cases, but it will potentially delay things.

What you can’t do as an injured worker is try to game the system.  Any idea you might have of how to get around work comp rules has been thought of before and blown up in the face of injured workers.  Illinois work comp cases don’t have to be perfect and when you stop being honest you can mess things up.

A recent example of this was a really nice guy who called me after a shoulder injury when he was lifting heavy materials above his head.  He smokes marijuana for PTSD and knows that he will fail the drug test. He went to the ER after he got injured, but hadn’t yet told his boss what happened.  His plan was to take vacation pay for a week, not used drugs and then report the accident when he got back.  He expects the drugs will be out of his system by that time.

While he might not fail a drug test with this strategy, he’s going to create a whole set of new problems.  While technically he has 45 days to report a work accident, the fact that he’s turning it in after a surprise vacation will be really suspicious.  The insurance company will immediately think he got hurt away from the job.  If he points to the ER report that might help him, but then it will make it suspicious that he didn’t report it instead of take vacation.  Their inability to take a drug test of him right after it happened may now be a defense to the case.

In this situation, the truth was her got hurt on a Wednesday and last smoked marijuana the Sunday before. He was obviously not impaired and although he was working alone when he got hurt, he had lunch with two co-workers who could testify that he was acting normal. Beyond that, the accident happened just after lunch and he had been performing the same job all day.  The job was so heavy duty that doing it impaired would be really hard.

In other words, with a couple phone calls and letters, even if the failed drug test caused his case to get denied, we likely could get benefits reinstated.  And if that didn’t work, a trial would almost surely go in his favor and could happen relatively quickly.

So if you know that you will fail a drug test, it’s ok and you don’t need to freak out.  What you can’t do is make your situation worse by trying to game the system.

If you have questions about a drug test or anything else related to Illinois work comp law, contact us at 888-705-1766.

Illinois Workers’ Compensation Settlement Tips

By Mike Helfand on Posted in Benefits

Most people we talk to about their Illinois work injuries will at some point have questions about a settlement.  Here are some questions we’ve received recently that were great and we think people would want to know about.

Is the first settlement offer ever the best offer?

When insurance companies make settlement offers in work comp cases, it happens after they’ve made an internal decision as to the most a case is worth.  An adjuster or their lawyer will be given a maximum amount of settlement authority.  So if they are told that the most they are allowed to pay on your case is $100,000.00, there is no way they will offer that much on the first offer.  They want to have room to negotiate.  They also often get a bonus or other incentive for staying under that top number.  It’s not an amazing settlement strategy so I would never recommend that you just take the first offer without countering them.

Is there a formula used to calculate what my case is worth?

Yes and no.  Yes, we determine your average weekly wage to establish your permanent partial disability (PPD) rate which is part of what your case will be worth.  And yes every body part has a maximum value of what an injury to that body part can be worth. But every case is different so there is no plug-in formula for saying how much you will get paid.  It’s all negotiable and there are a variety of factors that make a case worth more, the main ones being the treatment you’ve had and the recovery you have made.

I heard that Gallagher Bassett pays less than other insurance companies. Is that true?

No. Gallagher may fight cases hard, but so does Travelers, ESIS, The Hartford, etc. There is no insurance company or employer that worries us more than any other or affects what your case is truly worth.

If I take my case to trial am I able to settle it at a later date?

Yes.  This happens a lot, especially when a worker is permanently disabled or has a wage loss that leads to wage differential benefits being paid.

Is there a limitation on carpal tunnel settlements?

Yes, there can be if you made a full duty release recovery. In those cases, the most your case can be worth is 15% of the hand.  If you have any permanent restrictions it can and should be worth more.

When will workers comp offer me a settlement?

They don’t have to ever offer one which is one reason why you get a lawyer. If they do offer it, it shouldn’t happen until you are discharged from medical care.  Lately, though we see insurance companies trying to take advantage of people desperate financially due to Covid and making offers long before medical treatment is up. Don’t take those offers because if you do, you won’t be able to get medical care at their expense anymore.

If you have any questions about settlements or anything else related to Illinois work comp law, please call us at 312-346-5578 to speak with a lawyer for free.

Is It Even Worth It To Switch Lawyers?

By Mike Helfand on Posted in Tips if Injured

If you have an Illinois workers’ compensation case, you don’t want to hire the wrong law firm. Unfortunately, you usually won’t know you made a bad choice until you’ve signed the paperwork and the case has started.

The good news is that it costs nothing to switch attorneys.  The bad news is that in some cases a lawyer won’t want to take over your case.  A recent caller had a terrible law firm on her case.  Her question to me was a good one. She asked, “Is it even worth it to switch lawyers?”

What she meant was, will anything even change?  In her case, the answer was yes because even though the case was filed only a month or so ago, she’s already had three phone calls, out of four total, not returned.

With Covid and a lot of law firms working remotely, we’ve seen lawyers that usually give so-so service give terrible service.  They don’t have their secretaries or clerks there nagging at them to call someone back.  They have the distractions of home of a TV, spouse, kids, etc.  The people who suffer are their clients.

So when isn’t it worth it?  Well, every case is different, but we avoid taking over cases when:

  • There’s a really big settlement offer and it’s not clear the case is worth much more.
  • You’ve had multiple lawyers already.  If the first one you hire is bad, you better make sure the second one is the right fit.  We will consider being the third lawyer on a case, but there would have to be a good explanation as to what went wrong.
  • The case has gone to trial.  If you are waiting on an Arbitrator’s decision, there’s nothing a new lawyer can do to speed up that process. If the case is on appeal, it’s better for the attorney who tried the case to handle that.

Those are the biggest situations when it wouldn’t be worth it to a lawyer or likely to you.  So when is it worth it:

  • When your lawyer doesn’t call back.
  • When you discover your attorney has been lying to you.
  • When the lawyer doesn’t do what they say they will.
  • If you discover a conflict of interest.
  • If the attorney yells at you or belittles you.
  • When your attorney leaves the firm and they try to replace them with a young, inexperienced attorney.

We are unique in that if you call us, we’ll talk to you for free and give you an honest opinion about if you have a good firm and if it’s worth it to switch or not. Contact us any time for a free consultation.

Illinois Work Comp When You Own The Company

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

First things first.  We are for injured workers only. We don’t advise or represent employers or insurance companies. If you ended up on this page because an employee got hurt, we are the wrong firm for you if you are looking out for the employer’s interests.  The only advice we can give you is to call your insurance company.

Now that that is out of the way, in most businesses, the owner of the company is also an employee.  Sometimes they are suits sitting in an office and other times they are in the thick of things with their workers. Inevitably, they will also get hurt, especially when they do heavy duty work.

The owner of a construction company called me recently after getting a hernia from a big day of lifting on the job.  He’s facing surgery and understandably doesn’t want to pay for the out of pocket costs if he doesn’t have to.  He was filling out a form and saw the case would essentially be him vs. him. That didn’t make sense to him so he called to see if he can even bring a case.

The answer is that it depends on what decision he made when he got insurance.  Owners of at least 5% of a company in Illinois can opt out of workers compensation coverage.  They usually do it because insurance rates are based in part on the wages of employees. If the owner earns more than anyone, opting out could save them short term money. Of course long term it will cost you much more if you get hurt.

I usually advise only white collar workers who aren’t in industries where injuries often occur to opt out.  But even then if you travel a lot, you are really at risk.

The good news for my caller is that he did not opt out.  That means he will be treated like any other worker when it comes to bringing a case. He can get 100% of his medical bills paid, compensation for his time off of work and a settlement.  The only slight difference is that he’d normally be the contact person they’d speak to when investigating a claim.  Obviously he’s not going to say anything that would hurt his case.  So the job of the insurance company is slightly harder, but that’s not his problem.

I’ve actually seen cases where owners filed claims that I thought might be fought, but the insurance company appeared to roll over because they didn’t want to lose the business of the company.  That’s not how it should work, but it is how it really works which is all that matters in the end.

Would You Keep This Illinois Workers Compensation Attorney

By Mike Helfand on Posted in Tips if Injured

One thing that makes us unique is that we have created a state-wide network of experienced lawyers who do a great job for their clients, fight for them, and deliver great customer service. It’s not a group anyone can pay to join. Its attorneys I’ve gotten to know in 24 years of being a lawyer that I think do a good job. This makes us stand out because as a Chicago law firm, we aren’t trying to handle a case in southern Illinois no matter how good of a case it is. We know your best interest is to get a lawyer down that way and we will connect you with a great attorney that we trust.

If an attorney stops doing a good job they get booted from the network.  I would never recommend a lawyer to you that I wouldn’t suggest to a family member or friend. Sometimes attorneys get jaded or burned out or have life circumstances like a divorce that affects their work.  Injured Illinois workers shouldn’t suffer because an attorney is having personal issues. And sometimes I realize I was just wrong about a lawyer.

This happened about ten years ago. I had gotten to know a southern Illinois work comp attorney through a case we were on together and from seeing him on other cases at the Illinois Workers’ Compensation Commission.  We seemed like-minded and years later when a downstate worker came to me looking for advice I suggested him.

Long story short, I learned that he was not honest and did not treat clients the way I think they should be treated. I hadn’t thought of him for a long time until I got a phone call from a downstate worker with a serious injury. It turns out that she already had a lawyer and it’s this attorney that I know is garbage.  Here is what she told me about him:

He’s being a jerk to me, refusing to give straight answers about my case, and otherwise being non-responsive.

So while I tell people to work it out with their lawyer if they can, here’s a case where I know the attorney sucks and the client knows they suck.  With all of that though, she still wasn’t sure that she shouldn’t give him one more chance.

Once you’ve had one terrible lawyer, it’s easy to assume that all attorneys are that way.  I get that.  But I promise you that for every awful lawyer out there, there are two great ones.  It costs nothing to switch and you won’t owe money to your first lawyer for firing them.

When a lawyer yells at you, acts like a jerk, won’t answer questions, etc., they are being abusive to you.  You shouldn’t stay with someone who is being abusive and no matter how much they try to intimidate you, there is a way out from how they treat you.

So whether it’s finding the right attorney at our firm or from some other source, I highly recommend that you advocate for yourself and find someone who cares as much about your case as you do.

If you have any questions or want to speak to an attorney for free, call us at 888-705-1766.

 

 

Should You Settle Your Workers’ Compensation Case?

By Mike Helfand on Posted in Benefits

We are experienced workers’ compensation lawyers who will talk to you for free.  Call us at in confidence at 888-705-1766 any time or fill out our contact form.

One question I occasionally like to ask is what is something that is well known by Illinois work comp attorneys that their clients don’t know. There is a lot that could go on that list, but near the top would be that you don’t have to settle your case, and sometimes you shouldn’t.

While an insurance company doesn’t have to make a settlement offer, they can almost always be forced to.  If they don’t, you take your case to trial and assuming you win, you get paid that way. In most cases, we recommend that clients settle because it’s usually more money, quicker, and a sure thing.

But that doesn’t mean you should settle or want to.  If your lawyer thinks your case is worth $75,000.00, and they are only offering $50,000.00, it’s likely worth it to go to trial and get that extra $25,000.00. If there are a bunch of medical bills not being paid and you can prove they are reasonable and related to your work injury, going to trial might be the best option.

And there is the best reason to go to trial that too many lawyers don’t discuss with their clients. In Illinois workers’ compensation claims, if you go to arbitration and win, you keep your medical rights open for life as relates to that injury. If you had a fusion not settling might be a good idea. If you had a knee replacement, you might want to keep your medical rights open. You can get compensation for future medical care when settling too, but in some claims, you want to go to trial just to be safer.

The bottom line is that the power is yours and the decision should be yours.  Your lawyer should lay out the pros and cons of arbitration and settling. They should make a recommendation, even a strong one, but at the end of the day, it’s your case, your life, and your call.

Shockingly, a lot of law firms will tell their clients that they won’t go to trial and say settling is the only option. I get why some lazy lawyers don’t want to do the work, but that’s their job and why you hired them.  It’s not like a work comp case lasts for weeks. At most it’s two doctor depositions and then a day of your testimony.  If they don’t want to do this work they should find a new line of work.

 

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