If the insurance company is playing games, such as denying your claim without a good reason and generally jerking you around, you can file what’s called a petition for penalties. Sections 16 and 19 of the Illinois Workers’ Compensation Act give workers this option when their TTD benefits are unreasonably denied or their medical bills aren’t getting paid.

A petition for penalties is a great tool for injured workers when they’ve been treated unfairly by the insurance company. The insurer can be forced to pay you what they should have paid in the first place, plus penalties. One penalty is paid to you personally, in the amount of 50% of the medical bills that the insurance company failed to pay. Another is forcing them to pay attorney fees, in an amount equal to 20% of the unpaid medical bills. There’s also a daily penalty on unpaid TTD benefits (temporary total disability) if the failure to pay was unreasonable.

If there is a reasonable basis for the denial of your claim or the refusal to pay your medical bills, then penalties might not be appropriate. In general, penalties are reserved for when the insurance company acts in bad faith. If they’re acting reasonably, even if you think they’re wrong, and even if the judge ends up ruling against them, the thing to do is go in front of the arbitrator and argue your case.

In both of these situations – when an insurance company is acting in bad faith, and when an insurance company is denying your claim for a reason – you can’t fight it alone. Having an experienced and reputable Illinois workers’ comp attorney will make all of the difference, especially if they have a good reputation with the arbitrator who will be making the final decision.

But the point of even filing a penalties petition is to let the insurance company know that if they lose and it’s because they acted in bad faith, they stand to pay way more than had they just done the right thing.  Otherwise, what do they care if they lose a trial?  They will have earned interest on the money they didn’t spend and other than their lawyer fees it won’t cost them any more.  So you have to be on the offensive and aggressive or they will walk all over you.

By Michael Helfand