There are many reasons to file a claim for Illinois workers’ compensation if you can, one of which is coverage of your medical bills. If your work injury qualifies for benefits, then your treatment, including recommended surgery, should be covered 100%. There should be no co-pays or out-of-pocket expenses for you to worry about.
The insurance company isn’t going to agree to cover every type of treatment out there, of course. Your treatment has to be reasonable and related to your work injury. This should include emergency room visits, medications, doctor appointments, lab work, physical therapy, and surgery, among others. Even if the law says it should be covered, however, the insurance company is going to look for a way to not cover it. That’s their job.
For example, the insurance company might deny coverage in cases where the treatment is unconventional or alternative, or where it’s particularly expensive. Your fate lies in the opinion of your doctor. It’s important to have a doctor you trust and who has a good reputation. It’s also important that you communicate well with your doctor about how you got injured and what your symptoms are and how they progress.
If the insurance company disagrees with your doctor, they can make you get an Independent Medical Exam from another doctor. If that doctor has a differing opinion then you might have to go to a hearing, with an arbitrator who is similar to a judge, to argue for your treatment. It’s highly recommended that you have an Illinois workers’ compensation attorney represent you at that hearing.
Along these same lines, you should never feel that you are being forced into a certain type of treatment or pushed into having surgery that you don’t want to have.
Unfortunately, the medical benefits that seems guaranteed under Illinois law are not always easily obtained. Get a good doctor, follow their advice and don’t talk to the insurance company (have your lawyer do that).
