I’ve blogged on this before, but it still comes up a lot and recently came up when I got a call from someone looking to know whether they should hire an Illinois work comp attorney or just give up and put everything through their group insurance.

In a nutshell, the injured worker hurt his knees years ago. He’s been fine and without treatment for years, but while breaking up a fight at school he hurt his knee.  He reported it right away and went to the doctor. His doctor wants him to have a MRI and discussed surgery.

The insurance company then told him that his case is denied because he has pre-existing arthritis in his knee.  They knew about this from a pre-employment physical. And it’s 100% irrelevant.

When he called me he wanted to make sure that it was OK to just use his own insurance to get the treatment he needs.  It’s not OK and there are a bunch of reasons.

1. This is clearly a work related injury.  If the group insurance pays and then realizes that they shouldn’t have done so, they could/will go after him for reimbursement.

2. Even if for some reason that doesn’t happen, he’d still have to pay out of pocket expenses.  That doesn’t happen when you have a workers’ compensation case.

3. If he does need surgery, he will miss time from work. If he doesn’t pursue work comp he’ll be without pay for a long time.

4. He’ll eventually be entitled to a settlement which would likely be in the five figures or more if he pursues workers’ compensation.

Beyond all of that, it’s just the right thing to do and it’s the law.  Having a pre-existing condition does not bar you from pursuing Illinois workers’ compensation benefits, especially when you haven’t had treatment for years and were doing just fine until the accident.

This is one of the worst insurance company lies, but it’s one that they don’t stop because too many workers just go along with it.  If you do, you have to realize that you are costing yourself a ton of money and putting yourself at risk for no income and a lawsuit for reimbursement of benefits accidentally paid.  It’s simply not worth the risk.