A really nice guy called me. To say he was being screwed would be an understatement, but fortunately it’s a way that is so blatant that it will be an easy fix.
Long story short is that he got injured at work and the case was accepted. All his bills were paid, all his time off work was taken care. He was scheduled for surgery and was told to cut back on his insulin the day before the surgery by the nurse for the surgeon. His blood sugar spiked and he was not able to have the surgery. The doctor re-scheduled.
As insurance companies tend to do, they went from being reasonable and accepting the claim to telling him that since his diabetes is the reason he can’t have surgery, he needs to go on long term disability and will no longer receive workers’ compensation benefits.
There is a well established Illinois law that essentially says your employer takes you as they find you. In other words if you have diabetes or a heart condition or are allergic to anesthesia or anything else, too bad for the insurance company. The fact that his diabetes caused the surgery to be delayed is legally irrelevant. He should absolutely be receiving TTD benefits still and we referred him to a lawyer in our network who will make that happen.
Beyond all of this, while you can be forced to do non-invasive medical care like physical therapy, checkups, etc., you can’t be forced to have surgery. He could have shown up on the day of the operation and said, “Yeah, I changed my mind, not doing this” and the employer would have to either find him work within his restrictions or keep paying TTD benefits. Not every law in Illinois is common sense, but this one sure is. It’s your body so you get to choose what happens to it. Can you imagine if an insurance company was allowed to make you have a neck fusion or something life altering like that? It would be terrible and chaos.
I really have no idea why an insurance company would act this way. I think that every worker who has more than a minor injury should get legal representation to prevent games like this from happening. In this case the worker had no intention of getting a lawyer until he realized their unethical behavior gave them no choice. He probably never would have gotten legal representation otherwise and would have settled the case for way less than it was worth had they just done the right thing.
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