In Illinois workers’ compensation claims, sometimes you have a good-faith disagreement as to whether or not a case is compensable or benefits are owed. Maybe you were treating with a doctor for a similar problem before you got hurt. Perhaps they sent you to a credible IME doctor who doesn’t think your condition is work-related. Maybe a witness told a different story than you about what happened. None of these disputes are issues that can’t be overcome. You take your case to trial, present your evidence and let an Arbitrator decide. That is what they are there for after all.
Other times benefits get denied for no reason at all. Maybe you get a letter in the mail that said they did an investigation and determined your case isn’t compensable when that’s just not true. Maybe they just ghost you and don’t return calls. Maybe your case is accepted but it’s taking months to get medical procedures approved or your TTD checks are late all of the time and you are about to lose your house.
I’ve talked to many injured workers to whom this has happened, and they are understandably beyond frustrated. It’s one thing if a check is late once or you can’t get into your first physical therapy session. It’s a completely different story when it happens all the time over many months or years or when you are in terrible pain because they won’t call back your doctor to approve payment for a simple procedure.
So the question we hear a lot from these justifiably angry injured workers is, “Can I sue the insurance company or the adjuster?”
The answer unfortunately is that you can’t. It’s simply not allowed under Illinois law and the Illinois Workers’ Compensation Act. You can’t sue the employer either for these delays and it’s not considered negligence. I wish the answer was different.
So does that just mean they can get away with it?
Absolutely not. Under the Work Comp Act, when the insurance company acts unreasonably, we can file a petition for penalties and attorney fees. While this isn’t a lawsuit, it’s a request that the Arbitrator acknowledge the bad faith and unreasonable actions of the insurance company and punish them for it. Depending on how bad their behavior is, this could put tens of thousands or more extra dollars into your pocket.
To make this happen though, you need a fighter as your lawyer and that means someone who will prepare the case for trial and take it to trial. Without a trial, there isn’t a hearing on any petition for fees and/or penalties.
I will say that it’s often weak attorneys who won’t push back whose clients get hurt most by this bad behavior. Often a stern phone call is enough to get them to stop playing games. Other times, an experienced attorney has a good relationship with the adjuster or opposing attorney and can get things straight so you don’t get a raw deal.
Big picture, you can’t sue, but you can punish them if they are out of line which is presumably what you wanted to do with a lawsuit anyways. So it’s not called suing, but in the end, the effect can be the same.