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A rather flustered and recently injured Illinois worker called me with a very direct question. “How does workers’ compensation work in Illinois?” they asked.
They were flustered because they had been recently hurt on the job, and nobody is giving them answers. It’s a straightforward situation (they were hit by a forklift), but in the one call with the insurance company, they were told that the case was under investigation. That’s insurance company speak for, “We are going to jerk you around.”
So how does workers’ compensation work? It’s a very good question if you’ve never experienced the system before.
The first thing that happens is that a worker gets hurt while working or realizes that an injury they have is due to the repetitive nature of their job.
Step two is to get medical treatment. In almost every case you can choose your own doctor and you certainly can go to any ER you want. That treatment should be 100% paid for by the work comp insurance for your company. Be honest. Tell them what happened. And get a diagnosis.
Step three is to make sure your employer is notified of your accident/injury. If your boss sees you get hit by a forklift, that’s them having notice. If you are alleging carpal tunnel from typing all day or they didn’t see you get hurt, you have to report the claim to them, in writing or verbally. We recommend that you do both and document it.
After that, it really comes down to what your doctor says. If they say you need to be completely authorized off work due to your injury, you are entitled to 2/3 of your pay, tax-free. The same is true if your doctor gives you restrictions that your employer can’t accommodate such as no typing or no lifting more than 10 pounds. This payment for being off work can last as long as it takes for you to get better.
You can continue to treat, at no expense to yourself, for any medical condition that is related to your claim as long as the care is reasonable. For us, we highly recommend that our clients get referred to reputable specialists such as orthopedic doctors and trust their guidance. If you want a second medical opinion, you are usually entitled to that too.
When you are all better or as good as you are going to get, you may be entitled to a settlement. The value of that depends on your injury, treatment, recovery, wages, age, job history, any potential defenses to your case, and other things.
In between getting hurt and the case getting settled, you must be on the lookout for insurance company games. Our caller had experienced one already when they were told the case was under investigation. Here are some other things to look out for:
- Drug tests. They have a right to make you take one and if you refuse it could end your case. But just because you fail a test doesn’t mean that you lose your case. It means you have to prove that you weren’t inebriated when you got hurt which can be done by your testimony.
- Recorded statements. It’s not uncommon for the “investigation” to mean that the adjuster wants to ask you questions in a way that could cause you to lose your benefits. You don’t have to take part in telling them anything, certainly not in a recording. We highly recommend that you refuse to participate if asked and once you have a lawyer the insurance company can’t talk to you directly.
- Independent Medical Examination (IME). This is a one-time medical exam at the request of the work comp insurance company. They pay for it. The doctor is usually working for them, not looking out for you. It can be used to get an opinion, even if it’s absurd, that can be used to deny your case. Often these exams last less than five minutes.
- Surveillance. If your injury lingers, the insurance company at any time can pay a private investigator to follow you around and film you. Their goal is to catch you doing something that your doctor says you shouldn’t do. If you are honest and follow your doctor’s restrictions you’d think nothing could go wrong. But stuff happens like you are feeling good one day and decide to pick up your kid and carry them. Next thing you know your benefits are cut off because you lifted more than you should.
When benefits are wrongfully denied, that gets resolved by either having your lawyer convince the insurance company they are wrong or by filing for arbitration. And if a settlement offer isn’t made or isn’t fair, arbitration is the process too to make that happen.
While you may think I’m biased, it’s a really good idea to get an attorney. A good one will protect you along the way and in the end, not only make sure you get a settlement, but also get the most possible for your case. It costs nothing upfront to hire an attorney or file a case. Typically attorney fees are 20% of any settlement they get for you or any award at arbitration if your case goes to trial. If you’d like to speak with an attorney for free, please contact us any time.