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Illinois work injury cases are not lawsuits. When you are in a car accident and you file a lawsuit, you have to sue for negligence.  In those cases, fault matters.

Since work comp claims aren’t lawsuits, but instead claims for benefits, fault isn’t relevant. By that I mean you don’t have to prove anyone was negligent and in fact, in most cases, nobody is negligent. If you are lifting a box and your back goes out on you, it’s most likely nobody’s fault that happened.

But even if you are at fault, that doesn’t prevent you from having a case.  That doesn’t mean an insurance company won’t make you think that it matters.  Take this note I received recently from the spouse of an injured worker.

My husband got hurt at work last year. He fell going up the stairs. It was his fault he fell. He injured his shoulder and ended up tearing his bicep and had a torn rotator cuff. He had surgery and was off of work for a few months. There was a nurse case manager for work comp assigned to his case and attended dr appts. She told us he would receive a settlement when all was said and done. He was released back to full duty. He had not heard anything so he reached out to the work comp case manager asking about a settlement. She came back after consulting his corporate office and she is saying “no settlement offer will be extended”. I guessing it’s because they technically weren’t at fault. I just want to know if we have a case to go after them for a settlement?

The “fault” in this case was because the worker was running up the stairs since he was late for a meeting and carrying some items. This was all for the benefit of the employer and increased his risk of getting hurt.  So him being the reason that he was late doesn’t matter.  This is a great case and there is no defense to it as evidenced by the fact that they paid for all of his medical care.  Them not offering a settlement doesn’t mean he’s not entitled to one.

The insurance company appears to be shady from the get-go on this one. The nurse case manager should not have been attending his appointments.  A lawyer would have stopped that nonsense from happening. It’s too late to change the past, but the good news is it’s not too late to get a settlement and the case isn’t closed even though they said it was.  He is well within the time limits to file a case and once he does we can certainly get him a more than fair settlement. And if they don’t offer one the case can go to arbitration and he’ll be awarded the appropriate compensation there.

The good news here is that the wife was curious and didn’t take the insurance company’s word for it.  Had they done so, they likely would have missed out on a high five-figure or low six-figure payment.

As far as fault goes, the only time it really matters is when you are drunk, high, violating known rules, or being reckless when you get hurt. Beyond that, it’s mostly irrelevant when it comes to whether you have a case or not and if you are entitled to a settlement.