The best example of how Illinois work comp insurance companies are looking to not pay out legally owed benefits comes in cases where laborers with no history of health problems have their claims denied. It’s simple common sense that if you are doing a highly physical job for many, many years, your body will break down due to that work. Nobody is surprised when a football player says their body is broken down from years of high impact contact. And nobody can say with a straight face that if you lift heavy materials all the time, your back condition isn’t related to your job.
Yet these types of bogus denials happen all of the time. In a recent case, a journeyman carpenter slipped on stairs and fell nine steps onto his butt. He immediately felt back pain and went to the doctor. Of course the insurance company sent him to an IME who a couple of months after the accident said he was all better. So he had to lawyer up and go to court. Naturally, he ended up winning his case and getting his surgery and multiple pain injections approved for payment.
What made the case pretty much a slam dunk was that he’d been doing the job for a long time and had a complete lack of symptoms prior to the work accident happening. It also helped that the nature of his work was very heavy duty including a lot of lifting which of course over time could contribute to back troubles. What also helped him was that he went to the doctor right away, gave consistent statements to all doctors about how he got hurt and he had a MRI which showed the significant damage to his back. He also was a credible witness in the manner of how he testified and because he didn’t have a history of bringing work comp cases for every minor thing that happened to him on the job.
Of note in this case was that even though the MRI said there was a disc herniation and annual tear, the IME doctor said nothing on the scan would explain his symptoms. In my experience that is a total lie as not only was this a significant MRI finding, but MRI’s often don’t tell the whole story of why pain is happening. In other words, the hired gun doctor said what was best for his client, not the person he was examining. That’s my opinion.
The good news is that he won in the end. But to me it’s pathetic that he and other workers have to even jump through those hoops when common sense tells you that if he has a bad back, his job played a role and likely a big one. Nothing should have happened in this case other than him getting timely medical care that is all paid for. It sickens me that insurance companies will pay these IME doctors and defense attorneys all that money to fight a case that should never be denied in the first place.
