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I remember the first time a friend of mine had a knee replacement. He was in his early 50’s, a pretty fit and active guy and loved to play basketball. But years of activity and wear and tear caused him knee pain and he went under the knife. He’s doing great now although his basketball days are over. What his experience shows is that it’s not uncommon for bodies to break down as we get older.
Because knees, backs, shoulders, etc. can have problems as you age, it’s not uncommon for a work comp insurance company to fight a surgery claim in older workers. They can usually find some hack doctor to write a report that states your problems are due to age and not your job. Usually though these doctors don’t address what your job has been and how it affected you.
In other words, if you are a carpenter, plumber, laborer, etc and for years have been doing heavy duty work with a lot of lifting, squatting, bending, etc. it would make sense that those job activities would cause a lot of wear and tear on your knees. So if your end up needing a knee replacement surgery, it would make sense that it would be part of a workers compensation case.
And that’s what you need to do to prove under Illinois law that your need for a knee replacement is a work comp case. You have to show your job caused, aggravated or accelerated your problems. If so then your surgery and all other medical care should be paid for, you should be paid for your time off work and you should get a pretty significant settlement.
You can also prove it’s work related if you had a prior knee surgery that was work related and you didn’t make a recovery. In a recent case at the Illinois Workers’ Compensation Commission, a therapy aide hurt his knee breaking up a fight and had a knee scope. He didn’t get better and ended up with a total knee replacement. There was a clear chain of events from a work injury to the first surgery and then the need for the second surgery. This was a guy who had no physical problems before his work accident. The patella surgery he had caused severe inflammation.
The bottom line is that insurance companies will do whatever they can to deny benefits you are rightfully entitled to. This is very common with major injuries and procedures because if they win, they save hundreds of thousands of dollars. Don’t get discouraged or think you don’t have a case just because they deny your case. That’s not the end of the road of your case and if the facts show that your job contributed to your problem, you likely will still win benefits.