While Illinois is a very worker-friendly and common-sense state when it comes to work comp laws, we don’t pursue every case that we are contacted about. As these cases are taken on a contingency basis, it means you don’t pay a lawyer anything unless the case is successful. If there are clearly strong defenses to the case, finding an attorney can be hard.
Quite often injured workers create the very defenses used against them. Sometimes they lie to a doctor about how they got hurt because their boss asked them to. That can kill a case. Other times there’s such a big gap in treatment that proving your injury is related to a job accident is impossible.
By that I mean if you are hurt at work on January 10th, go to the ER that same day with leg pain, but never see a doctor again until ten months later, it would be a real challenge to prove your leg problems are related to that original accident. The defense would be that you were walking around for ten months on that leg and didn’t need medical care, so your problems must be from something else.
There’s a big exception to this defense. It’s when the delay in treatment happens because an insurance company doesn’t approve treatment.
Let’s say you have an accident at work and hurt your hip and shoulder. You go to the doctor right away and let them know you were injured on the job. You tell your employer too so nobody is disputing that you were hurt at work. Your doctor sends you to an orthopedic surgeon who at first recommends physical therapy. You begin that treatment and it doesn’t work. At that point, your doctor wants to do surgery on the hip.
The insurance company sends you to an IME who says that you need additional therapy on your shoulder, but that your hip is fine. As a result, the insurance company cuts you off. You focus on making your shoulder better and just do stretches and take medicine for your hip. You hire an attorney and end up in a trial nine months later. At that trial, the insurance company tries to argue through their lawyer that because you have a nine-month gap in treatment and your hip hasn’t gotten worse, that’s proof that your condition isn’t work-related.
What we’ve seen the Illinois Workers’ Compensation Commission do in these cases is not reward the insurance company for their delay and use what is called the chain of events theory. It basically says that if you had a body part in good health before an accident and then problems after an accident, you can prove your need for treatment is work-related.
The example I gave was from a real case and the Court ruled that the nine-month gap in treatment for the hip wasn’t a reason to deny benefits. The surgery recommendation was made and that was all that could be done for him. The delay wasn’t his fault but instead was the fault of the insurance company. There was no reason to go back to the doctor until the treatment was approved.
As a result, the Commission ordered the surgery to be paid for noting that it wasn’t the worker’s fault that a recommended procedure was authorized.
It’s not a surprising result and to me, clearly the right one. So you can have a delay in medical care and still win benefits, but your chances of winning are much greater when it’s the insurance company that caused the delay instead of you.