A recent caller to my office was a bit confused about his Illinois work comp claim. He told me that he was upset because he wasn’t getting TTD checks anymore even though he won his case. The call went on and I learned that he was hurt in September (this call took place in November).
With a few more questions, I realized his belief that he won was because he initially received a letter from the insurance company saying that his work comp benefits were approved. They got cut off a few weeks later for a variety of reasons. He had not won his work comp case, but he also hasn’t lost it either.
Before I go into what it means to actually win a work comp case, note that just because an insurance company starts paying benefits, doesn’t mean they can’t stop. Paying the first check or initial medical care or even doing it for a while isn’t an admission by them that you have a good case. New information can arise such as them having a witness come forward who disputes your accident. Or an IME doctor can say you are fine. Etc.
Most Illinois work comp cases don’t have actual wins or losses. Even if the case gets disputed at some point as many of them do, it’s also more likely that eventually the case will settle. Is a settlement of your work comp case a win? It might be to you if you are happy with the money you receive and are feeling better. It also might be a win in the eyes of the insurance company because they are happy that your case is closed or they feel they spent less on your case than they thought they’d have to.
If you get a settlement of $100,000 on your work comp case, I can see why you’d think that’s a win. But would you feel that way if we told you that you could have gotten $115,000? How about $150,000? How about if you discovered the case would have been worth $300,000 if you went to trial, but that would take an extra year?
There are no statistics on wins and losses in these situations because it’s impossible to measure. I wouldn’t worry about it, but instead encourage people to focus on their health, making a good recovery and getting the most of the benefits that are owed to them.
Wins and losses do happen if your case goes to trial. That’s because an Arbitrator will issue a written decision which rules on disputed issues. Even then, there’s no guarantee of a complete win. You might have a case where the insurance company is disputing how long you were entitled to TTD benefits and what the ultimate value of your case is. If your lawyer argued that you were entitled to nine month of TTD and the case is worth an additional $80,000 and the insurance company says three months of TTD and additional $50,000, is it a win if you get all of the TTD and $50,000???? How about seven months of TTD and $70,000? It’s all open to interpretation.
There are of course cases where you get nothing and it’s a clear loss or you get everything you are asking for and it’s a clear win. But even then, you might “win” but it takes you two years to get to that point so it can feel like a loss due to the hardship the delays cost.
So again, don’t worry about a win or a loss. Worry about getting the benefits you are entitled to and just remember that even if you are getting benefits now, the insurance company can try to take them away so it’s best to be prepared by having a lawyer in your corner who knows what they are doing.
