IL Work Comp – Insurance Companies Will Deny Anything

By Mike Helfand on Posted in Tips if Injured

One of the impacts of having a Republican Governor has been the appointment of more conservative, insurance company friendly Arbitrators.  I do think most of them look at cases objectively, but it’s just a fact that some are much more favorable to insurance companies than others.  In addition, due to some high profile cases, I believe that some Arbitrators feel worried that their decisions might end up in the newspaper.

As a result there’s been a definite shift in strategy by insurance companies.  They will deny many cases that years ago they would have accepted.  From their standpoint, if they go to trial and the Arbitrator is conservative, maybe they win.  Maybe they negotiate a settlement for less than the case was worth.  All of these things save/make them money.

There was a recent case that some insurance company was ballsy enough to take to trial and even appeal after they lost.  A union electrician was carrying three 40 inch long structures that weighed 20-25 pounds each.  While doing so he stepped in a gravel depression that and felt a pop in his knee.  He was eventually diagnosed with a meniscus tear and had surgery.

Sounds like a no brainer, slam dunk case, right?  Well the insurance company fought it saying that the depression he stepped in was only two inches deep, not 6-8 inches as the worker testified.  As a result they tried to argue that he wasn’t at an increased risk of injury.

The good news is that the Arbitrator rejected this ridiculous argument and the appeal was denied too.  Clearly the carrying of materials increased his risk of injury.  The bad news is that this poor worker who did nothing wrong had to have his payments delayed and his life screwed with because an insurance company had nothing to lose by messing around with him.

The bottom line is that no matter how clear cut your case seems or how cooperative the insurance company may seem, they are always looking to screw you over if they can.  You have to be prepared for this and more than ever and if your attorney doesn’t have a track record of going to trial, you will likely not get a good result.  Cases are still winnable, but you really need a fighter in your corner.

If you have questions about anything related to Illinois work comp, please fill out our contact form or call us at 312-346-5578 for a free consultation.

When You Go To Trial, Do You Have A Trial Lawyer?

By Mike Helfand on Posted in Tips if Injured

There are some things about Illinois workers’ compensation law that are myth and some that are fact.  One that is kind of both is the belief that one person stated to me that the attorney for the insurance company is going to be better than the attorney for the worker.

It’s not true in all cases of course, but in general, the lawyers who represent insurance companies are held more accountable than the ones that represent workers.  I can prove how it’s true.

  1. If your lawyer doesn’t call you back, you could fire them or get frustrated with them.  Usually you get frustrated and keep calling. If an attorney stopped returning the calls of an insurance adjuster they wouldn’t just lose one case, they’d lose every case that company had sent and would likely not get any more from them.  Their business would dry up.  Plain and simple, defense attorneys have to be accountable.
  2. If your lawyer lies to you, odds are that you won’t know it.  So when they say it will take years to get to trial (false) if you don’t know any better you’d believe it. Insurance adjusters and their bosses know the work comp system.  If their attorneys aren’t aggressive they will get fired.
  3. Speaking of which, your attorney can say that they are fighting for you, but the defense lawyer has to prove it.
  4. You assume your lawyer knows what they are talking about, the defense lawyer has to prove it. I used to work for an elite defense law firm and in every case when we got the file assignment we had to provide a huge written analysis of the case facts, the possible defenses, what the case is worth, what strategies they should take that can help fight the case, etc.  As the case goes on they have to write updates on the case constantly (or they get fired) and continue to analyze ways to win.
  5. The insurance companies are writing the checks. If your lawyer is asking for a lot of money, the insurance company wants to know how to pay as little as possible.  That again requires them to be very aggressive with their recommendations.
  6. Your attorney might not want to go to trial. The insurance company often tells their lawyers that they have to go to trial.
  7. A defense firm might have young lawyers working for them, but they get great training and don’t take cases to trial until they have a lot of experience.  Some lawyers for injured workers hire young lawyers and have them take cases to trial with little to no training or supervision.

So if your case is going to trial, you better have a real trial lawyer in your corner.  If they don’t return your calls, don’t remember the case facts when you talk to them, seem to busy for you, etc. before you need a trial, you are fooling yourself if you think they will magically care about your case and become organized when the case actually has to go to trial.

The bottom line is that there are many great attorneys for injured workers, but also many that suck and while it’s still possible they could win your case, the lazy ones don’t give you the best chance of success.  They are going up against someone who knows your case backwards and forwards and is motivated to beat you.  In fact they get rewarded if they beat you.  So when you first hire a lawyer you might not be thinking about a trial, but you should always consider the worst case scenario and whether or not you want that firm in your corner.

David Price Has Carpal Tunnel Syndrome

By Mike Helfand on Posted in Injuries

This isn’t our usual Illinois work comp post, but it’s relevant.  The Boston Red Sox have a pitcher named David Price who they are paying many millions to pitch for them.  He was just diagnosed with what is a somewhat unusual injury for a pitcher, carpal tunnel syndrome.

You typically see carpal tunnel in those who type all day or use their hands and wrists for repetitive activities, often with a lot of force.  Price, who reportedly has a mild case of carpal tunnel, might be playing a lot of video games of typing a lot on his phone or computer.  Maybe he has diabetes.  He’s not pregnant or overweight. All of those things can lead to developing carpal tunnel.

It’s also certainly possible that strengthening exercises caused this to happen. Or maybe he fell hard on his hands.  Or maybe he puts a lot of pressure on his wrist when he throws a curve ball or some other pitch.  We do know that he was pitching well and then lasted just one inning in one start when he left due to numbness in his throwing hand along with a loss of feeling in his finger tips.  That sure sounds like carpal tunnel to me.  In four starts since then he’s gotten rocked, giving up 20 runs in 22 innings.

While he likely won’t ever file a workers’ compensation claim because he’s making so much money from baseball and has a guaranteed contract, if this was a pitcher for the Cubs or White Sox, they’d certainly have a case.

Club officials are calling the diagnosis good news which I guess it is if they suspected he might have a shoulder or elbow injury.  But the reality is that you can bet he will at some point have to have a carpal tunnel release surgery.  One thing I’ve seen in 20 plus years of handling cases is that when you get carpal tunnel and don’t stop the activity that is causing the pain and numbness, it won’t go away without surgery.  It might have been curable had they gotten to it sooner, but it sounds like it’s fairly severe now.

If this happens to you and you are not a millionaire athlete with a guaranteed contract, the most important thing you can do is get to a doctor right away.  If they can treat it right away and you can make some accommodations to your activities, you might be able to avoid surgery.  We’ve been involved in hundreds of carpal tunnel claims in Illinois.  If you have questions or want help with a case, please don’t hesitate to get in touch for a free, confidential consultation.

Myofascial Pain Syndrome And Illinois Work Comp

By Mike Helfand on Posted in Injuries

Repetitive motion injuries are some of the most common injuries sustained while on the job. One of those injuries is called Myofascial Pain Syndrome. This can be a very painful muscle condition causing you to be unable to complete everyday tasks.

Myofascial Pain Syndrome is caused when trigger points, or sensitive areas of tight muscle fibers form after an injury or over use. Those trigger points are the root of the pain that can radiate through the entire muscle. Sometimes, the trigger points can even cause another unrelated part of your body to hurt as well. Some symptoms include pain, lack of sleep and stiffness, and pain in unrelated parts of the body. Treatment of the syndrome includes a mixture of physical therapy, stress reduction, and pain management and the issues typically will resolve itself over time.

Of course everybody has pain from time to time, but this trigger point injury is different. It’s a deep, aching pain that persists.  If you have this pain and it doesn’t go away, you need to see a doctor.

Related to work and Illinois workers’ compensation claims, we see this injury over and over with workers who do repetitive motion jobs and activities where their muscles contract repeatedly.  Because it’s not an injury from a one time accident usually, but over time, it’s VERY important that your treating doctor have an understanding of your job activities.  In other words, you can’t just say you work at a factory and expect that will be enough information for them to say your problems are related to your job. You must be very descriptive about what you do, how often you do it, how long you’ve been doing it, the weights you are lifting, the level of force and exertion you are using, etc.

Don’t worry if you aren’t sure exactly what to ask or say to your doctor.  That is part of what we do for you as you aren’t to be expected to know what to talk to him/her about.  Often we will be a part of that conversation with you or speak with your doctor directly.

From an Illinois workers’ compensation standpoint, these cases often get denied because insurance companies can find doctors who will say that your pain could have been caused by anything. That’s ok.  We know how to deal with it.  Whether you go with us or any other law firm, it’s important that they understand the medicine behind this injury as well as the right questions to ask your physician.  If your case is compensable then all of your medical bills will be paid (whether you have insurance or not), all your time off will be compensated and we can get you a settlement too.

If you have questions about a possible case and or want our thoughts on who the best lawyer is for your case, contact us at any time and we will do whatever we can to help you.

An Illinois Work Injury Worth Over $15 Million!

By Mike Helfand on Posted in Benefits

Typically when you have an accident on the job that causes an injury the best you can hope for is a good workers compensation case. A workers compensation case of course will cover all of your medical expenses, and financial benefits while you are off work recovering from the injury. Usually in cases like this you cannot sue your employer for negligence because that is barred under Illinois law.  But if a third party that is not your employer was involved in the accident, you might be able to sue them.

That’s exactly what happened in a recent case that while unique, shows the importance of making sure every angle is analyzed when pursuing a case.

The injured worker in this case was asked to unload a 300 pound desk.  The employer had contracted with some other companies to help on the job and an employee of one of these other companies let go of his end of the desk.  Ultimately this lead to a major back injury with surgery and the injured worker can no longer do his job.

After a further investigation (again, you can’t leave any stone unturned) it was discovered that there were safety violations by multiple companies so this worker was able to sue all of them.  Due to the seriousness of the injury along with the fact that there wasn’t adequate equipment or proper staffing, the case was successful.  The company that delivered the desk should have made reasonable accommodations with additional workers or a forklift to ensure that nobody was injured.  That of course did not happen.

To be clear, this is a unique case, but that doesn’t mean your case isn’t unique.  If other companies are involved in any way in your injury, we must know about it and a good attorney will ask these questions as part of their investigation.  In most cases you only have two years from the accident date to file a lawsuit or it will be forever barred (it can be as little as one year) so it’s really important to have these cases investigated right away.  It’s not enough to just know that other companies were involved.

I’m not a part of this case, but my guess is that the work comp case is worth around $500,000.00 so if nobody realized the worker could sue it would have cost him over $14 million.

Bottom line is that every angle must be analyzed in every case.  If you want our opinion as to whether or not you can do more than work comp, call us at 312-346-5578 for a free consultation with one of our lawyers.

 

How Do Illinois Workers’ Compensation Settlements Work?

By Mike Helfand on Posted in Benefits

At some point, everyone wants to know what their case is worth.  But if you are hurt on the job in Illinois you are going to hear terms like PPD or “percentage loss of use” and they can be really confusing.  Hopefully we can clear that up a bit.

Almost every Illinois work injury has some settlement value.  When you are done with your medical care is when it’s time to start thinking about a settlement which, if you aren’t permanently disabled or in a situation where you have a big wage loss, is called PPD or permanent partial disability.

In plain English, PPD is compensation for how your injury is likely to affect you in the future.  You get compensated for the diminished nature of whatever body part was injured.  It’s kind of a myth.  If you break your hand, usually it will grow back stronger so in theory there is no PPD.  In reality though if you break your hand at work you will be entitled to some sort of settlement or if the insurance company won’t pay, an award from an Arbitrator after a short hearing.

So how do you figure out what your case is worth?

First we need to know you average weekly wage. To determine your PPD rate for settlement, we take your average weekly wage (gross not net) and multiply it by 60%.  If you grossed $1,000 a week your PPD rate would be $600.  There is a cap on this amount.  The highest PPD rate you could have if you were injured today is $790.64.  So for anyone making $68,522.13 a year or more, $790.64 would be your PPD rate.

The second thing we need to know is what body part is hurt.

The third thing to know is what percentage loss of use did you sustain to that body part.  This is determined mostly by looking at your medical records, the treatment you have had, any restrictions you might have, need for future treatment and what complaints you currently have.  As lawyers we would compare what you are going through to other cases that have been decided at the Illinois Workers’ Compensation Commission.

We then take your PPD rate and multiply it by the number of weeks associated with your injured body part. The table below is the maximum value for any body part.

Part of Body And Maximum Number of Weeks Paid
Man as a whole (neck, back) 500

Hand 205

Thumb 76

Index finger 43

Middle finger 38

Ring finger 27

Pinky finger 22

Arm 253

Arm amputated above elbow 270

Arm amputated at shoulder joint 323

Foot 167

Big Toe 38

Any non-big toe 13

Leg 215

Leg amputated above knee 242

Leg amputated at hip joint 296

Loss of sight in one eye 162

Loss of one eye 173

Hearing loss in one ear due to occupational disease 100

Hearing loss in one ear due to accident or trauma 54

Loss of hearing in both ears 215

Kidney, spleen, or lung removal 10

Loss of one testicle 54

Loss of both testicles 162

 

If you tore your ACL and were determined to have a 40% loss of the leg.  40% of 215 (see the chart, a leg is worth up to 215 weeks) is 86.  So if you were making $1,000 a week, your PPD rate would be $600.  $600 x 86 means the case would be worth $51,600.00

If you lost 100% sight in one eye and you were making $1000/week prior to the injury you would multiply $600 (60% of your average weekly income) times 162 which would net a permanent benefit of $162,000. This number of course would change if losing your vision made you permanently disabled or caused a big wage loss.

If you were disfigured due to your on the job injury, like a scar on your face, the parties involved will need to agree on a number of weeks of compensation that injury is worth and then apply the same number of weeks to 60% of your average income, with a maximum of 162 weeks.

Does this seem confusing?  It can be, but hopefully this clears things up a bit.

Bonus tip.  Beware insurance companies who try to base what your injury is worth solely off of an AMA rating.  It would greatly undervalue what your case is worth.

And of course if you have any questions or concerns you can call us any time at 312-346-5578 for a free consultation.

When One Doctor Says It’s Work Related And The Other Says It’s Not

By Mike Helfand on Posted in Benefits

We are Illinois work injury attorneys with over 20 years of experience.  We are unique in that we are customer service focused, blunt and talk in plain English.  We treat our clients like family and through our state wide network of lawyers, we cover all of Illinois.  Fill out our contact form or call us at 312-346-5578 if you’d like help with a case or just want to ask questions.

A reader told us the following problem that is somewhat rare, but does happen enough that it’s worth writing about:

My fiancé went to a doctor with terrible back pain and wasn’t sure what the problem was. It could have been from the wear and tear of his job or just something he had. The doctor told him that it was something that happened at work. So he said it was work related. Then the second doctor that doctor recommended him to did a bunch of tests and said it was not work related but couldn’t diagnose it. So now neither insurance will cover his bills.

The question I first had was is either doctor referred by the insurance company. If that was the case then it would just be a matter or taking depositions and going to trial.  Unfortunately both doctors were chosen by the injured worker.

The second question I had was either doctor an orthopedic doctor.  When you have a back injury like this worker does, the opinion of an orthopedic doctor would be more credible.  Unfortunately the first doctor was a family doctor and the second one who said this isn’t work related is an orthopedic. So as it stands right now, he has no case.  You can’t go doctor shopping until you find a doctor who will say what you want.  Well you can, but it won’t look good.

He thought that was that, but this is where having a lawyer could have saved him a lot of trouble and hopefully will still save him.  This guy has been a heavy duty laborer for around 15 years and he’s a relatively young guy.  To win his case he doesn’t need to show that his job is the only reason he has back problems, he just has to show that it’s a contributing factor.

What I think happened here is two things: 1. He didn’t give the orthopedic doctor a detailed description of what he does every day for work.  How much he lifts, how often he does it, how long he’s been doing it for, what he notices about his back at the end of a long work day, the way he positions himself when he lifts, etc.  2. He didn’t ask the doctor if the job played a role in his back problems.

Many doctors don’t know the law nor should they.  It’s our job as lawyers to help you ask them the right questions. I can’t imagine that this orthopedic wouldn’t say that all of this lifting over a decade didn’t play any role in the back pain issues. If he does then it’s a winning case.

For this worker, not knowing the law is a pretty big risk. He’s likely going to have to find a new career and without the assistance of work comp benefits he could go from making over $40 an hour to minimum wage.  Beyond that he’d get buried in medical bills.

Bottom line is that when two doctors disagree it can hurt you, but it’s not the end of the world, at least not if you know what the law is.

“Why Would A Case Manager Say My Work Comp File Is Closed?”

By Mike Helfand on Posted in Tips if Injured

Via our new online chat system, a reader asked:

“Why Would A Case Manager Say My Work Comp File Is Closed?”

Can you imagine?   You have an accepted Illinois work injury case and one day you call the adjuster or get a letter from them (they never call you, that would take guts) and they tell you that your case has been closed.

This is a lazy insurance trick that must work sometimes because they keep doing it.  They hope by telling you that your case is closed they can get away without paying you any more benefits or a settlement.

The good news is that they aren’t a Judge so they can’t do this.  If it hasn’t been more than three years since your accident date or two years since they last paid you or a medical bill on your case, the time limits (statute of limitations) for bringing a case haven’t passed.

So by formally filing the case via an application for adjustment of claim with the Illinois Workers’ Compensation Commission, your case will automatically be “re-opened” not that it was ever really closed in the first place.

Bottom line is that this is just a scare tactic or settlement tactic by which the insurance company hopes to spend less than what they are legally obligated to on your case.  Insurance companies make billions with tactics like these.  The bad news is that when it works they are essentially stealing from injured workers.  The good news is that it’s an easy problem to solve.

To Win Your Case You Need Leverage

By Mike Helfand on Posted in Tips if Injured

A recent caller to my office had a recommendation for shoulder surgery after a work related accident.  She was upset because the insurance company had approved and then declined her surgery “pending an investigation” and was three weeks late on her TTD payments.

She wanted to know how she could solve the problem on her own and the honest answer is that she can’t because she has no leverage.

Because she hadn’t filed a case with the Illinois Workers’ Compensation Commission, she hadn’t been assigned an arbitrator or a status call date. As a result there was no trial motion that could be filed.  There also wasn’t a way to file a petition for penalties against the insurance company.

While these problems can be solved by actually filing a case, until then it’s not uncommon for an insurance company to just mess with you in the hopes that you will go away or use your personal insurance to cover your bills (which is a huge risk to you).  The strategy certainly must work because they keep on doing it.

Even once a case is filed, if the insurance company knows your lawyer doesn’t like to take cases to trial you don’t have leverage.  Believe it or not there are law firms who have a reputation for never going to trial and as a result their clients get hurt.

There are other ways you can create leverage.  A man called me wanting an opinion on what to do because the other side hadn’t responded to his attorney’s settlement offer and it had been over five months.  In a case like that he needs to show that he will go to trial and the first step (often) is to take the deposition of your treating doctor.  You’ve probably heard that a lot of cases settle right before a trial was about to start and it’s true.  It happens because you put the pressure on the insurance company to make a decision and present their best offer.

You also put pressure on them by filing 19b petitions when your benefits are denied and penalties petitions that you follow through on when they act unreasonably.  Believe it or not, an attorney can also put pressure on an insurance company just by picking up the phone. It’s human nature that people don’t like to say no or be confrontational.  So when we put them on the spot they often role over.

Bottom line is that just a little bit of aggression or even mild aggressiveness (if that’s what you call just filing a case) can help you stop the games and win the benefits you are entitled to by law. If you have questions or want help with a case, get in touch for a free, confidential consultation.  We cover all of Illinois.

Dentists With Pulmoary Fibrosis and Illinois Work Comp

By Mike Helfand on Posted in Injuries

Dental workers are getting sick, is their work environment to cause? According to the CDC, idiopathic pulmonary fibrosis (IPF) may be linked to the dentistry field.   So if you are a dentist, dental hygenist or other dental worker in Illinois and you have pulmonary fibrosis, you may have a workers’ compensation case.

IPF is a pulmonary disease that causes scarring in the lungs, which over time makes it nearly impossible for a person to breathe. Typically, this disease starts with shortness of breath, a dry cough and possibly fatigue. The disease progresses quickly and aggressively with an average 2.5 years survival after diagnosis. There are many professions that can contribute or even fully be the cause of IPF. Many of these professions involve breathing toxicity on a daily basis. In the dental field, that can mean powder forms of acrylics, silica and other compounds. It is clear that more studies need to be done to determine what other job related exposures could be causing dental workers harm.

All of these breathable toxins a person could be exposed to at work, make this a workers compensation case. In this specific case, all medical bills would be covered by workers comp, as well as a percentage of loss wages due to the illness.

Since this is such a serious illness, it’s not uncommon for people to stop working after they are diagnosed.  To have a claim you likely have to file it with the State within three years of your last exposure which presumably is your last day worked.  In other words, if you think you may have been injured due to conditions at work, call us today to review your specific details.  It’s a free consultation and we will help you figure out if there is a case or not.

A couple things to know:

1. If you are going through this you are not alone. This CDC report was issued after it became clear that a lot of dentists were being diagnosed with pulmonary fibrosis, especially compared to other professions.

2. These aren’t slam dunk cases by any means. You have to establish the toxins you’ve been exposed to as well as the frequency and need a doctor to state that your job contributed to your problems.

3. If you do have a case, all of your medical bills will be paid for, all of your time off work will be compensated and you will receive a payment for the permanent nature of your condition.

4. There is no cost to start a case and no fee unless you are successful.

Not every attorney can handle a case like this.  If you want to speak with an experienced lawyer call us any time at 312-346-5578 for a confidential, free consultation.

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