The Insurance Company Is Slow To Approve Medical Care

When an injured worker calls our office to discuss a case, one of the first things we try to figure out is if a case is accepted or denied. Accepted means that they are paying your medical bills and/or TTD benefits. Denied means that they aren’t paying one or both of those benefits. It’s usually a good idea to get a lawyer no matter if it’s accepted or denied, but knowing which it is helps us give you free advice.

There’s a third category that is more and more common these days. We get a lot of calls from injured Illinois workers who say something like:

I was hurt at work. My case was accepted and I’ve been seeing a doctor. But the insurance company is really slow to approve authorization for tests and treatment.

In other words, the insurance company doesn’t have a basis for denying your case, but they aren’t giving providers confirmation that they will pay for things like physical therapy, MRI’s, steroid injections, etc. So what ends up happening is that your care gets delayed and you get frustrated.

This also plays out with TTD checks. Whether they usually come weekly or bi-weekly, you begin to notice that they are a few days or weeks late. That of course can cause a financial hardship on you and your family.

None of this is unintentional. The insurance company wants to limit what they pay out on your case. If they don’t approve physical therapy for a month, maybe you’ll get better without it (highly unlikely), use your personal insurance or just give up. If your TTD check is late, maybe you’ll return to work against the advice of your doctor.

All of these actions by the insurance company put your health at risk. A delay in medical care can make many injuries substantially worse and in some cases, permanent. They also violate the Illinois Workers’ Compensation Act. Sadly, insurance companies do this because it works often enough that it saves them a lot of money.

There is only one solution. You have to officially file a case with the Illinois Workers’ Compensation Commission so you have leverage to act in response to their bad behavior. We fortunately find that doing this and having an attorney on the case stops a lot of the games, especially the delays in getting medical care. It shouldn’t come to that, but to them it’s just business.

Their goal is to frustrate you and they are usually successful. Just know that you can push back so you can focus on your health, listen to your doctor and make a great recovery. If you’d like our help, we are happy to talk to you any time for free and in confidence.

Sedgwick Says They Are Closing My Case In A Month!

Sedgwick is what is known as a third party administrator. In plain English that means that in Illinois workers compensation cases, they will process claims of their big corporate and government clients. So they act like an insurance company even though the bills are really being paid by your employer.

They have a reputation for being aggressive and sometimes even ruthless. Their big clients like Amazon or the City of Chicago surely love this as it saves them money they have to pay out for work injuries. And I do think they do a good job for their client’s interests. Injured workers tend not to like them so much.

I’ve heard a bunch of crazy stories of things done by their claims handlers. Some are legal but super aggressive. Others certainly border on the possibility of illegal or at least really scummy.

One in particular told me that a couple months after their case started, the adjuster said the case would be closed in a month. In my opinion, that’s a scummy thing to say because while they can say their internal file is closed and they won’t do anything else, it’s misleading to the injured worker.

It’s misleading, in my opinion, because it implies that the case is done and there’s nothing the worker can do. If the worker isn’t savvy enough to know the difference or call an attorney, they very easily could lose some rights. Specifically in this case, the worker might have needed medical care beyond that month. If a doctor says they do and it’s work related, the employer, via Sedgwick, should pay for it.

Beyond that, this worker, at some point, would be entitled to a settlement. What Sedgwick did here is what a lot of insurance companies do. They made the worker think that there wasn’t the possibility of a settlement because the case was “closed.” And if they can get the worker to wait too long, the case really will be closed because they won’t have filed paperwork in time with the Illinois Workers’ Compensation Commission. This particular worker would have lost tens of thousands of dollars. I’ve seen this happen to hundreds of people over the years based on misleading statements from just about any work comp insurance company you can think of.

The good news in this case is we were able to connect this worker with an attorney in his area who was able to file the case and surely will make a great financial recovery for him. By filing the case officially, it will be open and Sedgwick will have to deal with it.

The bottom line is that if the insurance company is telling you something, you don’t have to believe them. It may be true, it might be b.s. Verify for yourself. If you want to speak with a lawyer for free you can call us any time at 312-346-5578.

The First Question To Ask A Work Comp Attorney

One of the great things about hiring an Illinois workers’ compensation attorney is that there is no up front money involved. By law, we have to work on a contingency basis, which means we only get paid if we win the case. That fee is 20% of the settlement we get you. That said, some cases are worth more money in the hands of some lawyers as compared to others.

In other words, with one attorney you might be able to settle a case for $100,000 and with another you’d only get $75,000. Or in other cases the right lawyer will be the difference between winning or losing a trial. And of course a better lawyer is more likely to stop some of the nonsense that can come from insurance companies.

There is no one predictor for hiring the best lawyer for your case. But there is one basic question that you should ask before you sign up with any work comp attorney. The question is:

How long have you been licensed to practice law and been handling work comp cases in Illinois?

There is no right answer, but when you see a lawyer who has been only been licensed for a year or two, it’s a red flag. A big one. They might be the smartest, best lawyer with one year experience in the world. They might really care about doing a good job. But they are also limited by their real experience or lack there of.

In other words, if they are handling your case, it means that they are learning how to handle cases by practicing on your case. It’s certainly possible they could do a good job, but it’s more likely that something will come up that they’ve never dealt with before or that they will be pushed around a bit by the insurance company or defense lawyer.

There is one notorious Chicago workers’ compensation law firm who hires a lot of young lawyers and throws them to the wolves by assigning them a bunch of cases before they are really ready. Even if they have senior attorneys they can go to if they have questions, those lawyers won’t be holding their hand on phone calls with the insurance company or defense attorney, at pre-trials or at arbitration. And those senior attorneys have their own case load to worry about as well.

So how long should an attorney be licensed? There is no right answer, but I wouldn’t hire a work comp attorney with less than five years experience and if it’s a bigger injury I’d insist on someone with ten or more years of time handling cases.

And by the way, it’s not just really young attorneys you should look out for. Any time I see a lawyer in their 70’s or 80’s I really question what they are doing. Maybe they just don’t want to retire, but I find it hard to believe that they are really all in and trying to do a great job for all of their clients. Plus there’s also the risk that they will spend a lot of their time on vacation or that they will have health issues.

Bottom line is that it doesn’t cost any more to get the right attorney, but it could certainly cost you if you hire the wrong one.

Indoor Football League Workers Compensation

When it comes to work comp laws, many people don’t know that it applies to athletes. They are employees and all employees based out of Illinois, hired in Illinois or hurt in Illinois can receive Illinois workers’ compensation benefits. This includes Arena League and Indoor League football players.

So if you are playing for an Illinois based team or get hurt with an out of state team while playing in Illinois, you can bring a work comp claim here. You can also file one here if you were physically in Illinois when your contract for hire was completed.

Even though the pay and attention of these leagues is much smaller than the NFL, there are similar amounts of injuries and maybe even more injuries. These players get worse training and protection, less practice and are asked to do more than their NFL counterparts. There is also more pressure to play through pain and injury as it could really be your last chance. They also don’t have near the same level of medical staff that a NFL team would have. And finally, they don’t usually have a union to educate them and look out for them.

We’ve been fortunate enough to be able to help some of these players over the years and there are a couple red flags we’ve seen in how their cases have been handled:

  1. They often are paid at the wrong rate for their time off of work. Their work year isn’t 52 weeks, it’s the length of the season and that is how many weeks should be used to calculate off work payments. Many times players have been grossly underpaid.
  2. Other jobs are often not included in calculating wages when they should be. Many players have side jobs to support themselves such as personal training, office work, bouncing at a bar, etc. Those wages usually should be included and can make the value of a case much higher.
  3. In a couple of terrible situations, the club implied to the player they can only treat with their doctor. It happens a bit with out of state teams who don’t realize that Illinois law applies. Under Illinois law, you can choose your own doctor and they have to cover it.
  4. With one player we talked to, they were paid mileage to travel to go see a doctor, but were not given payment for a hotel room which was needed due to the distance traveled.

The key point is that all of these players are covered by Illinois work comp laws which are the best laws in the country for injured workers. They are no different than any other worker in Illinois and should be treated as such.

If you are an athlete who was hurt while working, we’d love to help you as we’ve been able to help many others. Call us any time for a free consultation at 312-346-5578.

What Happens When Your Employer Can’t Accommodate Your Restrictions

One feature of Illinois workers compensation cases is that workers will get hurt and recover, but perhaps not fully recover. It could be a temporary issue where you might be 100% in a few weeks or months or it could be permanent. And of course there are many instances right after a work accident where you can return to work, but maybe not to your full job.

When these situations happen, it’s likely your doctor will release you to return to work with restrictions. It could be something like no lifting more than 20 pounds or no overhead work. If you have a light duty or desk job then these restrictions probably don’t matter. But if you are a laborer or work in a factory setting then it could be a problem. In other words, if you are a carpenter, you probably will need to do overhead work. If you work on an assembly line, it’s likely you often lift more than 20 pounds.

In those situations, returning to work could be a risk to your health. So it comes down to will your employer accommodate those restrictions. Sometimes they say they will, but it’s really bs and they will pressure you to do more strenuous work than your body can handle. Other times they will simply state that if you can’t work your normal job there is no work for you.

When that happens, your job is to focus on getting healthy. In the meantime, you should receive TTD benefits on a weekly basis. You do not have to look for work within your restrictions. You also do not and should not try to return to work in violation of what your doctor recommends. There is no time limit for how long you can receive TTD benefits. Please note that if you have a second job that is within your doctor’s restrictions, you can continue to perform that work.

In some cases, your restrictions become permanent. In other words, for the rest of your work life you will be limited in how much you can lift, how long you can stand, etc. In one case, we represented a 20 something year old who was left with permanent restrictions for life before he turned 30. These restrictions happen when there are really serious accidents or medical issues. It also happens when you have a really heavy duty job.

When this happens and your employer can’t find work for you, you are then required to look for work within your restrictions. As long as you do that, you should receive maintenance benefits. These payments are the same amount as TTD. You can also request, at the expense of the insurance company, vocational rehabilitation. This is a medical benefit wherein a job counselor can help you look for work, prepare a resume, suggest lines of work that would be good for you, help you prepare for interviews and more.

This process also does not have a time limit, although generally speaking within six months or so we’d expect to have an idea how much you can earn.

The goal is for you to earn as much in the new job as you did in your old job. If there’s a significant gap, the insurance company could be on hook for 2/3 of the difference, tax free, for the longer of five years or until you turn 65. And if it’s determined that there is no stable job market for you due to your injuries and job capabilities, you could be declared permanently disabled and receive benefits for the rest of your life.

What we would warn you of is that employers and insurance companies often play games or otherwise try to stop you from receiving benefits. You should follow your doctor’s guidance and not let them pressure you. A good attorney can protect you from insurance company attacks like IME’s, surveillance or other actions. If you’d like to speak with an experienced lawyer for free, you can call us any time at 312-346-5578.

IL Work Comp – Stop Worrying About Old Injuries

One of the biggest myths that injured Illinois workers have is that if you have a pre-existing injury, you can’t file for workers comp. That’s simply not true.

I saw an extreme example of this recently with a guy that called my office about a back injury. He told me that his job had been really making his back ache of late. He does a lot of tile work which involves very heavy lifting. He hadn’t gone to the doctor about it because he didn’t think he could get worker’s compensation benefits.

The reason he thought that was because he had previously had back surgery and then hurt his back further when he was hurt in a motorcycle accident. The way he said it made it sound like this all happened in the last year and if that was the case, then yes his pre-existing problems could be relevant.

But as we talked further, I learned that he originally hurt his back in 2010 and last saw a doctor for back troubles in 2013! That problem was a lifetime ago.

Under Illinois workers compensation law, you will receive benefits if you can show that a job causes, accelerates OR aggravates a physical condition. So even though he may have some scar tissue from that surgery, the very clear reality is that he’s been healthy and more importantly, treatment free for ten years. A decade!

So in his case, the job is clearly aggravating his problem. He’s made a huge mistake by not getting to a doctor yet, but that’s fortunately a problem that can easily be fixed. He just needs to go to an orthopedic doctor and tell the truth which is:

  1. I hurt my back in 2010 and had surgery.
  2. I stopped treating in 2013 and haven’t been back to a doctor since.
  3. My back has felt fine until the last few months.
  4. At my job I lift a lot of tile. It’s very heavy and I notice while I’m doing it and at the end of the day my back is really sore.

And the case will go from there. That’s a winning Illinois workers compensation case. Some hack IME doctor might state that the problems are all due to the surgery, but there’s no credible defense to this case. That’s true due to the lack of need of medical care and the continuous heavy duty work he’s doing.

And note that it doesn’t have to be a ten year gap. If you can prove that your job is making your condition worse, you should win. If you last treated a month or two ago, you can still win if a MRI or other diagnostic test shows a physical change. And if it’s been a year or more, your case isn’t much different than the guy that had gone ten years without needing to see a doctor.

Your employer “takes you as they find you.” In plain English that means that if you have prior problems that their job makes worse, it’s not a defense that long ago you had hurt yourself.

That doesn’t mean that every problem you have is a case. But it does mean that old physical injuries don’t automatically kill your case. You should always seek out an attorney to see what options you have. If you’d like to discuss a case with us for free and in confidence, please call us any time at 312-346-5578.

Polish Speaking Workers Compensation Lawyers In Chicago

We are Chicago based workers compensation attorneys who since 1997 have helped injured workers. We are different in that our goal is to help you find the best attorney for your case. This includes helping you find a lawyer that speaks your language. That is why we created a state wide network of experienced work comp lawyers. We can refer you to a great Polish speaking workers compensation attorney in Chicago if that is what you need.

The rest of this post is in Polish for the benefit of the hundreds of Polish speakers we’ve helped. If you know someone who could use our help, call us any time at 312-346-5578 for a free consultation.

Jesteśmy doświadczonymi prawnikami zajmującymi się odszkodowaniami dla pracowników w Chicago. W Chicago jest więcej osób mówiących po polsku, niż gdziekolwiek na świecie poza Polską. Z dumą pomogliśmy wielu z nich w sprawach związanych z obrażeniami ciała przy pracy i obrażeniami ciała.

Wielu prawników mówi po polsku i w ten sposób zdobywa wielu klientów. Problem z niektórymi z nich polega na tym, że nie mówią swoim klientom, że nie mają dużego doświadczenia w sprawach związanych z poważnymi obrażeniami. Zajmujemy się wyłącznie sprawami związanymi z obrażeniami przy pracy i innymi obrażeniami ciała. Innymi słowy, to naprawdę zły pomysł, aby zatrudniać prawnika, który zajmuje się rozwodami, imigracją, a także twierdzi, że zajmuje się wypadkami samochodowymi. Posiadanie prawnika, który zajmuje się wszystkim, nie daje największych szans na sukces.

Nie zajmujemy się niczym innym niż przypadkami kontuzji. Za rozmowę z nami lub zatrudnienie nas nigdy nie jest pobierana żadna opłata. Zapłatę otrzymamy tylko wtedy, gdy wygramy sprawę. Co ważniejsze, mamy historię wygrywania i osiągania świetnych wyników. Zadbamy o to, abyś mógł współpracować z czołowym prawnikiem, który biegle włada językiem polskim.

Troszczymy się o rannych w Chicago i innych częściach Illinois, którzy zwracają się do nas o pomoc. Możemy pomóc rannym pracownikom i innym osobom w dowolnym miejscu w Illinois. Bardzo ważne jest, aby wcześnie znaleźć dobrego prawnika, ponieważ często może to zadecydować o wygranej lub przegranej sprawy. A jeśli nie jesteś pewien, czy masz sprawę, czy nie, chętnie pomożemy Ci to rozgryź.

Szanujemy niesamowitą etykę pracy naszych polskojęzycznych klientów.Wszystkie rozmowy są bezpłatne i poufne. Jeśli chcesz z nami porozmawiać i znaleźć najlepszego prawnika ds. obrażeń ciała dla swojej sprawy, możesz do nas zadzwonić w każdej chwili pod numer 312-346-5578. Pomagamy ludziom w całym stanie Illinois od 1998 roku i byłoby dla nas zaszczytem pomóc Ci reprezentować Cię w Twojej sprawie.

How The Insurance Company Decides Not To Pay

There was a great tweet thread the other day about a Colorado work comp case that has a lot of similarities as to how insurance companies deny Illinois workers’ compensation cases in bad faith.

The gist of it is that an electrician got hurt work when he slipped on some ice. In falling he tore his rotator cuff. He went through one year of physical therapy, which, by the way, is a really long time. After a MRI and the failed therapy, his orthopedic doctor recommended surgery. He needed approval from the work comp insurance and they said no.

They had either sent the worker for an IME or sent the medical records to a different orthopedic doctor. That physician said that surgery wasn’t necessary and more PT and steroid injections was the solution. The treating doctor thought this was odd so he investigated.

It turns out that the insurance company doctor was licensed, but banned from doing surgeries since 2017 by the medical board due to mistakes he made in multiple surgeries. Among other allegations was that he put a hip in backwards when it was replaced.

So basically the income stream of this doctor is cut off and to make up for it, he has to do these types of exams. While I don’t know him personally, it sure sounds like he’s a hired gun who will say what the insurance company needs to hear. Depending on how many of these reports he’s doing a year, he could be making in the seven figures off that alone. There are plenty of doctors in Illinois who do that.

And this is how insurance companies screw over workers and decide not to pay benefits or for medical procedures. They find doctors who will for the most part give them the opinion they are looking for. Often this happens after an exam that lasts less than five minutes. And they side with this opinion over your treating doctor who has provided care for your case over a long period of time.

It’s truly insane. And while we can usually win this type of case, especially when the insurance company doctor obviously isn’t credible, it sucks that treatment gets delayed and the worker has to suffer.

These are the types of things insurance companies do even when it seems like they are doing everything right or being nice. They are always looking to cut you off if they can.

And while sometimes they just cut you off without reason, in most cases this is how it’s done. And if it feels like the game is rigged, it’s because it often is. It’s why you need an attorney who knows what they are doing to push back and fight for you.

The Importance Of An Orthopedic Doctor

When it comes to helping people with Illinois workers’ compensation cases and questions, we look for trends. For a time, nurse case managers were being very disruptive. They still can be, but it’s calmed down a bit. Other times a lot of companies were calling employees independent contractors when they really weren’t. That still happens, but some companies have realized they can’t get away with it.

Another trend we see lately is companies really pressuring you to only treat with the company clinic doctor. They have a right to ask you to do this, but can’t (in most cases) make you do this.

This happens with large employers who are self insured, meaning they pay out all of their work comp costs. Think of large companies or the City of Chicago. They contract with outside medical providers who are motivated to keep costs down and favor the employer because if they lose that contract they lose a lot of money. And a lot of their workers will probably lose their jobs.

So what we see there is even when they give an injured worker treatment, they are cutting corners. They might provide physical therapy for you, but would limit it. Or as in the case of one injured worker that recently contacted us, they denied a MRI even though he had been dealing with a shoulder injury for six weeks.

The solution for this worker was pretty straight forward. They needed to be referred to an orthopedic doctor of their own choosing who would look out for their best interests. Almost every Illinois work comp case needs an orthopedic doctor, especially if it drags on for more than a couple of weeks.

Orthopedic doctors specialize in injuries to your muscles. So that can be back, neck, elbow, shoulder, wrist, knee, foot, hands, etc. Insurance companies don’t like them because they are more expensive than a family doctor, but that is because they are true specialists. And if you have shooting pains down your leg from a back injury, down your arm from a neck injury, can’t lift your arm due to a shoulder injury, etc., an orthopedic doctor is a must.

You want someone who deals with your type of injury every single day to be responsible for your medical care. They may suggest physical therapy. They might suggest a MRI. They could recommend a steroid injection (that solved my problem when I had a shoulder injury). Or they could tell you to have a surgery. Whatever they suggest, it will based on years of specialized training and treating similar patients.

In other words, an orthopedic doctor gives you the best chance of making a good recovery and getting back to a healthy, pain free life. It’s no different than getting a work comp lawyer who just does work comp as compared to someone who is doing divorces, DUI’s, real estate closings and more.

The good news is that there are a lot of great orthopedic doctors in Illinois, so finding a good one should not be a problem. And every work comp attorney I know can tell you who the best ones are in your area for your type of injury and the handful that you should avoid.

Bottom line is that you should not get stuck seeing some generic company clinic that has a motivation to not look out for your best interests. And if they tell you an orthopedic doctor isn’t needed, it’s likely a lie to save their client some money.

Why A Settlement Offer Might Be A Bad Thing

If you’d like to discuss your work comp case with an attorney for free, call us any time at 888-705-1766.

In every Illinois workers’ compensation case, the goal is to get better, get back to work and get a great settlement. That is what happens in most cases and leads to a happy client.

Quite often the insurance company won’t voluntarily make a settlement offer, or if they do, it’s a low ball one. It’s important to know that insurance companies make money by not paying out money on claims and limiting the amount they do pay out.

In some cases, the insurance company is eager to settle and if you get a settlement offer and accept it, it could be a bad thing. And it all goes back to my earlier point that insurance companies want to limit what they pay you for your Illinois work comp claim.

Under Illinois workers compensation law, the insurance company has to pay for 100% of medical expenses related to your claim as long as the care is reasonable. So often we see settlement offers made because the insurance company wants to cut off the possibility of having to pay for future medical care.

Take for example a construction worker we talked to who had a shoulder injury that resulted in surgery for a torn labrum. During the surgery there was an anesthesia error that caused a brand new problem. The surgeon wasn’t at fault, but also is a really arrogant guy. He said that he wasn’t going to treat the new problem and after about six months of physical therapy, he released the worker to return to work even though they have numbness in their fingertips from the anesthesia error.

So the insurance company is eager to settle and take advantage of the bad surgeon who won’t address an injury that isn’t part of the shoulder. But under Illinois law, because the surgery was for a work injury, the medical treatment for the surgery error is part of the work comp case.

If the worker takes a settlement now, they will lose their right to future medical care at the expense of the insurance company. In other words, if in a year they need a surgery that costs $250,000 to fix the new problem, they’d have to find some way to pay for it.

So the insurance company is eager to give a high five figure settlement today because they will potentially save four times that much in the future. They actually have risk management people whose job is to figure out the odds of those things happening. It’s how insurance companies make billions every year.

The good news is that this worker got to us before an offer was made and before he agreed to anything that would take away his rights. It was our advice that he not consider a settlement now, but instead try to work with his issues and see where he’s at in six months. It’s typical that nerve damage gets as good as it’s going to get a year after surgery or so.

That doesn’t put money in his pocket or ours right now, but it’s the best, safest and smartest thing for this worker. And that’s what a good attorney does; they protect their client.

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