What Is Your Case Worth When You Need More Treatment?

The most popular Illinois work comp law question we get is, “What is my case worth?”  I get it and we try to answer that question when we can.

The thing to know is it’s not black and white and every case is different.  So if you call us and want to know how much a torn bicep tendon is worth, we need to ask a lot of questions to give you an accurate answer and sometimes we can’t do that without seeing your medical records.

A recent caller wanted to know what his case was worth after tearing his meniscus and having surgery.  That injury is usually fairly straight forward and most people make a good recovery.  In this case though, the recovery wasn’t great and his doctor told him that he’d likely need a total knee replacement down the road and in the mean time would need injections to his knee every year.

This is a classic case of there’s no way to tell you what it’s truly worth without seeing your medical records.  The major issue is that this worker needs to be compensated for his future medical care.  This can be done by leaving his medical rights open, but insurance companies don’t like to do that when they give you a settlement.  It can also be done through a Medicare set aside which requires the insurance company to get an estimate as to what the future medical costs will be and give you that money now.  You have to pay for your care out of that fund until it runs out and if you don’t and ever need Medicare you could be out of luck.

Another way around this is to not settle, but go to Arbitration.  If you d this, you keep your medical rights open and may have a way to be compensated in the future when you can’t work when you have the knee replacement surgery.  It’s probably a smart play and you’ll still receive money similar to the settlement amount through the Arbitrator making an award. If you aren’t concerned that the case could be lost for some reason, you should seriously consider this option.

Big picture is that when you need more medical care in the future, especially if it’s for something serious like replacing a fusion, knee replacement, etc, your case is unique and you have to really have someone look at this from all angles.  You might think the settlement they offer you sounds great, but in our experience, the cases are usually worth much more because they are trying to close your case while limiting what they are obligated to do in the future.

If you’d like to talk with one of our attorneys about this for free, call us any time at 312-346-5578.  We cover all of Illinois.

Does Your Employer Need To File The Case So You Can Get Treatment?

A woman called my office with a pretty typical sounding work injury.  She had been hit in the head by a falling box and sustained a concussion and neck injury.  The concussion seems better, but she has shooting pains going down her arm which is a sign of a herniated cervical disc.  That can be a really serious injury and could go from bad to worse if she doesn’t get treatment right away. At a minimum she should be getting physical therapy.

While she was able to go to the emergency room without a problem, getting follow up care with her preferred neurologist has been a challenge.  Long story short is that the employer hasn’t reported the case to their insurance carrier so the worker can’t get a claim number.  The neurologist, who wants to get paid, won’t provide any treatment without a claim number because he wants to bill someone he can collect from.  No treatment means no recommendation for physical therapy, no MRI and her injury gets worse.

As often is the case, the only person losing out here is the one everyone should be worried about, the injured worker.

There is no legal reason for the company not to report the claim other than hoping to frustrate their employee with the hopes she goes away. They are risking a ton though as if they delay too long they’d lose their insurance and still be on the hook for all the bills.

In a situation like this you need to force their hand and file an Application For Adjustment Of Claim with the Illinois Workers’ Compensation Commission. This is the first thing an attorney does.  Doing so makes the case official, gets you assigned to an Arbitrator and gives the employer no choice but to report the claim.  That will generate a claim number and in a case like this should allow you to get medical treatment. You can get on the road to getting better and put the nonsense and games they are playing behind you.

Bottom line is that there does not need to be a case number in order to get treatment, but it can help.  If there isn’t one it means that somebody is playing games with your health and that of course is a big red flag.  If you have any concerns, questions or want help with a case, contact us at any time for a free consultation.

When Anxiety and Panic Can Be An Illinois Work Comp Case

Generally speaking, having anxiety, depression, panic, etc. is not a compensable case under the Illinois Workers’ Compensation Act.  You might have to work long hours or have a boss that screams a lot or feel pressure from unrealistic deadlines or have to do the work of many people.  This can understandably lead to stress and while I think it’s awful you have to go through that, the law is not usually on your side unfortunately.

There are though some exceptions.

The biggest exception is showing that something physical lead to a mental breakdown.  So if you hurt your back and have a fusion and become depressed because of how limited you are physcially, that would likely be a case.  Or as shown in a recent work comp claim, a woman whose unwanted physical contact lead to a mental breakdown was able to secure benefits.

In that case, a woman was standing at the counter on her job when her supervisor came up from behind and pinned her against the counter, simulating that he was having sex with her.  He hit her in the back and there was some bruising.

The Illinois Workers’ Compensation Commission found that she developed panic and anxiety issues as a result of this unwanted touching which resulted in some bruising.

We’ve seen other cases where a co-worker has punched someone, not causing a major physical injury, but making that person feel unsafe in the work place and in need of therapy.  It doesn’t matter if most people wouldn’t have that experience, it’s your experience after a physical touching that matters.

Like any other Illinois workers’ compensation claim, the most important thing is your health so you should get medical treatment ASAP. You also, like in any other case, prove your injury exists by going to a doctor.  If your problems are work related, 100% of your medical bills should be paid, you get compensated for your time off work and you would be entitled to a settlement.

These aren’t easy cases and if you are already treating with a mental health professional before your incident they become harder, but we are happy to talk to you for free about your case to see if you can make a claim.

IL Work Comp, Can Your Boss Talk To Your Doctor?

I’ve written on this blog many times about the danger of nurse case managers in Illinois workers’ compensation cases.  Bottom line is that some will try to talk to your doctor directly or schedule your appointments so they can attend. All of that is illegal.

A recent caller had a similar situation that I’d never come across before.  He hurt his leg at work and went to see a doctor.  But his supervisor insisted on coming to the appointment to make sure that there was no dispute in what the doctor heard about how he got hurt.  So that happened and then a follow up appointment was scheduled which the boss ended up cancelling and re-scheduling because he had to pick up his son at school.

This is all nuts and illegal.

Medical care in Illinois workers’ compensation cases is for the worker and patient privacy laws prevent anyone from interfering with their medical care.  That means your boss can’t talk to your doctor, can’t be in the exam room with you, can’t change your appointment to fit their schedule or do anything other than ask the office for a copy of medical records and bills.

My educated guess is that this was some overly exuberant risk manager type who may have meant well (or maybe not) but in a likely effort to protect the company was risking the health of an employee who was clearly hurt while working on the job.

The legal term for all of this is the Petrillo Doctrine which is a fancy way of saying that there was a case a while ago and the conclusion of that case is that nobody can talk to your doctors without your permission.  If they do, any information they get from the doctor would be barred at trial.  So don’t sign any documents that give them that right and know that even if you did, it can be revoked at any time.

Bottom line is that while your employer and the insurance company are entitled to information, it can’t come at the expense of your privacy or health.  Don’t get pushed around.  And as always, if you need our help or just have a questions, feel free to call us any time.

Work Comp Liens In Illinois When You Have A 3rd Party Case

Most Illinois workers’ compensation cases involve someone getting hurt on their job and bringing a claim against the insurance company for their employer. If you type a lot and get carpal tunnel or pop your back when lifting a box, there is no other case to be made other than workers comp.

In some cases though, you get hurt at work but it’s due to the negligence of someone who does not work for your employer.  The most common example is a car accident while driving, but we have also been involved with many construction accidents where scaffolds are not properly prepared or floors break or walls collapse as well as many other scenarios.  In office settings it’s not uncommon for someone to slip on a wet floor that was mopped by an outside cleaning service that didn’t put up a sign.

When this happens you have both a workers compensation claim as well as a “third party claim” which is lawyer talk that means the right to sue someone else for negligence.  In that situation, the most important issue is your health and it’s great that you can pursue a work comp case because they will pay for 100% of your medical care with no out of pocket expenses or co-pays.  And you get to choose your doctor and get prompt treatment. Workers comp will also pay you for your time off work.

Just like in any other work injury claim in Illinois, you will be entitled to a settlement, but if your injury is really serious, it’s likely that you will get more money from suing the 3rd party. For example, in a recent case, a construction worker had his right leg amputated due to the negligence of some other contractors.  The work comp case would have probably been worth $400,000-$600,000, but the third party case netted him seven million.

The unique thing about these cases is an Illinois law that says the work comp insurance company has a right to recover up to 75% of what it has paid if you make a third party recovery.  So if they paid $200,000.00 in bills and lost time, they could get up to $150,000.00 of that back.  This is called a lien.

There are a few important things to note:

1. The law is they can get up to 75% back, but that’s negotiable. Your attorney’s job is to make sure the most money possible ends up in your pocket.

2. Often an insurance company will waive their lien in agreement for you to settle the work comp case for $1.  They do this to close the case which ends their liability.  Workers’ comp insurance carriers love nothing more than a closed case even if they could potentially get more money back.

3. You should never settle the work comp case for $1 or agree to a lien payment until you know for sure what is going to happen on the 3rd party case.

4. Sometimes you’ll hire one firm for the PI case and one for the job injury case.  Sometimes you’ll have one firm that handles both.  The right decision depends on how you were injured. Some personal injury lawyers don’t know how to handle complex trucking accidents or how to analyze major injury cases.  Some can only handle slip and falls or car accidents.  We can help you figure out who is the best for both cases.  You want to make sure that your attorneys aren’t working to get the biggest fee for themselves at the expense of what you get.

5. In 3rd party cases, medical providers can put a lien on that case for their unpaid bills, but there are no liens allowed against a work comp case.  So if anyone tells you otherwise they are wrong.

Bottom line is that these are not typical cases and if your injury is serious you need someone who really knows what they are doing to look out for you. If you have questions or want our recommendation about what you should do, call us for free any time or fill out our contact form and we will call you.

Why Would This Chicago Work Comp Law Firm Do This?

There is a REALLY bad Chicago workers’ compensation law firm. They advertise a ton, assign young attorneys to many of their cases, have a lot of turnover and deliver terrible customer service. I know this because I am repeatedly told the same story by their unhappy clients.  We get about 4-5 calls from their clients on an average week and one week I had 11(!) of their clients call me.

In my opinion, they don’t care about their clients and worry more about their relationships with doctors who refer them cases. They do this by telling their clients to go see certain doctors and these clients unknowingly follow along, at times killing their case.

Rumor has it that they are now using some south side “neck and back clinic” place for a lot of their injured workers. Two of the recent callers to my office had gone there and something really odd happened with both of them.

Reportedly the doctor ordered a functional capacity exam (FCE) very early on in the treatment. I’ve never seen that happen because an FCE is typically done when your treatment is over and a doctor is trying to determine your permanent restrictions.  For one of the clients, she needed back surgery.  The other had herniated discs in his neck.  As a result they both “failed” the FCE because giving a consistent effort was not a possibility.

Based on the failed FCE, which never should have taken place, the insurance company cut off these clients.  The attorneys of course have done nothing to correct the case problems and the workers have been without benefits for many months.

If you read my blog you will know that I don’t believe in attorneys requiring a client to treat with a certain doctor. It almost always seems to be a situation where they are more interested in referring cases to each other than worrying about the injured client.  When I started practicing law I worked at a defense firm and took the deposition of a doctor who was treating a woman three times a week at his clinic. After about six months of care, the insurance company cut her off. He continued to treat her and on a Monday she rated her pain as an 4 out of ten and his notes said she needed one more month of physical therapy. The next day he learned he wouldn’t get paid anymore.  She came in on Wednesday and rated her pain as an 8 out of 10, and he said that she was fine and discharged her.  That’s an extreme example, but not surprising.

The bottom line is that if your attorney is telling you what doctor to see, it’s a red flag, and if they are asking you to have a FCE within the first six months after your injury, you should really question it.  It makes no sense to me why this would ever happen, and sadly in these two cases, it has really hurt two injured workers.

A Hip Replacement From The Repetitive Nature Of The Job

While Illinois work comp laws are very friendly to the worker, one of the truest things about them are that if your injury is due to the repetitive nature of your job, the insurance company is going to try and look for a way to fight your case even if it’s painfully obvious that the job is what caused your problems.

Case in point, imagine you are a delivery driver and you jump two plus feet off your truck 100-200 times a day because you worked on crowded city streets where there was not room for a ramp.  You do this job for years and begin to notice that your left hip is hurting and that’s the leg you usually land on first.  You go to the doctor and he diagnoses you with avascular necrosis of the femoral head which is medical jargon for saying your hip is messed up. This doctor tells you that you need a hip replacement.

Most people would say it’s obvious that the continuous jumping gradually made the worker’s hip injury worse until it became so bad that he sought medical care.  Well, it wasn’t so obvious to the insurance company because they fought the case that had these very facts.  Fortunately the Illinois Workers’ Compensation Commission did have common sense and believed his testimony that he had no prior problems with the hip and that the 14 years of doing this same activity over and over clearly aggravated and accelerated any underlying arthritic condition.

That’s usually how the insurance companies fight these cases.  They’ll say that you had some “underlying condition” that is the true source of all of your problems and that stuff like hundreds of thousands of work related jumps over the years have nothing to do with the problem.  It’s really pathetic, but this is what you are dealing with if you get hurt at work.

It’s really no surprise that a case like this got fought.  Hip replacement surgery is expensive and a case like this has a lot of settlement value.  So for the insurance company to roll the dice and hope that you don’t have the desire to hire a lawyer, that your lawyer will sell you out or that you’ll testify poorly and they will win is a worthwhile gamble. It might only work one out of ten times, but that one time saves them enough money that they can mess with the lives of people like you.

Big picture is that common sense usually prevails and Arbitrators are not dumb. If you have questions about a claim and want to speak to one our lawyers for free, call us any time at 312-346-5578.

Injuries Off The Clock Can Still Be A Work Comp Case

There are a lot of myths out there about Illinois workers’ compensation law.  Most of these are started by insurance companies or employers who want to discourage you from receiving the benefits you are entitled to under Illinois work comp laws.

One myth that we hear a lot is that you have to be on the clock to have a successful case.  It’s true that if you are off the clock your case will be investigated more thoroughly, but injuries off the clock can be cases.

For example, in a recent case, a security guard hurt her neck and back when a co-worker on a golf cart ran in to her.  Before the accident happened she had clocked out for the day and was on her cell phone waiting for a ride. She was in a designated waiting area at the time.

The insurance company fought the case of course, but the Illinois Workers’ Compensation Commission ruled in favor of the worker.  The employer told her to be in the area where she got hurt which, because other guards rode through there, exposed her to a risk of injury.

You can even be off the clock and at home and have a compensable case.  There have been multiple cases throughout the years where someone brought home a box of work materials for a meeting or other reason and then hurt their back while lifting that box.  Because the employer is benefiting from what you are doing, if you get hurt in the process you have a case.

There have even been cases where someone is driving to the grocery store after work and get in to an accident that it’s a work comp case.  In that type of claim the worker would have company info on their car. Essentially they are never really off the clock because by driving around and promoting the company, the employer is benefiting from them.  As a result, an injury in a car accident, even if you are just running an errand, would likely be a case.

Bottom line is that it’s always worth it to explore whether or not something about your job makes your injury a workers’ compensation case. It’s your right under Illinois law.  We are always willing to give a free consultation to discuss if you have a case and what your options might be.

Does My Attorney Have A Conflict Of Interest?

A lot of callers want to know if there lawyer has some sort of conflict of interest. It usually happens in small town cases.  If you hire a local attorney, chances are that they are going to know your boss from around town and may have a friendship with them.  That doesn’t mean that they won’t do a good job for you, but it can certainly make you wonder if they will fight all the way when needed, or if they will be worried about how your case impacts their life away from court.

My take on those situations is that if it makes you uncomfortable, it’s a big deal, and you should look to a different firm for legal help.

A recent caller to my office had a different conflict of interest with their lawyer.  She had hurt her back and hired an attorney. He recommended a doctor to her which we don’t do, but normally isn’t a huge conflict either, unless they insist you work with that doctor.

In this case, the conflict of interest was that the lawyer and doctor are siblings.  This, of course, raised a huge red flag with the insurance company and they are balking at paying the bill which is around $10,000.00.  There is a settlement offer and the attorney is telling the client to pay her sibling out of the settlement.

There are so many things wrong with this scenario.  Let’s count the ways:

  1. If the bills are related to the injury and reasonable, the insurance company should pay them directly and the lawyer should be fighting to make that happen.
  2. If for some reason the case was disputed and the bills were being paid out of the settlement, the attorney should be negotiating with the doctor to get them to take a lower amount.  That didn’t happen here because the attorney seems to care more about their sibling making money than the client getting a good result.
  3. By sending the client to his sibling, the lawyer created huge credibility issues for his client.  Imagine if the case went to trial and you were asked by the defense attorney, “How did you find your doctor that thinks you were hurt at work?”  If your answer is, “My lawyer sent me, they are siblings” the credibility of the doctor will be thrown out the window and your case will be really hurt.

I could go on, but that’s a big 3 of conflicts.

Bottom line is that if your lawyer gives any indication that they are looking out for anyone but you it’s a huge red flag.  Don’t hire them or if you already did, get rid of them.

As always, if you want to talk about a case, call us, fill out our contact form or hit the chat box to speak with an attorney for free.  We cover all of Illinois.

Illinois Job Injuries and Temporary Transitional Employment (TTE)

They say that the only two sure things in life are death and taxes.  Well I’m here to tell you that there is a third sure thing. If the insurance company can think of a way to cut off your benefits they will try it.

This latest effort over the last few years is a scam to try and cut off your TTD benefits with something called temporary transitional employment or TTE.  In a nutshell, you get hurt at work and have restrictions that your employer can’t accommodate.  Instead of paying you TTD benefits and have you sitting at home, the employer wants to pay you TTD and make you go work for a non-profit or charity.

They sell it as they are trying to help you transition back to full duty work eventually, but the reality is that they want you to refuse the assignment so they can cut off your benefits all together.  Imagine you’ve been a welder your whole life and now they want you to sit in an office and answer a phone all day or stuff envelopes.

It all sounds nice in theory, but the reality is that it doesn’t prepare you to get back to your actual job and doesn’t allow you to focus on your health and recovery. Beyond all of that, the Illinois Workers’ Compensation Commission has ruled that you don’t have to take this sham assignment if you don’t want to.

I will note that the validity of TTE assignments has not yet gone to the Appellate Court and I imagine it will some day, so it’s possible that this advice will change.  That said, aside from the fact that these jobs aren’t real, there are issues such as what if you get hurt on this “volunteer” job. Who would cover that new case, the new employer or the old one?  What happens when this assignment asks you to do work beyond your restrictions?  What are you supposed to do about days when you have to go to the doctor or physical therapy.

The geniuses who thought up TTE want nothing more than to increase their bottom line.  There is also a hint of they want to “make you earn it” as if you didn’t risk your health by doing your normal job duties that got you here in the first place.

The bottom line is that, as of now, you don’t have to go along with this assignment, but don’t be surprised if they try to fight you or come up with other ways to cut you off.  It’s always about their bottom line to them.

Any questions?  Call, chat or fill out our contact form.  It’s always free and you will always be able to talk to one of our lawyers.

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