Who Pays When an Illinois Workers’ Comp Insurer Goes Broke?

Injuries happen at the workplace. Sometimes a slip-and-fall on the way into work causes an injury; other times it is a car accident while driving as part of work duties. In some of the most serious cases, workplace violence may result in a life changing injury or even death. In most cases, workers' compensation is available following an on-the-job injury regardless of how the injury occurred.

Workplace violence is more common than many realize and ranges from simple assaults to robberies or sexual assaults. The Bureau of Justice Statistics in its last National Crime Victimization Survey found workplace violence accounted for approximately 15 percent of nonfatal violent crime from 2005 to 2009. Some of the professions at most risk are no surprise: law enforcement officers, security guards and bartenders. Strangers commit most of the incidents. Of workplace homicides, 28 percent involved victims working in sales.

Bullet Wound and a Permanent Injury

The Illinois Supreme Court recently heard oral arguments in a workers' comp case that looked at who pays workers' compensation benefits after an insurer goes broke.

The underlying workers' compensation claim was initiated after an employee at an industrial company sustained a bullet wound to her head while she was on the clock. The incident happened in 1985 and she filed a workers' compensation claim seeking benefits for the injury. In 1993, the Illinois Industrial Commission found she was totally and permanently disabled and ordered the employer to pay reasonable and necessary medical costs and weekly benefit payments for life.

What Happens When an Insurer Goes Broke?

Illinois has a nonprofit organization called the Illinois Insurance Guaranty Fund, which protects policyholders and claimants if an insurance company goes bankrupt. All insurance companies pay into the fund as a price of doing business in the state.

In this case, the employer's insurance filed for bankruptcy. The Fund stepped in to make payments, but stopped after paying up to the $300,000 ceiling. The Insurance Code has an exemption to the ceiling for any workers' compensation claims. Thus, the issue for the court to decide is whether the claim brought by the self-insured employer was a workers' compensation claim.

The appellate court found that if the legislature had intended to exclude self-insured employers whose insurance carriers had gone bankrupt it could have done so. Because it did not, the legislature intended these claims to be classified as workers' compensation and not subject to the ceiling.

While the case is quite technical, it could have implications for some policyholders. The Fund generally provides protection ensuring injured employees continue to receive benefits even after an insurer goes bankrupt.

The field of workers' compensation is complicated. Following a serious injury, it is important to consult an attorney who can ensure your rights are protected and you receive fair compensation.