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Workers' Compensation Archives

What Entitles Me To My TTD Benefits?

When you sustain an injury that arises out of and in the course of your employment, you are generally entitled to, at the very least, 3 basic rights under the Illinois Workers' Compensation Act ("Act"). You are entitled to 100% coverage of your medical bills, compensation for lost wages resulting from the work accident, and a settlement at the end of your case. If you do in fact have an injury that your doctor feels temporarily but completely incapacitates you from working, you are eligible for Temporary Total Disability (TTD) benefits. Your period of temporary and total disability continues until your treating doctor(s) have determined that you are at Maximum Medical Improvement (MMI). Being placed at MMI means that you have recovered as much as the permanent nature of your injury will permit, and no further treatment will provide any benefit to you. The Illinois Supreme Court has determined that the dispositive inquiry regarding TTD eligibility is whether or not you have reached MMI. Interstate Scaffolding, Inc., v Illinois Workers' Compensation Comm'n, 236 Ill.2d 132, 142, 923 N.E.2d 266 (2010).

Accidents and Workers' Compensation Claims

We have recently come across a problem that is affecting several of our clients and potential clients. We have had several situations of cases where potential clients are being told by their employers to report to their medical providers that an accident that occurred at work actually occurred at home or some other place that has nothing to do with the work place. The employers are attempting to do this in order to avoid making a workers compensation claim against their insurance or other coverage. However, in our experience most of the employers who are taking these kind of actions generally have some kind of problem with their workers compensation insurance or they make empty promises about how they will pay any medical bills that are generated from workers comp related medical treatment out of pocket instead of turning it into insurance.

How Is Your Average Weekly Wage Calculated?

When you are injured on the job and as a result cannot work, how much you receive in lost wage benefits and in settlement at the end of your case will depend on your average weekly wage (AWW). Most people automatically assume that their hourly rate multiplied by the number of hours they are normally scheduled to work will be their AWW. Sometimes, it can be much more complicated than that.

Timeline for a Workers' Compensation decision

After you finish receiving medical treatment for your workers' compensation accident, your attorneys will attempt to reach a settlement with the insurance carrier and/or attorney for the employer. If negotiations do not resolve in a settlement, then your workers' compensation case will have to be tried before an Arbitrator. A hearing date will be selected to try the case when your case appears on the Illinois Workers' Compensation Docket. Your case will appear on the workers' compensation docket in a city close to where you were injured. 

When is a Worker entitled to receive Temporary Total Disability Benefits?

An injured worker who is kept off work by a treating physician, while undergoing treatment, is entitled to receive 2/3 of his average weekly wage. This is called temporary total disability. This is defined as regular pay, not overtime pay, unless the overtime is mandatory. These benefits are paid while the Petitioner is in active treatment and is unable to work due to his work related injury. No deductions, such as taxes or Social Security, are taken from the temporary total disability check. However, there are exceptions. For example, child support will be taken out if it is owed.
A treating physician also includes, a chiropractor who keeps the worker off work, providing his treatment is deemed to be reasonable and necessary and there is an indication that the injured worker is benefiting from the medical treatment received.
If the physician releases the injured worker to return to work with restrictions and the employer is unable to provide accommodations for the restrictions, then the worker is entitled to continue to receive the temporary total disability benefits. These benefits will continue until the injured worker's medical condition has stabilized and he has reached maximum medical improvement. Maximum medical improvement occurs when the injured worker has reached a state where his or her condition cannot be improved by any additional treatment. This does not mean that the injured worker's medical condition is what it was prior to the time of the injury. Quite often, when the injured worker has reached medical maximum medical improvement, he still is having problems associated with his injury. Those difficulties are factored in when a case is tried before an arbitrator or when a case is settled.
If the employer fails to pay the temporary total disability benefits without a reasonable excuse, they are subject to penalties. That is one reason why the injured worker is required, by the Illinois Workers Compensation Act, to be examined by a physician chosen by the employer. This is called an independent medical examination. If, in fact, the doctor chosen, has a legitimate reason for stating that the injured worker is not entitled to receive temporary total disability benefits, then penalties will not be assessed against the employer. This does not mean, however, that the arbitrator will not still award the temporary total disability benefits, as it would be an issue to be determined by the Illinois Workers Compensation Commission.
Finally, you should be aware that when an injured worker receives temporary total disability benefits for an extended period of time, the insurance company will more than likely hire surveillance to follow you around to see if you are violating the restrictions.

Impairment Rating

In 2011, the law changed as to how your permanent partial disability, your settlement/award is calculated. The Illinois Workers' Compensation was amended to reflect that in all cases when the accident occurs after September 1, 2011, the Judge in calculating compensation/permanent partial disability should base its determination on factors including (i) An impairment rating; (ii) Occupation of the injured employee; (iii) Age of the employee at the time of the injury; (iv) employee's future earning capacity; and (v) evidence of disability corroborated by the treating medical records. 820 ILCS 305/8.1b (West 2012)) provides as follows with respect to the determination of PPD benefits: Impairment rating pursuant to AMA six edition is nothing but a grid system. Impairment is not the same thing as disability, the measure used to determine the compensation for the injured employee. The rating does not count for your pain, permanent restrictions, multiple injuries and prospective medical treatment. The insurance companies have been very fond of the impairment rating because some Judges in the past have given a lesser award in cases where there has been an impairment rating done. Traditionally, the impairment rating has not been required, but is usually done if the employer requests it.

New Computer Tools Aid In Diagnosing Concussions

How can you tell if a person has suffered a concussion after a fall or blow to the head? It's not always easy. A doctor must administer an array of tests to measure a person's cognitive abilities, such as memory, reaction time and word skills. The doctor may also order a CT scan or MRI to see if there is any internal bleeding in the cranial cavity.

Hearing loss cases

I was asked recently by a client whether a loss of hearing is a workers compensation case in the State of Illinois. The answer is yes, depending on the hearing loss and the amount of noise he is exposed to at work. Under Section 8(e) 16 of the Illinois Workers Compensation Act, a loss of hearing for compensation purposes is confined to the frequency of 1000, 2000 and 3000 decibels per second. A loss of hearing for frequency tones above 3000 decibels per second and under 1000 decibels are not recoverable. In other words, hearing loss cases are recoverable only if there is a loss within a specific range. Obviously, testing has to be performed by an audiologist to determine the loss in the particular frequencies.

Payment of statutory amputations

If you have suffered the misfortune of an industrial accident resulting in the amputation of an appendage, seek an attorney immediately. It is well established that the purpose of the Illinois Workers' Compensation Act (the Act) is to provide employees with a "prompt, sure remedy for their injuries and to require that the cost of industrial accidents be borne by the industry rather than its individual members." However, never is this truer than in the case of what is referred to as a "statutory amputation." This phrase is used because the Act treats amputations differently than it does other, less serious injuries. Amputations are typically irreversible, and therefore have distinct and separate rights that attach to them automatically. To be considered an amputation, the injury must affect more than just soft tissue. The injury must affect the bone as well.

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