An employer's liability to pay for medical services selected by the employee is governed by Section 8(a) of the Illinois Worker's Compensation Act. It states, in relevant part:
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.
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.
Most Illinois employees are entitled to workers' compensation benefits whenever they suffer a work-related injury. However, the definition of work-related may be rather broad. For instance, if someone is hurt at a company party or other function outside of the normal job site, that injury may be considered work-related. However, workers who are injured when they are commuting to or from work are usually not covered due to what is known as the going and coming rule.
Workers in the state of Illinois enjoy strong federal protections against accidents and injury in the workplace. The federal agency in charge of overseeing employee safety, the Occupational Safety and Health Administration, has recently expanded their system for the reporting of workplace injury and reinforced the laws protecting those who disclose these problems.
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.
Welders in Illinois and around the country should be concerned about toxic smoke and fumes as well as the fire risks associated with their jobs, according to the Occupational Safety and Health Administration. While a single stray spark can cause a fire, smoke and fumes containing metals like arsenic and lead and noxious gases such as hydrogen fluoride have been associated with several types of cancer and other catastrophic health issues.
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.
Hospitals and other health care facilities employ a lot of people in Illinois and across the U.S. As the fastest growing industry in the country, health care provides jobs for over 18 million people. Many of these health care workers are exposed to health and safety hazards on the job every day. According to data from the Occupational Safety and Health Administration, 6.8 percent of full-time health care employees suffered from a reportable work injury or illness in 2011.
Last time, we began looking at the current causation standard here in Illinois, noting that the standard is currently at one percent. Because employers must pay workers’ compensation benefits in full anytime they are at all responsible for the injury, the current law is favorable to employees. The proposal to change the causation standard to the percentage corresponding to an employer’s degree of responsibility would, therefore, be a step backward for employers.