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 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).
Does this mean that you are guaranteed TTD benefits until you have reached MMI? As with anything, there are exceptions to every rule. The first recognized exception to the MMI requirement is a refusal to comply with recommending treatment that your doctors feel will improve your condition(s). For example, suppose you have a slip and fall on ice in your employers’ parking lot that is deemed an “accident” within the meaning under the Act. After your initial emergency treatment, you follow up with your family doctor who diagnoses you with a back strain and recommends a course of formal physical therapy. Following the completion of your therapy, you still have complaints of pain, which your doctor feels warrants an MRI. The MRI shows a disc herniation and you are then referred to an orthopedic surgeon for more extensive treatment. The surgeon tells you that your condition requires epidural steroid injections followed by surgery. Further suppose that for non-religious reasons you tell your surgeon that you want to skip both the injections and the surgery, and would like to just continue with physical therapy for as long as you would like, and you refuse to allow the surgeon to schedule your injections. At this point, you have lost your eligibility for TTD benefits because you are refusing to submit to treatment that is essential to your recovery.
Second, and similarly, suppose that in the above scenario, you undergo the recommended surgery and your surgeon then refers you to physical therapy for 12 consecutive weeks, scheduled for 3 days a week, for 3 hours a day. You begin to feel better after the fourth week but refrain from reporting your improvement to your doctor, because you are afraid he will release you back to work. You are enjoying your vacation, and you are getting paid! Instead, you start to skip at least 1 session per week. After about 3 weeks of skipping sessions, your TTD benefits are terminated. You can’t understand why, since you are still attending therapy, albeit sporadically. Although you are not necessarily refusing treatment as in the above fact pattern, you are not making a good faith effort to rehabilitate yourself. First, your doctor scheduled 12 weeks of therapy for a reason and if you second guess his opinion, you should discuss it with him. Second, you are not being honest with your doctor about the progression of your recovery, which could result in an unnecessary extension in your treatment.
Last, let’s assume that you have had the surgery, you diligently and faithfully attended all your physical therapy, and now your doctor wants to send you back for a trial period. He places you on light duty. Your restrictions keep you from performing your usual job with your employer, but your boss calls you and says he found a desk job for you to do, that fall within your restrictions, and they will pay you your normal rate of pay and give you your normal amount of hours. You cringe at the thought of a desk job and tell your employer, thanks but no thanks, that you will be back as soon as the doctor thinks you are ready to perform your old job. You have just extinguished your TTD rights, and you will be waiting out your full duty release without pay. You have an obligation to accept work that falls within the physical restrictions prescribed by your doctor. If your concern is that even the light-duty will aggravate your condition, you still must give the light-duty work a try, and if it does cause pain, you can then go back to your doctor and have him modify your restrictions.
Always keep in mind that as a Petitioner, it is your burden to continuously prove entitlement to your benefits. Even if you have an accepted claim, it is recommended to have an attorney representing your interests and providing ongoing protection of these benefits. Please contact our office should you have any questions regarding your injury or claim.