Like every state, there is plenty to argue about with the workers compensation system in Illinois, but in two extremely important areas, Illinois injured workers are ahead of the game.
If you get hurt on the job in Illinois, you have the right to choose your doctor and direct the medical treatment you receive. Comfort and confidence with the doctor treating you obviously is a plus in a successful recovery.
“The absolute right to choose and direct your medical care is very important in Illinois and that’s pretty unusual when you look around at how other states do things,” said David Menchetti, who has been doing workers compensation law for 35 years in his hometown of Chicago.
“If you choose your doctor, there is a level of trust and belief that he has your best interest in mind as you are healing. If you go with a doctor paid by your company, he’s most interested in getting you back to work as soon as possible.”
The second benefit – medical fee reimbursement schedule – is not so obvious, but almost as critical to successful outcomes. Many states use Medicare’s rate schedule to reimburse doctors. The Medicare fees are so low that it’s not worth the time for the best doctors in those states to treat workers compensation cases.
Not in Illinois.
“By not limiting injured workers to doctors who accept Medicare’s minimum payments, you’ve allowed them to pick and choose the best doctors for their situation,” Menchetti said. “High quality medical treatments cost a lot of money, but because of Illinois’ reimbursement schedule, doctors are willing to do the extra work involved with a workers compensation case.”
That’s not to say that injured workers have it made in Illinois. The state lagged well behind in using the internet to make processing cases easier before finally allowing claims to be filed online in 2020. Now, they want all paperwork transmitted online. Any paper filings mailed to the IWCC on or after April 21, 2021, will not be accepted.
So, now that things are automated and workers have access to quality medical treatment, and the right to choose their doctor, Illinois can rightfully boast about being ahead of the game on key components of the workers compensation system.
“Electronic filing is a big step forward and there are some more things we can improve,” Menchetti said. “I’d like to see our programs educating workers about the system improve. I’d like our Commission to be a little more pro-active with the system.
“But as long as we allow injured workers to choose their own doctor, we’re in a pretty good situation.”
How to File a Workers Compensation Claim in Illinois
Filing a workers compensation claim in Illinois is a multi-step process that begins with the very obvious: Notify your employer that you’ve been hurt as soon as possible after the accident.
That much is obvious in most cases, but not all injuries are easily assigned to a single incident. A sore back, a stiff neck – contracting an occupational disease such as loss of hearing – often occur over time. Workers suffering with back problems, for example, may ignore the pain for days or weeks until it gets unbearable before filing a claim. That brings into play a challenge from the employer or insurance carrier that the injury was work related.
But that won’t happen if you tell your supervisor or employer as soon as you feel a twinge and it begins to ache. Ask a supervisor to make note of the date so there is a record that it happened at work. That gives you a way to fight claims that it was not work related.
Here’s a step-by-step guide to filing a workers comp claim in Illinois:
- Step 1: Notify your supervisor or employer – Do this immediately, or as soon as possible, and tell them that you have been injured on the job.
- Step 2: Seek medical treatment – Like Step 1, this is obvious and should be done as soon as possible. Also, make sure the treating physician or facility knows this is a work-related injury so bills go to your employer’s insurance carrier and not you.
- Step 3: Document your injury – Write down the time, date and a description of the accident. Get the names of any witnesses and, if possible, use a smartphone to take pictures of the accident scene. Both are invaluable if there is a dispute over your claim.
- Step 4: Chose your doctor – You are permitted (and advised) to choose your own doctor for treatment. If that is not possible, your employer may have a Preferred Provider Program (PPP) that supplies the names of doctors and facilities approved by the employer. Illinois law allows injured workers to make two choices of doctors for treatment. If you go to a PPP, that is one of your two choices. If you decline to see a PPP, that also counts as one of your two choices. Either way, by choosing your own doctor – and asking him/her to refer you to any other doctors needed for your treatment – you retain control of your medical needs.
- Step 5: Check the claim status – The employer is supposed to file a claim 45, known as the “First Report of Injury” with the Illinois Workers Compensation Commission (IWCC) within five days of being notified about an injury. The status of your claim can be found on the IWCC’s website.
If parts, or all of your claim, has been denied, the injured worker, or an attorney, must file a form called “An Application for Adjustment of Claim” and a “Proof of Service” form. Claims may be filed electronically, by mail or you can take them in person, to any Commission office. There is no fee for the forms, which can be found at http://www.iwcc.il.gov/forms.htm.
When the IWCC receives your Application for Adjustment of Claim and Proof of Service, it will notify you and the insurance carrier when the hearing will be held and who will be the arbitrator.
If you have not at least discussed your situation with a workers comp attorney at this point, now would be a good time to consider that.
Deadlines for Filing a Workers Comp Claim in Illinois
Deadlines are a vital part of the game in Illinois workers compensation cases and another of the many reasons it is wise to at least consult an attorney if you have disputes with your claim.
Here are a few of the deadlines that must be observed:
- Injured workers have 45 days to notify their employers of an injury and three years to file a claim for benefits or two years after the last compensation payment, whichever is later.
- Employers have 30 days to file a “First Report of Injury” with the Illinois Workers Compensation Commission for all injuries that result in a worker missing more than three days of work.
- Written reports of all job-related deaths must be made to the Commission within two working days.
- Injured workers should receive the first checks for Temporary Total Disability within 14 days.
- Appeals for arbitration and Commission decisions must be filed within 30 days.
- The statute of limitations says a claim must be filed within three years of the date of the injury.
Employers Responsibility in Illinois Workers Comp Claims
The first responsibility for an employer is to post a notice of what is expected when an accident happens and an employee is injured.
The notice should include information about:
- The person responsible for handling workers compensation claims
- Business address and phone number for the business
- Effective date and termination date for the insurance carrier
- Policy number
- Employer’s FEIN number
The employer should see to it that the injured worker receives necessary medical attention, whether on the job site or at an emergency room or Urgent Care Center.
The employer should inform the insurance carrier or workers compensation administrator as soon as possible.
If the employee misses three workdays, the employer should file a First Report of Injury with the IWCC and prepare to begin payment for Temporary Total Disability.
Employers are responsible for having workers compensation insurance to cover all employees, or petitioning with the state to be self-insured.
Employers are prohibited from charging employees for any part of the premium paid for workers compensation insurance.
Employers can’t discriminate against an employee who has filed a claim for workers compensation benefits. The employer can’t harass, fire or refuse to rehire employees who filed a claim.
Insurance Company’s Responsibility in Illinois Workers Comp Claims
Insurance companies are responsible for providing benefits to the injured worker, including paying for reasonable and necessary medical treatment and wage compensation for employees who miss more than three days of work because of injury.
Employers are prohibited from charging employees for any part of the premium paid for workers compensation insurance.
Employers can’t discriminate against an employee who has filed a claim for workers compensation benefits.
The insurance carrier may assign a nurse manager to the worker’s case to help gather medical records and bills.
It is wise to understand that the nurse manager is working for and paid by the insurance carrier. The nurse manager should not be in the examining room or offer advice that limits medical treatment. That includes speaking directly to your doctor about your medical care without first gaining your permission.
What Happens If Your Claim Is Denied?
Employers in Illinois receive approximately 250,000 reports of injuries from workers every year, but only about one-third of them involve the worker missing more than three days of work and thus requiring the employer to file a report with the IWCC.
Of the group missing extended work time, more than 50,000 cases end up going to arbitration, which is where disputed claims usually are settled. However, arbitration is a misleading term for what actually happens at this stage of the process.
The arbitrator sits on the sidelines while the injured worker (and presumably their attorney) tries to reach what is called a “settlement contract” with the insurance carrier on the claim. Every three months, the arbitrator will issue a “status call” to see if the two sides have resolved the matter and in 90% of the cases, they eventually do, though it usually takes a lot longer than three months.
The settlement contract is an agreement by both sides to close the claim in exchange for the injured worker receiving an amount of money. The average settlement contract takes about two years to wind its way to a conclusion.
The settlement contract can’t be sent to an arbitrator for approval until the injured worker has received an independent medical examination and doctors say the worker has reached Maximum Medical Improvement (MMI).
In the 10% of cases where no settlement is reached, one side or the other requests a trial and now the arbitrator becomes the judge and a hearing takes place. The burden of proof is on the injured worker, who must prove they are eligible for benefits because:
- The injury occurred while working in Illinois.
- An employer/employee relationship existed.
- The accident occurred in the course of employment.
- The medical condition was caused by the accident or exposure.
- The employer was notified of the injury within 45 days of the accident.
An actual trial occurs with depositions presented; witnesses and expert testimony; case law is cited … then the arbitrator has 60 days to make a decision to award benefits or deny benefits and dismiss the case.
Either side can appeal the arbitrator’s decision. When that happens, the case moves in front of a three-member panel, called “The Commission” which reviews the arbitrator’s decision.
No evidence or testimony is presented at this stage, though an attorney can present a five-minute oral argument. The members of the Commission look at the evidence presented and a transcript of the trial. They have 60 days to decide whether to uphold the arbitrator’s decision; reverse the decision or modify it.
The results at this stage are not good for injured workers appealing a case. The Commission let the arbitrator’s decision stand or decreased benefits in 82% of cases appealed by workers. When the insurance carrier appealed to reduce benefits, the Commission did not decrease benefits 73% of the time.
There are three more stages of appeals that either party can make, but it’s rare that cases reach either the Circuit Court (500 cases a year); the Appellate Court (100 cases a year) or the Illinois State Supreme Court (five cases a year).
Eligibility for Workers Compensation in Illinois
If you are employed in Illinois, you qualify for coverage under the state’s workers compensation laws.
Illinois law requires any company with one or more full or part-time employees to have workers compensation insurance. Sole proprietors, business partners, corporate officers, and members of limited liability companies may exempt themselves.
Also exempt are domestic workers employed for less than 40 hours a week for less than 13 weeks during a calendar year.
The majority of employers get their workers compensation insurance through companies that sell workers comp policies. However, an employer can petition the state to self-insure, but that is rare.
If an employer willfully fails to obtain insurance, he/she could be fined up to $500 for every day of noncompliance, with a minimum fine of $10,000. Corporate officers can be held personally liable if the company fails to pay the penalty. Since 2006, the Commission has collected over $7 million in fines. Fines are deposited into the Injured Workers’ Benefit Fund.
An employee may forfeit rights to workers compensation benefits if their injury was caused by the employee being intoxicated or abusing a controlled substance.
Benefits: What Does Workers Comp Cover in Illinois?
There are seven categories of benefits for workers compensation in the state of Illinois. They are built around paying for medical treatment and compensating an injured worker while he/she recovers from an injury and, hopefully, returns to work.
The seven categories include:
- Medical benefits
- Temporary total disability (TTD) benefits
- Temporary partial disability (TPD) benefits
- Permanent partial disability (PPD) benefits
- Permanent total disability (PTD) benefits
- Vocational Rehabilitation/Maintenance benefits
- Death/survivor benefits
There are numerous qualifying standards for each benefit, which makes it almost mandatory that an injured worker consult a workers compensation lawyer to be sure they take advantage of all benefits they could receive. Here is a brief look at each benefit.
Employers or their insurance carriers are required to pay for all reasonable and necessary medical care. That includes doctor visits, hospital and emergency room care, surgery, prescription drugs, physical therapy, medical appliances and more.
It the injured worker is disabled and need home modifications for wheelchair ramps, insurance may be responsible for those costs, too.
Injured workers should advise doctors’ offices or hospitals that this a workers compensation case and see to it that billing is sent to the insurance carrier. Employees are not responsible for co-payments or deductibles.
Employees are permitted to make two choices of doctors for their care. If the employer has a network of providers called a Preferred Provided Program (PPP), the employee may choose to opt out and select his/her own doctor.
However, opting out of the PPP counts as one of the choices of doctors. Choosing your own doctor would be considered a second choice. Any further choices have to be referrals from your doctor or be approved by your employer.
Employers may challenge a treatment and if the IWCC Commission finds the treatment was not reasonably necessary, the employer does not have to pay the bill.
Temporary Total Disability
Temporary Total Disability is awarded to employees who temporarily can’t do their job because of injury. Doctors must provide notice to verify that. TTD also can be awarded to an employee released to do light-duty work, but their employer is unable to accommodate it.
TTD is paid at 66.67% of the worker’s average weekly wage for the 52 weeks prior to being injured. TTD is not paid for the firs three days of work missed, but if the worker misses 15 or more calendar days, they will receive retroactive pay for the three days. Delays in paying TTD are common , so the IWCC advises employees to present the employer with a written demand for payment.
TTD ends when the employee returns to work or has achieved Maximum Medical Improvement (MMI) as determined by a physician.
Temporary Partial Disability
TPD is a benefit paid to an employee who has returned to work in light-duty capacity and is earning less than he/she did before getting injured. TPD is paid at 66.67% of the difference between the average amount the employee would be able to earn in the pre-injury job and the gross amount he or she earns in the light-duty job.
Permanent Partial Disability
Permanent partial disability is the partial or complete loss of a body part; the partial or complete loss of use of a body part; or, the partial loss of the body as a whole. Loss of use generally means the worker is unable to do things he/she did before the injury. PPD is only paid if the job-related injury results in permanent physical loss.
There are four types of benefits paid for PPD:
- Wage differential (Section 8(d)(1) of Workers’ Compensation Act): Wage differential is when the injured worker obtains a new job that pays less than the old job. Wage differential is two-thirds of the difference between the amount the employee earns in a new job and the amount they would be earning in their old job. An employee may be compensated for either the loss of wages or the permanent disability related to the same injury, but not both.
- Schedule of injuries (Section 8(e) of Workers’ Compensation Act): Body parts are given a value (expressed in terms of weeks) and that number is multiplied by 60% of the Average Workers Wage.
- Non-schedule injuries (person as a whole) (Section 8(d)2): If the condition is not listed on the schedule of injuries, but imposes certain limitations, the employee may be entitled to a percentage of 500 weeks of benefits. The number of weeks is then multiplied times 60% of the employee’s average weekly wage.
- Disfigurement (Section 8(c) of Workers’ Compensation Act): An employee who suffers a serious and permanent disfigurement to the head, face, neck, chest above the armpits, arm, hand, or leg below the knee, is entitled to a maximum of 162 weeks of benefits at the PPD rate. The number of weeks is then multiplied by 60% of the employee’s average weekly wage.
Permanent Total Disability Benefits
If an employee suffers the permanent and complete loss of use of both hands, both arms, both feet, both legs, both eyes, or any two such parts, he/she qualifies for PTD. They also may qualify they suffer a complete disability that renders the employee permanently unable to do any kind of work for which there is a reasonably stable employment market.
A worker with PTD is entitled to a weekly benefit equal to two-thirds (66 2/3%) of his or her average weekly wage, subject to minimum and maximum limits, for life. The minimums and maximums for PTD benefits are available in Commission offices and online at www.iwcc.il.gov/benefits.htm.
If the employee recovers enough to get a job, the employer may petition the IWCC to modify or terminate the benefits.
If an employer can’t return to his/her old job, their employer must pay for training necessary for the mental and vocational rehabilitation of the employee. That includes vocational retraining, including education at an accredited institution and counseling for and supervision of a job search program.
Employees are entitled to maintenance benefits that are not to be less than the employee’s TTD rate. They also are entitled to costs and expenses associated with the rehabilitation program.
In the case of death injuries resulting in death, the primary beneficiaries are the spouse and children under 18 of the deceased. Burial benefits consist of $8,000. The death benefits to survivors would be two-thirds of the employee’s gross average weekly wage in the 52 weeks before the injury.
If no primary beneficiaries exist, the benefit could go to totally dependent parents or, if they don’t exist, to persons who were at least 50% dependent on the employee at the time of death.
If the surviving spouse remarries and there are children, the benefits continue. If there are no children, the spouse is entitled to two years compensation, after which, all right to further benefits are extinguished.
- N.A. (2013, January) Illinois Workers Compensation Commission Handbook On Workers Compensation And Occupational Diseases. Retrieved from https://www2.illinois.gov/sites/iwcc/Documents/handbook.pdf
- N.A. (ND) Frequently Asked Questions (FAQs) Retrieved from https://www2.illinois.gov/sites/iwcc/resources/Pages/faq.aspx
- N.A. (ND) Illinois Workers Compensation Commission Comp File Implementation. Retrieved from https://www2.illinois.gov/sites/iwcc/resources/Pages/compfile_implementation.aspx