Workers Comp in Chicago

The state of Illinois has a very simple – very important! – document it asks employers to post at work sites to tell injured workers vital information they will need should their injury require immediate medical treatment.

The form has space for:

• Party handling workers compensation claims
• Business address and phone
• Effective date and termination date for insurance carrier
• Insurance policy number
• Employer’s FEIN number

It’s debatable whether you need the first three items when you’re in an emergency room trying to get a workplace injury treated, but there can be no debate you need the last two items – the insurance policy and employer’s FEIN number – when you walk in the door.

Is that information easily available at your workplace?

Ken Wolfe has been practicing workers compensation law in Chicago for over 40 years and says he can’t remember the last time he saw a notice with that information at a workplace, but he’s not surprised.

“You can’t rely on employers to get information out that might result in an increase in their premiums and hurt the bottom line,” Wolfe said. “You’d be surprised at the lack of knowledge out there about workers comp. We’ve got to come up with a better system that educates workers on what their benefits are and how to go about getting them.”

The good news in Chicago and Cook County is that the number of attorneys and judges dealing with workers compensation is relatively small. Attorneys representing injured workers know the judges that make conservative rulings and the ones who might be more liberal in their rulings.

“You definitely need to know the track record of all the judges and attorneys,” he said. “If you are able to call opposing counsel and you have a relationship with them, it can make the claims process much smoother and I think we have that in Chicago, for the most part.”

Reasons to Hire a Workers Comp Attorney in Chicago

Illinois state law requires business owners to have workers compensation insurance, even if they only employ one person and even if that is just a part-time employee. Employers can petition the state to self-insure, but the vast majority (over 90%) pay monthly premiums to insurance carriers to make sure employees are covered.

Yet, as Wolfe points out, many employers are reluctant to bring up the subject with their workforce, so when an employee is injured and get to an emergency room or urgent care center for treatment, they may not even know who the company’s insurance carrier is.

“I’ve had clients who have to go the human resources department at work and demand to know the name of the insurance carrier,” Wolfe said. “Why wouldn’t you divulge who your insurance carrier is?”

That’s just one of the questions workers may need help with if they get hurt on the job. Here are some other signs that hiring an attorney is the only way to get the benefits you’re entitled to.

• Employer won’t report claim to carrier.
• If you are out of work more than two weeks and haven’t received wage compensation benefits.
• You’re getting wage compensation benefits, but you question whether the calculations are accurate.
• If the employer or insurance carrier won’t authorize treatments you need.
• If there is any adverse action by the employer – you’ve been fired or laid off – and you suspect it’s because you got hurt on the job.
• Your employer labels you an independent contractor and says you are not covered by workers comp.
• If you get a denial of your claim for any reason.

What Do Workers Comp Attorneys in Chicago Do?

Before an injured worker can negotiate a settlement with the insurance carrier, the worker often must go through an independent medical examination or IME.

The doctor in an IME determines whether the worker has reached  “Maximum Medical Improvement” which is another way of saying that the worker is as good as they’re going to get from medical treatment.

“Just like every profession, there are good IME doctors and bad ones,” Wolfe said. “We have stored up a warehouse of files on who are the good ones and bad ones. We know  the doctors who will give a favorable report when warranted, and which doctors are just insurance company shills.”

Not many – if any! – injured workers could do that. It’s just one of the many things an attorney can do that the average person wouldn’t know how to do. Here are 10 more things a good workers compensation lawyer could do, that the average worker either wouldn’t know or couldn’t do on their own.

• Advising client on how to handle interviews with claims adjusters or opposing attorneys
• How to respond to demands by employers
• How to get medical bills paid
• How to prevent collection agencies from hounding you for unpaid bills
• What Illinois Workers Compensation Commission precedent is and the impact of collateral issues on a final ruling
• How to negotiate a settlement and what a case’s real value is
• If the case won’t settle, how to gather medical records and bills in the proper format when the case goes to court
• Knowledge of the rules of evidence
• Relevant case precedent for any disputes that arise

“We have to educate most workers on how the process plays out, especially those who are going through workers compensation for the first time,” Wolfe said. “We try to manage their expectations. Some employees have wildly inflated views on the value of their case and what their rights and obligations are.

“We explain things so they know where the guardrails are and what they can realistically expect down the road.”

How Much Does a Workers Comp Lawyer in Chicago Charge?

Illinois laws on paying a workers compensation attorney are very straightforward: attorneys receive a contingency fee of 20% of the disputed benefits recovered for the injured worker.

That’s it. There is no retainer. No out of pocket money to hire an attorney. The 20% fee only applies to disputed benefits, not benefits paid voluntarily, such as medical treatment or wage compensation.

If that seems like a lot, compare it to the 33%-40% that personal injury attorneys receive.

If a workers compensation attorney doesn’t recover anything, the client doesn’t owe anything and the attorney eats the cost of expenses he/she incurred while working on the case.

“And the first meeting to discuss your case and determine whether you have a claim … is free!” Wolfe said. “It’s absolutely risk free and very worker friendly. There is no charge if we don’t recover money for the worker. People who get hurt at work should not hesitate to pick up a phone and call an attorney if they have questions.”

Handling a Workers Comp Case on Your Own in Chicago, IL

The first step in a workers comp case is to notify your employer. That will kickstart the process of filing a workers compensation claim. If your claim is denied, you have the option to appeal the decision.

Filing a Workers Comp Claim in Chicago

Filing a workers compensation claim in Chicago 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 Chicago:

• 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 https://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 Claim

Deadlines are a vital part of the game in Chicago 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 for Filing a Claim

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 with Claims Form

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.

How to Appeal a Workers Compensation Claim in Chicago

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).