Workers Comp in Peoria

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Chicago has the Bulls, Bears, Cubs, the banks, the museums, the El, and the Magnificent Mile. Chicago is where the TV shows and movies are set. It even has its own T-rex and its own style of pizza.

Yes, in the Land of Lincoln, Chicago gets the attention — dare we say, the love. But venture south of Interstate 80, the artery that separates Chicagoland from the sprawling, fascinating, gritty Downstate, and you find the place, veteran workers compensation attorney Todd Strong says without a hint of irony, “where the real work gets done.”

Downstate is where molten steel gets turned into engine blocks for tractors, harvesters, and massive earthmovers; where corn and soybeans, under pressure and heat, become component parts of indispensable food products; and where coal, oil, and natural gas still rise in abundance from the Illinois Basin, providing ancient Paleozoic energy for a nation still dependent on fossil fuels and other petroleum products.

Downstate is where hands-on work happens, and, inevitably, employees get hurt. Muscles strained, joints twisted, bones broken, heads concussed, skin burned. Sometimes in combination. Sometimes all at once.

Sometimes they suffer work-related illnesses: pneumonoultramicroscopicsilicovolcanoconiosis — an actual word, the longest in the dictionary — is still a thing. Silicosis, from breathing microscopic coal dust. Black lung disease.

With 26 years in practice, Strong definitely plays in Peoria. He knows how folks work, how they sometimes get injured, and how quickly they can get lost in the maze that is the workers compensation system.

“In a perfect world,” he says, “they’d call me on Day Two. Unfortunately, it’s not a perfect world.”

Instead, workers delay. The operate under the (possibly mistaken) impression that workers compensation is supposed to smooth the way toward medical treatment and, if necessary, compensation for missed paychecks. They heed the recommendations of their bosses, the subtle pressure of their supervisors, and the promises of the insurance company.

Strong has heard it all before: “The insurance company usually presents itself as, ‘We’re going to be nice, we’re going to help you, we’re going to be your best friend.’ …

“The injured worker may come to me a year later and say, ‘Well, I’ve been waiting for the insurance company to get back to me. They never have.’ ”

And that is a problem.

Signs You Need a Workers Comp Lawyer in Peoria

Let’s get this out of the way: Of course workers comp lawyers are going to say injured employees need immediate legal representation. They want the work. But they’re also very likely right. Two things can be true at the same time.

The sooner an injured/sickened employee is represented, the sooner the professional litigator can begin guiding the case and advocating for the client.

“You’re dealing with an injured worker who, frankly, doesn’t have any experience with this,” Strong says. “They’re physically, emotionally, and mentally traumatized by whatever their injury is.

“I deal with these claims on a day-to-day basis. The insurance companies deal with them on a day-to-day basis. If the worker tries to take on the insurance company on his own. … ”

In short, it can end badly. Or, at least, not as well as if the worker had a tough, knowledgeable attorney to guide the process.

Strong notes the things to watch out for: Companies that send workers to the in-house clinic, or company doctors, who then feed the details of their findings to the employer and the adjuster.

These providers’ “first allegiance is not to the patient,” Strong says. “But they don’t explain that to the worker, and the workers don’t know. Did they read the fine print?”

An attorney will advocate for the “gold standard of medical care,” Strong says. A worker who reports with a probable torn tendon might otherwise get sent out for an inexpensive X-ray, not a pricy MRI.

“An X-ray isn’t going to tell you anything,” Strong says. “You need that MRI for a proper diagnosis.” Early legal representation often means the correct procedure is prescribed early on.

Workers also need an attorney if they suspect they’re being stalled. Stalls create blanks in the health record, blanks that can be construed to mean the worker wasn’t hurt in the first place, or aggravated the injury doing something completely unrelated to the job. A proper attorney immediately starts a paper trail, and pushes for timely treatment.

Other hints you need a lawyer:

  • Your employer or your employer’s insurance carrier claims you weren’t injured (or sickened) at work.
  • Medical providers are unwilling to see you.
  • The insurance carrier denies your claim, for whatever reason.
  • You’re unhappy with the diagnosis or prognosis provided by the physician recommended by the insurance carrier.
  • Your employer threatens, or even hints, you’ll be fired or demoted or otherwise poorly treated if you report your injury.
  • Peer pressure to deny your injury.
  • You have been sidelined for more than two weeks because of the injury/illness, but you have received no wage compensation.
  • The carrier pushes for a quick settlement. Remember that “best friend” relationship? The proper response: Let me talk to my lawyer.

What Does a Workers Comp Lawyer in Peoria Do?

Here in the heart of the Prairie State, in the great center square with Springfield, Decatur, Bloomington, and Peoria at the corners, Illinoisans put their backs into work that produces tangible things the world wants.

Attorney Strong knows the territory. He knows the players. He knows how agricultural products are manufactured, and the inherent danger of working around miles of pipes carrying soybean or corn oil under high pressure at high temperatures.

He knows chippers and grinders who spend their work lives in foundries taking the slag off engine blocks. After more than a quarter century, Strong can spot a grinder at the far end of a basketball court. Big shoulders. Muscular arms. A hand bent into a claw — nerve entrapment from 20 years of strenuous, repetitive labor.

Strong knows their tools, too, pencil, cup, and cam grinders, and sometimes he brings one or two to hearings. “I’ll ask the arbitrator to pick up the tool,” he says. “And the arbitrator will be like, ‘I don’t want to hurt my hand.’ ”

Besides bringing fascinating visual aids to hearings, here’s what else you can expect a workers comp lawyer does to push for the best outcome:

  • Depose incident witnesses and insurance claims adviser.
  • Conduct settlement negotiations.
  • Know expert witnesses to call when needed.
  • Experience with case law related to this case.
  • Immediate filing to trigger certain rights, including lifetime medical, vocational rehab services, job placement services, the ability to file emergency petitions for medical care, treatment, surgeries, medical supplies, and prescriptions,
  • Maintain a legal and proper chain of referral from medical provider to medical provider and assist the workers in getting access to quality medical care.
  • Obtain narrative reports, supporting medical evidence, IME exams, medical experts, vocational experts.
  • Calculate medical fee schedules and obtain the necessary billing forms to make sure all medical bills are properly processed for payment.
  • Research similar injuries to obtain highest possible awards for other workers with similar injuries.
  • Fight for lifetime medical benefits.
  • Fight for coordination of benefits with Medicare, MSA accounts, SSD set-offs, and/or disability pensions to obtain highest possible outcome.

Another key service a proper attorney will provide: Sorting out from the start who is and should be on the hook for the employee’s claim. As more and more companies turn away from traditional employees to staffing or payroll agencies to supply workers to their plants (and dodge all those benefits issues), the line blurs about who the employer is.

It’s not unusual for Strong to have a client who says, for instance, “I work at Caterpillar,” underestimating the power of the preposition. Does he work for Caterpillar, or merely at Caterpillar? The name of the employer on the direct deposit receipt oftentimes is everything, and it’s vital to know immediately.

How Much Does a Peoria Workers Comp Attorney Charge?

The vast majority of workers compensation cases nationwide proceed on a contingency basis. That is, once retained, the attorney fronts all costs and is paid no fee. Only when the injured worker prevails is the attorney able to recover his/her expenses and collect a fee. What the lawyer is paid is contingent, or depends, on what the injured worker is awarded.

Illinois statute sets the contingency fee in workers compensation cases at 20%. No recovery equals no fee.

However, says Strong, “I have yet to handle a case where the recovery was not increased by our involvement, even after deducting the legal fee.”

Additionally, the Illinois Bar regards investigation of potential third-party involvement — a company that supplied faulty machinery, or a subcontractor who performed subpar pipefitting work — part of the standard of care for attorneys representing injured workers.

If contributory negligence proves a factor, third-party lawsuits, not governed by the limitations of workers compensation, can produce enormous settlements or jury awards. The best time to capture witness statements and preserve the circumstances and the evidence? We see Attorney Strong’s hand raised. Yes? “In a perfect world, immediately.”

An injured, or sickened, worker — disoriented, in pain, rocked emotionally, psychologically, and physically — has enough to worry about without trying to navigate the legal system. Not when there are experts, such as Todd Strong, just a telephone call or mouse click away.

Handling a Workers Comp Case on Your Own in Peoria, 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 Peoria

Filing a workers compensation claim in Peoria 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 Peoria:

  • 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 Claim

Deadlines are a vital part of the game in Peoria 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 Peoria

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).

Sources:

About the author

Tom Jackson won dozens of national awards as a columnist for newspapers in Washington, D.C., Sacramento and Tampa. His writing has spread from business to politics to sports with an emphasis on community issues. Tom splits his time between Tampa and Cashiers, N.C. with his wife of 40 years, a college-age son and a yappy Shetland sheepdog named Spencer. Tom can be reached at tjackson@workerscompensationexperts.org.