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Injured on the Job? What You Should Know About Workers’ Comp

Workers’ Compensation and You

If you work in Illinois, there’s a high chance your company has a workers’ compensation insurance policy. Over 90% of employees are covered by our state’s Workers’ Compensation Act, including part-timers, those employed by out-of-state companies, and small business employees.

Knowing your right to workers’ compensation is only the first part of successfully receiving benefits, however. Claimants are often fed myths or denied payment by stingy insurers. This blog includes in-depth information your insurer may not tell you in an attempt to save money.

Workers’ Compensation Benefits Are Comprehensive

In Illinois, workers’ compensation claimants are eligible for 4 types of benefits: medical, disability, rehabilitation, and death. These payments may go further than you expect.

Medical benefits have to cover all “reasonably necessary” care. This means not only your ambulance ride and emergency room bills but also expenses like:

  • Physical therapy
  • Prescriptions
  • Prosthetics
  • Assistive devices

You can even claim the expenses required to modify your home if it is not accessible to you after your injury. Make sure you keep every receipt and bill so you can take full advantage of this opportunity.

Workers’ comp must also pay disability benefits to compensate you for lost wages and (if necessary) lasting loss of bodily function. The amount you will receive is based on the Schedule of Injuries and the percentage by which your abilities have diminished.

If your injury precludes you from returning to your old job, you are owed rehabilitation benefits to defray expenses like:

  • Vocational training
  • Job counseling
  • Physical rehabilitation
  • Incidental expenses (travel, supplies, etc.)

This benefit can help you get back on your feet after a serious injury, but not everyone knows they can take advantage of it. We can go through your expenses with you to determine what may be reimbursable under a workers’ compensation policy.

Finally, the death (or burial) benefit provides families of deceased workers with a funeral benefit of $8,000 plus payments equivalent to of an employee’s weekly wages in the year before the injury. These payments cannot exceed state maximums for workers’ compensation benefits.

Receiving Treatment After an Accident

In Illinois, workers are allowed to choose their own doctors—with some restrictions. If your employer has a Preferred Provider Program (PPP), you can choose any two physicians from the PPP network to treat you. Your employer must tell you if they have a PPP. If they do, you’ll want to follow it closely to avoid being responsible for your own bills.

If there is no PPP attached to your employer’s workers’ compensation program, you can choose any two physicians to treat you. Depending on your needs, you may receive referrals to specialists. These providers are not included in the two-physician limit.

While your employer cannot control your choice of providers, they can choose a doctor to do a full medical exam—think of it as a second opinion. They must provide you with adequate warning and work with you to make sure the appointment is reasonably convenient. They also must reimburse you for travel, meals, and lost wages, if applicable.

Notifying Your Company About Your Injury

Workers’ compensation claims have strict time limits, and if you do not report your injury within them, you may be denied coverage. We recommend you report your injuries as soon as possible. The longer you wait, the more delayed your benefits will be.

You must report your injuries no later than:

  • 45 days after an accident
  • 90 days after suspected radiation exposure

If you are diagnosed with an occupational disease, you should tell your employer as soon as you find out. While there is no set time limit for these claims, putting off the conversation could give the workers’ compensation insurer a reason to push back against your claim.

Though you have to start your claim right away, you should be aware the entire process may take a while. In Illinois, the average time to settlement is 2 years. Our lawyers can help you take care of your affairs and provide guidance and advice the whole time.

Benefit Payment During Pending Appeals

Especially if your claim is serious, you can expect the insurer will challenge it. You may have to file with the Workers’ Compensation Commission to have benefits awarded to you.

Even if you win in arbitration, your employer may appeal this decision. For as long as the appeal is pending (decisions must be made within 60 days of a Commission hearing), the employer is not required to pay your benefits.

If this happens to you, your medical provider also must pause collection—but you will have to notify them of the pending case and provide information like the case number so they can verify.

Employees who win an appeal will receive their benefits plus interest for the delay.

If Your Employer Doesn’t Have Insurance

Knowingly failing to carry workers’ compensation is a felony, so most employers don’t take this chance. However, if you are injured on a job and your company does not carry workers’ comp, you still have options.

The Injured Workers’ Benefit Fund covers injured workers who should have been covered by workers’ compensation but were not. It is funded by fines and penalties from those employers that broke the law. Filing a claim with this fund is a bit of a process, and you may need a lawyer to help. However, your claim might be worth tens of thousands of dollars—compensation you simply can’t afford to miss.

Workers’ Compensation and Government Programs

Workers’ compensation benefits may not be enough to cover your needs, especially if your injury led to a permanent disability. You are allowed to apply for and receive Social Security Disability Insurance (SSDI) at the same time you are receiving workers’ compensation payments. However, you should be aware the government may reduce your SSDI payout so you are earning no more than 80% of your average pay from before.

Because the Illinois workers’ compensation maximum changes every 6 months (it is currently $1,210.45, until 7/14/21), your SSDI payments may continue to decrease if your workers’ comp payments increase.

On the plus side, workers’ compensation benefits are not taxable, so you get to keep everything you receive.

Workers’ Compensation Claims Are Challenging. Don’t Go It Alone.

Now that you know a little more about workers’ compensation, it’s time to make sure you get the settlement you deserve. Remember, if you were injured while on the job, the law is on your side. It doesn’t matter if the injury was accidental, or even if it was caused by a mistake you made. You’re still eligible for workers’ compensation benefits.

If your insurer challenges your claim, remember they may still have to pay. They don’t get to make the final decision—that would be unfair to workers. However, if you end up at any sort of arbitration or hearing, you can be sure they’ll have an attorney representing them. Our workers’ compensation attorneys can help you level the playing field. We understand the ins and outs of workers’ compensation law and can take over the details of your claim, so you have one less thing to worry about while recovering.

Call The Tapella & Eberspacher Law Firm at (217) 394-5885 for a free consultation with our experienced attorneys. We are on your side.