Workers Compensation

Which Employees are Covered by the Law?

Almost each individual who is employed by a company in the state of Illinois is covered by the law from the moment they are hired for certain injuries or diseases that may be caused from their employment or duties required by their job.

What Injuries are Covered by the Law?

In most cases the law will include injuries that are caused, in whole or partially, by the employee’s work. For Example:

An employee who is injured by the repetitive use of a body part.
An employee who suffers a stroke, heart attack, or other physical problem caused by work.
An employee who had a pre-existing condition*
Injuries accrued by employer sponsored recreational programs (athletic events, parties, picnics, etc.)**

* Patient must be able to show the work aggravated that condition

** Only if the employee is ordered to participate by the employer

Injuries, accidental or otherwise, that incur while participating as a patient in a drug or alcohol rehabilitation program are not covered under the law.

Can an Employee be Fired for Reporting an Accident or Filing a Claim?

It is illegal for an employer to harass, discharge, refuse to rehire, or in any way discriminate against an employee for exercising his or her rights under the law.

What Medical Benefits are Covered Under the Law?

The employer is required to pay for all medical care that is reasonably necessary to cure or relieve the employee from the effect of the injury. These costs include but are not limited to

First Aid
Emergency care
Doctor visits
Hospital care
Surgery
Physical therapy
Chiropractic treatment
Pharmaceuticals
Prosthetic devices
Prescribed medical devices*.

*Devices such as a shoe lift or wheelchair may be covered.

What Benefits are Provided?

The law states the following benefit categories are provided to the employee:

Medical Care that is reasonably required to cure or relieve the employee of the effects of the injury
Temporary total disability (TTD) benefits while the employee is off work, recovering from the injury
Temporary partial disability (TPD) benefits while the employee is recovering from the injury but working on light duty
Vocational rehabilitation/maintenance benefits are provided to an injured employee who is participating in an approved vocational rehabilitation program
Permanent partial disability (PPD) benefits for an employee who sustains a permanent disability or disfigurement , but can work
Permanent total disability (PTD) benefits for an employee who is rendered permanently unable to work
Death benefits for surviving family members.

Who Pays for the Benefits?

By law, the employer is responsible for the cost of workers’ compensation. Most employers buy commercial workers’ compensation insurance, and the insurance company pays the benefits on the employer’s behalf. No part of the workers’ compensation insurance premium or benefit can be charged to the employee. Other employers obtain the state’s approval to self-insure.

What are the time limits for notifying the employer?

The employee must notify the employer within 45 days of the accident. Any delay in the notice to the employer can delay the payment of benefits. A delay of more than 45 days may result in the loss of all benefits.

What if the Employer Won't Pay the Worker Any Benefits?

The employee or the employee’s attorney should contact the employer directly to determine why benefits are not being paid. Poor communication often causes delays and misunderstanding. If the problem persists, the employee should file a claim at the Commission. Please note that an accident report does not trigger any action by the Commission.

Who Pays for the Medical Care?

If the employer does not dispute a medical bill, it will pay the medical provider directly. The employee is not required to pay co-payments or deductibles. If the employer disputes a bill, it must promptly give the employee a written explanation for the refusal. If a case is pending at the Commission, the provider cannot try to collect payment from the employee; once the employee notifies the provider that he or she has filed a claim with the Commission to resolve the dispute. The provider may send the employee reminders of the outstanding bill, and ask for information about the case such as the case number or status of the case. If the employee does not provide the requested information within 90 days of the date of the reminder, the provider may resume efforts to collect payment.

How are Prices for Medical Care Determined?

Most treatments that are covered under the Act and were provided on or after February 1, 2006 are subject to a medical fee schedule. The employer shall pay the lesser of the provider’s actual charge or the amount set by the fee schedule.

Can the Employee Choose the Treating Doctor or Hospital?

Yes, however, there are limits; the state of Illinois cannot direct care to a specific doctor or hospital. The employee, after filing their claim with their employer, typically will see a physician directed by the employer. If the employee chooses to they may go see a physician of their own choice, even if that physician is outside of the employee’s regular insurance network.

Can the Employer Ask for an Evaluation by its own Doctor?

Yes. On occasion an employer may request a full medical exam by the doctor of its choice.

Personal Injury

If you have suffered a Personal Injury we at Suburban Orthopaedics are here to help! We know that personal injury cases can be difficult, especially when attempting to obtain medical care. If you have been injured at another parties’ expense we have physicians and staff that can help assist you through the arduous process.

To discuss your injury, address your questions, and set an appointment for consultation with one of our orthopaedic specialists please contact our office at (630) 372-1100, log onto our Patient Portal or email us at [email protected]

Workers’ Compensation