Category Archives: Illinois Workers’ Compensation

Fees and Penalties against the Employer/Insurer in an Illinois Workers’ Compensation Case under Illinois law 820 ILCS 305 sections 19(k), 19(l) and 16.

By Steven Edelman

When an employer/insurer fails to pay an injured worker temporary total disability (TTD) then your attorney can file a request for 19(b) hearing and also requests fees and penalties against the employer/insurer for failure to to pay TTD. Fees and penalties are allowed under section 19(k), 19(l) and 16 of the Illinois workers’ compensation law found under 820 ILCS 305.

820 ILCS 305/19(k)

19(k) penalties: Under this section employer/insurers are penalized for non-payment of benefits owed to an injured worker. The penalty under this section is 50% of the unpaid amount.

See Illinois law per 820 ILCS 305/19(k)

“In case where there has been any unreasonable or vexatious delay of payment or intentional underpayment of compensation, or proceedings have been instituted or carried on by the one liable to pay the compensation, which do not present a real controversy, but are merely frivolous or for delay, then the Commission may award compensation additional to that otherwise payable under this Act equal to 50% of the amount payable at the time of such award. Failure to pay compensation in accordance with the provisions of Section 8, paragraph (b) of this Act, shall be considered unreasonable delay.” https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=082003050K19

820 ILCS 305/19(l)

19(l) penalties: This section of Illinois law allows a penalty against the employer/insurer of $30 per day for failure to pay weekly TTD compensation benefits up to a maximum penalty of $10,000. The law states under 820 ILCS 305(l):

“If the employee has made written demand for payment of benefits under Section 8(a) or Section 8(b), the employer shall have 14 days after receipt of the demand to set forth in writing the reason for the delay. In the case of demand for payment of medical benefits under Section 8(a), the time for the employer to respond shall not commence until the expiration of the allotted 30 days specified under Section 8.2(d). In case the employer or his or her insurance carrier shall without good and just cause fail, neglect, refuse, or unreasonably delay the payment of benefits under Section 8(a) or Section 8(b), the Arbitrator or the Commission shall allow to the employee additional compensation in the sum of $30 per day for each day that the benefits under Section 8(a) or Section 8(b) have been so withheld or refused, not to exceed $10,000. A delay in payment of 14 days or more shall create a rebuttable presumption of unreasonable delay.”

820 ILCS 305/16

16 penalties: This section provides for attorneys’ fees when 19(k) and 19(l) penalties are sought. The law states under 805 ILCS 305/16:

“Whenever the Commission shall find that the employer, his or her agent, service company or insurance carrier has been guilty of delay or unfairness towards an employee in the adjustment, settlement or payment of benefits due such employee within the purview of the provisions of paragraph (c) of Section 4 of this Act; or has been guilty of unreasonable or vexatious delay, intentional under-payment of compensation benefits, or has engaged in frivolous defenses which do not present a real controversy, within the purview of the provisions of paragraph (k) of Section 19 of this Act, the Commission may assess all or any part of the attorney’s fees and costs against such employer and his or her insurance carrier.”

https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=082003050K16

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

What is a case nurse in your Missouri or Illinois Workers’ Compensation case?

By Steven Edelman, Attorney, 314-631-6777

Missouri Workers’ Compensation

Illinois Workers’ Compensation

What is a case nurse?

  1. A case nurse is just what is sounds like. They are a nurse hired by the workers’ compensation insurance company to assist the injured worker with their case. The case nurse assists by scheduling and coordinating medical treatment with authorized doctors and medical providers. Case nurses also help the injured worker obtain prescription medication cards and fill prescriptions at pharmacies
  2. Cases nurses also make summaries of medical treatment received and sometimes provide reports to the injured worker and their attorney.
  3. Case nurses are not required by law. An injured worker has to consent to have a case nurse participate in the case. If the injured does not want a case nurse involved in her case, then the employer/insurer has no right to obtain a case nurse to participate in the case.
  4. If the injured worker/claimant agrees to have a case nurse participate, then they do not have to agree to have the case nurse sit in on the appointment with the doctor.
  5. If the case nurse interferes with medical treatment and the injured worker’s relationship with the doctor then their participation can be terminated immediately.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

Illinois Workers’ Compensation: Average Weekly Wage and Rate Explained & Why is it important?

What does average weekly wage (AWW) and rate mean in an Illinois workers’ compensation case?

By Steven A. Edelman, Attorney, (314) 631-6777, Ext. 14

Temporary Total Disability(TTD): In an Illinois workers’ compensation case the amount of money that you receive each week while you are off work due to the work injury is calculated based on the injured worker’s average weekly wage and rate. This weekly payment is referred to as temporary total disability (TTD).

Permanent Partial Disability (PPD): Additionally, the amount of money that an injured worker receives in a settlement or an award for the permanent disability that they suffer due to the work injury is calculated based on the injured worker’s average weekly wage (AWW) and rate. This permanent disability is referred to as permanent partial disability (PPD)

If two cases are similar in all other respects but for the AWW and Rate, then the higher the injured workers’ AWW and Rate, the more money their workers’ compensation case is worth, and the lower the AWW and Rate, the lower the value. Therefore, it is very important to correctly calculate average weekly wage and rate.

How to Calculate Average Weekly Wage (AWW):

We first have to calculate AWW to then calculate Rate.

In most cases the AWW is calculated using the average of the injured workers wages for the 52 weeks preceding the work injury. However, there are alternate methods to calculate the average weekly wage (AWW). The law specifically states that AWW is calculated as follows:

“The compensation shall be computed on the basis of the “Average weekly wage” which shall mean the actual earnings of the employee in the employment in which he was working at the time of the injury during the period of 52 weeks ending with the last day of the employee’s last full pay period immediately preceding the date of injury, illness or disablement excluding overtime, and bonus divided by 52; but if the injured employee lost 5 or more calendar days during such period, whether or not in the same week, then the earnings for the remainder of such 52 weeks shall be divided by the number of weeks and parts thereof remaining after the time so lost has been deducted. Where the employment prior to the injury extended over a period of less than 52 weeks, the method of dividing the earnings during that period by the number of weeks and parts thereof during which the employee actually earned wages shall be followed. Where by reason of the shortness of the time during which the employee has been in the employment of his employer or of the casual nature or terms of the employment, it is impractical to compute the average weekly wages as above defined, regard shall be had to the average weekly amount which during the 52 weeks previous to the injury, illness or disablement was being or would have been earned by a person in the same grade employed at the same work for each of such 52 weeks for the same number of hours per week by the same employer.” See Illinois Workers’ Compensation Law (820 ILCS 305/10)

After we calculate AWW, we then have to calculate Rate. The calculation of the rate is different for TTD and PPD.

Temporary Total Disability: The Temporary Total Disability (TTD) Rate is calculated by taking 66 2/3% of the average weekly wage (AWW). The law specifically states: “The compensation rate for temporary total incapacity under this paragraph (b) of this Section shall be equal to 66 2/3% of the employee's average weekly wage . . .” See Illinois Workers’ Compensation Law under (820 ILCS 305/6)

Permanent Partial Disability (PPD): The PPD rate is calculated by taking 60% of the average weekly wage (AWW). The law specifically states: “The compensation rate in all cases of serious and permanent disfigurement under paragraph (c) and of permanent partial disability under subparagraph (2) of paragraph (d) or under paragraph (e) of this Section shall be equal to 60% of the employee's average weekly wage . . .” See Illinois Workers’ Compensation Law under 820 ILCS 305/8

Very often the employer and their workers’ compensation insurer will calculate the injured worker’s AWW and rate incorrectly and pay a much lower rate for TTD and for permanency. It is extremely important to consult a lawyer at the Edelman Law Office to ensure your average weekly wage and rate are correctly calculated.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under Illinois workers’ compensation law. Call us for a free consultation: 314-631-6777, Ext. 14

Steven A. Edelman, Attorney

Illinois Workers’ Compensation, Temporary Total Disability (TTD) Explained

Temporary Total Disability (TTD)

Illinois Workers’ Compensation

Temporary Total Disability (TTD) is a check that you receive each week that you miss work because of the work injury either because (1)  The doctor takes you off work completely due to the work injury or (2) The doctor placed you on light duty work work restrictions, and the employer can not accommodate light duty work, and therefore you are off work. 

Your TTD check is equal to 66.67% of your gross average weekly wage. The gross average weekly wage is based on the average of your gross weekly wages for the 52 weeks preceding your date of injury. TTD for  governed by the law under 820 ILCS 305/8(b)

Common Problems with Temporary Total Disability (TTD) payments:

  1. The Employer pays the incorrect amount of temporary total disability (TTD).
  1. The Employer refuses to pay TTD despite the doctor placing you off work.
  1. The injured worker is on light duty work restrictions per the order of treating doctor. The employer then offers light duty work but with unreasonable requirements. For example, the offer of light duty work is at a location that is hours away, or out of state from the employee’s original assigned work location. The employer then refuses to pay TTD based on the offer of light duty work because the employee cannot reasonably travel to the light duty work. 
  1. The injured worker is on light duty restrictions per the order of their treating doctor. The employer then offers light duty work within the doctor’s accommodations but simultaneously tells the injured worker that they must perform additional full duty work outside of the doctor’s light duty restrictions. When the employee cannot do this full duty work, the employer sends the injured worker home. The employer then states that the employee refused light duty work, and therefore denies payment of TTD
  2. The Employer mails your TTD check to the employer’s address instead of mailing TTD directly to the injured worker. Mailing TTD to the employer creates unnecessary burden on the injured worker to travel to the employer to pick up their TTD check.

It is important that you immediately contact our law office to discuss your temporary total disability (TTD) benefits. We protect your rights and ensure that the employer pays you your benefits while you recover from your work injury. 

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under Illinois workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven A. Edelman, Attorney

Illinois Workers’ Compensation; Medical Treatment and Choice of Medical Provider Explained

Illinois Workers’ Compensation

Medical Treatment Explained in Illinois Workers’ Compensation Cases

The First Major Benefit under Illinois Workers’ Compensation Law: The first Major Benefit under the Illinois Workers’ Compensation Act is medical treatment paid for by the employer/workers’ compensation insurance company per the law 820 ILCS 305/8(a). 

Under Illinois workers’ compensation law, an injured worker has the right by law to choose two medical providers and the referrals from each of these two chosen providers are paid for by the employer/workers’ compensation insurer. The law specifically states that:

“[T]he employer’s liability to pay for such medical services selected by the employee shall be limited to:        (1) all first aid and emergency treatment; plus        
(2) all medical, surgical and hospital services

provided by the physician, surgeon or hospital initially chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said initial service provider or any subsequent provider of medical services in the chain of referrals from said initial service provider; plus
        (3) all medical, surgical and hospital services

 provided by any second physician, surgeon or hospital subsequently chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said second service provider or any subsequent provider of medical services in the chain of referrals from said second service provider. Thereafter the employer shall select and pay for all necessary medical, surgical and hospital treatment and the employee may not select a provider of medical services at the employer’s expense unless the employer agrees to such selection. At any time the employee may obtain any medical treatment he desires at his own expense.”
820 ILCS 305/8

Example:

The following is one example of facts of how an injured worker can choose his doctor in an Illinois workers’ compensation case. 

First Choice of Medical Provider:

  1. You suffer injury to your back at work.  (1) You then present to the employer’s recommended doctor, or (2) You choose your own medical provider and receive medical treatment. Whether you receive medical treatment from the employer’s recommended medical provider or from your chosen doctor, this first medical providers is designated as your first choice of medical provider, i.e. “first medical provider” under Illinois law. 
  1. Therefore, the Illinois workers’ compensation insurer will pay for this initial primary care medical provider and any subsequent medical treatment referred by them, which is considered the chain of medical treatment. 
  1. The first medical provider then refers you for a MRI of your back to be performed at a hospital near you. The MRI reveals a herniated disc in your lumbar spine. The workers’ compensation insurer must pay for this MRI as it was recommended by your initial primary care medical provider.
  1. Based on the results of the MRI, the initial primary care doctor then refers you to a specialist orthopedic spine doctor. Again, the workers’ compensation must pay for you to see the orthopedic spine doctor because this specialist was recommended by your first medical provider.
  1. The orthopedic doctor prescribes you an injection in your lower back and some physical therapy that you complete. The injection and physical therapy temporarily relieve your symptoms, but a short time later all your symptoms return. 
  1. The orthopedic doctor then recommends no further medical treatment despite your continuing symptoms and releases you from medical treatment.

Second Choice of Medical Provider:

  1. You then seek another opinion from a second orthopedic spine specialist, i.e. the  “Second medical Provider.” This second orthopedic doctor is then considered your second choice of medical provider. Therefore, the workers’ compensation insurer must pay your medical bills for you to see this second orthopedic doctor. 
  1. The second medical provider reviews your back MRI and prescribes you another three week session of physical therapy at a new physical therapy location. The insurer must pay for this physical therapy because it was recommended by your second chosen medical provider.
  1. After you complete physical therapy, the second medical provider recommends back surgery to fix your back. Again, the insurer must pay for this surgery because it was recommended by your second chosen doctor. 
  1. If you then decide that you do not want the surgery and decide that you want to obtain a second opinion from another doctor, any choice of doctor after the two above choices will then be chosen by the employer/insurer.  

It is important that you immediately contact our law office to discuss your two choices of doctors. We protect your rights and ensure that the employer pays for your medical treatment for the doctor that you have chosen. 

If you’ve been injured at work and the employer is not providing you medical treatment or the employer and workers’ compensation insurer have unjustifiably denied you medical treatment, then please immediately contact our law firm at 314-631-6777.

Steven A. Edelman, Attorney

Illinois Workers’ Compensation

The Three Major Benefits for Illinois Injured Workers under the Illinois Workers’ Compensation Law

Question: What are the three major benefits for an injured worker under Illinois Workers’ Compensation law?

The First Major Benefit under Illinois Workers’ Compensation Law: The first Major Benefit under the Illinois Workers’ Compensation Act is medical treatment paid for by the employer/workers’ compensation insurance company 820 ILCS 305/8(a). Under Illinois workers’ compensation law, an injured worker has the right by law to choose two medical providers and the referrals from each of these two chosen providers. The law states that:

  1. The employer shall pay for medical services for the employee’s First choice of medical provider and any provider in this chain of referrals from this first choice provider. 820 ILCS 305/8(a)(2)  
  2. The Employer shall pay for medical services for the employee’s Second choice of medical provider and any provider in this chain of referrals from this second choice of provider. 820 ILCS 305/8(a)(3)

The Second Major Benefit under Illinois Workers’ Compensation Law: The second major benefit under the Illinois Workers’ Compensation law is temporary total disability (TTD) 820 ILCS 305/8(b)

The Third Major Benefit under Illinois Workers’ Compensation Law: The third major benefit under Illinois Workers’ Compensation law is typically a lump sum settlement to compensate the injured worker for the permanent disability they suffer from the work injury. 

Illinois Workers’ Compensation: When do I have a workers’ compensation case in Illinois?

820 ILCS 305. Sec. 1 (b)

You have an Illinois workers’ compensation case if one of the following situations applies to you:

  1. The work injury occurred in Illinois regardless of the state you were hired.
  2. The work injury occurred outside the state of Illinois and your contract for hire was made within Illinois NOTE: If the last act of hiring you occurred in Illinois, then Illinois has jurisdiction, for example- you signed your employment contract in Illinois or completed your work training in Illinois.
  3. Workers whose employment is principally localized within the State of Illinois, regardless of the place of the accident or the place where the contract of hire was made, including non-citizens and minors.

It is very important that you recognize your ability to file your workers’ compensation case in Illinois if one of the above situations applies to you because there are important benefits under Illinois law that you are entitled to. One of these benefits under Illinois law is that you have the right to choose your medical provider to provide you with medical treatment for your work injury. The employer will then have to pay for your chosen medical provider.

If you’ve suffered a work injury in Illinois or you were injured outside the state of Illinois but you were hired in Illinois, call our law office immediately to discuss your rights under Illinois workers’ compensation law. One of our skilled attorneys will be happy to discuss your rights and benefits under Illinois workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven A. Edelman, Attorney