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.” |
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- The orthopedic doctor then recommends no further medical treatment despite your continuing symptoms and releases you from medical treatment.
Second Choice of Medical Provider:
- 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.
- 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.
- 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.
- 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
