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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. 

MISSOURI WORKERS’ COMPENSATION: SETTLEMENTS AND TRIAL AWARDS EXPLAINED

MISSOURI WORKERS’ COMPENSATION

Settlements and Trial Awards

The third major benefit in Missouri Workers’ Compensation cases is typically a lump sum settlement or a lump sum award from a trial judge to compensate the injured worker for permanent disability as a result of the work injury. 

  1. Settlements:

A settlement in a Missouri Workers’ Compensation case is when the injured worker agrees to accept a lump sum amount of money from the employer and workers’ compensation insurer to close their workers’ compensation.  

NOTE: Settlements must be approved by a workers’ compensation judge, who is referred to as an administrative law judge (ALJ). If a settlement contract is not approved by a judge then the settlement agreement is likely unenforceable, and the injured worker can still proceed forward with their workers’ compensation case. 

The law states under RSMo 287.390 in regards to Missouri Workers Compensation Settlements:

“Parties to claims hereunder may enter into voluntary agreements in settlement thereof, but no agreement by an employee or his or her dependents to waive his or her rights under this chapter shall be valid, nor shall any agreement of settlement or compromise of any dispute or claim for compensation under this chapter be valid until approved by an administrative law judge or the commission, nor shall an administrative law judge or the commission approve any settlement which is not in accordance with the rights of the parties as given in this chapter.  No such agreement shall be valid unless made after seven days from the date of the injury or death.  An administrative law judge, or the commission, shall approve a settlement agreement as valid and enforceable as long as the settlement is not the result of undue influence or fraud, the employee fully understands his or her rights and benefits, and voluntarily agrees to accept the terms of the agreement.

  2.  A compromise settlement approved by an administrative law judge or the commission during the employee’s lifetime shall extinguish and bar all claims for compensation for the employee’s death if the settlement compromises a dispute on any question or issue other than the extent of disability or the rate of compensation.”

  1. Trial Awards:

While many Missouri workers’ compensation cases settle with the employer/insurer, there are still many workers’ compensation cases that proceed to trial. A workers’ compensation case will proceed to trial if the injured worker and the employer and insurer can not agree on settlement terms to settle the workers’ compensation case.  In Missouri workers’ compensation cases trials are referred to as Hearings for a Final Award.

In Missouri workers’ compensation trials, there is no jury. There is only an administrative law judge (ALJ) that awards you money to compensate you for your work injury. 

If you have been hurt on the job and suffered a work injury, please call our office immediately to discuss your rights under Missouri workers’ compensation law. We work to obtain the largest settlement for you. We do not hesitate to proceed to trial if the employer and workers’ compensation insurer are unwilling to settle your case for what is fair and reasonable. 

Please call us if you have been injured on the job and have any questions about potential settlement of your Missouri workers’ compensation case. (314) 631-6777

Steven A. Edelman, Attorney

314-631-6777, Ext. 14

Missouri Workers’ Compensation: Temporary Total Disability (TTD) explained, RSMo 287.170

MISSOURI WORKERS’ COMPENSATION 

TEMPORARY TOTAL DISABILITY

Temporary Total Disability (TTD) is one of the three major benefits that an injured worker receives in a Missouri Workers’ Compensation case. Temporary total disability is referred to as TTD for abbreviation.  

TTD is a check for money which is equal to two-thirds of the gross average weekly wage of the injured worker based on the 13 weeks of gross wages prior to the work injury. The TTD check is typically mailed directly to the injured worker or in some occasions directly deposited to the injured worker’s bank account. Workers’ compensation pays the injured worker TTD for each week of work missed as a result of the work injury either because 

(1) The doctor places the injured worker off work due to the work injury 

OR 

(2) The doctor placed light duty restrictions on the injured worker, and the employer can not provide accommodated light duty work within the doctor’s restrictions; and therefore, the injured worker remains off work. 

Law: (RSMo 287.170) 

Temporary total disability is found in Missouri Law in the Revised Statutes of Missouri, RSMo 287.170 which states, in part, as follows:

“1.  For temporary total disability the employer shall pay compensation for not more than four hundred weeks during the continuance of such disability at the weekly rate of compensation in effect under this section on the date of the injury for which compensation is being made.  The amount of such compensation shall be computed as follows:

. . .

(4)  For all injuries occurring on or after August 28, 1991, the weekly compensation shall be an amount equal to sixty-six and two-thirds percent of the injured employee’s average weekly earnings as of the date of the injury; provided that the weekly compensation paid under this subdivision shall not exceed an amount equal to one hundred five percent of the state average weekly wage;

. . .

Temporary total disability payments shall be made to the claimant by check or other negotiable instruments approved by the director which will not result in delay in payment and shall be forwarded directly to the claimant without intervention, or, when requested, to claimant’s attorney if represented, except as provided in section 454.517, by any other party except by order of the division of workers’ compensation.

  3.  An employee is disqualified from receiving temporary total disability during any period of time in which the claimant applies and receives unemployment compensation.

  4.  If the employee is terminated from post-injury employment based upon the employee’s post-injury misconduct, neither temporary total disability nor temporary partial disability benefits under this section or section 287.180 are payable.  As used in this section, the phrase “post-injury misconduct” shall not include absence from the workplace due to an injury unless the employee is capable of working with restrictions, as certified by a physician.

  5.  If an employee voluntarily separates from employment with an employer at a time when the employer had work available for the employee that was in compliance with any medical restriction imposed upon the employee within a reasonable degree of medical certainty as a result of the injury that is the subject of a claim for benefits under this chapter, neither temporary total disability nor temporary partial disability benefits available under this section or section 287.180 shall be payable.”

Common Problems that Injured Workers have with the Employer and Workers’ Compensation regarding payment of Temporary Total Disability (TTD)

Injured workers regularly have problems with the employer and workers’ compensation insurer paying temporary total disability (TTD). 

Common problems include:

  1. The doctor places an injured worker off work, and workers’ compensation never pays temporary total disability.
  2. The employer/workers’ compensation insurer pay the wrong amount of temporary total disability, which is usually much lower than what you are entitled to receive. 
  3. Workers’ compensation unnecessarily delays payment of TTD.
  4. Workers’ compensation sends TTD checks at sporadic intervals, which cause financial difficulty for the injured worker. 
  5. An injured worker is released to work light duty work, and the employer instructs the injured worker to return to work full duty in contradiction to the doctor’s order of light duty restrictive work. The employer makes the injured worker work full duty instead of sending the injured worker home. In this situation, the injured worker exposes themselves to potential additional injury when they should be receiving TTD because the employer can not provide light duty work. 
  6. The employer fires an injured work for alleged“misconduct,” and therefore stops paying TTD
  7. The employer stops paying the injured worker TTD because they allege the injured worker declined light duty work. 

If you’ve suffered a work injury on the job in Missouri, and you are not receiving temporary total disability (TTD) then call our law office immediately for a free consultation. We pride ourselves on fighting for your rights and getting you the benefits you are entitled to by law.  Please call us immediately at 314-631-6777

Steven A. Edelman, Attorney

314-631-6777