Blog: Workers’ Compensation and Personal Injury

What is the Second Injury Fund (SIF) in a Missouri Workers’ Compensation Case?

Steven A. Edelman

The Second Injury Fund (SIF) is a state fund of money that is administered by Missouri State Treasurer and the Missouri Attorney General’s Office (AGO). The SIF is represented by an attorney from the AGO who is called an Assistant Attorney General (AAG). The money that funds the SIF comes from the Missouri State Treasury. The Missouri State Treasurer gets its money to fund the SIF from surcharges on the premiums paid by all Missouri employers when they pay for their workers’ compensation insurance coverage.

The purpose of the SIF is to protect employers from permanent and total disability (PTD) cases when the employee is found to be PTD due to their last work injury at the employer in combination with their pre-existing medical conditions and injuries. See also explanation of the purpose of the SIF by the courts:

“The purpose of the Second Injury Fund is twofold: to encourage the employment of individuals who are already disabled; and to relieve an employer or his insurer of liability for the previously disabled employee’s total and permanent disability where that disability is not specifically attributable to an injury suffered during the period of employment with that employer.” Parker v. Treasurer of the State of Missouri as Custodian of the Second Injury Fund WD83030 (Mo. App. W.D. 2020) citing Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003)

The injured worker’s pre-existing medical conditions and injuries have to meet specific requirements under Missouri law to be considered to combine with the last work injury at the employer. These requirements are stated in Missouri law under RSMo Section 287.220.3(2)(a) https://revisor.mo.gov/main/OneSection.aspx?section=287.220 which states that after January 1, 2014, all pre-existing injuries to combine against the SIF for PTD must meet the following:

“If any employee who has a preexisting permanent partial disability whether from compensable injury or otherwise, of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining reemployment if the employee becomes unemployed, and the preexisting permanent partial disability, if a body as a whole injury, equals a minimum of fifty weeks of compensation or, if a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, according to the medical standards that are used in determining such compensation, receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree or percentage of disability, in an amount equal to a minimum of fifty weeks compensation, if a body as a whole injury or, if a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, . . .” RSMo 287.220.2

AND

3. (1) All claims against the second injury fund for injuries occurring after January 1, 2014, and all claims against the second injury fund involving a subsequent compensable injury which is an occupational disease filed after January 1, 2014, shall be compensated as provided in this subsection.

(2) No claims for permanent partial disability occurring after January 1, 2014, shall be filed against the second injury fund. Claims for permanent total disability under section 287.200 against the second injury fund shall be compensable only when the following conditions are met:

(a) a. An employee has a medically documented preexisting disability equaling a minimum of fifty weeks of permanent partial disability compensation according to the medical standards that are used in determining such compensation which is:

(i) A direct result of active military duty in any branch of the United States Armed Forces; or

(ii) A direct result of a compensable injury as defined in section 287.020; or

(iii) Not a compensable injury, but such preexisting disability directly and significantly aggravates or accelerates the subsequent work-related injury and shall not include unrelated preexisting injuries or conditions that do not aggravate or accelerate the subsequent work-related injury;

https://revisor.mo.gov/main/OneSection.aspx?section=287.220

In summary, the pre-existing injuries or medical conditions that can combine must 1. Meet a 50 week threshold of disability; and be the result of either 2. Active duty military service, or 3. A direct result of a prior compensable work injury; or 4. the prior medical condition and injury must significantly aggravate or accelerate the work injury suffered at the employer.

If an injured worker is found to be PTD against the SIF, then the SIF is liable for paying the PTD value of the case, and the employer will only be liable for the work injury at the employer. An injured worker must file a claim against the SIF when they file the workers’ compensation case against the employer. An injured worker must list out the prior conditions and injuries on the claim that allege are disabling.

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

Can an injured worker recover benefits under Missouri Workers’ Compensation when the work injury aggravates a pre-existing condition?

By Steven Edelman, Attorney 314-631-6777

Missouri Law

The courts have stated the following:

“Missouri courts have long held a claimant can be compensated when a work injury aggravates a pre-existing condition to the level of disability,” provided there is medical causation of the work injury causing the resultant disability. Harris v. Ralls Cnty., 588 S.W.3d 579, 603 (Mo. App. E.D. 2019)

“The aggravation of a pre-existing condition or its symptoms may constitute a sufficient change in pathology to qualify for compensation . . .” Id.

‘It is well established law that a preexisting but non-disabling condition does not bar recovery of compensation if a job-related injury causes the condition to escalate to the level of disability.’ Id.

“A work accident may be the prevailing factor in causing an injury sustained due to the aggravation of preexisting, asymptomatic degenerative condition.” Id.

Steven Edelman, Attorney

What is Permanent and Total Disability (PTD) versus Permanent Partial Disability (PPD) in a Missouri Workers’ Compensation Case?

By Steven Edelman 314-631-6777

There are two types of Missouri workers’ compensation cases:

Permanent Partial Disability (PPD): A PPD case is one where the injured worker is able to return to work. The injured work may not be able to return to their old job due to the work injury, but they are still able to work a different job, whether in a different field or less strenuous position in the same area of work. This type of case is called a permanent partial disability or PPD case. Again, the injured worked is still able to work. Examples of PPD cases are many and can involve any type of injury. A PPD workers’ compensation case is different from a permanent total disability (PTD) case, where the injured worker can not return to work. The courts have defined permanent partial disability (PPD) as: A “permanent partial disability” is “a disability that is permanent in nature and partial in degree.” Cantrell v. Baldwin Transp. Inc. , 296 S.W.3d 17, 20 (Mo. App. 2009). “The level of permanent partial disability associated with an injury cannot be determined until the injury ‘reaches a point where it will no longer improve with medical treatment’ or, in other words, reaches maximum medical improvement.” Id . (quoting Cardwell v. Treasurer of State of Mo. , 249 S.W.3d 902, 910 (Mo.App.2008) ).
Permanent and Total Disability (PTD): In a PTD case, the injured worker is so injured that they can not return to their old job to work, nor can they work any other type of job due to their work injury. These types of cases are called PTD cases for short. The courts have defined PTD as the ‘inability to return to any employment and not merely [the] inability to return to the employment in which the employee was engaged at the time of the accident.’ RSMO 287.020.6, See Harris v. Ralls County, 588 S.W.3d 579 (Mo. App. E.D. 2019). ‘Any employee is permanently and totally disabled if no employer in the usual course of business would reasonably be expected to employ the employee in his or her present physical condition.’ Id. The burden is on the claimant to establish that he is permanently and totally disabled. Id. “Whether a claimant is permanently and totally disabled is a factual question, not a legal question. Id.

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?

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
Cases nurses also make summaries of medical treatment received and sometimes provide reports to the injured worker and their attorney.
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.
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.
If the case nurse interferes with medical treatment and the injured worker’s relationship with the doctor then their participation can be terminated immediately.

Steven Edelman, Attorney

When can you obtain repayment from the employer for your medical bills in a Missouri workers’ compensation case and how to make demands for medical treatment?

By Steven Edelman, Attorney (314) 631-6777

Missouri Workers’ Compensation RSMo 287.140

Medical Treatment under Missouri workers’ compensation law is governed by section 287.140 which states:

“[T]he employee, shall receive and the employer shall provide such medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines, as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury. If the employee desires, he shall have the right to select his own physician, surgeon, or other such requirement at his own expense.” RSMo 287.140

“Medical aid is one component of the compensation an injured worker is entitled to receive . . . This includes treatment that gives comfort or relief from pain even though a cure is not possible.” See Erwin v. Midway Arms, Inc., (Mo. App. W.D. 2025) citing Abt v. Miss. Lime Co., 420 S.W.3d 689, 704 (Mo. App. E.D. 2014)

Furthermore, medical treatment ‘should not be denied simply because’ and injured worker ‘may have achieved maximum medical improvement.’ Williams v. City of Ave., 982 S.W.2d 307, 311-12 (Mo. App. S.D. 1998) Overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220, 226 (Mo. banc 2003).

Medical Treatment

As a general rule, the employer controls and pays for the injured worker’s medical treatment.
The employee can choose to see their own doctor but will have to pay this medical treatment, and the employer will no longer be liable for the cost of the employee’s medical care.
When the employer has notice that the employee needs medical treatment or a demand is made on the employer to provide medical treatment, and the employer refuses or fails to provide the needed medical treatment, then the employer will be held liable for any reasonable and necessary medical treatment that this obtained by the employee. See Lyman v. Mo. Emps. Mut. Ins. Co., 407 S.W.3d 130 (Mo. App. S.D. 2013) citing Poole v. City of St. Louis, 328 S.W.3d 277, 291 (Mo. App. E.D. 2010).

Therefore, to hold the employer liable for repayment of the injured worker’s medical bills, an injured worker must prove that (1) Whether a demand for medical treatment was made to the employer; and (2) Whether the demand was refused or ignored.

NOTE: Under Missouri law there is no requirement by law that the injured worker update the employer on the course of the additional medical treatment. Additionally, no medical evidence is required to accompany a claimant’s demand for further medical treatment. See Nouraie v. Mo. Baptist Med. Ctr., No. 10-111746, 2013 WL 1093332 (Mo. Lab. Ind. Rel. Com. Mar. 13, 2023) which states that an injured worker need not prove the compensability of her injury before the employer has any obligation to provide medical examination or treatment. It is illogical to require an injured worker to obtain unauthorized medical treatment for the purpose of proving to an employer that it must authorize further medical treatment.

Practical Application:

It is sometimes necessary to obtain from the workers’ compensation employer and or insurer a written denial letter of medical treatment that the injured worker can show to their own doctor. This denial letter will sometimes help facilitate the employee’s own doctor to bill the employee’ personal health insurance for the medical treatment for the work injury. At the end of the case, the injured worker will seek reimbursement for the costs of this medical treatment from the employer/workers’ compensation insurer and indemnification and protection from their own health insurer for the portion of the medical bills paid by the employee’s health insurer.

Steven Edelman, Attorney

When can you obtain attorney’s fees and costs against the employer for your Missouri work injury?

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

Short Answer: When the employer commits outrageous conduct that is clear and egregious.

Missouri Workers’ Compensation RSMo 287.560

Missouri law states that in certain situations the court may assess costs against any party for unreasonable defending or prosecuting a workers’ compensation case. See Revised Statutes of Missouri Section 287.560 which states:

“[I]f the division or the commission determines that any proceedings have been brought, prosecuted or defended without reasonable ground, it may assess the whole cost of the proceedings upon the party who so brought, prosecuted or defended them.” RSMo 287.560

The courts have interpreted RSMo 287.560 as follows:

The court has the discretion to assess costs against a party;
The Workers’ Compensation Commission should exercise this power to assess costs against a party with great caution and “only when the case for costs is clear and the offense egregious.” See Erwin v. Midway Arms, Inc. (Mo. App. W.D. 2025) and the Missouri Supreme Court in Landman v. Ice Cream Specialties, 107 S.W.3d 220, 224, (Mo. banc 2003)

Examples of Cases when the Court awards Attorney’s fees and or Costs:

The Missouri Supreme Court upheld an award of costs and attorney fees against an employer for unreasonably contesting the work-related nature of the employee’s injury. Landman v. Ice Cream Specialties, 107 S.W.3d 220, 224, (Mo. banc 2003)

The employer acted unreasonably when it argued at a hearing before the” judge that the employee’s injury was not work-related. The employer pressed this argument even after its own examining medical doctor concluded that the injury was caused by work; and despite the employer promising to abide by their medical examiner’s conclusion in exchange for the employee not immediately seeking a trial; and despite having no evidence whatsoever to dispute the conclusion of its own medical examiner. Id. at 250

2. The Missouri Court of Appeals reversed the Missouri Workers’ Compensation Commission’s decision to not impose attorney’s fees and costs against the employer. The Missouri Court of Appeals concluded that the employer’s conduct was unreasonable and egregious. See Monroe v. Wal-Mart Assocs., Inc., 163 S.W.3d 501 (Mo. App. E.D. 2005)

In this case, the employee suffered hernia at work while lifting. The employer allowed the injured worker to leave work to go to an emergency room. The employer refused to pay for the emergency room and medical treatment claiming that the injury was not work-related. The employer based its denial on the employee’s prior medical records and an initial intake form from the emergency room visits which indicated that the visit was not work-related. No evidence suggested that the intake form was a medical opinion or that the employee even had an opportunity to review the form to verify its accuracy. The employer then maintained its denial of the work injury despite two doctors’ opinions that the employee’s hernia was work-related. The employer made no meaningful effort to resolve the case until the trial three years later. At trial the employer first admitted that the injury was work-related and provided no medical evidence to justify its years of defending the claim without justification. The court fount the above employer’s behavior was unreasonable and egregious and awarded costs and attorney’s fees against the employer.

Steven A. Edelman, Attorney

How does your Workers’ Compensation case effect your Social Security benefits?

By Steven A. Edelman, Attorney (314) 632-6777, ext. 14

Often times an injured worker can have a pending workers’ compensation case while at the same time receiving social security benefits. There are primarily three types of social security monthly benefits that are typically paid monthly.

Social Security Retirement: The first is regular social security retirement benefits, which is a monthly check that you get each week due to you meeting the retirement age under the social security law. The retirement age is based on your date of birth. https://www.ssa.gov/retirement
Social Security Disability Insurance (SSDI): The second, is social security disability (SSDI), which is based on your inability to work due to disabling medical conditions or injuries.
Supplemental Security Income (SSI): The third is social security income (SSI), See: https://www.ssa.gov/ssi

Question: How does a workers’ compensation case effect an injured worker’s receipt of the above three types of social security benefits?

When a workers’ compensation case is settled or an award is entered by a Judge, then an injured workers’ social security benefits can be reduced by the amount of money received in their workers’ compensation case based on what is called the 80% rule.

Social Security Anti-Offset and the 80% rule: This rule generally states that the combined receipt of social security benefits and workers’ compensation benefits can not exceed 80% of the highest gross income earning month of the injured worker. If the combined amount exceeds this 80% amount, then social security benefits will be reduced until the combined social security monthly benefits and workers’ compensation monthly benefits equals this 80% amount. See also the social security website: https://www.ssa.gov/OP_Home/handbook/handbook.05/handbook-0504.html

If a workers’ compensation case is settled, then your attorney can draft a special settlement agreement called a social security anti-offset stipulation for the purpose of attempting to prevent any reduction of social security benefits. These anti-offset stipulations are allowed by social security.

Steven A. Edelman, Attorney

How does your Workers’ Compensation Case effect your Medicare Benefits?

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

When a worker suffers a work injury, they may not consider the effect that their workers’ compensation case has on their Medicare benefits. Medicare is primarily relevant to a workers’ compensation case involving two situations: (1) Medicare Conditional Payments and (2) Medicare Set Aside (MSA)

Why would an Injured worker be receiving Medicare Benefits at the same time as their workers’ compensation case?

Some injured workers qualify by age to receive social security retirement benefits and Medicare benefits.
In the most serious of work injuries, an injured worker may find that they are unable to return to work at the employer where they suffered their work injury. Additionally, the worker can not maintain employment at any job in the gainful marketplace due to their continued disability from the work injury. If the injured worker can not return to work at any job, then they may apply for social security disability (SSDI). If approved for SSDI, within a set time, the injured worker will become eligible to receive Medicare benefits and or receive Medicare benefits.

Medicare’s Interest in a Worker’s Compensation Case:

When an injured worker is eligible to receive Medicare benefits or is already receiving Medicare benefits, then Medicare’s interest must be considered when the injured worker settles their workers’ compensation case. The mechanism to protect Medicare’s interest in a workers’ compensation settlement is by drafting a written document called a Medicare Set Aside (MSA). Additionally, a Medicare Conditional Payment search must be completed to confirm if any medical bills related to the work injury were paid by Medicare.

What is a Workers’ Compensation Medicare Set Aside (WCMSA) also known as a Medicare Set Aside (MSA)?: It is a written document typically prepared by a third party company hired by the employer/insurer for the purpose of calculating the amount of money that is “set aside” to pay for future medical treatment solely for the injured workers’ injured suffered at work. Once the MSA money is exhausted, then an accounting is given to Medicare, and Medicare will then pay for the cost of future medical treatment related to the work injury.

A MSA must be submitted to Medicare for Medicare’s review and approval. If Medicare approves the MSA, then the settlement may proceed forward. If Medicare does not approve the MSA, then the MSA must be recalculated and resubmitted to Medicare for approval.
Once the MSA is approved by Medicare, and the workers’ compensation case is settled, the MSA money deposited by the employer/insurer into a bank account. The MSA money is typically professionally administered by a third party company paid for by the employer/insurer.
After settlement of the workers’ compensation case, the professional administrator of the MSA account will then pay the medical bills for the injured worker that are related solely to medical treatment for the work injury. The MSA administrator will only pay the medical provider the amount of the medical bill that Medicare would pay per the Medicare guidelines. The balance of the medical bill is not collectible against the injured worker.

In order to comply with Section 1862(b) of the Social Security Act, Medicare is not permitted to pay for medical items or services, including prescription drug expenses, related to the workers’ compensation claim until the approved WMSA amount is appropriately exhausted (“properly spent”) on related medical care. See also: https://www.hhs.gov/guidance/document/cms-attorney-services#:~:text=%C2%A71395y(b)(2,policy%20or%20plan%20(including%20a

Important: Medicare’s interest is always considered in every workers’ compensation case. However, Medicare will only review Medicare Set Asides (MSA) in two situations:

The injured worker is Medicare beneficiary and the workers’ compensation settlement is greater than $25,000 AND
The injured worker “has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00” See also Medicare’s website website regarding Medicare Set Asides (MSA) and workers’ compensation benefits.

Failure to perform a MSA and obtain approval by Medicare may result in loss Medicare benefits.

Medicare Conditional Payments:

Medicare Conditional Payments: What are they? Medicare conditional payments are medical bills paid for by Medicare for the work injury, which are conditioned on Medicare being repaid. If an injured worker is a Medicare beneficiary, it is necessary for the parties to perform a Medicare conditional payment search. This is performed by writing to Medicare to confirm if Medicare paid for any medical bills related to medical treatment for the work injury. Any medical bills paid by Medicare must be repaid to Medicare, and as part of the the workers’ compensation settlement, the employer/insurer must assume, defend, indemnify and hold harmless the injured work for any Medicare conditional payments.

Steven A. 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

Step by Step timeline of an Illinois Workers’ Compensation Case:

By Steven A. Edelman, Illinois workers’ compensation trial attorney

314-631-6777, Ext. 14

If you have an Illinois workers’ compensation case, then your case will typically follow the below timeline.

Step 1: The injured worker suffers a work injury while in the course and scope of your employment. See Illinois Workers’ Compensation Act law 820 ILCS 305/6
Step 2: The injured worker makes a written or verbal report of the work injury to the employer within 45 days of the date of the work injury. See Illinois Workers’ Compensation Act law 820 ILCS 305/6(c)
Step 3: The injured worker then makes their first choice of medical provider to obtain medical treatment for the work injury. The injured worker must inform the workers’ compensation insurer and employer of their chosen medical provider. Your workers’ compensation attorney will give notice to the employer/insurer of the chosen medical provider. The choice of the medical provider is not made until the injured worker actually presents to the medical provider in an appointment. The employer/insurer will then provide and pay for this chosen medical provider through workers’ compensation. See Illinois Workers’ Compensation Act law 820 ILCS 305/8
Step 4: The injured worker obtains medical treatment from their chosen medical provider until the medical provider releases them from medical care.
Step 5: The injured worker completes authorized medical treatment, and the injured worker is released from all medical treatment per the order of the employee’s chosen treating doctor.
Step 6: Once the injured worker’s chosen doctor has released the injured worker from medical treatment, typically the employer/insurer will obtain an independent medical evaluation (IME) from their own separate chosen doctor. This evaluation is a called a Section 12 examination, named after the section of the law where it is discussed. The employee must attend the employer’s/insurer’s Section 12 exam. See Illinois Workers’ Compensation Act law 820 ILCS 305/12
Step 7: During this time after the injured worker is released form medical treatment, your workers’ compensation attorney will negotiate potential settlement of the injured worker’s case.
Step 8: Pre-Trial If the parties are unable to settle, then typically a trial request is submitted. Prior to a trial, the parties are required to attend a Pre-Trial conference with the Arbitrator (Judge). Your workers’ compensation attorney along with the employer’s/insurer’s, defense attorney will then attend Pre-trial. The arbitrator will give a recommendation of the value of the case based on the medical records, and all other relevant information. The arbitrator will also potentially resolve any other disputed issues or negotiation brought before the arbitrator. The arbitrator’s recommendation is not binding on any party. If you obtain a high settlement recommendation to settle your case from the judge, the employer does not have offer the high recommendation. Likewise, if you receive a low recommendation from the judge, the the injured worker does not have to agree and accept a settlement for the low recommendation.
Step 9: If the both the injured worker and the employer agree on the judge’s pre-trial recommendation, then the workers’ compensation case can be settled. If the parties do not agree on settlement at the time of the mediation, then the case will proceed to trial.
Step 10: Trial: If the parties can not settle the worker’s compensation case, then the case will proceed to trial in front of a Judge. There is no jury in a workers’ compensation case. The trial typically last a few hours to one day. Some trials can last more than one day. See Illinois Workers’ Compensation Act law 820 ILCS 305 et seq.

Steven A. Edelman, Attorney

Blog: Workers’ Compensation and Personal Injury

What is the Second Injury Fund (SIF) in a Missouri Workers’ Compensation Case?

Can an injured worker recover benefits under Missouri Workers’ Compensation when the work injury aggravates a pre-existing condition?

What is Permanent and Total Disability (PTD) versus Permanent Partial Disability (PPD) in a Missouri Workers’ Compensation Case?

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

When can you obtain repayment from the employer for your medical bills in a Missouri workers’ compensation case and how to make demands for medical treatment?

When can you obtain attorney’s fees and costs against the employer for your Missouri work injury?

How does your Workers’ Compensation case effect your Social Security benefits?

How does your Workers’ Compensation Case effect your Medicare Benefits?

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

Step by Step timeline of an Illinois Workers’ Compensation Case:

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