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Who is responsible for
providing for Workers' Compensation benefits under
the Workers' Compensation Act (the Act)?
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What
workers are covered by the Act?
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What
injuries are covered by the Act?
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Is a
worker entitled to benefits under the Act for
injuries that result from performing repetitive
motion in the course of the job?
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Does a
worker have a viable Workers' Compensation claim if
they re-injure a previous injury or aggravate a
pre-existing condition?
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Is a
worker who sustains an on-the-job injury entitled to
compensation if the injury causes disfigurement?
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What
medical benefits does the Act provide to workers
after they have sustained a work-related injury?
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What
benefits is an injured worker entitled to while off
work?
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Is it
important for a worker to give an accurate and
extensive description of the accident to their own
medical providers?
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What
benefits are provided by the Act if the injury
sustained by the worker are permanent in nature?
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What if
an injured worker is unable to return to their usual
trade or profession after their treating doctor has
exhausted all forms of treatment?
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What if
the injured employee, after their recovery, is
unable to return to an type of work?
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Is an
injured employee entitled to vocational
rehabilitation?
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What benefits are
payable to survivors of a worker whose death is
caused by a work-related accident?
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Must an
injured worker notify their employer of a
work-related injury?
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Does an
injured worker have to file their Workers'
Compensation claim within a specific period?
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Should an
injured worker allow their employer or its Workers'
Compensation insurance company to record a statement
of the accident?
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Should an
injured worker sign any documents for their employer
or the employer's Workers' Compensation insurance
company?
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Is an
injured worker required to submit to an examination
from a doctor selected by the Workers' Compensation
insurance company?
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Is an
injured worker required to cooperate with a
rehabilitation nurse retained by the employer' s
Workers' Compensation insurance company?
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What
redress does an injured worker have if they are not
receiving the benefits they are entitled to under
the Act?
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Should an
injured worker apply for unemployment benefits?
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Can a
worker receive Social Security Disability benefits
as a result of a work-related injury?
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Should an
injured worker apply for group health insurance
benefits instead of Workers' Compensation benefits?
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Can an
injured worker be harassed or fired for filing a
claim for Workers' Compensation benefits with the
Illinois Industrial Commission?
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When is a
Workers' Compensation claim considered settled and
permanently closed?
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Can a
worker file a lawsuit against their employer for the
injuries they sustained from a work-related
accident?
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Is an
injured worker entitled to monies for payment of
union dues, continuation of health insurance
benefits or other similar benefits?
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If an
injured worker decides, for whatever reason, to
discharge their present attorney, will they have to
pay more than 20% in attorney's fees or be concerned
about an interruption of their Workers' Compensation
benefits?
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What is a
Third Party case?
1. Who is
responsible for providing the benefits under the Workers' Compensation
Act (Act)?
A. The employer
is, by law, 100% responsible for providing benefits under the Act. The
employer, in certain situations, provides benefits directly
(self-insured) or indirectly through a Workers' Compensation insurance
company. A worker cannot be charged for benefits provided by the Act or
any portion of their employer's Workers' Compensation insurance premium.
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2. What
workers are covered by the Act?
A. Every worker injured in Illinois, hired in Illinois but injured while
working in another state or injured while working in another state for
an employer whose principle place of business in Illinois, is covered by
the Act.
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3. What
injuries are covered by the Act?
A. Any worker who has sustained an injury "arising out of and in
the course of their employment" has a potential claim under the
Act.
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4. Is a
worker entitled to benefits under the Act for injuries that result from
performing repetitive motions in the course of their job?
A. Yes. A worker who has sustained an injury, commonly referred to as "repetitive
trauma," is entitled to benefits under the Act. These types of
injuries generally result from a worker's repeated, consistent, physical
movement of a particular part of their body in the performance of their
normal work activity. Unfortunately, due to the fact that symptoms with
these types of injuries manifest themselves over a period of time, the
worker might not associate the eventual diagnosis of the injury as being
work-related.
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5. Does a
worker have a viable Workers' Compensation claim if they re-injure a
previously injured part of their body or aggravates a pre-existing
physical condition?
A. If a worker sustains a work-related injury to a previously injured
part of their body, regardless of whether the previous injury was
work-related, they are not barred from recovery under the Act.
Similarly, if they sustain an accident which aggravates or accelerates a
pre-existing physical condition, (arthritis, congenital back condition,
etc.) they are still entitled to all the rights and benefits provided by
the Act.
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6. Is a
worker who sustains an on-the-job injury entitled to compensation if the
injury causes disfigurement?
A. A worker who suffers a serious and permanent disfigurement (scar,
burn, etc.) to the head, face, neck, arms or legs as a result of a
work-related injury, is entitled to benefits under the Act.
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7. What medical benefits
does the Act provide to a worker after they have sustained an on-the-job
injury?
A. An injured worker is entitled to receive 100% of "all
necessary and reasonable medical expenses incurred as a result of a
job-related accident." These include first aid, emergency room
services, hospital care (inpatient/outpatient), doctor's fees,
prescriptions, etc.
The Act further provides that an injured worker is entitled to treatment
by
two (2) doctors of their own choosing (excluding
emergency room care) at the insurance company's expense. The insurance
company is also responsible to pay for fees and charges of any doctors
or hospitals which the injured worker is referred to by either of their
first two (2) choices (commonly known as the chain of referral).
If the injured worker wants to see or be treated by a third doctor, they
will be responsible for any medical expenses incurred, unless approved
by the Workers' Compensation insurance company.
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8. What
benefits is an injured worker entitled to while off work?
A. The Act provides that a worker receive Temporary Total
Disability benefits or T.T.D. benefits for the entire time the
worker's treating doctor requires them to remain off work to receive
treatment and recuperate from their injuries.
T.T.D. benefits are required to be paid within fourteen (14)
calendar days from the date the employer or one of his agents
receives notice of the accident from the injured worker, unless the
Workers' Compensation insurance company indicates, in writing, the
reason for its refusal to pay T.T.D. benefits to the injured worker.
T.T.D. benefits are calculated as two-thirds (2/3) of a worker's
average, gross, weekly wage for the year preceding the accident
(excluding overtime and bonuses). In addition to
numerous variations and complications in calculating the worker's
average, gross, weekly wage, the T.T.D. rate is subject to various
minimums and maximums prescribed by the Act.
More information on T.T.D. benefits
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9.
Is it important for a worker to give an
accurate and extensive description of the accident to their own medical
providers?
A. Yes. If a dispute arises as to how, when or if a worker sustained an
injury as a result of a work-related accident, a detailed and accurate
description of the accident given by the worker to his medical providers
could substantiate the worker's claim.
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10.
What benefits are provided by the Act if
the injury sustained by the worker are permanent in nature?
A. Even though an injured worker may return to their usual profession or
trade after sustaining an on-the-job injury, they could be entitled to
compensation for any complete or partial permanent loss of use of any
part of their body. This compensation is called Partial
Permanent Disability benefits or P.P.D.
The amount of Partial Permanent Disability benefits a worker is entitled
to is based on their P.P.D. rate and the level of permanency of their
injury. A worker's P.P.D. rate is calculated as sixty percent (60%) of
the worker's average, gross, weekly wage for the year preceding the
accident (subject to specific statutory minimums or maximums). There is
no predetermined or fixed amount (level of permanent disability) that is
applicable to a worker's injury. There are numerous factors which must
be taken into consideration to determine the approximate monetary value
of an injured worker's entitlement to P.P.D. benefits under the Act. It
is essential to understand that every injury sustained by a worker is
unique, therefore, requiring the knowledge of an experienced Workers'
Compensation attorney to assist the injured worker in recovering the
maximum amount of P.P.D. benefits to which they are entitled under the
Act.
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11.
What if an injured worker is unable to
return to their usual trade or profession after their treating doctor
has exhausted all forms of treatment?
A. If an injured worker can no longer perform their usual trade or
profession and must, therefore, accept a lower paying position, the
worker could be entitled to benefits equal to two-thirds (2/3)
of the difference between the average, gross, weekly, wage earned before
the accident and the wage they are earning after the accident.
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12.
What if the injured employee, after their
recovery, is unable to return to any type of work?
A. Under the Act, if the injured worker is unable to return to "any
type gainful employment" they would be considered totally and
permanently disabled and, therefore, would be entitled to weekly
benefits at the worker's T.T.D. rate for life or until such time as they
are capable of returning to some type of gainful employment.
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13.
Is an injured employee entitled to
vocational rehabilitation?
A. The Act provides that if a worker sustains an injury of such severity
that they are unable to return to the type of work they were doing at
the time of the accident (established by medical evidence), the Workers'
Compensation insurance company could be responsible to pay for
vocational rehabilitation to retrain the worker for a new job, trade or
profession consistent with their physical limitations. The employer's
Workers' Compensation insurance company may also be required to continue
paying the worker's weekly T.T.D. benefits for the entire rehabilitation
period. Whether an individual is eligible for vocational rehabilitation
depends on numerous factors specific to each worker.
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14.
What benefits are payable to survivors of
a worker whose death is caused by a work-related accident?
A. The maximum death benefit provided by the Act is twenty (20)
years of the deceased worker's T.T.D. rate or $250,000 whichever is
greater. Death benefits are payable to the widow(er) and or the
worker's dependent children under eighteen (18) years of age. Under
certain circumstances, monies could be paid to other dependent relatives
of the deceased worker if there is no surviving widow(er) or dependent
children.
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15.
Must an injured worker notify their
employer of a work-related injury?
A. Yes. The Act provides that an injured worker must report any accident
to their employer or any employee of the employer who is in a
supervisory capacity (foreman, superintendent, company nurse, etc.).
Notification, oral or written, must be within forty-five (45)
days from the date of the accident.
There are
four important factors an injured worker should
remember about the "notice" provisions of the Act:
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Informing a co-worker of an accident is not considered proper notice
under the Act.
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Notice of the accident should be given to the employer as soon as
possible after the accident regardless of the fact that the Act
allows forty-five (45) days.
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Notice of a worker's accident should, if possible, be in writing
even though it is not required by the Act. A worker should never
sign a blank accident report form. The worker should also retain a
copy of the completed accident report.
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Failure to give notice of the accident to the employer within
forty-five (45) days could result in the loss of all benefits and
rights under the Act.
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16.
Does an injured worker have to file their
Workers' Compensation claim within a specific period of time?
A. Yes. A worker who is injured as a result of a work-related accident,
must file a claim with the Illinois Industrial Commission within
three (3) years of the date of their accident or within two (2) years of
the latest payment of compensation, whichever of these dates is later.
This provision of the Act is legally referred to as the Statute of
Limitations. With regard to the Statute of Limitations, it is important
that every worker remember the following:
(a) Completion of an accident report form (or any other type of form
relative to an accident), for the employer or its Workers' Compensation
insurance company, is not considered "filing" of a claim under the Act.
Either the worker or their attorney, must file a specific form entitled
"Application for Adjustment of Claim" with the Illinois Industrial
Commission.
(b)
If an Application for Adjustment of Claim form is not filed with
the Illinois Industrial Commission within the Statute of Limitations,
the worker would lose their rights and benefits provided by the Act.
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17.
Should an injured worker allow their
employer or its Workers' Compensation insurance company to record a
statement of the accident?
A. No. In order for an injured worker to be entitled to benefits under
the Act, the employer or its Workers' Compensation insurance company
must simply receive proper notice of the accident, and the name and
address of the doctor(s) from which the worker is receiving treatment.
There is no requirement in the Act that this or any other information be
transmitted to the employer by a recorded statement. Furthermore, a
recorded statement is never taken to the benefit of the injured worker.
It is important the worker not submit to a recorded statement
considering that the statement could be used as evidence against the
worker at a subsequent hearing before the Illinois Industrial
Commission. A recorded statement may also negatively affect the
worker's rights relative to a potential Third Party case resulting from
the accident.
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18.
Should an injured worker sign any
documents for their employer or the Workers' Compensation insurance
company?
A. No. The only document an injured worker should sign is an accurately
completed accident report. Any other documents signed by the worker, no
matter how harmless or insignificant they may appear, could adversely
effect the worker's rights and benefits under the Act and/or a potential
third party case.
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19.
Is an injured worker required to submit
to an examination from a doctor selected by the Workers' Compensation
insurance company?
A. Yes. If an injured worker claims they are entitled to receive or are
receiving benefits under the Act, the Workers' Compensation insurance
company is entitled to have the worker examined by a doctor of its own
choosing at a reasonable time and place. The Workers' Compensation
insurance company must pay for the exam.
Failure to attend the examination could result in an interruption of
benefits to the injured worker.
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20.
Is an injured worker required to cooperate with a rehabilitation nurse
retained by the Workers' Compensation insurance company?
A. Yes. The Act provides that any injured worker who fails to cooperate
with the rehabilitation process can have their benefits terminated by
the Workers' Compensation insurance carrier?
CAUTION:
Seemingly innocent statements made by a worker to a rehabilitation nurse
are forwarded to the insurance adjustor handling the claim. Such
statements could have a negative affect on an injured worker' claim, as
well as, a potential recovery in a Third Party case.
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21.
What redress does an injured worker have
if they are not receiving the benefits they are entitled to under the
Act?
A. If an injured worker, under active medical treatment and off work
pursuant to their doctor's instructions, is not receiving their
benefits, they have the right to a hearing before an Arbitrator of the
Illinois Industrial Commission. At this hearing, the worker would have
the opportunity to present medical evidence and witnesses in support of
their claim for Workers' Compensation benefits.
Considering the complexity of such a hearing and the fact that an
experienced attorney will be defending the claim on behalf of the
insurance company, it is advisable that the injured worker retain an
experienced and competent Workers' Compensation attorney.
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22.
Should an injured worker apply for
unemployment benefits?
A. No. In applying for unemployment benefits during the period a worker
is off work due to an on-the-job injury, the worker must state
in writing that they are willing and able to work. Even though
the injured worker will rarely, if ever, be called for work, the
Workers' Compensation insurance company could argue that the injured
worker's statement to unemployment, is contrary to their claim that they
are unable to work.
However, recent court decisions have recognized the financial
difficulties facing an injured workers who is not receiving T.T.D.
benefits under the Act and have ruled that a worker who has applied for
unemployment benefits, in certain circumstances, is not barred from
claiming they are entitled to T.T.D. benefits. Nevertheless, it
is advisable that the worker discuss the circumstances of their accident
with an experienced Workers' Compensation attorney before applying for
unemployment benefits.
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23.
Can a worker receive Social Security
Disability benefits as a result of a work-related injury?
A. Yes. If an injured worker is disabled from working and it is
anticipated that their disability will continue for one year or more,
the worker could be eligible for Social Security Disability benefits. If
the above circumstances exists, it is advisable that the injured
worker file an application for Social Security Disability benefits with
their local Social Security office.
If the worker's initial claim and subsequent reconsideration are denied
by the Social Security Administration, the next step in the appeal
process would be to request a hearing before a Social Security
administrative law judge. It should also be noted that a Social Security
claimant
is responsible for attorney's fees in only those situations
where they receive an award by the Social Security administration.
More information about Social
Security Disability
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24.
Should an injured worker apply for group
health insurance benefits instead of Workers' Compensation benefits?
A. No. Often an employer will encourage their injured workers to apply
for group health insurance benefits instead of Workers' Compensation
benefits. However, it is advisable not to apply for group insurance
benefits for the following reasons:
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Most group health insurance policies do not provide for lost time or
Temporary Total Disability benefits (T.T.D.).
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Most group health insurance policies usually require that the
injured worker pay a portion of the medical expenses, whereas,
Workers' Compensation pays 100% of any injured worker's
reasonable and necessary medical expenses.
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The extensive rights and benefits an injured worker is entitled
under the Act (T.T.D., P.P.D., rehabilitation, etc.) are not
provided by group health insurance plans.
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Finally, and most importantly, group health insurance policies
frequently exclude the payment of any benefits for work-related
injuries and therefore, might require the injured worker to
indicate, in writing, that the benefits being provided are not a
result of a work-related injury. Such an admission could jeopardize
their Workers' Compensation claim.
More information about group health
insurance
versus Workers' Compensation
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25.
Can an injured worker be harassed
or fired for filing a claim for Workers' Compensation benefits?
A. No. The Act provides that it is unlawful for any employer or it's
Workers' Compensation insurance company to interfere with, coerce or
discriminate against any injured worker, in any manner, whatsoever, for
exercising their rights to obtain any or all of the benefits provided
for by the Act.
Additionally, if it can be proven that an employer fires or forced to
resign any injured worker in retaliation for filing a Workers'
Compensation claim, the worker could file a civil lawsuit against his
employer seeking damages in the Circuit Court. This type of lawsuit is
referred to as a "Retaliatory Discharge" lawsuit which
could result in substantial damages against the employer.
More information about Retaliatory
Discharge
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26.
When is a Workers' Compensation
claim considered settled and permanently closed?
A. A Workers' Compensation claim is considered settled only after
"Lump Sum" settlement contracts are prepared and signed by the
appropriate parties and approved by the Illinois Industrial Commission.
After the above process is concluded, the worker's claim is closed and
they are no longer entitled to Workers' Compensation benefits for their
injuries. In the event of a subsequent accident, the worker would need
to file a new claim for Workers' Compensation benefits.
NOTE: If an injured worker has
received various Workers' Compensation benefits from his employer but
never signed Lump Sum Settlement contracts, he may still have a
viable Workers' Compensation claim if the Statute of Limitations has not
expired.
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27.
Can a worker file a lawsuit
against his employer for the injuries he sustained for a work-related
accident?
A. No. In Illinois, the only remedy a worker has against their employer
is a Workers' Compensation claim filed with the Illinois Industrial
Commission.
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28.
Is an injured worker entitled to
monies for the payment of union dues, health insurance, or other similar
benefits?
A. No. Unfortunately, the Act does not provide monies to the worker for
any of the above mentioned benefits.
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29.
If an injured worker decides, for
whatever reason, to discharge his present attorney, will he have to pay
more than a 20% attorney's fee or be concerned about an interruption of
his Workers' Compensation benefits?
A. No. An injured worker dissatisfied with their present attorney has
the right to discharge their attorney and retain a new attorney.
Retaining a new attorney will not result in the injured worker being
charged more than a 20% attorney fee or result in the interruption of
the their Workers' Compensation benefits.
It is the responsibility of the newly retained attorney to pay the
previous attorney for any out-of-pocket expenses they might have
incurred, or for any time the attorney might have expended during the
handling of the injured worker's claim.
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30.
What is a Third Party case?
A. An injured worker could have the right to receive substantial
additional monetary damages in the form of a "Third Party" lawsuit if
the facts and circumstances of the accident establish that a Third Party
other than their employer or a co-worker is responsible for the
accident.
More information about Third Party cases.
What is the Workers' Compensation
Act?
Workers' Compensation Benefits
Guide to determining your weekly
disability benefits
Steps to protect your right to receive
Workers' Comp benefits
Methods for resolving your Workers'
Compensation claim
Role of attorneys in the
Workers' Compensation claim process
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