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Factors to Consider When Filing Workers’ Compensation Claims in Illinois

Workplace injury and workers’ compensation cases require medical record retrieval services since it would help lawyers clearly estimate the damages that are due to their clients. A state-mandated insurance program that provides benefits to employees who are injured in the course of employment, workers’ compensation is governed by specific laws and regulations in each state. Here, we will look at some important things to know about Illinois workers’ compensation law. It is estimated that more than 40,000 claims are filed in Illinois each year.

Workers Compensation ClaimsJust as most other states, a worker with a work-related illness or injury can receive workers’ compensation benefits irrespective of who is at fault for the illness or injury. These benefits are not taxable income to the employee unlike a worker’s salary and wages.

  • In Illinois, the state’s workers’ compensation act generally covers all injuries that are caused in whole or in part by the employee’s work including pre-existing conditions that are worsened by the employee’s job and work-related injuries sustained outside of the workplace.
  • Certain injuries are not covered by the Illinois Workers’ Compensation Act, and these include:
    • Injuries that are self-inflicted
    • Injuries sustained while an employee was not on the job
    • Injuries suffered while the employee was committing a serious crime
    • Injuries sustained when an employee’s conduct violated company policy
  • Apart from specific injuries, repetitive trauma injuries such as when a worker’s body breaks down due to the repetitive nature of his/her work can also be compensable.
  • Almost all workers, except Federal workers and most Chicago cops and farm workers, are covered under Illinois Workers’ Compensation law.
  • A worker hired in Illinois but injured when working in another state is also covered.
  • Workers’ comp claims are claims for benefits, they are not lawsuits. There are limited circumstances such as the following that allow employees to file a lawsuit against their employer in civil court.
    • When the employer has insufficient workers’ compensation insurance or no workers’ compensation insurance.
    • When the employer intentionally hurt the employee.
  • All injury claims are processed via the Illinois Workers’ Compensation Commission.
  • Independent contractors are not covered under workers’ compensation.
  • The first step in every workers’ compensation case is filing an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission.
  • The minimum time to formally file your case is 3 years from the date of accident or two years after the last payment of compensation (weekly benefit payments or medical payments), whichever is later.
  • An employee who is off work for a workplace injury is entitled to benefits equal to 2/3 of his/her average weekly wage up to a statutory maximum.
  • In Illinois, injured workers are entitled to 3 separate benefits – medical benefits, temporary off work benefits, and permanent impairment benefits.
  • Under the Illinois Workers’ Compensation Act, minors have the same rights and obligations as adults. Illegally employed minors may reject their rights under the Act within 6 months after an accident, and may sue the employer under the common law.
  • Under the Act, aliens have the same status as other employees, except that death benefits are reduced by half if the beneficiaries of those aliens do not reside in the United States, Canada, or Mexico, except as otherwise provided by treaty.
  • A mental or psychological condition caused by a work-related physical injury is compensable.
  • Suicide may be compensable in Illinois, if the reason for the suicide can be traced to an original compensable accident.
  • Domestic servants employed by a family are not automatically covered by the Act, unless the employer chooses to come under the Act or if the domestic servant is engaged in extra hazardous activities.
  • Intoxication from alcohol or drug use will not necessarily prevent an injured worker from receiving workers’ comp benefits, unless the intoxication caused the injuries. If the worker fails a drug or alcohol test, he/she has the burden of proving that the intoxication was not the cause of their injuries.
  • An employee injured while travelling as part of their job could receive workers’ comp benefits provided the activity they were performing at the time of injury was foreseeable to the employer.
  • Under certain circumstances, injuries occurring in employer-controlled parking lots even after an employee has clocked out may be compensable.
  • If an injury results from medical treatment provided at the request of the employer’s physician, it is compensable.
  • Injuries occurring during a recreational activity will be compensable only if the worker was compelled by the employer to participate in that activity.
  • A worker has the right to choose 2 different physicians, and any physician those doctors refer them to for the treatment of a work-related injury as long as that treatment is considered reasonable and necessary. If the employer has a preferred provider network, the employee must choose from that network. If he/she opts to choose a doctor outside of the network, they will have only one physician choice.
  • Even if a workers’ comp claim is denied, the employee still cannot file a lawsuit against the employer. Instead, he/she can file an appeal with the administrative agency in Illinois that governs workers’ compensation appeals – this governing agency is usually the workers’ comp appeals board.
  • Vocational rehabilitation benefits are available in some cases when a worker is too injured to return to work. In this case, workers’ comp will pay for an employee’s retraining or to go back to school.
  • While pain and suffering is not considered into the amount recovered by an employee injured on the job, pre-existing conditions will not exclude an employee from receiving benefits.
  • Workers Comp ClaimsA worker doesn’t need health insurance to make a claim.
  • Quitting one’s job in the midst of a workers’ comp case is not advisable and could cost the employee money. This is best done after consulting with a lawyer.
  • A worker coming to Illinois for an out-of-state employer may be subject to and eligible for benefits under the Illinois Workers’ Compensation Act.
  • Day workers /temporary workers are entitled to workers’ comp benefits if they are working through a temp agency.
  • An employee cannot be fired for pursuing a workers’ compensation claim.
  • What employees post on their social media accounts could have a bearing on their workers’ compensation. It is best to keep these pages private and not accept unknown friend requests, or post about one’s workers’ comp case.
  • If an employee has two jobs, and a work injury on one job prevents him/her from being able to work on the other, wages for both jobs are typically considered when calculating benefits.

Since a workers’ compensation claim or lawsuit involves an injury or illness, medical records are significant, and attorneys representing injured workers utilize medical review solutions to review these healthcare documents. The reports prepared provide an accurate evaluation of the injury-related medical need, identify causality and medically related treatment, and help in preparing evaluating, negotiating and settling a case. Under the Illinois Workers’ Compensation Act, all non-medical benefits are paid based on an injured worker’s Average Weekly Wage, which is an independent calculation from what the worker receives in compensation from his/her employer. Since legal procedures associated with pursuing a workers’ compensation claim in Illinois can be complicated, injured workers should ideally consult an experienced workers’ comp attorney for a positive outcome.

About MOS Medical Reviews

Headquartered in Tulsa, Oklahoma, Managed Outsource Solutions (MOS) provides quality medical record review services to physicians, attorneys, medical legal consultants, insurance companies, private corporations, case or chart review firms, and other organizations.