How Does the Illinois Workers’ Compensation Claims Process Work?
The Illinois workers’ compensation claims process is challenging because it is “statutory” and does not make a lot of intuitive sense. For coverage to apply, it requires specific rules to be followed after a work injury occurs. This page is intended to give a person an overview of the Illinois Workers’ Compensation Claims Process. As you will see, this process can take time and can get complicated quickly. Because of that, it is always recommended that if you were injured at work in Illinois that you contact a workers’ compensation attorney.
The worker’s compensation lawyers at the Noll Law Office are knowledgeable and aggressive attorneys who will obtain the evidence needed to prosecute your claim, negotiate with the insurance company and, if needed, take your case to arbitration. The Noll Law Office is a locally owned and operated business that will give you personalized attention. This cooperation between lawyer and client helps place those who are injured at ease, knowing that they have experienced legal representation in their corner. The Noll Law Office can worry about the claims process for you while you worry about healing from your injuries.
Their office is located in Springfield, Illinois, in the Historic Lincoln Depot. Their workers’ compensation lawyers are experienced trial attorneys who are familiar with the Illinois Workers’ Compensation system, including the available types of Illinois Workers’ Compensation Benefits and how to properly value settlements.
If you have been injured in a workplace accident, contact the Noll Law Office today for a free initial consultation at (217) 414-8889. They work on a contingency fee basis, meaning they will only get paid if they successfully obtain a settlement or arbitration award on your case. In addition, they will pay all of the up-front litigation costs related to your claim, so you are not out of pocket that money while you are fighting for the coverage you deserve.
The Steps of an Illinois Workers’ Compensation Commission Claim
The Illinois Workers’ Compensation Claims process is just the fancy name for the insurance process of reviewing and pursuing your claim for workers’ compensation benefits after sustaining a work injury.
Here’s a look at what you can expect from this process, from beginning to end.
Seek medical care.
Your first step is to get the medical treatment you need right away. Make sure to tell the physician how you came to be injured. Get in to get the medical care you need to avoid worsening medical conditions. Your physician will provide an initial diagnosis and provide any referrals for specialized care you might need. (For example, MRIs, Physical Therapy, Surgery, etc.).
Common workers’ compensation injuries include:
Notify your employer.
You must notify your employer within 45 days of the injury. If possible, notify the employer in writing. Do this as soon as possible so there are no questions about the injury later.
Determine work restrictions.
Often, a medical provider will place you on work restrictions while you heal. Be sure to obtain a note from your doctor and share it with your employer. Most employers will accommodate mild work restrictions while you recover from your injuries. If they do not and you are sent home, you are entitled to temporary wage benefits.
File a claim.
Claims are often filed with the insurance company before the Application for Adjustment of Claim can be filed with the Illinois Workers’ Compensation Commission. At times, insurance companies will improperly deny or delay coverage of medical care. So, you will want to speak with an attorney about filing the Application for Adjustment of Claim to avoid improper insurance practices. This will begin the formal claims process with the Illinois Workers’ Compensation Commission.
Continue to follow up with your doctor as directed until you feel better.
Follow your doctor’s instructions for care. Be sure you’re taking all medical treatment steps recommended. Continue to do this until you reach the maximum medical improvement and are released from care.
Complete an independent medical exam if needed.
It is not uncommon for an employer to require you to complete an independent medical examination (“IME”), which means they send you to their own chosen doctor for a review of your injuries and necessary medical care. If you do not have an attorney at this point, you should contact an attorney immediately. An IME can result in the termination of your benefits, even if all other evidence points to the fact that you did sustain a work injury and your own treating doctors recommend additional medical care.
Reach a settlement, if possible.
Some cases are able to be settled without an arbitration hearing. This will require the employee and the insurance company to come to an agreement as to the worker’s average weekly wage, the nature and extent of the injury, and the number of benefits that are due and owing.
If a case cannot be settled, the case will proceed forward to an arbitration hearing. At that hearing, evidence is put on, and an arbitrator will decide whether to award any benefits to the employee. The evidence usually consists of subpoenaed medical records and bills, subpoenaed documents from the employer, wage records, physician deposition testimony, and other pieces of evidence. If the arbitrator does decide to award benefits, the Arbitrator’s decision will include the specific award of compensation and medical benefits to be paid by the employer (technically, by the employer’s insurance company). This decision may be appealed by either party.
Illinois Workers’ Compensation Case Illustration
Jennifer works for a retailer, stocking shelves and unloading boxes that are delivered by the delivery truck. One day, the crates carrying the delivery items were not loaded correctly, leading to a heavy package falling off the rollers and smashing into her leg. The crush injury caused substantial injury to her knee. It required surgery to fix. Jennifer struggled with occupational therapy after the surgery and suffered from some lasting mobility issues. She could no longer kneel easily to stock shelves, squat, or completely bend her knee. Jennifer contacted an experienced workers’ compensation attorney at the Noll Law Office in Springfield, IL, to help her get compensation for her injury, coverage for her medical bills, and payment for the time she missed work. In addition, the Noll Law Office obtained a check for the permanent damage to her knee which is also an insured event.
How Long Does an Injury Claim Take and What Contributes to Claims Taking Longer to Resolve?
It can take anywhere from a few months to a few years for a workers’ compensation claim to be resolved. The biggest factors in determining how long a workers’ compensation claim will take are how badly the employee is injured and whether the workers’ compensation insurance company accepts or denies the claim.
The more severe the injury is, the longer an employee will receive medical treatment. For example, an employee who requires surgery with the placement of screws and pins will likely continue medical treatment far longer than an employee who suffers a mild sprain and some bruising. As such, the Illinois workers’ compensation claims process will run for greater lengths of time as additional medical treatment is received.
Below, you will read about the different phases of a workers’ compensation claim. Each of these steps may be shorter or longer depending on your injury and whether the insurance company disputes all or part of the claim.
Notice to the Employer
A worker has 45 days from the date of injury to notify their employer of their injury. While some exceptions do apply, it is always best to notify an employer immediately after an injury occurs. Preferably this notice should be in writing. The employer must then file an accident report with the Illinois Workers’ Compensation Commission, typically within 30 days.
The employer’s workers’ compensation insurance company will also be notified of the injury. The insurance company will then order a copy of your medical treatment records and review the written report of injury, together with any other evidence that exists (videos, etc.). The insurance company then approves or denies the claim purportedly on the evidence that it was provided. At times, in particular, when the injury is extremely obvious, approval is almost immediately provided. At other times, such as in repetitive trauma cases, approval moves quite slowly, if at all.
What Happens If I am Denied Coverage on My Claim? The “19b” hearing
If the insurance company denies coverage, the claim will be extended even longer. Your attorney will need to request an emergency “19b” hearing in front of the Arbitrator. This requires the attorney to obtain certified, subpoenaed copies of your medical records and bills, evidence of the accident, and deposition testimony of your treating physicians. Your attorney will ask your doctors to take a deposition and testify as to whether the doctor believes your injuries were sustained from your work accident. The physician will also need to explain what treatment is necessary to cure you of your injuries and whether you will ever fully recover.
It is a time-consuming process given the schedules of everyone involved (especially busy doctors) and can extend the Illinois workers’ compensation claims process for several months. If possible, you should run your medical treatment through private health insurance while your attorney prepares for emergency arbitration to avoid delays in your medical treatment. You do not want a medical condition to become worse as a result of an improper workers’ compensation denial.
Independent Medical Examinations (IME)
During this time, your employer may seek to have an “independent medical examination” (IME) completed to provide a physician’s opinion on whether:
- you were injured;
- your injury was related to the workplace accident;
- you can continue to work; and/or
- the treatment proposed by your doctors is appropriate.
These reviews are notoriously biased against workers and in favor of insurance companies. Why? The insurance companies pay for the examination and opinions. However, on occasion, IME will come back in favor of the injured worker.
If an IME is requested, you must attend but do not have to pay for travel expenses such as mileage, etc. If the IME is favorable towards you, that is great! Hopefully, you will receive workers’ compensation benefits. If the IME is not favorable towards you, your attorney should take the deposition of that IME physician in an objection to the report.
At emergency arbitration, the attorney will place your certified medical records and physician deposition transcripts into evidence. Witnesses will be subpoenaed to testify about the accident and other issues that have arisen in your case. The arbitrator will hear the evidence submitted by your attorney in addition to the evidence submitted by the defense counsel. After arbitration, the arbitrator will prepare a written decision that also extends the Illinois workers’ compensation claims process by several weeks.
Hopefully, you will be victorious and win the emergency hearing. The Respondent might then appeal, in which case your attorney will run you through the appeals process. Regardless, you should continue with medical treatment.
I’m As Good As I’m Going to Get After My Accident. What Happens Now?
At some point, you will reach “maximum medical improvement.” This means that you have recovered as much as you are going to after an accident. Sometimes, a person makes a full recovery. Other times, there are residual medical symptoms left behind. It just depends on what injury was sustained.
Once you have reached “maximum medical improvement,” or MMI, your attorney will begin preparing your case for “full and final” arbitration. This will be, hopefully, the final arbitration in your case. Your final medical records will be subpoenaed. Final depositions of your physicians might be taken. Your attorney should review any straggling medical symptoms you may have, such as:
- Restricted range of motion;
- Reduced strength;
- Nerve injuries; and
- Any other issues which may be in your medical records.
At MMI, your attorney should attempt to settle your case. If a settlement is not reached, final arbitration will be set. Should you want additional information about the Settlement of Illinois’ Work Comp Claims, you can read more about that process.
Full and Final Arbitration
Full and final arbitration is similar to emergency “19b” arbitrations in the sense that your attorney should place your certified medical records and physician deposition transcripts into evidence. Witnesses will be subpoenaed to testify about other issues that have arisen in your case. The arbitrator will hear the evidence submitted by your attorney in addition to the evidence submitted by the defense counsel. After arbitration, the arbitrator will prepare a written decision which also extends the claim by several weeks. The arbitrator will typically render a decision within six weeks of arbitration. Employers may or may not appeal that decision.
In conclusion, some minor workers’ compensation claims are completed within a few months. Other, more serious injuries result in a claim that may take years to complete. Every case is different and unique. Employers frequently dispute the nature and extent of the injury (a worker is not as injured as they say they are), coverage for some or all of the medical procedures, or cut off coverage entirely when a medical procedure is disputed. All of these things delay claims and can result in arbitration.
Having a local, aggressive workers’ compensation attorney fight for you usually greatly increases your chances of appropriate coverage for your medical treatment needs and a fair arbitration or settlement. The Noll Law Office is available to meet with you immediately to discuss your claim.
When Does Workers Compensation Apply to My Injury?
For Illinois Workers’ Compensation to apply, three things must be present: 1) you must be “employed,” 2) an “accident” must occur in which the employee is injured, and 3) the accident must “arise out of, and occurs during the course of, employment.”
First, you must be employed for workers’ compensation insurance coverage to apply to your injury and medical care. While there are some limited exceptions, independent contractors are not usually considered to be employees even if the contracted workers are hurt on the job. If there is a question of employment, you should talk to an attorney immediately to avoid forfeiting your insurance coverage.
Second, an “accident” must occur in which the employee is injured. An injury is considered accidental if it happens without design, and the injury is compensable if it arises out of and occurs during the course of employment. This covers a fairly broad category of activities. For example, it can encompass situations in which there is “repetitive” trauma to the body that causes the injury or aggravation of a previously existing medical condition.
What Does It Mean for an Accident to “Arise Out of, and in the Course of Employment?”
Generally, one looks to a causal connection. Does the injury have origins in some risk connected with, or incidental to, employment to determine whether the accident arose out of the employment relationship? The “course” of employment inquiry refers to the time, place, and location of the injury. When making this finding, the arbitrator will look at the facts and circumstances of your individual case.
If an injured employee is found to sustain an accident that arose out of, and during the course of, employment, then the employee is entitled to workers’ compensation insurance coverage of reasonable medical expenses for treatment of the work accident. This includes medical treatment to diagnose, relieve, or cure the bad effects of the claimant’s injury.
The employer’s insurance provider must pay for the necessary first aid, medical, surgical, and hospital services that cure the employee following the work accident. Put another way; the employee is entitled to recover only those medical expenses that are reasonable and causally related to the work accident.
The employer must also pay for treatment, instruction, and training necessary for the physical, mental, and vocational rehabilitation of the employee, including all maintenance costs and incidental expenses. Typically, this comes into play if an employee’s severe catastrophic injuries prevent his return to previous employment.
If you have a question about whether you are covered by workers’ compensation, contact a lawyer immediately. The Noll Law Office can guide you through the insurance claims process and provide you with an expert legal opinion as to whether you are entitled to coverage of benefits.
What Benefits Are Available?
There are many types of Illinois Workers’ Compensation Benefits available to an injured employee, and those benefits vary widely depending on the type of injury that the worker sustains. At a minimum, the employee is entitled to coverage of his or her medical bills if that employee is injured through the scope of their employment while working for his or her employer. The medical bills will be paid by the workers’ compensation insurance company.
The Illinois Workers Compensation publishes a handbook that explains in layperson terms what benefits are available. Essentially, the following benefits also may or may not exist, depending on the facts of the case:
- Temporary Total Disability (TTD) Benefits
- Temporary Partial Disability (TPD) Benefits
- Vocational Rehabilitation/Maintenance Benefits
- Permanent Partial Disability (PPD) Benefits
- Permanent Total Disability (PTD) Benefits
- Death/Survivors’ Benefits
Each benefit is different, and each benefit has its own calculations that are followed to determine the amount of benefit that is provided to the injured person.
If you are unsure of what benefits you are entitled to, you should contact the Noll Law Office immediately. Their attorneys are well-versed in benefits litigation and can help you determine what rights you have.
Required Forms for the Illinois Workers’ Compensation Claim Process
The Illinois Workers Compensation Commission has moved to an online filing system called Compfile. Much of the pleadings system is now automatically generated. This includes several forms that used to be printed out in hard copy.
Generally, after accident reports are completed, your attorney will assist you in filing an “application for adjustment of claim” on the Illinois Compfile system. This application paperwork details your biographical information, contact information, date of injury, name of the employer, and other details required to process your claim.
Once the application is uploaded, a link will be sent to your email for signature. You will need to log in at the link that is sent to you and sign the application. Congratulations! You now have an official claim pending. Copies of that paperwork are then sent to your employer and their insurance company so that the claim is appropriately tracked.
Your attorney should help you with the remaining workers’ compensation forms that apply to your case. Many of those forms are online at the Illinois Workers Compensation website. Common forms include:
- Petitions for Immediate (“Emergency”) Hearing Forms;
- Subpoena Forms;
- Appearance of Representative Forms;
- Requests for Hearing Forms;
- Notice of Motion and Order Forms; and,
- Settlement Contract Forms.
As noted above, many of these forms can now be completed or generated through the Compfile system. Your attorneys should explain how this system works for you during your upcoming meetings. If you have any questions about the claims process, you should contact an attorney immediately. The Noll Law Office stands ready to assist you with explaining the forms and their role in litigation and looks forward to your call.
Do You Need an Attorney?
It is not required that you have an attorney to file a worker’s compensation claim. However, as you can see, the claims process is complicated. Claims often involve depositions of doctors, issuing subpoenas, and presenting evidence in a quasi-judicial proceeding. So, it is often better to have an experienced work comp attorney advocating for you.
Common Issues with the Workers’ Compensation Claims Process
Common issues that might arise in your claim include:
- The employer disputes the accident;
- The employer disputes injury;
- The employer disputes that the medical care your physician recommended is necessary;
- The employer disputes that you have any residual medical limitations once treatment has been finished up.
The only way to address these issues is through negotiation and/or arbitration.
Not every situation results in the type of compensation outcome you expect. Our workers’ compensation lawyers have experience appealing arbitration decisions. However, the best way to avoid an appeal is to hire an attorney early on during the claims process to advocate for you.
Do I Have a Case?
Let the Noll Law Office provide you with an opinion during a free consultation. They will speak to you about what happened in your case and discuss possible strategies moving forward to obtain the benefits coverage you may be entitled to. Every case is different. Everyone’s body is different. You deserve a strong advocate who will review the specifics of your case and provide you with individualized legal opinions.
How the Noll Law Office Will Help
Expect their dedicated and highly experienced attorneys to help you through the Illinois workers’ compensation claim process. As a team of highly experienced workers’ compensation attorneys in Springfield, Illinois, they are ready to support you throughout this process. Contact the Noll Law Office now for a free initial consultation.