The way to get future medical treatment in your Illinois Workers Compensation case is often misunderstood.

As I have discussed before, usually the only way possible for future medical bills to be paid is to go to trial and win. This leaves open the avenue for you to collect on future medical needs.

There is not a medical card or insurance card issued. Instead you must request that the insurance company pay for the treatment needed. If they refuse, you must file a case with the Illinois Workers Compensation Commission.

For example, if you injured your back and had a surgery and went to trial and won, then 5 years later the doctor says you need a fusion. Assume the insurance company denies your request for the fusion, you then file for the Commission to review your case. Your doctor will have to testify that surgery is needed and it is related to your original work injury. You will also testify to your  condition, and the insurance company doctor will testify. A panel of 3 commissioners will review the testimony, documents and arguments. They will then issue a decision. This process can take anywhere from 1 to 3 years. So you can tell this process is far from perfect, but it is the only one in place to deal with future medical requests.

Illinois Workers’ Compensation law is set up to stream line the trial process.

You do not have to prove your work injury was the fault of your employer. You only have to prove the accident happened and that it is the cause of, or aggravated your condition, and that you continue to suffer from the injury.

Usually this means you will have to testify and there will not be the need for another witness. However, if there is a dispute about whether the accident occurred then you may have to bring in an eye-witness to testify about the accident.

Your doctor will testify by way of his deposition. The transcript of the testimony will be submitted to the Workers Compensation Arbitrator for him to read.

Since the witnesses are limited in number a Workers’ Compensation trial will often be completed in less than one hour.

In Illinois Workers’ Compensation cases the trial judge is called an arbitrator. The arbitrator is a full time employee of the State of Illinois. Her job is to conduct workers’ compensation trials, approve workers comp settlement contracts and rule on motions. She is usually assigned to one or two arbitration sites in the State of Illinois. For instance, in Central Illinois there are arbitration sites in Peoria, Bloomington, Springfield, Urbana, Clinton and Decatur. Cases are assigned to a specific site which is determined according to the location of the accident. For example, if you are injured in Champaign, but live in Lincoln, your case will be assigned to Urbana. The arbitrator remains responsible for all workmans compensation cases at her sites as long as she is assigned to the location. If she is transferred, then the new arbitrator hears your case.

Most arbitrators are lawyers, however, they do not have be a lawyer. Some have backgrounds in labor relations or insurance.

The arbitrator will hear the testimony in the trial, read the medical records and any of the doctors’ testimony, and write a decision in your case. This will usually take 60 days. Both sides have 30 days to appeal the decision to the Illinois Workers Compensation Commission if they disagree with the decision in any respect. More about appeals later.

I just had a Workers’ Compensation trial today for a client who wanted open medical benefits. He had a hand injury and was concerned that at some point in the future he would need medical treatment. The insurance companies want you to settle the case so everything closed out. Good for them. Not so good for you. When you settle, all future medical is your responsibility.

The trial takes a little more work but it preserves your rights to future medical benefits. It is not a perfect system, however, it is the only way to protect your opportunity to get medical benefits. You receive your money and keep your medical in play.

Any questions call Dirk at 309-827-4371 regarding Workers’ Compensation claims in Bloomington, Springfield, Peoria, Pontiac, Decatur and Champaign, Illinois.

Follow

Get every new post delivered to your Inbox.