Workers’ Compensation

An employee may be entitled to payment of medical bills incurred as a result of a work-related accident. The bills must be “causally connected” to the accident. Also, the treatment must be “necessary.” Illinois has a Workers’ Compensation fee schedule that dictates how much a medical provider or professional will be paid. Medical expenses are subject to the two-doctor chain-of-referral limit, which can be explained by your lawyer.

The Illinois Workers’ Compensation Act gives all employers and their insurance companies the ability to send an employee to a doctor of their choice for an “Independent Medical Evaluation” (otherwise known as an IME). The doctors they choose often dispute whether the treatment is necessary and/or casually connected to the work accident.

This is a wage substitute. It may apply if you are directed to remain off work by a doctor or if you are released to return to work with restrictions and your employer does not have work available within those restrictions. Ordinarily, the TTD payment is two-thirds of a Workers’ Average Weekly Wage (AWW) calculated on the 52 weeks you worked for the employer immediately before the accident. Illinois law provides for minimum and maximum payment amounts. Overtime wages are included in the AWW calculation in some instances.

When an employee is working light duty on a part-time basis or full-time basis and earns less than he or she would be earning if employed in the full capacity of the job or jobs, then the employee is entitled to temporary partial disability benefits. Temporary partial disability benefits are equal to two-thirds of the difference between the average amount that the employee would be able to earn in the full performance of his or her duties in the occupation in which he or she was engaged at the time of the accident and the gross amount which he or she is earning in the modified job provided by the employer or in any other job that the employee is working. 820 ILCS 305/8(a).

When an employee is not capable of returning to his or her pre-injury occupation as a result of a work-related accident and the employee has no transferable skills with which to earn a comparable living or no work is available within the employee’s skills, the employee is entitled to retraining at the employer’s expense. The Illinois Supreme Court has stated that an employee is entitled to rehabilitation when he or she sustained an injury that caused a reduction in earning power and there is evidence rehabilitation will increase his or her earning capacity. National Tea Co. v. Industrial Commission, 97 Ill.2d 424 (1983).

The National Tea Co. Court continued to innumerate several factors that are to be considered:

• Whether similar treatment failed in the past;
• Whether the employee is not “trainable” due to age, education, and occupation;
• Whether the employee has sufficient skills to obtain employment without further training or education;
• The relative costs and benefits to be derived from the program;
• The employee’s work–life expectancy;
• The employee’s ability and motivation to undertake the program; and,
• The prospects for recovering work capacity through medical rehabilitation or other means.

Illinois Workers’ Compensation Commission Rule 7110.10 provides that an employer must prepare a written assessment of the medical care and, if appropriate, rehabilitation required to return the employee to employment either when it is determined that the employee will not be able to resume regular duties or when the employee has been off work over 120 days, whichever occurs first. 50 Ill. Admin. Code Section 7110.10(a). Additional requirements are specified in the rule.

Expenses related to vocational rehabilitation are also the responsibility of the employer, such as tuition, books, and mileage. The employee is also entitled to weekly maintenance payments equal to temporary total disability benefits until rehabilitation is completed.

Once retraining is completed the employee is still entitled to permanent partial disability compensation. The Illinois Workers’ Compensation Act provides that an employee is entitled to disfigurement compensation for any serious and permanent disfigurement to the hand, head, face, neck, arm, leg below the knee or the chest above the axillary line – but not less than six months after the date of the accident. This benefit is not payable in addition to any other workers’ compensation disability benefits for the same part of the body. Before seeking disfigurement final compensation an employee should consider obtaining plastic or reconstructive surgery to minimize the disfigurement; however, plastic or reconstructive surgery is not required.

This is compensation for the damage done to a worker’s body. Some folks call this “my settlement.” Sometimes it is only a part of what they are actually entitled to. In order to determine what is fair compensation for our client a detailed analysis must be performed under this part of the Illinois Workers’ Compensation Act (The “Act”). The Act assigns a maximum number of permanent partial disability weeks to different parts of the body. We research a client’s specific injury to determine what part of the body is involved for Workers’ Compensation purposes and what percentage of that body part might be awarded by an Arbitrator of the Illinois Workers’ Compensation Commission. When applicable, that is just the beginning of the complicated analysis that must be performed in order to properly prepare our client’s case. It is a very important and complicated part of most Illinois Workers’ Compensation cases.

We will be able to further discuss this aspect of a case in person. Please feel free to call us for a free consultation.

If an employee who is the victim of a work-related accident becomes partially incapacitated from pursuing his or her usual and customary line of employment he or she is entitled to a decreased earning capacity award except in cases compensated under the specific schedule set forth in paragraph 305/8(e) of the Act. The employee is entitled to this compensation for the duration of his or her disability subject to the limitations for certain maximum amounts set forth in Section 305/8(b) of the Act. This compensation is equal to 66 – 2/3% of the difference between the average amount which he or she would be able to earn in the full performance of his or her duties in the job the employee was engaged in at the time of the accident and the average amount which he or she is earning or is able to earn in some suitable employment or business after the accident. For accidental injuries that occur on or after September 1, 2011, an award for wage differential shall be effective only until age 67 or 5 years from the date the award becomes final, whichever is later. 820 ILCS 305/8(d)1.

If an employee who is the victim of a work-related accident is permanently unable to work because of that injury, permanent total disability (PTD) benefits may be available. Permanent total disability compensation is in the amount of 66 and 2/3rds percent of the employee’s average weekly wage. Permanent total disability benefits are payable for the life of the employee or until the disability terminates. However, permanent total disability benefits are subject to maximum and minimum rates. These benefits are subject to adjustment.

The surviving spouse and dependent children of an employee who dies as a result of a work-related accident are entitled to death benefits under the Illinois Workers’ Compensation Act. Benefits for death claims are payable in the amount of 66 & 2/3rds % of the employee’s average weekly wage subject to minimums and maximums. Section 7 of the Illinois Workers’ Compensation Act outlines the duration for which death benefits are available. In addition, there is a one-time burial benefit in the amount of $8,000.00. Ultimately, the total Illinois Workers’ Compensation death benefit cannot exceed $500,000.00 or 25 years, whichever is greater. Benefits are terminated upon the remarriage of a spouse but may continue in the event that there are minor children of the deceased employee at the time of the remarriage.

Illinois Workers’ Compensation death benefits can be complicated and you should consult with an experienced workers’ compensation attorney.