What is workers’ compensation?
Workers’ compensation is a system of benefits provided by law to most workers who have job-related injuries or diseases. These benefits are paid regardless of fault. Each state has its own workers’ compensation law. Illinois’ law first took effect in 1912.
Which employees are covered by the law?
Almost every employee who is hired, injured, or whose employment is localized in the state of Illinois is covered by the law. These employees are covered from the moment they begin their jobs. What injuries and diseases are covered under the law? In most instances, the law covers injuries that are caused, in whole or in part, by the employee’s work. A worker injured by the repetitive use of a part of the body is covered, as is a person who experiences a stroke, heart attack, or other physical problem caused by work. A worker who had a pre-existing condition may receive benefits if he or she can show the work aggravated that condition. Injuries suffered in employer-sponsored recreational programs (e.g., athletic events, parties, picnics) are not covered unless the employee is ordered by the employer to participate. Accidental injuries incurred while participating as a patient in a drug or alcohol rehabilitation program are not covered.
What benefits are provided?
The law provides the following benefit categories, which are explained in later chapters:
- a) Medical care that is reasonably required to cure or relieve the employee of the effects of the injury;
- b) Temporary total disability (TTD) benefits while the employee is off work, recovering from the injury;
- c) Temporary partial disability (TPD) benefits while the employee is recovering from the injury but working on light duty;
- d) Vocational rehabilitation/Maintenance benefits are provided to an injured worker who is participating in an approved vocational rehabilitation program;
- e) Permanent partial disability (PPD) benefits for an employee who sustains a permanent disability or disfigurement, but can work;
- f) Permanent total disability (PTD) benefits for an employee who is rendered permanently unable to work;
- g) Death benefits for surviving family members. Are workers’ compensation benefits considered income? No. Workers’ compensation benefits are not taxable under state or federal law and need not be reported as income on tax returns.
Who pays for the benefits?
By law, the employer is responsible for the cost of workers’ compensation. Most employers buy commercial workers’ compensation insurance, and the insurance company pays the benefits on the employer’s behalf. No part of the workers’ compensation insurance premium or benefit can be charged to the employee. Other employers obtain the state’s approval to self-insure. What are the time limits for notifying the employer? Generally, the employee must notify the employer within 45 days of the accident. Any delay in the notice to the employer can delay the payment of benefits. A delay of more than 45 days may result in the loss of all benefits.
What if the employer won’t pay the worker any benefits?
The worker or the worker’s attorney should contact the employer directly to determine why benefits are not being paid. Poor communication often causes delays and misunderstanding. If the problem persists, the employee should file a claim at the Commission. Please note that an accident report does not trigger any action by the Commission.
Can a worker be fired for reporting an accident or filing a claim?
It is illegal for an employer to harass, discharge, refuse to rehire, or in any way discriminate against an employee for exercising his or her rights under the law. Such conduct by the employer may give rise to a right to file a separate suit for damages in the circuit court.
What medical benefits are covered under the law?
The employer is required to pay for all medical care that is reasonably necessary to cure or relieve the employee from the effects of the injury. This includes but is not limited to first aid, emergency care, doctor visits, hospital care, surgery, physical therapy, chiropractic treatment, pharmaceuticals, prosthetic devices, and prescribed medical appliances. The cost of devices, such as a shoe lift or a wheelchair, may be covered. If the work injuries result in a disability that requires physical modifications to the worker’s home, such as a wheelchair ramp, the employer may have to pay those costs, as well.
Who pays for the medical care?
If the employer does not dispute a medical bill, it will pay the medical provider directly. The worker is not required to pay co-payments or deductibles. If the employer disputes a bill, it must promptly give the worker a written explanation for its refusal. While a case is pending at the Commission, the provider cannot try to collect payment from the employee once the employee notifies the provider that he or she has filed a claim with the Commission to resolve this dispute. The provider may send the employee reminders of the outstanding bill, and ask for information about the case (e.g., case number, status of case). If the employee does not provide the information within 90 days of the date of the reminder, the provider may resume its efforts to collect payment.
Can the employee choose the treating doctor or hospital?
Yes, but there are limits. The employee is entitled to choose one medical provider and any other providers to whom the employee is referred. That means an employee may initially choose any doctor or hospital, even if the provider is outside the employee’s regular insurance network, and go to any doctor to whom the employee is referred by that provider. Generally, if the employee chooses a second doctor without the employer’s approval, the employer is not required to pay for those services. First aid and emergency care are not considered to be one of the worker’s two choices.
Does a worker have to allow employer-hired case managers to manage his or her care?
No. A worker may, without penalty, refuse or limit the involvement of nurses or case managers hired by the employer. The employee is obligated to provide medical records that are relevant to the case, but otherwise a worker’s medical care is confidential.
Can the employer ask for an evaluation by its own doctor?
Yes. On occasion, the employer may request a full medical exam by the doctor of its choice. When the employer gives the employee notice of the place and time of the exam, it must at the same time give the employee money to cover travel expenses, meals, lost wages, etc. The exam must be held at a reasonable time and place. The worker must undergo the exam, but he or she need not accept any treatment from the employer’s doctor. The employer’s doctor must give both parties the same report of the exam as soon as practicable, but not less than 48 hours before an arbitration hearing.
How are prices for medical care determined?
Most treatments that are covered under the Act and were provided on or after February 1, 2006 are subject to a medical fee schedule. The employer shall pay the lesser of the provider’s actual charge or the amount set by the fee schedule.