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Tips on Getting Medical Benefits in Illinois Workers' Compensation Cases

Written by: Michael J. Helfand

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Posted over 2 years ago. Applies to Illinois, 3 helpful votes, 0 comments

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All reasonable medical treatment is covered

In Illinois, 100% of your medical treatment is covered. This means no co-pays, deductibles, or other out-of-pocket expenses. Of course, there are limits. Coverage is only available for treatment that is reasonable and necessary. Also, treatment must be related to your work injury. In general, anything prescribed or recommended by your doctor -- prescription medications, physical therapy, tests, surgeries, medical devices -- is covered. If your employer or the workers' compensation insurance company disagree, they can deny benefits.

Notify your employer and file a claim

You cannot get workers' compensation benefits without filling out some forms and taking some initiative. The first thing you should do (after receiving medical care for your injury, of course), is notify your employer. Let a supervisor know that you were injured at work. Next you should file a claim with the Workers' Compensation Commission in Chicago (see link below). You can file in person or by mail. The form is called an "Application for Adjustment of Claim" and is the basic form every injured worker fills out to officially start their claim. If your employer doesn't dispute your injury and eligibility for benefits, you may start receiving benefits before you even file a claim. However, don't consider your work done. Filing a claim can give you a head start if there is a dispute down the road.

See your own doctor, and get referrals

In Illinois, you are allowed to see your own doctor (rather than one chosen by your employer or the insurance company). You are also allowed to have two "chains" of referrals. A chain is when your doctor refers you to a physical therapist, and then when that doesn't work, they refer you to a surgeon. A second opinion is allowed, but starts a new chain. So make sure you get referrals to see additional doctors when you can. Note that your employer can require you to see a doctor of their choosing for an exam. This is called an Independent Medical Exam (IME) and is paid for by the employer.

If benefits are denied, ask an arbitrator to decide

If your benefits are denied, right from the start or at any time, you can have your case heard by an arbitrator at the Workers' Compensation Commission. It's ultimately up to the arbitrator to decide what benefits are appropriate. It's highly recommended that you hire an attorney to represent you at this point (if not sooner). The insurance company's job is not to look out for your best interest, but rather to save the company money.

Don't settle too early

In most cases, the insurance company will offer the injured worker a settlement amount. This closes the claim. While settling your claim may be a good idea, timing is important. If you settle too early (before your treatment is complete, for example), then you can lose your right to further medical benefits. It's always a good idea to consult with a workers' compensation attorney before settling. It's a good way to ensure that you're getting full compensation.

Additional Resources

We are a group of attorneys who provide a free service to injured workers. If you need help finding an experienced workers' comp attorney anywhere in Illinois, give us a call. We'll recommend the attorney we think is right for you and your case. (312) 346-5320.

Illinois workers' compensation attorneys

Illinois Workers' Compensation Commission - forms