What Kinds of Benefits Can I Get in a Worker's Compensation Case In Illinois?
If your injury happened while you were on the job and was related to a job task you were performing, you are entitled to three main benefits:
- Payment of your medical bills
- Compensation for your time off work
- Payment for the permanency of your injury.
Below I have summarized each benefit more fully.
The employer is required to pay for all the medical care that is reasonably necessary to cure or relieve the employee from the effects of the injury. This can include first aid, emergency care, doctor visits, hospital care, surgery, physical therapy, chiropractic treatment, pharmaceuticals, prosthetic devices, and prescribed medical appliances.
Employers will typically pay medical bills directly and the injured employee will not be required to pay any co-payments or deductibles. An employer can dispute medical treatment, request an independent medical evaluation, request that a nurse case manager attend your medical appointments, conduct a utilization review, and use other means in an attempt to dispute liability for medical bills.
An injured employee may choose his or her own doctor, but is limited to only one doctor. However, the employee may see any doctor the employee is referred to by his/her chosen doctor and any doctor referred within that chain of doctors. The employee may not see another "chain" of doctors without the employer's approval.
Temporary Total/Partial Disability (TTD/TPD)
Temporary Total Disability (TTD) is compensation for the time that an employee is unable to work as a result of his/her injuries. TTD is calculated at 2/3 the employee's Average Weekly Wage (AWW). TTD is not paid for the first 3 lost work days unless the employee misses 14 or more calendar days due to the injury. Time taken off work for an injury must be pursuant to a doctor's note.
Temporary Partial Disability (TPD) is compensation for the time that an employee is restricted to light-duty and earning less than he/she would earn in the pre-injury job(s). TPD is paid until the worker has returned to his/her regular job or until he/she has reached maximum medical improvement. TPD is calculated at 2/3 of the difference between the average amount the worker would be able to earn in the pre-injury job(s) and the gross amount he or she earns in the light-duty job.
There are four different ways of compensating an injured worker for the lasting effects of his/her: Schedule, Non-Schedule, Wage Loss Differential, and Disfigurement.
The most common means of calculating the permanency is via a schedule of body parts as set forth in the Illinois Workers' Compensation Statute. Using the schedule as a guide, lawyers, arbitrators and judges are able to value an injured worker's injuries. To calculate the approximate value of a scheduled injury, 60% of the employee's average weekly wage (AWW) is multiplied by the number of weeks on the schedule for the injured body part and then multiplied by a percentage reflecting the loss of use or severity of injury of that body part. For instance, 100% of the loss of the use of a thumb would be complete amputation of the thumb and would be worth 76 weeks of 60% of the injured worker's average weekly wage. The schedule below applies to injuries sustained on or after June 28, 2011:
- Thumb: 76
- Index finger: 43
- 2nd finger: 38
- 3rd finger: 27
- 4th finger: 22
- Hand: 205
- Hand if carpal tunnel: 28.5-57
- Arm: 253
- Arm amputated above elbow: 270
- Arm amputated at shoulder joint: 323
- Toe (great toe/ "big" toe): 38
- Toe (any other toe): 13
- Foot: 167
- Leg: 215
- Leg amputated above knee: 242
- Leg amputated at hip joint: 296
- Eye: loss of vision: 162
- Eye removal (enucleation): 173
- Ear: hearing loss due to accident or trauma: 54
- Ear: hearing loss due to occupational disease: 100
- Ears (2)*: 215
- Kidney, spleen or lung (removal): 10
- Testicle (1): 54
- Testicles (2): 162
- Skull fracture: 6+
- Facial bone fracture: 2+
- Vertebra fracture: 6+
- Spine or transverse process fracture: 3+
Loss of a part of the thumb, finger, or toe up to the first joint from the tip is considered loss of one-half the digit, e.g. 38 weeks for half a thumb. Loss beyond the first joint is considered 100% loss of the digit.
*A loss due to noise exposure may also be compensable, if the employee can show that he or she was exposed to certain noise levels for the durations specified in the law.
Non-Schedule Injuries (person as a whole)
If the condition is not listed on the schedule of injuries, but it imposes certain limitations, the employee may be entitled to a percentage of 500 weeks of benefits based on the loss of the person as a whole. The number of weeks is then multiplied by 60% of the employee's average weekly wage. Typical injuries in this category are neck, back and spinal injuries.
In some cases, a person's injuries may prevent them from ever being able to return to their job. For instance, a truck driver who is involved in an accident that causes permanent paralysis would not be able to go back to work as a truck driver. In a situation such as this it may be advantageous to seek recovery on a wage differential basis. Wage differential claims entitle the injured person to receive two-thirds of the difference between their average weekly wage before the injury and their average weekly wage after the injury. An injured person may recover for the permanent damage according to the statutory schedule or under a wage differential claim; a petitioner cannot recover for both a wage differential and permanency.
For an employee injured on or after September 1, 2011, the employee shall be paid the wage differential amount for five years from the date of the award or until the employee reaches the age of 67, whichever is later. For example, if a 65 year old worker is injured and is awarded a wage differential on December 19, 2012, he is entitled to receive the wage differential payments until December 19, 2017. If a 25 year old employee is injured and is awarded a wage differential, he is entitled to receive the wage differential payments until he turns 67 years old.
An employee who suffers a serious and permanent disfigurement to the head, face, neck, chest above the armpits, arm, hand, or leg below the knee, is entitled to a maximum of 162 weeks of benefits at the PPD rate. The number of weeks is then multiplied times 60% of the employee's AWW.