Many employees injured on the job require extensive medical treatment, followed by weeks, months, or years off from work due to a permanent disability. These employees will file for workers’ compensation benefits.
Sometimes, another company, subcontractor, or individual is responsible for causing a work-related accident or unsafe workplace condition, where the victim could file a negligence claim against another party.
Not every submitted workers’ compensation claim requires the help of an attorney from the local law office. However, insurance companies denied many workers’ compensation claims, or employers dispute the instance, robbing the injured employee of the compensation they deserve.
A personal injury attorney answered some critical Illinois workers’ compensation FAQs below.
What Is Workers Compensation?
Nearly every employer must compensate every employee hurt at work or who becomes ill from a work-related exposure. Worker’s Comp benefits ensure the injured victim receives payment for the devastating costs of a work injury.
However, not all losses are covered. The program covers two-thirds of wages and all medical expenses associated with the work injury. However, the benefits program does not cover non-economic damages like pain, suffering, and emotional grief.
Workers Compensation Insurance?
The worker’s compensation benefits program is supplemented with Worker’s Compensation insurance with premiums paid by the worker’s employer.
Every state requires companies to purchase and maintain workers’ compensation insurance besides New Jersey and Texas.
The monthly premium amount is based on the business size, state law, workplace-related risks, and the type of work each employee does.
Where Is My Workers Compensation Check?
Is your check late, or did it arrive with the incorrect amount? If you (or family members) were injured in accidents at work, you are likely entitled to workers’ comp benefits through your employer’s insurance company.
Not receiving the total amount or not getting the check at all is intolerable for an injured employee with bills to pay and mouths to feed. State law dictates the time the insurance company has to send the first workers’ comp check, typically thirty days after benefits begin.
The amount the worker can expect to receive is based on the percentage of their disability as certified by their treating healthcare provider. An employee determined to be 100% disabled, making an average of $300 a week wage, is entitled to receive two-thirds of that amount ($300), receiving a $200 check.
How Does Workers’ Compensation Work?
The Workers’ Compensation insurance benefits program covers the employee’s expenses for a work injury or illness, including medical expenses and lost earnings from time away from work. Worker’s Comp is required by law, where the company owner pays premiums for liability insurance on every employee.
Worker’s Comp insurance protects businesses from an injured worker who might file a civil lawsuit seeking more than just the cost of medical bills and lost earnings.
The Workers Comp system also benefits employees injured by accident or job-related illness.
The process works by:
- Training the employee to report any workplace injuries immediately
- Employees filing a case through their employer’s Workers Comp insurance carrier
- Instructing injured workers to seek immediate medical treatment
- Waiting for the insurance company to approve or deny the worker’s benefits claim
- Giving the employee time to heal from their injury
- Preparing for the employee’s return to work
When the employee is healed and returns to their position, the insurance company must be notified to stop payments. If the employee is permanently injured, the insurance carrier might likely pay their permanent disability benefits.
Workers’ Compensation Investigations and What They Look For?
The Workers’ Compensation agency will hire an investigator whenever there is suspected fraud to ensure that only employees injured on the job get benefits.
There are numerous scenarios that the investigator could identify that are considered fraud. These include:
- An employee faking an illness or injury
- A worker exaggerates the extent of their injury to ensure they receive more money or are away from their job longer.
- A worker claiming a non-work injury occurred while at work
- An employee working at another occupation while collecting Workers’ Compensation benefits
Defrauding the worker’s compensation system is not a common occurrence. Once it is evaluated, an administrator will review the injured worker’s accident record, medical records, the patient’s medical history, and other pertinent data.
How Long Can You Receive Workers’ Compensation Benefits?
The extent of the worker’s injury and the time it takes to heal completely contribute to how long the employee will receive their workers’ comp benefits. Time-affected benefits might include:
Temporary – Any employee injured at work who loses the physical capability to perform their duties could receive Temporary Total Disability (TTD) benefits. These disability payments equal two-thirds of the injured victim’s average weekly wage (AWW). The benefits include compensation for all reasonable injury-related medical treatment and care.
Permanent – Typically, a workers’ compensation doctor will determine the injured worker’s eligibility for receiving permanent disability benefits through the Workers Comp system. Usually, the doctor will indicate that the victim’s condition will never improve from its current status, often called “maximum medical improvement.”
Partial – The workers’ compensation benefits system will calculate the injured worker’s permanent partial disability (PPD) benefits. Typically, these injured employees suffer from a lasting impairment but are not completely disabled and can only return to work in a lower-paying or modified occupation.
Full – Full Workers Comp benefits are available to injured workers who are totally and permanently disabled, their condition will never improve, and they cannot return to any job.
How To File For Workers Compensation?
State workers’ compensation laws regulate how to report a work injury under the Workers’ Compensation benefit program. Typically, the injured victim has thirty days to notify their employer of a work injury or illness.
Consider filing a worker’s compensation benefits case after filing a report with your employer seeking medical attention for your condition. After you fill out the claim form, your employer will contact the insurance company and the Worker’s Compensation agency.
Filing a claim as quickly as possible is beneficial because many states have significantly short deadlines that, if passed, block the injured worker from receiving benefits. Typically, the insurance company providing coverage for the employer will investigate the claim and either approve or deny payment.
You will begin receiving benefits within a few weeks after the claim was approved. However, if the insurance company denies your claim, you will have the right to appeal.
Consider talking to a Worker’s Compensation benefit attorney who can work on your behalf through the appellate process. Your lawyer can assist you in many ways, including gathering pertinent information to build a convincing case and negotiate with the insurance carrier.
Your lawyer can also represent you at every hearing. These attorneys typically offer a free consultation and work on contingency fee agreements, meaning you pay nothing upfront for their legal services.
Do Some Workers Comp Doctors Lie?
Employees injured at work should seek medical attention as soon as possible. At some point, the Worker’s Compensation benefit system will require workers to see company doctors, physicians, or health care providers.
These doctors may believe you are exaggerating the extent of your injuries to ensure you receive benefits covered by workers compensation. Honesty and describing your condition can help ensure your benefits are approved.
The Workers’ Comp system will likely not pay you for any pre-existing condition, like a pre-existing back problem, unless the doctor proves that the condition worsened due to accidents or work-related illness.
The doctor may change their mind if they review your medical history and medical records identifying a previous injury. To ensure you receive the compensation you deserve, you may want to speak with a work comp attorney to protect your case and rights.
An attorney working on your behalf can help answer many of your concerns and questions before undergoing a medical examination by a Workers Comp doctor.
How To Fight A Workers Compensation Claim?
Every employee injured at work has the right to file a workers’ compensation allegation to obtain benefits to pay for medical expenses and lost wages while they heal. However, the insurance company could quickly deny or delay a case while they investigate what happened.
Nearly every state allows employers to contest or dispute a submitted workers’ comp claim if they suspect their worker lied about their illness or injury when the harm occurred outside of their work.
The employer may have eyewitness accounts showing that the employee faked their injuries or was never harmed before filing.
Likewise, employees can contest a denied claim if the insurance carrier investigates what happened and determined the employee was not injured or suffered an illness through work-related exposure.
The injured employee can fight back against the insurance company, saying that the case was fraudulent or that the injuries occurred outside the employee’s scope. An arbitrator might be necessary if the employee disputes.
Can I Sue Workers Comp for Negligence?
Agreeing to a workers’ compensation settlement to receive benefit checks to cover physical injuries and lost wages forfeits your right to sue employers, with exceptions.
You also cannot seek punitive damages, as you would if you have filed a work-related injury lawsuit instead of submitting a workers’ compensation benefits claim.
However, you might have the legal right to bring a civil action against your employer if you do not file a workers’ compensation request or if your employer intentionally or negligently caused your injuries.
You may have evidence showing that your employer’s negligent or intentional act caused your work-related injury, and you have not yet agreed to a negotiated settlement, allowing you to bring an employer negligence lawsuit instead.
You could have grounds for a civil lawsuit if your employer does not provide workers’ compensation insurance coverage or fails to pay the insurance premiums. However, you must prove the case in court to resolve your lawsuit successfully.
Who Regulates Workers’ Compensation?
Every state regulates its worker’s compensation system to provide wage replacement payments, medical care, and vocational rehab for employees injured at work or suffering work-related illnesses.
At the federal level, the US Department of Labor  operates disability compensation programs through the Office of Workers’ Compensation Programs (OWCP).
What is a Third-Party Workplace Injury Lawsuit?
Many workers injured on the job have another option to recover financial damages over the benefit payments they receive through the workers’ compensation system. Your personal injury attorney might identify another party responsible for causing your injuries or work-related illness.
Potential defendants in a third-party workplace injury lawsuit might include an equipment manufacturing company that sold the defective devices, a maintenance company that created a hazardous area work, or a construction company/architect that used asbestos products as flame retardant when constructing the building decades ago.
The compensation awarded to the victim is payable in addition to the Worker’s Comp payments they receive weekly or monthly. The claim’s value depends on the extent of the worker’s injuries and the level of the defendant’s negligence.
Is It Worth Getting a Workers’ Compensation Attorney?
Employees injured in the workplace have a right to pursue a workers’ compensation case to ensure they receive benefits that replace their weekly wages and pay for their medical expenses.
However, receiving those benefits can be complicated, especially if you lack experience navigating civil tort law and the legal system.
A personal injury attorney specializing in Worker’s Comp benefits claims has the knowledge, skills, and experience to ensure you receive the maximum compensation you deserve.
Common reasons why injured workers will hire a personal injury attorney to handle their claim include:
- The employer denied the claim and will not pay the employee
- The employer’s insurance company settlement offer fails to cover the injured employee’s medical bills and lost wages
- Your injuries are so severe that you cannot return to your previous job. You are limited in what you can or cannot perform any work.
- You are planning to receive Social Security disability, the employee’s medical bills, and lost wages.
- The employer retaliated against you because you submitted a workers’ compensation claim.
- The serious misconduct of your employer and the negligent actions of another party led to your harm.
Your personal injury attorney will discuss the options and answer clients’ questions (FAQs), often through a free consultation, and make sure all the necessary forms are filed before the statute of limitations expires and bring the negotiation skills to resolve a case successfully.
Your law firm and lawyer will also build a compelling case to take the trial if you and the defendant cannot reach an acceptable settlement agreement. Once you’ve finished reading this article, reach out today.
Have More Illinois Workers’ Compensation FAQs? Talk to a Lawyer Today
As an injured worker, we appreciate that you may have additional questions about your legal rights and options. We always invite you to contact our office for a free consultation with an experienced workers comp lawyer who can advise you of your options.
Resources:  US Department of Labor