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Jonathan Rosenfeld

March 2, 2023

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illinois workers compensation medical benefits

When an employee is hurt or becomes ill from an accident or exposure at their job in Illinois, they are generally entitled to receive paid medical treatment under the Workers Compensation Act.

All injured workers must understand their rights to these medical benefits and learn how to ensure that they get coverage for all their medical bills relating to the work injury, especially injuries that may require long-term medical care.

Are you a worker with questions about your health care benefits and the Illinois Workers Compensation Law?

Contact the Chicago, IL personal injury attorneys at Rosenfeld Injury Lawyers LLC for a free consultation. Our law office can answer your questions regarding your legal rights.

Our attorneys regularly prosecute workers compensation cases when health benefits have been denied or delayed. Contact our office for a free case review.

Medical Treatments & Workers Compensation Benefits in Illinois

According to the Illinois Workers Compensation Act, injured employees are entitled to receive “medical care that is reasonably required to cure or relieve the employee of the effects of the injury.”

Although vague, this covers most health care costs such as:

  • First aid
  • Transport (ambulance/helicopter)
  • Emergency room and hospital bills
  • Physician visits
  • Prescriptions and treatments
  • Medical devices
  • Institutional care

Employees are allowed to choose their doctor, hospital, and treatments, which the employer must pay.

However, all healthcare facilities treating worker injuries under the Workers Compensation Act are required to give full reports when requested by writing from the employee, employer, or the Illinois Workers Compensation Commission.

Calculating an Average Weekly Wage

If you were injured on the job, your employer is likely required to pay your wages through an Illinois Workers Compensation system. The business must maintain an insurance policy with coverage for every employee.

The benefits include payment for medical bills, hospitalization expenses, and time away from work until the injured worker returns to their job. The insurance coverage does not cover non-tangible damages, including mental anguish, pain, and suffering.

The amount of benefits the employee receives is based on their “average weekly wage.” The compensation is based on the salary or wage earnings the worker generally produces every week.

In Illinois, the state law mandates how benefit plans work to ensure that the injured employee receives up to two thirds (66%) of their average weekly wage. The earnings are not taxable like all injury-based compensation payments.

Workers Calculating Average Wages

To begin the calculation, the worker must determine if they were employed full-time, part-time, or as a seasonal/intermittent employee before the injury occurred. The yearly salary or wages should be divided by the number of days the employee worked, excluding weekends, holidays, and vacation time.

Next, multiply the daily wage by the average of a full-time or part-time employee and divide that number by fifty-two to determine the average weekly wage.

Insurance Companies Calculating Differently

The insurance company may inadvertently calculate the injured worker’s average weekly wages to save money or increase profits. The insurer may determine that the full-time employee worked 240 days the previous year when they could have actually worked 260, increasing their annual earnings.

This simple miscalculation on a $60,000 a year job could cost the injured employee more than $250 a month in lost wages, which might be significant if paying extensive rehab and medical bills.

As shown above, calculating the average weekly wage can be challenging to meet workers comp insurance requirements. Without an accurate assessment of the employee’s earnings, any miscalculation could cost the injured worker thousands of dollars every year.

Our law firm recommends using attorneys who specialize in the Illinois Workers Compensation system to ensure you receive maximum benefits for your injuries.

Workers Compensation Claims, Including Permanent Disability and Temporary Disability Benefits

A typical Workers Compensation claim may involve payment for hospital and medical expenses necessary to identify, diagnose, treat, and rehab work-related illnesses and injuries. These partial or total disability benefits include money to pay for surgeries, medications, and doctor’s visits.

However, some workplace injuries can be catastrophic, leaving the victim with a temporary partial disability, temporary total disability, permanent partial disability, or permanent total disability.

According to the Illinois Workers Compensation Commission, employees can receive disability benefits if they have not yet completely recovered from their on-the-job illness or injury.

Typically, temporary partial and temporary total disability benefits are available until the employee’s condition is stabilized. Typically, a person with a temporary total disability will receive maximum compensation (up to two-thirds of wages or salary) or a percentage of their wages if they have a temporary partial disability.

These workers comp temporary disability benefits last until the workers can return to work. In some cases, the employer may ask injured workers to return to work taking on a light-duty job until they can continue in their previous position or undergo vocational rehabilitation.

However, injured workers are not required to accept light-duty work, especially if they continually undergo necessary medical treatment.

Likewise, permanent partial and permanent total disability benefits are available to workers because their condition cannot be stabilized. The doctors usually determine when their employees’ condition is “permanent and stationary,” meaning their condition will never get better than its current condition.

Usually, the patient’s doctor will write a report based on a permanent disability rating, corresponding to how much they should receive weekly, bi-weekly, monthly, or yearly compensation through their Workers Comp claim.

Typically, the insurance companies continue to cover the injured employee’s reasonable health care over the coverage life, which could last until death or their sixty-seventh year, when they would traditionally retire.

What to do if You are Injured at Work in Illinois?

Were you injured or became ill due to your work environment? First and foremost, you need to seek needed treatment as soon as possible and notify your employer that you have been injured, either orally or in writing.

According to the Illinois Workers Compensation Act, an employee should notify their employer as soon as practicable, but within 45 days of the work-related injury. For illnesses or occupational diseases, an employee should again notify their employer as soon as practicable.

For radiation exposure, a worker should notify their employer within 90 days of knowing that they have or may have been exposed to an excessive amount of radiation.

You will need to file an Illinois Workers Compensation Claim, allowing you to receive payments for medical treatments and other benefits for up to three years after the injury or illness or two years after the last payment of benefits, whichever is longer.

You may also file for an Application for Adjustment of Claim with the Commission to protect your legal rights to health care benefits for your accident injury.

Additional health care diagnosis will be required for permanent partial disability benefits and permanent total disability benefits through the workers compensation benefits program.

Death, Funeral, and Burial Benefits

The workers compensation program provides surviving family members with death benefits when employees die from an on-the-job accident, illness, injury. Typically, the death benefit is available to:

  • Minor children
  • The decedent’s spouse
  • Dependent grandchildren
  • Children under twenty-five years old currently enrolled in an accredited university or college
  • Non-dependent parents
  • Other dependent family members

Every adult family member will be required to provide documents to show their rights as a legal beneficiary. Typically, all wrongful death claims are paid retroactively starting the day after the worker died.

Our attorneys recommend hiring an attorney working on your behalf to handle your Workers Compensation case. Your lawyer can provide legal advice on filing your wrongful death accident claim before the statute of limitations expires.

Having an attorney on your side might ensure that your current medical bills and treatments are covered for your work injury, and that future health care expenses will be considered.

You will want to ensure that these medical bills will be paid if there is a long-term medical treatment needed. In the case of a settlement for a work injury, future health care bills are often no longer covered as part of the settlement.

It is crucial to have an experienced Illinois Workers Compensation attorney on your side to protect your financial interests. Contact our Chicago, IL law office today at (888) 424-5757 (toll-free phone call) or through the contact form to schedule a free consultation.

All discussions concerning your workers compensation benefits with our law office remain confidential through an attorney-client relationship.

Our legal team currently follows Centers for Medicare and Medicaid Services (CMS) Covid-19 social distancing guidelines to ensure everyone’s safety.

Client Reviews

Jonathan Rosenfeld was professionally objective, timely, and knowledgeable. Also, his advice was extremely effective regarding my case. In addition, Jonathan was understanding and patient pertaining to any of my questions or concerns. I was very happy with the end result and I highly recommend Jonathan Rosenfeld.

- Michonne Proulx

Extremely impressed with this law firm. They took control of a bad motorcycle crash that left my uncle seriously injured. Without any guarantee of a financial recovery, they went out and hired accident investigators and engineers to help prove how the accident happened. I am grateful that they worked on a contingency fee basis as there was no way we could have paid for these services on our own.

- Ethan Armstrong

Jonathan helped my family heal and get compensation after our child was suffered a life threatening injury at daycare. He was sympathetic and in constant contact with us letting us know all he knew every step of the way. We were so blessed to find Jonathan!

- Giulia

This lawyer really helped me get compensation for my motorcycle accident case. I know there is no way that I could have gotten anywhere near the amount that Mr. Rosenfeld was able to get to settle my case. Thank you.

- Daniel Kaim

Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial.

- Lisa
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