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WORKER’S COMPENSATION

Persons suffering injuries "arising out of and in the course of" employment have rights under the Worker's Compensation Act, regardless of who is at fault.  An accident arises out of the employment if the employee was exposed to a risk inherent in, incidental to, or related to the job.  Whether an injury occurs in the course of employment depends on the time, place and circumstances of the injury.  Thus, determination of whether an injury arises out of and in the course of employment depends on the facts of each case.  For instance an injury occurring before work, but caused by tripping on a crack in the employer's sidewalk, may be compensable.  However, a twisted ankle occurring within the employer's plant, while on the clock, may not be compensable if the only cause was the employee's clumsiness, as opposed to getting hit by a forklift, tripping over a box, or rushing to fill an order.  If you are injured on the job, or before or after, call an attorney to see if you have a case. 

Workers receive a number of benefits.  The major ones are listed below: 

1. Payment of all reasonable and necessary medical bills.  An important right of the worker is that he can choose his own treating doctor.  The worker can also see any doctor within a chain of referrals from that first choice of doctor.  Finally the worker can make a second choice of doctors and see any doctors within a chain of referrals from that second choice of doctors.  Again tricky questions can arise as to doctors from company clinics (generally not considered to be the worker’s choice), doctors in emergency rooms, and doctors seen after another doctor says that the worker needs no further treatment.  These questions are very important because if an insurance company does not agree that a doctor falls within the worker’s proper choices or referrals then the insurance company will refuse to pay for that doctor’s treatment or anywhere that that doctor sends the worker for further care.  There is no substitute for good legal advice on these issues.
2. Payment for lost time.  This is known as Temporary Total Disability (TTD). Payment is determined by taking 2/3 of average weekly wage (AWW) (AWW is calculated by taking the wages for the prior 52 weeks, including regular overtime and divided by the number of weeks or partial weeks that you worked)(overtime hours are sometimes included, but at a straight-time rate).   Frequently, insurance companies undercalculate your AWW by excluding overtime, commissions and shift differentials and by including weeks that you did not work. 

Payment is made only if off more than 3 days.  However, if the worker is off more than 14 days then they will be paid for those first 3 days also. 

To be paid one must be off work because a) a doctor says the worker is to be off work or, b) a doctor prescribes light duty, and the employer has no light duty available.

3. Payment of a lump sum for Permanent Partial Disability (PPD).  This is compensation for permanent injury.  Most companies will not make payment for this without an attorney getting involved.  The amount of compensation depends on 3 factors:

a. What part of the body was injured.  The Worker’s Compensation Act allows for greater compensation for injuries to certain body parts.  Generally, the order is as follows:

  • neck or back injuries
  • arm
  • leg
  • hand
  • foot
  • thumb
  • fingers
  • toes

Joint injuries affect the usage of the adjacent body part lower down on the appendage, and thus are usually deemed to be injuries to that lower appendage. (for example, an injury to the wrist usually affects usage of the hand, and therefore is usually deemed to be an injury to the hand. An injury to the shoulder is an injury to the arm.)

b.  The severity of the permanent injury.  This is determined as a percentage loss of use of the part of the body that was injured.

c.  Your rate of pay.

4. Vocational Rehabilitation.  One usually has a right to this if unable to return to one’s old job, and if the employer does not offer a new job.  Vocational rehabilitation normally consists of counseling and help with a job search.
5. Wage Differential.  If an employee is unable to return to his old job, the employer offers no new job at the same rate of pay, and the employee does a complete job search, and obtains alternative employment paying less than his old job, he has a right to choose between payment based on a percentage disability (see above) or based on a wage differential, whichever is higher.  These benefits are very difficult to obtain due to the ability of the insurance companies to question your medical restrictions, the permanency of those restrictions, and the adequacy of a job search.

In Illinois all workers’ compensation claims are administered by the Illinois Industrial Commission.  An application must be filed.  Arbitrations are held in front of an arbitrator.  Arbitrations are the same as a trial, but with no jury.  After trial each side prepares proposed findings.  The Arbitrator makes a decision, but either side may request a review in front of a panel of Commissioners from the Industrial Commission.  Thereafter, either side may appeal to the Circuit Court, the Appellate Court, and finally to the Illinois Supreme Court.

Frequent work injuries include:

  • Back/Neck-herniated, extruding, and bulging discs, compression fractures, radiculopathy, nerve root injuries.

  • Wrist: carpal tunnel, cubital tunnel, dislocation, fractures, tendonitis

  • Elbow: epicondylitis, tennis elbow

  • Shoulder: rotator cuff injuries, biceps tendon injuries, impingement syndrome

  • Knee: cartilage/meniscus tears, anterior and posterior cruciate ligament tears, chondromalacia, fractured knee cap/patella

  • Ankle: Bimalleolar and trimalleolar fractures, dislocations

  • Foot: fractures

  • Hand: fractures, crushing injuries, lacerations

 

For more information see FAQs for Worker’s Compensation.

 

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