Medical Care in Illinois Workers’ Compensation Claims

Workers' compensation is a system of benefits provided by law to most workers who have job-related injuries or diseases. Workers’ compensation benefits are paid regardless of fault.

In Illinois, an employee may recover medical expenses they have had to cover as a result of a workplace injury, as well as any future medical expenses the injured employee reasonably expects to incur.

The employer is required to pay for all medical care that is reasonably necessary to cure or relieve the employee from the effects of the injury. This includes, but is not limited to: first aid, emergency care, doctor visits, hospital care, surgery, physical therapy, chiropractic treatment, pharmaceuticals, prosthetic devices, gym memberships and prescribed medical appliances. We have seen cases where paralyzed injured workers have received medically prescribed vans or construction on their house. If the work injuries result in a disability that requires physical modifications to the employee’s home, such as a wheelchair ramp, the employer may have to pay those costs, as well. Additionally, the employee is not required to pay any co-pays or deductibles and there is no cap on the total benefits that can be paid in the lifetime of an injury.

If the employer does not dispute a medical bill, it will pay the medical provider directly. The worker is not required to pay co-payments or deductibles. If the employer disputes a bill, it must promptly give the employee a written explanation for its refusal.

After sustaining a workplace injury, the employee should take the following steps:

1) Seek first aid or medical attention immediately after the injury or the point at which gradual symptoms first begin affecting physical activities at work or at home

2) Cooperate with the doctors and make efforts to achieve a complete recovery and full return to work, if possible. An employee may lose benefits for injurious or unsanitary activities.

3) Tell the medical providers that the treatment is for a work-related condition. This lets the providers know that the employer, not the employee, is responsible for the medical bill.

4) Give the employer the name and address of the doctor or hospital chosen. If the employee changes providers, the employee should again notify the employer.

Additionally, the employee must also give the employer enough medical information for the employer to determine whether to accept or deny the claim. This includes all medical records relevant to the condition for which benefits are sought. A worker, however, is not required to give anyone free access to his or her doctor or medical records.

The employer is not required to provide benefits if it does not receive the medical information necessary to determine the worker’s medical status and fitness to work. If the employee's doctor does not send medical records to the employer, benefits may be delayed. That said, without your permission, the insurance company or their representative can not directly talk to your doctor or try to influence your care. Unfortunately this happens all of the time and is usually one of the first things a good attorney stops when they sign up on a case.

Under Illinois Workers' Compensation law, you have the right to receive medical treatment from a doctor of your own choice. Your employer is required by law to provide reasonable and necessary medical treatment for your work-related injury or medical condition.

Although your employer cannot control who treats you, they can require an evaluation by a doctor of their choosing provided they advance payment of your expenses including travel, meal money and lost wages, and, if necessary, a means of getting to the requested medical exam.

Remember, however, you have the right to choose your first doctor. If you are not satisfied with that choice, you may choose a second doctor. The use of any health care provider in the chain of referrals from your chosen doctor, is not considered a choice. If you wish to choose a third doctor, it requires your employer’s approval or you will have to pay.

Your employer is responsible for 100% of all reasonable and necessary medical, hospital and surgical expenses related to your job injury. There are no caps, time limits, co-pays, deductibles or other limitations. If any bill is disputed and in collections, a collection agency by law is barred from trying to collect from the injured worker until the case is resolved.

Finally, you can not be forced to have surgery, but you do have to cooperate with other reasonable medical care and your failure to do so can result in your benefits being suspended. An example would be blowing off appointments, ignoring lifting restrictions or smoking when your doctor has told you that if you don’t stop it will hurt your recovery.

Medical expenses are the most important part of your benefits and an experienced Illinois workers’ compensation attorney can help protect your rights to the prompt payment of your medical expenses by your employer. Please contact us if you have any questions or would like a referral to a lawyer that will look out for your best interests.