Worker’s Compensation Benefit System

What You Should Know About “Workers’ Compensation”

Law Offices of David L. Salgado, P.C

I. General Illinois Worker’s Compensation Information

Workers’ compensation is a no-fault benefits system provided for most workers with job-related injuries. The Occupational Diseases Act provides virtually the same benefits as workers’ compensation for job-related diseases.

All employers in the State of Illinois must carry workers’ compensation insurance or be approved for self-insurance by the State. Independent contractors are not covered by workers’ compensation, but their employees are. Every sole proprietor and every partner of a business may elect to be covered by the worker’s compensation laws.

Employers pay for the benefits either directly or through insurance coverage. Workers’ compensation costs cannot be charged to an employee.

The Illinois Worker’s Compensation Commission administers the law and resolves disputes, providing information and assistance to employees and employers.

It is against the law for any employer to harass, discharge, refuse to rehire, or in any way discriminate against employees who exercise their rights as provided under the Workers’ Compensation or Occupational Diseases Acts.

II. Circumstance of Injuries and Diseases Covered

Yes. Because worker’s compensation is a no-fault benefits system, you would be eligible whether or not you were responsible for the accident.

No. Again, because workers’ compensation does not consider questions of blame, you would be entitled only to workers’ compensation benefits provided in the law. However, you may be entitled to use independent parties who may be responsible for your injuries (manufacturer of a defective machine, driver of another vehicle, etc.).

Generally, injuries to all parts of the body (broken arm/hand/leg, etc.) or injuries caused by the repetitive use of a body part.

You will be entitled to benefits so long as you can show that your condition was aggravated by the work activity.

If your supervisor has directed you to complete this task, and your injury arises out of and in the course of your employment, your injuries are compensable.

Such social or athletic events are not a part of your job duties; therefore, they are generally not compensable. However, if your employer required your attendance, you may be covered.

If you can prove that your heart condition (even a previously diagnosed condition) was aggravated by your worker or that your job was a contributing factor to your heart attack, you would be entitled to compensation.

You may be able to claim compensation if you can prove exposure to industrial noise sufficient to cause your hearing loss. These levels are established by law.

Law Offices of David L. Salgado, P.C
Law Offices of David L. Salgado, P.C

III. Filing Procedures and Administration

Generally, notice can be given both orally or in writing. It is strongly recommended that you give written notice showing:

  1. The date and time of the accident,
  2. a brief description of the accident, injury, or disease, and
  3. the employee’s name, address, and telephone number.

You must notify your supervisor (a member of management, not a fellow worker) as soon as possible. Late notification can delay benefits payments; a delay of more than 45 days can result in loss of benefits. Injuries from radiological exposure must be reported to the employer within 90 days after you know of or suspect excessive radiation dosage. Notify the employer of occupational diseases or injuries resulting from repetitive trauma as soon as possible after you become aware of the condition

Generally, three years from the injury, death, or disablement in the case of an occupational disease, or within two years from the last payment of TTD or a medical bill, whichever is later.

Some cases have different time limitations, so it is always important to consult with an attorney if you have any questions about this.

The case will be assigned to an arbitrator in a specific county and will be set on an automatic 3-month cycle. The rotation will continue for three years until the case is either settled, tried, or dismissed. Complicated cases involving significant medical workup can extend the life of a case beyond three years.

Disputed cases often involve long delays, which can potentially surpass one year from the date of a trial. When a case is on appeal, the claimant’s benefits can be interrupted pending a final determination by the court.

Unlike other areas of law where attorneys charge 33% or more, attorneys are limited to 20% of the compensation recovered in worker’s compensation cases.

IV. Medical Benefits

The claimant is entitled to receive first aid, emergency care, doctor visits, including all medical care that is reasonably necessary to cure or relieve medical symptoms.

YES/NO: Effective 6/28/11, the Worker’s Compensation Act limits a worker’s choice of doctor. Under the old law, a work had two choices of doctors to choose from. Under the new law, the employee’s choices are greatly restricted. If the employer is part of a preferred provider program (PPP) network, the worker can choose to treat there. If the employee declines the employer’s PPP network, it counts as one of the two choices for medical doctors. If the employer does not have a PPP network, the employee may choose his own doctor, but it is important that all such selections be cleared by the insurance company to avoid becoming personally liable for medical bills.

First aid or emergency room care is generally not considered a selection against the employee’s choices.

Law Offices of David L. Salgado, P.C
Law Offices of David L. Salgado, P.C

V. Disability Benefits

TTD BENEFITS: During the time that a worker is either temporarily totally disabled (TTD) or on medical restrictions where the employer is unable to accommodate him or her with a light-duty job, the worker is entitled to TTD benefits calculated at two-thirds of the employee’s average weekly wage (AWW). TTD rates are subject to minimum and maximum limits. TTD benefits should commence within 14 days after the employee has given notice of the accident.

TPD BENEFITS: Temporary partial disability (TPD) is paid to a claimant who is working but still under medical restrictions and earning less than his pre-injury wages. The TPD payment is calculated at a two-thirds difference between what the worker is able to work in a full-time job and the gross amount of his present light-duty wages.

PPD BENEFITS: At the end of a case, the worker may be entitled to permanent partial disability (PPD), which reflects the complete or partial loss of a body part.

For injuries after September 1, 2011, disability will be assessed, taking into consideration American Medical Association impairment ratings, medical reports, coupled with other factors such as the person’s age, occupation, and future earning capacity.

PPD benefits are subject to minimum and maximum rates.

PTD BENEFITS: In cases where the worker is found to be permanently and totally disabled, the employee will receive lifetime benefits equaling 66 2/3rds% of his or her Average Weekly Wage, subject to cost-of-living adjustments.