Understanding Workers’ Compensation in Illinois
Workers’ compensation protects workers who have experienced work-related injuries. It is a no-fault system of benefits paid by employers. Illinois State law requires employers to bear the cost of workers’ compensation insurance. Most employers buy workers’ compensation benefits and the insurance company pays the benefits on the employer’s behalf, while other employers obtain the state’s approval to self-insure. If an employer self-insures, the employer is responsible for its own claims through a self-insurance mechanism. At one point, workers’ comp rates in Illinois were at the fourth most expensive in the country, but they have been declining over the past few years.
Who Is Covered By the Workers’ Compensation Act in Illinois?
Most employees who are hired, injured, or employed in Illinois are covered by the Workers’ Compensation Act. Accidents that arise out of and occur during the course of an employee’s employment are eligible to receive workers’ compensation benefits. Costs included in workers’ comp benefits are:
- reasonable medical care required to relieve the employee of his or her injury,
- temporary total or partial disability benefits while the employee is off of work and recovering from the injury,
- vocational rehabilitation for employees who are participating in an approved vocational rehabilitation program,
- permanent partial benefits for an employee who can work but has sustained some permanent disfigurement,
- permanent total disability benefits for an employee who is permanently unable to work, and
- death benefits for family member who survive the employee.
One of the most contentious issues in a workers’ compensation case is causation. In 2011, Steven Dunteman, a truck driver, sought benefits for an injury to his foot. Dunteman developed a blister on bottom of his left foot after having to repeatedly push the clutch down forcefully in his truck. However, after he lanced the blister using a sterilized needle, he developed an infection in his foot which required several foot surgeries and partial amputation of one toe. The Illinois’ Workers’ Compensation Commission said Dunteman shouldn’t get workers’ compensation because he caused his infection. However, the Fourth District Appellate Court of Illinois stated that even if the lancing of blister was the immediate cause of infection, the infection would not have occurred “but for” the existence of the work-related blister. Therefore, his employment remains a cause of his current condition of ill-being.
What Types of Disability Benefits Are Available?
There are two different types of disability benefits for employees: temporary and permanent. Temporary disability benefits are paid at 66% of an employee’s average wage, up to the state maximums, while permanent disability is paid either 66% of the difference in wages from before and after the injury, or by looking at a schedule of injuries, which lists a number of weeks of payments the employee is entitled to.
How Do I File A Workers’ Compensation Claim in Illinois?
To file a claim with the commission, the employee must file three copies of the Application for Adjustment of Claim, along with Proof of Service stating that copy of the application was served upon the employer.
After the employee submits the required documents, the commission assigns a case number and an arbitrator to the case. An employee should hire an attorney when he or she files a claim. If an employee does not hire an attorney, then the employee has to keep track of the claim, appear at hearings when it is necessary, and present evidence at the hearings to prove that he or she is eligible under the law for workers’ compensation benefits.
The arbitrator has to remain neutral and cannot help the employer or the employee, so if the employee chooses not to hire an attorney, but the employer hires an attorney, the employee might not receive the benefits he or she is entitled to under law, and the arbitrator cannot help the employee in any way.
How Did the 2011 Reforms Change Workers’ Compensation in Illinois?
To help reduce the amount that employers have to pay for workers’ compensation, Illinois state legislators have been passing reforms to try to control the costs of workers’ compensation for the past couple of decades. The 2011 Workers’ Compensation reform bill
- reduced the medical fee schedule by 30%,
- established a Preferred Provider Program with an employee opt out provision,
- capped wage differential awards at five years or age sixty seven,
- enhanced the Utilization Review provisions; and
- imposed a number of report obligations on insurers. .
The reform has begun to show results with payments falling below neighboring midwestern states. After the 2011 reform, medical payments fell nearly 15 percent, to an average of $14,513 per claim which is lower than Indiana’s ($18,863), Wisconsin’s ($17,787), and Iowa’s ($16,051).
What Future Reforms Could Affect Workers’ Compensation in Illinois?
While the 2011 reforms in workers’ compensation have brought down fees that doctors and hospitals can charge for treating workers, there is still room for improvement. Employers have not seen any relief from the high costs of workers’ compensation insurance. The 2011 reform was supposed to reduce insurance rates for employers, but most business owners have not seen any changes since the passing of the law, while insurance companies are profiting. The Illinois Trial Lawyer Association believes that legislators need to take a closer look at the insurance industry and its lack of regulations to rewrite the laws.