Synopsis: Back to the Basics–Overview and Definition of Workers’ Comp Benefits.

Editor’s comment: Every now and then, I consider it a strong idea to go back to the basics. Workers’ comp benefits arise when a given worker suffers an accident or disease that “arises out of” and occurs “in the course of” employ. This is shortened to AOO/ICO in WC parlance. In short, not everything that happens at work is covered but lots of stuff is.

 

Once suffering a work-related disease or illness, workers’ comp across the world provides three main benefits for injured workers: medical care, temporary total disability and permanency. This is a quick outline of Illinois WC benefits:

 

Medical benefits: Injured workers are entitled to full medical coverage of all reasonable, necessary and related medical care arising from their injury. Illinois enacted a medical fee schedule, effective February 1, 2006, for all related and necessary medical treatment. The fee schedule is changed every year to follow inflation.

 

Temporary total disability: Illinois allows for 66-2/3% of an employee’s average weekly wage during all periods they are temporarily totally disabled from all work.

 

Temporary partial disability: If an employee returns to any work following injury—part-time or full-time light duty work at a lower rate of pay on a temporary basis—Illinois law requires an employer make up the difference as TPD, or continue to pay temporary total disability until the employee returns to full duty.

 

Permanent disability in the IL WC system is awarded in six ways:

 

  1. Serious and permanent disfigurement: Typically, burns or scarring outside the ‘strike zone’.

 

  1. Specific loss: Some relative legal definition of percentage of loss of a specified body part or ‘member’—Illinois relies in part on AMA ratings in determining specific permanent loss.

 

  1. Nonspecific loss (typically referred to as ‘body as a whole’): Some relative legal definition of percentage of loss of the whole body—again Illinois relies on AMA ratings as one of five factors in determining permanent loss/impairment/disability.

 

  1. Wage differential benefits: Two-thirds of the difference between what the employee would have been making in his old job at present wage levels versus the average of what the employee is able to earn within the medical restrictions. For accidents after Sept 2011, this benefit is capped at age 67 or at 5 years of benefits if the injured worker is over age 62 at the time of award. For my readers, please note the new and growing IL minimum wage is going to take some of the sting out of wage loss claims because anyone with a job is going to be making more and more money, as the minimum wage grows.

 

  1. Amputation benefits—IL WC has high minimum and maximum amputation rates. These benefits can be dramatically high. Please also note the amputation benefits are due in full as soon as you are aware of the presence and extent of an amputation—I am happy to help on this one, just send me an email.

 

  1. Total and permanent disability: Two-thirds of the average weekly wage for life. Please note Illinois has a very high minimum and maximum rate for total and permanent disability, and unlike other states there is no cap on the number of years.

 

  1. Death: Two-thirds of the average weekly wage is payable to the surviving spouse and dependents for twenty-five years. Please note Illinois has a very high minimum and maximum rate for death benefits. Again, there are lots and lots of nuances—if you have questions and concerns about a death in your workplace, send me an email for the inside scoop. Please also note if a worker dies in your workplace, everyone who “experienced” the person’s passing may have PTSD claims that should be quietly addressed with counseling and care, if at all possible.

 

Other matters which may be characterized as WC benefits which any adjuster should be fully aware of:

 

Vocational rehabilitation is a benefit that may be claimed and/or awarded in specific circumstances. In rare instances, the Commission may order complete re-education or retraining of an individual at the employer’s expense due to an injury-related limitation and job change.

 

‘Maintenance’ was a term with a tortuous history in Illinois. In 2006, it was codified to equate with TTD when someone is in vocational counseling.

 

Mileage to treating doctors is also a question mark in Illinois—there is no requirement that Illinois employers/WC insurers pay a specific amount of mileage for an injured worker to go to medical providers in our Rules or Act. 

 

For Respondent to schedule an Independent Medical Examination or Section 12 Exam and have the employee legally required to attend, the employee is entitled to mileage, meals, and time lost from work in advance of the appointment. Effective July 20, 2005, the mileage amount based on the current IRS mileage rate is required to be sent to the employee with notice of the IME.

 

An Illinois employee can seek civil damages for retaliatory discharge and termination or failure to recall as a result of seeking workers’ compensation benefits. This would arise from a separate common law action and would not be heard by the IL WC Commission.

 

Penalties in Illinois are 50% of the amounts payable for temporary total disability or permanent partial disability which are not paid for frivolous reasons or withheld solely for delay. Penalties can be awarded for not paying penalties resulting in an additional 50% of the 50% already awarded. Although we are not aware of it happening, this could occur on an indefinite basis!

 

There is an additional penalty of $30 dollars a day with a cap of $10,00.00 which can be awarded for not paying temporary total disability for frivolous reasons or solely for delay.

 

There is an additional penalty of $30 dollars a day with a cap of $10,000.00 which can be awarded for not paying medical bills that are submitted with appropriate documentation after thirty days has passed.

 

Attorneys’ fees in Illinois, typically 20% of the disputed benefits can be ordered payable by the Respondent at the discretion of the Commission when benefits are withheld frivolously or solely for delay.

 

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Synopsis: Another New IL WC “Reform” Bill is Proposed. We are watching like hawks!!

 

Editor’s comment: Please note Illinois is a one-party state with no hope for Republicans to take any effective action to protect the interests of IL business—they are dramatically outnumbered in Springfield. This appears to be another reform bill that isn’t being put through the “agreed-bill” process where all sides make comment, negotiate and seek a consensus. Obviously, the Democrats are laughing at their counterparts across the aisle and doing whatever they want.

 

IL HB269, as amended is being called the Work Comp-No Insurance Process.

 

Last Action: Referred to Assignments (April 12, 2019)

 

Primary Sponsor: Representative Jay Hoffman (D-Belleville)/Senator Linda Holmes (D-Aurora)

 

Summary: Allows a Commissioner, rather than the Entire IL WC Commission, to issue an emergency work-stop order prior to a hearing.

The bill requires the Commission to issue a notice of emergency work-stop hearing when and emergency work-stop order has been issued.

 

IL Employers with 2 or more violations are prohibited from self-insuring for a period of one year.

 

Monies in the IL Self-Insurers Security Fund and in the Illinois Workers’ Compensation Commission Operations Fund may be expended for salaries and benefits of the Self-Insurers Advisory Board employees and the operating costs of the Board.

 

We learned about this legislation via the IL State Chamber of Commerce. I always recommend my clients join and support the State Chamber that is the number one watchdog for the interests of Illinois business.

 

 

Synopsis: Update on IL SB 1596.

 

Editor’s comment: I received an excellent article indicating the changes proposed in IL SB 1596 may not be effective until year 2044 due to a constitutional issue of longstanding nature.

 

If you are concerned about the business-busting aspects of this new proposed but misguided legislation and want to review that article, I am happy to send it. Please simply send a reply.