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Your Medical Rights Under The Illinois Workers' Compensation Act The Illinois Workers' Compensation Act is a state law which has been passed by the Illinois State legislature for the purpose of defining the rights of injured employees in the State of Illinois. Among the rights which are defined by this act are the rights of injured employees to medical care for the treatment of their injuries. The purpose of this short document is to help the injured employee understand what benefits he is entitled to receive and the scope of medical inquiry an employer is entitled to make regarding the employee's injury.
An injured employee has an absolute right to be treated by the doctor of his choice. The injured employee does not ever have to be treated by the doctor of the employer's choice. The only time that the injured employee has any obligation to be seen by the doctor of the employer's choice is if the employee is receiving temporary total disability benefits (checks for 2/3 of the employee's average weekly wage) and then the employee must only submit to an examination. He is not obligated to speak to this doctor. An injured employee has the right to have a second opinion by the doctor of his choice. This does not mean that an injured employee is limited to treatment by two doctors because if there is a chain referral between doctors this chain only counts as one doctor. As an example, if the injured employee initially sees his family doctor of his injury and that family doctor refers him to orthopedic surgeon for the treatment of back pain and the orthopedic surgeon refers him to a neurologist for an EMG and a radiologist for an MRI and the physical therapist for therapy, this is still only one doctor. As long as the chain of referral exists, payment for the treatment is the responsibility of the employer or its insurance company.
Who May Treat The Injured Employee The injured employee is not required to submit to any type of treatment by the employer's doctor including but not limited to additional X-rays, EMG'S, Mylegrams, MRI's, CT scans, Physical Therapy, Functional Capacity Test, or work-hardening programs. Only the doctor of the injured employee's choice has the right to order these tests for the injured employee. The only time that the employer's doctor can se the injured employee is for the purpose of examination while the injured employee is receiving benefits and prior to a hearing for the purpose of determining the extent of disability.
Medical Management of Your Claim Over the last several years, insurance companies have created something which they refer to as medical management. The stated purpose of medical management is to assist the injured employee in receiving the best possible medical care and to assist him in a rapid return to work. Unfortunately, the stated purpose and the reality of how medical management is used are completely different. Individuals engaged in medical management are almost always employees of either an insurance company or a company hired by an insurance company. The principal goals of this individual is cost containment and cost containment means spending as little money as possible on the injured employee. This is accomplished by getting second opinions on surgeries prescribed by treating doctors, suggesting that injured employees see other doctors who will want them to go back to work prematurely, and sending the injured worker to work-hardening an functional capacity tests prematurely. The term “medical management” does not exist within the Illinois Workers' Compensation Act. An injured employee is not required to submit himself to medical management in order to receive benefits under this law and doing so presents the hazard of having the injured employee subjected to continued second opinions of his treating doctor's medical care and to the testimony of this person at a future hearing regarding the injured worker's benefits. The Illinois Worker's Compensation Act requires that an injured employee cooperate with vocational rehabilitation, not medical management.
If the injured employee incurs expenses traveling to and from his doctor's office or to and from physical therapy or other hospital services, he is entitled to reimbursement for these expenses. In order to collect for these expenses records should be made and receipts should be kept so that if the insurance company resists payment these documents can be used at a hearing to prove these expenses .
What To Do If The Insurance Company Disputes Payment Of The Injured Employee's Medical Care It is not uncommon for an insurance company to dispute a claim for the liability of an injured employee's medical treatment. The easiest way to secure payment of these medical bills is to have them paid initially by group medical insurance. This is a perfectly acceptable method of getting prompt treatment and will not affect the eventual liability of the bills as long as the injured employee states on the group disability form that the bills are disputed. This statement is generally made on that portion of the group medical form which asks if the injury occurred at work. The injured employee should state that it is disputed and should also agree to reimburse the group medical provider in the event that collection is made through the worker's compensation insurance company. This document has been prepared by: Kim Edward Presbrey If you have any further questions regarding the subject matter of this document, please feel free to call or make an appointment and they will be answered free of charge.
A Guide For Union Stewards and Injured Employees Regarding Legal Rights and Duties in Illinois
Illinois Workers' Compensation Act An employee who is injured in an accident arising out of and in the course of his employment is entitled to receive benefits under the Workers' Compensation Act. These benefits include all necessary medical and hospital services, temporary total compensation benefits if the employee's injury results in three or more days of lost time, and additional compensation if a permanent disability results. An employee who suffers an accidental injury should keep a record of the following information to protect future rights and prevent any future misunderstandings with this employee regarding the circumstances surrounding the accident.
It is often helpful for the injured employee to maintain a “diary” of the events surrounding the accidental injury and its treatment by making notes on a calendar. Union stewards should maintain a log of all dates and other mentioned information. Problems concerning coverage of the employee can occur when employers are not provided documentation by employees.
Illinois Occupational Diseases Act An employee who is injured as a result of an exposure to an occupational disease arising out of an in the course of his employment is entitled to receive benefits under the Illinois Occupational Diseases Act. These benefits include all necessary medical and hospital services, temporary total compensation benefits if the employee's disease results in three or more days of lost time, and additional compensation if a permanent disability results. An employee who suffers an injury as a result of exposure to an occupational disease should keep a record o the following information to protect future rights and prevent any future misunderstandings with his employer regarding the circumstances surrounding the accident.
It is often helpful for the injured employee to maintain a “diary” of the events surrounding the occupational disease and its treatment by making notes on a calendar. Union stewards should maintain a log of all dates and other mentioned information. Problems concerning coverage of the employee can occur when employers are not provided documentation by employees.
Injuries As A Result Of Dangerous Machines, Or Other Aspects Of The Work Environment An employee who is injured while employed as previously described may have a claim against his employer and also a “THIRD PARTY”. This type of claim an include a wide variety of situations such as unguarded machinery, defective scaffolding equipment, chemicals without warning labels, and acts by others not employed by the injured employee's employer. An employee who suffers an injury as a result of a third party's acts should keep a record of the following information to protect his future rights.
CAUTION: Do not sign any release, group insurance forms, or contractual documents without first consulting a union official or an attorney. Signing such forms or documents could result in the denial of your claim by the Illinois Industrial Commission. This document has been prepared by: Kim Edward Presbrey
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Information Sheet For Divorce Clients This information sheet is provided to highlight many of the common areas of concern that are presented by divorce clients. Much of this information will be discussed in your initial interview. Hopefully it will provide the answers to many of your questions and perhaps lead you into other areas which you ought to consider as well.
Divorce cases are begun by filing a basic petition setting forth background information concerning the parties, the grounds for divorce, marital assets and debts, and a request for relief. A summons is then served upon the defendant giving the court power to act over the case and the parties. Procedurally, the parties next may petition the court for any temporary relief that they need. This can cover many areas including temporary custody, child support, orders of protection, maintenance and initial dispositions of property. Then the parties will exchange written documents call Interrogatories and Notice to Produce so as to become acquainted with the marital property and marital debts. Frequently, the lawyers will engage in settlement discussions which will lead to a resolution of the case at this stage. If the parties are unable to settle the case, it goes before a judge for informal conference known as a pre-trial. At the pre-trial, the lawyers generally discuss the issues of the marriage and their suggested resolution of the case. The judge will make certain recommendations based upon his experience in handling these sorts of cases in an effort to settle the case. These types of conferences are very informal and generally last no more than fifteen minutes to one-half hour. If the parties come to an agreement, the case is resolved at that point in time. If not, the case will be set for trial and the judge will resolve any and all contested issues between the parties. Our clients frequently ask how long will their divorce take. In many of the counties around Kane, it usually takes no more than thirty days to finish a case once the parties have come to a signed agreement. In Kane County , the judges encourage the parties to settle and will allow them to shorten that time to get settled cases out of the system. If there are contested issues that need investigation, a pre-trial conference, or a trial, then a client may expect the case to take between six months to one year to conclude.
Illinois has enacted basic guidelines for child support. Child support is based upon net income. For one child it is (20%), for two (25%), and three (30%). The percentage is increased even higher if there are more children. Net income is defined as gross income, less social security, federal and state taxes, any health insurance costs covering the children, and any union dues. While these are guidelines, most courts adhere to them strictly except in special cases. Besides child support, the payor usually is ordered to pay up to (50%) of day care expenses. At the time the case is finally resolved and child support is made permanent, other issues need to be decided such as education, health care costs (including uncovered expenses), and life insurance for protection for future child support obligations. Many counties have now begun mandatory arbitration or similar programs to attempt to resolve child custody cases. If custody is going to be an issue you can expect that you will be sent to such a program to attempt to resolve that issue in the beginning stages of your divorce. If a custody case goes to trial, you may expect that the court will appoint a lawyer to either speak for or represent the children. Additionally, both parties may hire their own experts to give an opinion to the court. Custody cases are decided upon what is in the best interests of the children. Once custody is determined, for a period of two years, a person who wants to change custody must show the other parent has subjected the children to mental or physical endangerment.
Frequently, clients ask whether they will be entitled to, or have to pay maintenance. Unlike child support, which is based on a percentage, there is no set amount that a court may set for maintenance. The decision is strictly in the court's discretion. A court will consider the party's need, length of marriage, the marital assets, and the proposed distribution in deciding whether maintenance will be awarded. The length of maintenance may be for a set time or for a reviewable term.
One of the functions of a divorce case is to divide the marital assets. These assets will be evaluated and a dollar value attributed to each asset. An asset will be awarded to one party or the other. Frequently, questions are raised about what assets a homemaker is entitled to in view of the fact that she did not monetarily contribute to the acquisition of these assets. By statute, courts are required to consider a homemaker's contribution in an equal degree to those of a money earner. Illinois is considered a marital property state. Generally, all property acquired during the course of the marriage is considered to be marital property. This includes obvious assets such as cars, a house and savings accounts. It also involves intangible assets such as pensions. Pensions may be divided by the use of a special type of divorce order so that each person has an interest in the pension plan. Along with the assets, the marital debts are divided. They are usually divided upon a person's ability to pay those debts. Sometimes a sizeable asset such as a car has a debt with it. Generally, a court will award the debt to the party who gets the asset. Many sizeable assets like a pension or house will have to be evaluated.
Once the parties have reached a settlement, it is reduced to writing. Settlement documents include a judgment, a settlement agreement and a joint custody agreement, if applicable. If there is a pension, a document called a Qualified Domestic Relations Order (QDRO) is used to divide a pension. That type of order also has to be approved by the pension administrator. The agreement is then presented to the judge in a short hearing called a prove up. The hearings last about ten minutes and one or both parties testify about the facts of the marriage and settlement.
Once the case is done, it is completely concluded unless an appeal is taken. Areas of modification relate to child support, custody and maintenance. Child support is always modifiable based upon a substantial change in circumstances. It is not unusual for support to be modified up or down for various reasons such as a loss of job, pay increases, or an increase in the cost of raising children. These changes are begun by filing of a petition by the person wishing the change. Usually, child support is paid through the State Disbursement Unit (SDU). For a small fee, the Clerk will provide a computer printout showing the payments, and the amount due. It is a good way to keep a record of the child support obligations. Child support is usually taken from the payor's wages by an order of withholding. Frequently, the parties are concerned with promises made which are not kept. That may include child support, maintenance, or transfers of property. If a person breaks a promise, the court can enforce it by a rule to show cause. If the court finds a person guilty then he or she can be held in contempt of court. Punishment can be jail time or the assessment of attorney's fees.
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Presbrey & Associates, P.C. 2004 All rights reserved