Injuries that Qualify for Workers’ Compensation
Jan. 25, 2021
According to the Illinois Workers’ Compensation Commission (IWCC), employers report approximately 250,000 workplace injuries each year. Most claims are settled before or during arbitration, but after an arbitrator reaches a decision, about 50% are appealed to the commission, or roughly 20% of all claims processed. In addition, about 20% of commission decisions are then appealed to the courts.
How does workers’ compensation work in Illinois? What does it mean to appeal a decision by an arbitrator? Where does the process end?
Illinois employers and employees involved in workers’ compensation cases in or around Naperville can always turn to us at Marker & Crannell for their answer. We have long been helping both employers and employees resolve workplace issues and fully exercise their rights under the law.
Overview of Workers’ Compensation in Illinois
The Illinois workers’ compensation system requires all employers to purchase insurance to cover workplace-related injuries and illnesses or to self-insure. The system is designed to be “no fault,” meaning that an injured worker need not show negligence on the part of the employer in order to be compensated for medical expenses and time lost from work. At the same time, however, except in rare cases, an employee cannot file a personal injury lawsuit against the employer.
The system is managed by the Illinois Workers’ Compensation Commission, or IWCC, as mentioned above. To ensure a fair outcome in each injury/illness situation, the IWCC provides several windows for appealing the compensation package being offered for one’s injury or illness.
For instance, if an employee finds the initial offer from the employer’s workers’ compensation insurance company lacking, they can take the issue before an arbitrator. If that decision is deemed insufficient, the next step is to appeal to the IWCC. Following that, appeals can be lodged with a circuit court, an appellate court, and finally the state supreme court, but the high court will only hear cases involving issues of leave.
Which Injuries Are Covered, and Which Are Not?
Besides some exceptions noted below, almost all diseases contracted and injuries suffered at work are covered by workers’ compensation. It is important to note that, should you contract COVID-19 at work, that entitles you to workers’ compensation benefits.
According to an analysis by the Travelers Companies, the most common workplace injuries are strains and sprains (30%); cuts and punctures (19%); contusions (12%); inflammation (5%); and fractures (5%).
The insurance giant’s “Injury Impact Report” listed the common causes of these injuries as:
Material handling (32%)
Slips, trips, and falls (16%)
Struck by or colliding with an object (10%)
Incidents involving tools (7%)
Cumulative trauma (4%)
A heart attack or stroke arising from a pre-existing condition is also covered if it can be shown to have been caused by work conditions.
Certain injuries are not covered, such as:
Self-inflicted injuries, including those from being involved in a fight
Injuries suffered while committing a crime
Injuries suffered while not on the job
Injuries suffered during a violation of company policies regulation employee conduct
What Benefits Are You Eligible For?
The employer is required to pay for all medical treatment and rehabilitation services. Typically, the injured employee will not be responsible for any copays or deductibles. The employee can also choose the doctor and accept referrals within that doctor’s chain, but the employee cannot go outside the initial doctor and his chain. The employer is also entitled to dispute medical treatments, order an independent medical evaluation, and take other steps to review the treatment process.
In cases where the injured employee must miss work to recuperate or must be reassigned to light duty while recovering, Illinois provides for:
Temporary Total Disability (TTD): When a doctor orders the employee to take time off to recuperate, the worker will be paid two-thirds of their Average Weekly Wage (AWW). The first three days are unpaid unless the total time off reaches 14 or more days.
Temporary Partial Disability (TPD): If by doctor’s order an employee is assigned to lighter duty at lesser pay, that person will be further compensated two-thirds of the difference between their normal AWW and the wage under lighter duty.
When it comes to permanent injuries, the Illinois Workers’ Compensation Statute provides four ways of compensation:
Scheduled Injury: The IWWC publishes a schedule of permanent weekly disability payments based on the loss of 25 specific body parts. The week is established at 60% of your AWW, and the number of weeks to be paid depends on the body part affected. Loss of a hand results in 205 weeks of payments, for instance. Loss of the big toe warrants 38 weeks.
Non-Scheduled Injury, or Loss of Percentage of Person as a Whole: For injuries not listed on the IIWC schedule, you are entitled to a percentage of 500 weeks at 60% of your AWW. Typical injuries in this category are neck, back, and spinal injuries. If the commission determines that your injury represents a loss of 30% of your person as a whole, you would receive 500 weeks at 60% pay, multiplied by 30%.
Permanent Total Disability: If your injury or illness prevents you from ever working again, or you suffered the loss of use of both eyes, legs, feet, arms, or hands (or any combination of two body parts), you are entitled to lifetime compensation at two-thirds your AWW, but with a mandated maximum of 133⅓% of the state average weekly wage.
Disfigurement: If you suffer a permanent change to your appearance through injury-related burning or scarring, you are entitled to a maximum of 162 weeks of 60% of your AWW. You cannot, however, receive both disability and disfigurement payments at the same time.
If an employee dies from an injury or work-related disease or suffers a fatality on the job, the worker’s survivors are entitled to two-thirds pay for 25 years, up to a total of $500,000. The weekly benefits are also subject to minimum and maximum caps. The rules change if a surviving spouse remarries, so check with a workers’ compensation attorney. There is also a one-time payment for funeral and burial expenses.
Why You Need An experienced Law Firm
Going up against an insurance company, arbitrator, commission hearing, or judge to obtain the just compensation due you can be a daunting task. There are complexities and legal subtleties that the average worker would not generally have knowledge of or experience with. Insurance companies are notorious for lowballing victims and their claims. They often hire "expert" doctors to review records or conduct an "independent" medical evaluation (IME) and determine that you are not as injured as your own doctors are claiming - these IME doctors make hundreds of thousands of dollars each year...one thing must be true, the insurance companies wouldn't spend that much money unless these doctors were saving them even more. You need solid representation by experienced attorneys.
If you’re in Naperville, or nearby in Aurora, Joliet, Wheaton, Woodbridge, or in adjoining locales, contact us at Marker & Crannell. We will bring our experience and dedication to your workers’ compensation claim to help you obtain the best possible result.