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By Magdalena F. Gonzalez

Workers’ Compensation is a form of insurance that provides employees with benefits when they are injured at work. An injured employee initiates the process of obtaining such benefits by opening a claim with their employer’s Workers’ Compensation insurance carrier. The employee must also file an Application for Adjustment of Claim with the Illinois Workers’ Compensation Commission (IWCC), the administrative entity that has jurisdiction to decide Workers’ Compensation claims in the state of Illinois under the Illinois Workers’ Compensation Act.

A Workers’ Compensation claimant is entitled to three broad categories of benefits: 1) payment of medical bills, 2) paid time off, and 3) a lump sum settlement. A claimant is entitled to paid time off if either: 1) their treating physician determines they are unable to work, or 2) the claimant’s treating physician determines they are unable to perform their work duties and the employer determines they are unable to accommodate the work restrictions determined by the physician. A claimant also may be entitled to partial time off if the claimant is able to work with restrictions and the employer determines they are able to accommodate those restrictions.

An employee with a Workers’ Compensation claim should always consider hiring an attorney to represent them to ensure they receive the benefits to which they are legally entitled.

Workers’ Compensation claims become more complicated if the insurance company denies the claim or some portion of it. For example, an insurance company may initially approve the claim — and thus pay for necessary medical treatment and any physician-mandated time off — but decline to pay for treatment down the road on the grounds that it is not medically necessary to treat the claimant’s work-related injury.

In these circumstances, an attorney would be better equipped to dispute the denial of benefits by the insurance company by filing a request for a hearing before an arbitrator for the IWCC. An attorney also is better equipped to negotiate a fair lump sum settlement than the average claimant because they are well-versed in the factors that the IWCC considers in evaluating a fair lump sum settlement under the Illinois Worker’s Compensation Act.

If you have been injured at work and are considering filing a Workers’ Compensation claim, please contact Gardi, Haught, Fischer & Bhosale LTD and a lawyer will be able to assist you in resolving your claim.

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