FAQs - Illinois Workers' Compensation
FAQs - Illinois Workers' Compensation
What is the history behind the Illinois Workers’ Compensation Act?
The Illinois legislature enacted the Workers’ Compensation Act over 100 years ago to provide benefits to workers who suffer job-related injuries or diseases.
What is the Illinois Workers’ Compensation Commission?
Claims for industrial accidents and injuries are not handled by the civil court system. Instead, payment of benefits is enforced by the Illinois Workers’ Compensation Commission (IWCC), a state agency.
How is workers’ compensation different than the civil court system?
Workers’ compensation is a “no-fault” system of benefits. This means that workers injured on the job are not required to prove negligence or fault on the part of the employer or anyone else. Injuries caused by a worker’s own negligence are also covered. As long as the injury is the result of an accident or occupational disease that had its origin in the workplace, it is covered under the Workers’ Compensation Act or the Occupational Diseases Act.
What are the main benefits under the Illinois Workers’ Compensation Act?
The Workers’ Compensation Act gives workers who have been injured on the job in Illinois three main benefits: (1) payment of reasonable and necessary medical bills; (2) payment of Temporary Total Disability (TTD) benefits (paid instead of wages when the employee is under a doctor’s care and is medically disabled from working; and (3) payment of Permanent Partial Disability (PPD) benefits (paid in compensation for the physical loss the worker suffers as a result of the injury).
(For more information about these individual benefits, see below).
Who is covered by the Workers’ Compensation Act?
The vast majority of people that work in Illinois are covered by the Illinois Workers’ Compensation Act. Exceptions are few, and include certain farm workers, employees of very small businesses with annual payrolls less than one thousand dollars, maritime workers, federal employees, and police officers and firefighters in Chicago.
You need not be an Illinois resident to be covered by the Illinois Workers’ Compensation Act. The Act covers anyone who was injured in Illinois; anyone who was originally hired in Illinois but was injured outside of Illinois; and anyone, such as a truck driver or traveling salesperson, whose principal place of employment is in Illinois, but may have been injured while working outside of Illinois. The jurisdictional guidelines of the Illinois Workers’ Compensation Act are quite broad and the benefits provided in Illinois are historically more generous in comparison to all other Midwestern states. It is always worthwhile to see if your injury is covered under the Illinois Workers’ Compensation Act, even if it occurred outside of Illinois or if you are not an Illinois resident.
What types of injuries are covered by the Act?
The Illinois Workers’ Compensation Act requires that benefits be paid for all accidental injuries arising out of and in the course of employment.
The term “accidental injuries” is interpreted quite broadly. It includes not only typical accidents, but also injuries that develop slowly over time due to repetitive trauma, such as carpal tunnel syndrome. It includes injuries as small as a cut finger that only leaves a disfiguring scar, and as serious as those that result in death. It is even broad enough to cover the following: injuries received in fist fights (if you are not the aggressor); accidents that occur on company premises while you are coming to or leaving work; heart attacks and strokes if they are caused by work; and a pre-existing condition if it is aggravated by work activities.
The “arising out of the employment” provision requires that the injury be directly caused by a hazard or risk of employment. In order to be covered under the Workers’ Compensation Act, the injury must be “job-related,” and the employment must put the worker at an increased risk of injury compared to the risk he or she would encounter off the job.
The “in the course of” provision requires that the accident take place at the time an employee is working, at a place that he/she is required to be for his/her job, and under circumstances that are required by his/her employment.
What is covered under the Illinois Occupational Diseases Act?
Under the Illinois Occupational Diseases Act, companion legislation to the Workers’ Compensation Act, occupational diseases or hearing loss caused by workplace exposure to noise, gases, vapors, dust, and other such hazardous conditions or substances are compensated in a similar manner as accidents under the Workers’ Compensation Act.
How does the Act treat firefighters, EMTs and paramedics differently?
The Act recognizes that the duties of firefighters, emergency medical technicians (EMTs), and paramedics may place them at greater risk for certain illnesses. These include health conditions related to blood borne pathogens, lung or respiratory disease, heart or vascular disease, hypertension, tuberculosis, cancer, hearing loss, or hernia.
Fortunately, in 2007, legislators amended the Illinois Workers’ Compensation Act and the Occupational Diseases Act to recognize that there are certain risks inherent to the duties of these workers. This amendment states that when a Firefighter, EMT, or Paramedic suffers from any of the above diseases or conditions, there is a rebuttable presumption that it arose out of and in the course of employment and is causally connected to the hazards or exposures of such employment. This amendment has provided a sword for our attorneys to strike back at the insurance adjuster’s defense. It forces the employer to first present evidence that the disease or condition is NOT related to work.
What is the Public Employees Disability Act?
PEDA was enacted to provide for a continuation of full pay for law enforcement officers, correctional officers, and firefighters who suffer a disabling injury in the line of duty. Under this statute, up to a year of full pay is given to public safety personnel injured in the line of duty. If the injured officer or firefighter continues to remain disabled from performing their duties after this year expires, they are then entitled to receive Temporary Total Disability (TTD) benefits under the Illinois Workers’ Compensation Act. TTD provides for two-thirds of your average weekly earnings, but it is tax free.
State correctional officers, other employees of the Department of Corrections, Employees of the Prisoner Review Board, and employees of the Department of Human Services working within a penal institution or a State mental health or developmental disabilities facility operated by the Department of Human Services are eligible for PEDA if they are full or part-time. However, law enforcement officers and firefighters must be employed full-time by the State of Illinois, any unit of local government, any State-supported college or university, or any other public entity granted the power to employ persons for such purposes.
Employees of the State of Illinois who become permanently unable to perform their duties due to an injury received as a willful act of violence by another employee of the State of Illinois are also eligible for benefits pursuant to this Act.
It is important to note that an officer or firefighter could be incapacitated for a period of time, return to work, and then be incapacitated for a subsequent period of time. Under PEDA, these personnel are entitled to receive 52 weeks of full pay, excluding the dates they return to light or full duty. Many municipalities have interpreted PEDA to require only payment for one calendar year from the date of injuries. This penalizes personnel who make a good-faith attempt to return to work. The Appellate Court has clarified that the year limitation is on the time an employee is unable to perform their duties, not on the calendar period following an injury.
Do I have to notify my employer of the injury?
The Workers’ Compensation Act requires that all accidents be reported to the employer within 45 days of the occurrence, or within 45 days of the last date of exposure to a hazardous condition or substance. Although the law allows 45 days, it is critical that all workplace injuries get reported as quickly as possible. Additionally, this notification must be to a supervisor, or to another company officer or official, not merely to a co-worker.
Many employers and their insurance companies provide their own notice requirements, pursuant to “company policy.” These company policy notice requirements do not change your rights under the Illinois Workers’ Compensation Act. No matter what people at work may tell you, you have 45 days to give notice of an accident in order to secure your rights under the Illinois Workers’ Compensation Act.
Also contrary to the “company policy” of many employers, this notice need not be in writing. Oral notice, telling your supervisor or company nurse that you were injured on the job, is sufficient under the law. You need not have signed a written notice statement on file with your employer to avail yourself of the benefits of the Illinois Workers’ Compensation Act. However, you do need to properly inform your employer of your injury in a timely fashion. It is helpful if you are able to verify that you gave such notice.
Do I have to pay taxes on my workers’ compensation benefits?
Benefits paid under the Workers’ Compensation Act are not classified as “income” for tax purposes. These benefits need not be reported on state or federal income tax returns.
Is my employer required to pay for medical expenses and treatment?
The law requires that the employer shall provide and pay for all necessary first aid, medical and surgical services reasonably required to cure or relieve the effects of the accidental injury. The employee has the obligation to cooperate in good faith in his or her own recovery at all times. The Act allows employers to utilize Preferred Provider Programs (PPP) as approved by the Illinois Department of Insurance. If an employer does not have an approved PPP, the injured worker has the right to see two doctors of their own choosing. If these chosen physicians refer the employee to other doctors or specialists (“chain of referrals”), payment of all such treatment remains the liability of the employer. Emergency medical services do not count as one of these choices.
If an employer has an approved PPP, the employee must be notified in writing. Employees should not assume that the company clinic is within the PPP. After reporting an injury, the employee can opt out of the PPP in writing at any time. By opting out, an employee uses up one of his two choices of physician. If the employee opts into the PPP, he/she has the right to choose two providers within the PPP, plus all medical providers referred by those two doctors, at the employer’s expense. If the Workers’ Compensation Commission finds that the care being rendered by the employee’s second choice of provider within the PPP is improper or inadequate, the employee may then choose a provider outside of the network at the employer’s expense. If an employee seeks non-emergency medical treatment prior to reporting an injury, that provider would constitute the employee’s sole choice of medical provider outside of the PPP.
What is a Section 12 Examination or Independent Medical Examination?
The employer may request that an injured worker be examined by a doctor for purposes of evaluation of the injured worker’s condition. The employer has the right to request an independent evaluation of this type, and must pay for the evaluation, as well as for the employee’s travel expenses and lost wages while attending the examination.
Does the Act cover treatment by chiropractors?
It is important to note that treatment rendered by chiropractors is covered under the Illinois Workers’ Compensation Act to the same extent as any other medical treatment.
Am I entitled to recover for lost wages?
While off work and under a doctor’s active treatment, injured workers in Illinois are entitled to Temporary Total Disability (TTD) benefits. Often known simply as “work comp,” TTD benefits equal two-thirds of your average gross weekly earnings, subject to certain statutory minimums and maximums. The period of TTD lasts while the doctor authorizes you off work, or while you are on light duty restrictions that your company cannot accommodate.
No TTD is payable for the first three days of work missed. If the time lost due to the injury continues for 14 days, the first three days grace period becomes payable by the employer.
If an injured worker is issued light duty restrictions by a treating or examining doctor, the employer is obligated to either: (1) provide work within the restrictions prescribed by the doctor or (2) make TTD payments. The employee is obligated to make a good faith effort to return to work, within his/her medically imposed restrictions.
The injured worker may also have the opportunity to make a claim for Temporary Partial Disability (TPD) benefits when the worker returns to light duty work and earns less than at the time of injury. This benefit applies only to a temporary condition and is not applicable when medically imposed restrictions are permanent in nature.
The Workers’ Compensation Act provides penalties and attorney’s fees that may be assessed against an employer who delays or denies payment of TTD benefits without written explanation to the employee or justification for such delay or denial.
Am I entitled to a settlement?
After the injured employee has recovered as far as medical treatment will permit and his or her period of TTD has ended, then the amount of Permanent Partial Disability (PPD), if any, can be assessed. PPD benefits are paid to the injured worker as compensation for the complete or partial loss, or loss of use, of the part of the body injured or of the body as a whole. This “loss of use” is a legal and medical assessment of the level of disability suffered as a direct result of the workplace injury. In assessing the amount of benefits, Arbitrators consider the injured employee’s age, occupation, future earning capacity, evidence of disability corroborated by the treating medical records, and a written report of a medical doctor detailing the level of the injured worker’s permanent impairment based on the American Medical Association’s “Guides to the Evaluation of Permanent Impairment.” Benefits are paid according to the percentage loss of use of the body or body part. The PPD rate is equal to 60% of your pre-injury average weekly wage, and like the TTD rate, is subject to statutory minimums and maximums.
Permanent disability benefits can also be calculated through proof of actual loss of wage-earning capacity. Under the “wage differential” theory, a worker’s post-injury wage is compared to his/her pre-injury wage. The employer is then required to pay two-thirds of the difference. This is payable weekly until the worker turns 67 years of age or for 5 years, whichever is later. The injured worker is not entitled to compensation for both the percentage loss of use and the wage loss he/she suffers.
What if I can never work again?
Very serious injuries, which result in the permanent inability to return to any kind of gainful employment, entitle the injured worker to Permanent Total Disability benefits: two-thirds of the pre-injury wage every week for life. Injured workers who have suffered the complete loss, or the permanent loss of use, of any two “members,” (i.e., arms, legs, eyes), are also entitled to Permanent Total Disability benefits.
What if I can’t return to my job and need to find new employment?
The Act provides for Vocational Rehabilitation in the event that an injured worker is on permanent restrictions that prohibit his return to his former position. This consists of job re-training and placement assistance at the company’s expense for workers whose injuries have left them unable to perform their former jobs. The objective of Vocational Rehabilitation is to return the injured worker to suitable employment at a wage rate similar to that earned before the workplace injury.
What does the Act provide for when an employee dies in a workplace accident?
In Illinois, the surviving spouse and/or minor children of the deceased worker are entitled to weekly benefits. If the worker does not leave a surviving spouse or minor children, benefits may be paid to certain other family members that were at least 50% dependent on the deceased worker’s income for support. The weekly benefit is two-thirds of the deceased employee’s gross average weekly wage during the 52 weeks before the injury, subject to certain minimums and maximums. The minimum weekly benefit for injuries occurring after July 15, 2011 is $473.03. The weekly benefit is paid for 25 years, or up to $500,000.00, whichever is more. The Illinois Workers’ Compensation Act also provides for a benefit of $8,000.00 to the survivor or the person paying for the burial expenses.
How do I file a claim?
It often becomes necessary to file a claim with the Illinois Workers’ Compensation Commission. Claims must be filed within the time allotted by law; otherwise, your right to benefits may be barred. Consult with an attorney to determine the filing period that would apply for your particular injury.
Claims must be filed with the Workers’ Compensation Commission on official Commission forms. Once your claim has been filed with the Illinois Workers’ Compensation Commission, only a settlement agreement on the pink form titled “Illinois Workers’ Compensation Commission Settlement Contract Lump Sum Petition and Order,” approved by the Commission, can close out your right to future medical care and disability compensation. No other statements, forms, letters or such documents prepared by your employer or anybody other than the Illinois Workers’ Compensation Commission can deprive you of your rights under the Act.
How long does it take for my claim to be handled?
One of the objectives of the workers’ compensation system in Illinois is to simplify the procedure by which benefits are paid for workplace injuries. Unfortunately, it sometimes takes several months for the average case to come to completion by trial or settlement. Often this is because of the length of time needed for the completion of necessary medical treatment.
What do I do if my employer is harassing me or has terminated me?
It is against the law for the employer to harass, fire, or discriminate against employees for exercising their rights under the Illinois Workers’ Compensation Act. Cases regarding conduct in retaliation for filing a claim under the Workers’ Compensation Act are filed in the Circuit Court, not with the Illinois Workers’ Compensation Commission.
What is Workers’ Compensation fraud?
The Workers’ Compensation Act also creates anti-fraud provisions for anyone who deliberately intends to misrepresent a material fact. The anti-fraud provisions apply not only to those who fraudulently file a claim, but also to employers who fraudulently deny a claim.
What is the Injured Workers’ Benefit Fund?
Pursuant to the Illinois Workers’ Compensation Act nearly every employer in Illinois is required to carry workers’ compensation insurance. Some employers in Illinois break the law and do not have workers’ compensation insurance or are not up-to-date on their insurance premiums. While the Act allows for criminal penalties to be assessed against an employer who failed to provide worker’s compensation insurance those penalties do nothing to help the injured employee.
In 2005, the Illinois Workers’ Compensation Commission established the Injured Workers’ Benefit Fund (“IWBF”) to provide workers’ compensation benefits to employees injured during the course of their employment whose employers did not have workers’ compensation insurance.
The Injured Workers’ Benefit Fund is the only way to provide benefits for injured employees when their employer does not have insurance. Unfortunately, the benefits afforded to workers under the IWBF are not entirely comparable to the benefits a worker would receive if his/her employer had adequate workers’ compensation insurance coverage.
One detriment to proceeding against the IWBF is that an employee only has “one shot” to pursue worker’s compensation benefits. Often employers dispute claims and do not pay injured workers appropriate temporary total disability benefits (off work benefits) or medical benefits. If an employer has adequate insurance, our office can file a motion for an emergency hearing and have the case heard before an Arbitrator to get these benefits instituted during the pendency of the injured workers’ case. In a case where the employer is uninsured and the worker must collect against the IWBF, proceeding on an emergency hearing is not a favorable option, as the employee only has one chance to proceed against the fund. An emergency hearing will prevent the employee from collecting a permanency award (settlement award) from the fund. Unfortunately, injured workers whose employers do not have workers’ compensation insurance coverage, must, from time to time, go without off work benefits or medical benefits.
The IWBF only pays out awards once a year, at the end of each fiscal year (currently June 30). This means that an injured worker can proceed against the IWBF in September, receive an award from an Arbitrator, and not receive payment of the award from the IWBF until the following June. This creates a long time delay for a worker, who has already suffered greatly due to the employer’s failure to carry adequate workers’ compensation insurance coverage.
The IWBF does not always pay 100% of the award. Payment of the award is subject to the availability of money in the IWBF each fiscal year. If there is insufficient money in the IWBF to pay all awards submitted, distribution is on a pro rata basis as determined by the Illinois Workers’ Compensation Commission.
It is important to make sure that your attorney understands how to proceed against the IWBF, as procedurally, there are many additional steps that must be taken before a trial. Our office has experience handling these types of claims and it is imperative that an injured worker hires an attorney with experience before the IWBF.
Although there are many downfalls to the IWBF, at this time it is the only remedy for workers’ injured during the course of their employment whose employers do not have adequate workers’ compensation insurance coverage. The remedy provided by the IWBF is better than the alternative, which is no recovery at all. Please contact our office with any further questions regarding the IWBF.