FAQ: Doctor / Medical Related

If your doctor releases you back to work, be sure to get a “trial” full-duty release so you can come right back to them if you start having problems again.

Never completely stop seeing your doctor until you are 200% sure you are healed or as good as you are going to get. If you stop treatment to “see how you feel,” the law presumes you have recovered fully.

Once you stop treating, it is very difficult to re-start. Make monthly or weekly follow-up appointments with your doctor until you are 100% certain you are going to be okay. Cancel the appointment if you are doing well.

This is very common. If your doctor thinks you need a medical procedure, get your doctor to put their reasons in writing. Take your doctor’s reasons to the company doctor and your employer.

If this dispute between your doctor and the company’s doctor cannot be resolved, you can use your regular employee insurance to get the medical care you need. Just be very careful and make sure you tell your regular insurance that you need care for a disputed work injury.

During this dispute, your employer can refuse to pay for your medical procedure until ordered to do so by the Workers Compensation Commission.

You cannot go to arbitration and get an order requiring your employer to pay medical benefits unless you file your claim. Once you sense that a dispute like this might be brewing, you should probably see your legal representative right away.

This is very common. If you can, you should go back to work. Very few injured workers experience a painless return to duty.

If your doctor thinks it is unsafe or unwise for you to go back to work, however, get your doctor to put their reasons in writing. Take your doctor’s reasons to the company doctor and your employer.

If this dispute between your doctor and the company’s doctor cannot be resolved, you can follow your doctor’s orders. Your employer does not have to pay you benefits during this dispute, however, until ordered to do so by the Workers Compensation Commission after arbitration.

You cannot go to arbitration and get an order requiring your employer to pay disability benefits unless you file your claim. Once you sense that a dispute like this might be brewing, you should probably see your legal representative right away.

Maybe. Under the Act, if you prove that a specific work activity or condition probably contributed to your heart attack, or that your heart condition was probably aggravated, or accelerated, by your job, you can recover benefits.

Even if you have pre-existing heart disease, you may still be eligible for workers’ compensation benefits if the medical evidence shows that your work was probably a factor in your heart attack. Important: there is an important difference in the law between “what is possible” and “what is probable” This often requires the assistance of medical experts.

“Job stress” heart attacks claims are rarely successful under current law.

The law entitles you to compensation for permanent partial loss of use, or permanent partial impairment, of all your body parts. This benefit is called Permanent Partial Disability (PPD”).

Not all injuries and diseases result in permanent partial disability. In general, you are only eligible for PPD benefits after your condition will not improve any more.

The amount of PPD compensation you might get depends on three things:

• Your average weekly wage (How much you were earning before the injury?)
• The degree of permanent impairment or disability (How bad is the damage?)
• The part of your body affected (What is damaged?)

If your employer disputes the extent of your injuries, the Workers Compensation Commission evaluates the degree of physical impairment and the effect of the disability on your life at arbitration. Factors that may be considered include your age, skill, occupation, training, inability to engage in certain kinds of work or activities, pain, stiffness or limitation of motion.

Yes. If you claim you are entitled to Workers’ Compensation, your employer can force you to attend an examination by a doctor of its choice. Do not let company doctors treat your injury. Remember: whoever pays the piper calls the tune. Never forget who signs the company doctor’s paycheck.

Obviously, if you are bleeding to death, break a bone, etc. and need emergency medical attention, accept it from the first doctor you see — no matter what.

Think of any visit to a company doctor as a “touch and go landing” on your way to your own doctor. Let the company doctor examine you. Tell them exactly how you got hurt at work.

Avoid letting any company doctor give you a prescription, order physical therapy, refer you to a “specialist,” etc. Once you accept treatment from a company doctor, you must use your precious “second opinion” to see your own “first” doctor!

To keep your claim valid, however, you must cooperate with your employer’s medical examination, provided your employer picks a reasonable time and place. If you refuse to let your employer’s doctor examine you, you can lose your benefits.

The employer pays for this exam, and must pay you mileage to and from, plus meals and lost wages. Remember: the law only lets the company doctor examine you. You have an absolute right to refuse treatment from their doctor.

Any medical debts incurred after February 01, 2006 are subject to special laws designed to protect injured workers with medical bill problems. How much protection you get under the law depends on whether your employer accepts or disputes your claim.

If your employer accepts your claim, your employer must pay your doctor within 60 days. You must provide your employer with all information required before they are obligated to pay. Your doctor must accept the payment your employer makes under the Workers Compensation Medical Fee Schedule as full payment. Doctors and hospitals cannot make you pay the difference between their charges and what your employer paid.

If your employer disputes your claim, however, unless you have filed your legal claim at the Workers Compensation Commission your doctor or hospital may seek payment of the actual charges from you directly. On the other hand, once you tell a doctor or hospital you filed a claim at the Workers Compensation Commission, the law bars them from seeking payment from you until your case is over. If you are having problems with medical bills or collections, this is another very good reason to file your claim.

After you file your claim and all collection efforts stop, should you resolve by settlement or by arbitration then doctors and hospitals may resume ordinary collection efforts. Any medical expenses left unpaid at the end of your case are your legal responsibility.

It is, therefore, critically important to keep careful track of all of your medical bills, charges and payments from the first day of your case to the last.

Effective February 1, 2006, Illinois law established a medical fee schedule that controls the charges for all medical treatment and procedures covered under the Workers Compensation Act. These charges are the maximums allowed by law. The Workers Compensation Commission adjusts the medical fees schedule annually for the rate of inflation.

Yes. If your doctor does not send medical reports to your employer or its insurance company, benefits may be delayed. Make sure you tell your doctor not to speak directly to your employer or its insurance representatives, however.

Your doctor’s report should include enough information to allow your employer to determine:

• Whether weekly benefit payments should be started, continued or stopped; and
• Whether treatment is necessary to cure or relieve the effects of your injury or disease.

Yes. If your injury or condition is work-related, you may select any doctor, surgeon, or hospital service you choose, at your employer’s expense, even if the doctor is outside your regular insurance plan or network.

Your employer cannot refuse to pay for medical treatment simply because they did not select or approve it in advance.

Go to a hospital emergency room, or see your own family doctor, immediately. Make sure the first thing you tell every doctor you see, every time, is that your injuries arose out of an accident on the job. Whenever you explain to anyone how you got hurt at work, make sure you say exactly what you told the Company when you first reported the accident. Be consistent. Be specific.

Make sure your doctors write down what you say in your medical records.

The Worker’s Compensation Act allows injured workers to obtain a second medical opinion at their employer’s expense. This second opinion does not include any doctors or specialists your treating doctor refers you to: those providers are part of your “first opinion.”