What Does Workers Comp Cover? What Is Available If I Got Hurt At Work?
What Does Workers Comp Cover? What Kind of Benefits and Help Can I Get If I Got Hurt at Work?
Injuries at work can drive you nuts. After an injury, you don't have money coming in and you might wonder what does workers comp cover?
In this article I want to cover with you the most common and even some of the less common things that the Illinois Worker's Compensation act provides for injured workers if they get hurt on the job
It's good for you to know what might be available and under what circumstances. So that's why I put this article together
Here are the benefits someone with a workers comp case may be entitled to.
If you're injured and it is covered by Illinois workers comp law, you are entitled to what is called temporary total disability payments, also known as TTD.
TTD is basically just paying you while you're off work. The payments are made by your employers workers compensation insurance company. The benefits are usually paid weekly or biweekly, and usually you get those benefits mailed directly to you. If there is a problem with your mail then your TTD can get mailed to your workers comp lawyer and they can forward the check to you or you can pick it up.
You don't get 100% of your pay when you receive TTD in a work injury case. Instead, you get two thirds of your pay.
It's not all bad news though. Payroll taxes are not deducted from your check so it turns out that TTD is about the same as you were taking home after taxes anyway.
If you typically work more than 40 hours a week and the overtime was mandatory, then you then your overtime also counts towards what you get paid while you were off work
Please note that you need a doctor's note in order to get TTD. Every time you go to the doctor, make sure you get a note from the doctor with your work status. Work status just means a note that says that you can either return to work, can't work at all, or you have job restrictions.
It will be up to your employer to determine whether they can accommodate your restrictions and offer you work within those restrictions, or whether they will just pay you TTD. If they offer you work within your restrictions you have to go to work and attempt to do the work.
But if you have a off work note completely, then you don't have to go to work. And they are supposed to pay you TTD for as long as you're off work with a doctor's note.
Under the Workers Comp Act, all related medical bills are paid by the employer or more specifically, the employer's workers compensation insurance.
The Illinois Worker's Compensation commission even sets special rates as to what the doctors get paid. It is similar to the way Blue Cross Blue Shield or other health insurance companies set a doctor's reimbursement rate for various procedures. Doctors are usually very happy with the reimbursement rate provided for in workers comp, so it's rarely difficult to find a doctor who is willing to treat you after work-related injury.
If your case is disputed or if your case is settled on a disputed basis, your settlement contract may or may not include that your employer has to pay your medical bills. This is something you should check for, especially if you're trying to settle your workers compensation case yourself, without the help of a workers comp lawyer. This is usually a big mistake.
If your case is completely denied or you lose your case or if your case is settled with settlement contract language that doesn't hold the company responsible for your bills, that's bad. You could find yourself owing a heck of a lot of money to doctors when you thought the bills were covered.
Settlement Money at the End of the Case.
Injured workers are entitled to a PPD settlement. PPD stands for permanent partial disability. It is a payment at the end of the case to pay you for the change to your body.
When an injured worker reaches MMI or "maximum medical improvement", that means they're done going to the doctor. The doctors have determined that they are as good as they are going to get and are as recovered as they can be from their work injury.
When that happens, it's time to start thinking about resolving the case. Sometimes, but not always.
Sometimes an injured worker reaches MMI but they still require lots of medical care and lots of medication because they are still suffering from a terrible disability and/or lots of pain.
Thankfully, most workers comp cases don't involve injuries that have that high degree of permanent serious consequences for an injured worker.
Calculating what you're entitled to under PPD settlement at the end of your case is sort of complicated. It takes into your account how much you are paid per hour, how severe your medical injuries are and how bad your outcome is. In other words, the better you heal in theory the less the case is worth.
Settling the PPD portion of workers compensation case in Illinois is not science or simple math. The numbers can only give us a range and then we haggle for the best outcome for our clients. It is generally a good idea never to accept the first offer in situations like this although with everything, there are exceptions.
Permanent Total Disability
When somebody gets hurt at work in a catastrophic way, they can't return to work. They can't earn any money. That's when they really worry about what does Workers Comp cover? They have permanent ongoing medical expenses which are usually tied to keeping their pain manageable.
When somebody gets hurt this bad at work, they're probably a candidate for Permanent Total Disability or "PTD". That means that they get paid for the rest of their working life and their injuries and medical care related to the work accident are all covered going forward.
Insurance companies don't like total permanent disability awards because they are very expensive. Payments are ongoing. Insurance companies don't like that.
Injured workers like it even less because it means they never get to return to the life that they had before their work injury.
Wage Differential Cases.
Although they are rare, when you are unable to return to work doing your old job but you are able to do some other job which pays less, you are entitled to 70% of the difference between the hourly rates
I know that sounds confusing so here's an example.
Let's say you make $20 an hour. You're injured at work. You can never return to doing your old job.
But you can return to a job that pays $10 an hour. And obviously the difference between $20 an hour and $10 an hour is $10 an hour.
A wage differential award would pay you a 70% of the difference between the two wages, or seven dollars, for every working hour for the rest of your working life.
It is meant to compensate you for the loss of income even when you are able to return to work doing something productive after work injury.
Vocational Rehab and Training
If you aren't able to return to your old job due to your workers comp injuries, you may be entitled to be trained for a new job. This includes aptitude testing, meeting with an expert to see what things you might be good at doing, and then receiving money for training and schooling so that you can learn to do your new job.
This is not very common but is something that a good Illinois workers comp lawyer can get you under the right circumstances, but it is part of what does workers comp cover.
Totally Disputed Settlement
There are about a million ways a workers comp insurance company can fight the case or manufacture evidence. There are also many ways that are legitimate that sometimes pop up in even a completely legitimate workers comp case.
If any of these pop up, we have a risk. It means that workers comp insurance is probably going to dispute and fight the case. It also means that we may need to go to trial in order to get you any benefits at all.
This is where having a good workers comp lawyer who you trust and who has experience comes in. Your workers comp lawyer will evaluate the case and the evidence. They will be able to tell you what the judge is likely to do based on what the evidence is going to be.
Lawyers who are over at the commission often know the tendencies of the judges. And, a lawyer can request a pretrial meeting with the judge and the workers comp insurance company lawyer to get an idea about what the judge thinks about the case. If the pretrial doesn't go well, that is a strong signal to you and your lawyer that you should consider a total disputed case settlement.
In a totally disputed settlement or "lump sum" settlement, you may be old back pay for wages, there may be outstanding medical bills, and they may also owe you money for PPD. But balanced against that is the chance that you'll lose the case based on the evidence.
If your lawyer thinks it's likely that you'll lose the case or get a really low award your lawyer might suggest a "lump sum" totally disputed settlement.
That's when the insurance company offers one sum of money but doesn't agree to pay you separate amounts for wages and separate amounts for medical bills. They give you want amount of money that you have to agree on and then usually your lawyer will contact the doctors and work out a deal on the medical bills so that you put as much money in your pocket.
Settlements like these are actually a good thing. If your lawyer thinks it's likely that you will lose the case or receive a very low award settling the case on this basis gives your workers comp lawyer leeway and some room to maneuver to make sure that you put as much money in your pocket as possible in your case.
This is a pretty exhaustive list of what is available under workers comp for an injured worker in the state of Illinois.
I hope this information helps you. If you have any questions please feel free to give me a call at 312-500-4500.
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Thanks for reading about what does workers comp cover and have a great day.