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Illinois workers’ compensation reforms lead to lower medical payouts

Written by Ankin Law Office

More than 155,600 Illinois residents were injured on the job during 2013, according to the U.S. Bureau of Labor Statistics. Many of these people required significant medical care during the weeks and months following the injury. An accident at work can change a person’s life in just a few seconds. Injured employees often need financial help to recover and rebuild. Recent controversial reforms to the Illinois workers’ compensation system have led to more restrictive rules and lower medical payouts for many disabled workers.

What does Illinois workers’ compensation do for employees?

Employees in Illinois have benefited from a state workers’ compensation program for more than 100 years. Workers’ compensation law requires employers to provide benefits for people who are injured on the job. These benefits help disabled employees by closing the gap in wages after an injury and providing for rehabilitation and medical costs. In some cases, these costs are extensive and long-lasting, as a Chicago injury lawyer knows.

Recent reforms in Illinois

After extensive debate, the Illinois General Assembly made wide-ranging changes to workers’ compensation law during 2011. The revised Illinois Workers’ Compensation Act reduces the amount of medical compensation paid to many injured workers. It also affects employee choice of medical care providers and vocational rehabilitation counselors.

Restricted options for medical care

Every Chicago injury lawyer is aware that these Illinois workers’ compensation reforms have imposed new limits on payouts for injured employees. Under the revised law, workers are entitled to reimbursement only for the following medical services:

  • First aid in the immediate aftermath of a job-related accident
  • Treatment in the emergency room after the accident
  • Medical and surgical services from the employee’s initial service provider
  • Medical and surgical services from specialists directly referred by the employee’s initial service provider
  • Treatment by a second medical service provider of the employee’s choice
  • Treatment by no more than one doctor outside the employer’s Preferred Provider Program, if such a network exists

The current guidelines are stricter than former Illinois workers’ compensation law, which allowed injured employees to obtain additional treatment from several doctors.

Only two doctors’ opinions are allowed under current Illinois law

According to the 2011 legislation passed by the General Assembly, workers may not consult more than two doctors unless they are willing to pay for the consultation and medical care out of their own funds or private insurance. Illinois workers’ compensation no longer covers the possibility of a third or further medical opinion after an accident on the job. Employers may also choose to establish a Preferred Provider Program, further restricting the worker’s choice of doctors. If workers decide to opt out of the PPP, that option is treated as a doctor choice, leaving the injured employee with the right to see only one doctor outside the network.

Additional medical referrals

The only exception to this limit is in the case of a direct referral by one of the two primary doctors. If one of these two doctors recommends treatment by another consultant, physician, expert or other medical service provider, the injured worker’s employer is liable for any costs arising from the additional consultation. If these additional medical consultants refer an injured worker to another specialist, the cost of that referral is also covered by Illinois workers’ compensation. The chain of referrals can continue indefinitely.

Adaptive devices and prosthetics

Recent workers’ compensation reforms also affect the range of prosthetics and adaptive devices paid for by employers after an accident on the job. According to the provisions of the 2011 Illinois Workers’ Compensation Act, employers are required to furnish only the following devices and services:

  • Prosthetic arms, legs, hands or feet
  • Artificial teeth or dentures
  • Artificial eyes
  • Braces and fixtures required to keep prosthetics in place
  • Repair and maintenance of prosthetics

Employers are not currently required to cover other adaptive devices under current Illinois law.

How do recent Illinois reforms affect injured workers?

Some injured employees have discovered that recent Illinois workers’ compensation reforms can make life more difficult after an accident. The two-doctor rule restricts an employee’s choices, even in difficult situations where an additional opinion may be needed. Many workers are also hesitant to opt out of an employer’s PPP because of further restrictions on medical benefits.

The new rules can add up quickly to a challenging situation for a disabled employee. If a person chooses to opt out of a PPP and does not find relief from the first doctor chosen outside the network, future options are severely limited. If the doctor cannot treat the condition successfully and will not make further referrals, continuing medical care is not paid by Illinois workers’ compensation. Some workers may even be reluctant to seek proper care because of limitations on medical payouts.

Workers’ compensation reform has serious effects on injured employees

According to a recent report by the Chicago Tribune, Illinois residents are falling into increased financial difficulties because of workers’ compensation reform. Payments by employers currently cover only 20 percent of the total cost of job-related injuries and illnesses. Even when employees benefit from workers’ compensation, they still earn an average of $31,000 less during the decade following an accident. This gap in wages and medical coverage has serious consequences for many injured workers in Illinois.

Navigating medical costs can be difficult for disabled workers. People who have been hurt on the job should consider calling a Chicago injury lawyer about their case.