Medical Benefits

Medical Benefits for Injured Workers
Click on the links below for more information about medical benefits for workers injured on the job.



Employee has the right to choose

Contrary to what many employers and insurance representatives may tell the injured worker, it is the right of the injured employee to choose his treating doctor. The employer might suggest a doctor for treatment, but it is a recommendation only, not a requirement. The employer might tell the employee that he or she has to go to the company doctor, often referred to as the occupational health physician. Again, this is a suggestion only, and not a requirement. The first priority should be your health, and your choice of a treating physician should be based on that factor first and foremost.

Payment

The workers compensation insurance carrier is required to pay all costs of treatment. There is no co-pay as there is with non-occupational treatment paid by the group insurance carrier. There is also no deductible. Therefore, every dollar of medical care must be paid by the insurance carrier.

Referrals

The injured employee is limited to two (2) chains of referrals. For example, let us say you see Doctor A, who refers you to Dr. B for special treatment and he refers you to Dr. C for tests. This is all within a single chain of referrals. You have a right to two (2) chains of referrals. Therefore, if you wish to see another doctor, ask to be referred. Your family physician is a good source for recommendations. This limitation does not include emergency care for the initial treatment.

Requirements

The injured employee must show that the medical care is “causally related” to the work injury. Also, the medical charges must be reasonable and necessary.

A 2006 amendment to the law provides for a “medical fee schedule”. The purpose is to begin setting reasonable medical fees for similar procedures. The fees allowed will vary according to zip code. The medical provider will be required to accept the payment provided by law and cannot seek the balance of a bill from the injured employee.

While a workers compensation case is pending, and if a bill or a claim is being contested, the medical provider can seek payment from the injured worker. However, if the injured worker provides proof that he has filed a case with the State of Illinois Workers Compensation Commission, all collection efforts on a medical bill must stop.

If a medical bill is agreed to be due to a work injury, the insurance carrier must pay the bill within sixty (60) days or face interest charges of 1% per month.

The Workers Compensation Act also provides for a Medical Advisory Board to advise the Workers Compensation Commission on medical fees. This system should provide for fair payments to medical providers while reducing the inflationary pressures on the cost of medical care.

Insurance company exams

The insurance company has the right to have you examined by one of their doctors. This is an examination only; he has no right to treat you. When notifying you of the exam, in writing, the insurance company must also send advance payment for your travel expenses associated with this exam.

Medical Case Management

Many insurance companies will hire a medical case manager to oversee your care. This can provide some assistance to you, for example in expediting appointments and payment of bills. However, you are not required to speak with this person if you choose not to.If you do, it is recommended that you set some ground rules. For example, you may require they not enter the examination room with you, since a doctor visit should be very personal and private.

This content is intended to provide general information and guidance only. You should see an attorney and obtain advice if you have questions or concerns regarding workers compensation. Most lawyers will not charge any fee for an initial consultation to review your case. Only by asking questions and obtaining answers will you obtain the rights and benefits to which you are entitled.