Settlements

In Illinois, Work Comp insurance is sometimes slow to pay or authorize medical treatment.

Often the fastest way to get treatment is to run the treatment through your group health insurance.

The most important thing is to get your treatment and get back to work.

Do not worry if your health insurance has to pay. Workers’ Compensation insurance will have to reimburse or pay back your group health insurance company at the end of the case.

However, if your health insurance pays for Work Comp bills, then your settlement contracts will have to reflect that Work Comp is going to pay your insurance company back or you may end owing your health insurance for the bills. Be very careful about this.

It just does not make sense to have a hearing to order the insurance company to pay for your prescriptions.

Usually you will have to make multiple telephone calls, and wait a long time to get your prescriptions approved.

The easiest way I have found to get prescriptions for injured workers is to go through a mail order pharmacy. The pharmacy will negotiate with the Workers’ Compensation insurance company directly to pay the bills and mail the prescriptions to you. At the end of the case the pharmacy bill will resolved with the insurance company.

In Illinois, the Workers’ Compensation Law provides that the injured worker is allowed to go to 2 doctors of her choice and unlimited referrals.

When the insurance company sends you to a doctor this does not count as a doctor of your choice.

For example, say you get hurt at work and your supervisor calls an ambulance to take you to the local hospital. The hospital visit is not your choice.

If work wants you to see an occupational doctor, then this is also their doctor. You can choose to see a neck specialist to examine your injury. This is your first choice of doctor.

Assume that the neck specialist thinks your shoulder is also injured. He then refers you to a shoulder specialist. This is not your second doctor because your first doctor has referred you to the shoulder specialist. You still have a second doctor choice if you need it.

As you can see it can complicated. The main thing to remember is that you are not stuck with the insurance company doctor.

For instance, the back is worth 500 weeks.

This is an example of a settlement:

Assume you have a surgery that is worth 20 percent of the back. 20 percent of 500 weeks equals 100 weeks.

Assume your average weekly wage is $500 per week. The Work Comp Law says you are entitled to 60 percent of your average weekly wage or $300 per week in this example.

$300 times 100 weeks equals $30,000. That is the value of your settlement.

As we have discussed in other posts, the nature of your injury, the type of surgery, and your restrictions make a difference in the amount of your settlement.