Workers Compensation Commission

Utilization Review is another medical provider looking over your doctor or chiropractor’s shoulder and telling them whether your treatment is reasonable and necessary. This is supposedly based on national standards.

The change to the Illinois Work Comp law gives the employers more rights in relying on the Utilization Review.

If the employer uses Utilization Review it requires the injured worker’s medical provider to provide timely and complete reports to support their requests for the treatment. If they do not, then you cannot require Work Comp to pay.

In light of the Utilization Review, medical bills can be denied on the grounds that the extent and scope of medical treatment is excessive and unnecessary.

When Utilization Review denies treatment the burden of proof shifts to the injured worker to prove by a preponderance of the evidence that the treatment is reasonable.

The Illinois Workers’ Compensation Commission is required to weigh all the evidence, including the Utilization Review opinion.

What all this means for the injured worker is:

Most likely the Employer will order more Utilization Review;

More weight will be given to the Utilization Review; and

More treatment will be denied to injured workers.

If you get notice of a utilization review, then you need to contact a lawyer immediately.

The hand is now only worth 190 weeks versus 205 weeks. This means the percentage is based on 190 weeks.

The most that can be awarded is 15 percent of the hand for carpal tunnel cases. This equals 28.5 weeks

The only exception is if you can prove greater disability by clear and convincing evidence. At that the maximum award is 30 percent of the hand. This equals 57 weeks.

Clear and convincing evidence is going to be a pretty high standard.

This should keep the value of carpal tunnel cases down quite a bit.

A wage differential is when your injury keeps you from working your old job, and the only work you can perform pays you at a lower rate.

The old law paid you the difference between the old and new job times 66 percent for the rest of your life.

Depending on your age and the wage difference this could amount to a large amount of money over your lifetime.

The new law provides that for injuries on or after September 1, 2011 you are only entitled to the wage differential until you reach age 67 or 5 years after the award becomes final, whichever is later.

This will result in lower settlements and awards.