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Generally, one must suffer an accident at work. Accidents are literally construed in favor of the injured employee under the Illinois Workers' Compensation Act. Some accidents are single and unexpected events. Other accidents occur as a result of repetitive trauma.
An aggravation of an old injury or an old condition can also be determined to be an accident under the Illinois Workers' Compensation Act. This is true even though the original accident may not have been work-related.
Besides the usual single event accidents of back injuries, broken limbs, concussions, and such things as contusions, accidental and work-related claims may include instances of:
The law requires that, to be compensable, the accident must arise out of and in the course of one's employement. There are instances at work-related and compensable accidents occuring at company-sponsored events, fights over the job, and even accidents in the company parking lots.
There is a requirement under the Illinois law that the employer be given notice of the accident within forty-five (45) days of its occurrence. The burden is on the employee to inform a person in charge of the accident and to show that it occurred at work. This notice can be given orally but it is generally a good idea to give this notice in writing.
Once it has been determined that an employee has been injured at work and has been given notice, the employee is entitled to temporary total disability, medical care, and permanent partial disability and, if it it can be proved permanent total disability. Temporary total disability is basically two-thirds of the employee's average weekly wage for the year proceeding the injury. It should be noted that these benefits are tax-free and are payable for the entire period of lost time due to injury.
Temporary total disability is paid after a waiting period of three lost working days. Once the injured has neen off work for fourteen (14) days due to his injury, the waiting period of three working days is paid. There is no limit on the loss of time that temporary total disability (TT) is paid. Before July 1, 1975, it could only be paid for sixty-four (64) weeks. This limit was changed after that date.
The injured employee is also entitled to all the necessary medical care needed to cure the effects of his injury. As a result of changes in the law on September 15,1980, the injured employee has a choice of two doctors. Should the first doctor refer the injured employee to another doctor, it is not considered to be a second doctor. There is no law that stipulates that the injured party must be treated by the company doctor.
If the doctor that the injured employee chooses places the employee in a hospital and the hospital refers the employee to another doctor, this counts as only one doctor under the law. This stipulation became effective on September 15, 1980.
Also connected with the liability of the employee to provide medical care is the right of the injured employee to be entitled to rehabilitation should it become necessary. This would also include vocational rehabilitation if the injured employee cannot perform the normal functions that he used to perform on his job.
Once the injured employee has returned from work or if the medical care has taken the employee as far as he can go, it is time to determine whether the employee has suffered a permanent injury.
In many cases these permanent injuries are settled by means of a pink settlement contract approved the Illinois Workers' Compensation Commission (IWCC). There is no other method for the employer to receive credit before the IWCC other than having the Commission approve the settlement contract.
If an employee signs the pink settlement contract and has the contract approved by the Commission, he usually has to give up his right to submit his case to arbitration, the right to have the decision of the arbitrator submitted to the Commission for review, the right to any further medical treatment for results of his injury at the employers' expense, and the right to additional benefits if his condition worsens further as a result of the accident. In rare instances these terms are sometimes waived.
If a case is not settled, it is generally proceeds to arbitration.
Many times, cases that are abitrated before the IWCC proceed to review process.
If a decision of the IWCC is final, the injured employee is entitled to medical care for the results of the injury for the rest of of his life. Should the condition worsen within two and one-half (2 1/2) years aftet the IWCC decision becomes final, the injured employee can apply for additional benefits or disability as a result of that accident. This is very important criteria to consider when one tries to settle a workers' compensation claim.
It is important to remember that, under the Illinois Workers' Compensation Act, the injured employee is entitled to two-thirds(2/3) of his average weekly wage for the year proceeding the injury tax-free, payment of medical bills,and disability in the form of either a settlement or an award by the IWCC.
A claim must generally be filed within three years of the date of the accident. There is also a provision which allows the claim to be filed within two years from the last payment of temporary total disability payments. Thus, a filing may be made within either of these time provisions and later one controls.
In my experience, it has generally been advisable to file the claim as soon as possible as it allows the attorney to gather the facts, documentation, and witnesses that are necessary to adequately prepare the case.
Additionally, the attorney receives the same fee whether he has the case for three years or three weeks.
The maximum fee on a workers' compensation case is twenty percent while before the IWCC. While it is not necessary to hire an attorney, it is many times advisable because of the complexities of these cases.
The injured employee can be entitled to many benefits under the Illinois Workers' Compensation Act. It is of the utmost importance that these benefits can be recognized by the injured employee.