Workers’ compensation - What to expect
Below is a basic flowchart of the workers’ compensation process.
Step 1 - Report Injury to Employer
Every case is different, but all (except those involving death) begin with an employee reporting their injury to their employer.
The employer in turn notifies their insurance company.
Step 2a - Medical Treatment
Once your injury is reported, your employer's insurance is required to pay for all medical care that is reasonably necessary. Often times this can be a source of contention between employees and their employers, which is why it is always advisable to seek legal advice. Treatment includes everything from first aid to surgery.
Medical providers cannot bill you once you tell them your injuries are related to a workplace accident and you have filed a claim with the IWCC (see below). If your employer does not pay them outright, they will be put on hold until the resolution of your claim.
You may choose the provider with limitations. If your employer has a Preferred Provider Program, you have a choice of two doctor's. You may reject these, but this will count as one choice. Afterwards, if you decide you do not like the new chain of providers, you must get permission from the employer to choose another.
Your employer may ask for an evaluation by a doctor of its choice. These are generally "industry" doctors whose findings skew in the employers favor.
Step 2b - File A Claim
As soon as possible injured parties should submit to the Illinois Workers' Compensation Commission:
Proof Of Service (stating that a copy of the above application was served upon the employer)
Attorneys file claims as a matter of course when signing up new clients. The Commission cannot order your employer to provide benefits if you have not filed a claim. Your case will be assigned a case number and an arbitrator. Your arbitrator and hearing site is based on the location of your accident. You can check this information at the link below:
Unless you hire an attorney, you are responsible for keeping track of your claim, appearing at hearings, and presenting evidence to prove your eligibility for benefits under Illinois law.
Step 3a - Temporary Benefits (with calculations)
After your workplace injury, your physician may or may not release you back to light-duty work.
If you are released and your employer has light-duty work available, you will be entitled to temporary partial disability checks
If your employer does not have light-duty work available, or you are told not to work by your physician, you are entitled to temporary total disability checks
Temporary Partial Disability (TPD)
Used when you can perform part-time or full-time light duty work while you recover.
(Old weekly paycheck) - (new lower weekly paycheck). Multiply this by (2/3)...see example
Temporary Total Disability (TTD)
TTD used when you cannot work at all while you recover.
AWW x (2/3)...see example
TTD is subject to minimum and maximum amounts determined by the date of injury, marital status and number of dependents ). In general. The minimum weekly check will be $220.00 - $330.00, not to exceed AWW. The maximum TTD varies.
Try using this calculator to make things easier
Step 3b - Vocational Rehabilitation Benefits
If you are unable to return to your previous job (usually the result of a serious injury), your employer must help arrange and pay for, among other things:
Counseling for job searches
Supervising a job search program
Vocational training - including education at an accredited learning institution
During this time, you are entitled to "maintenance benefits" equal to, or greater, than your TTD rate. You must cooperate in this process. If your new job will pay less than your pre-injury job, you may be entitled to a wage-differential sum of money. More on this below.
Step 4 - Winning a Claim
Cases are most commonly disputed for the following reasons:
Jurisdiction - your employer is subject to Illinois Law
Employment - you were not an employee of the company such that they are required to pay benefits under Illinois law
Accident - you did not have an accident at work / while working
Causation - you had an accident at work, but your injuries were not caused or aggravated by that accident
Notice - you notified your employer of the accident within the legal time limits
Once it is determined you have reached Maximum Medical Improvement (you have healed to the extent it is possible), your case will go to trial. Trial must be requested at an arbitrator's status call. Once trial is set, the arbitrator will determine the outcome of your case based on medical records, doctors' depositions, testimony and other paperwork. The arbitrator will issue a decision including benefits to be paid, if any, within 60 days.
Step 5 - Permanent Benefits (with calculations)
Ultimately your claim may end in settlement or an arbitrator's decision. "Damages" in workers' compensation is based on the level of disability as a result of the workplace injury. The level of disability is determined by five factors:
An impairment report prepared by a physician
Your occupation - how does your injury affect your work (example: a knee injury will likely affect a flight attendant or fireman more than someone who works behind a desk)
Your age at the time of the injury - older individuals are closer to retirement, younger individuals can switch professions more easily, etc.
Your future earning capacity
Evidence of disability supported by medical records
Permanent Partial Disability (PPD)
Permanent Partial Disability is (1) the complete or partial loss of a part of the body; (2) the complete or partial loss of use of a part of the body; (3) the partial loss of use of the body as a whole. Loss of use generally means you are unable to do things you were previously able to do.
PPD falls into one of three categories:
Schedule of Injuries
(1) Wage Differential
Wage differential is somewhat straight forward. If due to injury you are forced to take a new job that pays lower than your old job, utilize the following calculation:
(Pre-injury AWW) - (Current AWW) = Total
Total x (2/3) = PPD Benefit
For a detailed example click here
(2) Schedule of Injuries
For most injuries, the IWCC has set a value on certain body parts. This value is expressed as a number of weeks of compensation.
The easiest way to think about this is as follows:
Every body part can be used from 0-100%. 0% meaning total loss of use, 100% meaning total use
Every injury will potentially lead to a partial or total loss of use of that body part, which is determined by a number of factors
Every body part also has a set value expressed as a number of weeks. For example, 100% use of a leg is equal to 215 weeks, 100% of an arm is equal to 253 weeks
Thus, if it is determined that your injury resulted in the loss of 50% of the use of your right arm, that injury is equal to 253/2= 126.5 weeks
Try using this calculator to make things easier
Your PPD rate is determined by multiplying your AWW by 60%.
Just like TTD, your maximum PPD rate is subject to certain minimums and maximums based on marital status and number of dependents.
Minimum: $220 - $330 (not to exceed AWW)
Maximum: $664.72 - $794.56 (updated rates can be viewed here)
Once you determine the body part, percentage of loss, and PPD rate, you combine the three to determine your PPD. Consider the following example:
You injured your right knee during the course of your employment. At the time, you were making $1,000.00 a week. Your AWW is thus, $1,000.00.
Your PPD Rate is 60% of AWW or: $1000 x 0.6 = $600
It was determined your injury caused you 25% loss of use of your right knee. Checking the IWCC Schedule, you determine that 100% of a leg is 215 weeks. Thus, 25% of a leg is: 215 x 0.25 = 53.75. So, your injury is worth 53.75 weeks of pay.
Lastly we combine the two: 53.75 weeks at a PPD rate of $600.00 = a total PPD benefit of $32,250.00 (53.75 x $600).
Note: One category on the IWCC Schedule is a catchall for a number of injuries not specifically listed. This is referred to as Man As A Whole. It encompasses a wide variety of back, neck, head and other injuries.
This includes any injury that results in the permanent disfigurement to the:
Chest (above the armpits)
Leg (below the knee)
Using the Schedule of Injuries section as a guide, 100% disfigurement of any one of the above is equal to a maximum compensation of 162 weeks.
You can collect compensation for the loss of use or disfigurement of the same body part, but not both. So, if you injure your leg and the resulting surgery results in a large scar, you only collect for the scar or the loss of use. Not both.
Permanent Total Disability (PTD)
PTD is either:
The permanent and complete loss of use of both hands, both arms, both feet, both legs, both eyes, or any two such parts (e.g. one leg and one hand)
A complete disability that renders the employee permanently unable to do any kind of work for which there is a reasonably stable employment market
PTD is calculated as 66 2/3% of your average weekly wage, subject to minimum and maximum limits (min. $220.00 - $330.00, max. $1,336.91 - $1,463.80), for life. (click here for updated rates)
If the case is decided by an arbitrator, you will be eligible for cost of living payments from the Commission's Rate Adjustment Fund that reflects the increase in the statewide AWW during the preceding year. This ensures that in the year 2060 you are not forced to live on a wage that reflects a year 2020 cost of living.