A workers’ compensation claim may be filed by a worker who suffers from injuries or illnesses related to a job. Each state administers its own system of benefits to ensure that workers receive the compensation that they need. State law defines the maximum disability funds that an injured worker may receive during his or her time away from work. In Illinois, the legislature has created its own commission to deal with workers’ compensation claims. The Illinois’ Workers’ Compensation Commission is responsible for handling disputes between an injured worker and his or her employer.
If you have been injured on the job or suffer an illness related to your line of work, you may be eligible to file a workers’ compensation claim. You may also have separate claims for compensation against an employer, supervisor, manufacturer or distributor. Before you proceed with a workers’ compensation claim, you should have a solid understanding of the Illinois laws that may impact your ability to recover compensation. Some of the relevant Illinois laws to understand are:
- Rules put forth by the Illinois Workers’ Compensation Commission
- Principles of negligence law and strict products liability law
- Joint and several liability
- Modified comparative negligence
- Procedural rules behind the administration of the workers’ compensation benefits system in Illinois
- Regulations put forth by the Insurance Compliance Division
- Medical benefits
- Temporary Total & Partial Disability benefits
- Permanent Total & Partial Disability benefits
- Survivors’ benefits
Understanding Illinois workers’ compensation laws will ensure that you are prepared to move forward in your case. Here are some of the most relevant laws that you should know in filing your claim.
Workers’ Compensation Coverage
Under Illinois law, every employee who is hired, injured or works within the state of Illinois is eligible for workers’ compensation benefits. Workers receive coverage from the start of their employment.
An employee’s injury will be covered if it was caused by his or her work. In addition, an employee is covered if he or she is injured due to a repetitive use of a part of the body. A worker with a pre-existing condition may also receive benefits if the work worsened the condition.
Employees will not have their injuries covered if the injuries arose in the context of a company picnic, athletic event, corporate party or team-building program.
The Worker’s Burden of Proof
Workers who are injured on the job have the burden of proving their injury. Even if a worker is at fault for his or her own injury, he or she may still recover benefits. An employer does not have to prove anything, and an employer may deny or contest the elements of a worker’s legal claim.
The employee has a responsibility to promptly inform an employer of his or her injuries. He or she should give the written notice to an employer and not a co-worker. An employee should provide written notice that indicates:
- The date and time of the injury
- Location of the accident
- Description of one’s injury or illness; and
- The employee’s name, phone number, email and address information
The employer must be notified within 45 days of the date of the accident. Injuries resulting from radiation exposure must be reported within 90 days or the date in which an employee knows that he or she has been exposed to radiation.
An employee may not be fired as a result of filing a workers’ compensation claim. An employer may be fined or be subject to other sanctions for disciplining an employee for the sole reason that he or she has filed a workers’ compensation claim.
The Illinois Workers’ Compensation Act
The Illinois Workers’ Compensation Act clearly outlines the legal elements that must be proven in order to file a claim for benefits. An employee must prove:
- An employer was subject to the Illinois Workers’ Compensation Act or Occupational Diseases Act
- An individual was an employee on the date of his or her accident
- An individual suffered from injuries or illness as a result of usual and customary work
- An employee’s medical condition was aggravated due to his or her work
- An employee provided notice to an employer within 45 days of the accident
- The employee’s wages for 52 weeks before the accident
Duties of an Employer
Employers also have certain duties under the Illinois Workers’ Compensation Act. Employers are required to have workers’ compensation insurance. They must also post a public notice in an obvious place that discusses employees’ rights under the WCA and provides information on the employer’s workers’ compensation insurance policy. Employers also may not charge, harass or discriminate employees who file claims for benefits. An employer must maintain accurate records of employees who miss more than three days of work for job-related injuries and file a report with the Commission.
Punishments for Fraud and Failure to Have Insurance
Every employer must carry workers’ compensation insurance. Employees can check whether their employer has insurance with the Insurance Compliance Division. If an employer fails to have the requisite insurance, then he or she may be subject to misdemeanor or felony charges, imprisonment and fines that range from $500 to $25,000.
Employers, employees, insurance carriers and medical providers may be subject to sanctions for fraud relating to workers’ compensation claims. Those who file false claims or make false statements in connection with workers’ compensation claims may be charged with a misdemeanor or felony, imprisoned and fined $2,500 to $25,000.
Opening a Claim with the Commission
Employees may open a claim by filing three copies of the Application for Adjustment of Claim and Proof of Service with the Commission office. After a claim is filed, the worker will be provided with a case number and arbitrator for the case. Every two months, one’s case will receive a status call. A party may request a trial at that point. After three years, a case may be closed if the arbitrator has good cause to close it.
An employer has a legal responsibility to pay for all medical care that is reasonably necessary to rehabilitate the employee after an injury. Medical benefits may include the cost of medical equipment, medical devices, emergency visits, doctor appointments, surgery, physical therapy, first aid and visits to the chiropractor. Generally, the employee has the power to choose the doctor or hospital for his or her care.
Disability benefits are calculated according to a schedule. For “total” disability benefits, an employee may receive benefits for a certain period of time. “Permanent” disability benefits may be provided when the employee has suffered from a partial or total loss of a part of the body. For permanent partial disability benefits, an employee may receive a certain number of weeks paid for loss of a part of the body. For example, an employee with an amputated leg may receive benefits for 215 weeks. An employee who suffers from a thumb disability may receive benefits for 76 weeks.
Surviving family members may be eligible for benefits in the event that a worker died as a result of a job-related injury or illness. The surviving family will receive $8,000 for burial fees. Additional benefits are provided based on the greater of the employee’s gross weekly wages for the 52 weeks before the injury or $500,000. Family members may apply for cost-of-living adjustments.
Those who are interested in learning more about Illinois workers’ compensation benefits may call the Illinois’ Workers’ Compensation Commission or visit the website at www.iwcc.il.gov. Individuals may also wish to speak with an Illinois workers’ compensation attorney to receive additional assistance in filing a claim.