Open Medical In Workers Compensation Claims in Illinois

A worker is entitled to all related medical in the future, so long as they do not close out medical. The Illinois Workers’ Compensation Act (8A) says that an employer has to pay for “all the necessary first-aid, medical and surgical services, and all necessary medical, surgical and hospital services thereafter”. This was demonstrated in the recent case Dye v. Illinois Workers’ Compensation Commission.

In Dye the petitioner had a non-contested injury. She bumped her head. As a result she had headaches for some time and a small bump on her forehead. There was no fracture, but she was diagnosed with closed head trauma, a concussion, and an abrasion to her forehead. She did not treat for two years. Then she went back to a doctor. The arbitrator concluded that this doctor was the third doctor. This would have been out of the two physician rule which limits a petitioner’s medical to two doctors and the referral chains.

The commission reversed that finding holding that doctor worked with the same group as the other doctor the petitioner had treated with. Accordingly, the treatment with that doctor did not violate the two physician rule. However, the commission ruled that it was not clear whether there was observable disfigurement.

The doctor the petitioner saw wanted to do a surgery on the dent in the right forehead area to put fat there to correct it.

The Appellate Court ruled on this. The Appellate Court cited section 8A of the Workers’ Compensation Commission Act and indicates that, so long as the two physician rule is not violated, petitioner is entitled to future medical. The Appellate Court felt that the evidence was clear there was an indentation and observable disfigurement.

The ruling by the court is right. The evidence in the case, at least how the Appellate Court describes it, was strong that there was a disfigurement and a dent in the petitioner’s forehead. The respondent is required to pay for that along that it is related, reasonable, and necessary. This lasts as long as the workers lives.

Open medical is a very important right to injured workers. It gives them the right to have the workers compensation carrier pay for the medical associated with their injury for life. As long as the injured worker does not waive the right in settlement contracts they retain the right. Often it is worth going to trial just to keep medical open. If you go to trial there is no waiver of open medical and the worker can retain his or her rights. Unless a worker waives open medical, which is often done in a settlement contract, the worker retains the right to open medical benefits.

Ackerman Law Office regularly handles workers’ compensation cases. Please feel free to contact us is you have any type of workers’ compensation claim. Ackerman Law Office handles injury claims on a contingent fee. We only get paid a fee if you get paid.