Articles Posted in Workers Compensation

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.

In Venture-Newberg Perini Stone and Webster v. Illinois Workers’ Compensation Commission, the injury victim appealed the decision of the Sangamon County court. The facts are close, and probably could have gone either way at the commission. In one sense, they did go both ways, with the arbitrator ruling against the victim and the commission ruling in his favor.

The claimant was a fifty year old pipe-fitter who lived in Springfield, Illinois. He was a Union member with the Plumbers & Pipe-fitter Union, Local 137. As a Union member he would bid for his job. The respondent was a contractor that was hired to perform maintenance work in Cordova, Illinois, which is between 200 to 250 miles away from Springfield, but in the range of the pipe-fitters. The positions at the Cordova Plant were temporary and expected to last a few weeks.

The claimant and his friend reported to work. The two men spent the night at a hotel which was located about thirty miles from his job site. The men were scheduled to begin work at 7:00 in the morning, so they got up at 6:00 to drive to the job site. The claimant was a passenger in the car, driven by his friend, which skidded on a patch of ice. The claimant was seriously injured in the car accident.

In Supreme Catering v. Illinois Workers’ Compensation Commission, the victim got injured in a car accident while working for Supreme Catering. The victim presented medical bills in the amount of $141,017.00 and claimed temporary total disability benefits, TTD, of $200.00 per week for 52 5/7 weeks. The respondent disputed the matter on the issue of employer-employee relationship, denying the claim for compensation. The arbitrator found that the claimant was not an employee of the employer.

The claimant filed a petition for review of the arbitrator’s decision. The commission found that an employer-employee relationship did exist between the respondent and the victim. It ordered the responded to pay TTD for 52 5/7 weeks at the rate of $200.00 per week. It also ordered the medical bills paid.

The respondent appealed the commission’s decision to the circuit court. The circuit court found that the commission had not “sufficiently explained” its decision. It remanded back down to the commission to “explain” its decision.

In April of 2012, The Illinois Auditor General, William G. Holland, released an audit of the Illinois Workers’ Compensation claims. The Auditor General found many issues with the Illinois Workers’ Compensation system. The report “Workers’ Compensation Program as it Applies to State Employees” was over 100 pages.

The audit indicated that there are “no guidelines for how much to award.” “For instance, a common injury such as carpal tunnel syndrome meant compensation for the loss of five percent use of the hand in one case and total disability in the other.” This is not correct. The workers’ compensation system has in been effect for over 100 years. To suggest that arbitrators have been guessing at values for 100 years is not accurate.

Currently carpal tunnel syndrome claims are very predictable. For instance, in the three years preceding the audit, 2009-2011, there were 199 operated carpal tunnel claims arbitrated. One hundred and sixty-four fell within 15% and 22.5% of a hand. There are some that vary more than that. However, some carpal tunnel claims are more serious than others. For instance, some people have multiple surgeries. Additionally, some people fall and break their wrist, causing carpal tunnel syndrome. These are typically valued higher than the repetitive trauma carpal tunnel claims. For un-operated carpal tunnel claims in the three years preceding the audit, there were 17 cases. Sixteen of these were 10% of a hand or under. One case was 20% of a hand.