Getting Your Medical Bills Paid Through Worker’s Compensation
Pam: Barry, you had mentioned that there are three basic benefits in every worker’s compensation case. Can you go through those again?
Barry: Sure, the first of these is payment of your medical expenses. It gives you access to quality medical care. The second is temporary total disability, this is the two-thirds your average weekly wage while you’re off. The last one is the lump sum settlement called permanent partial disability which is the settlement you get at the end of the case and it’s associated with the permanent nature of the injury.
Pam: When you say that people get their medical expenses paid for, is that different from health insurance?
Barry: They’re totally different. In fact, most health insurance policies have a provision in them which specifically excludes work related injuries from coverage. So you can’t use your health insurance if you have an on the job injury. If you think about it makes sense from the health insurer’s perspective because they know that when you’re hurt on the job, there’s a legal requirement for your employer to have workers compensation insurance and one of the benefits that’s going to be provided for is the payment of medical expenses.
So another way that the worker’s compensation medical benefit is different from health insurance is that you’re actually covered your first day on the job with workers compensation. It’s not like health insurance where you have to be on the job 30 days or 60 days before you become eligible for health insurance through work. Now that’s not to say that if you get hurt your first day on the job, the worker’s compensation carrier is going to be eager to pay that claim because that sets off all kinds of alarms with the insurance companies to the legitimacy of the claim but you are in fact covered your first day on the job. I’ve had cases I’ve worked on where somebody has been hurt literally their first day on the job and they’ve been covered by worker’s compensation.
The other way that worker’s comp is different from health insurance is that health insurance ultimately is funded at least in part through deductions from your paycheck. You aren’t required to pay anything to be covered by worker’s compensation insurance, that’s something that your employer’s required to carry as a condition of having employees in the state of Illinois.
Pam: So then how do you find a doctor with workers comp?
Barry: Illinois is actually a pretty favorable environment for workers who’ve been hurt on the job. Now workers comp is a question of state law. Every states workers compensation system’s a little bit different and some states give more control over your medical care when you have an on the job injury to your employer. Some states actually allow your employer to really direct who you can and who you can’t see.
Now with the Illinois system is a little bit different in this regard in that you’re allowed to choose your own doctor. You’re allowed one doctor choice. Okay? Now if you go to see, let’s just say a primary care specialist after you’ve hurt your back lifting something on the job, if they refer to you to physical therapy, that’s still part of that one choice. If physical therapy doesn’t do you any good and they send you for a MRI, that’s still part of that one choice. If the MRI comes back and shows that you’ve got a herniated disc in your back and your primary care doctor says this is out of my league, you need to go see a specialist and he refers you to a specialist, as long as you have a referral from that first doctor, that’s all going to be considered part of your one choice.
So, you get to start that one chain of referrals at one point during the course of your care. The other option for you in terms of getting care is employers and their insurance company are allowed to set up panels and you can go see doctors outside that chain of referrals who are part of the panel that’s designated by your employer and their insurance company. So that’s another option that’s available to you should you be hurt on the job. The basic idea with the workers compensation medical benefit is that it’s going to give you access to quality care for care that’s related to the accident. Okay? That’s often an important issue and it’s something that sometimes is contested. But the idea behind all this is that you get access to quality medical care which allows you to get back to work doing what you did for a living and really returning to living as normal a life as you could before you were hurt on the job.