WORKER’S COMPENSATION
Workplace injuries in Illinois are covered by worker’s compensations
laws. Benefits are paid to the
employee regardless of fault. Let
me say that again, fault is not an issue. Only
two questions are relevant: was the employee injured, and did the injury occur
during the employee’s job performance.
1. What is workers’
compensation?
Workers' compensation is a
system of benefits provided by law to most workers who have job-related injuries
or diseases. These benefits are paid regardless of fault. The amount of the
benefits is limited by law.
2. Who is covered?
Almost every employee who is
hired, injured or whose employment is localized in the state of Illinois is
covered by workers' compensation. These employees are covered from the moment
they begin their jobs.
3. Who provides the
benefits?
The employer is responsible for providing benefits. The employer pays the benefits either directly or through a service or insurance company that administers the program for the employer. No part of the workers' compensation insurance premium or benefits can be charged to the employee. The employer must post a notice in the work place indicating the name, business address and business telephone number of the person, service company or insurance company (including the insurance policy number) to contact for questions relating to workers’ compensation.
4. For what injuries
and diseases are benefits paid?
In most instances, workers’
compensation benefits are paid for accidental injuries that are caused, in whole
or in part, by the employee’s work. Workers may also be compensated for
aggravation of a pre-existing condition. Injuries are accidental if they happen
unexpectedly,
without plan or design. This
includes injuries brought on by the repetitive use of a part of the body, as
well as strokes, heart attacks or any other physical problem caused by work.
Injuries suffered in
employer-sponsored recreational programs (e.g., athletic events, parties,
picnics) are not covered unless the employee is ordered by the employer to
participate. Accidental injuries incurred while participating as a patient in a
drug or alcohol rehabilitation program are not covered.
5. Can an employee be
fired because he or she reported an accident?
It is against the law for the employer to harass, discharge, refuse to rehire or in any way discriminate against an employee for exercising his or her rights under the Workers' Compensation or Occupational Diseases Acts. Such conduct by the employer may give rise to a right to file a separate suit for damages in the Circuit Court..6
6. Are workers'
compensation benefits subject to income tax?
7. Who should the
injured worker notify?
The employee must inform the
employer promptly. Any delay in the notice to the employer can delay the payment
of benefits; a delay of more than 45 days may result in the loss of all
benefits. Notice to a fellow worker who is not a part of management is not
considered notice to the
employer.
8. What should the
notice include?
The law requires the
employee to notify the employer of the date and place of the accident, if known.
To avoid possible delays, it is recommended that the notice to the employer also
include the employee's name, address, telephone number and Social Security
number, and a brief
description of the injury,
accident or disease.
9. Must the notice be
in writing?
Notice may be given orally
or in writing.
10. What are the time
limits for notifying the employer?
For accidental injuries,
within 45 days after the accident. For injuries resulting from radiological
exposure, the employee must notify the employer 90 days after the employee knows
or suspects that he or she has received an excessive dose of radiation. For
occupational diseases, the employee must notify the employer as soon as
practicable after he or she becomes
aware of the condition.
11. Can the employee
choose the treating doctor or hospital?
Yes. An employee may choose
any doctor or hospital at the employer's expense. It is recommended that the
employee inform his or her employer in writing of the name and address of the
doctor or hospital chosen. An employee may also obtain treatment from a doctor
or
hospital selected by the
employer. Under some circumstances, the employee may rely upon
treatment by prayer or
spiritual means alone.
12. Is there a limit
to the number of doctors an injured employee may select at the employer's
expense?
Yes. The employer’s
responsibility is to pay for all first aid and emergency services, two treating
physicians, surgeons or hospitals of the employee’s choice, and any additional
medical care providers to whom the employee is referred by the two physicians,
surgeons or hospitals.
Thereafter, the employee
must obtain the employer’s approval of additional doctors or hospital
services. If the employee chooses to see any other medical care providers not
approved by the employer, the employer is not required to pay for their
services. Emergency and first aid care will not be considered one of the
employee's two choices of doctors.
13. Must the employer
pay all physician and hospital bills?
If the treatment provided is
reasonably required to cure or relieve the employee from the effects of the
injury or disease, and the provider of the services has given the employer the
information required by law, the employer is required to pay all reasonable
charges. If these requirements are not met, the fact that the employee has
already paid all or part of a bill does not necessarily obligate the employer to
pay the bill. If the employer refuses to pay a medical bill, it must
14. Can the employer
ask for an evaluation by its own doctor?
Yes. If an employee claims
to be entitled to benefits and the employer asks for an examination by a doctor
of its choice, the employee must undergo the examination at a reasonable time
and place. The employer must pay for this examination. In addition, the employer
must pay, in advance, sufficient money to defray travel expenses by the most
convenient means and the cost of meals necessary during the trip. If the
employee loses time from work, the employer must provide reimbursement for lost
wages. An employee's refusal to be examined by the employer's
15. What if an
employee cannot return to the same occupation after an injury or exposure and
cannot earn as much money?
The employee may be entitled
to receive a wage differential. The wage differential is two-thirds of the
difference between the amount the injured worker is able to earn and the amount
he or she would be earning in the occupation in which the employee worked at the
time of the accident.
An employee may be
compensated for either the loss of wages or a permanent disability related to
the same injury or exposure.
16. Is the employee
entitled to vocational rehabilitation?
Where appropriate, the employer must pay for treatment, instruction and training necessary for the physical, mental and vocational rehabilitation of the employee, including all maintenance costs and incidental expenses. The employee must cooperate in a reasonable rehabilitative program. The employee may choose the provider of such reasonable vocational rehabilitation services or may accept the services of a provider selected by the employer.
17. What benefits are
provided?
First, the injured employee
is entitled to receive all necessary first aid, medical, surgical and hospital
services reasonably required to cure or relieve the effects of the injury or
disease. Where necessary, the employee is also entitled to receive appropriate
physical, mental or vocational
rehabilitation.
Second, employees who must
lose time from work in order to recover from the injury or disease are entitled
to receive weekly payments until they are able to return to work that is
reasonably available to them. The payments represent two-thirds (66 2/3%)
of the employee’s average weekly earnings during the year before the accident
or last exposure, subject to certain limits. No compensation is payable for the
first three working days, unless the lost time continues for 14 or more calendar
days from the date of injury. If these benefits are not paid within 14 days, and
the employer cannot justify the delay in payment, the employer may be required
to pay a penalty to the employee. If
an employer stops or withholds payment of these benefits before the employee has
returned to work, the employer must give the employee a written explanation for
this action no later than the date of the last payment. Failure to provide this
notice may result in assessment of penalties against the employer, as well as an
order to pay the employee’s attorney fees. If an employer unreasonably delays
payment or fails to pay these benefits, the employer may be required to pay a
penalty to the employee.
These include permanent
partial disability benefits, permanent total disability benefits, and survivor’s
benefits.
A permanent partial
disability is the complete or partial loss or loss of use of a part of the body,
or the partial loss of use of the body as a whole. “Loss of use” is not
specifically defined in the law, but it generally means the employee is unable
to do things with the body part or with the body as the whole that he or she was
able to do before the injury.
1. When are PPD
benefits paid?
Permanent partial disability
benefits are paid only if the job-related injury or disease results in some
permanent loss or loss of use of a part of the body or the whole body. Not all
injuries and diseases result in permanent partial disability. PPD benefits will
be paid only after the employee's condition has reached a point where it will
not improve any more.
2. How is the amount
of PPD benefits determined?
On a case-by-case basis, the
Industrial Commission evaluates the physical impairment and the effect of the
disability on the injured worker's life. Factors that may be considered include
the individual's age, skill, occupation, training, inability to engage in
certain kinds of work or
activities, pain, stiffness
or limitation of motion.. There are two ways in which PPD benefits may be
determined. In the first method, the amount depends on the part of the body
injured and the extent of the loss. The law places a value on certain body
parts, expressed as a number of weeks of compensation for each part. The number
of weeks provided for the various parts of the body are listed in the following
chart. If a body part is amputated, or if it cannot be used at all because of
the injury, the employee is paid at his or her weekly rate for the number of
weeks the law has set. Compensation for a partial loss of use is calculated by
multiplying the percentage of loss by the number of weeks listed. Alternately,
if the disability imposes certain limitations on an employee, he or she may be
entitled to the percentage of 500 weeks that the partial disability bears to
total disability.
Permanent Partial Disability
Benefits For 100% Loss of Use Body part Weeks Paid
The thumb 70
The 1st (or index) finger 40
The 2nd finger 35
The 3rd finger 25
The 4th finger 20
The great toe 35
Each other toe 12
The hand 190
The arm 235
The foot 155
The leg 200
The loss of one testicle 50
The loss of both testicles 150
The sight of one eye 150
The removal of one eye 160
The hearing of one ear:
Due to an accident or trauma 50
Due to an occupational disease 100
The hearing of both ears 200
Fractures resulting in permanent disability: Not less
than
Skull fracture 6
Fracture of a facial bone 2
Fracture of a vertebra 6
Fracture of a spine or transverse process 3
Removal of a kidney, spleen or lung 10
Loss
of a part of the thumb, finger or toe up to the first joint from the tip is
considered loss of one-half the digit, e.g., 35 weeks for half a thumb. Loss
beyond the first joint is considered 100% loss of the digit. If an arm is
amputated above the elbow, the employee is entitled to 250
weeks
of compensation. If an arm is amputated at the shoulder joint and no artificial
arm can be used, the employee is entitled to 300 weeks of compensation. If a leg
is amputated above the knee, the employee is entitled to 225 weeks. If a leg is
amputated at the hip joint and no artificial leg can be used, the employee is
entitled to 275 weeks of compensation
3. How are
disabilities not listed on the chart compensated?
An employee who sustains a
permanent injury or impairment to parts of the body not listed in the chart is
entitled to the percentage of 500 weeks that the partial disability bears to
total disability.
4. What if an injury
causes a disfigurement?
An employee who suffers a
serious and permanent disfigurement to the hand, head, face, neck, arms, legs
below the knee, or chest above the armpits as a result of a job-related injury
is entitled to benefits for up to 150 weeks at the PPD rate. An employee may not
collect compensation for
disfigurement and PPD benefits for the same body part. Unless a settlement has been reached at an earlier date, the employee must wait at least six months from the day of injury for a hearing to determine if a disfigurement resulting from the accident is serious and permanent..19
A permanent total disability
is defined as a complete disability which renders the employee permanently
unable to do any kind of work for which there is a reasonably stable employment
market; or the
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 arm.
1. How long is the PTD
benefit paid?
An employee who is
permanently and totally disabled is entitled to benefits for life.
If an employee who has been
assigned PTD benefits returns to work or is able to return to work, benefits may
be terminated or modified.
2. How is the PTD
benefit determined?
The benefit is two-thirds
(66 2/3%) of the employee’s gross
average weekly wage. The average is based on the employee’s wages during the
year before the injury or exposure, subject to certain limits. PTD recipients
are also entitled to additional payments four times a year, beginning in the
second year after the award, which reflects the increase in the statewide
average weekly wage during the preceding year. These payments are made from the
Rate Adjustment Fund, administered by the Industrial Commission.
3. What is the minimum
PTD benefit?
The weekly benefit cannot be
less than 50% of the statewide average weekly wage at the time of the injury or
last exposure.
4. What is the maximum
PTD benefit?
The maximum benefit can be
no more than 133 1/3% of the statewide
average weekly wage at the time of the injury or last exposure.
1. Who is entitled to
survivors’ benefits?
If the injury or disease
results in the death of the employee, full benefits are paid to the spouse
and/or children. Benefits are paid to children until age 18; or until age 25 if
a full-time student; or, if physically or mentally incapacitated, for the
duration of the incapacity. If there is no eligible spouse or child, the
benefits will be paid to totally dependent parents. If the spouse remarries and
there are no children at the time of remarriage who are entitled to benefits,
the spouse is entitled to a final lump sum payment equal to two years of
compensation. All rights to further benefits are extinguished. In cases where
there is no eligible spouse, child or totally
dependent parent, benefits
may be paid to other survivors, such as partially dependent children, parents,
grandparents, grandchildren or other heirs who were at least 50% dependent on
the employee. The benefit for such individuals will depend on the degree of
their dependency.
2. How is the amount
of the survivors’ benefit determined?
The benefit is two-thirds
(66 2/3%) of the employee’s gross
average weekly wage. The average is based on the employee’s wages during the
year before the injury or exposure, subject to certain limits. In addition,
beneficiaries who have been awarded a survivors’ benefit are entitled to
payments from the Rate Adjustment Fund in the same manner as those awarded
permanent and total
disability benefits.
3. What is the minimum
survivors’ benefit?
Subject to reductions for
partially dependent individuals, the weekly benefit cannot be less than 50% of
the statewide average weekly wage.
4. What is the maximum
survivors’ benefit?
The maximum benefit can be
no more than 133 1/3% of the statewide
average weekly wage at the time of the injury or last exposure
5. Is there a limit to
the total amount payable for a survivors' benefit?
Yes. The survivors’ benefit is limited to 20 years of weekly benefits or $250,000, whichever is more.
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