Workplace accidents happen every day. As a result, workers’ compensation is available for most injured workers. If you have suffered a workplace injury, or have developed an occupational illness, you may be eligible for workers’ compensation benefits. Unfortunately, many employees do not understand the process or how it works. Below we have put together a guide to help you.
If you are unsatisfied with the amount the insurance company has offered after a workplace injury, you will need to obtain an experienced attorney to obtain a better settlement. For injuries in Illinois and Missouri, contact our workers’ compensation lawyers with JSK.
How Do Workers’ Compensation Claims Work?
You must follow a specific process if you wish to obtain financial compensation or a settlement after a workplace injury. If the insurance company fully or partially approves your claim, you can receive at least a portion of the benefits you need. If the insurance provider denies your claim, you might not receive any benefits at all.
As soon as you sustain an injury or occupational illness, the workers’ compensation process starts. Throughout the process, you will face many deadlines. The first and most crucial is reporting your work injury. In Illinois, you have 45 days to report an injury to your employer. In Missouri, you only have 30 days to report. You should always report any injury as soon as possible and notify your employer in writing if possible. Please keep a record of the notice in the event that it is contested.
You will also need to prove to the insurance provider you were injured at work. For this, you will need to collect important evidence and talk with witnesses that will help prove your case. Workers’ compensation is a no-fault system, so it is important to include all evidence within your claim, even if it shows you were partly to blame. You will also have to prove the total cost of your medical bills, as well as the nature and severity of your injuries. Medical reports, x-rays, doctors’ notes, and medical invoices are all very valuable pieces of evidence when proving the elements of a workers’ compensation claim.
Your employer and their insurance provider will likely conduct an investigation to confirm the accident and resulting injury. After the investigation, the insurance company is required to inform you whether they approved or denied your claim. Often the insurance company will send you a formal looking letter indicating that they are denying your claim. Please note that the insurance is not the final say in such situations. You can fight the denial and have your case heard by a Judge/Arbitrator who will determine if your injury is work-related. The experienced lawyers at JSK have been fighting these denial of benefits for decades.
Benefits Available in Workers’ Compensation Claims
Under the workers’ compensation laws in both Illinois and Missouri, benefits should cover all of your medical costs. In Illinois, you can choose the physician you wish to see, but in Missouri, the employer has the right to choose your doctor for you. However, in Missouri, if the employer abandons their right to chose the medical care provider, you may be entitled to chose your own doctor.
The benefits you may receive will fall into five different categories in Missouri and six in Illinois. You must meet the criteria in each category to obtain the full benefits you deserve. When you meet the criteria, your employer is responsible for making some of the first benefits payment within days of receiving notice that you were hurt. The five categories of benefits available are as follows:
- Medical treatment: Your employer is responsible for paying for your medical treatment related to your work injury.
- Temporary partial disability benefits (TPD): If you can return to working lighter duties, for less pay or less hours, and your employer accommodates your medical restrictions, you can receive benefits for temporary partial disability. The amount you receive will depend on the difference in pay you are currently receiving for the modified work, and the full amount you would be eligible for in TTD benefits. When you go back to full capacity work or reach maximum medical improvement, benefits will usually stop.
- Temporary total disability benefits (TTD): If you are unable to return to work, or if your employer does not accommodate light duty restrictions, you are eligible for TTD benefits. These benefits are calculated at 2/3 of your average weekly wage. The calculation is different in Missouri and Illinois.
- Permanent partial disability benefits (PPD): If you are permanently impaired in a workplace injury, such as if you lost a limb, you can receive permanent partial disability benefits. The amount of benefits you can receive will depend on the severity of your injury. Generally speaking, your injury will be assigned a certain number of weeks. That number is then multiplied by the amount you are entitled to depending on your average weekly wage. These benefits will usually come into effect after you have reached maximum medical improvement. You can claim these benefits even if you are receiving other benefits under workers’ comp.
- Permanent total disability benefits (PTD): If your injury is so severe it causes a serious disability and you cannot return to work, you may be entitled to receive PTD benefits. These are considered lifetime benefits, so you can receive them for the rest of your life.
- Wage differential: In Illinois, and only in Illinois, if your work injury leaves you with permanent work restrictions that removes you from your profession and negatively impacts your income, the insurance may be responsible for paying you 2/3 of the amount that you would be making if you were still in the same profession as compared to the lower amount that you are receiving in your new post-accident profession.
What is a Workers’ Compensation Settlement?
If an injury sustained in the workplace results in a permanent or partial disability, your case will likely end in a settlement. The insurance company may not offer a settlement if you do not work with a workers’ compensation lawyer or if you go back to work fairly soon after the injury. If you cannot return to work though, and you are working with a knowledgeable attorney, you may be entitled to a settlement that will account for your current and future loss of wages and earning capacity.
A settlement offer may be made directly by the insurance company and can have many advantages such as allowing you to obtain the benefits you need more quickly. However, each injury has a range of settlement value. In order to obtain the fullest amount that you are entitled under the law, you will need the assistance of an experienced attorney. Please note that the insurance company will never offer you the full value of your case if you are unrepresented because they know that most injured workers are unaware of the true trial value of their cases.
Further, any settlement must include the payment of all medical bills as well as prospective medical care. This element of a settlement requires that the individual call of the medical providers to confirm that the bills have been appropriately paid. Once you accept a settlement offer and it is approved, you forfeit your right to take any further legal action. You will not be able to file another workers’ compensation claim for the same injury nor will you be able to sue your employer. As a result, it is recommended that you confer with an experience attorney before accepting any offer from the insurance company.
Should You Accept or Refuse a Settlement Offer?
It is important to review any settlement offer made by the insurance company very carefully. You have to make sure any settlement offer will fully cover the cost of your injuries. An experienced workers’ compensation lawyer in Illinois or Missouri can help determine when a settlement offer is fair.
The length of time it will take to finalize a settlement offer will depend on whether you accept or reject a settlement offer. You may be very tempted to accept the first settlement offer you get. However, it is nearly impossible to know what your injuries will cost before you are finished treatment. Even though accepting the first offer will mean receiving the benefits you need more quickly, it may not fully cover your expenses.
Not All Workers’ Comp Claims End in a Settlement
If you feel as though the insurance company refuse to offer a fair settlement, you should seek legal assistance with an experienced workers’ compensation attorney as your next step is to proceed forward to trial to have a judicial determination on the value of your case. Your employer will also attend and each will have the chance to present evidence and arguments to the arbitrator. You will testify about the accident and the resulting ongoing problems. The insurance company will cross-examine you and may call their own witnesses. A court reporter will also be in attendance so they can record everything that is said at the hearing.
After each side has presented their case, the Judge/Arbitrator will then make a decision. Their decision will include whether you deserve workers’ compensation benefits and if so, the amount you are entitled to receive.
Workers’ Compensation Settlements Must Be Finalized
Simply accepting a workers’ compensation settlement does not make it final. The settlement must be sent to the Judge/Arbitrator that oversees these offers. Along with the settlement offer you should include your medical expenses and medical documents.
As long as you include the important documents associated with your settlement, the agency will likely review and approve the settlement fairly quickly. The settlement is considered final after the government agency approves it. You should never get this far in the process if you are in any way uncomfortable with the offer. You cannot go back to claim more in benefits in the future once the settlement is finalized.
Call Our Workers’ Compensation Lawyer in Illinois and Missouri Today
Although the vast majority of workers’ comp cases end in a settlement, this is not always true. At the Law Office of Jerome Salmi Kopis, our Illinois and Missouri workers’ compensation lawyer can negotiate a fair settlement on your behalf and review any offer you are given to ensure it is fair. Call us today at (618) 726-2222 or contact us online to schedule a free consultation with one of our skilled attorneys.