The Illinois Workers'
Compensation Commission
Frequently Asked Questions
General Information
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
party of the workers' compensation insurance
premium or benefits can be charged to the employee.
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 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. What benefits are provided?
A. Medical Care Benefits
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. (For more information, see category "Medical
Benefits")
B. Temporary Total Disability Benefits
Employees who must
lose time from work in order to recover from 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 temporary total
disability benefits are not paid within 14 days, and the employer cannot justify
the delay in payment, the employer may be
requires to pay a penalty to the employee.
C. Permanent Disability, Disfigurement and Death Benefits
When the employee
has sustained an injury or disease which results in permanent disability,
scarring or other disfigurement,
additional benefits are provided to the employee.
If the injury or
disease results in the employee's death, certain members of the employee's
family
are entitled to benefits.
6. Who administers the law?
The Illinois Workers'
Compensation
Commission is responsible for administering the law, providing
information and assistance to employees and employers, and
resolving any disputes regarding
employees' entitlement to benefits and the amount of benefits.
The Illinois Workers' Compensation
Commission does not pay benefits--this is the responsibility of the employer.
7. Can employee be fired if 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 and employee for excising 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.
8. Are workers' compensation benefits subject to income tax?
No.
Workers' compensation payments are not subject to state or federal incomes tax
and need not
be reported on returns as income.
Reporting An Injury or Exposure
1. Who should the injured worker notify?
The employee must
inform the employer promptly. Any delay in notice to the employer can
delay
payment of benefits; a delay in more than
45 days may result in the loss of benefits. Notice to a
fellow worker who is not part of management is not
considered notice to the employer.
2. What should the notice include?
The law requires the employee to notify the employer of the date and place 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.
3. Must the notice be in writing?
Notice may be given orally or in writing.
4. 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
disease, the employee must notify the employer as soon as practicable after he
or
she becomes aware of the condition.
5. What should the employer do after receiving notice?
The employer should promptly take the following steps:
(a) Inform the
insurance carrier or administrator responsible for the workers' compensation
program.
(b) Provide all
necessary first aid and medical services and pay temporary total disability
benefits
when due.
(c) If the
employee cannot work for more than three days because of the injury, the
employer must
do on
of the following:
(i) begin payments of temporary total disability; or
(ii) provide the employee with a written explanation of what
additional information the
employer
needs before payments can begin; or
(iii) provide the employee with a written explanation of why benefits are being denied.
6. What records must the employer maintain?
Employers are required
by law to maintain accurate records of work-related deaths, injuries or
illness (other than minor injuries requiring only
first aid and not involving further medical treatment,
loss of consciousness, restriction of work, motion
or transfer to another job).
Written reports of all
job-related accidental deaths must be made to the Commission no later than
two working days following the death.
Written reports of
job-related injuries or illness resulting in the loss of more than three
scheduled
work days made to the Commission between
the 15th and 25th of each month.
Initial reports are made
on form #45, called "Employer's First Report of Injury or Illness;"
subsequent reports are made on form #85,
called "Employer's Supplementary or Final Report of
Injury or Illness."
Medical Benefits
Because prompt medical care may be essential to the employee's maximum recovery, the employee should seek medical attention immediately after the injury. The employee must cooperate in reasonable programs to assist hid or her recovery and return to work.
1. 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.
2. 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.
3. Must the employer pay all physicians 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 the bill
does not necessarily obligate the employer
to pay the bill.
If the employer refuses
to pay a medical bill, it must promptly give the employee a written
explanation of the basis for the refusal.
4. 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 own 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 doctor can result in loss of benefits.
5. 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 reasonable rehabilitative program.
The employee must choose
the provider of such reasonable vocational rehabilitation services or may
accept the service of a provider selected
by the employer.
6. What information must the employee give the employer?
The employer must given sufficient medical information to determine whether benefits are due.
7. Should the employee's doctor send medical reports to the employer?
Yes. If the
employee's doctor does not send medical reports to the employer or its service
or
insurance company, benefits may be delayed.
The report should
include sufficient information to allow the employer to determine whether
benefit
payments should be initiated, continued or
terminated; to determine whether treatment is necessary
to cure or relieve the employee from the
effects of the injury or disease; and to determine whether
the charges are reasonable.
8. Should the doctor selected by the employer send reports to the employee?
Yes. The doctor
must report the same information to both parties. The employee is entitled
to
complete copies of all medical reports and
records obtained by or in the possession of the employer.
9. If and employee changes doctors, who should be notified?
To avoid any delay in
the payment of compensation benefits and medical expenses, the employee
should notify the employer of any change in
the medical care providers.