Tag Archives: medical treatment

Illinois Workers’ Compensation: Average Weekly Wage and Rate Explained & Why is it important?

What does average weekly wage (AWW) and rate mean in an Illinois workers’ compensation case?

By Steven A. Edelman, Attorney, (314) 631-6777, Ext. 14

Temporary Total Disability(TTD): In an Illinois workers’ compensation case the amount of money that you receive each week while you are off work due to the work injury is calculated based on the injured worker’s average weekly wage and rate. This weekly payment is referred to as temporary total disability (TTD).

Permanent Partial Disability (PPD): Additionally, the amount of money that an injured worker receives in a settlement or an award for the permanent disability that they suffer due to the work injury is calculated based on the injured worker’s average weekly wage (AWW) and rate. This permanent disability is referred to as permanent partial disability (PPD)

If two cases are similar in all other respects but for the AWW and Rate, then the higher the injured workers’ AWW and Rate, the more money their workers’ compensation case is worth, and the lower the AWW and Rate, the lower the value. Therefore, it is very important to correctly calculate average weekly wage and rate.

How to Calculate Average Weekly Wage (AWW):

We first have to calculate AWW to then calculate Rate.

In most cases the AWW is calculated using the average of the injured workers wages for the 52 weeks preceding the work injury. However, there are alternate methods to calculate the average weekly wage (AWW). The law specifically states that AWW is calculated as follows:

“The compensation shall be computed on the basis of the “Average weekly wage” which shall mean the actual earnings of the employee in the employment in which he was working at the time of the injury during the period of 52 weeks ending with the last day of the employee’s last full pay period immediately preceding the date of injury, illness or disablement excluding overtime, and bonus divided by 52; but if the injured employee lost 5 or more calendar days during such period, whether or not in the same week, then the earnings for the remainder of such 52 weeks shall be divided by the number of weeks and parts thereof remaining after the time so lost has been deducted. Where the employment prior to the injury extended over a period of less than 52 weeks, the method of dividing the earnings during that period by the number of weeks and parts thereof during which the employee actually earned wages shall be followed. Where by reason of the shortness of the time during which the employee has been in the employment of his employer or of the casual nature or terms of the employment, it is impractical to compute the average weekly wages as above defined, regard shall be had to the average weekly amount which during the 52 weeks previous to the injury, illness or disablement was being or would have been earned by a person in the same grade employed at the same work for each of such 52 weeks for the same number of hours per week by the same employer.” See Illinois Workers’ Compensation Law (820 ILCS 305/10)

After we calculate AWW, we then have to calculate Rate. The calculation of the rate is different for TTD and PPD.

Temporary Total Disability: The Temporary Total Disability (TTD) Rate is calculated by taking 66 2/3% of the average weekly wage (AWW). The law specifically states: “The compensation rate for temporary total incapacity under this paragraph (b) of this Section shall be equal to 66 2/3% of the employee's average weekly wage . . .” See Illinois Workers’ Compensation Law under (820 ILCS 305/6)

Permanent Partial Disability (PPD): The PPD rate is calculated by taking 60% of the average weekly wage (AWW). The law specifically states: “The compensation rate in all cases of serious and permanent disfigurement under paragraph (c) and of permanent partial disability under subparagraph (2) of paragraph (d) or under paragraph (e) of this Section shall be equal to 60% of the employee's average weekly wage . . .” See Illinois Workers’ Compensation Law under 820 ILCS 305/8

Very often the employer and their workers’ compensation insurer will calculate the injured worker’s AWW and rate incorrectly and pay a much lower rate for TTD and for permanency. It is extremely important to consult a lawyer at the Edelman Law Office to ensure your average weekly wage and rate are correctly calculated.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under Illinois workers’ compensation law. Call us for a free consultation: 314-631-6777, Ext. 14

Steven A. Edelman, Attorney

Step by Step timeline of an Illinois Workers’ Compensation Case:

By Steven A. Edelman, Illinois workers’ compensation trial attorney

314-631-6777, Ext. 14

If you have an Illinois workers’ compensation case, then your case will typically follow the below timeline.

  1. Step 1: The injured worker suffers a work injury while in the course and scope of your employment. See Illinois Workers’ Compensation Act law 820 ILCS 305/6
  2. Step 2: The injured worker makes a written or verbal report of the work injury to the employer within 45 days of the date of the work injury. See Illinois Workers’ Compensation Act law 820 ILCS 305/6(c)
  3. Step 3: The injured worker then makes their first choice of medical provider to obtain medical treatment for the work injury. The injured worker must inform the workers’ compensation insurer and employer of their chosen medical provider. Your workers’ compensation attorney will give notice to the employer/insurer of the chosen medical provider. The choice of the medical provider is not made until the injured worker actually presents to the medical provider in an appointment. The employer/insurer will then provide and pay for this chosen medical provider through workers’ compensation. See Illinois Workers’ Compensation Act law 820 ILCS 305/8
  4. Step 4: The injured worker obtains medical treatment from their chosen medical provider until the medical provider releases them from medical care.
  5. Step 5: The injured worker completes authorized medical treatment, and the injured worker is released from all medical treatment per the order of the employee’s chosen treating doctor.
  6. Step 6: Once the injured worker’s chosen doctor has released the injured worker from medical treatment, typically the employer/insurer will obtain an independent medical evaluation (IME) from their own separate chosen doctor. This evaluation is a called a Section 12 examination, named after the section of the law where it is discussed. The employee must attend the employer’s/insurer’s Section 12 exam. See Illinois Workers’ Compensation Act law 820 ILCS 305/12
  7. Step 7: During this time after the injured worker is released form medical treatment, your workers’ compensation attorney will negotiate potential settlement of the injured worker’s case.
  8. Step 8: Pre-Trial If the parties are unable to settle, then typically a trial request is submitted. Prior to a trial, the parties are required to attend a Pre-Trial conference with the Arbitrator (Judge). Your workers’ compensation attorney along with the employer’s/insurer’s, defense attorney will then attend Pre-trial. The arbitrator will give a recommendation of the value of the case based on the medical records, and all other relevant information. The arbitrator will also potentially resolve any other disputed issues or negotiation brought before the arbitrator. The arbitrator’s recommendation is not binding on any party. If you obtain a high settlement recommendation to settle your case from the judge, the employer does not have offer the high recommendation. Likewise, if you receive a low recommendation from the judge, the the injured worker does not have to agree and accept a settlement for the low recommendation.
  9. Step 9: If the both the injured worker and the employer agree on the judge’s pre-trial recommendation, then the workers’ compensation case can be settled. If the parties do not agree on settlement at the time of the mediation, then the case will proceed to trial.
  10. Step 10: Trial: If the parties can not settle the worker’s compensation case, then the case will proceed to trial in front of a Judge. There is no jury in a workers’ compensation case. The trial typically last a few hours to one day. Some trials can last more than one day. See Illinois Workers’ Compensation Act law 820 ILCS 305 et seq.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under Illinois workers’ compensation law. Call us for a free consultation: 314-631-6777, Ext. 14

Steven A. Edelman, Attorney

Illinois Workers’ Compensation; Medical Treatment and Choice of Medical Provider Explained

Illinois Workers’ Compensation

Medical Treatment Explained in Illinois Workers’ Compensation Cases

The First Major Benefit under Illinois Workers’ Compensation Law: The first Major Benefit under the Illinois Workers’ Compensation Act is medical treatment paid for by the employer/workers’ compensation insurance company per the law 820 ILCS 305/8(a). 

Under Illinois workers’ compensation law, an injured worker has the right by law to choose two medical providers and the referrals from each of these two chosen providers are paid for by the employer/workers’ compensation insurer. The law specifically states that:

“[T]he employer’s liability to pay for such medical services selected by the employee shall be limited to:        (1) all first aid and emergency treatment; plus        
(2) all medical, surgical and hospital services

provided by the physician, surgeon or hospital initially chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said initial service provider or any subsequent provider of medical services in the chain of referrals from said initial service provider; plus
        (3) all medical, surgical and hospital services

 provided by any second physician, surgeon or hospital subsequently chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said second service provider or any subsequent provider of medical services in the chain of referrals from said second service provider. Thereafter the employer shall select and pay for all necessary medical, surgical and hospital treatment and the employee may not select a provider of medical services at the employer’s expense unless the employer agrees to such selection. At any time the employee may obtain any medical treatment he desires at his own expense.”
820 ILCS 305/8

Example:

The following is one example of facts of how an injured worker can choose his doctor in an Illinois workers’ compensation case. 

First Choice of Medical Provider:

  1. You suffer injury to your back at work.  (1) You then present to the employer’s recommended doctor, or (2) You choose your own medical provider and receive medical treatment. Whether you receive medical treatment from the employer’s recommended medical provider or from your chosen doctor, this first medical providers is designated as your first choice of medical provider, i.e. “first medical provider” under Illinois law. 
  1. Therefore, the Illinois workers’ compensation insurer will pay for this initial primary care medical provider and any subsequent medical treatment referred by them, which is considered the chain of medical treatment. 
  1. The first medical provider then refers you for a MRI of your back to be performed at a hospital near you. The MRI reveals a herniated disc in your lumbar spine. The workers’ compensation insurer must pay for this MRI as it was recommended by your initial primary care medical provider.
  1. Based on the results of the MRI, the initial primary care doctor then refers you to a specialist orthopedic spine doctor. Again, the workers’ compensation must pay for you to see the orthopedic spine doctor because this specialist was recommended by your first medical provider.
  1. The orthopedic doctor prescribes you an injection in your lower back and some physical therapy that you complete. The injection and physical therapy temporarily relieve your symptoms, but a short time later all your symptoms return. 
  1. The orthopedic doctor then recommends no further medical treatment despite your continuing symptoms and releases you from medical treatment.

Second Choice of Medical Provider:

  1. You then seek another opinion from a second orthopedic spine specialist, i.e. the  “Second medical Provider.” This second orthopedic doctor is then considered your second choice of medical provider. Therefore, the workers’ compensation insurer must pay your medical bills for you to see this second orthopedic doctor. 
  1. The second medical provider reviews your back MRI and prescribes you another three week session of physical therapy at a new physical therapy location. The insurer must pay for this physical therapy because it was recommended by your second chosen medical provider.
  1. After you complete physical therapy, the second medical provider recommends back surgery to fix your back. Again, the insurer must pay for this surgery because it was recommended by your second chosen doctor. 
  1. If you then decide that you do not want the surgery and decide that you want to obtain a second opinion from another doctor, any choice of doctor after the two above choices will then be chosen by the employer/insurer.  

It is important that you immediately contact our law office to discuss your two choices of doctors. We protect your rights and ensure that the employer pays for your medical treatment for the doctor that you have chosen. 

If you’ve been injured at work and the employer is not providing you medical treatment or the employer and workers’ compensation insurer have unjustifiably denied you medical treatment, then please immediately contact our law firm at 314-631-6777.

Steven A. Edelman, Attorney

Illinois Workers’ Compensation

The Three Major Benefits for Illinois Injured Workers under the Illinois Workers’ Compensation Law

Question: What are the three major benefits for an injured worker under Illinois Workers’ Compensation law?

The First Major Benefit under Illinois Workers’ Compensation Law: The first Major Benefit under the Illinois Workers’ Compensation Act is medical treatment paid for by the employer/workers’ compensation insurance company 820 ILCS 305/8(a). Under Illinois workers’ compensation law, an injured worker has the right by law to choose two medical providers and the referrals from each of these two chosen providers. The law states that:

  1. The employer shall pay for medical services for the employee’s First choice of medical provider and any provider in this chain of referrals from this first choice provider. 820 ILCS 305/8(a)(2)  
  2. The Employer shall pay for medical services for the employee’s Second choice of medical provider and any provider in this chain of referrals from this second choice of provider. 820 ILCS 305/8(a)(3)

The Second Major Benefit under Illinois Workers’ Compensation Law: The second major benefit under the Illinois Workers’ Compensation law is temporary total disability (TTD) 820 ILCS 305/8(b)

The Third Major Benefit under Illinois Workers’ Compensation Law: The third major benefit under Illinois Workers’ Compensation law is typically a lump sum settlement to compensate the injured worker for the permanent disability they suffer from the work injury. 

MISSOURI WORKERS’ COMPENSATION: SETTLEMENTS AND TRIAL AWARDS EXPLAINED

MISSOURI WORKERS’ COMPENSATION

Settlements and Trial Awards

The third major benefit in Missouri Workers’ Compensation cases is typically a lump sum settlement or a lump sum award from a trial judge to compensate the injured worker for permanent disability as a result of the work injury. 

  1. Settlements:

A settlement in a Missouri Workers’ Compensation case is when the injured worker agrees to accept a lump sum amount of money from the employer and workers’ compensation insurer to close their workers’ compensation.  

NOTE: Settlements must be approved by a workers’ compensation judge, who is referred to as an administrative law judge (ALJ). If a settlement contract is not approved by a judge then the settlement agreement is likely unenforceable, and the injured worker can still proceed forward with their workers’ compensation case. 

The law states under RSMo 287.390 in regards to Missouri Workers Compensation Settlements:

“Parties to claims hereunder may enter into voluntary agreements in settlement thereof, but no agreement by an employee or his or her dependents to waive his or her rights under this chapter shall be valid, nor shall any agreement of settlement or compromise of any dispute or claim for compensation under this chapter be valid until approved by an administrative law judge or the commission, nor shall an administrative law judge or the commission approve any settlement which is not in accordance with the rights of the parties as given in this chapter.  No such agreement shall be valid unless made after seven days from the date of the injury or death.  An administrative law judge, or the commission, shall approve a settlement agreement as valid and enforceable as long as the settlement is not the result of undue influence or fraud, the employee fully understands his or her rights and benefits, and voluntarily agrees to accept the terms of the agreement.

  2.  A compromise settlement approved by an administrative law judge or the commission during the employee’s lifetime shall extinguish and bar all claims for compensation for the employee’s death if the settlement compromises a dispute on any question or issue other than the extent of disability or the rate of compensation.”

  1. Trial Awards:

While many Missouri workers’ compensation cases settle with the employer/insurer, there are still many workers’ compensation cases that proceed to trial. A workers’ compensation case will proceed to trial if the injured worker and the employer and insurer can not agree on settlement terms to settle the workers’ compensation case.  In Missouri workers’ compensation cases trials are referred to as Hearings for a Final Award.

In Missouri workers’ compensation trials, there is no jury. There is only an administrative law judge (ALJ) that awards you money to compensate you for your work injury. 

If you have been hurt on the job and suffered a work injury, please call our office immediately to discuss your rights under Missouri workers’ compensation law. We work to obtain the largest settlement for you. We do not hesitate to proceed to trial if the employer and workers’ compensation insurer are unwilling to settle your case for what is fair and reasonable. 

Please call us if you have been injured on the job and have any questions about potential settlement of your Missouri workers’ compensation case. (314) 631-6777

Steven A. Edelman, Attorney

314-631-6777, Ext. 14

Authorized Medical Treatment Explained in Missouri Workers’ Compensation Cases

MISSOURI WORKERS’ COMPENSATION LAW

Authorized Medical Treatment Explained

Missouri Workers’ Compensation Law in section RSMo 287.140 states:

  1. “In addition to all other compensation paid to the employee under this section, the employee shall receive and the employer shall provide such medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines, as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury. If the employee desires, he shall have the right to select his own physician, surgeon, or other such requirement at his own expense.”

As cited in the above Missouri law, authorized medical treatment under Missouri Workers’ Compensation Law is defined as medical treatment provided to the injured worker at no cost to the injured worker. Under Missouri law, The employer and workers’ compensation insurer get to the choose the doctor and medical providers to provide medical treatment to the injured worker.

The employer’s workers’ compensation insurance company is responsible by law to pay for and provide all types of medical treatment to cure and relieve the effects of your work injury. Medical treatment provided by the employer includes, but is not limited to, x-rays, CT scans, prescription medication, MRI, physical therapy, injections, surgery, EMG Nerve Conduction Studies, psychiatric and medical treatment for mental injuries, pain management, emergency medical treatment, ambulance, prosthetic replacement of injured body parts, canes, walkers, and even in home health care where applicable.

NOTE: The injured worker does not get to choose his own doctor or medical provider. If the injured worker goes to his own doctor or medical provider, then the injured worker is likely solely responsible to pay the medical bills for his own chosen doctor.

MOST COMMON PROBLEMS FOR INJURED WORKERS:

  1. At any time during your workers’ compensation case, the employer and workers’ compensation insurer will unnecessarily delay in providing you medical treatment.
  2. The employer and the workers’ compensation insurer will deny you medical treatment based upon the employer’s workers’ compensation doctor stating that you are released from medical treatment despite the fact that you have continuing, severe symptoms that need further medical treatment.
  3. The employer and the workers’ compensation insurer will deny you medical treatment in contradiction to a doctor’s recommendation for additional medical care.
  4. It is extremely important that you contact our law office immediately to discuss your case with an experienced attorney. One of our top priorities is to get you the medical treatment which you are entitled to by law.

If you’ve been injured at work and the employer is not providing you with authorized medical treatment or the employer and workers’ compensation have unjustifiably denied you medical treatment, please immediately contact our law firm at 314-631-6777.

Steven A. Edelman, Attorney

314-631-6777

Three Major Workers’ Compensation Benefits under Missouri Workers’ Compensation Law

Missouri Workers’ Compensation Benefits:

The Three Major Benefits under Missouri Workers’ Compensation are the following:

  1. Authorized medical treatment paid for by the employer/insurer. In Missouri, the medical provider is chosen by employer/insurer, which is called authorized medical treatment. Authorized medical treatment is explained in Missouri law in the Revised Statutes of Missouri (RSMo) Section 287.140
  2. Temporary Total Disability (TTD): This is a check that you get each week you are off work because of the work injury. TTD checks are equal to two-thirds of your gross average weekly wage (AWW). Temporary total disability is explained in RSMo Section 287.170
  3. Typically a lump sum settlement or a lump sum awarded to you by the trial judge to compensate you for the permanent disability you suffered due to the work injury. See Code of State Regulations (CSR) under 8 CSR 50-1.010 et seq.

Common Problems and Issues for Injured Workers in Missouri Workers’ Compensation Cases:

Employers and workers’ compensation insurance companies often pay injured workers a lower, incorrect amount of temporary total disability (TTD) and under settle cases with injured workers who are not represented by a workers’ compensation attorney. Employers will often terminate medical treatment when it become too expensive despite the fact that you are not finished with medical treatment and require further surgery or evaluation.

Please call our office immediately to discuss your rights and benefits under Missouri law and to protect you from these common Missouri workers’ compensation issues.

Steven A. Edelman, Attorney