Illinois Worker's Compensation - Help For Injured Illinois Workers

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  1. #1
    Join Date
    Feb 2007
    Posts
    2

    Default Re: Do you have a W/C question

    I've been out of work since November and have gotten a workers comp check for a total of 4 days. Workers comp refuses to pay until they get a second opinion which they finally informed me of in Jan. after they ran out of other excuses. The owner of the company that I work for has already acknowledged to the insurance company it is a work related injury. But I was told i need a second opinion. My primary doctor has indicated I had arthritis and the bones in my spine when pointed and pinching my nerves thus causing me to feel pain down my arms and back.
    I do alot of heavy lifting and repetition in my job, I've been told the insurance company can deny my claim since arthritis is usually not work related. My doctor indicated in some case like he believes mine is that heavy lifting and repetitive lifting can cause arthritis and the bone structure is definately something brought on by injury.
    My worry is that i will be denied my claim and be out of 4 months of wages plus any future earnings especially since the doctor will not release for work because of all the medications i am taking. Can the workers comp insurance deny me and if so do i have any recourse?

  2. #2
    Join Date
    Feb 2007
    Location
    chicago area
    Posts
    27

    Default Re: Do you have a W/C question

    First of all, with it being a workers' comp. claim, why did you go see a primary doctor and not an orthopedic or neurological specialist, experienced in industrial accidents or injuries? Have your primary doctor immediately refer you to an orthopod or a neurologist, and make sure you provide the specialist with a detailed job history and job description. If comp. won't cover the referral, then put it under your group health insurance, for now.

    If you only received 4 days TTD since November, when did you realize you had a problem? It should have been on the 5th day!!!!

    As to waiting for the insurer to get a second opinion, based on what you said regarding the first 2 issues I presume you are not represented by an attorney. By not pushing the matter, thru counsel, in November and December and January, you permitted the employer's insurer time to get their quack doctor on board and give them ammunition against you.

    As to worrying that you may be denied your claim and being out 4 months of wages plus any future earnings. Well, all I can say is if you do not have an attorney, get an attorney NOW!!!! If you do have an attorney, and retained him or her back in November, December or January, then it sounds like they are not helping you to aggressively pursue this matter and it might be time to seek a more aggressive attorney.

    As to whether workers' comp can deny you... It looks like they did deny you, and are denying you, and will be denying you in the future. GET A LAWYER NOW !!!!! Good Luck.

  3. #3
    Join Date
    Feb 2007
    Posts
    2

    Default Re: Do you have a W/C question

    The workers comp insurance assigned me a IME in Jan. I went to my primary doctor after i saw a workers comp doctor once, who basically just gave me medicine and said to see him in 2 weeks and to go back to work in 3 days, After i kept having pain i made an appointment with my reg doctor and that is where the problems began, even though my doctor was submitting info to my job and insurance co. the insurance co claimed they never got it.
    Test were done but nothing was found til the MRI in Jan and that is when an IME was assigned to me.
    Went to see their doctor yesturday and their doctor who is still in school said it was just a sprain and when I told her what my doctor said she went back looked at the mri and said she saw the arthritis but it was a small amount and no bone damage.
    I'll will be seeing an orthopeditc specialist that my doctor referred me to in mid march. I asked for a copy of what their doctor said so i can show my doctors but I was told that I would have to ask my insurance case worker for it.
    Their doctor said it was ok to go back to work with a 20 lb restriction but my doctor said it would be a bad idea because if the nerve is damaged too much I can be paralyzed. So since I recieved no paperwork to give my job I have not returned to work.
    So at this point I'm waiting to hear from my insurance rep to see what she says. I was told by the IME that I should recieve a check for back pay in a couple weeks since it is work related and comfirmed by their doctor. She also told me I needn't go to my other appointment with my specialist which I informed her I will be keeping that appointment.
    I waited on getting an attorney because I just wanted to get better and didn't want to make it seem like I was in it for money plus I was ignorant enough to keep believing the insurance rep when she kept having an excuse on why payments hadn't started.
    So now I'm stuck between diagnoses. I will be happy if my specialist has the same diagnoses as their doctor because my injury wouldn't be so severe but somehow I don't think that would be likely. Do I have any recourse if my specialist confirms my primary doctors diagnoses?

  4. #4
    Join Date
    Feb 2007
    Location
    chicago area
    Posts
    27

    Default Re: Do you have a W/C question

    As to any recourse, you have no recourse if you do not have an attorney. As to lost wages, if their doctor said go back to work and you failed to attempt to, then you may not have recourse as to lost wages. You always have to make a good a faith attempt to return to work with in restrictions set by IME doctors. At least give it a try, before running back to your treating Dr. and getting an overriding note or revision on restrictions. Failure to attempt to return to work, as suggested by an IME doctor, justifies termination and no payment of benefits. So if you haven't attempted to work within the restrictions, confirm that no light duty work exists and/or if it does, get into work and attempt to do it and then go back to your doctor if you have problems.

    As to filing a 19(b) motion, I could tell by what you previously posted that you probably were not represented. You can't file a 19(b) motion until you have formally filed before the industrial commission. Since no attorney, it cannot be done. Even with a filed 19(b) motion, you would not prevail at this time. You have nothing saying you cannot work and nothing formally saying your condition is work related. Get an attorney NOW. You have a right to be represented and your failure to seek legal counsel immediately may have ruined your chances to prevail. Every day you wait makes it that much more difficult. Quit relying on good faith and people to do the right thing... God helps those who help themselves. Good luck

  5. #5
    Join Date
    Feb 2007
    Location
    chicago area
    Posts
    27

    Default Re: Arthritis and Workers Comp Claims

    File a claim on your own with the Industrial Commision? He who represents themselves has a fool for a client. Get an attorney. You have to many issues here to be playing lawyer.

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