Mandatory Claim Reporting Date extended to Jan 1, 2011


CMS MIR update alert advises workers' comp and liability RREs that the compliance date for claim reporting is now extended from 4-1-10 until 1-1-11, effective immediately.

  • All RREs should now be registered with the COBC, and either in or preparing for file testing. Data testing may continue during 2010, as needed.
  • All data exchange testing will be completed by December 31, 2010. RREs that have completed file data exchange testing in place are encouraged to proceed to claim reporting data exchange status.
CMS will post an updated "Section 111 NGHP User Guide" and a number of new Alerts during the week of February 22. CMS is expected to post steps that carriers and self insureds can take to assure their ongoing compliance with the Section 111 claim reporting requirements.

Chicago Workers Compensation Attorney
-- 2-19-10


Back Due Child Support Ordered Paid out of Workers Comp Settlement


Section 21 of the Illinois Workers Compensation Act (820 ILCS 305/21 (West 2008)) prohibits all liens on Illinois workers compensation arbitration awards or settlements. This section specifically provides in pertinent part:

“No payment, claim, award or decision under this Act shall be assignable or subject to any lien, attachment or garnishment, or be held liable in any way for any lien, , penalty or damages."

Under the law, very few liens are allowed on Illinois workers compensation settlements or awards. There are exceptions of course for Public Aid liens and Medicare’s lien for past related payments but generally the purpose of prohibiting liens in Illinois workers compensation is to protect the injured worker from outstanding claims to ensure that the family has sufficient money to support themselves. However, at least one case now finds that Illinois workers compensation settlements are not immune from claims for past due child support.

In a recent case of Illinois Dept. of Healthcare and Family Services v. Bartholomew (4th Dist. 12/8/09) an unmarried father was already under a wage garnishment order against his paycheck for $428 / month for child support and $85 per month for back due child support. In a further administrative order, he was prohibited from "dissipating" his workers compensation settlement of $175,000. The father agreed that the mother should receive 20% of the workers comp settlement money to pay for his current child support obligations but he contested the lien of about $9,000 claimed in back due child support and interest.

This case confirms that the Withholding Act, 750 ILCS 28/15 paragraph (d), considers “income” to mean any source of periodic payment, including workers compensation payments or settlements. Further, Section 20 (c) (3) specifically allows for withholding of “income” for past due child support.

If the workers compensation settlement is for payment for the loss of a hand, foot, leg or other injury, that money may not be considered as “income” for other purposes since it is not "earned income" but really compensation for the loss or partial loss of the worker's body parts. But here, the Illinois General Assembly and our legislators have established that it is our public policy to withhold money from statutorily defined "income" to ensure that all support judgments are enforced by all available means.

Chicago Workers Compensation Attorneys
-- 02-07-10


Illinois Temporary Disability Awarded After Termination for Cause


The Illinois Supreme Court recently upset many Illinois defense attorneys and insurance claims professionals in a hotly contested decision ruling that the employer owes temporary disability benefits even after a "firing for cause" where the worker is on light duty restrictions and has not yet medically stabilized or reached MMI.  
Illinois workers comp attorney

This case has been the subject of some spirited discussion on the Workers Compensation Forum on LinkedIn with worries that injured employees can now start fights, threaten supervisors or even commit crimes leading to their valid discharge and still be able to collect temporary total disability compensation.

For background, an Illinois construction worker, Jeff Urban, was working light duty following a legitimate heat stroke injury and returned to work on light duty when he was allegedly fired for writing religious graffiti on a store room shelf. (yes, this was the subject of an earlier post; Carpenter fired for Religious Graffiti).

It turns out that an ugly argument had erupted over an overpayment in a light duty check weeks following the graffiti incident. Although the worker had voluntarily reported the payroll error to the payroll department, he was confronted in a heated exchange about cashing and keeping the overpayment. The argument escalated when the worker called the local police to the job site to file charges of harassment against an administrative assistant whereupon he was terminated shortly thereafter.

The employer based the termination on defacement of property for writing the religious graffiti on shelves in a store room. The defacement of property would normally be a valid cause for firing in Illinois, but it came out that the graffiti occurred weeks earlier and other workers that scribbled graffiti were not similarly fired. The firing really only occurred after the heated argument over the overpayment in the light duty check which was in fact a payroll error. All temporary disability benefits were terminated following the argument and the employee's termination.

At trial, an Arbitrator denied temporary benefits after termination. The Commission however, reversed and awarded temporary disability benefits focusing on the fact that the injury had not yet stabilized nor reached MMI. They found that the worker was still temporarily disabled from his regular duty job despite the employer's argument about denying benefits over a termination for cause.

In a case of first impression, the Illinois Appellate Court considered the entitlement of a worker to temporary disability pay, or actually temporary partial disability pay, where the worker was working under light duty restrictions but fired for an unrelated cause. Interstate Scaffolding v. Workers Compensation Commission (Oct. 20, 2008, 3rd Dist App.)

The Appellate Court naturally looked to Professor Larson on Workers Compensation Law (see Larson's Worker's Compensation Law § 84.04D Physical Incapacity -- Employee's Misconduct, at 84-17 (2007).

Under prior Illinois law, the right to ongoing disability after leaving light duty employment had centered on whether the departure from light duty employment was voluntary or volitional on the worker's part or whether departure was involuntary due to the work related injury medical disability.

In reviewing cases from other jurisdictions provided by Larson's, the Interstate Appellate Court noted that some jurisdictions do deny compensation where the disability played no part in the discharge citing Palmer v. Alliance 917 So.2d 510, 514 (L.A. Ct. App.2005) and Calvert v. General Motors, 327 N.W.2d 542.546 (Mich. Ct. App. 1982) holding an employee discharged for "just cause" is not entitled to ongoing disability benefits.

Other jurisdictions however were also noted to uphold the right to collect benefits after a firing while on light duty employment only if the employee could prove that the inability to find other employment was related to the job injury disability itself, citing Cunningham v. Atlantic, 901 A.2d 956 (N.J. Super.Ct. App. Div. 2006) and Marsolek v. Hormel, 438 N.W.2d 922, 924 (Minn.1989) (that a justifiable discharge for misconduct suspends the rights to compensation unless the cause of the employee's inability to find other suitable employment is related to the work injury disability)

The Appellate Court found that there was no evidence that the employer terminated the worker merely to avoid paying disability benefits, but rather that it was the worker's own volitional conduct in defacing company property that was the real cause for discharge. The employee would have continued to receive benefits until medically stabilized but for his own misconduct. Accordingly, a divided Appellate Court found temporary benefits after the termination were properly denied.

You can contrast this decision with other recent Illinois Commission decisions in Wleklinski v Kelly Services (08 IWCC 254, March 2008) where a temporary worker at RR Donnelly suffered a wrist sprain accident on 11/14/06 with immediate notice and immediate medical care. The employer terminated the worker for leaving her machine early and failing to punch out on the day of the accident. The employer refused to pay any temporary disability benefits claiming a valid termination and they failed to provide any suitable light duty work. The arbitrator awarded temporary disability benefits and a total of $7,616.07 in penalties and attorneys fees stating that merely severing the employment relationship was not sufficient to sever the employer's obligation to provide ongoing temporary total benefits for an undisputed accident.

In Sapp v Wal-Mart (06 IWCC 459 , May 2006) a 37 year old cashier had an uncontested low back injury lifting a fan into a shopping cart. She was subsequently terminated for absenteeism while on light duty. The arbitrator denied benefits after the termination but the Commission reversed and awarded temporary benefits. The Commission focused on the test for determining ongoing entitlement to disability benefits following the termination as whether the medical condition had reached Maximum Medical Improvement and not just whether the cashier was capable of working light duty. Accordingly, the Commission awarded temporary disability benefits following the termination.

The Illinois Commission previously decided Alicea v. Sysco (06 IWCC 596, July 2006), wherein a 42 year old working for Sysco Food Services injured his right shoulder in an undisputed accident and underwent surgery for a shoulder dislocation but the employer previously fired him for violation of a safety rule during the accident. The employer then denied benefits entirely during a light duty release to return to work arguing that the safety rule violation termination barred the right to temporary disability benefits altogether. The Arbitrator held and the Commission affirmed that the termination based upon the safety rule violation did not entirely remove the worker from the sphere of employment and they awarded entitlement to temporary disability benefits.

Our Illinois Supreme Court considered the question of an employee's "discharge for cause" as a basis for denying temporary disability benefits. The Court looked to the law found in the Illinois Workers Compensation Act and found no statutory authority to justify denial, suspension, or termination of TTD benefits based upon an employee's discharge by his employer for unrelated causes. Interstate Scaffolding v. Workers Compensation Commission. (1-22-2010, Docket # 107852)The "test" according to the Court is, was and always has been whether the employee "remains temporarily disabled" as a result of the work related injury and "whether the employee is capable of returning to the work force."

They noted that the Illinois Workers Compensation Act supports suspension or termination of disability benefits for (1) refusing reasonable medical treatment, (2) for failing to cooperate with rehabilitation efforts or (3) for refusing work which falls within the treating doctor's restrictions however they concluded that no statutory basis exists in the Act for terminating benefits following an unrelated discharge for cause.

The Illinois Supreme Court was emphatic in stating that Illinois is an employment "at-will" state and an employee may be discharged for any reason or no reason at all, but whether the discharge is for a valid cause or whether the discharge is somehow discriminatory are simply matters foreign to Illinois Workers Compensation. The entitlement to ongoing temporary disability compensation is wholly a separate issue and not dependent upon the propriety of the discharge.

There are plenty of laws that govern whether a termination is
proper or wrongful but that issue is not necessarily for the Commission to decide. Its their given job to decide if someone is temporarily disabled from a work related injury and not the propriety of the firing.

According to the Supreme Court, where an employee has been fired for unrelated cause by his employer, the test for deciding entitlement to ongoing TTD benefits remains whether the employee has medically stabilized or whether the employee continues to show that he is temporarily totally disabled from regular work.

Since the Commission found that this employee proved that he remained temporarily totally disabled from regular work as a result of his work injury and he proved that he had not yet reached maximum medical improvement,
the Commission's award of ongoing temporary disability benefits was sufficiently supported by the evidence even in the face of an alleged "termination for cause".

This decision is not to say that the Illinois Workers Compensation Commission won't deny temporary disability benefits in the future where the facts demonstrate that some volitional act of the employee removes him or her self from light duty employment but rather, that a discharge for cause is not a basis for automatic suspension, denial or termination of temporary total disability benefits under the Illinois Workers Compensation Act

Chicago Workers Compensation Attorney
-- 2-03-10