Mandatory Claim Reporting Date extended to Jan 1, 2011

2-19-10

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

2-07-2010

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

2-03-2010

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.  

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

Illinois Construction Workers Presumed to be Employees

9-05-09

New laws apply to employers and contractors in the construction industry eff., January 1, 2008. Illinois Attorney General Lisa Madigan is now prosecuting non-compliant employers under the new law. All construction workers working for construction contractors after January 1, 2008 are presumed to be employees of the contractor by law unless they meet the specific exceptions listed in (b) and (c) below as set out in Section 10 of the new Employee Classification Act.

(820 ILCS 185/10)
Sec. 10. Applicability; status of individuals performing service.

(a) For the purposes of this Act, an individual performing services for a contractor is deemed to be an employee of the employer except as provided in subsections (b) and (c) of this Section.

(b) An individual performing services for a contractor is deemed to be an employee of the contractor unless it is shown that:

(1)the individual has been and will continue to be free from control or direction over the performance of the service for the contractor, both under the individual's contract of service and in fact

(2) the service performed by the individual is outside the usual course of services performed by the contractor; and

(3) the individual is engaged in an independently established trade, occupation, profession or business; or

(4) the individual is deemed a legitimate sole proprietor or partnership under subsection (c) of this Section

(c) The sole proprietor or partnership performing services for a contractor as a subcontractor is deemed legitimate if it is shown that:

(1) the sole proprietor or partnership is performing the service free from the direction or control over the means and manner of providing the service, subject only to the right of the contractor for whom the service is provided to specify the desired result;

(2) the sole proprietor or partnership is not subject to cancellation or destruction upon severance of the relationship with the contractor;

(3) the sole proprietor or partnership has a substantial investment of capital in the sole proprietorship or partnership beyond ordinary tools and equipment and a personal vehicle;

(4) the sole proprietor or partnership owns the capital goods and gains the profits and bears the losses of the sole proprietorship or partnership;

(5) the sole proprietor or partnership makes its services available to the general public or the business community on a continuing basis;

(6) the sole proprietor or partnership includes services rendered on a Federal Income Tax Schedule as an independent business or profession;

(7) the sole proprietor or partnership performs services for the contractor under the sole proprietorship's or partnership's name;

(8) when the services being provided require a license or permit, the sole proprietor or partnership obtains and pays for the license or permit in the sole proprietorship's or partnership's name;

(9) the sole proprietor or partnership furnishes the tools and equipment necessary to provide the service;

(10) if necessary, the sole proprietor or partnership hires its own employees without contractor approval, pays the employees without reimbursement from the contractor and reports the employees' income to the Internal Revenue Service;

(11) the contractor does not represent the sole proprietorship or partnership as an employee of the contractor to its customers; and

(12) the sole proprietor or partnership has the right to perform similar services for others on whatever basis and whenever it chooses.

(d) Where a sole proprietor or partnership performing services for a contractor as a subcontractor is deemed not legitimate under subsection (c) of this Section, the sole proprietorship or partnership shall be deemed an individual for purposes of this Act.

(e) Subcontractors or lower tiered contractors are subject to all provisions of this Act.

(f) A contractor shall not be liable under this Act for any subcontractor's failure to properly classify persons performing services as employees, nor shall a subcontractor be liable for any lower tiered subcontractor's failure to properly classify persons performing services as employees.

(Source: P.A. 95-26, eff. 1-1-08.)

If an employer/ contractor miss-classifies a worker as an independent contractor in violation of the new law, the Attorney General of Illinois can and will prosecute and the courts can and do assess fines, stop work orders or other remedies. The Illinois Department of Labor will also notify other State agencies such as the Department of Employment Security (unemployment taxes), the Department of Revenue (income taxes for State & Fed) and the Illinois Workers’ Compensation Commission (Workers comp insurance compliance penalties) who are all then required to review and check the contractor’s compliance with each of their own respective laws. Contractors found in multiple violations can be in a whole world of hurt.

Recently, Attorney General Lisa Madigan settled claims against 5 Chicago area construction firms that were accused of falsely classifying their employees as independent contractors in violation of the new law rather than as employees.

The settling defendants are:

• Jerry Ryce Builders, Inc. and Jerry Ryce Masonry, Inc., owned by Boguslaw Omielan and operating out of 3801 South Archer Chicago, Ill.; and
  
• J S Masonary, Inc., JS Masonry & Tuckpointing, Inc., and JS Masonry & Stone, Inc., owned by Jan Staszel and operating out of 9001 W. Deerwood, Palos Hills, Ill.

The 5 companies have agreed to pay more than $79,000 in fines. The settlement agreement forbids the companies from participating in public construction projects for the next 4 years.

“This agreement requires these five companies to legally recognize the hard-working men and women they employ by no longer denying them the benefits to which they are entitled,” Madigan said. “Illinois businesses, especially those involved in the construction trades, should be aware that this practice – which harms workers and puts honest employers at a competitive disadvantage – will not be tolerated.”

The Illinois Workers Compensation Commission will also take notice of the new law when looking at independent contractor defenses in workers compensation construction injury claims involving actual or claimed employees. There seems to be a recent trend at the Commission to favor employment relationships in cases for injured workers in both trucking and the construction industry.

To review construction accident work injury claims, contact an experienced Illinois workers compensation attorney. The construction area and the rights of the parties are often confusing. Often, a loaned/borrowed employment relationship may exist in a construction setting which may be governed by the subcontract indemnification agreements or by the agreements for primary liability for workers compensation claims or other such hold harmless language in the construction contracts.


Chicago Workers Compensation Attorney -- 9-05-09

Illinois Workers Compensation Medical Fee Schedule Seminars

8-21-09 The Workers Compensation Commission will hold public seminars for payers and providers to review the new Illinois Workers Comp Medical Fee Schedule for injury related medical care on or after Feb.1, 2009. (Instructions and Guidelines for Treatment ) Payer and Provider Seminars are now scheduled: Mount Vernon (10/13/09), Collinsville (10/14/09), Springfield (10/28/09), Chicago (11/3 and 11/4/09), Peoria (11/10/09) and Rockford (11/17/09) see dates and locations and registration information. The Illinois Workers Comp Medical Fee Schedule sets forth maximum limits for 1) ambulatory surgical centers 2) hospital outpatient surgery, radiology, laboratory, physical medicine and rehabilitation services and 3) new rates for specialized rehabilitation hospitals. Maximum payment rates are now set as the lesser of 1) the listed Fee Schedule amount 2) the actual amount charged or 3) the contract "negotiated" rate in provider contracts. An existing contract will control over amounts in the new fee schedule. Interest charges may apply for late payment after 60 days but only after providers supply the necessary minimum information required. For assistance call our office at (312) 541-0049 or email us at beb@workcomp-chicago.com Chicago Workers Compensation Attorney -- 8-21-09

Mandatory Insurer Reporting User Manual Released 8-04-09

8-18-09

We often report on important developments involving Medicare coordination with Illinois workers compensation claims. For those following the Mandatory Insurer Reporting requirements (MIR), the Centers for Medicare & Medicaid Services (CMS) released an updated Liability and Workers Compensation Insurance User Guide Version 2 dated 8-04-09. The 225 page document is offered to help insurance carriers and administrators understand upcoming claim reporting requirements for cases involving Medicare beneficiaries.

CMS also released an "Alert" dated 7-31-09 to define who is required to report under the new law -- that is anyone that CMS terms a Responsible Reporting Entity (RRE). The definition essentially boils down to any party that is responsible to pay the claim which may include the members of insurance risk pools, self insureds companies, any company with a deductible and workers compensation insurance carriers.

This document is in draft only and is subject to revision after additional public comment. It attempts to solve the double reporting problem with companies that keep deductibles or self insured retentions (SIR) and tries to define exactly who or what entity is responsible for the claim reporting.

Chicago Workers Compensation Attorney -- 8-18-09

Illinois Workers Compensation Medical 2 Doctor Rule

8-11-09

Illinois workers compensation allows injured workers to have a choice of picking two doctors for treatment. Hospital emergency care does not count as a choice of doctor but after that, if you start medical treatment with any physician, it is going to be considered as using one of your two choices for a doctor.

Your initial doctor can refer you to as many specialists or therapists as are necessary to evaluate and treat your injuries. But say you have a disagreement with your 1st doctor or you feel not enough is being done to treat your injury. Section 8(a) of the Illinois Workers Compensation Act allows for a 2nd independent choice of doctor at the employer's expense under workers compensation. A third choice of doctor will not be paid for as a medical expense under Illinois workers comp to prevent doctor shopping.

All injured workers should be aware of the two doctor rule or they may find themselves paying out of pocket for medical care that should have been covered in workers compensation medical benefits. And, an Illinois workers compensation attorney will not be able to force payment of those medical bills because by law an employer is not responsible for a 3rd choice of doctor.

For a review of basic rules and Illinois workers compensation benefits, see our web site for a short article outlining basic benefits. A recent court case also reinforces the two-physician rule where a worker received some free acupuncture, it did not count as a choice of physician. See the Appellate Court's most recent decision on the 2 doctor rule at Comfort Masters (May 2008).

For further questions concerning medical treatment or workers compensation benefits contact a Chicago Workers Compensation attorney for answers and assistance. Our Attorneys at WorkComp Chicago have handled Illinois work injury claims for over 20 years with a 98% overall success rate. Aggressive Illinois workers compensation attorneys with a strong record of success in workers compensation settlements, trials and appeals.

Chicago Workers Compensation Attorney 08-11-09

Illinois Truckers as Independent Contractors or Employees; Nature of the Business Test Matters

8-10-09

Illinois adopted a stricter test in 2007 that favors classifying workers as an employee rather than as an independent contractor. No single factor determines whether a worker will be classified as an employee or an independent contractor but the factors that will be considered are as follows:

• whether the employer dictates the person's schedule
• whether the employer pays the person hourly
• whether the employer withholds taxes
• whether the person can be discharged (fired) at will
• and most important whether the employer may control the manner in which the work is done

Every case will of course be looked at individually but the courts will now look at whether the worker's services form a regular part of the employer's general business or whether their duties are part of their own separate business. If that's so, many workers will now be presumed to fall under workers' compensation coverage like in the case of many truck drivers and construction workers who are regularly and wrongly named as independent contractors.

There is a growing trend to classify owner-drivers of trucks as employees when they work continuously for a company and that driving forms an integral part of the employers business. By the court looking to the "nature of the business" test more workers who are labeled independent contractors will be treated as employees for workers compensation and be entitled to Illinois workers compensation benefits.

The Illinois Supreme Court announced the new "integral nature of the business" decision in Roberson (May 2007)

Many Illinois workers are wrongly classified as independent contractors to save the employer from workers compensation premiums and withholding taxes. Injured workers should contact an Illinois workers compensation attorney to determine whether they should be covered by Illinois workers compensation.

For questions call a Chicago workers compensation attorney for answers and assistance with a claim for benefits at info@workcomp-chicago.com.


Chicago Workers Compensation Attorney 8-10-09

2008 Annual Report Illinois Workers Compensation Commission

7-06-09

On June 30, 2009, the Commission released its Annual Report of Operations for 2008. Highlights indicate that total claims of 57,515 were up slightly 1.5% from previous year totals of 56,685 including both filed claims and pro se settlements. Total claims were down approximately 8% from FY2004.

The Commission operates the state court system for workers' compensation cases. In Fiscal Year 2008, the Commission's operating expenditures were $18.6 million. The Commission's end of year headcount was 162 employees, plus the chairman, nine commissioners, and six Self-Insurance employees who are counted separately, for a total of 178 people. Illinois provides 33 Arbitrators statewide for hearings, settlement approvals and pretrial in approximately 30 hearing locations throughout the state.

The Insurance Compliance unit collected $1.8 million in fines in FY2008 from 66 uninsured employers with 900 workers that were found to be operating without workers’ compensation insurance. If the Commission finds an employer knowingly and willfully failed to obtain insurance coverage, they can be fined up to $500 for every day of noncompliance, with a minimum fine of $10,000. Corporate officers may be held personally liable if the company fails to pay the fine. Under the new compliance laws which took effect July 20, 2005, an employer may also face criminal charges and/or a work-stop order for failing to obtain workers' compensation insurance coverage.

Each year roughly 250,000 work accidents occur in Illinois but only claims involving 3 days or more lost time from work are reportable to the Commission. Approximately 80,000 injuries are reported by employers each year involving 3 days or more lost time. Out of all reportable injuries, approximately 60,000 formal new claims are filed each year by either a formal Application for Benefits or as an original settlement.

In an original settlement, the worker generally does not have an attorney 95% of the time and settles direct with the employer or the insurance carrier. In the year 2008, the annual report reflects original or “pro se" settlements were filed in 9,322 cases representing 16% of all claims. Overall, an injured worker hired an attorney 84% of the time with a formal filed Application for Benefits.

Not surprisingly, Chicago and the collar counties with hub cities within an hour or so from Chicago account for approximately 60% of all Illinois work injury claims. Also not surprisingly, back and neck claims accounted for the largest sector of reported injuries totaling 20% of all injuries in 2008.

Thanks to the addition of a third panel of Commissioners deciding cases at the Review level, in 2008 the formal written decisions from the Commission on appeal from an Arbitration Decision increased by 13% from 2007. A total of 1,195 formal Review Decisions were entered in FY2008 representing 2% of all claim closures. Dismissals accounted for an alarming 9% of cases disposed of while settlements represented 86% of all case closures.

Interestingly, when an injured worker filed an appeal to the Review level before the Commissioners, benefits were increased only 15% of the time. In appeals by the worker, benefits were actually reversed or decreased in 13% of the cases. The great majority of appeals by the worker resulted in no change of the Arbitration Decision in 72% of decisions in appeals filed by the employee.

In employer appeals to the Review stage, benefits were affirmed almost 66% of the time. However, the employer was successful in obtaining a reduction or a decrease in benefits awarded from the Arbitration Decision in 21% of the appeals filed by an employer. Outright reversals were obtained in only 6% of the Review Decisions filed and benefits were actually increased in 6% of the decisions appealed from.

The average time that a case takes from filing an Application for Benefits through the final formal Decision on Review is approximately 4.2 years. That number is deceptively high because in most cases the attorneys and arbitrators are forced to wait until medical care has concluded before an assessment of the permanent nature of the injury can be made or while waiting on final medical restrictions and assessing a return to work status.

The actual appeal times on Review decreased during 2008 to 16 months or 1.33 years from the date of the Arbitration Decision. This represents a significant improvement in delay times on Review. In 19(b) Emergency Petitions for Benefits, the wait time for a Review Decision was under one year at 11 months.

Most litigated cases at the Illinois Commission are settled by and between the attorneys. While total claims disposed of in 2008 totaled 59,533 between settlements, decisions and dismissals, actual formal Arbitration Decisions were issued in only 3,594 cases representing a ratio of 6% of total claim dispositions.

In comparison, the average time it takes for settlement from date of application for benefits until the date of settlement approval was 1.9 years.

The take away message for most may be that the Commission works best in the vast majority of claims by resolving disputes and contested cases through compromise settlement. Parties may be best served by representation with an experienced Illinois workers compensation attorney to arrive at an early compromise settlement rather than face the uncertainties and delays of trial and appeal.

It should be noted that Arbitrators in Illinois perform a significant crucial key function in supplying sound pretrial recommendations to assist attorneys in resolving disputed areas of disagreement in contested cases.

Formal Decisions of the Arbitrator were appealed in only 48% of cases that went to trial and decision so the informal pretrial recommendations by the Arbitrator weigh very strongly with the parties. After all, it's not nice to ignore the pretrial recommendations of the person most crucial to deciding the disputed issues of the case.

Contact an Illinois workers compensation attorney for assistance at (312) 541-0049 or email our office at info@Workcomp-Chicago.com.

Chicago Workers Compensation Attorney -- 7-06-09

IL Workers Comp Medical Fee Schedule Changes

7-05-09

The Illinois Workers Compensation Medical Fee Schedule adopted new Medicare Medical Severity codes for hospital inpatient services. The new MS-DRG codes are now part of the Illinois Medical Fee Schedule as of June 30,2009.

Medicare changed its inpatient codes from the DRG (Diagnosis Related Group) to the MS-DRG (Medical Severity-Diagnosis Related Group) to account for degrees of severity in medical treatment and the Illinois Workers Compensation Commission has now followed suit with modifications to adopt the changes. This will only affect workers compensation treatment for hospital inpatient services.

To allow transition time for the industry to adopt the new payment protocols, the Workers’ Compensation Medical Fee Advisory Board and the Commission have asked providers and payers to follow a July 31, 2009 effective date.

For all prior dates of treatment, the inpatient fee schedule uses the older DRG codes. Providers and payers should work to translate these bills using the CMS crosswalk, Grouper Version 24.0.

No separate right currently exists for medical providers to assert a claim for payment of related medical bills at the Illinois Workers Compensation Commission. However, the law does provide for interest payments and penalties on non payment of injury related medical invoices.

To enforce payment of medical bills for workers compensation, providers will require the assistance of an Illinois workers compensation attorney to file an application on behalf of the patient. For more information or assistance, contact our office.

Chicago Workers Compensation Attorney -- 7-05-09