Medical Care Benefits Under The Illinois Workers Compensation System
Medical care benefits are one of the various types of workers compensation benefits generally available to injured workers in Illinois. Medical benefits that are covered under the workers compensation act typically include all necessary medical care that is reasonably required to cure or relieve the injured employee of the effects of the accidental work injury.
Medical care benefits can include, for example:
- First aid
- Emergency care
- Doctor visits
- Hospital care
- Surgery
- Physical therapy
- Chiropractic treatment
- Pharmaceuticals
- Prosthetic devices and artificial limbs
- Prescribed medical appliances
- Replacement or repaired dentures, glasses, lenses or artificial members
- Wheelchairs, lift devices and ramps
- Physical modifications to worker’s home for certain disabilities
Who Pays For Medical Care Benefits
The employer of the injured worker is required to pay for medical care benefits. Employers will sometimes evaluate or challenge the reasonable necessity of medical care sought by an injured worker, including performing a utilization review of the worker’s past, present and future medical treatments relating to the injury. An employer sometimes also will seek a medical exam by a doctor of its choice to evaluate the reasonableness and necessity of medical care being sought.
When an injured employee makes a claim to their employer or the employers workers compensation insurer, if the employer or insurance company doesn’t dispute the bill for medical care, usually it will directly pay the medical care provider. In most cases, medical expenses are covered without payment of deductible or co-insurance amounts by the employee. If the employer or insurance company denies the claim, the employee may be able to file a workers compensation claim with the IWCC. If a workers’ compensation claim is pending with the IWCC and the employee notifies the doctor or healthcare provider that a workers comp claim was filed, the doctor or healthcare provider cannot attempt to collect payment from (i.e., balance bill) the employee.
The price for most medical treatments provided on or after February 1, 2006 is set forth in a fee schedule, and the employer generally pays the lesser of the actual charges or the amount in the fee schedule, except that an employer or insurance carrier may also contract for and pay a negotiated rate with a medical provider.
What Healthcare Providers Can An Injured Employee Seek Medical Treatment From
Usually, an injured worker can select the healthcare provider or doctor of his or her choosing to treat the work injuries. However, if an employee has a PPP (a Preferred Provider Program), a participating employee must choose a doctor from the PPP network. If the worker does not have a PPP or chooses not to participate in a PPP, then generally the injured employee can select the healthcare provider of his or her choosing. There are also limits on the number of providers an employee can visit.
Unfortunately, workers compensation insurers often will attempt to deny or reduce the amount of medical care benefits. If you have been injured in an accident at work in Illinois, an Illinois workers compensation attorney or work injury lawyer may be able to help you recover medical care benefits.
If You Or A Loved One Were Injured At Work, You May Be Entitled To Medical Care Benefits From Your Employer. Contact A Workers Compensation Lawyer.
Fill Out The Form On The Right To Request A Free Review By A Workers’ Compensation Attorney.