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I fell at work last night reported and now at the Drs my…

Customer Question
I fell at work...

I fell at work last night reported and now at the Drs my question do I get paid while at the drs? I am an hourly employee

Lawyer's Assistant: Have you discussed the injury with a manager or HR? Or with a lawyer?

Yes hr

Lawyer's Assistant: Are you an "at will" employee? Do you belong to a union?

At will no union

Submitted: 4 months ago.Category: Employment Law
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Customer reply replied 4 months ago
Can I get an answer now going into the drs
Customer reply replied 4 months ago
How many questions do I get for $35??
Answered in 11 minutes by:
3/16/2018
Employment Lawyer: Ray, Employment lawyer replied 4 months ago
Ray
Ray, Employment lawyer
Category: Employment Law
Satisfied Customers: 48,197
Experience: 30 years in Employment law
Verified

Hi and welcome to JA. Ray here to help you today.Please bear with me a few moments while I review your question, conduct and prepare your response.

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Employment Lawyer: Ray, Employment lawyer replied 4 months ago

You need to make sure you have a workers comp claim filed.And really they need to direct you to an approved doctor since they are paying for it.You would have medical coverage and lost wages thru wc here.But you need to make sure employer filed it here.

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Customer reply replied 4 months ago
Thanks Ray just afraid I am going to get called into the dr
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

Whats state are you in here?

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Customer reply replied 4 months ago
Illinois
Customer reply replied 4 months ago
I am at where they sent me with a accident claim filled out
Customer reply replied 4 months ago
They made me punch out to come here
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

This is what you need here

fhttps://www2.illinois.gov/sites/iwcc/Documents/ia1form.pdf

Good then you should be coverered.

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Customer reply replied 4 months ago
That’s what I want to know if that is legal
Customer reply replied 4 months ago
Shouldn’t I be paid while at the drs now?
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

An employee who is injured at work and needs time off can receive temporary total disability benefits. The first three work days of disability are not paid unless you need at least 14 days off work. These benefits are paid until your doctor declares that you have reached maximum medical improvement.

Temporary total disability benefits are two-thirds of your average weekly wage, up to a maximum amount set by law. As of July 15, 2017, the maximum benefit is $1,440.60 per week. This cap only kicks in if your annual salary is around $110,000 or more. (The cap is updated every six months; you can find a list of the maximums at the website of the Illinois Workers’ Compensation Commission.)

Temporary partial disability benefits are paid when workers are able to return to light duty or part-time work that pays less than their normal wages. These benefits are two-thirds of the difference between what you would have been able to earn before the injury and what you are currently making.

Example: You earned $950 per week before your injury and would have received a scheduled $50 raise while you were off work. You are now working part-time and earning $400 per week. You would take the difference between $1,000 (what you would have been making) and $400, which is $600. You would then receive two-thirds of that amount, which is $400 per week.

Yes they can punch you out here but wc pays you

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Employment Lawyer: Ray, Employment lawyer replied 4 months ago
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Customer reply replied 4 months ago
I am just talking about going to the drs nowand they made me punch out
Customer reply replied 4 months ago
But when and how does wc kick in
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

This is covered by wc here separately from employer, here is more

An injured employee is entitled to payment of "reasonable" and "necessary" and related medical care subject to the limitations of the Illinois Medical Fee Schedule. This includes reimbursement for any out of pocket prescription expense, appliances or prosthetics necessary to cure or alleviate the effects of an injury. You do not want to wait until your medical care has been cut off before speaking to an attorney.

The medical care must be both "reasonable" and "necessary" in order to qualify for payment or reimbursement. The Illinois Workers Compensation Act does not provide for experimental, unproven or unnecessary procedures. The employer is only required to pay for medical care which is necessary to cure or alleviate the effects of the injury. This does not include measures which are purely “palliative” or procedures which are designed to simply relieve symptoms.

Since medical care is now subject to Utilization Review, the employer's liability for payment of medical care may be limited to evidence based medical standards as established by national guidelines. UR review reports are used to deny care but often the UR reviewer has not been sent all your medical records and a timely appeal can be taken submitting additional evidence.

For example, it is quite common for an employer to limit chiropractic care or physical therapy to 2 to 3 months following a muscle strain type injury. Illinois will generally follow national medical guidelines for determinations of what is reasonable or necessary medical care for a particular injury or given diagnosis.

Once the medical treatment has plateaued to the point that any further care will not achieve any further medical improvement, the patient's condition is said to have reached "MMI" or maximum medical improvement. Additional ongoing medical care may or may not be available after a finding of MMI depending on the nature of the injury or given diagnosis.

The American Medical Association recognizes 2 principles regarding the definition of MMI:

(1) Where all reasonable therapeutic interventions designed to improve the condition have been offered; and/or

(2) Where the patient has reached a stable and stationary medical condition in which permanent impairment is not expected to significantly change over the ensuing 12 months.

Generally, treatment will not be authorized under workers compensation after a worker has reached the 1st definition of MMI whereas ongoing medical care may be entirely necessary and paid under the 2nd definition.

Note temporary disability benefits may not be available in either case since the question now becomes one of "permanency" or the need to assess the "permanent" nature of the injury which may include an award for partial disability, partial wage loss award or complete and total disability.

B. Choice of Physician

Under the Act, the employee is limited to his or her independent choice of 2 physicians. Either of the these 2 independent choices of doctor may refer the employee to other doctors or specialists as necessary for x-rays, medical testing, follow-up care, surgery or consultation.

After 7/1/11 the choice of 2 doctors may be limited to the employer's PPO plan or limited to 1 choice of doctor outside of the PPO plan if the employer is notified in writing that the injured worker elects to OPT OUT of the employer's PPO plan.

Emergency medical care or visits to a hospital emergency room do not qualify as a choice of physician, however, undertaking follow-up care at the emergency facility or medical center will be considered a choice of physician. The employer is not required to pay for any third choice of physician not in the chain of referral.

If the employer has a PPO plan on or after 7/1/11 that has been approved by the Illinois Dept. of Insurance, the employer is not required to pay for physicians outside of the PPO plan or network of doctors unless they are specifically notified in writing that the injured employee "elects to opt out" of the PPO plan.

This new provision was largely designed to prevent doctor shopping and limit choice of physician.

C. Independent Medical Exam

At any point during the course of medical care, the employer is entitled to obtain an exam or IME by a physician of their choosing to determine any ongoing need for medical care or determine the state of disability. These examinations are usually set to cut off ongoing medical care or to answer whether an injured employee can or cannot return to work. Travel money is to be advanced to defray reasonable expenses to and from the employer’s medical evaluation. You shouldn't wait until a employer IME exam is set before contacting an attorney for advice.

Often disputes arise between the opinions of the treating physician and the opinions of the employer independent medical examination (IME) physician regarding the need for medical care, whether the worker remains disabled and off work or whether suggested surgery is reasonable or necessary. The employer is entitled to rely upon the opinions of their physician to terminate ongoing medical care or refuse a requested surgery or disability benefits. It is at this point that an attorney is absolutely necessary for representation to push for the treating physician's recommendations.

In the event of a dispute between the treating and examining physicians, disputes are commonly submitted to the Illinois Workers’ Compensation Commission for resolution. An arbitrator designated by the Commission is assigned the duty of resolving all disputed yet conflicting medical opinions. The arbitrator is free to adopt any one of the medical opinions expressed including either the treating physician or the employer’s IME physician in deciding an award of compensation.

D. Utilization Review

Changes were adopted in the Workers’ Compensation Act in 2005 to give the employer the right of "Utilization Review" or a medical record review by a doctor of equal standing in what is known as "peer to peer" review on or after July 20, 2005.

The right to ongoing medical care can be disputed based upon a URAC approved, utilization review opinion. These disputes may require submission to arbitration to resolve any conflicts of opinion. Utilization review can be conducted in advance of a proposed surgery in a “prospective review” or after the fact in a “retrospective review” to determine the reasonableness or necessity of medical care.

Under the 2011 reforms, employers denying medical care based upon a UR report must now make the UR doctor available for telephone or video deposition at the employer's expense.

E. Medical Invoices and the Medical Fee Schedule

Prior to February 1, 2006, employers could dispute the amount of a medical bill as not "reasonable" or not "usual and customary". This left many injured workers responsible for payment of outstanding balances owed on medical invoices in excess of payments made by the workers compensation insurance carrier. Employers were not required under the Act to pay "unreasonable or excessive" medical invoices and disputes often arose.

The reasonableness of the amount of disputed medical invoices often needed to be submitted to arbitration before the Commission to determine the "reasonable" amount of the medical charges for medical treatment incurred prior to February 1, 2006.

After new statutory amendments, as of February 1, 2006, the "reasonable" amount for payment of a particular medical invoice for a work-related injury under the Illinois Workers Compensation Act is now to be determined under the Illinois Workers Compensation Medical Fee Schedule.

The medical fee schedule sets forth caps or limits for reimbursement or payment of medical invoices based on the particular medical procedure code, the date of service and the location (zip code) where the medical care is provided.

II. Temporary Disability Benefits

All injured workers are entitled to payment of temporary total disability benefits during a period of total disability following a work-related injury. Disability benefits are payable at 66 2/3 % of the workers’ “average weekly wage" subject to certain maximum and minimum weekly disability benefits set forth in the Act.

Benefits are not payable for the first 3 days of lost time following an injury unless the employee is required to miss 10 or more working days as a result of the injury. After 10 days of time lost from work the employer is required to make up payment for the first 3 days of lost time.

All benefits under Illinois Workers Compensation are based on a formula using the workers' average weekly wage. How are wages calculated for IL workers comp ? Average weekly wage contemplates the actual earnings for the 52 weeks of employment immediately prior to the date of accident excluding voluntary overtime.

Overtime earnings are specifically not included under the Act however, where the overtime is "mandatory" or regularly consistent, the overtime hours are included in calculation of regular earnings but only at the straight time rate of pay.

The calculation of average weekly wage is often highly disputed and disagreements may need to be submitted to arbitration where the disputes cannot be resolved upon review of the wage records. Where it is impossible to calculate the full 52-week average weekly wage given the short duration or length of employment, special rules apply.

As long as a temporary disability is related to the work injury, the worker is entitled to receive payment for "temporary total" disability. It is the workers’ obligation to provide documentation from a physician establishing the periods of temporary total disability to the employer. This is commonly supplied by way of an "off work" slip, work status reports or a physician's off work note.

Most employers have a policy for terminating employees who fail to show up for work or fail to provide necessary documentation to establish a legitimate basis to be off work. Most employers have a 3 day "no call, no show" termination policy. Any release to return to work should be provided to the employer as soon as possible and the injured employee must be ready to report to work on restricted duty.

Most Illinois Workers Compensation adjusters cannot issue temporary disability benefits unless they have the proper current medical documentation in their file to establish "current disability". If documentation of disability is not forthcoming, issuance of disability benefits may be delayed or even denied.

A. Light Duty Release to Return to Work

In the event that the physician issues a release to return to light-duty work, the employee must notify his or her employer promptly. The employer will usually provide light duty work within the restrictions, if available, to prevent further lost time off work and disability payments.

If the worker is returned to light duty work at a reduced rate of pay, the Act now provides for a "temporary partial" disability benefit to offset any temporary reduction in pay. The light duty work provided may be subject to special conditions in the collective bargaining agreement where unions are involved.

Where the employer is unable to accommodate the light duty work restrictions, the entitlement to ongoing disability benefits continues so long as the worker is under medical treatment and temporarily disabled from his or her regular occupation. However, the failure to report for light-duty work, where such work is available, will result in the denial of benefits and may result in termination.

B. Discharge from Medical Care and Permanent Restrictions

Once a worker has recovered from the injuries to the extent medically possible, the disability is no longer considered to be "temporary" in nature. Once a condition has plateaued or stabilized to the extent medically possible, any remaining disability or restrictions are considered to be "permanent" in nature. In this case, the worker is no longer entitled to "temporary total" disability benefits.

If an employer is able to accommodate the permanent restrictions in the same job position or at the same rate of pay, these permanent restrictions are considered in making an assessment of compensation for permanent disability to the affected body part or area of the body. (see permanent partial disability below)

Where the worker is unable to return to regular work or unable to return to work at a reduced rate of pay, the law may provide for ongoing "maintenance" disability benefits during a period of vocational retraining or job placement. Where there is a permanent reduction in wages due to the permanent restrictions, the law provides for a wage supplement or partial pension to offset the loss of earnings effect of the injury.

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Customer reply replied 4 months ago
If they don’t find anything wrong so I missed my pm wages
Customer reply replied 4 months ago
In addition looks likes it’s going to end up on my own time
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

If you were injured here they should pick up medical.If they don't find anything then you probably aren't getting wages if you are cleared to return to work.Please don't shoot the messenger being honest.

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Employment Lawyer: Ray, Employment lawyer replied 4 months ago

Prayers to you that you are ok here.At least you document if you have problems later on.

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Customer reply replied 4 months ago
Sorry but you didn’t answer my question
Customer reply replied 4 months ago
Ok got it I guess
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

You aren't going to get paid if you weren't injured.Under the law above they only pay if you were hurt and under care for awhile.

I appreciate the chance to help you today.Thanks

If you can positive rate 5 stars it is much appreciated.

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Customer reply replied 4 months ago
How do I cancel my subscription for the site now?
Employment Lawyer: Ray, Employment lawyer replied 4 months ago

I only answer questions here, did you have more

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Employment Lawyer: Ray, Employment lawyer replied 4 months ago

I appreciate the chance to help you.I wish you the best here.

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Customer reply replied 4 months ago
how do I cancel justanaswer
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