Some truths about Illinois workers compensation law are just common sense. If you get hurt because you are drunk, you don’t have a case. That’s one example. But other times things come up that aren’t common sense.
Twice in the last week I’ve heard from injured Illinois workers who had similar situations. Both got clearly hurt at work. Both had accepted cases where they were off work and getting medical care for a few months. And for both everything was taken care of by the insurance company.
But then suddenly and without explanation, one was told that they could continue to get medical care but no more TTD. The other was told they’d still get TTD, but that most of the wanted medical care, including surgery, would not be authorized. The one whose TTD got cut off was off work completely by their doctor and there is no light duty work available. The one that needs surgery has seen two doctors who both agree that surgery is needed.
So how and why can this happen?
The most logical and likely explanation has to do with how insurance companies are run. Every time an insurance company opens up a new claim, they set what are called reserves. That’s an estimate as to what a case is going to cost them. As you can imagine, they want to keep that number as low as possible. In fact, many insurance company workers get compensated by keeping payouts below the reserve number.
Now of course sometimes they have to adjust and raise that number. In order to avoid doing that, some insurance company workers will do things that make no sense in the hope that you go along with it. This includes cutting off some or all benefits without reason.
The reason they only do some, not all is likely because the reserve for the benefit they cut off is likely about to hit its number. Or it could be because if they cut you off completely, you are more likely to run to an attorney.
I can tell you that this type of math happens in every case. That doesn’t mean they won’t raise the reserve or that they will definitely cut you off without reason, but I do promise you that they are thinking about it. So even when they seem nice or that they are doing what they are supposed to, their goal is to limit your benefits and ultimately end them.
Other ways they do this is through IME’s, surveillance, recorded statements and nurse case managers. Those actions can give them justifiable reasons to cut you off.
The good news, if there is any, is that usually when a lawyer comes on board to a case where you’ve been cut off without reason we can get benefits approved pretty quickly. Under Illinois work comp law, the insurance company can’t just decide not to pay you. They have to have good reason. And if they don’t, they can get hammered with penalties.
So bottom line is don’t stress, but whether it’s through us or someone else you find and like, make sure to get an aggressive, experienced attorney in your corner. A good one can solve problems that make no sense.