Must an employee file a claim with the Industrial Commission to receive benefits?
It is not mandatory. Employees who are not receiving all the workers compensation benefits provided by law, however, should file a claim.
Employees who are receiving benefits but are concerned about protecting their rights to receive future medical care and compensation for disability should file. All claims must be filed within the time limits prescribed by law.
The filing of a fraudulent claim may subject an employee to a penalty under Illinois law.
What should the employee and employer know about voluntary payments of compensation?
By accepting payment of workers' compensation benefits and medical benefits, an employee does not waive or give up any rights under the Workers' Compensation Act. Merely signing receipts or other reports requested by the employer will not waive the employee's rights.
In order to close out an employee's rights, a settlement must be written on the pink form called "Settlement Contract Lump Sum Petition and Order" provided by the Industrial Commission. The Industrial Commission must approve the settlement before an employee's rights are terminated.
If a dispute arises regarding the amount of compensation due an employee, the employee has at least two years from the date of the last voluntary workers' compensation payment to file a claim with the Industrial Commission.
The payment of compensation benefits to an employee does not represent the employer's admission of liability. Even if a claim is filed with the Industrial Commission after some compensation benefits have been paid, the employer still has the right to contest its liability to pay any compensation at all.
What if an employee does not receive the benefits provided by law?
The employee may contact the employer or the employer's representative directly. Failure to communicate may result in confusion or misunderstanding.
The employer and employee may also contact the Industrial Commission for more information. If a dispute remains unresolved, a claim should be filed with the Industrial Commission.
What should the employee and employer know about retaining an attorney?
Both the employer and the employee may retain legal counsel, and frequently do. If an attorney is retained by the employee, the law sets the following requirements:
The attorney's fee must be stated on the "Attorney Representation Agreement" form, signed by the employee (or in death cases, by the beneficiaries) and approved by the Industrial Commission.
The attorney's fee is limited to 20% of the amount of compensation recovered, unless additional fees are allowed by the Commission after a hearing.
In death, partial and total disability cases, the amount of the attorney's fee shall not exceed 20% of benefits payable for 364 weeks, unless additional fees are allowed by the Commission.
Attorneys shall not charge a fee on TTD benefits unless the employer fails to pay these benefits in a timely manner or in the proper amount; or unless the employer stops paying such benefits, and payments are obtained or reinstated through the efforts of the attorney.
Attorneys shall not charge a fee on amounts paid for undisputed medical expenses. Attorneys shall not be paid if the amount of compensation obtained does not exceed an amount offered to the employee in writing before hiring an attorney.
May the parties settle a claim for compensation benefits?
Yes, claims may be settled between the employer and the employee directly or through their representatives, provided the settlements are approved by the Industrial Commission.
What should the employee and employer know about settlements?
A lump sum settlement is a contract between the employee and the employer to close a claim in exchange for an agreed-upon amount of compensation and medical services.
Cases in which the employer denies liability or disputes the amount of compensation are often settled by lump sum settlements. By settling such cases, the employee avoids the risk of getting no compensation or less than is provided in the settlement, and the employer avoids the risk of paying more than is provided in the settlement.
Unless they provide otherwise, approved settlement agreements usually close out the employee's rights to future medical benefits, vocational rehabilitation and additional compensation payments, even if the employee's condition worsens. Any right that is not supposed to be extinguished by the settlement should be expressly reserved in writing in the settlement agreement.
An employee who is not represented by an attorney must appear in person before a representative of the Industrial Commission, who will review the settlement and insure the employee understands its effect, before approval is granted.
Any settlement contract made within seven days of the injury is presumed to be fraudulent.
Settlements that are made without Industrial Commission approval do not close out the employee's rights under the law. In such cases, the time an employee may file a claim with the Industrial Commission is extended indefinitely.
How are claims presented to the Industrial Commission?
Three copies of the "Application for Adjustment of Claim" form must be filed with the Industrial Commission, along with a proof of service certificate stating that a copy of the application was served on the employer by mail or personal delivery. There is no fee for the forms or for filing the claim.
Who presides over workers' compensation claims?
An arbitrator appointed by the Industrial Commission acts as fact-finder and judge, conducts the hearing, and decides on the amount of benefits to which the employee is entitled. The hearing is conducted according to the Rules Governing Practice Before the Industrial Commission. Copies are available without charge from the Industrial Commission.
Is it possible to appeal the arbitrator's decision?
Yes. The employee and the employer both have the right to appeal a decision if dissatisfied. After reviewing summaries of the facts and law involved in the case and sometimes, after hearing oral arguments, the Commission will issue an opinion.
Decisions of the Commission are final for cases involving employees of the State of Illinois. In all other cases, either party may appeal to the Circuit Court and, from there, to the Industrial Commission Division of the Appellate Court. In some cases, further appeal may be taken to the Illinois Supreme Court.
Is there a way to get a expedited hearing?
Yes. An employee who claims to be unable to work as the result of an injury or exposure and who is not receiving TTD or medical benefits may file a petition for an expedited hearing under Section 19(b-1) of the law. Forms are available from the Industrial Commission.
Is there any other method for resolving disputed claims?
Yes. If the only disputed issues are TTD, PPD or medical expenses, the parties may agree to voluntary arbitration. By doing so, they submit their case to an arbitrator and waive their rights to review by the Commission. The arbitrator's findings of fact are final; only questions of law may be appealed to the Circuit Court.
Under this procedure, the parties submit a completed form requesting voluntary arbitration, and select an arbitrator from a list of five arbitrators provided by the Commission. If they cannot agree on an arbitrator, they may select one from the American Arbitration Association.
Do the employer and employee have additional rights after an award provided by the Industrial Commission has been or is being paid?
Yes, if an award is paid in installments and there has been no lump sum settlement contract approved by the Industrial Commission, an employee may be entitled to the following:
Additional medical, surgical or hospital services reasonably required to cure or relieve the effects of the injury or disease. These benefits are available for life, but the need for these services must be connected to the work-related injury or disease.
The expenses must be reasonable and necessary. If the employer does not agree to the expenses, the employee may file a petition asking the Commission to decide the disputed issues.
If within 30 months after the award an employee can show that the disability resulting from the job-related injury or illness has increased or recurred, a petition for additional compensation benefits may be filed.
If within 30 months after the award an employer can show that the disability resulting from the job-related injury or illness has decreased or has ended, a petition for a reduction in compensation benefits may be filed.
If the Industrial Commission has entered an award for permanent and total disability in a case that does not involve the complete loss or loss of use of two major body members and the employer can show that the employee is no longer totally disabled, the employer may petition the Commission for an order terminating the PTD payments to the employee.
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