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Medical benefits in workers' compensation claims

Each year, many people are injured in workplace accidents in Illinois. Employers in the state are required to carry workers' compensation coverage in order to protect employees that are injured while working on the job. Workers' compensation in turn is designed to compensate employees for associated expenses caused by the injuries.

A major category of expenses covered under workers' compensation claims relates to medical care. This can include physical therapy, chiropractic care, doctor visits, medication, surgery and prosthetic devices. If the injury resulted in a physical disability necessitating the use of a wheelchair, the coverage may extend to modifying the employee's home to make it handicap-accessible as well.

If an employer is disputing a medical service, the employer must file an objection but cannot seek payment from the employee for the medical treatment while the dispute is pending at the state Workers' Compensation Commission. It is important for an injured employee to provide the necessary information and to cooperate with physicians. Employees need to be aware that while they may generally choose the doctor, they may be limited by the number of available doctors whom they can see in order to get payment for their treatment.

If an employer disputes the necessity of medical treatment, the employee should respond to the dispute and provide medical documentation demonstrating the care was needed and is for an injury sustained at the workplace. If a dispute is filed, the employer may have its own physician examine the employee. Any report by the employer's physician must be provided to both the employer and the employee no later than 48 hours prior to a hearing on the disputed care. Affected employees may benefit from seeking the advice and counsel of a workers' compensation attorney.

Source: Illinois Workers' Compensation Commission, "Handbook on Workers' Compensation and Occupational Disease", October 18, 2014

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