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Does workers’ compensation cover long-term care?

On Behalf of | Apr 11, 2024 | Workers' Compensation

Injured workers need to understand whether they have workers’ compensation coverage and, if so, what these benefits cover. These benefits are meant to provide workers with the medical care they need to heal from their work-related injuries or illnesses.

There are several aspects of workers’ compensation coverage that may concern injured workers in Illinois. For example, some may wonder if long-term care is covered. The answer to this question isn’t always clear-cut.

Medical benefits and long-term care

Under Illinois workers’ compensation laws, medical benefits are provided to cover the cost of treatment for work-related injuries or illnesses. This includes immediate medical care and also necessary long-term treatment.

If an injury or illness suffered in the workplace necessitates ongoing care, such as long-term medical treatment, physical therapy or nursing services, workers’ compensation insurance should cover these expenses. The key is that the care must be deemed necessary and related to the work injury.

Specifics of long-term care coverage

The scope of long-term care covered by workers’ compensation in Illinois can encompass various services, from in-home nursing care to long-term rehabilitation facilities. For an injured worker to receive these benefits, the care must be prescribed by a healthcare provider as part of the worker’s treatment plan.

The insurance carrier or employer may request periodic reviews to assess the continued necessity of long-term care. Based on the employee’s recovery progress, this can lead to adjusting or disputing coverage as deemed appropriate.

Challenges in securing long-term care benefits

Securing coverage for long-term care under workers’ compensation can sometimes be challenging. Insurers may dispute the necessity of long-term care or argue that the care extends beyond what is reasonable for work-related injury or illness.

In such cases, the employee has the burden of proof to demonstrate that the long-term care is directly related to a workplace injury and is medically necessary. Disputes may require appeals, such as hearings before the Illinois Workers’ Compensation Commission, to resolve.

Injured workers who need long-term care should ensure they get legal assistance to bolster their case with such consequential coverage at stake. A legal representative can explain all options and work toward presenting the injured party’s side of the matter effectively.