Failure to Pay for Approved Treatment for Injured Auto Workers

Attorneys for Chicago Employees Harmed On the Job

One of the benefits available under the Illinois Workers’ Compensation Act is payment of reasonable and necessary medical care of an employee with a work-related injury. Reasonable medical care usually consists of care that is well established, and is unlikely to include experimental treatments. However, in some cases, an issue arises because of an unlawful failure to pay for approved treatment for an injured auto worker. If you are concerned about an insurer’s failure to pay, you can speak with a Chicago workers’ compensation lawyer regarding your legal rights.

Failure to Pay for Approved Treatment for Injured Auto Workers

The Illinois Workers’ Compensation Act provides that an employer or its insurer must pay medical costs for reasonably necessary medical care to cure or relieve an injured worker from injury symptoms or impacts. Reasonably necessary medical care can include emergency care, first aid, pharmaceuticals, and medical devices. The purpose of this law is to shield injured workers and offer a method of recovery that doesn’t require you to prove fault.

Generally, medical care provided under state workers’ compensation law will require prior authorization. The authorization is secured to make sure the bill will be paid. So, for example, you would need approval to get diagnostic testing such as an MRI for a spinal injury you sustained as an auto worker.

When there are delays in payment or failures to pay, the Illinois Workers’ Compensation Act provides that if an employer or insurer doesn’t pay for the pre-approved medical treatment, it can be penalized in an amount equal to 50% of the amount payable at the time of the award. The failure to pay needs to be without good and just cause for this penalty to apply.

Once a health care provider sends the workers’ compensation insurer a bill, it has just 30 days to make the payment. They can only avoid making the payment for a good faith reason, or where the bill is too vague. Sometimes insurers delay paying in hopes of saving money.

Petition for Immediate Hearing

If an insurer declines to pay for approved treatment without reason, you can file a 19(b) petition for immediate hearing before an arbitrator, which is an emergency hearing and places pressure on an insurer to make the payment. You are also entitled to file for penalties based on an unreasonable delay in paying benefits. At the hearing, the arbitrator is asked to resolve the dispute surrounding the insurer’s failure to pay for an approved treatment. This hearing may not be literally immediate in terms of when it occurs, but it will speed up the process. A work injury attorney can help you navigate the petition and hearing process.

When a 19(b) petition is filed with the Illinois Workers’ Compensation Commission, a copy will be sent to the employer. The employer has 15 days to respond. The arbitrator will then make a decision.

Sometimes there is a failure to pay because the employer’s independent medical examiner (IME) disagrees about the course of care recommended by your treating doctor, and this issue must be resolved. Penalties won’t be awarded in most cases in which there are conflicting medical opinions between your treating doctor and the insurer’s independent medical examination doctor, even if it proves to be the case that the IME doctor is incorrect. Penalties have been awarded when there has been a failure to pay a statutory amputation benefit, failure to timely pay an undisputed benefits award, deliberate underpayment of benefits, or deliberate delay in payment of benefits.

Hire an Experienced Workers’ Compensation Lawyer in Chicago

If you have questions about an insurer’s failure to pay for approved treatment for injured auto workers, you can consult a seasoned workers’ compensation attorney. At Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca, we represent workers in Rockford, Champaign, Aurora and Quincy, as well as Sangamon, Winnebago, Cook, Adams, and Kane Counties. We look closely at our clients’ situations to determine whether there are other forms of relief available in addition to workers’ compensation. Contact us at 312-724-5846 or by completing our online form.