Failure to pay for Approved Treatment
Under the Illinois Workers’ Compensation Act, employees may file a claim for benefits after suffering a job-related accident or illness. The Act provides that an employer is responsible for covering medical costs that are reasonable and necessary if they result from an injury or repetitive trauma. Most employers purchase workers’ compensation insurance, and the insurance company makes benefit payments on the employer’s behalf. When injured employees receive medical treatment, there may be care that requires authorization by the employer’s insurance company. If the employer or insurer authorizes treatment but fails to pay, it may be penalized if the employee shows that their failure was unreasonable. At Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca, our Chicago workers’ compensation lawyers have been bringing these claims for decades, successfully holding employers and insurance companies to their legal obligations.Seeking Payment and Approval for Medical Treatment Following a Job Injury
Employees entitled to workers’ compensation benefits may recover medical expenses, payment for a partial or total disability, and lost wages. The Illinois Workers’ Compensation Act (IWCA) states that an employer or its insurer is responsible for paying medical costs for anything “reasonably necessary” to cure or relieve the injured worker from the effects of their injury. This may include first aid, doctor visits, surgery, pharmaceuticals, and prosthetic devices.
The purpose of the IWCA is to protect injured workers and provide a means of recovery outside tort law. Often, medical treatments for injured workers, such as diagnostic testing like MRIs or CT scans, require pre-approval or authorization by the employer. Authorization ensures the medical provider that their bill will be paid. Insurance companies or employers may delay in authorizing treatment. Alternatively, medical treatment may be approved, but there may be a delay in paying for the treatment.
According to the IWCA, delays in payment may result in penalties for the party “liable to pay the compensation.” In other words, when an employer or its insurer does not pay for pre-authorized medical treatment, it may face a penalty equal to 50% of the amount payable at the time of the award. The failure to pay for treatment must be without good and just cause.
Determining factors include whether the failure to pay was unreasonable and created an obligation on behalf of the insurer to pay for the treatment. Liability for failing to pay for medical treatment serves to dissuade employers and insurance companies from denying an injured worker medical care.Retain a Chicago Lawyer for Your Workers’ Compensation Claim
Workers’ compensation provides an intricate system of obligations for the payment of medical treatment. Injured employees in need of knowledgeable legal counsel can rely on the Chicago workers’ compensation attorneys at Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca to help them assert their rights. If you or a loved one is facing a denial of payments for medical costs following a workplace injury, we can help. Our job injury lawyers have also represented people in Aurora, Champaign, Springfield, Rockford, and Quincy, as well as other areas of Kane, Cook, Sangamon, Champaign, Winnebago, and Adams Counties. Contact our office for a free, confidential consultation online or by calling (800) 444-1525.