Recently released data found that the 2011 changes have resulted in a 20% reduction in medical and disability payments. The changes are having the intended effect of restricting access to medical care and limiting monetary recovery for permanent injuries. Not surprisingly, insurance company premiums have not reduced to mirror the reduction in payments. While the insurance companies increase their bottom line, the worker and employer suffer.
Most of the changes only apply to work accidents after 9/1/11. With the election of a new governor, workers compensation benefit reductions are at the forefront. The new governor, chamber of commerce and manufacturing association have made further reductions in workers’ rights a priority. Items being discussed are further reductions in awards for permanent injuries by making the AMA impairment rating the only factor for determining a disability percentage, additional restrictions on the right to chose your own physician, and a requirement that the work accident by the sole or only cause of the condition thereby eliminating cases involving pre-existing conditions.
Your choice of attorney is more important than ever. You don’t want to be a statistic or the average. While we can’t eliminate the effects of the 2011 changes, our office can minimize the effects of the changes on your case through pro-active representation.
Now more than ever you need to be proactive from the beginning.
Protect your rights.
Call the Law Office of Chris Doscotch for a no-charge consultation at 309-681-9970 or email firstname.lastname@example.org.
Below are links to the 2011 law changes and further information on how the new law effects Illinois workers.
The full text to the 2011 bill changing the laws:
This change will effectively allow an employee to select one doctor, as opposed to two. The employer will now have the option of entering into a preferred provider program. This will benefit the employer in two ways. First, it will allow employers to enter into contracted medical fee discount plans with medical providers. Second, it will restrict the injured employee from a second choice of doctor. Most employers want to enter into a PPO network to control the cost and treatment provided to the injured worker. Also, many injured employees who are treated through their own choice of doctors without giving written notice to their employer will find that their bills might not be paid. Referrals from treating doctors become crucial to the injured workers care. Written notice by the injured worker of their desire to opt-out of the PPO network will be mandatory.
HOW IT WILL WORK
- After the injury occurs and is reported, the employer must notify the injured employee in writing shortly after the injury of the PPO network where they would like the injured employee to be treated.
- If the employer does not have a PPO network, the employee can select two doctors plus referrals, which is not affected by the change in law.
- If the injured employee chooses to opt-out (must be in writing) and declines to go to a doctor within the PPO network, the injured worker automatically loses one choice of doctor and will only have the choice to go out of the network.
- If the injured employee chooses to opt-out (must be in writing) after they have seen a doctor within the PPO network, they will have one choice of doctor still remaining. (click here for an opt-out form)
HOW THIS AFFECTS YOU
By setting up a PPO network, the employer will try to control four areas:
1) Limit access of the injured worker to get the treatment they need,
2) Insurance companies will try to cost shift the responsibilities of paying for treatment to the injured workers group insurance,
3) The employer will set up medical fee discount plans with those providers in the PPO network to reduce costs, and
4) Employers will try to control the doctors within the PPO network, and in doing so, they will control the treatment.
This new change will make it more important than ever to choose your treating doctor carefully. Many will not treat patients when worker’s compensation is involved. By seeing the wrong doctor, an injured employee may force themselves into the care and treatment of the employer’s PPO network.
For all accidents occurring on or after September 1, 2011, permanent partial disability shall be established by a licensed physician reporting on the level of impairment in writing. The report shall include an evaluation of medically defined and professionally appropriate measurements of impairment that shall include, but not be limited to, lost range of motion, loss of strength, any atrophy or tissue mass reduction or any other measurement that may establish the nature and extent of impairment. The most current edition of the American Medical Associations Guide to the Evaluation of Permanent Impairment shall be used.
In determining permanent partial disability value, the Commission shall base its determination on the following factors:
1) The reported level of impairment pursuant to the above Section,
2) The occupation of the employee,
3) The age of the employee at the time of injury,
4) The employee’s future earning capacity, and
5) Evidence of disability corroborated by the treating medical records. Of note, no single enumerating factor shall be the sole determining factor for disability.
HOW THIS AFFECTS YOU
The AMA guidelines negatively affect injured workers. The AMA is a very conservative way to rate the severity of the injury. It does not fully account for the injured worker’s true disability. The AMA guidelines can reduce settlements or awards of disability by 50% or greater. An injured employee should never ask their treating doctor to rate their injury based on the AMA guidelines. It also makes it very important to discuss with your treating doctor, prior to them releasing you from care, about pain, loss of range of motion, or any other symptoms they are experiencing. The injured employee should never sign a medical authorization allowing the insurance company to communicate with your doctor for anything but requests for medical records or bills. Do not authorize the insurance company to request an AMA evaluation for permanent impairment from your doctor.
For all injuries that occur on or after September 1, 2011, an award for wage differential shall be effective only until the employee reaches the age of 67 or 5 years from the date the award becomes final, whichever is later. This is capping the value of a wage differential award because it now has a cutoff date. This can affect the value of the award an injured employee receives.
- 50 years old $20.00/hr x 40 hours a week = $800 week
- Injured and not able to return to job, but is able to work a different job with restrictions.
- New Job - $10.00/hr x 40 hours a week = $400 week
- Old Law = $264 a week for the remainder of life. If injured worker lives to be 78 years old the total award paid would be $384,384.00.
- New Law = $264 a week until injured worker turns 67. The total amount of the award paid would be $233,376.00.
-The change in law would cost this individual $151,017.00.
HOW THIS AFFECTS YOU
This new change will greatly reduce the amount of compensation an injured worker will get if they fall into the above category. It forces the injured worker to “retire” at the age of 67, whether this was their intention or not. It does not take into account that the injured worker who is collecting this type of award is not making the same contributions to their Social Security retirement. This is unfair to the injured worker.
The new law reduces the value of the hand from 205 weeks to 190 weeks if the claim involves carpal tunnel syndrome due to repetitive or cumulative trauma. This immediately reduces the value of any permanency settlement by almost 8%. The new law also caps the Permanent Partial Disability award at 15% of a hand, except for cause shown by clear and convincing evidence in which case the award shall not exceed 30% of a hand.
Old settlement - 15% of hand at $500.00 AWW (205 x 15% = 30.75 weeks x $500.00 aww = $15,375.00)
New Settlement – 15% of hand at $500.00 AWW (190 x 15% = 28.5 weeks x $500.00 aww = $14,250.00)
This is a $1,125 difference that the injured employee has lost due to the new law taking affect.
HOW THIS AFFECTS YOU
This new law and the caps that are put on the awards can potentially be very problematic for injured workers. Not only does it reduce the amount of money the workers will be entitled to via permanency awards, it also does not address what will happen if there are permanent restrictions given to employees that limit or eliminate their ability to perform their job.
This changes the law from TPD being based on the net earnings of the modified job to the TPD being based on the gross earnings. This will reduce the amount of money an injured employee will be paid by the insurance company if their work injury restricts them from working the full amount of hours they worked prior to the injury and the restrictions being placed on them.
Pre Injury - Worker 40 hours per week x wage ($10.00) = $400.00 per week ($264.00- TTD)
Restricted Duty- Worker- 20 hours per week x wage ($10.00) = $200.00 per week (gross) minus taxes $150.00 per week (net)
Old law- employee would receive a TPD check of $114 per week to compensate the loss of the 20 hours of work due to the restriction.
New Law - employee would receive a TPD check in the amount of $64.00 per week.
Injured employee will be out $50.00 per week based on this hypothetical.
HOW THIS AFFECTS YOU
This new law will directly affect the amount of disability pay an injured employee is paid. This new law will save insurance companies money by reducing the amount that is owed to an injured worker who is working a modified schedule because of restrictions from their work injury.
Utilization Reviews may be used by employers/insurance companies when determining payment of bills and authorization for treatment. This consists of the employer/insurance sending medical bills or treatment records and recommendations to doctors for analysis and opinions of whether to pay for or authorize treatment. These doctors do not even see the injured workers.
If a Utilization Review denies either paying medical bills or authorizing treatment, the employee has the burden to show why their treatment deviates from the standards used in the UR, and that that deviation in treatment was necessary to cure or relieve the injury.
HOW THIS AFFECTS YOU
The employer/insurance company will try to not pay medical bills, if they can find a doctor who says their treatment was unnecessary or excessive. They will also try to deny the treatment that has been recommended by the doctor for the same reasons. If this happens it is crucial to depose the doctor who authored the UR opinion to show how the injured worker’s care was reasonable and necessary.