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Can Workers’ Compensation Cover Cosmetic Surgery?Workers’ compensation benefits are meant to pay for medical treatment for your work-related injury. When a claim is filed, insurance companies often argue with workers about whether injuries are related to the work incident and whether the treatment is necessary for recovery. Cosmetic surgery is a gray area in workers’ compensation that may not seem like it would fall in the category of necessary treatment. However, a scar from an injury can degrade your quality of life, making corrective treatment appropriate as a workers’ compensation expense.

Disfigurement

An injury or a related medical procedure can leave a permanent visible mark, known as a disfigurement. In terms of workers’ compensation law, disfigurement is cosmetic damage to the body that does not affect your ability to perform your work. Visible scars and lost teeth are common examples of disfigurement. Insurers often argue against paying for corrective surgery on a disfigurement because they believe it goes beyond the treatment that is necessary to physically function. However, a disfigurement can affect your quality of life and, by extension, your work performance:

  • Scars on normally visible places of the body can cause embarrassment and distress; and
  • A scar may cause pain or itching, which a cosmetic surgery could fix.

Receiving Compensation

It may take several months after your injury to determine whether you have a disfigurement. Surgery may leave a scar, and you need time to see whether your scar will heal. Whether your disfigurement qualifies for workers’ compensation benefits and how much you receive depends on the size and location of the disfigurement. Surgery to correct a small scar may not be covered, but an arbitrator or the Illinois Workers’ Compensation Commission may award you additional compensation for cosmetic surgery if you have a noticeable scar on your:

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Receiving Workers’ Compensation for Mental TraumaThe injuries you receive at work can go beyond what can be physically diagnosed. Sometimes, an incident at work can be traumatic enough that it causes a mental disorder, such as depression or anxiety. A mental health professional can diagnose your mental disorder and state whether the work incident likely caused the disorder. Illinois law allows you to receive workers’ compensation benefits if you can prove the correlation between the work incident and your mental health. You can use a “mental-physical” claim or “mental-mental” claim.

Mental-Physical

A mental-physical claim is when a physical incident at work caused trauma that led to your mental condition. This can easily happen when you suffer a traumatic injury in the process of your normal work duties. A factory worker who was severely injured while using machinery may feel anxious about returning to work. The worker could be diagnosed with post-traumatic stress disorder if he or she suffers panic attacks due to that anxiety.

Seemingly minor injuries can also create mental trauma depending on the nature of the incident. For instance, someone sexually assaulted by a supervisor may suffer bruises that do not require medical treatment. However, being assaulted at work is traumatic and would understandably cause the victim anxiety about returning to the workplace. The Illinois Workers’ Compensation Commission has awarded benefits in such a scenario.

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Work Injuries Can Extend Beyond Normal Working HoursInjuries that are covered by workers’ compensation insurance extend beyond what many employees realize. For instance, you may believe that you needed to be working “on the clock” for an injury to be work-related. Your employer’s responsibility for your health can continue even after your official work hours. The workers’ compensation insurance provider will likely contest any injury claim that occurs outside of your paid hours or the workplace. This should not discourage you from filing for workers’ compensation benefits.

Qualifying for Benefits

Job requirements can dictate your actions beyond your documented working hours. Many employees are required or compelled to take their work home with them or perform work-related tasks after work. Even the requirement to travel to and from a work site can potentially expose you to danger. When wondering whether an injury is work-related, you should ask:

  • Was I performing a task that was required as part of my job?;
  • Was my employer benefitting from my actions?;
  • Was my employer aware or could my employer have been expected to be aware that I was at a work site during my free time?;
  • Does my employer own or maintain the property where the injury occurred?; and
  • Would I have been in the situation that caused my injury if not for my work?

If you answer “yes” to any of these questions, it is worth exploring whether your injury would qualify for workers’ compensation benefits.

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New Illinois Law Would Allow Latent Injury Claims Past Statute of ReposeThe Illinois General Assembly has passed legislation that extends the opportunity to receive compensation when people suffer from work-related occupational diseases. If signed by the governor, the law would allow plaintiffs to file civil lawsuits against employers if the statute of repose for workers’ compensation has expired. The Illinois Supreme Court ruled in 2015 that workers’ compensation was the only recourse for people seeking compensation for occupational diseases and that the 25-year statute of repose is a strict time limit for when a plaintiff must file a claim. The new law would effectively circumvent that ruling.

Occupational Diseases

Unlike most workplace injuries, an occupational disease develops from long-term exposure to a contaminant and not from a specific event. Common causes of occupational diseases include:

  • Exposure to radioactive materials; and
  • Inhalation of harmful substances, such as asbestos.

The period of repose is the length of time after the worker’s last known contact with the contaminant that a plaintiff has to file a workers’ compensation claim. Depending on the cause of the occupational disease, the statute of repose could be as little as two years or as long as 25 years. However, it can take years to decades for a worker to become aware of an occupational disease, such as cancer or respiratory diseases.

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Ways Your Employer May Try to Fire You After a Workers' Compensation ClaimYour employer cannot fire you in retaliation for you filing a workers’ compensation claim. Doing so would allow you to file a wrongful termination lawsuit and could also result in criminal penalties against your employer. However, your employer can legally terminate your employment after you have filed a workers’ compensation claim if there is another reason for your termination. If you believe that your employer is punishing you for your injury claim, you must document your employer’s actions as evidence of their retaliation.

Reasons for Firing

Most employers are smart enough to not tell you that they are firing you because of your workers’ compensation claim. However, your employer could be looking for an excuse to fire you that they can say was unrelated to your claim. Valid reasons to terminate your employment could include:

  • Misconduct on your part;
  • Layoffs due to a declining budget;
  • Not having a job that can accommodate your physical restrictions after you have reached maximum medical improvement; or
  • You refusing to accept a new position with your employer that accommodates your needs.

Firing you would not let your employer’s insurer off the hook for your workers’ compensation claim. You could still receive a settlement and benefits for your injury. Instead, your employer may be trying to replace you with a healthy employee who has no work restrictions.

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