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Extra Effort Towards Safety Can Reduce Workplace InjuriesFor all the ideas that employers and lawmakers have for reducing workers’ compensation costs, improving workplace safety would be the most effective. Not only would it help prevent the need for workers’ compensation claims, but it could also increase productivity and employee morale. The federal government created the Occupational Safety and Health Act to enforce and encourage greater safety measures in the workplace. In Illinois, the federal Occupational Safety and Health Administration oversees private-sector employers, while the state has its own OSHA to regulate public sector employers. Employers are required to maintain safe working environments for their employees, but further safety measures are often voluntary.

OSH Act Requirements

The OSHA conducts unannounced investigations at worksites in order to check compliance with OSH Act requirements. Employers must take several actions to provide a safe workplace for its employees, including:

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Suing a Third Party for a Workplace InjuryThe Illinois Workers’ Compensation Act was created in part so that injured workers would not need to file personal injury lawsuits against their employers. As long as the employer has workers’ compensation insurance, the employer can cover the worker’s medical expenses without a direct cost to itself. By collecting the workers’ compensation benefits, the worker is not allowed to sue the employer for additional damages. However, an injured worker can file a personal injury lawsuit against a third party who was responsible for the injury. The worker may seek the damages in addition to his or her workers’ compensation.

Benefits of Lawsuits

Workers’ compensation benefits are meant to pay for the medical expenses needed for a worker to reach maximum medical improvement. Workers may also be compensated for lost pay if they are disabled and unable to fully return to work. Workers can receive greater compensation with a personal injury lawsuit because they can also request money for:

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Illinois Workers' Compensation Claims Likely Limited to Amount NeededThe Illinois Workers’ Compensation Commission created fee schedules in order to establish the maximum amount of money that may be awarded for different medical expenses in a workers’ compensation claim. The commission determined the maximum amounts by using the fees that were in the 80th percentile for a medical service and taking 90 percent of that amount. The fee schedules are divided into geographic regions and annually updated based on the Consumer Price Index. Categories of medical expenses include:

  • Procedures and treatments;
  • Hospital inpatient and outpatient fees;
  • Emergency room fees;
  • Rehabilitation services;
  • Medical prescriptions;
  • Dental services; and
  • Professional services.

Though fee schedules establish how much a workers’ compensation claimant may receive, the IWCC is unlikely to award more than what is needed to pay for a claim.

Recent Case

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How Utilization Review Affects Workers' Compensation CasesAfter employees are granted workers’ compensation for their workplace injuries, employers and insurance companies may still dispute what medical services the compensation should cover. Workers want treatments that can help them fully recover and regain a quality of life. Insurers want the most cost-effective option that will adequately treat the injury. The two sides may disagree upon which treatments are necessary and which are gratuitous. The Illinois Workers’ Compensation Act allows employers to seek a utilization review to determine whether the medical treatment an employee is receiving is necessary to recover from the injury.

Utilization Review

According to Illinois law, a utilization review evaluates whether the level and quality of medical care in a workers’ compensation case is efficient and appropriate, based on standard practices for treating the injury. When an employer conducts a utilization review, a medical professional can make his or her decision based on:

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Differences Between Workers' Compensation and Personal InjuryThe similarities between workers’ compensation and personal injury cases can make them at times difficult to distinguish. Both involve people being injured and needing monetary compensation in order to pay for recovery. In the simplest terms, workers’ compensation is a personal injury that occurs as a result of someone’s work. Workers’ compensation laws were created to help injured workers without having to sue their employers or coworkers. By accepting workers’ compensation benefits, an employee waives his or her right to sue an employer. However, there are more differences between workers' compensation and personal injury cases than the circumstances of the injury. In some cases, an employee injured at work may have the right to file a personal injury lawsuit.

Need for Fault

In personal injury lawsuits, the plaintiff must prove that the defendant was at fault for his or her injury. Workers’ compensation claims require the claimant to prove that his or her injury arose from work. In most cases, it is easier to prove the latter than the former. The source of an injury is more based on facts than determining who was a fault for the injury. By allowing a workers’ compensation claim, the employer is not admitting negligence and is covered by its insurance.

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