Failure to Pay For Approved Treatment

Workers’ Compensation Lawyers Assisting People in Wheaton and Schaumburg

The Illinois Workers’ Compensation Act (ICWA) provides for payment of reasonable and necessary medical care for employees suffering a work-related injury or illness. According to law, “reasonable medical care” includes well-established procedures and treatments, and is unlikely to cover experimental or alternative care. In some situations, an employer or insurer may dispute the proposed treatment or fail to pay for approved medical treatment. The dedicated Wheaton and Schaumburg workers’ compensation attorneys at Therman Law Offices are here to help you understand your rights and next steps if you are facing a situation involving an employer’s failure to pay for approved medical treatment. Together, we have over 35 years of legal experience, and are here to help people hold employers accountable for their legal obligations to injured workers.

Failure to Pay for Approved Treatment

According to the IWCA, employers or their insurance companies must pay for medical care to treat workers injured in the course and scope of employment. In the majority of cases, reasonably necessary medical care covers first aid, emergency costs, medical devices, and pharmaceuticals. Employees are not required to prove fault for their injuries according to the Act, and are protected from retaliation by their employers.

Medical care provided for injured workers under the IWCA typically requires that an employer pre- authorize treatment. This helps to ensure that the cost for treatment will be paid. For example, if an injured worker suffering a sprain requires an x-ray, they would likely need to get approval for this diagnostic testing.

An employer or insurance company that delays payment or fails to pay for approved treatment may be penalized. The IWCA makes clear that for pre-approved medical treatment, the penalization can be 50% of the amount payable at the time of the award. In order for this penalty to apply, the failure to pay needs to be without good and just cause. Examples of common situations where penalties that may be awarded include a failure to pay for an undisputed benefit or a statutory amputation benefit.

The standard deadline for an employer or workers’ compensation insurer to pay for authorized medical treatment is 30 days after a health care provider submits a bill. If there is a good faith reason for the employer not to pay, or if the bill is vague, then they may have the right to avoid making the payment. In some cases, insurers simply delay paying a bill in order to save money.

Failure to pay for approved treatment may occur when there is conflict regarding medical treatment. If the employer’s independent medical examination (IME) doctor disagrees with the treatment recommended by the employee’s personal doctor, this issue must be resolved. The employer will not be penalized if this dispute remains, even if the IME doctor is not correct. A skilled workers’ compensation attorney can guide you through the process in the event of a conflict in this area.

Filing a Petition for an Immediate Hearing

If an employer or their insurance company fails to pay for approved medical treatment, an injured worker has legal options. One option is to file a 19(b) petition under the IWCA. This is a formal request for an immediate hearing before an arbitrator. As referenced above, in some cases the worker is also entitled to file for penalties if there is an unreasonable delay in paying for benefits.

Workers’ Compensation Attorneys for Wheaton and Schaumburg Residents

If you are facing a situation in which the insurer or employer is failing to pay for approved treatment, you can reach out to Therman Law Offices. We advocate for injured workers in a range of industries in Wheaton and Schaumburg, and are extensively familiar with the IWCA. Our approach is to closely examine clients’ situations in order to pursue the relief and compensation they need. Our lawyers also represent people throughout West Chicago, Lemont, Elmhurst, Oakbrook Terrace, Westmont, Downers Grove, Clarendon Hills, Lisle, Bolingbrook, and Darien. Call our office today to learn more about your legal rights. Call us at 312-588-1900 or complete our online form.