What Are My Workers’ Compensation Medical Benefits in Illinois?
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What types of medical services are covered?
The employer is required to pay all the NECESSARY medical expenses of an employee injured while working. This includes care needed to diagnose, relieve or cure an injury. All hospital, medical and surgical expenses that are incurred by the employee as a result of the work injury are included. In addition, the employer is required to pay for the treatment and training needed to rehabilitate the injured person (employee) mentally, physically or vocationally. In the case of amputation or the loss of an arm, hand, foot, leg, eye or natural teeth – the employer is required to supply a replacement for the body part that was lossed. This included any braces that may need to accompany that new body part. In addition, the employer has the obligation to keep the artificial body part in good condition for the rest of the employee’s life.
Covered Expenses – Reasonable & Necessary
In order for medical bills / expenses to paid under the Workers’ Compensation Act, the treatment MUST BE reasonable and necessary to fix the end result of the work accident or work injury. Some guidelines include; was the procedure, used to diagnose / cure or relieve symptoms of a work injury? Was the medical treatment customary or a normal course of treatment? An employer is NOT liable or responsible for medical treatment for an injury that did not occur while at work.
Choice of physicians – under work comp, an injured employee has the right to consult up to two doctors of their choice for treatment. Those expenses are covered under the Workers’ Compensation Act. However, this can get complicated. For example, if a person is first taken to the emergency room for their work injury does this visit count as the use of one their doctor consults under the choice of physician rules? The answer is the emergency room visit may or may not count depending on the circumstances. If it is determined that the emergency room visit was not required for a true medical emergency, then the emergency room doctor may be considered as one of the two doctors the injured employee is entitled to visit under the act. This can get complex – please consult with an experienced workers compensation lawyer for help you understand your specific situation and circumstances.
Referral to a specialist? If either of the two doctors consulted for treatment of the work related injury refers the employee to a specialist, then any and all medical care provided by that specialist for the work injury is covered under work comp.
What are the durations of medical benefits under work comp?
What is the treatment for continuing symptoms?
What happens if symptoms or conditions occur down the road that currently do not exist?
What are your and your employer’s rights to your medical records?
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