Workers Compensation Claims

Transcription

1 Workers Compensation Claims What You Should Know... w WCTI WORKERS COM PENSATION TRUST OF ILLINOIS

2 Employer To protect its rights and assure proper administration of the Illinois Workers Compensation Act, the EMPLOYER, after receiving notice of a work-related injury, should: Promptly conduct a thorough investigation to determine if the injury was the result of a work-related accident. Send the employee to the company clinic for a drug test. Maintain contact with the injured employee to monitor his/her claim. Report the claim to CCMSI within 5 days. 5 No in house payment of medical bills is allowed as a member of WCTI. All injuries requiring medical treatment must be submitted to WCTI.

3 Employee If an employee is injured on the job, he/she may be entitled to benefits under the Illinois Workers Compensation Act regardless of who may be at fault. To protect his/her rights and obtain appropriate and timely benefits, an INJURED EMPLOYEE should: Make sure the employer knows about the injury as soon as possible. Promptly seek medical care. Provide the employer with the name, address and telephone number of the doctor. Request the treating doctor provide pertinent information to the employer and claim administrator. Make sure all doctor s slips are given to the employer immediately following all appointments. 6 Contact their CCMSI Claim Representative following each doctor s appointment to communicate current treatment information. Deb Schiesl (630) / Members A-K Georgiann Quattrochi (630) / Members L-Z Karen Hunt (630) / Medical Only Claims

4 Benefits for Employees Injured by a Work-Related Accident 1. Reasonable and necessary medical care. If treatment is necessary, the employer must pay the reasonable costs of necessary treatment by any two doctors chosen by the employee and any referrals by the first two doctors. The employer must also pay the costs of emergency treatment and first aid. 2. Weekly disability benefits while the employee is off work, authorized by his/her doctor. These benefits equal 2/3 of the gross earnings based on an average of 52 weeks of earnings prior to the date of injury. These benefits are subject to maximums and minimums set by the Illinois Workers Compensation Commission. Disability benefits are not paid for the first three scheduled workdays off following the accident unless disability extends to 14 or more calendar days. NO DISABILITY BENEFITS ARE PAID FOR THE DATE OF INJURY. Example Employee was injured on a Monday. His next scheduled workdays are Tuesday, Wednesday, and Thursday. The employee returned to work on Friday. No benefits would be paid because the employee did not miss more than three scheduled workdays. Once benefits have started, all benefits will be paid on calendar days, not scheduled workdays. BENEFIT CHECKS Benefit checks will be mailed to the employers on a weekly basis. Employees should be instructed to come into the office to pick up their checks. This allows for periodic observation of and contact with employees who are collecting Temporary Total Disability benefits.

5 Employee Information If the employee believes he or she may not be receiving all available benefits, he/she should: 1. Review the Information Handbook published by the Illinois Workers Compensation Commission and be aware of all of his/ her rights and obligations. It can be found at 2. Contact the employer s Claims Administrator (WCTI) and discuss the situation. There may be some misunderstanding that can be easily resolved. 3. Request information from the: Illinois Workers Compensation Commission 100 West Randolph St., Suite Chicago, Illinois Phone: (312)

6 Some Commonly Asked Workers Compensation Questions Can the injured employee choose the treating doctor or hospital? Yes. An employee may choose his doctor or hospital at the employer s expense. 2. Is there a limit to the number of doctors an injured employee may select at the employer s expense? Yes. An employee is entitled to two choices of doctors plus any medical providers in the referral chain from those original two doctors. If, after the second choice of doctor or hospital, the employee chooses to see any other doctors not chosen by the employer, the employee must pay for them. Emergency and first aid care is not considered one of an employee s two choices of doctors. 3. Must the employer pay all the bills of the doctor or hospital? If treatment provided is necessary and the charges are reasonable, the employer is required to pay them. 4. Should the employee s doctor send medical reports to the employer? Yes. If the employee s doctor does not send medical reports to the employer or its claim administrator, benefits may be delayed. 5. Does the Illinois Workers Compensation Commission issue workers compensation checks? No. Benefit checks are issued by the employer s workers compensation claims administrator (WCTI). Information regarding an employer s claims administrator should be posted for all employees to view.