Don’t Add Insult to Injury

No matter how many workplace safety measures your company puts in place, you simply cannot prevent every accident from occurring.

When a workplace accident does occur, it—and the subsequent injuries—can trigger the Illinois Workers’ Compensation Act. “The goal of the Workers’ Compensation Act is to protect the workers of Illinois injured as a result of performing their work duties,” says Jason Kolecke, a workers’ compensation attorney at Hennessy & Roach in Chicago. 

“Under the Illinois no-fault system, an employee’s fault is not a defense to a work-comp claim,” adds Jeanmarie Calcagno, a workers’ compensation attorney at Kopka Pinkus Dolin in Chicago. “Hopefully, the fact that parties are not arguing over fault provides a more immediate remedy for injured workers.” 

After a Job-Related Injury

A claim isn’t initiated unless the injury is properly reported. “An injured worker is under a statutory obligation to provide notice of his or her work-related accident within 45 days of the accident,” Calcagno says. 

Once an employer is made aware of a workplace injury, the incident must be reported to the Illinois Workers’ Compensation Commission. “The first step an employer needs to take is to provide notice to the state and their insurance carrier,” says Kolecke. “That’s what will ensure benefits are paid and medical is approved.”

Steps must also be taken to “ensure the injured worker receives proper medical care and treatment,” adds Calcagno. “Even if the injury is called in days later, make sure the employee receives the care they are entitled to.” 

Potential Benefits Under Coverage

Primary workers’ compensation benefits include wage loss and medical expenses, though payments are subject to a waiting period. “Approved claimants receive benefits starting on the fourth day after an injury is reported,” Kolecke says. “If [an employee] is off work for two weeks consecutively, the first three days of wage loss is paid retroactively.” 

According to Calcagno, claimants are entitled to “medical treatment that is deemed reasonable and necessary related to the accident itself. This treatment continues until they reach a point of maximum medical improvement [MMI].”

A determination of whether an employee has reached MMI is made by a medical professional. “Hopefully the employee can return to work on a full-duty basis upon reaching MMI—or even before,” she continues. “If they cannot, the employee may be entitled to assistance benefits that will facilitate their return to gainful employment in a stable labor market.” 

While wage loss is a staple of workers’ compensation coverage, Kolecke says, “pain and suffering are not compensated.” 

He continues: “People with pre-existing conditions may be covered, but there are limitations. This is a gray area that presents factual questions. [The Illinois Workers’ Compensation Commission] will evaluate how the accident affected the pre-existing condition, and the commission will consider if the injury constitutes a mere continuation of the condition, which is not covered.”

And while traveling employees are generally covered, “courts look to see if the injury arose out of conduct that was reasonable and foreseeable,” says Calcagno. 

Preventative Measures

Of course, it is important to set and disseminate clear company policies. “The key is to educate your employees on safety in the workplace, and to always have an open line of communication,” Calcagno says. “Ongoing training is also essential. Education isn’t just a one-time thing.”

Kolecke notes that you should let employees know what is expected of them, including rules and regulations that should be followed. Providing safety training and fostering open communication is crucial. 

Claim Defenses

The four strategies an employer may use to dispute a claim at its outset, according to Kolecke, include: “lack of notice, factual inconsistencies, delay of medical treatment and witness testimony. Also,” he says, “document any misconduct, warnings, or work completed contrary to stated rules.”

Notwithstanding Illinois’ no-fault system, employee behavior can nullify coverage. “In certain situations, intentional acts are not covered. When an employer suspects foul play, or something of the sort, a defense can be raised to remove an alleged work-related incident from the statutory remedy,” Calcagno says.

Workplace injuries sustained while under the influence of alcohol or drugs can also negate coverage, adds Kolecke. Notably, an employee under the influence of marijuana while injured at work cannot rely on Illinois’ recreational marijuana laws. 

Knowledge Is Key

Though you simply can’t stop every accident from occurring, both attorneys emphasize the importance of preventing workplace accidents. “The key is to educate your employees on safety in the workplace, and partner with your insurer to identify any issues within the workplace that could lead to an accident,” says Calcagno. “The best employers listen to their employees about any issues they may be having in performing their jobs.”