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I have the pleasure of talking to 5-10 people a day who have Illinois work comp questions. A recent caller asked a really good question. She had been receiving work comp benefits for over six months due to a serious leg injury. There was no dispute that she hurt herself at work. The accident was witnessed and she received treatment right away. All of her medical bills have been paid including for a surgery. All of her time off work was paid up until about a month before she called me.
What happened next is the work comp insurance just stopped paying. She’s still treating with her doctor. Her doctor still has her off work. The TTD checks just stopped coming and the insurance adjuster hasn’t called her back. She wanted to know if this was legal.
The short answer is that an insurance company can’t just stop paying you if you are authorized off of work unless they have good cause. What would be good cause? Here are some examples:
- The send you to an independent medical exam (IME) and their hired gun doctor says you can return to work or your accident wasn’t work related.
- They discover new facts about the accident that bring in to question whether or not they should have approved it in the first place. For example, somebody comes forward and tells them you really got hurt at home.
- Surveillance is conducted on you by the insurance company and that video indicates you are faking your injury.
- Your doctor says you can return to work even though you don’t feel you can.
- Your employer has work for you within your medical restrictions.
None of those things happened in this case. She has a few months more to go before her doctor thinks she will be released to return to work. So why is this happening and what can be done about it?
I suspect it’s one of two things. Either the adjuster is playing games and hoping to frustrate this nice woman into going back to work too soon. Or the adjuster quit/was fired and nobody has taken over their files. Insurance companies aren’t always organized and their priority is never making sure that people who should get paid do get paid.
The way we can solve the problem is to make calls to other people at the insurance company that our lawyers have had cases against and see what is really going on. Sometimes those simple phone calls can make things better. If they are just messing with her, they wouldn’t have likely done so if she was represented. The other option is to file a 19(b) petition for immediate hearing at the Illinois Workers’ Compensation Commission along with a petition for penalties. This will force them to respond for their actions and potentially punishing them for acting in bad faith.
So the good news is that she has a likely very solvable problem. It’s frustrating that she needs to deal with this nonsense, but at least the law is on her side and the problem likely can be solved in short order.