Under Illinois workers’ compensation law, if you refuse reasonable medical treatment, that could result in your case being denied or ended. In other words, if you hurt your back on the job and your doctor suggests physical therapy, if you refuse to participate, it could end your case.
There is a BIG exception to this rule.
Link to You Can Not Be Forced To Have Surgery If Hurt At Work In Illinois You Can Not Be Forced To Have Surgery If Hurt At Work In Illinois
One thing an insurance company (or anyone else) can not make you do is have surgery. This is true even if it is a relatively quick and likely successful surgery like for carpal tunnel. It is also true if having surgery could get you back to work full duty and not having the surgery will leave you with permanent restrictions.
The reason for this is because surgery is invasive and even the safest surgeries have risks. It is your choice as to what to do or not do with your body. This is all pretty sensible.
Link to Reasons Why People Refuse To Have Surgery Reasons Why People Refuse To Have Surgery
Some people refuse surgery because they are scared or had a bad experience previously. One former client refused to do anything with anesthesia because they are convinced that is why their father developed Alzheimer’s.
And a recent caller to my office did not want the surgery because he had a lot of family events coming up. One child was getting married, another was going to graduate college and he and his wife had a big safari anniversary trip planned. He had a torn rotator cuff and while he could do regular day to day activities, he can no longer work his heavy duty labor job. That is because without surgery his restrictions are no lifting overhead more than ten pounds. A ton of his work is overhead lifting.
A rotator cuff repair takes about 45 minutes, but will require six months of recovery. It is absolutely his right to turn down the surgery even if the reasons are so he will be able to enjoy some fun outside of work. I would not want to be in an arm sling for wedding photos either.
Link to When You Do Not Want Surgery Now, But Might Later When You Do Not Want Surgery Now, But Might Later
Because he does not want the surgery, his doctor has declared him to be at maximum medical improvement (MMI) and has discharged him from his care with permanent restrictions. Because he has a job within his restrictions that pays the same as he used to make (he got very lucky), the case is ready to be settled.
His question to me was about having surgery at a later date. He doesn’t love his new job and is worried about limited arm mobility as he gets older. He wanted to know if he could settle, but get them to pay for the surgery at a later date.
While everything is negotiable, most Illinois workers’ compensation settlements close out your medical rights. Insurance companies want certainty. But he has two options to get what he wants:
- He can take his case to arbitration. When you win an arbitration (and this case is not disputed, so he would win), you still get the equivalent of a settlement, but you keep your medical rights open as relates to that injury. So if in two, five, 10 years or whenever he wants to have rotator cuff surgery, the insurance company would have to pay for all of it as long as he can prove the need for surgery is related to the work accident.
- He can settle and request a Medicare Set Aside. Any time you settle an Illinois work comp case, you are supposed to take into consideration the rights of Medicare. Basically that means that if it is anticipated that you might need future medical care, you and the insurance company can not make Medicare pay for it. So what happens is that the insurance company has to fund a surgery now and give that money to you. This is separate from the settlement dollars.
The great part of this is you can put that surgery money in your pocket and control it. If you ever do have the surgery, if you want to use Medicare, you will have to contribute these dollars first. Otherwise if they catch that it should have been part of work comp, you’d have to pay them back. And if you never have the surgery, the money is just yours.
Link to The Bottom Line The Bottom Line
The TL/DR version of this post is that you can not be forced to have surgery if hurt on the job. And if you might want surgery down the road, there are options for you even if you settle your case.
And if you have any questions or want a free case review, please call us any time at 312-346-5578.