Taking on Insurance Companies and Others to Get the Benefits You Need for Your Workplace Injury

Your workplace injury legal action (or actions) may be very straightforward or may be highly complex. What might start out as a seemingly simple request for additional benefits based on an unanticipated need for a secondary medical procedure may possibly set off many wide-ranging legal consequences. The key is to have the skilled Illinois workplace injury counsel you need to be ready for whatever comes next.

G.B. was a worker whose injury action proved to fall into the “complex” column. In the spring of 2017, G.B. was injured while working as a forklift driver in McHenry County. The damage to the driver’s shoulder was bad enough that he required rotator cuff surgery. Later on, doctors determined that the worker needed a follow-up surgery. That led G.B. to request an adjustment of the workers’ compensation claim for benefits that he’d filed earlier.

What ensued was a web of allegations and litigation over G.B.’s claim, all triggered through no fault of the worker. As many employers, especially larger employers, do, G.B.’s employer had workers’ compensation insurance. However, G.B.’s employer allegedly covered the forklift driver’s lost wages and medical expenses after the first surgery without notifying the insurance company. According to the insurer, it only found out after G.B. sought the adjustment to his claim based on the need for a second surgery.

Of course, none of that was G.B.’s fault. Nevertheless, he went months with no payment of his claims based on the second surgery. That led him to take further legal action, seeking monetary penalties for “unreasonable and vexatious delay.” This is an option if your claim isn’t being paid and there is no good-faith reason for the delay, and these penalties can be an important element of a truly complete recovery if you’ve been forced to suffer from mounting medical bills and no income while your claim remains unpaid.

The insurer, as many insurers are prone to doing, sought to avoid any financial obligation for G.B.’s claim. It filed an action asking for a declaratory judgment that would rule that, when the employer paid G.B. initially without contacting the insurer, the employer “voluntarily decided to forego coverage,” so the insurer wasn’t liable for anything. The insurer also asked the court to order a temporary total stop to the forklift driver’s case before the Illinois Workers Compensation Commission (IWCC) until the court ruled on the declaratory judgment request.

This, of course, presented dual problems for the injured employee. In addition to the insurer’s attempting to avoid paying, the insurer was potentially delaying a much-needed adjustment of workers’ compensation benefits. When that happens, you need to know how to attack such action in the legal system. For G.B., that meant challenging the insurer’s request for a stay of the IWCC case.

The worker was ultimately successful. The appeals court issued a ruling saying that the trial court did not have the legal authority to issue the stay that the insurer sought in the IWCC action. Specifically, the appeals court explained that, under Illinois law, the legal rule called the “doctrine of primary jurisdiction” doesn’t permit trial courts to stay an administrative proceeding like an IWCC case. Based on that, the worker was entitled to proceed forward with his workers’ compensation claim for adjustment of benefits.

Whether straightforward or complex, your workplace injury case can be aided, and potentially made more fruitful, by putting skilled legal counsel on your side. If you’ve been hurt at work, reach out to the experienced Chicago workplace injury attorneys at Katz, Friedman, Eisenstein, Johnson, Bareck & Bertuca. Our attorneys have been helping injured workers for many years and are here to discuss your case. To set up a free case evaluation, contact us at 800-444-1525 or through our website.

More Blog Posts:

Illinois Court Says Police Officer Entitled to Seek Benefits for Injury Suffered Inspecting Commercial Truck, Chicago Injury Attorneys Blog, Dec. 5, 2018

Illinois Railway Worker Obtains $21M Damages Award for Foot Injury Suffered in Railyard Accident, Chicago Injury Attorneys Blog, Nov. 17, 2017