Workers’ Compensation Medical Benefits
Illinois Workers’ Compensation Explained
Chapter 6 – Medical Benefits
This chapter discusses the “Medical” benefits that may be due because of a work injury. While these benefits are frequently referred to as “medical” benefits because they are provided the section of the workers’ compensation act covering medical treatment, the character of the benefits to be paid can be far more expansive than the term “medical” might lead one to believe.
Under the Act, assuming all necessary elements of the compensable claim can be proven, the employer is liable for the reasonable and necessary medical treatment to “cure or relieve” from the effects of the injury.
1. Medical Expenses
Section 8(a) of the Act provides:
“The employer shall provide and pay for all the necessary first aid, medical and surgical services and all necessary medical, surgical and hospital services thereafter incurred, limited however, to that which is reasonably required to cure or relieve from the effects of the accidental injury. . . . If, as a result of the injury the employee is unable to be self-sufficient the employer shall further pay for such maintenance or institutional care as shall be required. . .
Where the accidental injury results in the amputation of an arm, hand, leg, or foot, or the enucleation of an eye, or the loss of any natural teeth, the employer shall furnish an artificial of any such members lost or damaged in accidental injury arising out of and in the course of employment, and shall also furnish the necessary braces in all proper and necessary cases.”
820 ILCS 305/8(a)
The scope of the employer’s obligation to pay medical expenses is unlimited as to time or amount. As long as the medical expenses incurred are reasonable for the services performed, and reasonably required to treat, alleviate pain, or otherwise make the injury more bearable to the employee, then the employer will be required to pay for them. However, the employer’s obligation is not without restrictions. The employee is limited to a choice of two doctors, and any medical providers in the chain of referral from either of these two doctors. There are some provisions where this “two doctor limit” may be restricted, such as where an employer implements a “preferred provider program.” However, unless and until an employer notifies the employee of such a program, the employee may rely upon the two-doctor limit.
There is nothing in the act that prevents an employer from agreeing to cover an employee seeing a doctor outside of the two-doctor limit. At times there are reasons why yet another doctor might become necessary.
Notably absent from Section 8(a) is any requirement that an injured worker be treated by a physician of the employer’s choosing. It is the employee who is entitled to choose from whom they will receive medical treatment. The employee is not required to see the company doctor for medical treatment, although under §12 of the Act the employer may request the employee be examined by a doctor of its choice if certain criteria are met. This is known as an “IME,” or independent medical exam. If the employee chooses to continue treating with an IME doctor the employer selected for an examination, it will normally count as a choice of doctor by the employee.
2. Extra-ordinary benefits
Medical expenses are not just limited to payment for doctor and hospital charges. Section 8(a) also requires:
“The employer shall also pay for treatment, instruction, and training necessary for the physical, mental, and vocational rehabilitation of the employee, including all maintenance costs and expenses incidental thereto.” 820 ILCS 305/8(a)
Under this section, an employer can also be required to pay for such rehabilitation expenses as are necessary under the circumstances. This can include such benefits as Maintenance Benefits, discussed in our chapter on Temporary benefits, and can include an indefinite number of other expenses. For example, we have held employers responsible to pay for a new home, home modifications, wheel chair vans, wheelchair ramps, home cleaning services, non-skilled attendant care, and other necessary expenses to assist in the rehabilitation of an injured worker.