Medical Bills and Treatment Authorization After an Illinois Work Injury
An injured Illinois worker may be entitled to medical care that is reasonably necessary to cure or relieve the effects of a work-related injury. This can include emergency treatment, doctor visits, diagnostic testing, physical or occupational therapy, medication, injections, surgery, hospitalization, and appropriate rehabilitation.
Disputes can arise before treatment occurs, when an employer or workers’ compensation insurance carrier delays or refuses to authorize care recommended by a treating physician. Other disputes arise after treatment, when medical bills remain unpaid or a provider begins collection efforts. The Law Offices of Millon & Peskin, Ltd. represents injured workers in both types of disputes.
What Medical Treatment Must Workers’ Compensation Cover?
Section 8(a) of the Illinois Workers’ Compensation Act generally requires the employer to provide and pay for medical services that are reasonably required to cure or relieve the effects of an accidental work injury. Whether particular treatment must be covered depends on the facts and medical evidence in the claim.
A doctor’s recommendation is important, but a prescription or treatment order does not automatically resolve every dispute. The employer or insurance carrier may contest whether the condition is related to the work accident, whether the proposed care is medically necessary, whether sufficient records were submitted, or whether the provider is within an authorized choice of physician and chain of referrals.
What If Recommended Treatment Is Delayed or Denied?
When a treating doctor recommends an MRI, therapy, injections, surgery, or another form of care, the provider will often submit the treatment order and supporting records to the workers’ compensation carrier. If the request is not approved, it is important to identify the stated reason rather than assume that the delay is final.
The carrier may request additional records, dispute medical causation, schedule an independent medical examination, or rely on utilization review. Utilization review is a process permitted under Illinois law for evaluating the medical necessity and appropriateness of proposed or completed treatment. A utilization-review determination is evidence the Illinois Workers’ Compensation Commission may consider, but the Commission considers it together with the other medical and factual evidence. The treating physician’s examination findings, diagnostic studies, response to prior care, and explanation of the treatment recommendation may therefore be important.
For a more detailed discussion, read what injured Illinois workers can do when workers’ compensation denies a doctor’s recommended treatment.
What Should an Injured Worker Do About a Treatment Delay?
Keep a copy of the prescription or treatment order. Confirm that the medical provider submitted the request and the records supporting it. Ask for a copy of any written denial or utilization-review decision. Continue attending appropriate medical appointments, follow the treating provider’s instructions, and promptly provide the relevant documents to a workers’ compensation attorney.
Depending on the circumstances, an attorney may follow up with the Respondent, determine whether additional medical support is needed, address a utilization-review decision, or request that the Illinois Workers’ Compensation Commission decide whether the treatment should be provided. The appropriate response depends on the medical evidence, the reason for the denial, the urgency of the requested care, and the procedural history of the claim.
What If Work-Related Medical Bills Are Unpaid?
A separate problem occurs when treatment has already been provided but the employer or insurance carrier does not pay the bills. The dispute may involve whether the accident is compensable, whether the treatment is causally related to the injury, whether the charges are reasonable and necessary, or whether the proper billing information was supplied.
Illinois law provides protections against certain collection activity while a workers’ compensation claim concerning the bills is pending before the Commission. The injured worker should notify the medical provider that the claim is pending and provide the information the provider reasonably requests about the case. A provider may still send reminders and request claim information. If the worker fails to respond to a proper request for information within the applicable period, collection efforts may resume.
Do not ignore medical bills, collection notices, or requests from a provider. Keep copies and provide them to your attorney so that the status of each bill and the reason for nonpayment can be evaluated.
For additional information, read how medical causation can affect responsibility for treatment and benefits.
Can an Insurance Carrier Face Consequences for an Unreasonable Delay?
Penalties or attorney’s fees may be available in some cases involving an unreasonable or vexatious delay, but they are not automatic. The outcome depends on the legal standard, the carrier’s stated reason, the available medical evidence, any utilization review, and the history of the requests and responses.
Learn more about when unreasonable benefit delays may support penalties under Illinois law.
Speak With an Illinois Workers’ Compensation Attorney
If prescribed treatment has been delayed or denied, medical bills remain unpaid, or a provider has contacted you about collection, The Law Offices of Millon & Peskin, Ltd. can review the treatment recommendation, medical records, carrier response, utilization-review materials, and billing information.
We represent injured workers from offices in Wheaton, Rosemont, Arlington Heights, and Chicago. Contact us to schedule a free consultation about the circumstances of your Illinois workers’ compensation claim.