Employer Initially Generous, Then…

By: Matthew J. Healy

Q:I injured my lower back while lifting heavy equipment at work. I immediately reported the injury to my supervisor. That day he took me to the company doctor and that doctor recommended I not return to work until I recover. My employer has been fairly good to me: they paid me a portion of my usual paycheck and covered some of my medical bills, but I have heard nothing further from them. After some physical therapy, my own doctor told me this was as good as my back was going to get. I have since returned to work but my back is just not as stable or strong as it used to be. What are my rights?

A:First of all, your employer (or employer's insurer) did the right thing under worker's compensation law by paying you wages while you were off work due to an on-the-job injury. If your employer paid you two-thirds of your average weekly wage, based on your wages for the period of 52 weeks before the date of the occurrence, then you have received the correct amount to which you are entitled under the law. Any amount less is inadequate under the law. In addition, some employees (e.g. City of Chicago and Cook County) get pension benefits which are added on to the two-thirds from the employer.

Second, if your employer is not disputing that your injury was job-related, nor disputing the extent of your injury, then the employer should cover the medical expenses related to that injury. Under no circumstances should the employee be required to pay medical expenses for undisputed work-related injuries.

Third, if your doctor believes that your injury is permanent, then you are entitled to a permanency award. Typically, doctors rely on tests such as MRIs and CT scans, and to a lesser extent, X-rays, to best determine objective evidence of permanency. For example, objective evidence of a herniated disk in the lower back is more likely to be seen on an MRI rather than an X-ray. Although MRIs are more expensive than X-rays, they tend to show the extent of an injury in greater detail. If the test results are positive, your doctor will likely give an opinion that your job-related injury is permanent. Under this scenario, your employer is responsible for this disability and you will be entitled to a settlement or an award for permanency.

If you have sustained a permanent injury, it is in your best interests to retain an attorney who specialized in this field to advise you of the fair value of your claim.

Note that employer's insurers, like any business, are for-profit entities, not charities. Therefore, they may attempt to minimize the nature and/or extent of your injury. You would be well served to seek legal advice to ensure you receive full and fair worker's compensation benefits.

WHO WILL HELP PAY PASSENGER'S MEDICAL BILLS?

Q:Recently, my son was a passenger in a friend's car when the car was in an accident. The car was struck by another car whose driver was apparently drinking. My son broke his leg and had surgery requiring a steel rod to be inserted. The medical bills are mounting fast and our health insurance is only paying 80%. Are there other ways to pay these bills?

A:Yes. This presents a classic multi-liability scenario. Depending on the unique facts of your case, there could be multiple sources of recovery: the other driver who was drinking, the drinking establishment who served that other driver, the driver of the car in which your son was a passenger, and your son's own (or your own if he is a dependent living in your home) insurance policy's uninsured or underinsured motorist and medical payment provisions.

If there is evidence that indicates that the other driver failed to obey traffic laws, then some liability will be attributed to him. If there is evidence that the other driver was drinking, this is even more reason to attribute liability to him. If the other driver was over-served at a tavern prior to the accident, then the tavern might be partially responsible.

If there is evidence that the driver of the car in which your son was a passenger failed to obey traffic laws, then the driver may be partially liable to his passengers for their injuries.

However, even if the driver, the other driver, and the tavern are partially liable, they may be unable to fully compensate (through their own insurance or otherwise) your son for his injuries. If so, then the underinsured (UIM) provision of your son's auto insurance policy is triggered. In Illinois, when one purchases auto insurance, he or she must be offered UIM coverage. Your son should seek UIM coverage when the at-fault party or parties have inadequate coverage to pay for his injuries.

Keep in mind that the medical payments coverage provision in an auto insurance policy is also available. Typically, medical payment coverage is much smaller, often between $5,000 and $50,000, but it is readily accessible to an injured party because it is paid out regardless of who is at fault.

If after reading your insurance policy, you find yourself dizzy, forward it to your injury attorney and he or she can make sense of it.

This general discussion of rights and responsibilities in worker's compensation claims and personal injury actions should not be considered a substitute for individual legal advice.