Business & Work

What is workers’ compensation?

Workers’ compensation gives financial benefits to employees who become ill or injured because of their job duties. It is a no fault system, meaning that employees get benefits regardless of who is at fault for the job-related injury.

What medical costs does workers' compensation pay for?

Workers’ compensation pays for all medical costs reasonably needed to heal from or relieve the employee from the effects of an injury. This includes:

• First aid,
• Emergency care,
• Doctor’s visits,
• Hospital care,
• Surgery,
• Physical therapy,
• Chiropractic treatment,
• Medicines,
• Prosthetic devices,
• Prescribed medical appliances,
• Devices such as a lift or wheelchair, and
• Changes to your home, such as a wheelchair ramp.

If an employer agrees to pay a medical bill, it will pay the provider directly. However, an employer is not required to pay co-pays or deductibles unless the service is covered under a group health plan.  

Once an employee files a claim with the Illinois Workers’ Compensation Commission (the “Commission”) to resolve a disagreement with an employer, a medical provider cannot try to collect payment from the employee after the provider is notified of the claim. However, the provider may send the employee reminders of an outstanding bill and ask for case information. If this information is not provided within ninety days, the medical provider may restart their collection efforts. 

What other benefits are included in workers' compensation?

Workers’ compensation also includes benefits if you are:

• Off work to heal from an injury. This is known as Temporary Total Disability (TTD) benefits.
• At work on light duty while healing from the injury. This is known as Temporary Partial Disability (TPD) benefits
• In an approved vocational recovery program.
• Permanently disabled or disfigured, but can work. This is known as Permanent Partial Disability (PPD) benefits.
• Made permanently unable to work. This is known as Permanent Total Disability (PTD) benefits.

Workers’ compensation also pays death benefits. These are benefits to surviving family members.

Who chooses my medical provider when I am injured or sick?

You choose your own medical provider.

Your choice will be limited to a selected network if your employer has joined a Preferred Provider Program (PPP). Under the "two doctor rule," you can choose any two doctors who are part of your employer's PPP network.

If your employer does not have a PPP, then you can choose to go to any medical provider. You can also choose another provider for a second opinion. You may go to any provider that either of your two choices refers you to.

If you choose a third doctor without your employer's approval, the employer may not be required to pay.

First aid and emergency care do not count as one of your two choices.

You may be evaluated by your employer's own medical provider.

Your employer may have you get a full exam by a doctor they choose. They must give you money to cover the cost of the exam. This includes travel expenses, meals, lost wages, and other expenses.

The exam must be at a reasonable time and place. You must let the employer’s doctor examine you, but you do not have to accept any treatment.

If your employer has a PPP, they must inform you about the PPP in writing.  

The doctor must give you and your employer the same exam report as soon as possible. It must be at least 48 hours before an arbitration hearing. You may also ask for a copy of all relevant medical records in your employer's possession.

What is the cost of treatment in workers' compensation cases?

The law on workers' compensation includes a list of the cost of most treatments. This list of costs is called a “fee schedule.” The employer will pay the provider’s actual charge, or the amount set by the fee schedule, whichever is less.

Your employer may contract with a provider to cover care required by the Illinois Workers' Compensation Act. The cost will be agreed to in the contract.

What are the disability categories for workers' compensation?

Temporary total disability (TTD)

TTD is a benefit available to injured workers who are:

• Unable to work for a short period, or
• Able to do light-duty work, but their employer cannot give light-duty work to them.

The employer pays TTD benefits to an injured employee until:

• The worker has returned to work, or
• The worker has reached "maximum medical improvement," even if that does not result in full recovery.

TTD is not paid for the first three lost work days, unless the employee misses 14 or more calendar days due to the injury.

The benefit amount is two-thirds of the employee’s average weekly wage. This amount is subject to minimums and maximums. The employee should send a written demand for TTD benefits as soon as possible and include a doctor's note. The employer should make the first TTD payment within 14 days of notice of the injury.

Temporary partial disability (TPD)

TPD is a benefit covering the time in which an injured employee is still healing and is working light duty, on a part-time or full-time basis. The employee is earning less than he or she would earn in the pre-injury job(s). The employer pays TPD benefits to an injured employee until the worker has returned to his or her regular job or has finished healing.

Permanent partial disability (PPD)

PPD is:

• The complete or partial loss of a part of the body,
• The complete or partial loss of use of a part of the body, or
• The partial loss of use of the body as a whole.

Loss of use is not specifically defined in the law. It usually means the employee cannot do things he or she was able to do before the injury.

The Commission cannot decide that an employee has a PPD until the employee has reached maximum medical improvement.  

PPD is paid only if the job-related injury results in some permanent physical loss.

The Commission awards four types of benefits for a PPD:

• Wage differential award: Where, due to the injury, the employee obtains a new job that pays less than the pre-injury employment.
• Schedule of Injury: Based on the value of certain body parts, expressed as a number of weeks of compensation for each body part.
• Non-Schedule Injury: Where the condition is not listed on the schedule of injuries, but it imposes certain limitations.
• Disfigurement: An employee who suffers a serious and permanent disfigurement to the head, face, neck, chest above the armpits, arm, hand, or leg below the knee.

Permanent total disability (PTD)

PTD is either:

• The permanent and complete loss of use of:
  • Both hands,
  • Both arms,
  • Both feet,
  • Both legs,
  • Both eyes, or
  • Any two such parts, like one leg and one arm, or,
• A complete disability that renders the employee permanently unable to do any kind of work for which there is a reasonably stable job market.

An employee who is found to be permanently and totally disabled is entitled to a weekly benefit equal to two-thirds (66.67%) of their average weekly wage for life. This is subject to minimum and maximum limits.

Are there job counseling and other programs for getting back to work?

Vocational rehabilitation may be available to a person who is getting workers’ compensation. This includes counseling for job searches, supervising a job search program, and vocational retraining. This may include education at an accredited learning institution.

If the employee cannot return to the pre-injury job, the employer must pay for treatment, instruction, and training necessary for the physical, mental, and vocational training of the employee. The employee must cooperate in the recovery programs.

The employee may choose the provider of such services or may accept the services of a provider selected by the employer. The maintenance benefit must not be less than the employee’s TTD rate.

Are benefits provided in cases of fatal injuries?

In case of fatal injuries, workers’ compensation pays burial and survivors' benefits to surviving family members.

The burial benefit is $8,000 for injuries resulting in death occurring after February 1, 2006. For injuries resulting in death prior to February 1, 2006, the benefit is $4,200.

Workers’ compensation benefits are not taxable income under state or federal law and do not need to be reported as taxable income on tax returns. 

The survivor's benefit is two-thirds of the employee's gross average weekly wage during the 52 weeks prior to the injury. The primary beneficiaries of survivors' benefits are the employee's spouse and children under the age of 18.

Need help getting information on workers' compensation?

For more information on getting workers' compensation benefits in Illinois, see the Workers' Compensation and Occupational Diseases Handbook.

You can also visit the Illinois Workers' Compensation Commission website.