A recent caller to our office sustained a really serious back injury while working in Illinois. He already has had two back fusions and the treating surgeon has told him that the second fusion failed and that he can no longer work. He has been receiving work comp benefits (TTD) for over three years.
At various times, the insurance company has sent him to an IME to confirm surgery was needed. At each time the IME doctor has agreed with the treating surgeon. Under Illinois law, the insurance company can send you to a new IME when a new issue arises. In this case, the doctor just declared him permanently disabled which is a new issue.
So, of course, the insurance company sent him to a new IME and this one says the worker can do sedentary work which basically means they think he can sit at a desk all day. The treating doctor disagrees due to the constant pain and need to alternate between standing and sitting all the time.
So after all of these years, the insurance company has cut him off and stopped paying TTD benefits. It’s a huge problem for him as this is his sole source of income, although he’s applying for social security disability benefits. It’s not like he can go out and get some job.
So what are his options?
- He can try to do the sedentary desk job. Not saying I recommend it, but you can always call their bluff and try it. If you give a sincere effort and fail, they likely would have to put you back on TTD pending a new IME which likely wouldn’t happen.
- Talk to his doctor about if he can drive. He’s on a lot of medications and the job is 30 minutes from home. If his doctor says it’s not safe for him to drive that long, the burden would shift to the insurance company to pay for an Uber, Taxi, etc. which almost never happens.
- He can go to trial and let an Arbitrator decide. That could take some time as both the IME doctor and treating doctor would have to give a deposition. But it’s a really small issue so it wouldn’t take too long. And if the IME opinion is clearly baseless or if it conflicts with prior IME’s, the Arbitrator could slam the insurance company with penalties and fees.
What this worker can’t do is get frustrated and resign. That could greatly reduce the value of the settlement. If he’s struggling financially, we can likely get him a tax free advance on his eventual settlement from the insurance company (not a loan). This is surely a frustrating situation for him, but fortunately the whole case isn’t in dispute and it’s a solvable problem.
This type of scenario comes up all of the time. What you can and should do depends on your injury and what the doctors are saying. If you’d like to discuss it with a lawyer for free, you can contact us any time at 312-346-5578. We help everywhere in Illinois.
