Reasonable & Necessary Medical Care for
Work Injuries in Peoria, Illinois
A fundamental benefit of the Illinois Workers’ Compensation Act is the employer’s liability for the costs associated with reasonable and necessary related medical care pursuant to the effects of or the aggravating effects of accidental injury or repetitive trauma manifestation. The section of the Illinois Workers’ Compensation Act which discusses the employer’s liability to pay for such medical services selected by the employee is discussed in Section 8(a)1-3 of the Illinois Workers’ Compensation Act which limits the employer’s liability to the following:
All first aid and emergency treatment; plus
All medical, surgical, and hospital services provided by the physician, surgeon, or hospital initially chosen by the employee or by any other physician, consultant, expert, institution, or another provider of services recommended by the initial service provider or any subsequent provider of medical services in the chain of referrals from the initial service provider; plus
All medical, surgical, and hospital services provided by any second physician, surgeon, or hospital subsequently chosen by the employee or by any other physician, consultant, expert, institution, or other providers of services recommended by said second service provider or any subsequent provider of medical services in the chain of referrals from said second service provider. Thereafter the employer shall select and pay for all necessary medical, surgical, and hospital treatment, and the employee may not select a provider of medical services at the employer’s expense unless the employer agrees to such selection. At any time the employee may obtain any medical treatment he desires at his own expense. This paragraph shall not affect the duty to pay for rehabilitation referred to above.
The term reasonable within the context of Section 8(a) of the Illinois Workers’ Compensation Act refers generally to the modality and costs of care and how those costs compare to what is being charged by other medical providers with similar qualifications providing similar modalities of care and treatment.
The term necessary within the meaning of Section 8(a) of the Act refers to whether the necessity of the medical care and treatment which is the subject of the bill being submitted to the employer for payment relates to the effects of or the aggravating effects of the accidental injury or repetitive trauma manifestation at issue.
Amendments to Section 8(a) of the Illinois Workers’ Compensation Act were made in 1980. The most notable change to Section 8(a) of the Act at that time was the inclusion of what has now come to be known as the two-doctor rule. Simply stated, the two-doctor rule limits the injured worker to two medical providers of his own choosing. However, the injured worker can still see as many medical providers as is necessary providing the injured worker is referred to subsequent physicians by one of the first two medical providers. In other words, the injured worker is entitled to two chains of referred doctors providing their care is reasonable and necessary.
Clear Guidance on Legal Authorizations for Medical Care
Unfortunately, many times, despite the obvious nature of an injury and the necessity for related medical care, medical providers, particularly specialists, will insist on receiving authorization from your opponent in the workers’ compensation case before the specialist will provide the injured worker the care he or she needs.
Contact our office to talk with attorney John Lesaganich about obtaining medical benefits for a work accident injury or disability. At our office, initial consultations are always free and confidential. We are located on Main Street in downtown Peoria, across from the courthouse.