After you’re involved in a personal injury accident; whether it be a motor vehicle accident, slip and fall, dog bite, or other similar action, you will seek medical attention. Very often, this will result in an ambulance ride to an emergency room, a family or friend driving you to the emergency room, or perhaps, you or someone else driving you to an urgent health clinic. Either way, there will be costs associated with the medical transportation and/or medical treatment.

Immediately after an accident, you may have exchanged insurance information with the at-fault party. Your first instinct may be that the at-fault party’s insurance should have to pay for your medical bills, and you are not wrong; but, there are specific ways to go about recovering against an insurance company. If you take the at-fault party’s insurance information, such as the name of the insurance company and policy number, and provide it to the emergency room triage nurse or front desk staff as the insurance coverage on your treatment, most likely, those expenses will not be paid (at least not at that time, or how you are expecting them to be paid). Similarly, if you file a claim with the at-fault driver’s insurance and then simply provide the insurance company and claim number to your doctor, hospital, therapist, etc., most likely those expenses will also not get paid (again, at least not at that time, or how you are expecting them to be paid).

A “third-party” case, or a case against another driver, a homeowner, or property owner for a personal injury case is unlike a claim under workers’ compensation. In workers’ compensation, you provide the insurance claim number to a medical provider and the billing and payment go directly from the medical provider to the insurance company for payment. If your workers’ compensation claim is accepted, most likely the expense will be paid, and you will not be contacted or informed about the means and process for payment. However, that is not how personal injury cases are handled for payment of medical expenses. In fact, providing the at-fault party’s insurance company, policy number, and or claim number (unless it is the claim number for the “medical payments” portion of the insurance coverage) can actually cause more problems than benefits in your case. This is especially true if you have a regular health insurance plan, Medicaid, or Medicare. Issues can arise with using the at-fault party’s insurance as your “bill-to” insurance, because if and when payment is not issued, the facility will contact you for payment of the amount in full. This can cause delays in payment, issues with potential collections if the delay goes on for too long, and in worst-case scenarios, a delay of too long may cause the bill to be unable to be submitted to your health insurance company.

In a personal injury case, when you go to the emergency room, a hospital, your doctor’s office, a physical therapy facility, radiology office, or for any medical treatment, use your health insurance card for means of payment, if possible. If not, the best alternative is the use of “medical payments” coverage, either through the at-fault party’s insurance, or through your own insurance. A separate claim may need to be open with the medical payments department of the insurance company, and using a claim number given to you when you reported the accident will often not be sufficient for payment.

The reason simply giving the insurance information to a medical provider will not ensure payment, is because the at-fault party’s insurance company does not engage in a “pay-as-you-go” practice. Instead, how a resolution of these types of cases works is once medical treatment is completed, or once a significant and certain amount of medical expenses has been incurred, a demand for settlement or for a turnover (tender) of the entire amount of the insurance policy is placed upon the insurance company. After a settlement or tender of the insurance policy is completed, a portion of the compensation received is used to pay off medical expenses, co-pays, insurance liens, physician’s liens, and/or other lien holders.

As such, when you are in a car accident, slip and fall accident, or other personal injury accident, you should give your medical providers your primary health insurance, Medicaid, or Medicare information. You should still file a claim with the at-fault party’s insurance and secure a claim number. However, afterward, give that information to your attorney representing you in the matter. If you do not seek counsel, which we would not recommend, retain that insurance information until after you complete treatment. If there are co-pays, co-insurance, or deductibles with your health care plan, you may need to pay those expenses up front, and then keep records of all payments made fora later potential recovery in your resolution of the claim. As discussed above, you may also be able to use “medical payments” coverage for co-pays, co-insurance, or deductibles, so save copies of payments made and again, give that information to your attorney. Once your medical treatment is completed you and your counsel will fight to try and get all your out-of-pocket expenses, your medical expenses, your lost wages, and your pain and suffering compensated by the at-fault insurance company.

Simply put, while the at-fault person should be held accountable, and their insurance company should pay, there is a specific means by which to attempt to secure payment of compensation. Due to these concerns, we always recommend you seek counsel to represent you in a personal injury matter. If you believe you may have a case, please contact the injury attorneys at Urban & Burt, Ltd. for a free consultation (708) 687-5200.

If you’ve been injured at work, there are going to be a lot questions you have regarding your rights and what to do to protect those rights.

• Should I “sue” my employer?
• Do I get paid? How much?
• My employer/the insurance company says I had a pre-existing condition, what do I do now?

There are going to be a lot more questions than these three, and there are nuances in every claim, but these are some of the most frequently asked questions when it comes to be injured while working at your job.

So, should you “sue” your employer?

When you are injured at work, you don’t “sue” your employer like you would see on television. A workers’ compensation claim is not a typical lawsuit and is not you suing your employer in court. When you are injured at work, you have the right to certain benefits if you sustained an accident that arose out of, and in the course of your employment. In that situation, you file an Application for Adjustment of Claim, which places your employer on notice that you wish to evoke your rights under the Illinois Workers’ Compensation Act. However, this does not mean the process is easy and non-adversarial. When you are injured at work, your employer may have defenses to your claim for benefits, and in several instances disputes arise over your benefits. That is why even though you are not technically “suing” your employer, you should seek a lawyer to protect your rights under the Act.

Do you get paid? How much?

In Illinois, if you sustain a compensable work injury, you may be entitled to temporary total disability benefits (amongst other potential benefits). You are entitled to these benefits after you sustain an injury, if you medical doctor opines you cannot return to your pre-injury job for a temporary amount of time.

If you are entitled to these benefits, the amount of money you are entitled to is 66 2/3rds of your average weekly wage. As I indicated above, disputes may arise regarding your rights, and frequently, disputes arise as to the average weekly wage of an employee. Typically, your average weekly wage is calculated by the amount of money you earned in the year proceeding your accident date. Your average weekly wage may include overtime wages, if those wages were earned as a result of mandatory overtime, but may not include wages earned for voluntary overtime. Your benefits may also be determined by whether you have any dependents, the number of weeks you worked, whether you are a part-time or full-time employee, and can also be impacted by State Minimum or Maximum Rates depending on how much you earn in your job.

For example, if you earned $52,000.00 in the year before your accident, and worked 52 weeks, you would have an average weekly wage of $1,000.00, and be entitled to weekly benefits for temporary total disability of $666.67. What happens if you have a pre-existing medical condition? – If you are injured at work, and injure a body part you injured or had treatment to in the past, your workers’ compensation claim may not necessarily be over. However, oftentimes an employer will inform you that your workers’ compensation claim is denied because your injury pre-existed your work accident.

My employer/the insurance company says I had a pre-existing condition, what do I do now?

In Illinois, a pre-existing condition does not act as an outright bar to compensability. If a work accident aggravates, accelerates, or exacerbates your pre-existing condition, you can still have a compensable claim under the Act. Several examples of an “aggravation claim,” include situations where an injury is worsened by a work accident, either because of a structural change to an existing injury/body part, or because a non-symptomatic (often called asymptomatic) condition becomes symptomatic as a result of a work accident. In addition, if an accident accelerates the need for treatment, or the degeneration of a condition, and this can also be a compensable injury under the Act.

If you have had an injury while at work, please contact our skilled workers’ compensation attorneys at Urban & Burt, Ltd. at (708) 687-5200.

This time of year sidewalks, walkways, roadways, driveways, and pretty much every inch of ground we walk on is covered in snow or ice at different times. While we all do our best to walk carefully, where the proper footwear, and be mindful of our surroundings, we cannot always see black ice, or sometimes, there is simply no safe place to walk. So, what can you do if you slip and fall on ice or snow this winter and are injured as a result, and do you have a legal course of action for compensation as a result of those injuries? There are several factors that play a role in determining whether you “have a case” for a slip and fall on ice or snow. One of the main issues and first questions that must be asked is “where did you fall?” Perhaps more specifically, “who owned the property where you fell?” If you fell on property owned by a city, state, or other municipality, you may be faced with an uphill battle regarding a compensable claim. Under the Illinois Local Government and Governmental Employees Tort Immunity Act, the government typically has immunity from lawsuits for injuries that arise out of a condition caused by the weather; including, ice and snow.

If you slipped and fell on a property owned by a business, the law in Illinois is normally governed by the “natural accumulation” rules. Generally, a business does not face responsibility from injuries resulting from a slip and fall accident if the slip and fall was due to the natural accumulation of ice and snow. However, if that business undertakes efforts to remove ice and snow on the property, they must do so without acting with negligence. This essentially means if they opt to remove ice and/or snow from their property, they must not create a dangerous condition by engaging in that removal activity.

Some common instances where a business has created a negligent or dangerous condition by removing ice and snow include improperly located downspouts/drainage systems and removing ice and snow to a dangerous location. In the instance of the downspout, if a business runs their gutter system directly into a parking lot without another drainage system in the parking lot, and after water builds up in the parking lot it re-freezes into large ice sheets, this may be considered an unnatural accumulation. Likewise, if a business plows or shovels snow to one corner of the parking lot, but that corner is located on a steep grade or the highest point of the property causing it to melt and run down into the rest of the parking lot, if that ice refreezes, there again could be an unnatural accumulation.

The bottom line in many of these cases is that they are extremely fact specific matters and frequently require experts who can testify about whether the actions of a business created an unnatural accumulation of ice and snow. For those reasons, it is best to seek an attorney as soon as possible to evaluate whether you have a potentially compensable slip and fall claim. If you believe you may have a claim, please contact the injury attorneys at Urban & Burt, Ltd. for a free consultation (708) 687-5200.