Illinois Workers’ Compensation Medical Benefits

If you were injured on the job in Illinois, one of your most pressing concerns is likely how you will afford the medical care you need. Fortunately, the Illinois Workers’ Compensation Act provides a legal framework that entitles injured workers to receive medical benefits without paying out of pocket. These benefits can cover everything from emergency room visits and surgeries to long-term rehabilitation and prescriptions. However, understanding what you’re entitled to–and how to ensure you actually receive it–is not always straightforward. At The Law Firm of Kevin A. Moore, we help injured workers across Illinois secure the full scope of benefits the law allows, starting with critical medical treatment.

What Medical Expenses Are Covered Under Illinois Workers’ Compensation?

The Illinois Workers’ Compensation Act requires employers or their insurance carriers to pay for all reasonably necessary medical treatment that is related to a job injury. This includes both immediate and ongoing care. If your claim is accepted, you should not have to use your own health insurance or pay any deductibles or co-pays for covered services.

• The range of medical services covered includes:
• Emergency room visits and ambulance services
• Hospitalization and surgical procedures
• Diagnostic testing such as MRIs, X-rays, and blood work
• Visits to doctors, specialists, and chiropractors
• Physical therapy and rehabilitation
• Prescription medications
• Medical devices like braces, wheelchairs, or crutches
• Travel expenses for trips to and from authorized medical providers

All of these services must be directly related to your workplace injury. For example, if you injure your back lifting heavy equipment, chiropractic treatment or physical therapy to recover from that injury would be covered. But any unrelated medical care–like treatment for an old knee injury from a car accident years ago–would not qualify under your workers’ comp claim.

In some cases, disputes arise over whether a particular treatment is “reasonable” or “necessary.” That is where having experienced legal representation becomes crucial. At The Law Firm of Kevin A. Moore, we work closely with your medical providers and fight back against unjustified claim denials or attempts to limit your care.

Can You Choose Your Own Doctor?

Illinois gives injured workers more freedom than many other states when it comes to selecting a treating physician. You have the right to choose your own doctor, rather than being limited to a physician selected by your employer or their insurance company. However, this right is not without limitations.

Under Illinois law, you are entitled to select up to two treating physicians of your own choosing, along with any referrals made by those doctors. This is known as the “two-doctor rule.” So, if your first doctor refers you to a specialist, that specialist does not count as your second choice–it’s considered part of your treatment chain.

However, if your employer has a Preferred Provider Program (PPP) that is properly registered with the state and they inform you of it in writing, you must choose one of the doctors within that network unless you opt out in writing. If you opt out, that counts as one of your two choices under the two-doctor rule.

Failing to follow the proper steps in this process could limit your medical coverage. For example, if you switch to a third doctor without a referral, your employer might refuse to pay for that treatment, arguing it falls outside the allowed scope. To avoid losing access to care or ending up with medical bills, it’s critical to make informed choices about your medical providers early in your claim.

What Happens If the Insurance Company Denies Medical Benefits?

One of the most frustrating things injured workers face is having necessary medical treatment delayed or denied by the insurance company. Even though Illinois law obligates employers to provide prompt medical care for injured workers, insurers may dispute whether certain treatments are related to the injury, are medically necessary, or are within the scope of coverage. Common reasons for denial include:

• The insurer claims the treatment is excessive or not medically justified
• The injury is deemed to be pre-existing or unrelated to your job
• The insurer believes you have reached Maximum Medical Improvement (MMI) and no further care is needed

When these situations arise, you are not without options. You have the right to request a hearing before the Illinois Workers’ Compensation Commission (IWCC). At that hearing, your attorney can present medical records, opinions from your treating physicians, and expert testimony to prove that the denied treatment is medically necessary and should be covered.

Additionally, if your treatment has been delayed due to insurance company inaction, you may be entitled to penalties and attorney’s fees. Section 19(k) of the Illinois Workers’ Compensation Act allows for penalties of up to 50% of the amount owed if the delay is unreasonable or vexatious. This gives workers leverage in cases where insurers act in bad faith.

Contact a Workers’ Compensation Lawyer for the Medical Benefits You Deserve

If you’ve been hurt on the job and are unsure about what medical benefits you are entitled to, we’re here to help. We know how critical proper medical care is to your recovery and long-term health. Our legal team can guide you through the complex rules of Illinois workers’ compensation law and protect your right to care.

Don’t wait until your condition worsens or medical bills start piling up. Contact The Law Firm of Kevin A. Moore today for a free consultation. Let us fight for the treatment and support you need to heal and move forward with your life.