• This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn more.

What happens after Worker's Comp. limit is reached?

#1
What is the name of your state (only U.S. law)? IL

My brother is going through an experience with Worker's Comp. right now. He fell and hurt his hand real bad and there are have been many expenses since then. The helicopter flight to the next city (because there was no hand surgeon on duty at the hospital in town), and that alone cost $49,000. Since then, there was the initial surgery to close his hand up after severing an artery, then another surgery to try to repair damaged nerves (2 fingers are still numb), transportation back and forth to the hospital 100 miles away, and now a nursing home stay (believe it or not), then future physical therapy. All this on top of not being able to work, which means payments for that.

I've heard Worker's Comp. is capped at $100,000. If the helicopter ride cost about half of that right off the top, I see no way that everything else is going to stay under the limit. What happens then? Should I be advising my brother to skip some of the treatments that are being advised?
 

quincy

Senior Member
#2
What is the name of your state (only U.S. law)? IL

My brother is going through an experience with Worker's Comp. right now. He fell and hurt his hand real bad and there are have been many expenses since then. The helicopter flight to the next city (because there was no hand surgeon on duty at the hospital in town), and that alone cost $49,000. Since then, there was the initial surgery to close his hand up after severing an artery, then another surgery to try to repair damaged nerves (2 fingers are still numb), transportation back and forth to the hospital 100 miles away, and now a nursing home stay (believe it or not), then future physical therapy. All this on top of not being able to work, which means payments for that.

I've heard Worker's Comp. is capped at $100,000. If the helicopter ride cost about half of that right off the top, I see no way that everything else is going to stay under the limit. What happens then? Should I be advising my brother to skip some of the treatments that are being advised?
Unless you are a doctor who specializes in the types of injuries suffered by your brother, you should not be advising him on his medical treatment.

Here is a link to the Illinois workers compensation laws: https://www2.illinois.gov/sites/iwcc/Pages/default.aspx
 
Last edited:

cbg

Scotch Egg
#3
You are misunderstanding what you are reading.

While there is a maximum weekly benefit (not, how many weeks, but how much per week) there is on wage replacement, that cap does not apply to medical bills.

You should not be advising your brother to do anything, since you do not understand how the process works. Or rather, the only thing you should be advising him to do is to speak to a workers comp attorney, who does.
 
#4
Unless you are a doctor who specializes in the types of injuries suffered by your brother, you should not be advising him on his medical treatment.

Here is a link to the Illinois workers compensation laws: https://www2.illinois.gov/sites/iwcc/Pages/default.aspx
Thanks for the link.
From what little I've been able to understand (or think I understand) from what I read there, my brother is in for a major surprise. I haven't mentioned anything to him about the financial aspect of all this since he's a big worrier. But it doesn't look good at all.
 

quincy

Senior Member
#5
I am sorry about your brother and your concern for him is natural. The best that you can do for your brother is to direct him to legal and medical professionals in his area who can provide necessary help.

I wish him well.
 
Last edited:

cbg

Scotch Egg
#6
I agree that the concern is natural. But since Subjection1 is very badly misunderstanding how workers compensation works and has some very incorrect ideas here, I think it even more important that someone who knows workers comp law be involved.
 
#7
I agree that the concern is natural. But since Subjection1 is very badly misunderstanding how workers compensation works and has some very incorrect ideas here, I think it even more important that someone who knows workers comp law be involved.
I forgot to mention that he has been in contact with a lawyer (yep, even more expense!) who has been advising him. I only have contact with my brother by email, but he's been telling me what he's been doing. He actually told me that the lawyer said he's never heard of anyone going on disability from a workplace injury.
But you're right when you say I don't know how Worker's Comp. works. I thought that it was just an insurance policy that employers have that pays up to $100,000 to cover everything an employee would have to pay as the result of an injury suffered on the job. If there's more to it than that (and I'm sure there is), I'm all ears!
 

cbg

Scotch Egg
#8
Very, very generally;

When an employee has a illness or injury that is work-related, workers compensation pays the associated medical bills and also provides a weekly wage replacement. When the employee has reached their maximum improvement, there can be a settlement that will compensate the employee and take care of any future medical needs associated with that illness or injury.

Obviously there can be multiple permutations of the above, but the important thing is that in NO state is there a $100,000 cap on medical benefits. I have no idea where you are getting that from unless your state has some kind of cap on the ultimate final settlement. But that is separate from the payment of medical care, not a total benefit per injury. You may rest assured that there is not going to be a cap on the total amount of medical care that your brother is able to receive. His lawyer will advise him on how to maximize his benefits.
 
#9
Very, very generally;

When an employee has a illness or injury that is work-related, workers compensation pays the associated medical bills and also provides a weekly wage replacement. When the employee has reached their maximum improvement, there can be a settlement that will compensate the employee and take care of any future medical needs associated with that illness or injury.

Obviously there can be multiple permutations of the above, but the important thing is that in NO state is there a $100,000 cap on medical benefits. I have no idea where you are getting that from unless your state has some kind of cap on the ultimate final settlement. But that is separate from the payment of medical care, not a total benefit per injury. You may rest assured that there is not going to be a cap on the total amount of medical care that your brother is able to receive. His lawyer will advise him on how to maximize his benefits.
Thank you for that information! It does seem that I wasn't understanding how it all works. I went back to look up where I got the $100,000 limit idea. Here's what I found before that gave me that idea.

From the following link: http://gnadeinsurance.com/workers-compensation-insurance.html
"Workers' Comp premiums are based on payrolls with essentially unlimited limits. Minimum limits for employers liability are $100,000 for each accident, $100,000 for each employee with a $500,000 policy limit. These limits are generally higher if you have an umbrella policy or if required by your customers."

Upon reading it again, it does seem to indicate that the $100,000 figure IS a limit. But doesn't that mean that it's the limit that they will pay out? The employer is a restaurant chain, so I doubt they saw a need to be insured for higher amounts. The accident my brother had there was as a dishwasher. How can a dishwasher hurt himself so badly??? Well, he was carrying a stack of dishes and slipped and fell because the floor was slick. He cut his hand on a broken piece of glass when the dishes fell.
 

cbg

Scotch Egg
#10
I don't have time right now to explain insurance in detail with you. Suffice it to say that first, the $100,000 you are looking at is a MINIMUM, not a maximum, and second, you are not looking at payout amounts there. That is NOT saying that the maximum payout is $100,000.
 

quincy

Senior Member
#11
I forgot to mention that he has been in contact with a lawyer (yep, even more expense!) who has been advising him. I only have contact with my brother by email, but he's been telling me what he's been doing. He actually told me that the lawyer said he's never heard of anyone going on disability from a workplace injury.
But you're right when you say I don't know how Worker's Comp. works. I thought that it was just an insurance policy that employers have that pays up to $100,000 to cover everything an employee would have to pay as the result of an injury suffered on the job. If there's more to it than that (and I'm sure there is), I'm all ears!
Your brother was smart to consult with an attorney. He wants to make sure his attorney knows workers compensation laws, though.

There are question and answer sections on the Illinois website. Reading through those can help you and your brother understand workers compensation a bit better. The site explains how the benefits are paid. It is a lot to absorb but the information provided is worth reading.
 

cbg

Scotch Egg
#12
Hmm. I could swear that I later went back and gave the poster a more detailed explanation of what she was reading when I had more time than I did when I made the first post.
 

quincy

Senior Member
#13
Hmm. I could swear that I later went back and gave the poster a more detailed explanation of what she was reading when I had more time than I did when I made the first post.
I don't think you did. I was waiting for it, though. :)
 

cbg

Scotch Egg
#14
I wrote it in my head, but I really did think I'd gone back and put it in the thread too.

If she comes back, I'll do the research review again.