Under the Illinois Workers’ Compensation Act, injured workers are entitled to receive medical treatment for their work-related injuries for as long as necessary, provided they do not waive this right in a settlement agreement.
This principle, commonly referred to as “open medical,” remains a critical protection for employees navigating the recovery process after a workplace injury..
Statutory Foundation: Section 8(a)
Section 8(a) of the Illinois Workers’ Compensation Act (8A) mandates that employers must pay for:
“All the necessary first-aid, medical and surgical services, and all necessary medical, surgical and hospital services thereafter.”
This provision ensures that workers can access ongoing care related to their injury, including future treatment, surgeries, and rehabilitation, as long as the care is deemed reasonable, necessary, and causally related to the original injury.
Case Law: Dye v. Illinois Workers’ Compensation Commission
In Dye v. Illinois Workers’ Compensation Commission, the petitioner had a non-contested injury: she bumped her head. As a result, she had headaches for some time and a small bump on her forehead. There was no fracture, but she was diagnosed with closed head trauma, a concussion, and an abrasion to her forehead.
She did not treat for two years.
Although she did not seek treatment for two years, she later consulted a physician who recommended corrective surgery. The arbitrator concluded that this doctor was the third doctor. This would have been out of the “two-physician rule,” which limits a petitioner’s medical to two doctors and the referral chains.
The Illinois Workers’ Compensation Commission reversed that finding holding that doctor worked with the same group as the other doctor the petitioner had treated with, and therefore the treatment did not violate the rule. However, the commission ruled that it was not clear whether there was observable disfigurement.
The Appellate Court upheld this decision, emphasizing that the petitioner was entitled to future medical care under Section 8(a), particularly given the evidence of disfigurement.
The doctor the petitioner saw wanted to do a surgery on the dent in the right forehead area to put fat there to correct it.
The Appellate Court ruled on this. The Appellate Court cited section 8A of the Workers’ Compensation Commission Act and indicates that, so long as the two physician rule is not violated, petitioner is entitled to future medical.
The Appellate Court felt that the evidence was clear there was an indentation and observable disfigurement.
Our take
The ruling by the court is right. The evidence in the case, at least how the Appellate Court describes it, was strong that there was a disfigurement and a dent in the petitioner’s forehead. The respondent is required to pay for that along that it is related, reasonable, and necessary. This lasts as long as the worker lives.
Preserve your right to open medical
Open medical is a very important right to injured workers. It gives them the right to have the workers compensation carrier pay for the medical associated with their injury for life.
As long as the injured worker does not waive the right in settlement contracts they retain the right.
Often, it is worth going to trial just to keep medical open. If you go to trial there is no waiver of open medical and the worker can retain his or her rights. Unless a worker waives open medical, which is often done in a settlement contract, the worker retains the right to open medical benefits.
Strategic Considerations for Injured Workers
Open medical rights are often one of the most valuable components of a workers’ compensation claim. They provide long-term protection and financial security by ensuring that the employer or insurer continues to cover necessary medical expenses.
Workers should be aware that:
- Going to trial preserves open medical rights by default.
- Settlement agreements may include language that waives future medical care—this must be reviewed carefully.
- Negotiating settlements that retain medical rights is possible and often advisable in cases involving serious or long-term injuries.
Professional Guidance Is Essential
Before entering any settlement, injured workers should consult with a qualified workers’ compensation attorney. Legal counsel can help ensure that the worker’s rights are protected and that any agreement reflects the full scope of their medical needs.
Ackerman Law Office regularly handles workers’ compensation cases. We can advise you on open medical. Contact us is you have any type of workers’ compensation claim. Ackerman Law Office handles injury claims on a contingent fee. We only get paid a fee if you get paid.