Since 2001 Findgreatlawyers.com has been the leading internet resource to find Illinois lawyers and Illinois legal information

In workers’ compensation, medical fee schedules set the amount of money that doctors and other medical providers can charge for treating a work injury. The fee schedule addresses many types of treatment, from office visits to physical therapy to surgery. It also sets a default amount for treatment that’s not specifically listed. The fee schedule even takes into account the area of the state where the treatment was received.

These fees generally are paid by employers’ insurance companies. When you have a work injury that is covered under workers’ comp law, your employer is responsible for paying for all medical treatment that is reasonable and related to your work injury. Most employers pay for insurance coverage, so the insurer is the one reimbursing the doctors.

If you get hurt at work and your claim is approved, your medical bills will be paid – usually by your employer’s insurance company – according to the set fee schedule. The reimbursement amount generally is less than the going rate.

Illinois first adopted a fee schedule in 2006, with fees to be adjusted every year based on the Consumer Price Index. In 2011, there were several significant changes to Illinois’ workers’ compensation law, and the medical fee schedule was one of them. Fees were reduced by about 30%.

Lawmakers argued that they wanted to make Illinois more business friendly by making it more affordable to do business here. Lower fees mean lower insurance premiums for employers. Obviously, most doctors and other providers disagreed with this change. The default rate (for treatment not listed in the schedule) was previously about 75%. As of September 1, 2011, the default rate is 53.2%. These newest changes affect treatment as of September 1, 2011.

There are some instances where the scheduled amount isn’t paid. Some insurance carriers have contracts with health care providers that set their own medical fee schedule. Another instance is when the provider’s usual fee is less than the amount in the fee schedule. In that case, the lesser amount should be charged.

Even though insurance payments aren’t 100%, doctors and other providers cannot charge the patient for the remainder of the payment, in most situations. And the law says that if an Application for Adjustment of Claim has been filed, a provider cannot continue to try and collect payment from the injured worker.

For you as an injured worker, the key thing to know is that if you are hurt on the job, 100% of your medical care should be taken care of by the insurance company and there should be no attempts to collect any payments from you.

If you have further questions about medical fee schedules, or any other part of Illinois workers’ compensation law, please contact us. Our goal is to answer your questions honestly and in the most straightforward way we can.