Appellate court rules: employer must pay medical expenses in workers’ compensation case

The Appellate Court of Illinois recently decided an important workers’ compensation case. The court denied an employer’s request for a rehearing in a case concerning the issue of whether the company’s intent was to stipulate to payment of certain rates for the medical treatment expenses of an employee. 

The court upheld the award of benefits to the worker and ordered the Workers’ Compensation Commission to reconsider the worker’s reimbursement request for his home modifications.

The claimant, Jeffrey Berman, was employed as a food-service manager by Compass Group. He injured his back on March 19, 2009 while picking up a 40-pound box of bottled soda. A subsequent fall led to extensive complications that required hospitalization. The claimant was awarded benefits, and the employer stipulated to a fee schedule for payments for medical expenses.

In legal settings, “stipulation” refers to an agreement between the attorneys on either side of the case about certain facts and issues. The agreements are voluntary, and they are usually intended to save time in courtroom disputes. In this case, the two sides stipulated to issues concerning the company’s obligations to its employee.

On appeal, Compass Group argued that the medical expenses should have been based on a negotiated rate rather than a fee schedule. However, the court ruled that the fee schedule must stand, because the company had entered into a stipulation agreeing to it.

The claimant also cross-appealed, arguing that it was improper for the Commission to reject his claim for reimbursement for home modifications that he undertook himself based on the recommendation of a physical therapist. The Commission rejected his claim because the modifications were not recommended by a doctor. The court ruled, though, that the recommendation of a doctor is not always required, and remanded the case for further proceedings on that issue.

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