Here are the key issues to note regarding the 52-year old woman's treatment following her auto accident: 1. Her physical therapist thoroughly documented her lost normal life activities, which is important for establishing damages for pain and suffering. 2. No follow-up letter was sent to one of the referring physicians, Dr. Haak, so it's unclear if he was fully updated on her treatment progress. 3. Occupational therapy focuses more on helping patients regain skills needed for daily living and work, while physical therapy aims to improve mobility and manage pain. 4. It's unusual for there to be no close-out report or bill upon completion of therapy, as this provides closure and documents final functional status.

1. ATHLETICO
Hamburger University
Oak Brook, Illinois
January 11, 2013
Howard H. Ankin
Ankin Law Office LLC
162 West Grand Avenue
Chicago, IL 60654
312-346-8780
www.ankinlaw.com

2.  A liability accident which most commonly is an
automobile accident or slip and fall accident
provides for money for medical bill, lost monies,
loss of a normal life and pain and suffering.
 Cases are customarily assessed by looking at:
 1. Liability.
 2. Damages.
 3. Ability to pay.
 The ability to pay a judgment often is based on
insurance available. The minimum insurance
coverage in IL is 20/40.
 This means $20k per person and $40k no matter
how many people are to divide the $40k with no
single person recovering more than $20k.
 The typical “full coverage” policy is 100/300.

3.  An automobile policy holder can insure
themselves for additional coverage where an at-
fault driver may not have enough coverage.
 A driver can insure against an uninsured motorist
for whatever exposure it feels necessary/can
afford. Typically capped at 1M
 A driver can insure for the difference between the
underinsured driver’s policy and theirs.
 Example: Defendant driver has 50/100 policy. The
driver has a 100/300 policy. Driver could
potentially collect $150K from the defendant and
$50K from driver’s policy.

4.  Typically a defendant and/or its insurance
carrier will not pay any medpay until the close
of the claim. Exception = property damage.
 An injury victim typically has 3 options for
payment of medical bills:
 1. Automobile medical pay coverage.
 2. Health insurance.
 3. Self Pay/Doctor’s lien.

5.  Medical pay coverage on a typical standard
policy is $5K but can be purchased in many
denominations. This payment is paid
regardless of fault. Typically, it is paid on a
“first come, first served” basis. “Grabbing the
med pay.”
 If an injury victim could pay all of his medical
bills by group health insurance and use the
med pay for out-of-pocket co-payments,
potentially they could have no medical bills
outstanding for care and treatment.

6. Sec. 10. Lien created; limitation. (a) Every health care professional and health care provider that renders any service
in the treatment, care, or maintenance of an injured person, except services rendered under the provisions of the
Workers' Compensation Act [820 ILCS 305/1 et seq.] or the Workers' Occupational Diseases Act [820 ILCS 310/1 et
seq.], shall have a lien upon all claims and causes of action of the injured person for the amount of the health care
professional's or health care provider's reasonable charges up to the date of payment of damages to the injured person.
The total amount of all liens under this Act, however, shall not exceed 40% of the verdict, judgment, award,
settlement, or compromise secured by or on behalf of the injured person on his or her claim or right of action.
(b) The lien shall include a written notice containing the name and address of the injured person, the date of the injury,
the name and address of the health care professional or health care provider, and the name of the party alleged to be
liable to make compensation to the injured person for the injuries received. The lien notice shall be served on both the
injured person and the party against whom the claim or right of action exists. Notwithstanding any other provision of
this Act, payment in good faith to any person other than the healthcare professional or healthcare provider claiming or
asserting such lien prior to the service of such notice of lien shall, to the extent of the payment so made, bar or prevent
the creation of an enforceable lien. Service shall be made by registered or certified mail or in person.
(c) All health care professionals and health care providers holding liens under this Act with respect to a particular
injured person shall share proportionate amounts within the statutory limitation set forth in subsection (a). The
statutory limitations under this Section may be waived or otherwise reduced only by the lienholder. No individual
licensed category of health care professional (such as physicians) or health care provider (such as hospitals) as set
forth in Section 5 [770 ILCS 23/5], however, may receive more than one-third of the verdict, judgment, award,
settlement, or compromise secured by or on behalf of the injured person on his or her claim or right of action. If the
total amount of all liens under this Act meets or exceeds 40% of the verdict, judgment, award, settlement, or
compromise, then:
(1) all the liens of health care professionals shall not exceed 20% of the verdict, judgment, award, settlement, or
compromise; and
(2) all the liens of health care providers shall not exceed 20% of the verdict, judgment, award, settlement, or
compromise;

7.  provided, however, that health care services liens shall be satisfied to the extent possible
for all health care professionals and health care providers by reallocating the amount
unused within the aggregate total limitation of 40% for all health care services liens
under this Act; and provided further that the amounts of liens under paragraphs (1) and
(2) are subject to the one-third limitation under this subsection.
If the total amount of all liens under this Act meets or exceeds 40% of the verdict,
judgment, award, settlement, or compromise, the total amount of all the liens of
attorneys under the Attorneys Lien Act [770 ILCS 5/0.01 et seq.] shall not exceed 30% of
the verdict, judgment, award, settlement, or compromise. If an appeal is taken by any
party to a suit based on the claim or cause of action, however, the attorney's lien shall
not be affected or limited by the provisions of this Act.
(d) If services furnished by health care professionals and health care providers are billed
at one all-inclusive rate, the total reasonable charges for those services shall be
reasonably allocated among the health care professionals and health care providers and
treated as separate liens for purposes of this Act, including the filing of separate lien
notices. For services provided under an all-inclusive rate, the liens of health care
professionals and health care providers may be asserted by the entity that bills the all-
inclusive rate.
(e) Payments under the liens shall be made directly to the health care professionals and
health care providers. For services provided under an all-inclusive rate, payments under
liens shall be made directly to the entity that bills the all-inclusive rate.

9.  Amy Stanton v. Carolyn Rea & Robert Roe, 2012 il
App 5th 110187, Decided November 2, 2012, In order
to ensure that plaintiff receives 30% of the
judgment as intended by the Act it is necessary
that computation of the 40% [allotment for medical
providers and professionals] does not begin until
costs associated with bringing the case to trial and
securing payment of the judgment have been
deducted from the amount of the original verdict.
In the instant case, the trial court should have
begun its calculations of 40% for the lienholders
after payment of attorney fees and costs necessary
in securing the judgment.”

10.  A statutory right of recovery providing for
payment of medical bills, lost time,
permanency recovery and other benefits.
 Medical bills paid have to be reasonable and
necessary. Necessity is a fact question.
 Petitioners want to rely on doctor’s opinion.
 Respondents want to rely on IMEs and
Utilization Review.

11.  Law is in flux.
 Must dispute UR and place dispute in client
file.
 Client will need an attorney.
 This weeks dispute: Dept. of Financial
Regulation requiring in-state UR providers.
 Strength of the doctor customarily wins
medical necessity dispute.

14. Who is responsible for payment of transportation services to medical appointments?
 In Gen. Tire & Rubber Co, the Illinois Appellate Court held that the Respondent would be
responsible for the payment of transportation services as long as they are reasonable.
211 Ill. App. 2d 641, 651 (Ill. App. 1991).
 In that case, the Petitioner incurred $1,588.00 in travel expenses to treat with his
physician. The Petitioner lived in Mt. Vernon and sought treatment with a doctor who
practiced in Evansville, Indiana, which was approximately 100 miles from his home.
The court held that because his doctor was the most familiar with the Petitioner’s
condition and medical history, it was reasonable that he travel to this doctor. As such,
the court found that it was the Respondent’s responsibility to pay those expenses and
awarded the Petitioner costs of $1,588.00.
Who is responsible for payment of translation services at medical appointments?
 Similarly, the Respondent is responsible for the payment of reasonable medical services
which can include translation services at medical appointments. The court held that
pursuant to section 8(a) of the Act, whatever is “reasonably required to cure or relieve
from the effects of the accidental injury” is the Respondent’s responsibility. Id. at 649-
650. If the translation services are necessary to facilitate the doctor’s appointment and
treat the patient, the Respondent can be responsible for the charges incurred.
 Gen. Tire & Rubber Co. v. The Indus. Comm., 211 Ill. App. 3d 641 (Ill. App. 1991).

15.  An injured worker can maintain a host of causes of
action at the same time. It is not uncommon to have a
delivery driver who is injured in an auto accident or a
laborer on a construction site bring an action against a
general contractor or an office worker fall down on
another’s premises while working.
 The injured party can maintain both a workers’
compensation case and a third party liability case. The
recovery of both involving sophisticated subrogation
issues and is covered under Section 5 of the Illinois
Workers’ Compensation Act.
 Beyond these two cases you could also have a Social
Security Disability case, products liability suit or
medical malpractice cause of action arising out of one
incident.

16.  52 year old woman is in an auto accident and
sustains injuries to her hand, neck and arm.
First seeks treatment with family physician
then hand and spine specialists. Important
issues to note:
 1. Therapist does good job of documenting loss of
normal life activities. (collosis software)
 2. There is no follow up letter to Dr. Haak.
 3. Is there a difference between occupational v.
physical therapy?
 4. Why no close out report or bill for close out?
 5. Billed to BC/BS with no bill to med pay.