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Cosmetic Surgery as Medical Expenses.

According to the Workers’ Compensation Act in Illinois, the employer is required to pay for services related to work injuries. Those services include, “all the necessary first aid, medical and surgical services, and all necessary medical, surgical and hospital services thereafter incurred, limited, however, to that which is reasonable required to cure or relieve from effects of the accidental injury.” 820 ILCS 305/8(a) (West 2006). Therefore, the employer not only needs to pay for current medical costs, but also future medical costs that may arise from the work-related injury. For example, if you are injured at work and your injury requires a series of surgeries, your employer will likely need to pay for those surgeries.

Recently, in a case arising from the Illinois Workers’ Compensation Commission to the Third District Appellate Court of Illinois, the court determined that medical expenses could also occasionally include cosmetic surgery. In that case, a furnace operator injured herself at work when a steel pipe struck her right temple. She had a concussion, an abrasion to the forehead, and she was diagnosed with closed head trauma. However, her scans of the brain came back normal, and her skull was intact. She returned to full work duties within two weeks.

Her employer helped with the medical bills for the accident. However, the contested portion occurred when she went back to the doctor about a small indentation in her forehead. The abrasion did not heal correctly and left a dent in her head. Her doctors inspected the dent and determined that it was doing no real harm, but was just a skin deformity resulting from her accident. Her dermatologist suggested she do some fat grafting to fix the indentation. Because she desired to have the dent fixed, she sought Workers’ Compensation to help pay for the required surgery.

The court noted that they will generally defer to the Workers’ Compensation Commission for fact determinations and are hesitant to overrule the Commission’s determinations unless they are “against the manifest weight of the evidence.” The court looked to the wording in the Workers’ Compensation Act to determine if the fat-grafting procedure used to correct the indentation would be included under the Act. According to section 8(c), compensation will cover “serious and permanent disfigurement.” Therefore, the Commission considered whether the dent in her forehead was actually “serious and permanent.” However, the court explained that because this treatment was prospective—she had not had the surgery yet—it would fall under section 8(a) and not section 8(c). Section 8(a) did not have the same language regarding “serious and permanent,” so the court determined that the disfigurement did not need to be serious and permanent when considering prospective cosmetic treatment.

The court also explained that the term “disfigurement” is not defined in the Act. Another case, however, did provide a workable definition: “that which impairs or injures the beauty, symmetry, or appearance of a person or thing; that which renders unsightly, mis-shapen, or imperfect, or deforms in some manner.” Superior Mining Co. v. Industrial Comm’n, 309 Ill. 339, 340, 141 N.E. 165 (1923). Given that the injured party’s doctors described a visible dent in her forehead that was not there before the accident, the court found that the dent amounted to disfigurement under the Superior Mining definition. Therefore, the Commission’s conclusion that “the evidence is at best unclear as to whether [claimant] has an observable disfigurement,” was not supported by the weight of the evidence. The court awarded the injured party Workers’ Compensation for her corrective surgery.

It is important to note that the injured party has the burden to prove that not only are the injuries work-related, but that the medical treatment is necessary. Because of this burden, it is vital to have competent attorneys to help you make your claim. The Workers’ Compensation Act is meant to benefit you, but you can only make a successful claim if you are knowledgeable about the extent of the law. If you think you may have a Workers’ Compensation claim, contact McCarthy, Callas, and Feeney at 1-309-788-2800, and we will be happy to address your questions.

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