Guidelines or Rules? How Do the Rules of Evidence Apply at the Commission?
All trials conducted before the Illinois Workers’ Compensation Commission (“Commission”) proceed under the rules set forth in the Illinois Workers’ Compensation Act (“the Act”) and rules set forth by the Illinois Supreme Court (specifically, the Rules of Evidence). “Evidence” as a legal concept is complicated. So complicated, in fact, that law schools teach a whole course on the topic.
Ask any law school student in an Evidence course to list and explain the exceptions to hearsay, and you are sure to elicit a shudder or groan. That said, not every aspect of evidence is so complex. Consider “foundation,” for example. For a document to be admitted as evidence, a proper foundation must be laid, which can be done several ways. Perhaps the easiest way is by showing that the document was obtained by subpoena.
The rules of evidence are not always strictly adhered to in workers’ compensation. Additionally, there is no discovery in workers’ compensation in Illinois. As a result, there can be an element of surprise in the evidence or witnesses presented at trial.
The Act addresses some issues that overlap with the rules of evidence, including foundation. Pursuant to Section 16 of the Act, records, reports, and bills are admissible if they are certified to be true and accurate by the provider. In other words, the records should be admissible if they were obtained by a properly issued subpoena.
Is Section 16 adhered to by practitioners and by the Commission? The answer is not simple.
Most cases brought before the Illinois Workers’ Compensation Commission settle without requiring a formal trial. Sometimes, however, trial is necessary due to a dispute regarding whether an accident occurred. Sometimes the dispute rests on “nature and extent” of the injury. And sometimes, the disputes rest on whether medical treatment was reasonable and necessary, with a tag-along issue of whether medical bills for that treatment must be paid.
The Illinois Workers’ Compensation Act addresses what bills are required to be paid, and even when they should be paid. Pursuant to Section 8(a) of the Act, a claimant is entitled to compensation for all necessary medical, surgical, and hospital services that are reasonably required to cure or relieve the effects of an injury. The claimant bears the burden of proving by a preponderance of the evidence all elements necessary to sustain an award of compensation. The Act also mandates that bills provided to the employer or third-party payer be paid within 30 days of receipt, as long as the bill contains the required data elements necessary to adjudicate the bill.
At trial, the Arbitrator establishes what treatment is reasonably required. In turn, the Arbitrator also determines which bills are reasonable and related to the work injury. Case precedent and the Act dictate that a claimant must lay the proper foundation for a medical bill that is unpaid by demonstrating the bill was made in the regular course of business at or near the time of the transaction. [Land & Lakes Co. v. Indus. Comm’n (Dawson), 834 N.E.2d 583, 587 (Ill. 2d Dist. 2005)] Medical records documenting a claimant’s treatment are sufficient proof that the medical bills are necessary and causally connected to a work-related injury. [Shafer v. Illinois Workers’ Compensation Comm’n, 2011 IL App (4th) 100505WC, 976 N.E.2d 1, 364 Ill. Dec. 1] The Court seems to uphold this position in denying bills in cases where a demand is made for payment, but supporting documents are not offered, and awarding bills that were not offered where medical records were. [Jewel Cos. v. Indus. Comm’n, 125 Ill. App. 3d 92, 80 Ill. Dec. 589, 465 N.E.2d 935 (1984); Bravo v. Metropolitan Pier & Exposition Authority, 2004 Ill. Wrk. Comp. LEXIS 161, (Ill. Workers’ Comp. Bd. February 25, 2004)] The seemingly lax application of the rules may allow for a bill to be awarded even if a medical bill is not offered at arbitration.
How can an Arbitrator award bills that were not offered into evidence at the time of trial? Such practice seems to contradict Section 16 of the Act, which requires that records be obtained by a properly issued subpoena to be admissible. If a document is not admitted at trial, it obviously did not comport with the foundational rules of the Act.
Arbitrators should not award medical bills which are absent from the record. Doing so contradicts the Act, the rules of evidence, and case precedent. Nevertheless, bills continue to be awarded premised upon vague language for “reasonable and related treatment.” Employers are finding themselves responsible for treatment that the claimant has not proven was either reasonable or necessary. This sets a dangerous precedent that leaves employers open to liability for medical bills without much recourse.
Since the bills are unknown at the time of Arbitration, when must they be presented to the employer? Without having reviewed the medical records, how can a finder of fact determine whether the treatment was, in fact, reasonable and necessary? If an employer receives bills after a trial, who addresses whether the treatment is related? Must the employer simply pay any bill from that provider within the time frame, regardless of the type of treatment?
The recent practice of awarding bills with no medical records to substantiate those bills allows claimants (and their attorneys) to proceed to trial without being fully prepared and encourages Arbitrators to issue less-than-precise decisions pertaining to treatment and bills. It may seem like a small issue, but the potential for receiving very large bills without an avenue for appeal or dispute, is a very real and serious consequence for employers. Perhaps medical bills are not the most exciting issue to fight about, but the issue deserves attention for correct application of the rule.
Historically, when the rules of evidence (the same rules that cause law school students to lose sleep) are not ardently applied to trials at the Commission, this comes at a cost to the employer. It is time for the Illinois Workers’ Compensation Commission to demand strict compliance with the Rules of Evidence and the rules set forth in the Illinois Workers’ Compensation Commission Act.