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No Bills? No Problem: The Risky Shift in Medical Proof After AIM National Lease v. Illinois Workers’ Compensation Commission
No bills? No problem! The Appellate Court in AIM National Lease v. Illinois Workers’ Compensation Commission, 2026 IL App (1st) 250494WC-U ordered an employer to reimburse a group carrier for payments toward medical bills that were not introduced at trial.
At trial, the petitioner introduced a group carrier’s “Statement of Benefits” that he alleged showed how much the carrier paid for each date of service. The document did not identify the treatments performed on each date or an itemization of cost. The evidence included a second document from the carrier that included a spreadsheet with a total amount paid that was in contradiction to the Statement of Benefits. The petitioner did not introduce any medical bills corresponding to the dates of service in the carrier’s documents. The Arbitrator awarded all reasonable and related medical expenses reflected in the Statement of Benefits. The Commission affirmed and allowed the employer to deduct any expenses not associated with the medical records in evidence. The total medical expense award was $204,559.62.
At the Appellate Court, the employer argued that they should not be liable for bills that were not in evidence. If they were liable for the bills, the employer argued their liability was limited to the lesser of the negotiated rate, the provider’s actual charge, or the fee schedule amount. Without the bills, the employer reasoned, they could not calculate the actual charge or fee schedule amount to determine if either was less than the negotiated rate paid by the carrier. Therefore, the employer could not determine their liability under Section 8(a) of the Act. The case rested on the statutory interpretation of Section 8(a) of the Act, which states: “The employer shall provide and pay the negotiated rate, if applicable, or the lesser of the health care provider’s actual charges or according to a fee schedule.”
The Appellate Court held that the amount the carrier paid was the negotiated rate under Section 8(a). The Court focused on the word “or” in the plain language of the Act, implying that the Commission should first determine if the negotiated rate applied. If the bills were unpaid without negotiated rates applied, then the employer could review the actual charge and fee schedule amount to determine which was less. The Court held the employer was liable for the negotiated rate, and the Commission did not need to consider the actual charge or fee schedule amount.
In addition, the Court found that there was a conflict between the Statement of Benefits and spreadsheet. In one example, the Statement of Benefits claimed a payment of $168,526.34 to one provider, while the carrier’s spreadsheet showed a payment of $50,059.40 for the same dates of service. The Court remanded the case with instructions for the Commission to address the contradictory documents and determine how much the carrier paid.
What is so troubling about this case for employers is the Appellate Court’s dismissive attitude about the lack of medical bills in evidence. This seems to shift the burden to the employer to confirm bills, current balances, and any payments made by third parties. Although the Court did not require the medical bills at trial, they found the carrier payments must correspond to treating records in evidence.
The Appellate Court decision highlights the importance of confirming the accuracy of medical payments prior to trial. If the petitioner introduces a Statement of Benefits from the insurer, defense attorneys should obtain all bills mentioned in the document to properly evaluate exposure. The defense attorney should subpoena the providers to confirm what payments the carrier made for each date of service. Also, the attorney should issue a subpoena to the group carrier for a spreadsheet showing the actual payments made. In our experience, a Statement of Benefits does not always reflect the amounts the carrier paid for dates of service. For example, a Statement of Benefits might include a “Benefits Provided” column claiming to show the payments made for each date of service. This number often includes not only the payments, but also the contractual adjustments made by the provider. In AIM National Lease, the Court highlighted just one payment discrepancy that reflected a difference of over $100,000 between the Statement of Benefits and the carrier’s payment ledger.
For cases with significant medical balances, the savings for employers could be hundreds of thousands of dollars. If there is a contradiction between the carrier’s ledger and the provider’s medical bills, the parties should address the discrepancies prior to trial. As stated earlier, defense attorneys should provide the most accurate exposure assessment to their clients. They should not blindly trust a carrier ledger without confirming the balances reflected on each billing statement. The AIM National Lease case confirms that failing to confirm carrier payments early can leave employers navigating costly surprises post-trial. If you have any questions about medical bills at trial, please feel free to reach out to me here.