Trial Win vs. Aldi Distribution Center: Forcing Insurance Companies to Approve Workers’ Compensation Surgery

Insurance companies frequently deny serious workers’ compensation claims, especially when injured workers require spinal surgery. At McHargue & Jones, we regularly represent workers whose claims have been denied or whose medical treatment has been refused by insurance companies. When insurers refuse to approve necessary treatment, we take those cases to trial before the Illinois Workers’ Compensation Commission.

This recent case involved a worker injured while working at an Aldi Distribution Center warehouse. After the insurance company denied surgery and disputed the seriousness of the injury, the case proceeded to trial. The judge ultimately ruled in favor of the injured worker and ordered the employer to approve spinal surgery and pay disability benefits.

The Workplace Injury at the Aldi Distribution Center

The injured worker was employed as an order picker in an Aldi distribution warehouse. Like many warehouse workers, his job required repeatedly lifting and stacking boxes of product onto pallets so they could be shipped to retail stores.

During one shift, the worker lifted boxes while preparing pallets for shipment. As he stood up from the lifting position, he felt a sudden sharp pain in his lower back. The pain worsened overnight, and he sought medical treatment shortly afterward.

The Medical Treatment and Diagnosis

After the injury, the worker underwent medical evaluation and diagnostic imaging. An MRI revealed significant lumbar spine problems consistent with a disc injury.

Back injuries like these are common in physically demanding jobs and often involve disc bulges, annular tears, or nerve compression. We explain these conditions in detail in our guide to disc bulges and herniated discs in Illinois workers’ compensation cases.

The worker attempted conservative treatment including therapy and injections. Unfortunately, those treatments did not relieve his symptoms. Because the pain continued to interfere with normal activities and work ability, a spine surgeon ultimately recommended lumbar fusion surgery.

The Insurance Company Disputed the Injury

The employer’s insurance company refused to approve the recommended surgery. This is a common tactic in serious workers’ compensation claims involving back injuries.

Insurance companies often attempt to blame the condition on degenerative changes or pre-existing problems rather than the workplace accident. We discuss this tactic in our article explaining how insurers use pre-existing conditions to dispute workers’ compensation claims.

Insurers also frequently rely on hired doctors performing Independent Medical Examinations (IMEs) in an attempt to contradict the treating physician’s recommendations.

The Insurance Company Used Social Media Evidence

In addition to disputing the medical treatment, the insurance company attempted to attack the worker’s credibility. Investigators reviewed the worker’s Facebook account and located photographs that showed the worker performing normal daily activities with his family.

Insurance companies frequently search social media in workers’ compensation cases. Investigators may review Facebook, Instagram, and other platforms looking for photos or videos they believe contradict a worker’s reported physical limitations. We explain how these investigations work in our article on workers’ compensation investigations and surveillance.

At trial, the employer argued that these photos suggested the worker was capable of physical activity and therefore did not need surgery.

The arbitrator was not persuaded. The judge explained that injured workers may still perform normal daily activities with their families, and the photos did not contradict the medical evidence showing a serious back injury.

The Workers’ Compensation Trial

Because the insurance company refused to approve surgery and disputed the claim, the case proceeded to trial before the Illinois Workers’ Compensation Commission.

The main issues at trial included whether the worker’s back condition was related to the workplace accident, whether the recommended medical treatment was reasonable and necessary, and whether the worker was entitled to disability benefits.

Through testimony and medical records, we demonstrated that the worker’s symptoms began immediately after the lifting incident and continued throughout the course of treatment.

The Judge Favored the Treating Surgeon Over the IME Doctor

One of the most important issues in the case involved conflicting medical opinions. The insurance company relied on an IME doctor who claimed the worker had only a temporary strain and did not require surgery.

The treating surgeon, however, reviewed the MRI imaging and determined that the worker had a significant lumbar disc injury causing ongoing pain and nerve symptoms.

The arbitrator ultimately gave greater weight to the treating physician’s opinion. The judge noted that the treating doctor had evaluated the worker multiple times and reviewed the diagnostic imaging in detail, while the IME opinion relied primarily on the written MRI report rather than the imaging itself.

Because of this, the arbitrator concluded that the recommended lumbar fusion surgery was reasonable and necessary.

The Judge Ordered Surgery and Disability Benefits

After reviewing the evidence, the arbitrator ruled in favor of the injured worker.

The decision ordered the employer to approve lumbar fusion surgery, pay outstanding medical bills, and pay disability benefits while the worker remained unable to return to work.

Disability payments in workers’ compensation cases are known as temporary total disability (TTD) benefits. You can learn more about how these payments work in our guide to how much workers’ compensation pays in Illinois.

Back Injuries Are Among the Most Disputed Workers’ Compensation Claims

Serious back injuries frequently occur in physically demanding jobs such as warehouse work, manufacturing, construction, and retail stocking. We regularly represent injured workers in these industries, including retail and grocery workers whose jobs require repetitive lifting.

Many workers also want to understand what their case may ultimately be worth. We discuss the factors that affect settlement value in our article on how much a back injury may be worth in an Illinois workers’ compensation case.

Denied Workers’ Compensation Claim?

Many injured workers contact our firm after their claim has been denied or their medical treatment has been refused. If that has happened in your case, you may want to read our guide on what to do when a workers’ compensation claim is denied in Illinois.

At McHargue & Jones, we regularly represent injured workers in these disputes and take cases to trial when insurance companies refuse to approve necessary treatment.

Frequently Asked Questions About Workers’ Compensation Trials

Can a workers’ compensation judge order surgery?

Yes. If a treating doctor recommends surgery and the insurance company refuses to approve it, an Illinois Workers’ Compensation Commission arbitrator can order the employer to authorize and pay for the procedure after a hearing.

Why do insurance companies deny workers’ compensation surgery?

Insurance companies often argue that the condition is degenerative or pre-existing, or rely on IME doctors to dispute the treating physician’s recommendation.

Do warehouse workers often suffer back injuries?

Yes. Warehouse jobs often involve repetitive lifting and stacking that can place significant strain on the spine.

What happens if workers’ compensation stops paying checks?

If disability benefits stop while you remain under medical restrictions, a hearing can be requested before the Illinois Workers’ Compensation Commission.

Do I need a lawyer if my workers’ compensation claim is denied?

If your claim has been denied or surgery has been refused, speaking with an experienced workers’ compensation lawyer can help determine whether your case should proceed to trial.

About the Author

This article was written by Matthew C. Jones, a Chicago workers’ compensation trial lawyer at McHargue & Jones.

Our firm represents injured workers throughout Illinois in cases involving denied workers’ compensation claims, disputed back injuries, denied surgery, cut-off disability benefits, and workers’ compensation trials.