Trial Win: Joliet IWCC Orders Hip Replacement Surgery After Workers’ Comp Denial (Section 19(b) Emergency Hearing)
Workers’ compensation insurance companies in Chicago and across Illinois often deny legitimate claims by blaming injuries on “pre-existing conditions,” refusing to approve surgery, or cutting off wage-loss benefits like TTD. When that happens, injured workers are forced into a fight—not just for money, but for medical treatment they urgently need. At McHargue & Jones, LLC, we regularly handle these denied workers’ comp cases through aggressive litigation, including depositions and testimony from treating doctors, and we take cases to trial when the insurance company refuses to do the right thing. In a recent case in Joliet, Illinois, we won a major decision after taking the case to trial under Section 19(b) of the Illinois Workers’ Compensation Act, securing approval of hip replacement surgery and back pay benefits the insurance company denied.
This was also a Spanish-speaking client. Attorney Matthew C. Jones, who is fluent in Spanish, personally prepared and tried the case, and we used an interpreter when necessary to ensure our client could fully tell his story and be clearly understood at trial.
Quick Summary: What This IWCC Decision Accomplished
In this Joliet workers’ compensation trial under Section 19(b), the Illinois Workers’ Compensation Commission found the injured worker and his treating orthopedic surgeon credible, rejected the defense IME position, and ordered approval of hip replacement surgery along with payment of past-due wage benefits.
The Work Accident: Fall From a Ladder While Working as a Landscaper
Our client, a landscaper in his 30s, suffered a serious workplace accident when he fell off a ladder while working.
Before this injury, he was doing well. He was working full duty, had no significant limitations, and was able to perform the physical demands of landscaping without difficulty.
After the fall, he began developing severe hip pain that worsened over time and ultimately prevented him from working at the same level he had before.
The Diagnosis: Severe Hip Damage Requiring Hip Replacement Surgery
As his symptoms progressed, our client was evaluated and treated by an orthopedic specialist. Medical testing revealed severe hip damage, and his treating orthopedic surgeon ultimately recommended a hip replacement surgery.
This was not an optional procedure. It was necessary treatment to restore function and address the damage caused by the work-related trauma.
Unfortunately, workers’ comp insurance companies frequently deny surgical treatment even when it is clearly recommended by treating specialists. If this is happening to you, we discuss what to do next in our guide:
Workers’ Comp Denied My Surgery in Illinois – What to Do Next (Fast).
The Denial: Workers’ Comp Claimed the Condition Was “Pre-Existing”
Instead of approving treatment and benefits, the workers’ compensation insurance company sent our client for an Independent Medical Examination (IME).
This is one of the most common tactics used in Illinois workers’ comp cases. Insurance companies often rely on IME doctors to create a basis to deny benefits, cut off checks, or refuse surgery.
In our client’s case, the defense IME doctor claimed the hip condition was “pre-existing” and not caused by the fall—even though our client was working full duty and pain-free before the accident.
If you have been sent for an IME, it is critical to understand what it is and how it can impact your claim. We explain this in detail here:
IMEs in Illinois Workers’ Compensation: What Injured Workers Need to Know.
Illinois Workers’ Comp and Pre-Existing Conditions: The Insurance Company’s Favorite Excuse
One of the most common defenses we see in denied workers’ comp cases is the argument that an injury is “degenerative” or “pre-existing.”
This defense is especially common in cases involving:
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hip injuries
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back injuries
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knee injuries
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shoulder injuries
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surgery recommendations
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long-term disability
But Illinois law does not require a worker to be “perfectly healthy” before an accident. Workers’ compensation benefits can still apply when a workplace injury aggravates or accelerates an underlying condition.
We explain this common battle in more detail here:
Navigating a Workers’ Compensation Claim With a Pre-Existing Condition.
In this case, the insurance company tried to use the “pre-existing” argument to avoid paying for surgery and wage-loss benefits.
Why We Took This Case to Trial Under Section 19(b)
Because the denial was causing real harm, we filed for an expedited hearing under Section 19(b) of the Illinois Workers’ Compensation Act.
A Section 19(b) trial is designed to move faster than a standard workers’ compensation case. It is often used when there is an urgent dispute over benefits such as:
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temporary total disability (TTD) checks
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medical treatment approvals
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surgery authorization
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specialist referrals
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diagnostic testing
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disability disputes
When an insurance company denies benefits, it can take months—or even years—for a case to fully resolve without litigation. Section 19(b) is one of the strongest legal tools available to force the IWCC to decide the dispute as quickly as possible.
Our Trial Strategy: Treating Orthopedic Surgeon Testimony vs. Defense IME Doctor
To prove our client’s case, we presented testimony from his treating orthopedic surgeon.
The surgeon explained an important medical concept that defense insurance doctors often ignore:
A condition can exist without symptoms until trauma triggers it.
Our client may have had underlying hip issues, but he was asymptomatic, working full duty, and functioning normally before the fall. The trauma from falling off a ladder aggravated the condition, made it symptomatic, and resulted in severe impairment requiring surgery.
This type of medical explanation is exactly why doctor testimony and depositions matter in serious Illinois workers’ comp cases.
Cross-Examining the Defense Doctor: Exposing the Weakness of the “Pre-Existing” Defense
The defense IME doctor did not admit he was wrong. But through cross-examination, we were able to highlight the unreasonable nature of his position.
The timeline was clear:
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our client was working full duty before the fall
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he had no disabling hip pain before the accident
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after the fall, he could not perform his job normally
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he now requires a hip replacement
In other words: before the accident, he did not need surgery. After the accident, he did.
That is exactly the kind of real-world causation evidence that Arbitrators understand.
The Hearing Location: Joliet IWCC Trial
We tried this case before the Illinois Workers’ Compensation Commission (IWCC) in Joliet, Illinois.
Our client testified and did an outstanding job. His testimony was credible, consistent, and supported by his medical records and job history.
Because our client primarily spoke Spanish, attorney Matthew C. Jones (fluent in Spanish) worked directly with him throughout the case and at trial, and we used an interpreter when needed to ensure the testimony was clear and accurate. That matters—because credibility and communication are often decisive in contested workers’ comp trials.
The Result: Judge Ordered Back Pay and Approved Hip Replacement Surgery
The Arbitrator ruled in our client’s favor.
The Judge found our client and his treating orthopedic surgeon to be credible and supported by the evidence.
As a result, the IWCC decision awarded:
✅ Approval of hip replacement surgery
✅ All past-due TTD benefits (back pay)
✅ Medical benefits related to the injury
This was a significant decision that may represent hundreds of thousands of dollars in total workers’ compensation benefits on a case that the insurance company was aggressively denying.
What Benefits Can Be Awarded in Illinois Workers’ Comp Cases?
Many workers don’t realize the full range of benefits available under Illinois workers’ comp law. Depending on the injury, workers may be entitled to:
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medical treatment coverage
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TTD (temporary total disability) benefits
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permanent partial disability (PPD) benefits
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vocational rehabilitation
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other disability-related compensation
You can read a full breakdown here:
Types of Workers’ Comp Benefits in Illinois.
A Note About Appeals: The Defense May Challenge the Decision
In Illinois workers’ compensation cases, employers and insurance companies generally have the right to appeal an Arbitrator’s decision.
However, this was a major win for our client, and we are confident the Illinois Workers’ Compensation Commission will uphold this ruling if the defense chooses to appeal. The evidence was strong, the treating physician testimony was clear, and the defense IME position did not match the facts of the case.
Most importantly, the Judge’s decision reflects what Illinois workers’ comp law is designed to do: protect injured workers when a workplace accident causes disability and the need for medical treatment.
Why This Matters: Denied Workers’ Comp Claims Are Common in Illinois
Unfortunately, this type of denial is extremely common.
Insurance companies routinely deny legitimate claims by arguing:
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“the injury is pre-existing”
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“the accident didn’t cause it”
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“the worker is exaggerating”
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“the worker doesn’t need surgery”
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“treatment is unrelated”
This happens even when the worker was healthy and working full duty before the injury.
If your workers’ comp claim has been denied, you may still have a strong case. We explain what to do next here:
Denied Workers’ Comp in Illinois – What to Do Next.
Section 19(b) Hearings Can Force Workers’ Comp to Act Fast
One of the biggest advantages of Section 19(b) is that it can push the IWCC to resolve urgent disputes faster than the standard litigation timeline.
When surgery or treatment is delayed, injured workers can suffer:
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worsening medical damage
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longer recovery periods
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increased disability
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unnecessary pain
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financial collapse from unpaid wage benefits
Emergency hearings exist because workers should not be forced to suffer while an insurance company delays medically necessary treatment.
Why Hiring a Workers’ Comp Attorney Matters in Denied Surgery Cases
When an insurance company denies surgery or claims an injury is “pre-existing,” the case becomes a legal and medical battle. These cases often require:
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gathering medical records
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coordinating treating doctor testimony
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challenging IME reports
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preparing the injured worker for testimony
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cross-examining defense doctors
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taking the case to trial
We explain why legal representation matters here:
The Benefits of Hiring a Workers’ Comp Attorney.
This is especially true in surgery denial cases, where the stakes can involve life-changing medical care and long-term disability benefits.
Frequently Asked Questions (FAQ): Section 19(b) and Denied Workers’ Comp Benefits in Illinois
What is a Section 19(b) emergency hearing in Illinois workers’ compensation?
A Section 19(b) hearing is an expedited workers’ compensation trial process under Illinois law. It is used to resolve urgent disputes faster than normal litigation, especially when a worker is being denied medical treatment, surgery, or wage-loss benefits and needs the IWCC to decide the issue quickly.
Can workers’ comp deny surgery in Illinois?
Yes. Workers’ comp insurance companies frequently deny surgery requests by claiming the condition is not work-related or the procedure is not necessary. When surgery is denied, a worker may need to pursue a hearing before the Illinois Workers’ Compensation Commission to force approval.
If you are dealing with this issue, see:
Workers’ Comp Denied My Surgery in Illinois – What to Do Next (Fast).
What if workers’ comp says my injury is a pre-existing condition?
Insurance companies often deny claims by arguing an injury is pre-existing or degenerative. However, Illinois workers’ compensation benefits may still apply if a work accident aggravated, accelerated, or made the condition symptomatic.
Read more here:
Navigating a Workers’ Compensation Claim With a Pre-Existing Condition.
How do IME doctors affect Illinois workers’ comp cases?
IME doctors are often hired by insurance companies to dispute causation, treatment needs, or disability. Their reports are commonly used to deny benefits or refuse surgery. Many workers’ comp trials involve challenging IME opinions through treating doctor testimony and cross-examination.
Learn more here:
IMEs in Illinois Workers’ Compensation: What Injured Workers Need to Know.
What benefits can an injured worker receive in an Illinois workers’ comp case?
Depending on the injury, an injured worker may be entitled to medical treatment, TTD benefits, permanent disability benefits, vocational rehabilitation, and other compensation.
See:
Types of Workers’ Comp Benefits in Illinois.
Can an Illinois workers’ comp trial decision be appealed?
Yes. Employers and insurance companies typically have the right to appeal an Arbitrator’s decision. However, strong medical evidence and credible testimony often lead to the decision being upheld.
Should I hire a workers’ comp lawyer if my benefits are denied?
If your claim is denied, your checks stop, or your surgery is refused, it is often a sign the insurance company is preparing for litigation. In serious cases, having an experienced Illinois workers’ comp trial attorney can significantly increase your chances of winning benefits.
Learn more:
The Benefits of Hiring a Workers’ Comp Attorney.
Final Thoughts: We Fight Denied Workers’ Comp Claims—and We Take Them to Trial
This Joliet IWCC trial win is a perfect example of why injured workers should not assume a denial is final.
Our client was a hardworking landscaper in his 30s, working full duty before a fall from a ladder changed everything. The insurance company tried to avoid responsibility by claiming the condition was “pre-existing” and denying surgery and wage benefits.
We fought back, presented treating doctor testimony, challenged the defense IME opinion, and took the case to trial under Section 19(b). The Judge agreed with our client and ordered the benefits he deserved.
If your workers’ comp claim has been denied, you may still have options.
Start here:
Denied Workers’ Comp in Illinois
And if your surgery was denied:
Workers’ Comp Denied My Surgery in Illinois – What to Do Next (Fast)
