medical bills in this matter i would like to begin with medical bills which i believe i will spend most of my time on by way of background employees submitted his medical bills through his wife's group health insurance these bill total a little over one hundred sixty five thousand dollars however after p p o discounts and write offs and reductions the bills came to approximately fifty two thousand dollars the arbitrator though did award the medical bills of one hundred sixty five thousand dollars the original amount that was owed even though the group health insurance only had to pay a little over fifty two thousand dollars which the foundation very admitting these you know i guess basically just establishing that he went through this trader on a certain date showing the different treatment that he received on that date were actually paid were only fifty two thousand little over fifty two thousand dollars basically my entire argument here today is that if you were to if this honorable court was to confirm the decision of the commission awarding one hundred sixty five thousand dollars in medical bills even though only fifty two thousand were paid would result in a windfall unjust enrichment to the employee in this matter what happens in every turkey that happens in toward cases your honor but basically i think does he has simply provided case law which is correct that applies to tort cases in illinois i do not believe that should apply to all my workers compensation cases because it is a common law doctrine that  applied and as we know tort is a common law the only worker's compensation act though is the remedial act that was created by statute this act provides a fix for remedy for an employee to recover against no fault act as we all know and no negligence needs to be shown therefo economically hole for why it is liable for correct in this matter what i am arguing is that the employee in this case is liable for the fifty just above fifty two thousand dollars that was paid through his wife's group health insurance it's my understanding that the wife's group health insurance will come after the employee for the amount that was paid for the just over fifty two thousand also there was a little over one thousand one hundred dollars paid by employee out of pocket expenses which i understand he should also recoup for but i think that it should stop there he's an employee who was already given an award for  permanency that of thirty five percent loss of use of the man as a whole if we were to award an employee thirty five percent loss and use a man as a whole on top of the approximately one hundred eleven thousand dollars in medical bills that he's not credit because as we know a j credit only deals with the employer's group health insurance therefore they would derive or go around that avenue and then they would be able to recoup the actual expenses but they're not liable reimbursed by the workers compensation and sure how do we know who their p p o point form that that doesn't bring them up to bill for the difference it's my understanding that the  one not with the medical bills were thoroughly discussed with the doctors and their greed on accepting the lower the amount of the lower amount and i believe it is case law that once they have accepted the lower amount as payment in full that they bill in this particular case i don't think i would have objection because like i said i believe it is my understanding that they were agreed to they agreed to the reduction of bills and the discounts and as i s to them of the original amount and although it's not authoritative certainly persuasive cases in other jurisdictions such as tennessee and missouri has differentiated tort law and worker's compensation law and these are located in my  brief tennessee court has stated that to allow an injured worker to receive the full amount of medical bills and sort of the amount actually would result in an authorized extra benefits that are not contemplated by the owner worker our student by the workers compensation back and we think about what the employee actually owes and is liable for currently is the fifty two thousand dollars toward him the one hundred sixty five thousand he pays the fifty two thousand and then he is sitting there with one hundred  eleven thousand dollars that is owed to no one i think that when you add this on top of the t t d award top of the p p d award this certainly creates a windfall that the employee is not owed there is not due it's not his right to have this extra windfall of one hundred ten thousand dollars when he is only while before just over fifty two that will be the award was for one hundred else he basically is getting a windfall this is for men oh that seems to be the theme of my argument here but any time you are receiving these benefits that you are not then liable for it certainly is a windfall injuries the first two doctors that you saw were dr clara which is this family doctor and dr luken neither of these doctors provided a causal connection opinion either way treating petitioner or treating employee to be entering employee in november two thousand and five and provide a causal connection opinion in january two thousand and seven during this time dr shapely accepted the group health insurance through employees wife he may no indication whatsoever during any of these visits that this could be work related or this could have been an aggravation or acceleration until january two thousand and seven drawing your attention to that date in january eighteenth two thousand and seven it was actually employee himself who brought this to the doctor's attention the employee walks into the office  according to what it seems like in the notes and asked dr shapely dr do you think this could be work related it was only then at that point in time that dr shapely did provide opinion that it could be work related  whatever period something like that and quote it was in fact only true that the shooter had been working for approximately seven months as a forklift driver for the point of the poem in this matter therefore i believe that dr is conclusion that it was not work related as dr bayliss is an unbiased doctor in this matter employee was sent to him in order to treat for his carpal tunnel syndrome why would the commission have to believe him over the other i believe that since dr shaved his opinion is resting on the fact that he believed employee had been performing these repetitive movements for eight years ten years the legislature created a safe harbor for the response respondents who determined that they are going to deny claims that safe harbors codified section eight j a j get as a legislative aide bit any group carrier who comes in to rescue the claimant so that his medical treatment can go forward they should get a benefit of it because if the disparity saying no we're not paying a dime the feeling that there were discounts the fact that there were payments the fact that there were adjustments is not a relevant inquiry can become lateral source will the logic of the collateral source rule is this the person or entity liable to pay some form of benefit if they we thieves whether knowingly whether it's with malice whether it's with serendipity can now get the benefit of a stranger to the equation can dance what happened here that's what happened here or even some of it is damages  five years that i've appeared before this body we have a case in illinois were a justice of this body really will section ten to say they want to be section or section eight rather says  doesn't say the employer must pay or shall pay for reasonable necessary treatment then the opinion translated that language is said that the respondent is required to pay the usual and customary charges to the trish threshold that this may end it's a windfall it is as justice said we have no evidence in this record that those doctors are going to come back to him for more money repetitive trauma action because they didn't pay the bills you have to stand up and you don't get the benefit in illinois of using somebody else's insurance for your insurance because you made a mistake that's not the law or is that healthy of that policy comes from the fact that you have to be responsible for your actions whether you're a corporation whether you're a respondent whether you're an individual again there is no evidence in this record your honor of the consequences to the petitioner to his spouse to his spo just like employers now want to use people as if they're pawns they want to move them from one volunteer position to another you're going to have a case in a few months that addresses that question whether that's accommodative employment the volunteered in that goodwill this isn't a pla they want a black letter of specific specific language and they want the guy to go in there and say dr i turn my head forty seven thousand times a day and i've been doing this for nine point five years and then they want them back to the same large egg type this is a work er conspiring here that's why the chiropractors got such a thorough history and i know you've heard better this decision is sound on the law this decision follows these records you know it would be wonderful if doctors were cognizant of what we discuss here in this forum so that they could document this and now with electronic records they're even getting less unlimited of the issues unless someone with above the histories and we're really going to h i believe that the causal connection issue as in pretty much argued on the first there my first argument or i would like to draw you just his attention to and i apologize i don't have the record number but it is page twenty three of plagiarism exhibit nine which is dr shapeways deposition and he stated that the only that he didn't have any of dr clay rose records he believed the only information he had regarding employee at that time j employers attempt to receive a credit in this case the employer is not attempting to receive the credits they're attempting to we are saying that we will that bridge employer is liable for the medical bills they were actually paid and no time in our brief do you see that we claim are that the employer claims an h a credit in this matter the point is that the only created provided in the end is employer provided health insurance the legislature could have said you get credit for any insurance carrier but they didn't so why should we legislate that i don't believe that the original drafters of the statute contemplated this benefit being given think the bottom line is that if there is a bill owed that amount is paid and no time in here any day course and you pay three times four times as much as what the bill is we've got money on the table and i believe it is what's what's paid and that's i guess our contention today is that it's what's paid going back to the phrase that i have used several times throughout this argument is that it is going to be a windfall it's an unjust enrichment to employees  they will continue to submit these health insurance bill or these bills through some of their sponsors group health insurance because they now see a loophole or a way around the act the other side of that is it