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Rep. David Reis
Filed: 4/11/2011
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1 | | AMENDMENT TO HOUSE BILL 2602
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2 | | AMENDMENT NO. ______. Amend House Bill 2602 by replacing |
3 | | everything after the enacting clause with the following:
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4 | | "Section 5. The Workers' Compensation Act is amended by |
5 | | changing Sections 1, 8, 8.1, 8.2, 8.3, 8.7, 11, 16, 19, and |
6 | | 25.5 and by adding Sections 1.1, 4b, 16b, and 16c.
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7 | | (820 ILCS 305/1) (from Ch. 48, par. 138.1)
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8 | | Sec. 1. This Act may be cited as the Workers' Compensation |
9 | | Act.
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10 | | (a) The term "employer" as used in this Act means:
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11 | | 1. The State and each county, city, town, township, |
12 | | incorporated
village, school district, body politic, or |
13 | | municipal corporation
therein.
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14 | | 2. Every person, firm, public or private corporation, |
15 | | including
hospitals, public service, eleemosynary, religious |
16 | | or charitable
corporations or associations who has any person |
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1 | | in service or under any
contract for hire, express or implied, |
2 | | oral or written, and who is
engaged in any of the enterprises |
3 | | or businesses enumerated in Section 3
of this Act, or who at or |
4 | | prior to the time of the accident to the
employee for which |
5 | | compensation under this Act may be claimed, has in
the manner |
6 | | provided in this Act elected to become subject to the
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7 | | provisions of this Act, and who has not, prior to such |
8 | | accident,
effected a withdrawal of such election in the manner |
9 | | provided in this Act.
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10 | | 3. Any one engaging in any business or enterprise referred |
11 | | to in
subsections 1 and 2 of Section 3 of this Act who |
12 | | undertakes to do any
work enumerated therein, is liable to pay |
13 | | compensation to his own
immediate employees in accordance with |
14 | | the provisions of this Act, and
in addition thereto if he |
15 | | directly or indirectly engages any contractor
whether |
16 | | principal or sub-contractor to do any such work, he is liable |
17 | | to
pay compensation to the employees of any such contractor or
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18 | | sub-contractor unless such contractor or sub-contractor has |
19 | | insured, in
any company or association authorized under the |
20 | | laws of this State to
insure the liability to pay compensation |
21 | | under this Act, or guaranteed
his liability to pay such |
22 | | compensation. With respect to any time
limitation on the filing |
23 | | of claims provided by this Act, the timely
filing of a claim |
24 | | against a contractor or subcontractor, as the case may
be, |
25 | | shall be deemed to be a timely filing with respect to all |
26 | | persons
upon whom liability is imposed by this paragraph.
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1 | | In the event any such person pays compensation under this |
2 | | subsection
he may recover the amount thereof from the |
3 | | contractor or sub-contractor,
if any, and in the event the |
4 | | contractor pays compensation under this
subsection he may |
5 | | recover the amount thereof from the sub-contractor, if any.
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6 | | This subsection does not apply in any case where the |
7 | | accident occurs
elsewhere than on, in or about the immediate |
8 | | premises on which the
principal has contracted that the work be |
9 | | done.
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10 | | 4. Where an employer operating under and subject to the |
11 | | provisions
of this Act loans an employee to another such |
12 | | employer and such loaned
employee sustains a compensable |
13 | | accidental injury in the employment of
such borrowing employer |
14 | | and where such borrowing employer does not
provide or pay the |
15 | | benefits or payments due such injured employee, such
loaning |
16 | | employer is liable to provide or pay all benefits or payments
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17 | | due such employee under this Act and as to such employee the |
18 | | liability
of such loaning and borrowing employers is joint and |
19 | | several, provided
that such loaning employer is in the absence |
20 | | of agreement to the
contrary entitled to receive from such |
21 | | borrowing employer full
reimbursement for all sums paid or |
22 | | incurred pursuant to this paragraph
together with reasonable |
23 | | attorneys' fees and expenses in any hearings
before the |
24 | | Illinois Workers' Compensation Commission or in any action to |
25 | | secure such
reimbursement. Where any benefit is provided or |
26 | | paid by such loaning
employer the employee has the duty of |
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1 | | rendering reasonable cooperation
in any hearings, trials or |
2 | | proceedings in the case, including such
proceedings for |
3 | | reimbursement.
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4 | | Where an employee files an Application for Adjustment of |
5 | | Claim with
the Illinois Workers' Compensation
Commission |
6 | | alleging that his claim is covered by the
provisions of the |
7 | | preceding paragraph, and joining both the alleged
loaning and |
8 | | borrowing employers, they and each of them, upon written
demand |
9 | | by the employee and within 7 days after receipt of such demand,
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10 | | shall have the duty of filing with the Illinois Workers' |
11 | | Compensation Commission a written
admission or denial of the |
12 | | allegation that the claim is covered by the
provisions of the |
13 | | preceding paragraph and in default of such filing or
if any |
14 | | such denial be ultimately determined not to have been bona fide
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15 | | then the provisions of Paragraph K of Section 19 of this Act |
16 | | shall apply.
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17 | | An employer whose business or enterprise or a substantial |
18 | | part
thereof consists of hiring, procuring or furnishing |
19 | | employees to or for
other employers operating under and subject |
20 | | to the provisions of this
Act for the performance of the work |
21 | | of such other employers and who pays
such employees their |
22 | | salary or wages notwithstanding that they are doing
the work of |
23 | | such other employers shall be deemed a loaning employer
within |
24 | | the meaning and provisions of this Section.
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25 | | (b) The term "employee" as used in this Act means:
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26 | | 1. Every person in the service of the State, including |
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1 | | members of
the General Assembly, members of the Commerce |
2 | | Commission, members of the
Illinois Workers' Compensation |
3 | | Commission, and all persons in the service of the University
of |
4 | | Illinois, county, including deputy sheriffs and assistant |
5 | | state's
attorneys, city, town, township, incorporated village |
6 | | or school
district, body politic, or municipal corporation |
7 | | therein, whether by
election, under appointment or contract of |
8 | | hire, express or implied,
oral or written, including all |
9 | | members of the Illinois National Guard
while on active duty in |
10 | | the service of the State, and all probation
personnel of the |
11 | | Juvenile Court appointed pursuant to Article VI
of the Juvenile |
12 | | Court Act of 1987, and including any official of the
State, any |
13 | | county, city, town, township, incorporated village, school
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14 | | district, body politic or municipal corporation therein except |
15 | | any duly
appointed member of a police department in any city |
16 | | whose
population exceeds 200,000 according to the last Federal |
17 | | or State
census, and except any member of a fire insurance |
18 | | patrol maintained by a
board of underwriters in this State. A |
19 | | duly appointed member of a fire
department in any city, the |
20 | | population of which exceeds 200,000 according
to the last |
21 | | federal or State census, is an employee under this Act only
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22 | | with respect to claims brought under paragraph (c) of Section |
23 | | 8.
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24 | | One employed by a contractor who has contracted with the |
25 | | State, or a
county, city, town, township, incorporated village, |
26 | | school district,
body politic or municipal corporation |
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1 | | therein, through its
representatives, is not considered as an |
2 | | employee of the State, county,
city, town, township, |
3 | | incorporated village, school district, body
politic or |
4 | | municipal corporation which made the contract.
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5 | | 2. Every person in the service of another under any |
6 | | contract of
hire, express or implied, oral or written, |
7 | | including persons whose
employment is outside of the State of |
8 | | Illinois where the contract of
hire is made within the State of |
9 | | Illinois, persons whose employment
results in fatal or |
10 | | non-fatal injuries within the State of Illinois
where the |
11 | | contract of hire is made outside of the State of Illinois, and
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12 | | persons whose employment is principally localized within the |
13 | | State of
Illinois, regardless of the place of the accident or |
14 | | the place where the
contract of hire was made, and including |
15 | | aliens, and minors who, for the
purpose of this Act are |
16 | | considered the same and have the same power to
contract, |
17 | | receive payments and give quittances therefor, as adult |
18 | | employees.
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19 | | 3. Every sole proprietor and every partner of a business |
20 | | may elect to
be covered by this Act.
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21 | | An employee or his dependents under this Act who shall have |
22 | | a cause
of action by reason of any injury, disablement or death |
23 | | arising out of
and in the course of his employment may elect to |
24 | | pursue his remedy in
the State where injured or disabled, or in |
25 | | the State where the contract
of hire is made, or in the State |
26 | | where the employment is principally
localized.
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1 | | However, any employer may elect to provide and pay |
2 | | compensation to
any employee other than those engaged in the |
3 | | usual course of the trade,
business, profession or occupation |
4 | | of the employer by complying with
Sections 2 and 4 of this Act. |
5 | | Employees are not included within the
provisions of this Act |
6 | | when excluded by the laws of the United States
relating to |
7 | | liability of employers to their employees for personal
injuries |
8 | | where such laws are held to be exclusive.
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9 | | The term "employee" does not include persons performing |
10 | | services as real
estate broker, broker-salesman, or salesman |
11 | | when such persons are paid by
commission only.
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12 | | (c) "Commission" means the Industrial Commission created |
13 | | by Section
5 of "The Civil Administrative Code of Illinois", |
14 | | approved March 7,
1917, as amended, or the Illinois Workers' |
15 | | Compensation Commission created by Section 13 of
this Act.
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16 | | (d) The term "accident" as used in this Act means an
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17 | | occurrence arising out of the employment resulting from a risk
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18 | | incidental to the employment and in the course of the
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19 | | employment at a time and place and under circumstances
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20 | | reasonably required by the employment. |
21 | | (e) The term "injury" as used in this Act means a condition |
22 | | or impairment that arises out of and in the course of |
23 | | employment. An injury, its occupational cause, and any
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24 | | resulting manifestations or disability must be established to a
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25 | | reasonable degree of medical certainty, based on objective
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26 | | relevant medical findings, and the accidental compensable
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1 | | injury must be the major contributing cause of any resulting
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2 | | injuries. For the purposes of this Section, "major contributing
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3 | | cause" means the cause which is more than 50% responsible for
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4 | | the injury as compared to all other causes combined for which
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5 | | treatment or benefits are sought. "Injury" includes the |
6 | | aggravation of a pre-existing condition by an accident arising |
7 | | out of and in the course of the employment, but only for so |
8 | | long as the aggravation of the pre-existing condition continues |
9 | | to be the major contributing cause of the disability. |
10 | | (1) An injury is deemed to arise out of and in the
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11 | | course of the employment only if: |
12 | | (A) it is reasonably apparent, upon consideration
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13 | | of all circumstances, that the accident is the major |
14 | | contributing cause of the injury; and |
15 | | (B) it does not come from a hazard or risk
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16 | | unrelated to the employment to which employees would
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17 | | have been equally exposed outside of the employment. |
18 | | (2) An injury resulting directly or indirectly from
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19 | | idiopathic causes is not compensable. |
20 | | (Source: P.A. 93-721, eff. 1-1-05.)
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21 | | (820 ILCS 305/1.1 new) |
22 | | Sec. 1.1. Standards of Conduct. |
23 | | (a) Commissioners and arbitrators shall dispose of all |
24 | | Workers' Compensation matters promptly, officially, and |
25 | | fairly, without bias or prejudice. Commissioners and |
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1 | | arbitrators shall be faithful to the law and maintain |
2 | | professional competence in it. Commissioners and arbitrators |
3 | | shall in a timely manner take appropriate action or initiate |
4 | | appropriate disciplinary measures against a Commissioner, |
5 | | arbitrator, lawyer, or others for unprofessional conduct which |
6 | | the Commissioner or arbitrator may become aware of. |
7 | | (b) Except as otherwise provided in this Act, the Canons of |
8 | | the Code of Judicial Conduct as adopted by the Supreme Court of |
9 | | Illinois govern the hearing and non-hearing conduct of members |
10 | | of the Commission and arbitrators under this Act. The |
11 | | Commission may set additional rules and standards, not less |
12 | | stringent than those rules and standards established by the |
13 | | Code of Judicial Conduct, for the conduct of arbitrators. |
14 | | (c) The following provisions of the Code of Judicial |
15 | | Conduct do not apply under this Section: |
16 | | (1) Canon 3(B), relating to administrative |
17 | | responsibilities. |
18 | | (2) Canon 6(C), relating to annual filings of economic |
19 | | interests. Instead of filing declarations of economic |
20 | | interests with the Clerk of the Illinois Supreme Court |
21 | | under Illinois Supreme Court Rule 68, members of the |
22 | | Commission and arbitrators shall make filings |
23 | | substantially similar to those required by Rule 68 with the |
24 | | Chairman, and such filings shall be made available for |
25 | | examination by the public. |
26 | | (d) An arbitrator or a Commissioner may accept an |
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1 | | uncompensated appointment to a governmental committee, |
2 | | commission, or other position that is concerned with issues of |
3 | | policy on matters which may come before the arbitrator or |
4 | | Commissioner if such appointment neither affects his or her |
5 | | independent professional judgment nor the conduct of his or her |
6 | | duties. |
7 | | (e) Decisions of an arbitrator or a Commissioner shall be |
8 | | based exclusively on evidence in the record of the proceeding |
9 | | and material that has been officially noticed. |
10 | | (820 ILCS 305/4b new) |
11 | | Sec. 4b. Collective Bargaining Agreements. |
12 | | (a) Definitions. |
13 | | For purposes of this Section, the term "construction |
14 | | employer" means any person or legal entity or group of |
15 | | persons or legal entities engaging in or planning to engage |
16 | | in any constructing, altering, reconstructing, repairing, |
17 | | rehabilitating, refinishing, refurbishing, remodeling, |
18 | | remediating, renovating, custom fabricating, maintaining, |
19 | | landscaping, improving, wrecking, painting, decorating, |
20 | | demolishing, and adding to or subtracting from any |
21 | | building, structure, airport facility, highway, roadway, |
22 | | street, alley, bridge, sewer, drain, ditch, sewage |
23 | | disposal plant, water works, parking facility, railroad, |
24 | | excavation or other project, development, real property, |
25 | | or improvement, or to do any part thereof, whether or not |
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1 | | the performance of the work herein described involves the |
2 | | addition to, or fabrication into, any structure, project, |
3 | | development, real property, or improvement herein |
4 | | described of any material or article of merchandise and |
5 | | shall also include moving construction related materials |
6 | | on the job site or to or from the job site. |
7 | | (b) Provisions. |
8 | | Upon appropriate filing, the Commission and the courts |
9 | | of this State shall recognize as valid and binding any |
10 | | provision in a collective bargaining agreement between any |
11 | | construction employer or group of employers and a labor |
12 | | organization which is recognized or certified and the |
13 | | exclusive representative of the employer's employees under |
14 | | the National Labor Relations Act, 29 U.S.C. § 151, et al., |
15 | | which contains certain obligations and procedures relating |
16 | | to workers' compensation. This agreement must be limited |
17 | | to, but need not include, all of the following: |
18 | | (1) an alternative dispute resolution ("ADR") |
19 | | system to supplement, modify, or replace the |
20 | | procedural or dispute resolution provisions of this |
21 | | Act. The system may include mediation, arbitration, or |
22 | | other dispute resolution proceedings, the results of |
23 | | which shall be final and binding upon the parties; |
24 | | (2) an agreed list of medical treatment providers |
25 | | that may be the exclusive source of all medical and |
26 | | related treatment provided under this Act; |
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1 | | (3) the use of a limited list of impartial |
2 | | physicians to conduct independent medical |
3 | | examinations; |
4 | | (4) the creation of a light duty, modified job, or |
5 | | return to work program; |
6 | | (5) the use of a limited list of individuals and |
7 | | companies for the establishment of vocational |
8 | | rehabilitation or retraining programs that may be the |
9 | | exclusive source of rehabilitation and retraining |
10 | | services provided under this Act; or |
11 | | (6) the establishment of joint labor management |
12 | | safety committees and safety procedures. |
13 | | (c) Void Agreements. |
14 | | Nothing in this Section shall be construed to authorize |
15 | | any agreement in a collective bargaining agreement that |
16 | | diminishes or increases a construction employer's |
17 | | entitlements under this Act or an employee's entitlement to |
18 | | benefits as otherwise set forth in this Act. For the |
19 | | purposes of this Section, the procedural rights and dispute |
20 | | resolution agreements under subparagraphs (1) thru (6) of |
21 | | subsection (b) of this Section are not agreements which |
22 | | diminish or increase a construction employer's |
23 | | entitlements under this Act or an employee's entitlement to |
24 | | benefits under this Act. Any agreement that diminishes or |
25 | | increases the construction employer's entitlements under |
26 | | this Act or an employee's entitlement to benefits as set |
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1 | | forth in this Act are null and void. Nothing in this |
2 | | Section shall be construed as creating a mandatory subject |
3 | | of bargaining. |
4 | | (d) Form of Agreement. |
5 | | The agreement reached herein shall demonstrate that: |
6 | | (1) the construction employer or group of |
7 | | employers and the recognized or certified exclusive |
8 | | bargaining representative have entered into a binding |
9 | | collective bargaining agreement adopting the ADR plan |
10 | | for a period of no less than 2 years; |
11 | | (2) contractual agreements have been reached with |
12 | | the construction employer's workers' compensation |
13 | | carrier, group self-insurance fund, and any excess |
14 | | carriers relating to the ADR plan; |
15 | | (3) procedures have been established by which |
16 | | claims for benefits by employees will be lodged, |
17 | | administered and decided while affording procedural |
18 | | due process; |
19 | | (4) the plan has designated forms upon which claims |
20 | | for benefits shall be made; |
21 | | (5) the system and means by which the construction |
22 | | employer's obligation to furnish medical services and |
23 | | vocational rehabilitation and retraining benefits |
24 | | shall be fulfilled and provider selected; |
25 | | (6) the method by which mediators or arbitrators |
26 | | are to be selected. |
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1 | | (e) Filing. |
2 | | A copy of the agreement and a statement identifying the |
3 | | parties to the agreement shall be filed with the |
4 | | Commission. Within 21 days of receipt of an agreement, the |
5 | | Chairman shall review the agreement for compliance with |
6 | | this Section and notify the parties of its acceptance, or |
7 | | notify the parties of any additional information required, |
8 | | or any recommended modification that would bring the |
9 | | agreement into compliance. If no additional information or |
10 | | modification is required, the agreement shall be valid and |
11 | | binding from the time the parties receive acceptance of the |
12 | | agreement from the Chairman. Upon receipt of any requested |
13 | | information or modification, the Chairman shall notify the |
14 | | parties within 21 days whether the agreement is in |
15 | | compliance with this Section. If no additional information |
16 | | or modification is required, the agreement shall be valid |
17 | | and binding from the time the parties receive acceptance of |
18 | | the agreement from the Chairman. All rejections made by the |
19 | | Chairman under this subsection shall be subject to review |
20 | | by the courts of this State, said review to be taken in the |
21 | | same manner and within the same time as provided by Section |
22 | | 19 of this Act for review of awards and decisions of the |
23 | | Commission. Upon the review, the Circuit Court shall have |
24 | | power to review all questions of fact as well as of law. |
25 | | (f) Notice to Insurance carrier. |
26 | | If the construction employer is insured under this Act, |
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1 | | he, she, or it shall provide notice to and obtain consent |
2 | | from his, her, or its insurance carrier, in the manner |
3 | | provided in the insurance contract, of his, her, or its |
4 | | intent to enter into an agreement as provided in this |
5 | | Section with his, her, or its employees. |
6 | | (g) Employees' Claims for Workers' Compensation Benefits. |
7 | | (1) claims for benefits shall be filed with the ADR |
8 | | plan administrator within those periods of limitation |
9 | | prescribed by this Act. Within 10 days of the filing of a |
10 | | claim, the ADR plan administrator shall serve a copy of the |
11 | | claim application upon the Commission, which shall |
12 | | maintain records of all ADR claims and resolutions. |
13 | | (2) settlements of claims presented to the ADR plan |
14 | | administrator shall be evidenced by a settlement |
15 | | agreement. All such settlements shall be filed with the ADR |
16 | | plan administrator, who within 10 days shall forward a copy |
17 | | to the Commission for recording. |
18 | | (3) upon assignment of claims, unless settled, |
19 | | mediators and arbitrators shall render final orders |
20 | | containing essential findings of fact, rulings of law and |
21 | | referring to other matters as pertinent to the questions at |
22 | | issue. The ADR plan administrator shall maintain a record |
23 | | of the proceedings. |
24 | | (h) Reporting Requirements. |
25 | | Annually, each ADR plan administrator shall submit a report |
26 | | to the Commission containing the following information: |
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1 | | (1) the number of employees within the ADR program; |
2 | | (2) the number of occurrences of work-related injuries |
3 | | or diseases; |
4 | | (3) the breakdown within the ADR program of injuries |
5 | | and diseases treated; |
6 | | (4) the total amount of disability benefits paid within |
7 | | the ADR program; |
8 | | (5) the total medical treatment cost paid within the |
9 | | ADR program; |
10 | | (6) the number of claims filed within the ADR program; |
11 | | and |
12 | | (7) the disposition of all claims.
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13 | | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
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14 | | Sec. 8. The amount of compensation which shall be paid to |
15 | | the
employee for an accidental injury not resulting in death |
16 | | is:
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17 | | (a) The employer shall provide and pay the negotiated rate, |
18 | | if applicable, or the lesser of the health care provider's |
19 | | actual charges or according to a fee schedule, subject to |
20 | | Section 8.2, in effect at the time the service was rendered for |
21 | | all the necessary first
aid, medical and surgical services, and |
22 | | all necessary medical, surgical
and hospital services |
23 | | thereafter incurred, limited, however, to that
which is |
24 | | reasonably required to cure or relieve from the effects of the
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25 | | accidental injury , even if a health care provider sells, |
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1 | | transfers, or otherwise assigns an account receivable for |
2 | | procedures, treatments, or services covered under this Act . If |
3 | | the employer does not dispute payment of first aid, medical, |
4 | | surgical,
and hospital services, the employer shall make such |
5 | | payment to the provider on behalf of the employee. The employer |
6 | | shall also pay for treatment,
instruction and training |
7 | | necessary for the physical, mental and
vocational |
8 | | rehabilitation of the employee, including all maintenance
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9 | | costs and expenses incidental thereto. If as a result of the |
10 | | injury the
employee is unable to be self-sufficient the |
11 | | employer shall further pay
for such maintenance or |
12 | | institutional care as shall be required.
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13 | | Except as provided in subsection (a-1) of this Section, for |
14 | | up to 60 days from the report of injury to the employer, the |
15 | | employer shall choose all necessary medical, surgical and |
16 | | hospital services reasonably required to cure or relieve from |
17 | | the effects of the accidental injury, at the employer's |
18 | | expense. The employee shall cooperate with and adhere to the |
19 | | plan of care or treatment recommendations of the providers |
20 | | selected by the employer, unless the proposed care and |
21 | | treatment threatens the life, health or recovery of the injured |
22 | | employee. Upon a finding by the Commission, that the employer's |
23 | | choice of medical care is rendering improper or inadequate |
24 | | care, the employee may then choose a second physician, surgeon, |
25 | | and hospital services at the employer's expense. Initial |
26 | | emergency services, taking place within 45 days of the |
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1 | | accident, shall not constitute a choice of physician, surgeon, |
2 | | or hospital services by the employer or employee. Except as |
3 | | provided in subsection (a-1) of this Section, the The employee |
4 | | may after 60 days from the report of injury at any time elect |
5 | | to secure his own physician,
surgeon and hospital services at |
6 | | the employer's expense . , or,
|
7 | | Upon agreement between the employer and the employees, or |
8 | | the employees'
exclusive representative, and subject to the |
9 | | approval of the Illinois Workers' Compensation
Commission, the |
10 | | employer shall maintain a list of physicians, to be
known as a |
11 | | Panel of Physicians, who are accessible to the employees.
The |
12 | | employer shall post this list in a place or places easily |
13 | | accessible
to his employees. The employee shall have the right |
14 | | to make an
alternative choice of physician from such Panel if |
15 | | he is not satisfied
with the physician first selected. If, due |
16 | | to the nature of the injury
or its occurrence away from the |
17 | | employer's place of business, the
employee is unable to make a |
18 | | selection from the Panel, the selection
process from the Panel |
19 | | shall not apply. The physician selected from the
Panel may |
20 | | arrange for any consultation, referral or other specialized
|
21 | | medical services outside the Panel at the employer's expense. |
22 | | Provided
that, in the event the Commission shall find that a |
23 | | doctor selected by
the employee is rendering improper or |
24 | | inadequate care, the Commission
may order the employee to |
25 | | select another doctor certified or qualified
in the medical |
26 | | field for which treatment is required. If the employee
refuses |
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1 | | to make such change the Commission may relieve the employer of
|
2 | | his obligation to pay the doctor's charges from the date of |
3 | | refusal to
the date of compliance.
|
4 | | Any vocational rehabilitation counselors who provide |
5 | | service under this Act shall have
appropriate certifications |
6 | | which designate the counselor as qualified to render
opinions |
7 | | relating to vocational rehabilitation. Vocational |
8 | | rehabilitation
may include, but is not limited to, counseling |
9 | | for job searches, supervising
a job search program, and |
10 | | vocational retraining including education at an
accredited |
11 | | learning institution. The employee or employer may petition to |
12 | | the Commission to decide disputes relating to vocational |
13 | | rehabilitation and the Commission shall resolve any such |
14 | | dispute, including payment of the vocational rehabilitation |
15 | | program by the employer. |
16 | | The maintenance benefit shall not be less than the |
17 | | temporary total disability
rate determined for the employee. In |
18 | | addition, maintenance shall include costs
and expenses |
19 | | incidental to the vocational rehabilitation program. |
20 | | When the employee is working light duty on a part-time |
21 | | basis or full-time
basis
and earns less than he or she would be |
22 | | earning if employed in the full capacity
of the job or jobs, |
23 | | then the employee shall be entitled to temporary partial |
24 | | disability benefits. Temporary partial disability benefits |
25 | | shall be
equal to two-thirds of
the difference between the |
26 | | average amount that the employee would be able to
earn in the |
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1 | | full performance of his or her duties in the occupation in |
2 | | which he
or she was engaged at the time of accident and the |
3 | | gross net amount which he or she
is
earning in the modified job |
4 | | provided to the employee by the employer or in any other job |
5 | | that the employee is working. |
6 | | No employer shall be required to pay temporary partial
|
7 | | disability benefits to an employee who has been discharged for
|
8 | | cause on or after the effective date of this amendatory Act of
|
9 | | the 97th General Assembly. Upon notification by the employer,
|
10 | | the Commission shall suspend temporary partial disability
|
11 | | benefits being paid to an employee who has been discharged for
|
12 | | cause. Following a hearing, the Commission may reinstate the
|
13 | | temporary partial benefits and retroactively restore any
|
14 | | benefits the employer should have paid if it finds the
|
15 | | employer's discharge of the employee was not for cause. If the
|
16 | | Commission determines that the employee was discharged for
|
17 | | cause, the temporary partial disability benefit shall be
|
18 | | terminated. "Discharge for cause" means a discharge resulting
|
19 | | from the employee's voluntary violation of a rule or policy of |
20 | | the employer not caused by the employee's disability. |
21 | | Every hospital, physician, surgeon or other person |
22 | | rendering
treatment or services in accordance with the |
23 | | provisions of this Section
shall upon written request furnish |
24 | | full and complete reports thereof to,
and permit their records |
25 | | to be copied by, the employer, the employee or
his dependents, |
26 | | as the case may be, or any other party to any proceeding
for |
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1 | | compensation before the Commission, or their attorneys.
|
2 | | When an employee makes a claim for benefits under the Act, |
3 | | he or she waives their privacy privilege with any treating
|
4 | | provider to the extent solely to allow the employer to obtain
|
5 | | from a treating provider the necessary information to determine
|
6 | | whether the condition of ill-being in question for which
|
7 | | treatment is sought is work related, what that treatment is for
|
8 | | purposes of approval of care, and whether or not, based upon
|
9 | | the condition of ill-being, the employee is entitled to other |
10 | | benefits. The employer shall be entitled to contact the
|
11 | | treating provider to seek information and answers from the
|
12 | | treating provider regarding whether the condition of ill-being
|
13 | | in question for which treatment is sought is work related, what
|
14 | | that treatment or course of treatment is for purposes of
|
15 | | approval of care, and the return to work options that the |
16 | | employer may have for the employee. |
17 | | Notwithstanding the foregoing, the employer's liability to |
18 | | pay for such
medical services selected by the employee shall be |
19 | | limited to:
|
20 | | (1) all first aid and emergency treatment; plus
|
21 | | (2) all medical, surgical and hospital services |
22 | | provided by the
physician, surgeon or hospital initially |
23 | | chosen by the employer employee or by any
other physician, |
24 | | consultant, expert, institution or other provider of
|
25 | | services recommended by said initial service provider or |
26 | | any subsequent
provider of medical services in the chain of |
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1 | | referrals from said
initial service provider; plus
|
2 | | (3) except as provided in subsection (a-1) of this |
3 | | Section, all medical, surgical and hospital services |
4 | | provided by any second
physician, surgeon or hospital |
5 | | subsequently chosen by the employee as allowed under this |
6 | | Section or by
any other physician, consultant, expert, |
7 | | institution or other provider of
services recommended by |
8 | | said second service provider or any subsequent provider
of |
9 | | medical services in the chain of referrals
from said second |
10 | | service provider. Thereafter the employer shall select
and |
11 | | pay for all necessary medical, surgical and hospital |
12 | | treatment and the
employee may not select a provider of |
13 | | medical services at the employer's
expense unless the |
14 | | employer agrees to such selection. At any time the employee
|
15 | | may obtain any medical treatment he or she desires at his |
16 | | or her own expense. This paragraph
shall not affect the |
17 | | duty to pay for rehabilitation referred to above.
|
18 | | Where, as provided in Section 11 of this Act, an employee |
19 | | is determined to be so intoxicated that the intoxication |
20 | | constituted a departure from employment, the employer shall |
21 | | only be liable to pay inpatient and outpatient hospital |
22 | | services furnished by a provider qualified to furnish those |
23 | | services that are needed to evaluate or stabilize an emergency |
24 | | medical condition. Emergency treatment for injuries caused by |
25 | | intoxication does not include post stabilization medical |
26 | | services. |
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1 | | When an employer and employee so agree in writing, nothing |
2 | | in this
Act prevents an employee whose injury or disability has |
3 | | been established
under this Act, from relying in good faith, on |
4 | | treatment by prayer or
spiritual means alone, in accordance |
5 | | with the tenets and practice of a
recognized church or |
6 | | religious denomination, by a duly accredited
practitioner |
7 | | thereof, and having nursing services appropriate therewith,
|
8 | | without suffering loss or diminution of the compensation |
9 | | benefits under
this Act. However, the employee shall submit to |
10 | | all physical
examinations required by this Act. The cost of |
11 | | such treatment and
nursing care shall be paid by the employee |
12 | | unless the employer agrees to
make such payment.
|
13 | | Where the accidental injury results in the amputation of an |
14 | | arm,
hand, leg or foot, or the enucleation of an eye, or the |
15 | | loss of any of
the natural teeth, the employer shall furnish an |
16 | | artificial of any such
members lost or damaged in accidental |
17 | | injury arising out of and in the
course of employment, and |
18 | | shall also furnish the necessary braces in all
proper and |
19 | | necessary cases. In cases of the loss of a member or members
by |
20 | | amputation, the employer shall, whenever necessary, maintain |
21 | | in good
repair, refit or replace the artificial limbs during |
22 | | the lifetime of the
employee. Where the accidental injury |
23 | | accompanied by physical injury
results in damage to a denture, |
24 | | eye glasses or contact eye lenses, or
where the accidental |
25 | | injury results in damage to an artificial member,
the employer |
26 | | shall replace or repair such denture, glasses, lenses, or
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1 | | artificial member.
|
2 | | The furnishing by the employer of any such services or |
3 | | appliances is
not an admission of liability on the part of the |
4 | | employer to pay
compensation.
|
5 | | The furnishing of any such services or appliances or the |
6 | | servicing
thereof by the employer is not the payment of |
7 | | compensation.
|
8 | | Except for the changes to the first paragraph of this |
9 | | subsection (a), the changes to this subsection (a) apply only |
10 | | to accidental injuries that occur on or after the effective |
11 | | date of this amendatory Act of the 97th General Assembly. |
12 | | (a-1) To satisfy its liabilities under this Section for the |
13 | | provision of medical treatment to injured employees, an |
14 | | employer may utilize a preferred provider program approved by |
15 | | the Illinois Department of Insurance pursuant to Article XX-1/2 |
16 | | of the Illinois Insurance Code. The provider network shall |
17 | | include an adequate number and type of physicians or other |
18 | | providers to treat common injuries experienced by injured |
19 | | employees based on the type of occupation or industry in which |
20 | | the employee is engaged, and the geographic area where the |
21 | | employees are employed. |
22 | | Medical treatment for injuries shall be readily available |
23 | | at reasonable times to all employees. To the extent feasible, |
24 | | all medical treatment for injuries shall be readily accessible |
25 | | to all employees. |
26 | | All treatment provided shall be provided in accordance with |
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1 | | standards of care of nationally recognized peer review |
2 | | guidelines as well as nationally recognized treatment |
3 | | guidelines and evidence-based medicine, as appropriate. |
4 | | Notwithstanding the provisions of subsection (a) of this |
5 | | Section and for injuries incurred after the effective day of |
6 | | this amendatory Act of the 97th General Assembly, an employee |
7 | | of an employer utilizing a preferred provider network shall |
8 | | only be allowed to select a participating provider from the |
9 | | network. An employer shall be responsible for all medical care |
10 | | provided by participating providers under this Section |
11 | | determined by the Commission to be reasonable or necessary. |
12 | | (b) If the period of temporary total incapacity for work |
13 | | lasts more
than 3 working days, weekly compensation as |
14 | | hereinafter provided shall
be paid beginning on the 4th day of |
15 | | such temporary total incapacity and
continuing as long as the |
16 | | total temporary incapacity lasts. In cases
where the temporary |
17 | | total incapacity for work continues for a period of
14 days or |
18 | | more from the day of the accident compensation shall commence
|
19 | | on the day after the accident.
|
20 | | 1. The compensation rate for temporary total |
21 | | incapacity under this
paragraph (b) of this Section shall |
22 | | be equal to 66 2/3% of the
employee's average weekly wage |
23 | | computed in accordance with Section 10,
provided that it |
24 | | shall be not less than 66 2/3% of the sum of the Federal |
25 | | minimum wage under the Fair Labor
Standards Act, or the |
26 | | Illinois minimum wage under the Minimum Wage Law,
whichever |
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1 | | is more, multiplied by 40 hours. This percentage rate shall |
2 | | be
increased by 10% for each spouse and child, not to |
3 | | exceed 100% of the total
minimum wage calculation,
|
4 | | nor exceed the employee's average weekly wage computed in |
5 | | accordance
with the provisions of Section 10, whichever is |
6 | | less.
|
7 | | 2. The compensation rate in all cases other than for |
8 | | temporary total
disability under this paragraph (b), and |
9 | | other than for serious and
permanent disfigurement under |
10 | | paragraph (c) and other than for permanent
partial |
11 | | disability under subparagraph (2) of paragraph (d) or under
|
12 | | paragraph (e), of this Section shall be equal to 66
2/3% of |
13 | | the employee's average weekly wage computed in accordance |
14 | | with
the provisions of Section 10, provided that it shall |
15 | | be not less than
66 2/3% of the sum of the Federal minimum |
16 | | wage under the Fair Labor Standards Act, or the Illinois |
17 | | minimum wage under the Minimum Wage Law, whichever is more, |
18 | | multiplied by 40 hours. This percentage rate shall be |
19 | | increased by 10% for each spouse and child, not to exceed |
20 | | 100% of the total minimum wage calculation,
nor exceed the |
21 | | employee's average weekly wage computed in accordance
with |
22 | | the provisions of Section 10, whichever is less.
|
23 | | No employer shall be required to pay temporary total
|
24 | | disability benefits to an employee who has been discharged
for |
25 | | cause on or after the effective date of this amendatory
Act of |
26 | | the 97th General Assembly. Upon notification by the
employer, |
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1 | | the Commission shall suspend temporary total disability |
2 | | benefits being paid to an employee who has been
discharged for |
3 | | cause. Following a hearing, the Commission
may reinstate the |
4 | | temporary total disability benefits and
retroactively restore |
5 | | any benefits the employer should
have paid if it finds the |
6 | | employer's discharge of the
employee was not for cause. If the |
7 | | Commission determines
that the employee was discharged for |
8 | | cause, the temporary
total disability benefit shall be |
9 | | terminated. "Discharge
for cause" means a discharge resulting |
10 | | from the employee's
voluntary violation of a rule or policy of |
11 | | the employer not
caused by the employee's disability.
|
12 | | 2.1. The compensation rate in all cases of serious and |
13 | | permanent
disfigurement under paragraph (c) and of |
14 | | permanent partial disability
under subparagraph (2) of |
15 | | paragraph (d) or under paragraph (e) of this
Section shall |
16 | | be equal to
60% of the employee's average
weekly wage |
17 | | computed in accordance with
the provisions of Section 10, |
18 | | provided that it shall be not less than
66 2/3% of the sum |
19 | | of the Federal minimum wage under the Fair Labor Standards |
20 | | Act, or the Illinois minimum wage under the Minimum Wage |
21 | | Law, whichever is more, multiplied by 40 hours. This |
22 | | percentage rate shall be increased by 10% for each spouse |
23 | | and child, not to exceed 100% of the total minimum wage |
24 | | calculation,
|
25 | | nor exceed the employee's average weekly wage computed in |
26 | | accordance
with the provisions of Section 10, whichever is |
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1 | | less.
|
2 | | 3. As used in this Section the term "child" means a |
3 | | child of the
employee including any child legally adopted |
4 | | before the accident or whom
at the time of the accident the |
5 | | employee was under legal obligation to
support or to whom |
6 | | the employee stood in loco parentis, and who at the
time of |
7 | | the accident was under 18 years of age and not emancipated. |
8 | | The
term "children" means the plural of "child".
|
9 | | 4. All weekly compensation rates provided under |
10 | | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this |
11 | | Section shall be subject to the
following limitations:
|
12 | | The maximum weekly compensation rate from July 1, 1975, |
13 | | except as
hereinafter provided, shall be 100% of the |
14 | | State's average weekly wage in
covered industries under the |
15 | | Unemployment Insurance Act, that being the
wage that most |
16 | | closely approximates the State's average weekly wage.
|
17 | | The maximum weekly compensation rate, for the period |
18 | | July 1, 1984,
through June 30, 1987, except as hereinafter |
19 | | provided, shall be $293.61.
Effective July 1, 1987 and on |
20 | | July 1 of each year thereafter the maximum
weekly |
21 | | compensation rate, except as hereinafter provided, shall |
22 | | be
determined as follows: if during the preceding 12 month |
23 | | period there shall
have been an increase in the State's |
24 | | average weekly wage in covered
industries under the |
25 | | Unemployment Insurance Act, the weekly compensation
rate |
26 | | shall be proportionately increased by the same percentage |
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1 | | as the
percentage of increase in the State's average weekly |
2 | | wage in covered
industries under the Unemployment |
3 | | Insurance Act during such period.
|
4 | | The maximum weekly compensation rate, for the period |
5 | | January 1, 1981
through December 31, 1983, except as |
6 | | hereinafter provided, shall be 100% of
the State's average |
7 | | weekly wage in covered industries under the
Unemployment |
8 | | Insurance Act in effect on January 1, 1981. Effective |
9 | | January
1, 1984 and on January 1, of each year thereafter |
10 | | the maximum weekly
compensation rate, except as |
11 | | hereinafter provided, shall be determined as
follows: if |
12 | | during the preceding 12 month period there shall have been |
13 | | an
increase in the State's average weekly wage in covered |
14 | | industries under the
Unemployment Insurance Act, the |
15 | | weekly compensation rate shall be
proportionately |
16 | | increased by the same percentage as the percentage of
|
17 | | increase in the State's average weekly wage in covered |
18 | | industries under the
Unemployment Insurance Act during |
19 | | such period.
|
20 | | From July 1, 1977 and thereafter such maximum weekly |
21 | | compensation
rate in death cases under Section 7, and |
22 | | permanent total disability
cases under paragraph (f) or |
23 | | subparagraph 18 of paragraph (3) of this
Section and for |
24 | | temporary total disability under paragraph (b) of this
|
25 | | Section and for amputation of a member or enucleation of an |
26 | | eye under
paragraph (e) of this Section shall be increased |
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1 | | to 133-1/3% of the
State's average weekly wage in covered |
2 | | industries under the
Unemployment Insurance Act.
|
3 | | For injuries occurring on or after February 1, 2006, |
4 | | the maximum weekly benefit under paragraph (d)1 of this |
5 | | Section shall be 100% of the State's average weekly wage in |
6 | | covered industries under the Unemployment Insurance Act.
|
7 | | 4.1. Any provision herein to the contrary |
8 | | notwithstanding, the
weekly compensation rate for |
9 | | compensation payments under subparagraph 18
of paragraph |
10 | | (e) of this Section and under paragraph (f) of this
Section |
11 | | and under paragraph (a) of Section 7 and for amputation of |
12 | | a member or enucleation of an eye under paragraph (e) of |
13 | | this Section, shall in no event be less
than 50% of the |
14 | | State's average weekly wage in covered industries under
the |
15 | | Unemployment Insurance Act.
|
16 | | 4.2. Any provision to the contrary notwithstanding, |
17 | | the total
compensation payable under Section 7 shall not |
18 | | exceed the greater of $500,000
or 25
years.
|
19 | | 5. For the purpose of this Section this State's average |
20 | | weekly wage
in covered industries under the Unemployment |
21 | | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 |
22 | | per
week and the computation of compensation rates shall be |
23 | | based on the
aforesaid average weekly wage until modified |
24 | | as hereinafter provided.
|
25 | | 6. The Department of Employment Security of the State |
26 | | shall
on or before the first day of December, 1977, and on |
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1 | | or before the first
day of June, 1978, and on the first day |
2 | | of each December and June of each
year thereafter, publish |
3 | | the State's average weekly wage in covered
industries under |
4 | | the Unemployment Insurance Act and the Illinois Workers' |
5 | | Compensation
Commission shall on the 15th day of January, |
6 | | 1978 and on the 15th day of
July, 1978 and on the 15th day |
7 | | of each January and July of each year
thereafter, post and |
8 | | publish the State's average weekly wage in covered
|
9 | | industries under the Unemployment Insurance Act as last |
10 | | determined and
published by the Department of Employment |
11 | | Security. The amount when so
posted and published shall be |
12 | | conclusive and shall be applicable as the
basis of |
13 | | computation of compensation rates until the next posting |
14 | | and
publication as aforesaid.
|
15 | | 7. The payment of compensation by an employer or his |
16 | | insurance
carrier to an injured employee shall not |
17 | | constitute an admission of the
employer's liability to pay |
18 | | compensation.
|
19 | | (c) For any serious and permanent disfigurement to the |
20 | | hand, head,
face, neck, arm, leg below the knee or the chest |
21 | | above the axillary
line, the employee is entitled to |
22 | | compensation for such disfigurement,
the amount determined by |
23 | | agreement at any time or by arbitration under
this Act, at a |
24 | | hearing not less than 6 months after the date of the
accidental |
25 | | injury, which amount shall not exceed 150 weeks (if the |
26 | | accidental injury occurs on or after the effective date of this |
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1 | | amendatory Act of the 94th General Assembly
but before February
|
2 | | 1, 2006) or 162
weeks (if the accidental injury occurs on or |
3 | | after February
1, 2006) at the
applicable rate provided in |
4 | | subparagraph 2.1 of paragraph (b) of this Section.
|
5 | | No compensation is payable under this paragraph where |
6 | | compensation is
payable under paragraphs (d), (e) or (f) of |
7 | | this Section.
|
8 | | A duly appointed member of a fire department in a city, the |
9 | | population of
which exceeds 200,000 according to the last |
10 | | federal or State census, is
eligible for compensation under |
11 | | this paragraph only where such serious and
permanent |
12 | | disfigurement results from burns.
|
13 | | (d) 1. If, after the accidental injury has been sustained, |
14 | | the
employee as a result thereof becomes partially |
15 | | incapacitated from
pursuing his usual and customary line of |
16 | | employment, he shall, except in
cases compensated under the |
17 | | specific schedule set forth in paragraph (e)
of this Section, |
18 | | receive compensation for the duration of his
disability, |
19 | | subject to the limitations as to maximum amounts fixed in
|
20 | | paragraph (b) of this Section, equal to 66-2/3% of the |
21 | | difference
between the average amount which he would be able to |
22 | | earn in the full
performance of his duties in the occupation in |
23 | | which he was engaged at
the time of the accident and the |
24 | | average amount which he is earning or
is able to earn in some |
25 | | suitable employment or business after the accident. For |
26 | | accidental injuries that occur on and after the effective date |
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1 | | of this amendatory Act of the 97th General Assembly, an award |
2 | | for wage differential under this subsection shall be effective |
3 | | only until the employee reaches the age of 67 or 5 years from |
4 | | the date the award becomes final, whichever is later.
|
5 | | 2. If, as a result of the accident, the employee sustains |
6 | | serious
and permanent injuries not covered by paragraphs (c) |
7 | | and (e) of this
Section or having sustained injuries covered by |
8 | | the aforesaid
paragraphs (c) and (e), he shall have sustained |
9 | | in addition thereto
other injuries which injuries do not |
10 | | incapacitate him from pursuing the
duties of his employment but |
11 | | which would disable him from pursuing other
suitable |
12 | | occupations, or which have otherwise resulted in physical
|
13 | | impairment; or if such injuries partially incapacitate him from |
14 | | pursuing
the duties of his usual and customary line of |
15 | | employment but do not
result in an impairment of earning |
16 | | capacity, or having resulted in an
impairment of earning |
17 | | capacity, the employee elects to waive his right
to recover |
18 | | under the foregoing subparagraph 1 of paragraph (d) of this
|
19 | | Section then in any of the foregoing events, he shall receive |
20 | | in
addition to compensation for temporary total disability |
21 | | under paragraph
(b) of this Section, compensation at the rate |
22 | | provided in subparagraph 2.1
of paragraph (b) of this Section |
23 | | for that percentage of 500 weeks that
the partial disability |
24 | | resulting from the injuries covered by this
paragraph bears to |
25 | | total disability. If the employee shall have
sustained a |
26 | | fracture of one or more vertebra or fracture of the skull,
the |
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1 | | amount of compensation allowed under this Section shall be not |
2 | | less
than 6 weeks for a fractured skull and 6 weeks for each |
3 | | fractured
vertebra, and in the event the employee shall have |
4 | | sustained a fracture
of any of the following facial bones: |
5 | | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or |
6 | | mandible, the amount of compensation allowed under
this Section |
7 | | shall be not less than 2 weeks for each such fractured
bone, |
8 | | and for a fracture of each transverse process not less than 3
|
9 | | weeks. In the event such injuries shall result in the loss of a |
10 | | kidney,
spleen or lung, the amount of compensation allowed |
11 | | under this Section
shall be not less than 10 weeks for each |
12 | | such organ. Compensation
awarded under this subparagraph 2 |
13 | | shall not take into consideration
injuries covered under |
14 | | paragraphs (c) and (e) of this Section and the
compensation |
15 | | provided in this paragraph shall not affect the employee's
|
16 | | right to compensation payable under paragraphs (b), (c) and (e) |
17 | | of this
Section for the disabilities therein covered.
|
18 | | (e) For accidental injuries in the following schedule, the |
19 | | employee
shall receive compensation for the period of temporary |
20 | | total incapacity
for work resulting from such accidental |
21 | | injury, under subparagraph 1 of
paragraph (b) of this Section, |
22 | | and shall receive in addition thereto
compensation for a |
23 | | further period for the specific loss herein
mentioned, but |
24 | | shall not receive any compensation under any other
provisions |
25 | | of this Act. The following listed amounts apply to either
the |
26 | | loss of or the permanent and complete loss of use of the member
|
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1 | | specified, such compensation for the length of time as follows:
|
2 | | 1. Thumb- |
3 | | 70 weeks if the accidental injury occurs on or |
4 | | after the effective date of this amendatory Act of the |
5 | | 94th General Assembly
but before February
1, 2006.
|
6 | | 76
weeks if the accidental injury occurs on or |
7 | | after February
1, 2006.
|
8 | | 2. First, or index finger- |
9 | | 40 weeks if the accidental injury occurs on or |
10 | | after the effective date of this amendatory Act of the |
11 | | 94th General Assembly
but before February
1, 2006.
|
12 | | 43
weeks if the accidental injury occurs on or |
13 | | after February
1, 2006.
|
14 | | 3. Second, or middle finger- |
15 | | 35 weeks if the accidental injury occurs on or |
16 | | after the effective date of this amendatory Act of the |
17 | | 94th General Assembly
but before February
1, 2006.
|
18 | | 38
weeks if the accidental injury occurs on or |
19 | | after February
1, 2006.
|
20 | | 4. Third, or ring finger- |
21 | | 25 weeks if the accidental injury occurs on or |
22 | | after the effective date of this amendatory Act of the |
23 | | 94th General Assembly
but before February
1, 2006.
|
24 | | 27
weeks if the accidental injury occurs on or |
25 | | after February
1, 2006.
|
26 | | 5. Fourth, or little finger- |
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1 | | 20 weeks if the accidental injury occurs on or |
2 | | after the effective date of this amendatory Act of the |
3 | | 94th General Assembly
but before February
1, 2006.
|
4 | | 22
weeks if the accidental injury occurs on or |
5 | | after February
1, 2006.
|
6 | | 6. Great toe- |
7 | | 35 weeks if the accidental injury occurs on or |
8 | | after the effective date of this amendatory Act of the |
9 | | 94th General Assembly
but before February
1, 2006.
|
10 | | 38
weeks if the accidental injury occurs on or |
11 | | after February
1, 2006.
|
12 | | 7. Each toe other than great toe- |
13 | | 12 weeks if the accidental injury occurs on or |
14 | | after the effective date of this amendatory Act of the |
15 | | 94th General Assembly
but before February
1, 2006.
|
16 | | 13
weeks if the accidental injury occurs on or |
17 | | after February
1, 2006.
|
18 | | 8. The loss of the first or distal phalanx of the thumb |
19 | | or of any
finger or toe shall be considered to be equal to |
20 | | the loss of one-half of
such thumb, finger or toe and the |
21 | | compensation payable shall be one-half
of the amount above |
22 | | specified. The loss of more than one phalanx shall
be |
23 | | considered as the loss of the entire thumb, finger or toe. |
24 | | In no
case shall the amount received for more than one |
25 | | finger exceed the
amount provided in this schedule for the |
26 | | loss of a hand.
|
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1 | | 9. Hand- |
2 | | 190 weeks if the accidental injury occurs on or |
3 | | after the effective date of this amendatory Act of the |
4 | | 94th General Assembly
but before February
1, 2006.
|
5 | | 205
weeks if the accidental injury occurs on or |
6 | | after February
1, 2006. |
7 | | The loss of 2 or more digits, or one or more
phalanges |
8 | | of 2 or more digits, of a hand may be compensated on the |
9 | | basis
of partial loss of use of a hand, provided, further, |
10 | | that the loss of 4
digits, or the loss of use of 4 digits, |
11 | | in the same hand shall
constitute the complete loss of a |
12 | | hand.
|
13 | | 10. Arm- |
14 | | 235 weeks if the accidental injury occurs on or |
15 | | after the effective date of this amendatory Act of the |
16 | | 94th General Assembly
but before February
1, 2006.
|
17 | | 253
weeks if the accidental injury occurs on or |
18 | | after February
1, 2006. |
19 | | Where an accidental injury results in the
amputation of |
20 | | an arm below the elbow, such injury shall be compensated
as |
21 | | a loss of an arm. Where an accidental injury results in the
|
22 | | amputation of an arm above the elbow, compensation for an |
23 | | additional 15 weeks (if the accidental injury occurs on or |
24 | | after the effective date of this amendatory Act of the 94th |
25 | | General Assembly
but before February
1, 2006) or an |
26 | | additional 17
weeks (if the accidental injury occurs on or |
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1 | | after February
1, 2006) shall be paid, except where the |
2 | | accidental injury results in the
amputation of an arm at |
3 | | the shoulder joint, or so close to shoulder
joint that an |
4 | | artificial arm cannot be used, or results in the
|
5 | | disarticulation of an arm at the shoulder joint, in which |
6 | | case
compensation for an additional 65 weeks (if the |
7 | | accidental injury occurs on or after the effective date of |
8 | | this amendatory Act of the 94th General Assembly
but before |
9 | | February
1, 2006) or an additional 70
weeks (if the |
10 | | accidental injury occurs on or after February
1, 2006)
|
11 | | shall be paid.
|
12 | | 11. Foot- |
13 | | 155 weeks if the accidental injury occurs on or |
14 | | after the effective date of this amendatory Act of the |
15 | | 94th General Assembly
but before February
1, 2006.
|
16 | | 167
weeks if the accidental injury occurs on or |
17 | | after February
1, 2006.
|
18 | | 12. Leg- |
19 | | 200 weeks if the accidental injury occurs on or |
20 | | after the effective date of this amendatory Act of the |
21 | | 94th General Assembly
but before February
1, 2006.
|
22 | | 215
weeks if the accidental injury occurs on or |
23 | | after February
1, 2006. |
24 | | Where an accidental injury results in the
amputation of |
25 | | a leg below the knee, such injury shall be compensated as
|
26 | | loss of a leg. Where an accidental injury results in the |
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1 | | amputation of a
leg above the knee, compensation for an |
2 | | additional 25 weeks (if the accidental injury occurs on or |
3 | | after the effective date of this amendatory Act of the 94th |
4 | | General Assembly
but before February
1, 2006) or an |
5 | | additional 27
weeks (if the accidental injury occurs on or |
6 | | after February
1, 2006) shall be
paid, except where the |
7 | | accidental injury results in the amputation of a
leg at the |
8 | | hip joint, or so close to the hip joint that an artificial
|
9 | | leg cannot be used, or results in the disarticulation of a |
10 | | leg at the
hip joint, in which case compensation for an |
11 | | additional 75 weeks (if the accidental injury occurs on or |
12 | | after the effective date of this amendatory Act of the 94th |
13 | | General Assembly
but before February
1, 2006) or an |
14 | | additional 81
weeks (if the accidental injury occurs on or |
15 | | after February
1, 2006) shall
be paid.
|
16 | | 13. Eye- |
17 | | 150 weeks if the accidental injury occurs on or |
18 | | after the effective date of this amendatory Act of the |
19 | | 94th General Assembly
but before February
1, 2006.
|
20 | | 162
weeks if the accidental injury occurs on or |
21 | | after February
1, 2006. |
22 | | Where an accidental injury results in the
enucleation |
23 | | of an eye, compensation for an additional 10 weeks (if the |
24 | | accidental injury occurs on or after the effective date of |
25 | | this amendatory Act of the 94th General Assembly
but before |
26 | | February
1, 2006) or an additional 11
weeks (if the |
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1 | | accidental injury occurs on or after February
1, 2006)
|
2 | | shall be
paid.
|
3 | | 14. Loss of hearing of one ear- |
4 | | 50 weeks if the accidental injury occurs on or |
5 | | after the effective date of this amendatory Act of the |
6 | | 94th General Assembly
but before February
1, 2006.
|
7 | | 54
weeks if the accidental injury occurs on or |
8 | | after February
1, 2006.
|
9 | | Total and permanent loss of
hearing of both ears- |
10 | | 200 weeks if the accidental injury occurs on or |
11 | | after the effective date of this amendatory Act of the |
12 | | 94th General Assembly
but before February
1, 2006. |
13 | | 215
weeks if the accidental injury occurs on or |
14 | | after February
1, 2006.
|
15 | | 15. Testicle- |
16 | | 50 weeks if the accidental injury occurs on or |
17 | | after the effective date of this amendatory Act of the |
18 | | 94th General Assembly
but before February
1, 2006.
|
19 | | 54
weeks if the accidental injury occurs on or |
20 | | after February
1, 2006.
|
21 | | Both testicles- |
22 | | 150 weeks if the accidental injury occurs on or |
23 | | after the effective date of this amendatory Act of the |
24 | | 94th General Assembly
but before February
1, 2006.
|
25 | | 162
weeks if the accidental injury occurs on or |
26 | | after February
1, 2006.
|
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1 | | 16. For the permanent partial loss of use of a member |
2 | | or sight of an
eye, or hearing of an ear, compensation |
3 | | during that proportion of the
number of weeks in the |
4 | | foregoing schedule provided for the loss of such
member or |
5 | | sight of an eye, or hearing of an ear, which the partial |
6 | | loss
of use thereof bears to the total loss of use of such |
7 | | member, or sight
of eye, or hearing of an ear.
|
8 | | (a) Loss of hearing for compensation purposes |
9 | | shall be
confined to the frequencies of 1,000, 2,000 |
10 | | and 3,000 cycles per second.
Loss of hearing ability |
11 | | for frequency tones above 3,000 cycles per second
are |
12 | | not to be considered as constituting disability for |
13 | | hearing.
|
14 | | (b) The percent of hearing loss, for purposes of |
15 | | the
determination of compensation claims for |
16 | | occupational deafness,
shall be calculated as the |
17 | | average in decibels for the thresholds
of hearing for |
18 | | the frequencies of 1,000, 2,000 and 3,000 cycles per |
19 | | second.
Pure tone air conduction audiometric |
20 | | instruments, approved by
nationally recognized |
21 | | authorities in this field, shall be used for measuring
|
22 | | hearing loss. If the losses of hearing average 30 |
23 | | decibels or less in the
3 frequencies, such losses of |
24 | | hearing shall not then constitute any
compensable |
25 | | hearing disability. If the losses of hearing average 85
|
26 | | decibels or more in the 3 frequencies, then the same |
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1 | | shall constitute and
be total or 100% compensable |
2 | | hearing loss.
|
3 | | (c) In measuring hearing impairment, the lowest |
4 | | measured
losses in each of the 3 frequencies shall be |
5 | | added together and
divided by 3 to determine the |
6 | | average decibel loss. For every decibel
of loss |
7 | | exceeding 30 decibels an allowance of 1.82% shall be |
8 | | made up to
the maximum of 100% which is reached at 85 |
9 | | decibels.
|
10 | | (d) If a hearing loss is established to have |
11 | | existed on July 1, 1975 by
audiometric testing the |
12 | | employer shall not be liable for the previous loss
so |
13 | | established nor shall he be liable for any loss for |
14 | | which compensation
has been paid or awarded.
|
15 | | (e) No consideration shall be given to the question |
16 | | of
whether or not the ability of an employee to |
17 | | understand speech
is improved by the use of a hearing |
18 | | aid.
|
19 | | (f) No claim for loss of hearing due to industrial |
20 | | noise
shall be brought against an employer or allowed |
21 | | unless the employee has
been exposed for a period of |
22 | | time sufficient to cause permanent impairment
to noise |
23 | | levels in excess of the following:
|
|
24 | | Sound Level DBA |
|
|
25 | | Slow Response |
Hours Per Day |
|
26 | | 90 |
8 |
|
|
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1 | | 92 |
6 |
|
2 | | 95 |
4 |
|
3 | | 97 |
3 |
|
4 | | 100 |
2 |
|
5 | | 102 |
1-1/2 |
|
6 | | 105 |
1 |
|
7 | | 110 |
1/2 |
|
8 | | 115 |
1/4 |
|
9 | | This subparagraph (f) shall not be applied in cases of |
10 | | hearing loss
resulting from trauma or explosion.
|
11 | | 17. In computing the compensation to be paid to any |
12 | | employee who,
before the accident for which he claims |
13 | | compensation, had before that
time sustained an injury |
14 | | resulting in the loss by amputation or partial
loss by |
15 | | amputation of any member, including hand, arm, thumb or |
16 | | fingers,
leg, foot or any toes, such loss or partial loss |
17 | | of any such member
shall be deducted from any award made |
18 | | for the subsequent injury. For
the permanent loss of use or |
19 | | the permanent partial loss of use of any
such member or the |
20 | | partial loss of sight of an eye, for which
compensation has |
21 | | been paid, then such loss shall be taken into
consideration |
22 | | and deducted from any award for the subsequent injury.
|
23 | | 18. The specific case of loss of both hands, both arms, |
24 | | or both
feet, or both legs, or both eyes, or of any two |
25 | | thereof, or the
permanent and complete loss of the use |
26 | | thereof, constitutes total and
permanent disability, to be |
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1 | | compensated according to the compensation
fixed by |
2 | | paragraph (f) of this Section. These specific cases of |
3 | | total
and permanent disability do not exclude other cases.
|
4 | | Any employee who has previously suffered the loss or |
5 | | permanent and
complete loss of the use of any of such |
6 | | members, and in a subsequent
independent accident loses |
7 | | another or suffers the permanent and complete
loss of the |
8 | | use of any one of such members the employer for whom the
|
9 | | injured employee is working at the time of the last |
10 | | independent accident
is liable to pay compensation only for |
11 | | the loss or permanent and
complete loss of the use of the |
12 | | member occasioned by the last
independent accident.
|
13 | | 19. In a case of specific loss and the subsequent death |
14 | | of such
injured employee from other causes than such injury |
15 | | leaving a widow,
widower, or dependents surviving before |
16 | | payment or payment in full for
such injury, then the amount |
17 | | due for such injury is payable to the widow
or widower and, |
18 | | if there be no widow or widower, then to such
dependents, |
19 | | in the proportion which such dependency bears to total
|
20 | | dependency.
|
21 | | Beginning July 1, 1980, and every 6 months thereafter, the |
22 | | Commission
shall examine the Second Injury Fund and when, after |
23 | | deducting all
advances or loans made to such Fund, the amount |
24 | | therein is $500,000
then the amount required to be paid by |
25 | | employers pursuant to paragraph
(f) of Section 7 shall be |
26 | | reduced by one-half. When the Second Injury Fund
reaches the |
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1 | | sum of $600,000 then the payments shall cease entirely.
|
2 | | However, when the Second Injury Fund has been reduced to |
3 | | $400,000, payment
of one-half of the amounts required by |
4 | | paragraph (f) of Section 7
shall be resumed, in the manner |
5 | | herein provided, and when the Second Injury
Fund has been |
6 | | reduced to $300,000, payment of the full amounts required by
|
7 | | paragraph (f) of Section 7 shall be resumed, in the manner |
8 | | herein provided.
The Commission shall make the changes in |
9 | | payment effective by
general order, and the changes in payment |
10 | | become immediately effective
for all cases coming before the |
11 | | Commission thereafter either by
settlement agreement or final |
12 | | order, irrespective of the date of the
accidental injury.
|
13 | | On August 1, 1996 and on February 1 and August 1 of each |
14 | | subsequent year, the Commission
shall examine the special fund |
15 | | designated as the "Rate
Adjustment Fund" and when, after |
16 | | deducting all advances or loans made to
said fund, the amount |
17 | | therein is $4,000,000, the amount required to be
paid by |
18 | | employers pursuant to paragraph (f) of Section 7 shall be
|
19 | | reduced by one-half. When the Rate Adjustment Fund reaches the |
20 | | sum of
$5,000,000 the payment therein shall cease entirely. |
21 | | However, when said
Rate Adjustment Fund has been reduced to |
22 | | $3,000,000 the amounts required by
paragraph (f) of Section 7 |
23 | | shall be resumed in the manner herein provided.
|
24 | | (f) In case of complete disability, which renders the |
25 | | employee
wholly and permanently incapable of work, or in the |
26 | | specific case of
total and permanent disability as provided in |
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1 | | subparagraph 18 of
paragraph (e) of this Section, compensation |
2 | | shall be payable at the rate
provided in subparagraph 2 of |
3 | | paragraph (b) of this Section for life.
|
4 | | An employee entitled to benefits under paragraph (f) of |
5 | | this Section
shall also be entitled to receive from the Rate |
6 | | Adjustment
Fund provided in paragraph (f) of Section 7 of the |
7 | | supplementary benefits
provided in paragraph (g) of this |
8 | | Section 8.
|
9 | | If any employee who receives an award under this paragraph |
10 | | afterwards
returns to work or is able to do so, and earns or is |
11 | | able to earn as
much as before the accident, payments under |
12 | | such award shall cease. If
such employee returns to work, or is |
13 | | able to do so, and earns or is able
to earn part but not as much |
14 | | as before the accident, such award shall be
modified so as to |
15 | | conform to an award under paragraph (d) of this
Section. If |
16 | | such award is terminated or reduced under the provisions of
|
17 | | this paragraph, such employees have the right at any time |
18 | | within 30
months after the date of such termination or |
19 | | reduction to file petition
with the Commission for the purpose |
20 | | of determining whether any
disability exists as a result of the |
21 | | original accidental injury and the
extent thereof.
|
22 | | Disability as enumerated in subdivision 18, paragraph (e) |
23 | | of this
Section is considered complete disability.
|
24 | | If an employee who had previously incurred loss or the |
25 | | permanent and
complete loss of use of one member, through the |
26 | | loss or the permanent
and complete loss of the use of one hand, |
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1 | | one arm, one foot, one leg, or
one eye, incurs permanent and |
2 | | complete disability through the loss or
the permanent and |
3 | | complete loss of the use of another member, he shall
receive, |
4 | | in addition to the compensation payable by the employer and
|
5 | | after such payments have ceased, an amount from the Second |
6 | | Injury Fund
provided for in paragraph (f) of Section 7, which, |
7 | | together with the
compensation payable from the employer in |
8 | | whose employ he was when the
last accidental injury was |
9 | | incurred, will equal the amount payable for
permanent and |
10 | | complete disability as provided in this paragraph of this
|
11 | | Section.
|
12 | | The custodian of the Second Injury Fund provided for in |
13 | | paragraph (f)
of Section 7 shall be joined with the employer as |
14 | | a party respondent in
the application for adjustment of claim. |
15 | | The application for adjustment
of claim shall state briefly and |
16 | | in general terms the approximate time
and place and manner of |
17 | | the loss of the first member.
|
18 | | In its award the Commission or the Arbitrator shall |
19 | | specifically find
the amount the injured employee shall be |
20 | | weekly paid, the number of
weeks compensation which shall be |
21 | | paid by the employer, the date upon
which payments begin out of |
22 | | the Second Injury Fund provided for in
paragraph (f) of Section |
23 | | 7 of this Act, the length of time the weekly
payments continue, |
24 | | the date upon which the pension payments commence and
the |
25 | | monthly amount of the payments. The Commission shall 30 days |
26 | | after
the date upon which payments out of the Second Injury |
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1 | | Fund have begun as
provided in the award, and every month |
2 | | thereafter, prepare and submit to
the State Comptroller a |
3 | | voucher for payment for all compensation accrued
to that date |
4 | | at the rate fixed by the Commission. The State Comptroller
|
5 | | shall draw a warrant to the injured employee along with a |
6 | | receipt to be
executed by the injured employee and returned to |
7 | | the Commission. The
endorsed warrant and receipt is a full and |
8 | | complete acquittance to the
Commission for the payment out of |
9 | | the Second Injury Fund. No other
appropriation or warrant is |
10 | | necessary for payment out of the Second
Injury Fund. The Second |
11 | | Injury Fund is appropriated for the purpose of
making payments |
12 | | according to the terms of the awards.
|
13 | | As of July 1, 1980 to July 1, 1982, all claims against and |
14 | | obligations
of the Second Injury Fund shall become claims |
15 | | against and obligations of
the Rate Adjustment Fund to the |
16 | | extent there is insufficient money in the
Second Injury Fund to |
17 | | pay such claims and obligations. In that case, all
references |
18 | | to "Second Injury Fund" in this Section shall also include the
|
19 | | Rate Adjustment Fund.
|
20 | | (g) Every award for permanent total disability entered by |
21 | | the
Commission on and after July 1, 1965 under which |
22 | | compensation payments
shall become due and payable after the |
23 | | effective date of this amendatory
Act, and every award for |
24 | | death benefits or permanent total disability
entered by the |
25 | | Commission on and after the effective date of this
amendatory |
26 | | Act shall be subject to annual adjustments as to the amount
of |
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1 | | the compensation rate therein provided. Such adjustments shall |
2 | | first
be made on July 15, 1977, and all awards made and entered |
3 | | prior to July
1, 1975 and on July 15 of each year
thereafter. |
4 | | In all other cases such adjustment shall be made on July 15
of |
5 | | the second year next following the date of the entry of the |
6 | | award and
shall further be made on July 15 annually thereafter. |
7 | | If during the
intervening period from the date of the entry of |
8 | | the award, or the last
periodic adjustment, there shall have |
9 | | been an increase in the State's
average weekly wage in covered |
10 | | industries under the Unemployment
Insurance Act, the weekly |
11 | | compensation rate shall be proportionately
increased by the |
12 | | same percentage as the percentage of increase in the
State's |
13 | | average weekly wage in covered industries under the
|
14 | | Unemployment Insurance Act. The increase in the compensation |
15 | | rate
under this paragraph shall in no event bring the total |
16 | | compensation rate
to an amount greater than the prevailing |
17 | | maximum rate at the time that the annual adjustment is made. |
18 | | Such increase
shall be paid in the same manner as herein |
19 | | provided for payments under
the Second Injury Fund to the |
20 | | injured employee, or his dependents, as
the case may be, out of |
21 | | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 |
22 | | of this Act. Payments shall be made at
the same intervals as |
23 | | provided in the award or, at the option of the
Commission, may |
24 | | be made in quarterly payment on the 15th day of January,
April, |
25 | | July and October of each year. In the event of a decrease in
|
26 | | such average weekly wage there shall be no change in the then |
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1 | | existing
compensation rate. The within paragraph shall not |
2 | | apply to cases where
there is disputed liability and in which a |
3 | | compromise lump sum settlement
between the employer and the |
4 | | injured employee, or his dependents, as the
case may be, has |
5 | | been duly approved by the Illinois Workers' Compensation
|
6 | | Commission.
|
7 | | Provided, that in cases of awards entered by the Commission |
8 | | for
injuries occurring before July 1, 1975, the increases in |
9 | | the
compensation rate adjusted under the foregoing provision of |
10 | | this
paragraph (g) shall be limited to increases in the State's |
11 | | average
weekly wage in covered industries under the |
12 | | Unemployment Insurance Act
occurring after July 1, 1975.
|
13 | | For every accident occurring on or after July 20, 2005 but |
14 | | before the effective date of this amendatory Act of the 94th |
15 | | General Assembly (Senate Bill 1283 of the 94th General |
16 | | Assembly), the annual adjustments to the compensation rate in |
17 | | awards for death benefits or permanent total disability, as |
18 | | provided in this Act, shall be paid by the employer. The |
19 | | adjustment shall be made by the employer on July 15 of the |
20 | | second year next following the date of the entry of the award |
21 | | and shall further be made on July 15 annually thereafter. If |
22 | | during the intervening period from the date of the entry of the |
23 | | award, or the last periodic adjustment, there shall have been |
24 | | an increase in the State's average weekly wage in covered |
25 | | industries under the Unemployment Insurance Act, the employer |
26 | | shall increase the weekly compensation rate proportionately by |
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1 | | the same percentage as the percentage of increase in the |
2 | | State's average weekly wage in covered industries under the |
3 | | Unemployment Insurance Act. The increase in the compensation |
4 | | rate under this paragraph shall in no event bring the total |
5 | | compensation rate to an amount greater than the prevailing |
6 | | maximum rate at the time that the annual adjustment is made. In |
7 | | the event of a decrease in such average weekly wage there shall |
8 | | be no change in the then existing compensation rate. Such |
9 | | increase shall be paid by the employer in the same manner and |
10 | | at the same intervals as the payment of compensation in the |
11 | | award. This paragraph shall not apply to cases where there is |
12 | | disputed liability and in which a compromise lump sum |
13 | | settlement between the employer and the injured employee, or |
14 | | his or her dependents, as the case may be, has been duly |
15 | | approved by the Illinois Workers' Compensation Commission. |
16 | | The annual adjustments for every award of death benefits or |
17 | | permanent total disability involving accidents occurring |
18 | | before July 20, 2005 and accidents occurring on or after the |
19 | | effective date of this amendatory Act of the 94th General |
20 | | Assembly (Senate Bill 1283 of the 94th General Assembly) shall |
21 | | continue to be paid from the Rate Adjustment Fund pursuant to |
22 | | this paragraph and Section 7(f) of this Act.
|
23 | | (h) In case death occurs from any cause before the total
|
24 | | compensation to which the employee would have been entitled has |
25 | | been
paid, then in case the employee leaves any widow, widower, |
26 | | child, parent
(or any grandchild, grandparent or other lineal |
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1 | | heir or any collateral
heir dependent at the time of the |
2 | | accident upon the earnings of the
employee to the extent of 50% |
3 | | or more of total dependency) such
compensation shall be paid to |
4 | | the beneficiaries of the deceased employee
and distributed as |
5 | | provided in paragraph (g) of Section 7.
|
6 | | (h-1) In case an injured employee is under legal disability
|
7 | | at the time when any right or privilege accrues to him or her |
8 | | under this
Act, a guardian may be appointed pursuant to law, |
9 | | and may, on behalf
of such person under legal disability, claim |
10 | | and exercise any
such right or privilege with the same effect |
11 | | as if the employee himself
or herself had claimed or exercised |
12 | | the right or privilege. No limitations
of time provided by this |
13 | | Act run so long as the employee who is under legal
disability |
14 | | is without a conservator or guardian.
|
15 | | (i) In case the injured employee is under 16 years of age |
16 | | at the
time of the accident and is illegally employed, the |
17 | | amount of
compensation payable under paragraphs (b), (c), (d), |
18 | | (e) and (f) of this
Section is increased 50%.
|
19 | | However, where an employer has on file an employment |
20 | | certificate
issued pursuant to the Child Labor Law or work |
21 | | permit issued pursuant
to the Federal Fair Labor Standards Act, |
22 | | as amended, or a birth
certificate properly and duly issued, |
23 | | such certificate, permit or birth
certificate is conclusive |
24 | | evidence as to the age of the injured minor
employee for the |
25 | | purposes of this Section.
|
26 | | Nothing herein contained repeals or amends the provisions |
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1 | | of the
Child Labor Law relating to the employment of minors |
2 | | under the age of 16 years.
|
3 | | (j) 1. In the event the injured employee receives benefits,
|
4 | | including medical, surgical or hospital benefits under any |
5 | | group plan
covering non-occupational disabilities contributed |
6 | | to wholly or
partially by the employer, which benefits should |
7 | | not have been payable
if any rights of recovery existed under |
8 | | this Act, then such amounts so
paid to the employee from any |
9 | | such group plan as shall be consistent
with, and limited to, |
10 | | the provisions of paragraph 2 hereof, shall be
credited to or |
11 | | against any compensation payment for temporary total
|
12 | | incapacity for work or any medical, surgical or hospital |
13 | | benefits made
or to be made under this Act. In such event, the |
14 | | period of time for
giving notice of accidental injury and |
15 | | filing application for adjustment
of claim does not commence to |
16 | | run until the termination of such
payments. This paragraph does |
17 | | not apply to payments made under any
group plan which would |
18 | | have been payable irrespective of an accidental
injury under |
19 | | this Act. Any employer receiving such credit shall keep
such |
20 | | employee safe and harmless from any and all claims or |
21 | | liabilities
that may be made against him by reason of having |
22 | | received such payments
only to the extent of such credit.
|
23 | | Any excess benefits paid to or on behalf of a State |
24 | | employee by the
State Employees' Retirement System under |
25 | | Article 14 of the Illinois Pension
Code on a death claim or |
26 | | disputed disability claim shall be credited
against any |
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1 | | payments made or to be made by the State of Illinois to or on
|
2 | | behalf of such employee under this Act, except for payments for |
3 | | medical
expenses which have already been incurred at the time |
4 | | of the award. The
State of Illinois shall directly reimburse |
5 | | the State Employees' Retirement
System to the extent of such |
6 | | credit.
|
7 | | 2. Nothing contained in this Act shall be construed to give |
8 | | the
employer or the insurance carrier the right to credit for |
9 | | any benefits
or payments received by the employee other than |
10 | | compensation payments
provided by this Act, and where the |
11 | | employee receives payments other
than compensation payments, |
12 | | whether as full or partial salary, group
insurance benefits, |
13 | | bonuses, annuities or any other payments, the
employer or |
14 | | insurance carrier shall receive credit for each such payment
|
15 | | only to the extent of the compensation that would have been |
16 | | payable
during the period covered by such payment.
|
17 | | 3. The extension of time for the filing of an Application |
18 | | for
Adjustment of Claim as provided in paragraph 1 above shall |
19 | | not apply to
those cases where the time for such filing had |
20 | | expired prior to the date
on which payments or benefits |
21 | | enumerated herein have been initiated or
resumed. Provided |
22 | | however that this paragraph 3 shall apply only to
cases wherein |
23 | | the payments or benefits hereinabove enumerated shall be
|
24 | | received after July 1, 1969.
|
25 | | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; |
26 | | 94-695, eff. 11-16-05.)
|
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1 | | (820 ILCS 305/8.1 new) |
2 | | Sec. 8.1. Determination of permanent partial disability. |
3 | | For accidental injuries that occur on or after December 31, |
4 | | 2011, permanent partial disability shall be established using |
5 | | the following criteria: |
6 | | (a) A physician licensed to practice medicine in all of its |
7 | | branches shall certify the level of impairment in writing. The |
8 | | certification shall include a demonstration using medically |
9 | | defined objective measurements of impairment that include, but |
10 | | are not limited to: loss of range of motion, loss of strength, |
11 | | and measured atrophy of tissue mass consistent with the injury. |
12 | | The most current edition of the American Medical Association's |
13 | | "Guides to the Evaluation of Permanent Impairment" shall be |
14 | | applied in determining the level of impairment. |
15 | | (b) The certification of the physician shall establish the |
16 | | level of impairment. |
17 | | (c) In determining the level of disability, the Commission |
18 | | shall base their determination on the level of impairment as |
19 | | certified by the physician. The Commission may deviate from the |
20 | | level of impairment only using the following additional |
21 | | factors: (i) the occupation of the injured employee, including |
22 | | whether the injured employee is able to perform their previous |
23 | | work activities, and (ii) the employee's future earning |
24 | | capacity. In determining the level of disability, the reasons |
25 | | for any deviation from the level of impairment as certified by |
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1 | | the physician licensed to practice medicine in all of its |
2 | | branches must be explained in detail in a written order and |
3 | | proven by a preponderance of the evidence. |
4 | | (820 ILCS 305/8.2)
|
5 | | Sec. 8.2. Fee schedule.
|
6 | | (a) Except as provided for in subsection (c), for |
7 | | procedures, treatments, or services covered under this Act and |
8 | | rendered or to be rendered on and after February 1, 2006, the |
9 | | maximum allowable payment shall be 90% of the 80th percentile |
10 | | of charges and fees as determined by the Commission utilizing |
11 | | information provided by employers' and insurers' national |
12 | | databases, with a minimum of 12,000,000 Illinois line item |
13 | | charges and fees comprised of health care provider and hospital |
14 | | charges and fees as of August 1, 2004 but not earlier than |
15 | | August 1, 2002. These charges and fees are provider billed |
16 | | amounts and shall not include discounted charges. The 80th |
17 | | percentile is the point on an ordered data set from low to high |
18 | | such that 80% of the cases are below or equal to that point and |
19 | | at most 20% are above or equal to that point. The Commission |
20 | | shall adjust these historical charges and fees as of August 1, |
21 | | 2004 by the Consumer Price Index-U for the period August 1, |
22 | | 2004 through September 30, 2005. The Commission shall establish |
23 | | fee schedules for procedures, treatments, or services for |
24 | | hospital inpatient, hospital outpatient, emergency room and |
25 | | trauma, ambulatory surgical treatment centers, and |
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1 | | professional services. |
2 | | (a-1) These charges and fees shall be designated by geozip |
3 | | or any smaller geographic unit. The data shall in no way |
4 | | identify or tend to identify any patient, employer, or health |
5 | | care provider. As used in this Section, "geozip" means a |
6 | | three-digit zip code based on data similarities, geographical |
7 | | similarities, and frequencies. A geozip does not cross state |
8 | | boundaries. As used in this Section, "three-digit zip code" |
9 | | means a geographic area in which all zip codes have the same |
10 | | first 3 digits. If a geozip does not have the necessary number |
11 | | of charges and fees to calculate a valid percentile for a |
12 | | specific procedure, treatment, or service, the Commission may |
13 | | combine data from the geozip with up to 4 other geozips that |
14 | | are demographically and economically similar and exhibit |
15 | | similarities in data and frequencies until the Commission |
16 | | reaches 9 charges or fees for that specific procedure, |
17 | | treatment, or service. In cases where the compiled data |
18 | | contains less than 9 charges or fees for a procedure, |
19 | | treatment, or service, reimbursement shall occur at 76% of |
20 | | charges and fees as determined by the Commission in a manner |
21 | | consistent with the provisions of this paragraph. This |
22 | | subsection shall apply until July 1, 2011. |
23 | | (a-2) Providers of out-of-state procedures, treatments, |
24 | | services, products, or supplies shall be reimbursed at the
|
25 | | lesser of that state's fee schedule amount or the fee schedule
|
26 | | amount that would apply to the region where the employer is
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1 | | located. If no fee schedule exists in that state, the provider
|
2 | | shall be reimbursed at the lesser of the actual charge or the |
3 | | fee schedule amount that would apply to the region where the |
4 | | employer is located. If out-of-state treatment is being
|
5 | | undertaken and the employer is also located outside the State
|
6 | | of Illinois, the provider shall be reimbursed at the lesser of
|
7 | | the actual charge or the fee schedule amount that would apply
|
8 | | to the location of the accident. The Commission has the |
9 | | authority to set the maximum allowable payment to providers of |
10 | | out-of-state procedures, treatments, or services covered under |
11 | | this Act in a manner consistent with this Section. |
12 | | (a-3) Not later than September 30 in 2006 and each year |
13 | | thereafter, the Commission shall automatically increase or |
14 | | decrease the maximum allowable payment for a procedure, |
15 | | treatment, or service established and in effect on January 1 of |
16 | | that year by the percentage change in the Consumer Price |
17 | | Index-U for the 12 month period ending August 31 of that year. |
18 | | The increase or decrease shall become effective on January 1 of |
19 | | the following year. As used in this Section, "Consumer Price |
20 | | Index-U" means the index published by the Bureau of Labor |
21 | | Statistics of the U.S. Department of Labor, that measures the |
22 | | average change in prices of all goods and services purchased by |
23 | | all urban consumers, U.S. city average, all items, 1982-84=100. |
24 | | (a-4) Notwithstanding the provisions of subsection (a), |
25 | | the following provisions shall apply to the medical fee |
26 | | schedule starting on July 1, 2011: |
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1 | | (1) The Commission shall establish and maintain fee |
2 | | schedules for procedures, treatments, products, services, |
3 | | or supplies for hospital inpatient, hospital outpatient, |
4 | | emergency room, accredited ambulatory surgical treatment |
5 | | facilities, prescriptions filled and dispensed outside of |
6 | | a licensed pharmacy, dental services, and professional |
7 | | services. An accredited ambulatory surgical treatment |
8 | | facility is one defined by the Illinois Department of |
9 | | Public Health or by accreditation organizations determined |
10 | | by the Commission. Services provided at an unaccredited |
11 | | ambulatory surgical treatment facilities shall not be |
12 | | compensated under the Illinois Workers' Compensation |
13 | | Medical Fee Schedules. |
14 | | This fee schedule shall be based on the fee schedule |
15 | | amounts already established by the Commission pursuant to |
16 | | subsection (a) of this Section. However, these fee schedule |
17 | | amounts shall be grouped into regions consistent with |
18 | | nationally recognized reimbursement zip codes in Illinois and |
19 | | shall represent the average amount for a procedure, treatment |
20 | | or service for all the geozips reorganized into the new region. |
21 | | (2) In cases where the compiled data contains less than |
22 | | 9 charges or fees for a procedure, treatment, product, |
23 | | supply, or service or where the fee schedule amount cannot |
24 | | be determined by the non-discounted charge data, |
25 | | non-Medicare relative values and conversion factors |
26 | | derived from established fee schedule amounts, coding |
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1 | | crosswalks, or other data as determined by the Commission, |
2 | | reimbursement shall occur at 76% of charges and fees until |
3 | | July 1, 2011 and 53.2% of charges and fees thereafter as |
4 | | determined by the Commission in a manner consistent with |
5 | | the provisions of this paragraph. |
6 | | (3) To establish additional fee schedule amounts, the |
7 | | Commission shall utilize provider non-discounted charge |
8 | | data, non-Medicare relative values and conversion factors |
9 | | derived from established fee schedule amounts, and coding |
10 | | crosswalks. The Commission may establish additional fee |
11 | | schedule amounts based on either the charge or cost of the |
12 | | procedure, treatment, product, supply, or service. |
13 | | (4) Implants shall be reimbursed at 25% above the net |
14 | | manufacturer's invoice price less rebates, plus actual |
15 | | reasonable and customary shipping charges whether or not |
16 | | the implant charge is submitted by a provider in |
17 | | conjunction with a bill for all other services associated |
18 | | with the implant, submitted by a provider on a separate |
19 | | claim form, submitted by a distributor, or submitted by the |
20 | | manufacturer of the implant. "Implants" include the |
21 | | following codes or any substantially similar updated code |
22 | | as determined by the Commission: 0274 |
23 | | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens |
24 | | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 |
25 | | (investigational devices); and 0636 (drugs requiring |
26 | | detailed coding). Non-implantable devices or supplies |
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1 | | within these codes shall be reimbursed at 65% of actual |
2 | | charge, which is the provider's normal rates under its |
3 | | standard chargemaster. A standard chargemaster is the |
4 | | provider's list of charges for procedures, treatments, |
5 | | products, supplies, or services used to bill payers in a |
6 | | consistent manner. |
7 | | (5) The Commission shall automatically update all |
8 | | codes and associated rules with the version of the codes |
9 | | and rules valid on January 1 of that year, including the |
10 | | most current version of the National Correct Coding |
11 | | Initiative Edits as published by the Center for Medicare |
12 | | and Medicaid Services. |
13 | | (a-5) For procedures, treatments, services, or supplies |
14 | | covered under this Act and rendered or to be rendered on or |
15 | | after July 1, 2011, the maximum allowable payment shall be 70% |
16 | | of the fee schedule amounts in place as of June 30, 2011, which |
17 | | shall be adjusted yearly by the Consumer Price Index-U, as |
18 | | described in subsection (a) of this Section. |
19 | | (a-6) Prescriptions filled and dispensed outside of a |
20 | | licensed pharmacy shall be subject to a fee schedule that shall |
21 | | not exceed the Average Wholesale Price (AWP) plus a dispensing |
22 | | fee of $4.18. AWP or its equivalent as registered by the |
23 | | National Drug Code shall be set forth for that drug on that |
24 | | date as published in Medispan. |
25 | | (b) Notwithstanding the provisions of subsection (a), if
|
26 | | the Commission finds that there is a significant limitation on
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1 | | access to quality health care in either a specific field of
|
2 | | health care services or a specific geographic limitation on
|
3 | | access to health care, it may change the Consumer Price Index-U
|
4 | | increase or decrease for that specific field or specific
|
5 | | geographic limitation on access to health care to address that
|
6 | | limitation. |
7 | | (c) The Commission shall establish by rule a process to |
8 | | review those medical cases or outliers that involve |
9 | | extra-ordinary treatment to determine whether to make an |
10 | | additional adjustment to the maximum payment within a fee |
11 | | schedule for a procedure, treatment, or service. |
12 | | (d) When a patient notifies a provider that the treatment, |
13 | | procedure, or service being sought is for a work-related |
14 | | illness or injury and furnishes the provider the name and |
15 | | address of the responsible employer, the provider shall bill |
16 | | the employer directly. The employer shall make payment and |
17 | | providers shall submit bills and records in accordance with the |
18 | | provisions of this Section. |
19 | | (1) All payments to providers for treatment provided |
20 | | pursuant to this Act shall be made within 60 days of |
21 | | receipt of the bills as long as the claim contains |
22 | | substantially all the required data elements necessary to |
23 | | adjudicate the bills. |
24 | | (2) In the case of nonpayment to a provider within 60 |
25 | | days of receipt of the bill which contained substantially |
26 | | all of the required data elements necessary to adjudicate |
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1 | | the bill or nonpayment to a provider of a portion of such a |
2 | | bill up to the lesser of the actual charge or the payment |
3 | | level set by the Commission in the fee schedule established |
4 | | in this Section, the bill, or portion of the bill, shall |
5 | | incur interest at a rate of 1% per month payable to the |
6 | | provider. |
7 | | (e) Except as provided in subsections (e-5), (e-10), and |
8 | | (e-15), a provider shall not hold an employee liable for costs |
9 | | related to a non-disputed procedure, treatment, or service |
10 | | rendered in connection with a compensable injury. The |
11 | | provisions of subsections (e-5), (e-10), (e-15), and (e-20) |
12 | | shall not apply if an employee provides information to the |
13 | | provider regarding participation in a group health plan. If the |
14 | | employee participates in a group health plan, the provider may |
15 | | submit a claim for services to the group health plan. If the |
16 | | claim for service is covered by the group health plan, the |
17 | | employee's responsibility shall be limited to applicable |
18 | | deductibles, co-payments, or co-insurance. Except as provided |
19 | | under subsections (e-5), (e-10), (e-15), and (e-20), a provider |
20 | | shall not bill or otherwise attempt to recover from the |
21 | | employee the difference between the provider's charge and the |
22 | | amount paid by the employer or the insurer on a compensable |
23 | | injury , or for medical services or treatment determined by the |
24 | | Commission to be excessive or unnecessary . |
25 | | (e-5) If an employer notifies a provider that the employer |
26 | | does not consider the illness or injury to be compensable under |
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1 | | this Act, the provider may seek payment of the provider's |
2 | | actual charges from the employee for any procedure, treatment, |
3 | | or service rendered. Once an employee informs the provider that |
4 | | there is an application filed with the Commission to resolve a |
5 | | dispute over payment of such charges, the provider shall cease |
6 | | any and all efforts to collect payment for the services that |
7 | | are the subject of the dispute. Any statute of limitations or |
8 | | statute of repose applicable to the provider's efforts to |
9 | | collect payment from the employee shall be tolled from the date |
10 | | that the employee files the application with the Commission |
11 | | until the date that the provider is permitted to resume |
12 | | collection efforts under the provisions of this Section. |
13 | | (e-10) If an employer notifies a provider that the employer |
14 | | will pay only a portion of a bill for any procedure, treatment, |
15 | | or service rendered in connection with a compensable illness or |
16 | | disease, the provider may seek payment from the employee for |
17 | | the remainder of the amount of the bill up to the lesser of the |
18 | | actual charge, negotiated rate, if applicable, or the payment |
19 | | level set by the Commission in the fee schedule established in |
20 | | this Section. Once an employee informs the provider that there |
21 | | is an application filed with the Commission to resolve a |
22 | | dispute over payment of such charges, the provider shall cease |
23 | | any and all efforts to collect payment for the services that |
24 | | are the subject of the dispute. Any statute of limitations or |
25 | | statute of repose applicable to the provider's efforts to |
26 | | collect payment from the employee shall be tolled from the date |
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1 | | that the employee files the application with the Commission |
2 | | until the date that the provider is permitted to resume |
3 | | collection efforts under the provisions of this Section. |
4 | | (e-15) When there is a dispute over the compensability of |
5 | | or amount of payment for a procedure, treatment, or service, |
6 | | and a case is pending or proceeding before an Arbitrator or the |
7 | | Commission, the provider may mail the employee reminders that |
8 | | the employee will be responsible for payment of any procedure, |
9 | | treatment or service rendered by the provider. The reminders |
10 | | must state that they are not bills, to the extent practicable |
11 | | include itemized information, and state that the employee need |
12 | | not pay until such time as the provider is permitted to resume |
13 | | collection efforts under this Section. The reminders shall not |
14 | | be provided to any credit rating agency. The reminders may |
15 | | request that the employee furnish the provider with information |
16 | | about the proceeding under this Act, such as the file number, |
17 | | names of parties, and status of the case. If an employee fails |
18 | | to respond to such request for information or fails to furnish |
19 | | the information requested within 90 days of the date of the |
20 | | reminder, the provider is entitled to resume any and all |
21 | | efforts to collect payment from the employee for the services |
22 | | rendered to the employee and the employee shall be responsible |
23 | | for payment of any outstanding bills for a procedure, |
24 | | treatment, or service rendered by a provider. |
25 | | (e-20) Upon a final award or judgment by an Arbitrator or |
26 | | the Commission, or a settlement agreed to by the employer and |
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1 | | the employee, a provider may resume any and all efforts to |
2 | | collect payment from the employee for the services rendered to |
3 | | the employee and the employee shall be responsible for payment |
4 | | of any outstanding bills for a procedure, treatment, or service |
5 | | rendered by a provider as well as the interest awarded under |
6 | | subsection (d) of this Section. In the case of a procedure, |
7 | | treatment, or service deemed compensable, the provider shall |
8 | | not require a payment rate, excluding the interest provisions |
9 | | under subsection (d), greater than the lesser of the actual |
10 | | charge or the payment level set by the Commission in the fee |
11 | | schedule established in this Section. Payment for services |
12 | | deemed not covered or not compensable under this Act is the |
13 | | responsibility of the employee unless a provider and employee |
14 | | have agreed otherwise in writing. Services not covered or not |
15 | | compensable under this Act are not subject to the fee schedule |
16 | | in this Section. |
17 | | (f) Nothing in this Act shall prohibit an employer or
|
18 | | insurer from contracting with a health care provider or group
|
19 | | of health care providers for reimbursement levels for benefits |
20 | | under this Act different
from those provided in this Section. |
21 | | (g) On or before January 1, 2010 the Commission shall |
22 | | provide to the Governor and General Assembly a report regarding |
23 | | the implementation of the medical fee schedule and the index |
24 | | used for annual adjustment to that schedule as described in |
25 | | this Section.
|
26 | | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.) |
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1 | | (820 ILCS 305/8.3)
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2 | | Sec. 8.3. Workers' Compensation Medical Fee Advisory |
3 | | Board. There is created a Workers' Compensation Medical Fee |
4 | | Advisory Board consisting of 9 members appointed by the |
5 | | Governor with the advice and consent of the Senate. Three |
6 | | members of the Advisory Board shall be representative citizens |
7 | | chosen from the employee class, 3 members shall be |
8 | | representative citizens chosen from the employing class, and 3 |
9 | | members shall be representative citizens chosen from the |
10 | | medical provider class. Each member shall serve a 4-year term |
11 | | and shall continue to serve until a successor is appointed. A |
12 | | vacancy on the Advisory Board shall be filled by the Governor |
13 | | for the unexpired term. |
14 | | Members of the Advisory Board shall receive no compensation |
15 | | for their services but shall be reimbursed for expenses |
16 | | incurred in the performance of their duties by the Commission |
17 | | from appropriations made to the Commission for that purpose. |
18 | | The Advisory Board shall advise the Commission on |
19 | | establishment of fees for medical services and accessibility of |
20 | | medical treatment. Additionally, by December 31, 2011, the |
21 | | Board shall issue a written report, to be delivered to the |
22 | | Chairman of the Commission and the General Assembly, containing |
23 | | (i) recommendations on how to streamline the process under |
24 | | which workers' compensation medical providers bill for their |
25 | | services, insurers process and issue payments and health care |
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1 | | providers receive such payments and (ii) a recommended set of |
2 | | best practices for workers' compensation insurers and medical |
3 | | providers to transition from a paper-based payment system to an |
4 | | electronic-based billing and payment system.
|
5 | | (Source: P.A. 94-277, eff. 7-20-05.) |
6 | | (820 ILCS 305/8.7) |
7 | | Sec. 8.7. Utilization review programs. |
8 | | (a) As used in this Section: |
9 | | "Utilization review" means the evaluation of proposed or |
10 | | provided health care services to determine the appropriateness |
11 | | of both the level of health care services medically necessary |
12 | | and the quality of health care services provided to a patient, |
13 | | including evaluation of their efficiency, efficacy, and |
14 | | appropriateness of treatment, hospitalization, or office |
15 | | visits based on medically accepted standards. The evaluation |
16 | | must be accomplished by means of a system that identifies the |
17 | | utilization of health care services based on standards of care |
18 | | of or nationally recognized peer review guidelines as well as |
19 | | nationally recognized treatment guidelines and evidence-based |
20 | | medicine evidence based upon standards as provided in this Act . |
21 | | Utilization techniques may include prospective review, second |
22 | | opinions, concurrent review, discharge planning, peer review, |
23 | | independent medical examinations, and retrospective review |
24 | | (for purposes of this sentence, retrospective review shall be |
25 | | applicable to services rendered on or after July 20, 2005). |
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1 | | Nothing in this Section applies to prospective review of |
2 | | necessary first aid or emergency treatment. |
3 | | (b) No person may conduct a utilization review program for |
4 | | workers' compensation services in this State unless once every |
5 | | 2 years the person registers the utilization review program |
6 | | with the Department of Insurance Financial and Professional |
7 | | Regulation and certifies compliance with the Workers' |
8 | | Compensation Utilization Management standards or Health |
9 | | Utilization Management Standards of URAC sufficient to achieve |
10 | | URAC accreditation or submits evidence of accreditation by URAC |
11 | | for its Workers' Compensation Utilization Management Standards |
12 | | or Health Utilization Management Standards. Nothing in this Act |
13 | | shall be construed to require an employer or insurer or its |
14 | | subcontractors to become URAC accredited. |
15 | | (c) In addition, the Director Secretary of Insurance |
16 | | Financial and Professional Regulation may certify alternative |
17 | | utilization review standards of national accreditation |
18 | | organizations or entities in order for plans to comply with |
19 | | this Section. Any alternative utilization review standards |
20 | | shall meet or exceed those standards required under subsection |
21 | | (b). |
22 | | (d) This registration shall include submission of all of |
23 | | the following information regarding utilization review program |
24 | | activities: |
25 | | (1) The name, address, and telephone number of the |
26 | | utilization review programs. |
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1 | | (2) The organization and governing structure of the |
2 | | utilization review programs. |
3 | | (3) The number of lives for which utilization review is |
4 | | conducted by each utilization review program. |
5 | | (4) Hours of operation of each utilization review |
6 | | program. |
7 | | (5) Description of the grievance process for each |
8 | | utilization review program. |
9 | | (6) Number of covered lives for which utilization |
10 | | review was conducted for the previous calendar year for |
11 | | each utilization review program. |
12 | | (7) Written policies and procedures for protecting |
13 | | confidential information according to applicable State and |
14 | | federal laws for each utilization review program. |
15 | | (e) A utilization review program shall have written |
16 | | procedures to ensure that patient-specific information |
17 | | obtained during the process of utilization review will be: |
18 | | (1) kept confidential in accordance with applicable |
19 | | State and federal laws; and |
20 | | (2) shared only with the employee, the employee's |
21 | | designee, and the employee's health care provider, and |
22 | | those who are authorized by law to receive the information. |
23 | | Summary data shall not be considered confidential if it |
24 | | does not provide information to allow identification of |
25 | | individual patients or health care providers. |
26 | | Only a health care professional may make determinations |
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1 | | regarding the medical necessity of health care services during |
2 | | the course of utilization review. |
3 | | When making retrospective reviews, utilization review |
4 | | programs shall base reviews solely on the medical information |
5 | | available to the attending physician or ordering provider at |
6 | | the time the health care services were provided. |
7 | | (f) If the Department of Insurance Financial and |
8 | | Professional Regulation finds that a utilization review |
9 | | program is not in compliance with this Section, the Department |
10 | | shall issue a corrective action plan and allow a reasonable |
11 | | amount of time for compliance with the plan. If the utilization |
12 | | review program does not come into compliance, the Department |
13 | | may issue a cease and desist order. Before issuing a cease and |
14 | | desist order under this Section, the Department shall provide |
15 | | the utilization review program with a written notice of the |
16 | | reasons for the order and allow a reasonable amount of time to |
17 | | supply additional information demonstrating compliance with |
18 | | the requirements of this Section and to request a hearing. The |
19 | | hearing notice shall be sent by certified mail, return receipt |
20 | | requested, and the hearing shall be conducted in accordance |
21 | | with the Illinois Administrative Procedure Act. |
22 | | (g) A utilization review program subject to a corrective |
23 | | action may continue to conduct business until a final decision |
24 | | has been issued by the Department. |
25 | | (h) The Department of Insurance Secretary of Financial and |
26 | | Professional Regulation may by rule establish a registration |
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1 | | fee for each person conducting a utilization review program. |
2 | | (i) Upon receipt of written notice that the employer or the |
3 | | employer's agent or insurer wishes to invoke the utilization |
4 | | review process, the provider of medical, surgical or hospital |
5 | | services shall submit to the utilization review, following URAC |
6 | | procedural guidelines and appeal process. If the provider fails |
7 | | to submit to utilization review of proposed treatment or |
8 | | services, the charges for the treatment or service shall not be |
9 | | compensable or collectible against the employer, the |
10 | | employer's agent or insurer, or the employee. When an employer |
11 | | denies payment of or refuses to authorize payment of first aid, |
12 | | medical, surgical, or hospital services under Section 8(a) of |
13 | | this Act that complies with subsection (b) of this Section, |
14 | | that denial or refusal to authorize shall create a rebuttable |
15 | | presumption that the extent and scope of medical treatment is |
16 | | excessive or unnecessary. That presumption may be rebutted by |
17 | | establishing by a preponderance of the evidence that a variance |
18 | | from the standards of care or guidelines used pursuant to |
19 | | subsection (a) of this Section is reasonably required to cure |
20 | | and relieve the employee from the effects of his or her injury |
21 | | or that the utilization review did not comply with subsection |
22 | | (b) of this Section. |
23 | | (i) A utilization review will be considered by the |
24 | | Commission, along with all other evidence and in the same |
25 | | manner as all other evidence, in the determination of the |
26 | | reasonableness and necessity of the medical bills or treatment. |
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1 | | Nothing in this Section shall be construed to diminish the |
2 | | rights of employees to reasonable and necessary medical |
3 | | treatment or employee choice of health care provider under |
4 | | Section 8(a) or the rights of employers to medical examinations |
5 | | under Section 12. |
6 | | (j) When an employer denies payment of or refuses to |
7 | | authorize payment of first aid, medical, surgical, or hospital |
8 | | services under Section 8(a) of this Act, if that denial or |
9 | | refusal to authorize complies with a utilization review program |
10 | | registered under this Section and complies with all other |
11 | | requirements of this Section, then there shall be a rebuttable |
12 | | presumption that the employer shall not be responsible for |
13 | | payment of additional compensation pursuant to Section 19(k) of |
14 | | this Act and if that denial or refusal to authorize does not |
15 | | comply with a utilization review program registered under this |
16 | | Section and does not comply with all other requirements of this |
17 | | Section, then that will be considered by the Commission, along |
18 | | with all other evidence and in the same manner as all other |
19 | | evidence, in the determination of whether the employer may be |
20 | | responsible for the payment of additional compensation |
21 | | pursuant to Section 19(k) of this Act.
|
22 | | The changes to this Section made by this amendatory Act of |
23 | | the 97th General Assembly apply only to medical services |
24 | | provided on or after the effective date of this amendatory Act |
25 | | of the 97th General Assembly. |
26 | | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
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1 | | (820 ILCS 305/11) (from Ch. 48, par. 138.11)
|
2 | | Sec. 11. The compensation herein provided, together with |
3 | | the
provisions of this Act, shall be the measure of the |
4 | | responsibility of
any employer engaged in any of the |
5 | | enterprises or businesses enumerated
in Section 3 of this Act, |
6 | | or of any employer who is not engaged in any
such enterprises |
7 | | or businesses, but who has elected to provide and pay
|
8 | | compensation for accidental injuries sustained by any employee |
9 | | arising
out of and in the course of the employment according to |
10 | | the provisions
of this Act, and whose election to continue |
11 | | under this Act, has not been
nullified by any action of his |
12 | | employees as provided for in this Act.
|
13 | | Accidental injuries incurred while participating in |
14 | | voluntary recreational
programs including but not limited to |
15 | | athletic events, parties and picnics
do not arise out of and in |
16 | | the course of the employment even though the
employer pays some |
17 | | or all of the cost thereof. This exclusion shall not apply
in |
18 | | the event that the injured employee was ordered or assigned by |
19 | | his employer
to participate in the program.
|
20 | | Accidental injuries incurred while participating as a |
21 | | patient in a drug
or alcohol rehabilitation program do not |
22 | | arise out of and in the course
of employment even though the |
23 | | employer pays some or all of the costs thereof. |
24 | | Any injury to or disease or death of an employee arising |
25 | | from the administration of a vaccine, including without |
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1 | | limitation smallpox vaccine, to prepare for, or as a response |
2 | | to, a threatened or potential bioterrorist incident to the |
3 | | employee as part of a voluntary inoculation program in |
4 | | connection with the person's employment or in connection with |
5 | | any governmental program or recommendation for the inoculation |
6 | | of workers in the employee's occupation, geographical area, or |
7 | | other category that includes the employee is deemed to arise |
8 | | out of and in the course of the employment for all purposes |
9 | | under this Act. This paragraph added by this amendatory Act of |
10 | | the 93rd General Assembly is declarative of existing law and is |
11 | | not a new enactment.
|
12 | | No compensation shall be payable if (i) the employee's |
13 | | intoxication is the proximate cause of the employee's |
14 | | accidental injury or (ii) at the time the employee incurred |
15 | | accidental injury, the employee was so intoxicated that the |
16 | | intoxication constituted a departure from the employment. |
17 | | Admissible evidence of the concentration of (1) alcohol, (2) |
18 | | cannabis as defined in the Cannabis Control Act, (3) a |
19 | | controlled substance listed in the Illinois Controlled |
20 | | Substances Act, or (4) an intoxicating compound listed in the |
21 | | Use of Intoxicating Compounds Act in the employee's blood, |
22 | | breath, or urine at the time the employee incurred the |
23 | | accidental injury shall be considered in any hearing under this |
24 | | Act to determine whether the employee was intoxicated at the |
25 | | time the employee incurred the accidental injuries. If at the |
26 | | time of the accidental injuries, there was 0.08% or more by |
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1 | | weight of alcohol in the employee's blood, breath, or urine or |
2 | | if there is any evidence of impairment due to the unlawful or |
3 | | unauthorized use of (1) cannabis as defined in the Cannabis |
4 | | Control Act, (2) a controlled substance listed in the Illinois |
5 | | Controlled Substances Act, or (3) an intoxicating compound |
6 | | listed in the Use of Intoxicating Compounds Act or if the |
7 | | employee refuses to submit to testing of blood, breath, or |
8 | | urine, then there shall be a rebuttable presumption that the |
9 | | employee was intoxicated and that the intoxication was the |
10 | | proximate cause of the employee's injury. The employee may |
11 | | overcome the rebuttable presumption by the preponderance of the |
12 | | admissible evidence that the intoxication was not the proximate |
13 | | cause of the accidental injuries. Percentage by weight of |
14 | | alcohol in the blood shall be based on grams of alcohol per 100 |
15 | | milliliters of blood. Percentage by weight of alcohol in the |
16 | | breath shall be based upon grams of alcohol per 210 liters of |
17 | | breath. Any testing that has not been performed by an |
18 | | accredited or certified testing laboratory shall not be |
19 | | admissible in any hearing under this Act to determine whether |
20 | | the employee was intoxicated at the time the employee incurred |
21 | | the accidental injury. |
22 | | All sample collection and testing for alcohol and drugs |
23 | | under this Section shall be performed in accordance with rules |
24 | | to be adopted by the Commission. These rules shall ensure: |
25 | | (1) compliance with the National Labor Relations Act |
26 | | regarding collective bargaining agreements or regulations |
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1 | | promulgated by the United States Department of |
2 | | Transportation; |
3 | | (2) that samples are collected and tested in |
4 | | conformance with national and State legal and regulatory |
5 | | standards for the privacy of the individual being tested, |
6 | | and in a manner reasonably calculated to prevent |
7 | | substitutions or interference with the collection or |
8 | | testing of reliable sample; |
9 | | (3) that split testing procedures are utilized; |
10 | | (4) sample collection is documented, and the |
11 | | documentation procedures include: |
12 | | (A) the labeling of samples in a manner so as to |
13 | | reasonably preclude the probability of erroneous |
14 | | identification of test result; and |
15 | | (B) an opportunity for the employee to provide |
16 | | notification of any information which he or she |
17 | | considers relevant to the test, including |
18 | | identification of currently or recently used |
19 | | prescription or nonprescription drugs and other |
20 | | relevant medical information; |
21 | | (5) that sample collection, storage, and |
22 | | transportation to the place of testing is performed in a |
23 | | manner so as to reasonably preclude the probability of |
24 | | sample contamination or adulteration; and |
25 | | (6) that chemical analyses of blood, urine, breath, or |
26 | | other bodily substance are performed according to |
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1 | | nationally scientifically accepted analytical methods and |
2 | | procedures. |
3 | | The changes to this Section made by this amendatory Act of |
4 | | the 97th General Assembly apply only to accidental injuries |
5 | | that occur on or after the effective date of this amendatory |
6 | | Act of the 97th General Assembly. |
7 | | (Source: P.A. 93-829, eff. 7-28-04.)
|
8 | | (820 ILCS 305/16) (from Ch. 48, par. 138.16)
|
9 | | Sec. 16. The Commission shall make and publish procedural |
10 | | rules and
orders for carrying out the duties imposed upon it by |
11 | | law and for
determining the extent of disability sustained, |
12 | | which rules and orders
shall be deemed prima facie reasonable |
13 | | and valid.
|
14 | | The process and procedure before the Commission shall be as |
15 | | simple
and summary as reasonably may be.
|
16 | | The Commission upon application of either party may issue |
17 | | dedimus
potestatem directed to a commissioner, notary public, |
18 | | justice of the
peace or any other officer authorized by law to |
19 | | administer oaths, to
take the depositions of such witness or |
20 | | witnesses as may be necessary in
the judgment of such |
21 | | applicant. Such dedimus potestatem may issue to
any of the |
22 | | officers aforesaid in any state or territory of the United
|
23 | | States. When the deposition of any witness resident of a |
24 | | foreign
country is desired to be taken, the dedimus shall be |
25 | | directed to and the
deposition taken before a consul, vice |
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1 | | consul or other authorized
representative of the government of |
2 | | the United States of America, whose
station is in the country |
3 | | where the witness whose deposition is to be
taken resides. In |
4 | | countries where the government of the United States
has no |
5 | | consul or other diplomatic representative, then depositions in
|
6 | | such case shall be taken through the appropriate judicial |
7 | | authority of
that country; or where treaties provide for other |
8 | | methods of taking
depositions, then the same may be taken as in |
9 | | such treaties provided.
The Commission shall have the power to |
10 | | adopt necessary rules to govern
the issue of such dedimus |
11 | | potestatem.
|
12 | | The Commission, or any member thereof, or any Arbitrator |
13 | | designated
by the Commission shall have the power to administer |
14 | | oaths, subpoena
and examine witnesses; to issue subpoenas duces |
15 | | tecum, requiring the
production of such books, papers, records |
16 | | and documents as may be
evidence of any matter under inquiry |
17 | | and to examine and inspect the same
and such places or premises |
18 | | as may relate to the question in dispute.
The Commission, or |
19 | | any member thereof, or any Arbitrator designated by
the |
20 | | Commission, shall on written request of either party to the
|
21 | | dispute, issue subpoenas for the attendance of such witnesses |
22 | | and
production of such books, papers, records and documents as |
23 | | shall be
designated in the applications, and the parties
|
24 | | applying for such subpoena shall advance the officer and |
25 | | witness fees
provided for in civil actions pending in circuit |
26 | | courts of this State, except
as otherwise
provided by Section |
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1 | | 20 of this Act. Service of such subpoena shall be
made by any |
2 | | sheriff or other person. In case any person
refuses to comply |
3 | | with an order of the Commission or subpoenas issued by
it or by |
4 | | any member thereof, or any Arbitrator designated by the
|
5 | | Commission or to permit an inspection of places or premises, or |
6 | | to
produce any books, papers, records or documents, or any |
7 | | witness refuses
to testify to any matters regarding which he or |
8 | | she may be lawfully
interrogated, the Circuit Court of the |
9 | | county in which the hearing or
matter is pending, on |
10 | | application of any member of the Commission or any
Arbitrator |
11 | | designated by the Commission, shall compel obedience by
|
12 | | attachment proceedings, as for contempt, as in a case of |
13 | | disobedience of
the requirements of a subpoena from such court |
14 | | on a refusal to testify
therein.
|
15 | | The records, reports, and bills kept by a treating |
16 | | hospital, treating physician, or other treating healthcare |
17 | | provider that renders treatment to the employee as a result of |
18 | | accidental injuries in question, certified to as true and |
19 | | correct by
the hospital, physician, or other healthcare |
20 | | provider or by designated agents of the hospital, physician, or |
21 | | other healthcare provider, showing the medical and
surgical |
22 | | treatment given an injured employee by such hospital, |
23 | | physician, or other healthcare provider, shall be
admissible |
24 | | without any further proof as evidence of the medical and
|
25 | | surgical matters stated therein, but shall not be conclusive |
26 | | proof of
such matters. Any records, reports and bills submitted |
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1 | | under this Section shall be limited for the purpose of |
2 | | establishing that the care and treatment was rendered and shall |
3 | | not be for the purpose of establishing causal connection, need |
4 | | for care or degree of disability. There shall be a rebuttable |
5 | | presumption that any such records, reports, and bills received |
6 | | in response to Commission subpoena are certified to be true and |
7 | | correct. This paragraph does not restrict, limit, or prevent |
8 | | the admissibility of records, reports, or bills that are |
9 | | otherwise admissible. This provision does not apply to reports |
10 | | prepared by treating providers for use in litigation.
|
11 | | The Commission at its expense shall provide an official |
12 | | court
reporter to take the testimony and record of proceedings |
13 | | at the hearings
before an Arbitrator or the Commission, who
|
14 | | shall furnish a transcript of such testimony or proceedings to |
15 | | either
party requesting it, upon payment therefor at the rate |
16 | | of $1.00
per page for the original and 35 cents per page for |
17 | | each copy of such
transcript. Payment for photostatic copies of |
18 | | exhibits shall be extra.
If the Commission has determined, as |
19 | | provided in Section 20
of this Act, that the employee is a poor |
20 | | person, a transcript of such
testimony and proceedings, |
21 | | including photostatic copies of exhibits,
shall be furnished to |
22 | | such employee at the
Commission's expense.
|
23 | | The Commission shall have the power to determine the |
24 | | reasonableness
and fix the amount of any fee of compensation |
25 | | charged by any person,
including attorneys, physicians, |
26 | | surgeons and hospitals, for any service
performed in connection |
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1 | | with this Act, or for which payment is to be
made under this |
2 | | Act or rendered in securing any right under this Act.
|
3 | | Whenever the Commission shall find that the employer, his |
4 | | or her agent,
service company or insurance carrier has been |
5 | | guilty of delay or
unfairness towards an employee in the |
6 | | adjustment, settlement or payment
of benefits due such employee |
7 | | within the purview of the provisions of
paragraph (c) of |
8 | | Section 4 of this Act; or has been guilty of
unreasonable or |
9 | | vexatious delay, intentional under-payment of
compensation |
10 | | benefits, or has engaged in frivolous defenses which do not
|
11 | | present a real controversy, within the purview of the |
12 | | provisions of
paragraph (k) of Section 19 of this Act, the |
13 | | Commission may assess all
or any part of the attorney's fees |
14 | | and costs against such employer and
his or her insurance |
15 | | carrier.
|
16 | | (Source: P.A. 94-277, eff. 7-20-05.)
|
17 | | (820 ILCS 305/16b new) |
18 | | Sec. 16b. Signature constitutes certification. The |
19 | | signature of an attorney on any petition, motion, or other |
20 | | paper filed with the Commission constitutes a certification by |
21 | | he or she that he or she has read the petition, motion, or |
22 | | other paper, and, that to the best of his or her knowledge, |
23 | | information, and belief formed after reasonable inquiry that it |
24 | | is well grounded in fact, that it is warranted by existing law |
25 | | or a good faith argument for an extension, modification, or |
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1 | | reversal of existing law, and that it is not interposed for any |
2 | | improper purpose, such as to harass or to cause unnecessary |
3 | | delay or needless increase in the cost of litigation. If a |
4 | | petition, motion, or other paper is signed in violation of this |
5 | | Section, the Commission, upon motion or upon its own |
6 | | initiative, may impose on the attorney an appropriate penalty |
7 | | or may order him or her to pay the other party the amount of |
8 | | reasonable expenses incurred because of the filing of the |
9 | | petition, motion, or other paper, including reasonable |
10 | | attorneys' fees. |
11 | | (820 ILCS 305/16c new) |
12 | | Sec. 16c. Gift Ban. |
13 | | (a) An attorney appearing before the Commission shall not |
14 | | provide compensation or any gift to any person in exchange for |
15 | | the referral of a client involving a matter to be heard before |
16 | | the Commission except for a division of a fee between lawyers |
17 | | who are not in the same firm in accordance with Rule 1.5 of the |
18 | | Code of Professional Responsibility. For purposes of this |
19 | | Section, "gift" means any gratuity, discount, entertainment, |
20 | | hospitality, loan, forbearance, or any other tangible or |
21 | | intangible item having monetary value including, but not |
22 | | limited to, cash food and drink and honoraria except for up to |
23 | | $75 per day per person for food and beverage. |
24 | | (b) Violation of this Section is a Class A misdemeanor.
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1 | | (820 ILCS 305/19) (from Ch. 48, par. 138.19)
|
2 | | Sec. 19. Any disputed questions of law or fact shall be |
3 | | determined
as herein provided.
|
4 | | (a) It shall be the duty of the Commission upon |
5 | | notification that
the parties have failed to reach an |
6 | | agreement, to designate an Arbitrator.
|
7 | | 1. Whenever any claimant misconceives his remedy and |
8 | | files an
application for adjustment of claim under this Act |
9 | | and it is
subsequently discovered, at any time before final |
10 | | disposition of such
cause, that the claim for disability or |
11 | | death which was the basis for
such application should |
12 | | properly have been made under the Workers'
Occupational |
13 | | Diseases Act, then the provisions of Section 19, paragraph
|
14 | | (a-1) of the Workers' Occupational Diseases Act having |
15 | | reference to such
application shall apply.
|
16 | | 2. Whenever any claimant misconceives his remedy and |
17 | | files an
application for adjustment of claim under the |
18 | | Workers' Occupational
Diseases Act and it is subsequently |
19 | | discovered, at any time before final
disposition of such |
20 | | cause that the claim for injury or death which was
the |
21 | | basis for such application should properly have been made |
22 | | under this
Act, then the application so filed under the |
23 | | Workers' Occupational
Diseases Act may be amended in form, |
24 | | substance or both to assert claim
for such disability or |
25 | | death under this Act and it shall be deemed to
have been so |
26 | | filed as amended on the date of the original filing
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1 | | thereof, and such compensation may be awarded as is |
2 | | warranted by the
whole evidence pursuant to this Act. When |
3 | | such amendment is submitted,
further or additional |
4 | | evidence may be heard by the Arbitrator or
Commission when |
5 | | deemed necessary. Nothing in this Section contained
shall |
6 | | be construed to be or permit a waiver of any provisions of |
7 | | this
Act with reference to notice but notice if given shall |
8 | | be deemed to be a
notice under the provisions of this Act |
9 | | if given within the time
required herein.
|
10 | | (b) The Arbitrator shall make such inquiries and |
11 | | investigations as he or
they shall deem necessary and may |
12 | | examine and inspect all books, papers,
records, places, or |
13 | | premises relating to the questions in dispute and hear
such |
14 | | proper evidence as the parties may submit.
|
15 | | The hearings before the Arbitrator shall be held in the |
16 | | vicinity where
the injury occurred after 10 days' notice of the |
17 | | time and place of such
hearing shall have been given to each of |
18 | | the parties or their attorneys
of record.
|
19 | | The Arbitrator may find that the disabling condition is |
20 | | temporary and has
not yet reached a permanent condition and may |
21 | | order the payment of
compensation up to the date of the |
22 | | hearing, which award shall be reviewable
and enforceable in the |
23 | | same manner as other awards, and in no instance be a
bar to a |
24 | | further hearing and determination of a further amount of |
25 | | temporary
total compensation or of compensation for permanent |
26 | | disability, but shall
be conclusive as to all other questions |
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1 | | except the nature and extent of said
disability.
|
2 | | The decision of the Arbitrator shall be filed with the |
3 | | Commission which
Commission shall immediately send to each |
4 | | party or his attorney a copy of
such decision, together with a |
5 | | notification of the time when it was filed.
As of the effective |
6 | | date of this amendatory Act of the 94th General Assembly, all |
7 | | decisions of the Arbitrator shall set forth
in writing findings |
8 | | of fact and conclusions of law, separately stated, if requested |
9 | | by either party.
Unless a petition for review is filed by |
10 | | either party within 30 days after
the receipt by such party of |
11 | | the copy of the decision and notification of
time when filed, |
12 | | and unless such party petitioning for a review shall
within 35 |
13 | | days after the receipt by him of the copy of the decision, file
|
14 | | with the Commission either an agreed statement of the facts |
15 | | appearing upon
the hearing before the Arbitrator, or if such
|
16 | | party shall so elect a correct transcript of evidence of the |
17 | | proceedings
at such hearings, then the decision shall become |
18 | | the decision of the
Commission and in the absence of fraud |
19 | | shall be conclusive.
The Petition for Review shall contain a |
20 | | statement of the petitioning party's
specific exceptions to the |
21 | | decision of the arbitrator. The jurisdiction
of the Commission |
22 | | to review the decision of the arbitrator shall not be
limited |
23 | | to the exceptions stated in the Petition for Review.
The |
24 | | Commission, or any member thereof, may grant further time not |
25 | | exceeding
30 days, in which to file such agreed statement or |
26 | | transcript of
evidence. Such agreed statement of facts or |
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1 | | correct transcript of
evidence, as the case may be, shall be |
2 | | authenticated by the signatures
of the parties or their |
3 | | attorneys, and in the event they do not agree as
to the |
4 | | correctness of the transcript of evidence it shall be |
5 | | authenticated
by the signature of the Arbitrator designated by |
6 | | the Commission.
|
7 | | Whether the employee is working or not, if the employee is |
8 | | not receiving or has not received medical, surgical, or |
9 | | hospital services or other services or compensation as provided |
10 | | in paragraph (a) of Section 8, or compensation as provided in |
11 | | paragraph (b) of Section 8, the employee may at any time |
12 | | petition for an expedited hearing by an Arbitrator on the issue |
13 | | of whether or not he or she is entitled to receive payment of |
14 | | the services or compensation. Provided the employer continues |
15 | | to pay compensation pursuant to paragraph (b) of Section 8, the |
16 | | employer may at any time petition for an expedited hearing on |
17 | | the issue of whether or not the employee is entitled to receive |
18 | | medical, surgical, or hospital services or other services or |
19 | | compensation as provided in paragraph (a) of Section 8, or |
20 | | compensation as provided in paragraph (b) of Section 8. When an |
21 | | employer has petitioned for an expedited hearing, the employer |
22 | | shall continue to pay compensation as provided in paragraph (b) |
23 | | of Section 8 unless the arbitrator renders a decision that the |
24 | | employee is not entitled to the benefits that are the subject |
25 | | of the expedited hearing or unless the employee's treating |
26 | | physician has released the employee to return to work at his or |
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1 | | her regular job with the employer or the employee actually |
2 | | returns to work at any other job. If the arbitrator renders a |
3 | | decision that the employee is not entitled to the benefits that |
4 | | are the subject of the expedited hearing, a petition for review |
5 | | filed by the employee shall receive the same priority as if the |
6 | | employee had filed a petition for an expedited hearing by an |
7 | | Arbitrator. Neither party shall be entitled to an expedited |
8 | | hearing when the employee has returned to work and the sole |
9 | | issue in dispute amounts to less than 12 weeks of unpaid |
10 | | compensation pursuant to paragraph (b) of Section 8. |
11 | | Expedited hearings shall have priority over all other |
12 | | petitions and shall be heard by the Arbitrator and Commission |
13 | | with all convenient speed. Any party requesting an expedited |
14 | | hearing shall give notice of a request for an expedited hearing |
15 | | under this paragraph. A copy of the Application for Adjustment |
16 | | of Claim shall be attached to the notice. The Commission shall |
17 | | adopt rules and procedures under which the final decision of |
18 | | the Commission under this paragraph is filed not later than 180 |
19 | | days from the date that the Petition for Review is filed with |
20 | | the Commission. |
21 | | Where 2 or more insurance carriers, private self-insureds, |
22 | | or a group workers' compensation pool under Article V 3/4 of |
23 | | the Illinois Insurance Code dispute coverage for the same |
24 | | injury, any such insurance carrier, private self-insured, or |
25 | | group workers' compensation pool may request an expedited |
26 | | hearing pursuant to this paragraph to determine the issue of |
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1 | | coverage, provided coverage is the only issue in dispute and |
2 | | all other issues are stipulated and agreed to and further |
3 | | provided that all compensation benefits including medical |
4 | | benefits pursuant to Section 8(a) continue to be paid to or on |
5 | | behalf of petitioner. Any insurance carrier, private |
6 | | self-insured, or group workers' compensation pool that is |
7 | | determined to be liable for coverage for the injury in issue |
8 | | shall reimburse any insurance carrier, private self-insured, |
9 | | or group workers' compensation pool that has paid benefits to |
10 | | or on behalf of petitioner for the injury.
|
11 | | (b-1) If the employee is not receiving medical, surgical or |
12 | | hospital
services as provided in paragraph (a) of Section 8 or |
13 | | compensation as
provided in paragraph (b) of Section 8, the |
14 | | employee, in accordance with
Commission Rules, may file a |
15 | | petition for an emergency hearing by an
Arbitrator on the issue |
16 | | of whether or not he is entitled to receive payment
of such |
17 | | compensation or services as provided therein. Such petition |
18 | | shall
have priority over all other petitions and shall be heard |
19 | | by the Arbitrator
and Commission with all convenient speed.
|
20 | | Such petition shall contain the following information and |
21 | | shall be served
on the employer at least 15 days before it is |
22 | | filed:
|
23 | | (i) the date and approximate time of accident;
|
24 | | (ii) the approximate location of the accident;
|
25 | | (iii) a description of the accident;
|
26 | | (iv) the nature of the injury incurred by the employee;
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1 | | (v) the identity of the person, if known, to whom the |
2 | | accident was
reported and the date on which it was |
3 | | reported;
|
4 | | (vi) the name and title of the person, if known, |
5 | | representing the
employer with whom the employee conferred |
6 | | in any effort to obtain
compensation pursuant to paragraph |
7 | | (b) of Section 8 of this Act or medical,
surgical or |
8 | | hospital services pursuant to paragraph (a) of Section 8 of
|
9 | | this Act and the date of such conference;
|
10 | | (vii) a statement that the employer has refused to pay |
11 | | compensation
pursuant to paragraph (b) of Section 8 of this |
12 | | Act or for medical, surgical
or hospital services pursuant |
13 | | to paragraph (a) of Section 8 of this Act;
|
14 | | (viii) the name and address, if known, of each witness |
15 | | to the accident
and of each other person upon whom the |
16 | | employee will rely to support his
allegations;
|
17 | | (ix) the dates of treatment related to the accident by |
18 | | medical
practitioners, and the names and addresses of such |
19 | | practitioners, including
the dates of treatment related to |
20 | | the accident at any hospitals and the
names and addresses |
21 | | of such hospitals, and a signed authorization
permitting |
22 | | the employer to examine all medical records of all |
23 | | practitioners
and hospitals named pursuant to this |
24 | | paragraph;
|
25 | | (x) a copy of a signed report by a medical |
26 | | practitioner, relating to the
employee's current inability |
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1 | | to return to work because of the injuries
incurred as a |
2 | | result of the accident or such other documents or |
3 | | affidavits
which show that the employee is entitled to |
4 | | receive compensation pursuant
to paragraph (b) of Section 8 |
5 | | of this Act or medical, surgical or hospital
services |
6 | | pursuant to paragraph (a) of Section 8 of this Act. Such |
7 | | reports,
documents or affidavits shall state, if possible, |
8 | | the history of the
accident given by the employee, and |
9 | | describe the injury and medical
diagnosis, the medical |
10 | | services for such injury which the employee has
received |
11 | | and is receiving, the physical activities which the |
12 | | employee
cannot currently perform as a result of any |
13 | | impairment or disability due to
such injury, and the |
14 | | prognosis for recovery;
|
15 | | (xi) complete copies of any reports, records, |
16 | | documents and affidavits
in the possession of the employee |
17 | | on which the employee will rely to
support his allegations, |
18 | | provided that the employer shall pay the
reasonable cost of |
19 | | reproduction thereof;
|
20 | | (xii) a list of any reports, records, documents and |
21 | | affidavits which
the employee has demanded by subpoena and |
22 | | on which he intends to
rely to support his allegations;
|
23 | | (xiii) a certification signed by the employee or his |
24 | | representative that
the employer has received the petition |
25 | | with the required information 15
days before filing.
|
26 | | Fifteen days after receipt by the employer of the petition |
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1 | | with the
required information the employee may file said |
2 | | petition and required
information and shall serve notice of the |
3 | | filing upon the employer. The
employer may file a motion |
4 | | addressed to the sufficiency of the petition.
If an objection |
5 | | has been filed to the sufficiency of the petition, the
|
6 | | arbitrator shall rule on the objection within 2 working days. |
7 | | If such an
objection is filed, the time for filing the final |
8 | | decision of the
Commission as provided in this paragraph shall |
9 | | be tolled until the
arbitrator has determined that the petition |
10 | | is sufficient.
|
11 | | The employer shall, within 15 days after receipt of the |
12 | | notice that such
petition is filed, file with the Commission |
13 | | and serve on the employee or
his representative a written |
14 | | response to each claim set forth in the
petition, including the |
15 | | legal and factual basis for each disputed
allegation and the |
16 | | following information: (i) complete copies of any
reports, |
17 | | records, documents and affidavits in the possession of the
|
18 | | employer on which the employer intends to rely in support of |
19 | | his response,
(ii) a list of any reports, records, documents |
20 | | and affidavits which the
employer has demanded by subpoena and |
21 | | on which the employer intends to rely
in support of his |
22 | | response, (iii) the name and address of each witness on
whom |
23 | | the employer will rely to support his response, and (iv) the |
24 | | names and
addresses of any medical practitioners selected by |
25 | | the employer pursuant to
Section 12 of this Act and the time |
26 | | and place of any examination scheduled
to be made pursuant to |
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1 | | such Section.
|
2 | | Any employer who does not timely file and serve a written |
3 | | response
without good cause may not introduce any evidence to |
4 | | dispute any claim of
the employee but may cross examine the |
5 | | employee or any witness brought by
the employee and otherwise |
6 | | be heard.
|
7 | | No document or other evidence not previously identified by |
8 | | either party
with the petition or written response, or by any |
9 | | other means before the
hearing, may be introduced into evidence |
10 | | without good cause.
If, at the hearing, material information is |
11 | | discovered which was
not previously disclosed, the Arbitrator |
12 | | may extend the time for closing
proof on the motion of a party |
13 | | for a reasonable period of time which may
be more than 30 days. |
14 | | No evidence may be introduced pursuant
to this paragraph as to |
15 | | permanent disability. No award may be entered for
permanent |
16 | | disability pursuant to this paragraph. Either party may |
17 | | introduce
into evidence the testimony taken by deposition of |
18 | | any medical practitioner.
|
19 | | The Commission shall adopt rules, regulations and |
20 | | procedures whereby the
final decision of the Commission is |
21 | | filed not later than 90 days from the
date the petition for |
22 | | review is filed but in no event later than 180 days from
the |
23 | | date the petition for an emergency hearing is filed with the |
24 | | Illinois Workers' Compensation
Commission.
|
25 | | All service required pursuant to this paragraph (b-1) must |
26 | | be by personal
service or by certified mail and with evidence |
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1 | | of receipt. In addition for
the purposes of this paragraph, all |
2 | | service on the employer must be at the
premises where the |
3 | | accident occurred if the premises are owned or operated
by the |
4 | | employer. Otherwise service must be at the employee's principal
|
5 | | place of employment by the employer. If service on the employer |
6 | | is not
possible at either of the above, then service shall be |
7 | | at the employer's
principal place of business. After initial |
8 | | service in each case, service
shall be made on the employer's |
9 | | attorney or designated representative.
|
10 | | (c) (1) At a reasonable time in advance of and in |
11 | | connection with the
hearing under Section 19(e) or 19(h), the |
12 | | Commission may on its own motion
order an impartial physical or |
13 | | mental examination of a petitioner whose
mental or physical |
14 | | condition is in issue, when in the Commission's
discretion it |
15 | | appears that such an examination will materially aid in the
|
16 | | just determination of the case. The examination shall be made |
17 | | by a member
or members of a panel of physicians chosen for |
18 | | their special qualifications
by the Illinois State Medical |
19 | | Society. The Commission shall establish
procedures by which a |
20 | | physician shall be selected from such list.
|
21 | | (2) Should the Commission at any time during the hearing |
22 | | find that
compelling considerations make it advisable to have |
23 | | an examination and
report at that time, the commission may in |
24 | | its discretion so order.
|
25 | | (3) A copy of the report of examination shall be given to |
26 | | the Commission
and to the attorneys for the parties.
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1 | | (4) Either party or the Commission may call the examining |
2 | | physician or
physicians to testify. Any physician so called |
3 | | shall be subject to
cross-examination.
|
4 | | (5) The examination shall be made, and the physician or |
5 | | physicians, if
called, shall testify, without cost to the |
6 | | parties. The Commission shall
determine the compensation and |
7 | | the pay of the physician or physicians. The
compensation for |
8 | | this service shall not exceed the usual and customary amount
|
9 | | for such service.
|
10 | | (6) The fees and payment thereof of all attorneys and |
11 | | physicians for
services authorized by the Commission under this |
12 | | Act shall, upon request
of either the employer or the employee |
13 | | or the beneficiary affected, be
subject to the review and |
14 | | decision of the Commission.
|
15 | | (d) If any employee shall persist in insanitary or |
16 | | injurious
practices which tend to either imperil or retard his |
17 | | recovery or shall
refuse to submit to such medical, surgical, |
18 | | or hospital treatment as is
reasonably essential to promote his |
19 | | recovery, the Commission may, in its
discretion, reduce or |
20 | | suspend the compensation of any such injured
employee. However, |
21 | | when an employer and employee so agree in writing,
the |
22 | | foregoing provision shall not be construed to authorize the
|
23 | | reduction or suspension of compensation of an employee who is |
24 | | relying in
good faith, on treatment by prayer or spiritual |
25 | | means alone, in
accordance with the tenets and practice of a |
26 | | recognized church or
religious denomination, by a duly |
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1 | | accredited practitioner thereof.
|
2 | | (e) This paragraph shall apply to all hearings before the |
3 | | Commission.
Such hearings may be held in its office or |
4 | | elsewhere as the Commission
may deem advisable. The taking of |
5 | | testimony on such hearings may be had
before any member of the |
6 | | Commission. If a petition for review and agreed
statement of |
7 | | facts or transcript of evidence is filed, as provided herein,
|
8 | | the Commission shall promptly review the decision of the |
9 | | Arbitrator and all
questions of law or fact which appear from |
10 | | the statement of facts or
transcript of evidence.
|
11 | | In all cases in which the hearing before the arbitrator is |
12 | | held after
December 18, 1989, no additional evidence shall be |
13 | | introduced by the
parties before the Commission on review of |
14 | | the decision of the Arbitrator.
In reviewing decisions of an |
15 | | arbitrator the Commission shall award such
temporary |
16 | | compensation, permanent compensation and other payments as are
|
17 | | due under this Act. The Commission shall file in its office its |
18 | | decision
thereon, and shall immediately send to each party or |
19 | | his attorney a copy of
such decision and a notification of the |
20 | | time when it was filed. Decisions
shall be filed within 60 days |
21 | | after the Statement of Exceptions and
Supporting Brief and |
22 | | Response thereto are required to be filed or oral
argument |
23 | | whichever is later.
|
24 | | In the event either party requests oral argument, such |
25 | | argument shall be
had before a panel of 3 members of the |
26 | | Commission (or before all available
members pursuant to the |
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1 | | determination of 7 members of the Commission that
such argument |
2 | | be held before all available members of the Commission)
|
3 | | pursuant to the rules and regulations of the Commission. A |
4 | | panel of 3
members, which shall be comprised of not more than |
5 | | one representative
citizen of the employing class and not more |
6 | | than one representative citizen
of the employee class, shall |
7 | | hear the argument; provided that if all the
issues in dispute |
8 | | are solely the nature and extent of the permanent partial
|
9 | | disability, if any, a majority of the panel may deny the |
10 | | request for such
argument and such argument shall not be held; |
11 | | and provided further that 7
members of the Commission may |
12 | | determine that the argument be held before
all available |
13 | | members of the Commission. A decision of the Commission
shall |
14 | | be approved by a majority of Commissioners present at such |
15 | | hearing if
any; provided, if no such hearing is held, a |
16 | | decision of the Commission
shall be approved by a majority of a |
17 | | panel of 3 members of the Commission
as described in this |
18 | | Section. The Commission shall give 10 days' notice to
the |
19 | | parties or their attorneys of the time and place of such taking |
20 | | of
testimony and of such argument.
|
21 | | In any case the Commission in its decision may find |
22 | | specially
upon any question or questions of law or fact which |
23 | | shall be submitted
in writing by either party whether ultimate |
24 | | or otherwise;
provided that on issues other than nature and |
25 | | extent of the disability,
if any, the Commission in its |
26 | | decision shall find specially upon any
question or questions of |
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1 | | law or fact, whether ultimate or otherwise,
which are submitted |
2 | | in writing by either party; provided further that
not more than |
3 | | 5 such questions may be submitted by either party. Any
party |
4 | | may, within 20 days after receipt of notice of the Commission's
|
5 | | decision, or within such further time, not exceeding 30 days, |
6 | | as the
Commission may grant, file with the Commission either an |
7 | | agreed
statement of the facts appearing upon the hearing, or, |
8 | | if such party
shall so elect, a correct transcript of evidence |
9 | | of the additional
proceedings presented before the Commission, |
10 | | in which report the party
may embody a correct statement of |
11 | | such other proceedings in the case as
such party may desire to |
12 | | have reviewed, such statement of facts or
transcript of |
13 | | evidence to be authenticated by the signature of the
parties or |
14 | | their attorneys, and in the event that they do not agree,
then |
15 | | the authentication of such transcript of evidence shall be by |
16 | | the
signature of any member of the Commission.
|
17 | | If a reporter does not for any reason furnish a transcript |
18 | | of the
proceedings before the Arbitrator in any case for use on |
19 | | a hearing for
review before the Commission, within the |
20 | | limitations of time as fixed in
this Section, the Commission |
21 | | may, in its discretion, order a trial de
novo before the |
22 | | Commission in such case upon application of either
party. The |
23 | | applications for adjustment of claim and other documents in
the |
24 | | nature of pleadings filed by either party, together with the
|
25 | | decisions of the Arbitrator and of the Commission and the |
26 | | statement of
facts or transcript of evidence hereinbefore |
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1 | | provided for in paragraphs
(b) and (c) shall be the record of |
2 | | the proceedings of the Commission,
and shall be subject to |
3 | | review as hereinafter provided.
|
4 | | At the request of either party or on its own motion, the |
5 | | Commission shall
set forth in writing the reasons for the |
6 | | decision, including findings of
fact and conclusions of law |
7 | | separately stated. The Commission shall by rule
adopt a format |
8 | | for written decisions for the Commission and arbitrators.
The |
9 | | written decisions shall be concise and shall succinctly state |
10 | | the facts
and reasons for the decision. The Commission may |
11 | | adopt in whole or in part,
the decision of the arbitrator as |
12 | | the decision of the Commission. When the
Commission does so |
13 | | adopt the decision of the arbitrator, it shall do so by
order. |
14 | | Whenever the Commission adopts part of the arbitrator's |
15 | | decision,
but not all, it shall include in the order the |
16 | | reasons for not adopting all
of the arbitrator's decision. When |
17 | | a majority of a panel, after
deliberation, has arrived at its |
18 | | decision, the decision shall be filed as
provided in this |
19 | | Section without unnecessary delay, and without regard to
the |
20 | | fact that a member of the panel has expressed an intention to |
21 | | dissent.
Any member of the panel may file a dissent. Any |
22 | | dissent shall be filed no
later than 10 days after the decision |
23 | | of the majority has been filed.
|
24 | | Decisions rendered by the Commission and dissents, if any, |
25 | | shall be
published together by the Commission. The conclusions |
26 | | of law set out in
such decisions shall be regarded as |
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1 | | precedents by arbitrators for the purpose
of achieving a more |
2 | | uniform administration of this Act.
|
3 | | (f) The decision of the Commission acting within its |
4 | | powers,
according to the provisions of paragraph (e) of this |
5 | | Section shall, in
the absence of fraud, be conclusive unless |
6 | | reviewed as in this paragraph
hereinafter provided. However, |
7 | | the Arbitrator or the Commission may on
his or its own motion, |
8 | | or on the motion of either party, correct any
clerical error or |
9 | | errors in computation within 15 days after the date of
receipt |
10 | | of any award by such Arbitrator or any decision on review of |
11 | | the
Commission and shall have the power to recall the original |
12 | | award on
arbitration or decision on review, and issue in lieu |
13 | | thereof such
corrected award or decision. Where such correction |
14 | | is made the time for
review herein specified shall begin to run |
15 | | from the date of
the receipt of the corrected award or |
16 | | decision.
|
17 | | (1) Except in cases of claims against the State of |
18 | | Illinois, in
which case the decision of the Commission |
19 | | shall not be subject to
judicial review, the Circuit Court |
20 | | of the county where any of the
parties defendant may be |
21 | | found, or if none of the parties defendant can
be found in |
22 | | this State then the Circuit Court of the county where the
|
23 | | accident occurred, shall by summons to the Commission have
|
24 | | power to review all questions of law and fact presented by |
25 | | such record.
|
26 | | A proceeding for review shall be commenced within 20 |
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1 | | days of
the receipt of notice of the decision of the |
2 | | Commission. The summons shall
be issued by the clerk of |
3 | | such court upon written request returnable on a
designated |
4 | | return day, not less than 10 or more than 60 days from the |
5 | | date
of issuance thereof, and the written request shall |
6 | | contain the last known
address of other parties in interest |
7 | | and their attorneys of record who are
to be served by |
8 | | summons. Service upon any member of the Commission or the
|
9 | | Secretary or the Assistant Secretary thereof shall be |
10 | | service upon the
Commission, and service upon other parties |
11 | | in interest and their attorneys
of record shall be by |
12 | | summons, and such service shall be made upon the
Commission |
13 | | and other parties in interest by mailing notices of the
|
14 | | commencement of the proceedings and the return day of the |
15 | | summons to the
office of the Commission and to the last |
16 | | known place of residence of other
parties in interest or |
17 | | their attorney or attorneys of record. The clerk of
the |
18 | | court issuing the summons shall on the day of issue mail |
19 | | notice of the
commencement of the proceedings which shall |
20 | | be done by mailing a copy of
the summons to the office of |
21 | | the Commission, and a copy of the summons to
the other |
22 | | parties in interest or their attorney or attorneys of |
23 | | record and
the clerk of the court shall make certificate |
24 | | that he has so sent said
notices in pursuance of this |
25 | | Section, which shall be evidence of service on
the |
26 | | Commission and other parties in interest.
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1 | | The Commission shall not be required to certify the |
2 | | record of their
proceedings to the Circuit Court, unless |
3 | | the party commencing the
proceedings for review in the |
4 | | Circuit Court as above provided, shall pay
to the |
5 | | Commission the sum of 80¢ per page of testimony taken |
6 | | before the
Commission, and 35¢ per page of all other |
7 | | matters contained in such
record, except as otherwise |
8 | | provided by Section 20 of this Act. Payment
for photostatic |
9 | | copies of exhibit shall be extra. It shall be the duty
of |
10 | | the Commission upon such payment, or failure to pay as |
11 | | permitted
under Section 20 of this Act, to prepare a true |
12 | | and correct typewritten
copy of such testimony and a true |
13 | | and correct copy of all other matters
contained in such |
14 | | record and certified to by the Secretary or Assistant
|
15 | | Secretary thereof.
|
16 | | In its decision on review the Commission shall |
17 | | determine in each
particular case the amount of the |
18 | | probable cost of the record to be
filed as a part of the |
19 | | summons in that case and no request for a summons
may be |
20 | | filed and no summons shall issue unless the party seeking |
21 | | to review
the decision of the Commission shall exhibit to |
22 | | the clerk of the Circuit
Court proof of payment by filing a |
23 | | receipt showing payment or an affidavit
of the attorney |
24 | | setting forth that payment has been made of the sums so
|
25 | | determined to the Secretary or Assistant Secretary of the |
26 | | Commission,
except as otherwise provided by Section 20 of |
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1 | | this Act.
|
2 | | (2) No such summons shall issue unless the one against |
3 | | whom the
Commission shall have rendered an award for the |
4 | | payment of money shall upon
the filing of his written |
5 | | request for such summons file with the clerk of
the court a |
6 | | bond conditioned that if he shall not successfully
|
7 | | prosecute the review, he will pay the award and the costs |
8 | | of the
proceedings in the courts. The amount of the bond |
9 | | shall be fixed by any
member of the Commission and the |
10 | | surety or sureties of the bond shall be
approved by the |
11 | | clerk of the court. The acceptance of the bond by the
clerk |
12 | | of the court shall constitute evidence of his approval of |
13 | | the bond.
|
14 | | Every county, city, town, township, incorporated |
15 | | village, school
district, body politic or municipal |
16 | | corporation against whom the
Commission shall have |
17 | | rendered an award for the payment of money shall
not be |
18 | | required to file a bond to secure the payment of the award |
19 | | and
the costs of the proceedings in the court to authorize |
20 | | the court to
issue such summons.
|
21 | | The court may confirm or set aside the decision of the |
22 | | Commission. If
the decision is set aside and the facts |
23 | | found in the proceedings before
the Commission are |
24 | | sufficient, the court may enter such decision as is
|
25 | | justified by law, or may remand the cause to the Commission |
26 | | for further
proceedings and may state the questions |
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1 | | requiring further hearing, and
give such other |
2 | | instructions as may be proper. Appeals shall be taken
to |
3 | | the Appellate Court in accordance
with Supreme Court Rules |
4 | | 22(g) and 303. Appeals
shall be taken from the Appellate
|
5 | | Court to the Supreme Court in accordance with Supreme Court |
6 | | Rule 315.
|
7 | | It shall be the duty of the clerk of any court |
8 | | rendering a decision
affecting or affirming an award of the |
9 | | Commission to promptly furnish
the Commission with a copy |
10 | | of such decision, without charge.
|
11 | | The decision of a majority of the members of the panel |
12 | | of the Commission,
shall be considered the decision of the |
13 | | Commission.
|
14 | | (g) Except in the case of a claim against the State of |
15 | | Illinois,
either party may present a certified copy of the |
16 | | award of the
Arbitrator, or a certified copy of the decision of |
17 | | the Commission when
the same has become final, when no |
18 | | proceedings for review are pending,
providing for the payment |
19 | | of compensation according to this Act, to the
Circuit Court of |
20 | | the county in which such accident occurred or either of
the |
21 | | parties are residents, whereupon the court shall enter a |
22 | | judgment
in accordance therewith. In a case where the employer |
23 | | refuses to pay
compensation according to such final award or |
24 | | such final decision upon
which such judgment is entered the |
25 | | court shall in entering judgment
thereon, tax as costs against |
26 | | him the reasonable costs and attorney fees
in the arbitration |
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1 | | proceedings and in the court entering the judgment
for the |
2 | | person in whose favor the judgment is entered, which judgment
|
3 | | and costs taxed as therein provided shall, until and unless set |
4 | | aside,
have the same effect as though duly entered in an action |
5 | | duly tried and
determined by the court, and shall with like |
6 | | effect, be entered and
docketed. The Circuit Court shall have |
7 | | power at any time upon
application to make any such judgment |
8 | | conform to any modification
required by any subsequent decision |
9 | | of the Supreme Court upon appeal, or
as the result of any |
10 | | subsequent proceedings for review, as provided in
this Act.
|
11 | | Judgment shall not be entered until 15 days' notice of the |
12 | | time and
place of the application for the entry of judgment |
13 | | shall be served upon
the employer by filing such notice with |
14 | | the Commission, which Commission
shall, in case it has on file |
15 | | the address of the employer or the name
and address of its |
16 | | agent upon whom notices may be served, immediately
send a copy |
17 | | of the notice to the employer or such designated agent.
|
18 | | (h) An agreement or award under this Act providing for |
19 | | compensation
in installments, may at any time within 18 months |
20 | | after such agreement
or award be reviewed by the Commission at |
21 | | the request of either the
employer or the employee, on the |
22 | | ground that the disability of the
employee has subsequently |
23 | | recurred, increased, diminished or ended.
|
24 | | However, as to accidents occurring subsequent to July 1, |
25 | | 1955, which
are covered by any agreement or award under this |
26 | | Act providing for
compensation in installments made as a result |
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1 | | of such accident, such
agreement or award may at any time |
2 | | within 30 months, or 60 months in the case of an award under |
3 | | Section 8(d)1, after such agreement
or award be reviewed by the |
4 | | Commission at the request of either the
employer or the |
5 | | employee on the ground that the disability of the
employee has |
6 | | subsequently recurred, increased, diminished or ended.
|
7 | | On such review, compensation payments may be |
8 | | re-established,
increased, diminished or ended. The Commission |
9 | | shall give 15 days'
notice to the parties of the hearing for |
10 | | review. Any employee, upon any
petition for such review being |
11 | | filed by the employer, shall be entitled
to one day's notice |
12 | | for each 100 miles necessary to be traveled by him in
attending |
13 | | the hearing of the Commission upon the petition, and 3 days in
|
14 | | addition thereto. Such employee shall, at the discretion of the
|
15 | | Commission, also be entitled to 5 cents per mile necessarily |
16 | | traveled by
him within the State of Illinois in attending such |
17 | | hearing, not to
exceed a distance of 300 miles, to be taxed by |
18 | | the Commission as costs
and deposited with the petition of the |
19 | | employer.
|
20 | | When compensation which is payable in accordance with an |
21 | | award or
settlement contract approved by the Commission, is |
22 | | ordered paid in a
lump sum by the Commission, no review shall |
23 | | be had as in this paragraph
mentioned.
|
24 | | (i) Each party, upon taking any proceedings or steps |
25 | | whatsoever
before any Arbitrator, Commission or court, shall |
26 | | file with the Commission
his address, or the name and address |
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1 | | of any agent upon whom all notices to
be given to such party |
2 | | shall be served, either personally or by registered
mail, |
3 | | addressed to such party or agent at the last address so filed |
4 | | with
the Commission. In the event such party has not filed his |
5 | | address, or the
name and address of an agent as above provided, |
6 | | service of any notice may
be had by filing such notice with the |
7 | | Commission.
|
8 | | (j) Whenever in any proceeding testimony has been taken or |
9 | | a final
decision has been rendered and after the taking of such |
10 | | testimony or
after such decision has become final, the injured |
11 | | employee dies, then in
any subsequent proceedings brought by |
12 | | the personal representative or
beneficiaries of the deceased |
13 | | employee, such testimony in the former
proceeding may be |
14 | | introduced with the same force and effect as though
the witness |
15 | | having so testified were present in person in such
subsequent |
16 | | proceedings and such final decision, if any, shall be taken
as |
17 | | final adjudication of any of the issues which are the same in |
18 | | both
proceedings.
|
19 | | (k) In case where there has been any unreasonable or |
20 | | vexatious delay
of payment or intentional underpayment of |
21 | | compensation, or proceedings
have been instituted or carried on |
22 | | by the one liable to pay the
compensation, which do not present |
23 | | a real controversy, but are merely
frivolous or for delay, then |
24 | | the Commission may award compensation
additional to that |
25 | | otherwise payable under this Act equal to 50% of the
amount |
26 | | payable at the time of such award. Failure to pay compensation
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1 | | in accordance with the provisions of Section 8, paragraph (b) |
2 | | of this
Act, shall be considered unreasonable delay.
|
3 | | When determining whether this subsection (k) shall apply, |
4 | | the
Commission shall consider whether an Arbitrator has |
5 | | determined
that the claim is not compensable or whether the |
6 | | employer has
made payments under Section 8(j). |
7 | | (l) If the employee has made written demand for payment of
|
8 | | benefits under Section 8(a) or Section 8(b), the employer shall
|
9 | | have 14 days after receipt of the demand to set forth in
|
10 | | writing the reason for the delay. In the case of demand for
|
11 | | payment of medical benefits under Section 8(a), the time for
|
12 | | the employer to respond shall not commence until the expiration
|
13 | | of the allotted 60 days specified under Section 8.2(d). In case
|
14 | | the employer or his or her insurance carrier shall without good |
15 | | and
just cause fail, neglect, refuse, or unreasonably delay the
|
16 | | payment of benefits under Section 8(a) or Section 8(b), the
|
17 | | Arbitrator or the Commission shall allow to the employee
|
18 | | additional compensation in the sum of $30 per day for each day
|
19 | | that the benefits under Section 8(a) or Section 8(b) have been
|
20 | | so withheld or refused, not to exceed $10,000.
A delay in |
21 | | payment of 14 days or more
shall create a rebuttable |
22 | | presumption of unreasonable delay. Notwithstanding the |
23 | | foregoing, any such additional compensation awarded on or after |
24 | | the effective date of this amendatory Act of the 97th General |
25 | | Assembly that is awarded because the benefits under Section |
26 | | 8(a) have been so withheld or refused shall be distributed |
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1 | | first to the provider of medical services to pay any unpaid |
2 | | amounts due and any interest due under Section 8.2.
|
3 | | (m) If the commission finds that an accidental injury was |
4 | | directly
and proximately caused by the employer's wilful |
5 | | violation of a health
and safety standard under the Health and |
6 | | Safety Act in force at the time of the
accident, the arbitrator |
7 | | or the Commission shall allow to the injured
employee or his |
8 | | dependents, as the case may be, additional compensation
equal |
9 | | to 25% of the amount which otherwise would be payable under the
|
10 | | provisions of this Act exclusive of this paragraph. The |
11 | | additional
compensation herein provided shall be allowed by an |
12 | | appropriate increase
in the applicable weekly compensation |
13 | | rate.
|
14 | | (n) After June 30, 1984, decisions of the Illinois Workers' |
15 | | Compensation Commission
reviewing an award of an arbitrator of |
16 | | the Commission shall draw interest
at a rate equal to the yield |
17 | | on indebtedness issued by the United States
Government with a |
18 | | 26-week maturity next previously auctioned on the day on
which |
19 | | the decision is filed. Said rate of interest shall be set forth |
20 | | in
the Arbitrator's Decision. Interest shall be drawn from the |
21 | | date of the
arbitrator's award on all accrued compensation due |
22 | | the employee through the
day prior to the date of payments. |
23 | | However, when an employee appeals an
award of an Arbitrator or |
24 | | the Commission, and the appeal results in no
change or a |
25 | | decrease in the award, interest shall not further accrue from
|
26 | | the date of such appeal.
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1 | | The employer or his insurance carrier may tender the |
2 | | payments due under
the award to stop the further accrual of |
3 | | interest on such award
notwithstanding the prosecution by |
4 | | either party of review, certiorari,
appeal to the Supreme Court |
5 | | or other steps to reverse, vacate or modify
the award.
|
6 | | (o) By the 15th day of each month each insurer providing |
7 | | coverage for
losses under this Act shall notify each insured |
8 | | employer of any compensable
claim incurred during the preceding |
9 | | month and the amounts paid or reserved
on the claim including a |
10 | | summary of the claim and a brief statement of the
reasons for |
11 | | compensability. A cumulative report of all claims incurred
|
12 | | during a calendar year or continued from the previous year |
13 | | shall be
furnished to the insured employer by the insurer |
14 | | within 30 days after the
end of that calendar year.
|
15 | | The insured employer may challenge, in proceeding before |
16 | | the Commission,
payments made by the insurer without |
17 | | arbitration and payments
made after a case is determined to be |
18 | | noncompensable. If the Commission
finds that the case was not |
19 | | compensable, the insurer shall purge its records
as to that |
20 | | employer of any loss or expense associated with the claim, |
21 | | reimburse
the employer for attorneys' fees arising from the |
22 | | challenge and for any
payment required of the employer to the |
23 | | Rate Adjustment Fund or the
Second Injury Fund, and may not |
24 | | reflect the loss or expense for rate making
purposes. The |
25 | | employee shall not be required to refund the challenged
|
26 | | payment. The decision of the Commission may be reviewed in the |
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1 | | same manner
as in arbitrated cases. No challenge may be |
2 | | initiated under this paragraph
more than 3 years after the |
3 | | payment is made. An employer may waive the
right of challenge |
4 | | under this paragraph on a case by case basis.
|
5 | | (p) After filing an application for adjustment of claim but |
6 | | prior to
the hearing on arbitration the parties may voluntarily |
7 | | agree to submit such
application for adjustment of claim for |
8 | | decision by an arbitrator under
this subsection (p) where such |
9 | | application for adjustment of claim raises
only a dispute over |
10 | | temporary total disability, permanent partial
disability or |
11 | | medical expenses. Such agreement shall be in writing in such
|
12 | | form as provided by the Commission. Applications for adjustment |
13 | | of claim
submitted for decision by an arbitrator under this |
14 | | subsection (p) shall
proceed according to rule as established |
15 | | by the Commission. The Commission
shall promulgate rules |
16 | | including, but not limited to, rules to ensure that
the parties |
17 | | are adequately informed of their rights under this subsection
|
18 | | (p) and of the voluntary nature of proceedings under this |
19 | | subsection (p).
The findings of fact made by an arbitrator |
20 | | acting within his or her powers
under this subsection (p) in |
21 | | the absence of fraud shall be conclusive.
However, the |
22 | | arbitrator may on his own motion, or the motion of either
|
23 | | party, correct any clerical errors or errors in computation |
24 | | within 15 days
after the date of receipt of such award of the |
25 | | arbitrator
and shall have the power to recall the original |
26 | | award on arbitration, and
issue in lieu thereof such corrected |
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1 | | award.
The decision of the arbitrator under this subsection (p) |
2 | | shall be
considered the decision of the Commission and |
3 | | proceedings for review of
questions of law arising from the |
4 | | decision may be commenced by either party
pursuant to |
5 | | subsection (f) of Section 19. The Advisory Board established
|
6 | | under Section 13.1 shall compile a list of certified Commission
|
7 | | arbitrators, each of whom shall be approved by at least 7 |
8 | | members of the
Advisory Board. The chairman shall select 5 |
9 | | persons from such list to
serve as arbitrators under this |
10 | | subsection (p). By agreement, the parties
shall select one |
11 | | arbitrator from among the 5 persons selected by the
chairman |
12 | | except that if the parties do not agree on an arbitrator from
|
13 | | among the 5 persons, the parties may, by agreement, select an |
14 | | arbitrator of
the American Arbitration Association, whose fee |
15 | | shall be paid by the State
in accordance with rules promulgated |
16 | | by the Commission. Arbitration under
this subsection (p) shall |
17 | | be voluntary.
|
18 | | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
|
19 | | (820 ILCS 305/25.5)
|
20 | | Sec. 25.5. Unlawful acts; penalties. |
21 | | (a) It is unlawful for any person, company, corporation, |
22 | | insurance carrier, healthcare provider, or other entity to: |
23 | | (1) Intentionally present or cause to be presented any |
24 | | false or
fraudulent claim for the payment of any workers' |
25 | | compensation
benefit.
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1 | | (2) Intentionally make or cause to be made any false or
|
2 | | fraudulent material statement or material representation |
3 | | for the
purpose of obtaining or denying any workers' |
4 | | compensation
benefit.
|
5 | | (3) Intentionally make or cause to be made any false or
|
6 | | fraudulent statements with regard to entitlement to |
7 | | workers'
compensation benefits with the intent to prevent |
8 | | an injured
worker from making a legitimate claim for any |
9 | | workers'
compensation benefits.
|
10 | | (4) Intentionally prepare or provide an invalid, |
11 | | false, or
counterfeit certificate of insurance as proof of |
12 | | workers'
compensation insurance.
|
13 | | (5) Intentionally make or cause to be made any false or
|
14 | | fraudulent material statement or material representation |
15 | | for the
purpose of obtaining workers' compensation |
16 | | insurance at less
than the proper rate for that insurance.
|
17 | | (6) Intentionally make or cause to be made any false or
|
18 | | fraudulent material statement or material representation |
19 | | on an
initial or renewal self-insurance application or |
20 | | accompanying
financial statement for the purpose of |
21 | | obtaining self-insurance
status or reducing the amount of |
22 | | security that may be required
to be furnished pursuant to |
23 | | Section 4 of this Act.
|
24 | | (7) Intentionally make or cause to be made any false or
|
25 | | fraudulent material statement to the Division of |
26 | | Insurance's
fraud and insurance non-compliance unit in the |
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1 | | course of an
investigation of fraud or insurance |
2 | | non-compliance.
|
3 | | (8) Intentionally assist, abet, solicit, or conspire |
4 | | with any
person, company, or other entity to commit any of |
5 | | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) |
6 | | of this subsection (a).
|
7 | | (9) Intentionally present a bill or statement for the |
8 | | payment for medical services that were not provided. |
9 | | For the purposes of paragraphs (2), (3), (5), (6), and (7), |
10 | | and (9), the term "statement" includes any writing, notice, |
11 | | proof of injury, bill for services, hospital or doctor records |
12 | | and reports, or X-ray and test results.
|
13 | | (b) Sentence for violations of subsection (a): Any person |
14 | | violating subsection (a) is guilty of a Class 4 felony. Any |
15 | | person or entity convicted of any violation of this Section |
16 | | shall be ordered to pay complete restitution to any person or |
17 | | entity so defrauded in addition to any fine or sentence imposed |
18 | | as a result of the conviction.
|
19 | | (1) A violation in which the value of the property |
20 | | obtained or attempted to be obtained is $300 or less is a |
21 | | Class A misdemeanor. |
22 | | (2) A violation in which the value of the property |
23 | | obtained or attempted to be obtained is more than $300 but |
24 | | not more than $10,000 is a Class 3 felony. |
25 | | (3) A violation in which the value of the property |
26 | | obtained or attempted to be obtained is more than $10,000 |
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1 | | but not more than $100,000 is a Class 2 felony. |
2 | | (4) A violation in which the value of the property |
3 | | obtained or attempted to be obtained is more than $100,000 |
4 | | is a Class 1 felony. |
5 | | (5) A person convicted under this Section shall be |
6 | | ordered to pay monetary restitution to the insurance |
7 | | company or self-insured entity or any other person for any |
8 | | financial loss sustained as a result of a violation of this |
9 | | Section, including any court costs and attorney fees. An |
10 | | order of restitution also includes expenses incurred and |
11 | | paid by the State of Illinois or an insurance company or |
12 | | self-insured entity in connection with any medical |
13 | | evaluation or treatment services. |
14 | | (6) For the purposes of this Section, where the exact |
15 | | value of property obtained or attempted to be obtained is |
16 | | either not alleged or is not specifically set by the terms |
17 | | of a policy of insurance, the value of the property shall |
18 | | be the fair market replacement value of the property |
19 | | claimed to be lost, the reasonable costs of reimbursing a |
20 | | vendor or other claimant for services to be rendered, or |
21 | | both. |
22 | | (c) The Department Division of Insurance of the Department |
23 | | of Financial and Professional Regulation shall establish a |
24 | | fraud and insurance non-compliance unit responsible for |
25 | | investigating incidences of fraud and insurance non-compliance |
26 | | pursuant to this Section. The size of the staff of the unit |
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1 | | shall be subject to appropriation by the General Assembly. It |
2 | | shall be the duty of the fraud and insurance non-compliance |
3 | | unit to determine the identity of insurance carriers, |
4 | | employers, employees, or other persons or entities who have |
5 | | violated the fraud and insurance non-compliance provisions of |
6 | | this Section. The fraud and insurance non-compliance unit shall |
7 | | report violations of the fraud and insurance non-compliance |
8 | | provisions of this Section to the Special Prosecutions Bureau |
9 | | of the Criminal Division of the Office of the Attorney General |
10 | | or to the State's Attorney of the county in which the offense |
11 | | allegedly occurred, either of whom has the authority to |
12 | | prosecute violations under this Section.
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13 | | With respect to the subject of any investigation being |
14 | | conducted, the fraud and insurance non-compliance unit shall |
15 | | have the general power of subpoena of the Department Division |
16 | | of Insurance.
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17 | | (d) Any person may report allegations of insurance |
18 | | non-compliance and fraud pursuant to this Section to the |
19 | | Division of Insurance's fraud and insurance non-compliance |
20 | | unit whose duty it shall be to investigate the report. The unit |
21 | | shall notify the Commission of reports of insurance |
22 | | non-compliance. Any person reporting an allegation of |
23 | | insurance non-compliance or fraud against either an employee or |
24 | | employer under this Section must identify himself. Except as |
25 | | provided in this subsection and in subsection (e), all reports |
26 | | shall remain confidential except to refer an investigation to |
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1 | | the Attorney General or State's Attorney for prosecution or if |
2 | | the fraud and insurance non-compliance unit's investigation |
3 | | reveals that the conduct reported may be in violation of other |
4 | | laws or regulations of the State of Illinois, the unit may |
5 | | report such conduct to the appropriate governmental agency |
6 | | charged with administering such laws and regulations. Any |
7 | | person who intentionally makes a false report under this |
8 | | Section to the fraud and insurance non-compliance unit is |
9 | | guilty of a Class A misdemeanor.
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10 | | (e) In order for the fraud and insurance non-compliance |
11 | | unit to investigate a report of fraud related to an employee's |
12 | | claim by an employee , (i) the employee must have filed with the |
13 | | Commission an Application for Adjustment of Claim and the |
14 | | employee must have either received or attempted to receive |
15 | | benefits under this Act that are related to the reported fraud |
16 | | or (ii) the employee must have made a written demand for the |
17 | | payment of benefits that are related to the reported fraud. |
18 | | Upon receipt of a report of fraud, the employee or employer |
19 | | shall receive immediate notice of the reported conduct, |
20 | | including the verified name and address of the complainant if |
21 | | that complainant is connected to the case and the nature of the |
22 | | reported conduct. The fraud and insurance non-compliance unit |
23 | | shall resolve all reports of fraud against employees or |
24 | | employers within 120 days of receipt of the report. There shall |
25 | | be no immunity, under this Act or otherwise, for any person who |
26 | | files a false report or who files a report without good and |
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1 | | just cause. Confidentiality of medical information shall be |
2 | | strictly maintained. Investigations that are not referred for |
3 | | prosecution shall be destroyed upon the expiration of the |
4 | | statute of limitations for the acts under investigation |
5 | | immediately expunged and shall not be disclosed except that the |
6 | | employee or employer who was the subject of the report and the |
7 | | person making the report shall be notified that the |
8 | | investigation is being closed , at which time the name of any |
9 | | complainant not connected to the case shall be disclosed to the |
10 | | employee or the employer . It is unlawful for any employer, |
11 | | insurance carrier, or service adjustment company , third party |
12 | | administrator, self-insured, or similar entity to file or |
13 | | threaten to file a report of fraud against an employee because |
14 | | of the exercise by the employee of the rights and remedies |
15 | | granted to the employee by this Act.
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16 | | For purposes of this subsection (e), "employer" means any |
17 | | employer, insurance carrier, third party administrator, |
18 | | self-insured, or similar entity.
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19 | | For purposes of this subsection (e), "complainant" refers |
20 | | to the person contacting the fraud and insurance non-compliance |
21 | | unit to initiate the complaint.
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22 | | (f) Any person convicted of fraud related to workers' |
23 | | compensation pursuant to this Section shall be subject to the |
24 | | penalties prescribed in the Criminal Code of 1961 and shall be |
25 | | ineligible to receive or retain any compensation, disability, |
26 | | or medical benefits as defined in this Act if the compensation, |
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1 | | disability, or medical benefits were owed or received as a |
2 | | result of fraud for which the recipient of the compensation, |
3 | | disability, or medical benefit was convicted. This subsection |
4 | | applies to accidental injuries or diseases that occur on or |
5 | | after the effective date of this amendatory Act of the 94th |
6 | | General Assembly.
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7 | | (g) Civil liability. Any person convicted of fraud who |
8 | | knowingly obtains, attempts to obtain, or causes to be obtained |
9 | | any benefits under this Act by the making of a false claim or |
10 | | who knowingly misrepresents any material fact shall be civilly |
11 | | liable to the payor of benefits or the insurer or the payor's |
12 | | or insurer's subrogee or assignee in an amount equal to 3 times |
13 | | the value of the benefits or insurance coverage wrongfully |
14 | | obtained or twice the value of the benefits or insurance |
15 | | coverage attempted to be obtained, plus reasonable attorney's |
16 | | fees and expenses incurred by the payor or the payor's subrogee |
17 | | or assignee who successfully brings a claim under this |
18 | | subsection. This subsection applies to accidental injuries or |
19 | | diseases that occur on or after the effective date of this |
20 | | amendatory Act of the 94th General Assembly.
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21 | | (h) The All proceedings under this Section shall be |
22 | | reported by the fraud and insurance non-compliance unit shall |
23 | | submit a written report on an annual basis to the Workers' |
24 | | Compensation Advisory Board the General Assembly, the |
25 | | Governor, and the Attorney General by January 1st and July 1st |
26 | | of each year. This report shall include, at the minimum, the |
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1 | | following information: |
2 | | (1) The number of allegations of insurance |
3 | | non-compliance and fraud reported to the fraud and |
4 | | insurance non-compliance unit. |
5 | | (2) The source of the reported allegations |
6 | | (individual, employer, or other). |
7 | | (3) The number of allegations investigated by the fraud |
8 | | and insurance non-compliance unit. |
9 | | (4) The number of criminal referrals made in accordance |
10 | | with this Section and the entity to which the referral was |
11 | | made. |
12 | | (5) All proceedings under this Section .
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13 | | (Source: P.A. 94-277, eff. 7-20-05.)
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14 | | Section 99. Effective date. This Act takes effect upon |
15 | | becoming law.".
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