HB2525 EnrolledLRB100 06927 JLS 16978 b

1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Sections 456, 457, and 458 and by adding Section 462a
6as follows:
 
7    (215 ILCS 5/456)  (from Ch. 73, par. 1065.3)
8    Sec. 456. Making of rates. (1) All rates shall be made in
9accordance with the following provisions:
10    (a) Due consideration shall be given to past and
11prospective loss experience within and outside this state, to
12catastrophe hazards, if any, to a reasonable margin for profit
13and contingencies, to dividends, savings or unabsorbed premium
14deposits allowed or returned by companies to their
15policyholders, members or subscribers, to past and prospective
16expenses both countrywide and those specially applicable to
17this state, to underwriting practice and judgment and to all
18other relevant factors within and outside this state;
19    (b) The systems of expense provisions included in the rates
20for use by any company or group of companies may differ from
21those of other companies or groups of companies to reflect the
22requirements of the operating methods of any such company or
23group with respect to any kind of insurance, or with respect to

 

 

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1any subdivision or combination thereof for which subdivision or
2combination separate expense provisions are applicable;
3    (c) Risks may be grouped by classifications for the
4establishment of rates and minimum premiums. Classification
5rates may be modified to produce rates for individual risks in
6accordance with rating plans which measure variation in hazards
7or expense provisions, or both. Such rating plans may measure
8any differences among risks that have a probable effect upon
9losses or expenses;
10    (d) Rates shall not be excessive, inadequate or unfairly
11discriminatory.
12    A rate in a competitive market is not excessive. A rate in
13a noncompetitive market is excessive if it is likely to produce
14a long run profit that is unreasonably high for the insurance
15provided or if expenses are unreasonably high in relation to
16the services rendered.
17    A rate is not inadequate unless such rate is clearly
18insufficient to sustain projected losses and expenses in the
19class of business to which it applies and the use of such rate
20has or, if continued, will have the effect of substantially
21lessening competition or the tendency to create monopoly in any
22market.
23    Unfair discrimination exists if, after allowing for
24practical limitations, price differentials fail to reflect
25equitably the differences in expected losses and expenses. A
26rate is not unfairly discriminatory because different premiums

 

 

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1result for policyholders with like exposures but different
2expenses, or like expenses but different loss exposures, so
3long as the rate reflects the differences with reasonable
4accuracy.
5    (e) The rating plan shall contain a mandatory offer of a
6deductible applicable only to the medical benefit under the
7Workers' Compensation Act. Such deductible offer shall be in a
8minimum amount of at least $1,000 per accident.
9    (f) Any rating plan or program shall include a rule
10permitting 2 or more employers with similar risk
11characteristics, who participate in a loss prevention program
12or safety group, to pool their premium and loss experience in
13determining their rate or premium for such participation in the
14program.
15    (2) Except to the extent necessary to meet the provisions
16of subdivision (d) of subsection (1) of this Section,
17uniformity among companies in any matters within the scope of
18this Section is neither required nor prohibited.
19(Source: P.A. 82-939.)
 
20    (215 ILCS 5/457)  (from Ch. 73, par. 1065.4)
21    Sec. 457. Rate filings. (1) Every Beginning January 1,
221983, every company shall prefile file with the Director every
23manual of classifications, every manual of rules and rates,
24every rating plan and every modification of the foregoing which
25it intends to use. Such filings shall be made at least not

 

 

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1later than 30 days before after they become effective. A
2company may satisfy its obligation to make such filings by
3adopting the filing of a licensed rating organization of which
4it is a member or subscriber, filed pursuant to subsection (2)
5of this Section, in total or, with the approval of the
6Director, by notifying the Director in what respects it intends
7to deviate from such filing. If a company intends to deviate
8from the filing of a licensed rating organization of which it
9is a member, the company shall provide the Director with
10supporting information that specifies the basis for the
11requested deviation and provides justification for the
12deviation. Any company adopting a pure premium filed by a
13rating organization pursuant to subsection (2) must file with
14the Director the modification factor it is using for expenses
15and profit so that the final rates in use by such company can
16be determined.
17    (2) Each Beginning January 1, 1983, each licensed rating
18organization must prefile file with the Director every manual
19of classification, every manual of rules and advisory rates,
20every pure premium which has been fully adjusted and fully
21developed, every rating plan and every modification of any of
22the foregoing which it intends to recommend for use to its
23members and subscribers, at least not later than 30 days before
24after such manual, premium, plan or modification thereof takes
25effect. Every licensed rating organization shall also file with
26the Director the rate classification system, all rating rules,

 

 

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1rating plans, policy forms, underwriting rules or similar
2materials, and each modification of any of the foregoing which
3it requires its members and subscribers to adhere to not later
4than 30 days before such filings or modifications thereof are
5to take effect. Every such filing shall state the proposed
6effective date thereof and shall indicate the character and
7extent of the coverage contemplated.
8    (3) A filing and any supporting information made pursuant
9to this Section shall be open to public inspection as soon as
10filed after the filing becomes effective.
11    (4) A filing shall not be effective nor used until approved
12by the Director. A filing shall be deemed approved if the
13Director fails to disapprove within 30 days after the filing.
14(Source: P.A. 82-939.)
 
15    (215 ILCS 5/458)  (from Ch. 73, par. 1065.5)
16    Sec. 458. Disapproval of filings. (1) If within 30 thirty
17days of any filing the Director finds that such filing does not
18meet the requirements of this Article, he shall send to the
19company or rating organization which made such filing a written
20notice of disapproval of such filing, specifying therein in
21what respects he finds that such filing fails to meet the
22requirements of this Article and stating when, within a
23reasonable period thereafter, such filing shall be deemed no
24longer effective. A company or rating organization whose filing
25has been disapproved shall be given a hearing upon a written

 

 

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1request made within 30 days after the disapproval order. If the
2company or rating organization making the filing shall, prior
3to the expiration of the period prescribed in the notice,
4request a hearing, such filings shall be effective until the
5expiration of a reasonable period specified in any order
6entered thereon. If the rate resulting from such filing be
7unfairly discriminatory or materially inadequate, and the
8difference between such rate and the approved rate equals or
9exceeds the cost of making an adjustment, the Director shall in
10such notice or order direct an adjustment of the premium to be
11made with the policyholder either by refund or collection of
12additional premium. If the policyholder does not accept the
13increased rate, cancellation shall be made on a pro rata basis.
14Any policy issued pursuant to this subsection shall contain a
15provision that the premium thereon shall be subject to
16adjustment upon the basis of the filing finally approved.
17    (2) If at any time subsequent to the applicable review
18period provided for in subsection (1) of this Section, the
19Director finds that a filing does not meet the requirements of
20this Article, he shall, after a hearing held upon not less than
21ten days written notice, specifying the matters to be
22considered at such hearing, to every company and rating
23organization which made such filing, issue an order specifying
24in what respects he finds that such filing fails to meet the
25requirements of this Article, and stating when, within a
26reasonable period thereafter, such filings shall be deemed no

 

 

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1longer effective. Copies of said order shall be sent to every
2such company and rating organization. Said order shall not
3affect any contract or policy made or issued prior to the
4expiration of the period set forth in said order.
5    (3) Any person or organization aggrieved with respect to
6any filing which is in effect may make written application to
7the Director for a hearing thereon, provided, however, that the
8company or rating organization that made the filing shall not
9be authorized to proceed under this subsection. Such
10application shall specify the grounds to be relied upon by the
11applicant. If the Director shall find that the application is
12made in good faith, that the applicant would be so aggrieved if
13his grounds are established, and that such grounds otherwise
14justify holding such a hearing, he shall, within thirty days
15after receipt of such application, hold a hearing upon not less
16than ten days written notice to the applicant and to every
17company and rating organization which made such filing.
18    If, after such hearing, the Director finds that the filing
19does not meet the requirements of this Article, he shall issue
20an order specifying in what respects he finds that such filing
21fails to meet the requirements of this Article, and stating
22when, within a reasonable period thereafter, such filing shall
23be deemed no longer effective. Copies of said order shall be
24sent to the applicant and to every such company and rating
25organization. Said order shall not affect any contract or
26policy made or issued prior to the expiration of the period set

 

 

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1forth in said order.
2    (4) Whenever an insurer has no legally effective rates as a
3result of the Director's disapproval of rates or other act, the
4Director shall on request of the insurer specify interim rates
5for the insurer that are high enough to protect the interests
6of all parties and may order that a specified portion of the
7premiums be placed in an escrow account approved by him or her.
8When new rates become legally effective, the Director shall
9order the escrowed funds or any overcharge in the interim rates
10to be distributed appropriately, except that refunds to
11policyholders that are de minimis shall not be required.
12(Source: P.A. 82-939.)
 
13    (215 ILCS 5/462a new)
14    Sec. 462a. Premiums; review.
15    (a) Premiums shall not be excessive. A premium is excessive
16if it is likely to produce a profit that is unreasonably high
17for the insurance provided or if expenses are unreasonably high
18in relation to the coverage or services rendered.
19    (b) At any time, an insured may file a request for review
20of a premium with the Director. The request shall be in such
21form as the Director prescribes and shall specify the grounds
22on which the premium is excessive.
23    If, within 30 days of any proper request for review under
24this Section, the Director finds that the premium does not meet
25the requirements of this Section, he or she shall send to the

 

 

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1insurer a written notice of disapproval of premium, specifying
2therein in what respects he or she finds that the premium fails
3to meet the requirements of this Section, stating when, within
4a reasonable period thereafter, the premium shall be deemed no
5longer effective, and ordering an adjustment of the premium. An
6insurer whose premium has been disapproved shall be given a
7hearing upon a written request made within 30 days after the
8disapproval order. If the insurer requests a hearing, the
9premium shall be effective until the expiration of a reasonable
10period specified in any order entered thereon. If, after a
11hearing, the premium is found to be excessive, the Director
12shall order an adjustment of the premium. The insurer shall
13refund to the insured any amount found to be excessive under
14this Section.
15    If the Director finds that a review is not warranted or a
16premium is not excessive, he or she shall provide notice of
17that decision to the insured and the insurer.
18    (c) An insurer shall provide all information requested by
19the Director as he or she determines necessary to assist in
20review of premiums under this Section.
 
21    (215 ILCS 5/460 rep.)
22    Section 10. The Illinois Insurance Code is amended by
23repealing Section 460.
 
24    Section 15. The Workers' Compensation Act is amended by

 

 

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1changing Sections 1, 8, 8.1b, 8.2, 8.2a, 14, 19, 25.5, and 29.2
2and by adding Sections 4e, 8.1, and 29.3 as follows:
 
3    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
4    Sec. 1. This Act may be cited as the Workers' Compensation
5Act.
6    (a) The term "employer" as used in this Act means:
7    1. The State and each county, city, town, township,
8incorporated village, school district, body politic, or
9municipal corporation therein.
10    2. Every person, firm, public or private corporation,
11including hospitals, public service, eleemosynary, religious
12or charitable corporations or associations who has any person
13in service or under any contract for hire, express or implied,
14oral or written, and who is engaged in any of the enterprises
15or businesses enumerated in Section 3 of this Act, or who at or
16prior to the time of the accident to the employee for which
17compensation under this Act may be claimed, has in the manner
18provided in this Act elected to become subject to the
19provisions of this Act, and who has not, prior to such
20accident, effected a withdrawal of such election in the manner
21provided in this Act.
22    3. Any one engaging in any business or enterprise referred
23to in subsections 1 and 2 of Section 3 of this Act who
24undertakes to do any work enumerated therein, is liable to pay
25compensation to his own immediate employees in accordance with

 

 

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1the provisions of this Act, and in addition thereto if he
2directly or indirectly engages any contractor whether
3principal or sub-contractor to do any such work, he is liable
4to pay compensation to the employees of any such contractor or
5sub-contractor unless such contractor or sub-contractor has
6insured, in any company or association authorized under the
7laws of this State to insure the liability to pay compensation
8under this Act, or guaranteed his liability to pay such
9compensation. With respect to any time limitation on the filing
10of claims provided by this Act, the timely filing of a claim
11against a contractor or subcontractor, as the case may be,
12shall be deemed to be a timely filing with respect to all
13persons upon whom liability is imposed by this paragraph.
14    In the event any such person pays compensation under this
15subsection he may recover the amount thereof from the
16contractor or sub-contractor, if any, and in the event the
17contractor pays compensation under this subsection he may
18recover the amount thereof from the sub-contractor, if any.
19    This subsection does not apply in any case where the
20accident occurs elsewhere than on, in or about the immediate
21premises on which the principal has contracted that the work be
22done.
23    4. Where an employer operating under and subject to the
24provisions of this Act loans an employee to another such
25employer and such loaned employee sustains a compensable
26accidental injury in the employment of such borrowing employer

 

 

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1and where such borrowing employer does not provide or pay the
2benefits or payments due such injured employee, such loaning
3employer is liable to provide or pay all benefits or payments
4due such employee under this Act and as to such employee the
5liability of such loaning and borrowing employers is joint and
6several, provided that such loaning employer is in the absence
7of agreement to the contrary entitled to receive from such
8borrowing employer full reimbursement for all sums paid or
9incurred pursuant to this paragraph together with reasonable
10attorneys' fees and expenses in any hearings before the
11Illinois Workers' Compensation Commission or in any action to
12secure such reimbursement. Where any benefit is provided or
13paid by such loaning employer the employee has the duty of
14rendering reasonable cooperation in any hearings, trials or
15proceedings in the case, including such proceedings for
16reimbursement.
17    Where an employee files an Application for Adjustment of
18Claim with the Illinois Workers' Compensation Commission
19alleging that his claim is covered by the provisions of the
20preceding paragraph, and joining both the alleged loaning and
21borrowing employers, they and each of them, upon written demand
22by the employee and within 7 days after receipt of such demand,
23shall have the duty of filing with the Illinois Workers'
24Compensation Commission a written admission or denial of the
25allegation that the claim is covered by the provisions of the
26preceding paragraph and in default of such filing or if any

 

 

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1such denial be ultimately determined not to have been bona fide
2then the provisions of Paragraph K of Section 19 of this Act
3shall apply.
4    An employer whose business or enterprise or a substantial
5part thereof consists of hiring, procuring or furnishing
6employees to or for other employers operating under and subject
7to the provisions of this Act for the performance of the work
8of such other employers and who pays such employees their
9salary or wages notwithstanding that they are doing the work of
10such other employers shall be deemed a loaning employer within
11the meaning and provisions of this Section.
12    (b) The term "employee" as used in this Act means:
13    1. Every person in the service of the State, including
14members of the General Assembly, members of the Commerce
15Commission, members of the Illinois Workers' Compensation
16Commission, and all persons in the service of the University of
17Illinois, county, including deputy sheriffs and assistant
18state's attorneys, city, town, township, incorporated village
19or school district, body politic, or municipal corporation
20therein, whether by election, under appointment or contract of
21hire, express or implied, oral or written, including all
22members of the Illinois National Guard while on active duty in
23the service of the State, and all probation personnel of the
24Juvenile Court appointed pursuant to Article VI of the Juvenile
25Court Act of 1987, and including any official of the State, any
26county, city, town, township, incorporated village, school

 

 

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1district, body politic or municipal corporation therein except
2any duly appointed member of a police department in any city
3whose population exceeds 500,000 according to the last Federal
4or State census, and except any member of a fire insurance
5patrol maintained by a board of underwriters in this State. A
6duly appointed member of a fire department in any city, the
7population of which exceeds 500,000 according to the last
8federal or State census, is an employee under this Act only
9with respect to claims brought under paragraph (c) of Section
108.
11    One employed by a contractor who has contracted with the
12State, or a county, city, town, township, incorporated village,
13school district, body politic or municipal corporation
14therein, through its representatives, is not considered as an
15employee of the State, county, city, town, township,
16incorporated village, school district, body politic or
17municipal corporation which made the contract.
18    2. Every person in the service of another under any
19contract of hire, express or implied, oral or written,
20including persons whose employment is outside of the State of
21Illinois where the contract of hire is made within the State of
22Illinois, persons whose employment results in fatal or
23non-fatal injuries within the State of Illinois where the
24contract of hire is made outside of the State of Illinois, and
25persons whose employment is principally localized within the
26State of Illinois, regardless of the place of the accident or

 

 

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1the place where the contract of hire was made, and including
2aliens, and minors who, for the purpose of this Act are
3considered the same and have the same power to contract,
4receive payments and give quittances therefor, as adult
5employees.
6    3. Every sole proprietor and every partner of a business
7may elect to be covered by this Act.
8    An employee or his dependents under this Act who shall have
9a cause of action by reason of any injury, disablement or death
10arising out of and in the course of his employment may elect to
11pursue his remedy in the State where injured or disabled, or in
12the State where the contract of hire is made, or in the State
13where the employment is principally localized.
14    However, any employer may elect to provide and pay
15compensation to any employee other than those engaged in the
16usual course of the trade, business, profession or occupation
17of the employer by complying with Sections 2 and 4 of this Act.
18Employees are not included within the provisions of this Act
19when excluded by the laws of the United States relating to
20liability of employers to their employees for personal injuries
21where such laws are held to be exclusive.
22    The term "employee" does not include persons performing
23services as real estate broker, broker-salesman, or salesman
24when such persons are paid by commission only.
25    (c) "Commission" means the Industrial Commission created
26by Section 5 of "The Civil Administrative Code of Illinois",

 

 

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1approved March 7, 1917, as amended, or the Illinois Workers'
2Compensation Commission created by Section 13 of this Act.
3    (d) To obtain compensation under this Act, an employee
4bears the burden of showing, by a preponderance of the
5evidence, that he or she has sustained accidental injuries
6arising out of and in the course of the employment. Except as
7provided in subsection (e) of this Section, accidental injuries
8sustained while traveling to or from work do not arise out of
9and in the course of employment.
10    For the purposes of this subsection (d):
11    "In the course of employment" refers to the time, place,
12and circumstances surrounding the accidental injuries.
13    "Arising out of the employment" refers to causal
14connection. It must be shown that the injury had its origin in
15some risk connected with, or incidental to, the employment so
16as to create a causal connection between the employment and the
17accidental injuries. An injury arises out of the employment if,
18at the time of the occurrence, the employee was performing acts
19he or she was instructed to perform by his or her employer,
20acts which he or she had a common law or statutory duty to
21perform, or acts which the employee might reasonably be
22expected to perform incident to his or her assigned duties. A
23risk is incidental to the employment where it belongs to or is
24connected with what an employee has to do in fulfilling his or
25her duties.
26    (e) Where an employee is required to travel away from his

 

 

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1or her employer's premises in order to perform his or her job,
2the traveling employee's accidental injuries arise out of his
3or her employment, and are in the course of his or her
4employment, when the conduct in which he or she was engaged at
5the time of the injury is reasonable and when that conduct
6might have been anticipated or foreseen by the employer.
7Accidental injuries while traveling do not occur in the course
8of employment if the accident occurs during a purely personal
9deviation or personal errand unless such deviation or errand is
10insubstantial.
11    In determining whether an employee was required to travel
12away from his or her employer's premises in order to perform
13his or her job, along with all other relevant factors, the
14following factors may be considered: whether the employer had
15knowledge that the employee may be required to travel to
16perform the job; whether the employer furnished any mode of
17transportation to or from the employee; whether the employee
18received, or the employer paid or agreed to pay, any
19remuneration or reimbursement for costs or expenses of any form
20of travel; whether the employer in any way directed the course
21or method of travel; whether the employer in any way assisted
22the employee in making any travel arrangements; whether the
23employer furnished lodging or in any way reimbursed the
24employee for lodging; and whether the employer received any
25benefit from the employee traveling.
26(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,

 

 

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1eff. 7-13-12.)
 
2    (820 ILCS 305/4e new)
3    Sec. 4e. Safety programs and return to work programs;
4recalculation of premiums and waiver of self-insurers fee.
5    (a) An employer may file with the Commission a workers'
6compensation safety program or a workers' compensation return
7to work program implemented by the employer. The Commission may
8certify any such safety program as a bona fide safety program
9after reviewing the program for the following minimum
10requirements: adequate safety training for employees;
11establishment of joint employer-employee safety committees;
12use of safety devices; and consultation with safety
13organizations. The Commission may certify any such return to
14work program as a bona fide return to work program after
15reviewing the program for the following minimum requirements:
16light duty or restricted duty work; leave of absence policy;
17and full duty return to work policy. The Commission shall
18notify the Department of Insurance of the certification.
19    (b) Upon receipt of a certification notice from the
20Commission under this Section related to an employer that
21provides workers' compensation through an insurer, the
22Director of Insurance shall immediately direct in writing the
23employer's workers' compensation insurer to recalculate the
24workers' compensation premium rates for the employer so that
25those premium rates incorporate and take into account the

 

 

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1certified program.
2    (c) If any workers' compensation safety program or a
3workers' compensation return to work program implemented by a
4self-insured employer is certified under this Section, the
5annual fee under Section 4d of this Act shall be reduced by 30%
6for the self-insured employer as long as the workers'
7compensation safety program or a workers' compensation return
8to work program continues. The self-insured employer shall
9certify the continuation of the program by each July 1 after
10the waiver is obtained.
 
11    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
12    Sec. 8. The amount of compensation which shall be paid to
13the employee for an accidental injury not resulting in death
14is:
15    (a) The employer shall provide and pay the negotiated rate,
16if applicable, or the lesser of the health care provider's
17actual charges or according to a fee schedule, subject to
18Section 8.2, in effect at the time the service was rendered for
19all the necessary first aid, medical and surgical services, and
20all necessary medical, surgical and hospital services
21thereafter incurred, limited, however, to that which is
22reasonably required to cure or relieve from the effects of the
23accidental injury, even if a health care provider sells,
24transfers, or otherwise assigns an account receivable for
25procedures, treatments, or services covered under this Act. If

 

 

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1the employer does not dispute payment of first aid, medical,
2surgical, and hospital services, the employer shall make such
3payment to the provider on behalf of the employee. The employer
4shall also pay for treatment, instruction and training
5necessary for the physical, mental and vocational
6rehabilitation of the employee, including all maintenance
7costs and expenses incidental thereto. If as a result of the
8injury the employee is unable to be self-sufficient the
9employer shall further pay for such maintenance or
10institutional care as shall be required.
11    The employee may at any time elect to secure his own
12physician, surgeon and hospital services at the employer's
13expense, or,
14    Upon agreement between the employer and the employees, or
15the employees' exclusive representative, and subject to the
16approval of the Illinois Workers' Compensation Commission, the
17employer shall maintain a list of physicians, to be known as a
18Panel of Physicians, who are accessible to the employees. The
19employer shall post this list in a place or places easily
20accessible to his employees. The employee shall have the right
21to make an alternative choice of physician from such Panel if
22he is not satisfied with the physician first selected. If, due
23to the nature of the injury or its occurrence away from the
24employer's place of business, the employee is unable to make a
25selection from the Panel, the selection process from the Panel
26shall not apply. The physician selected from the Panel may

 

 

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1arrange for any consultation, referral or other specialized
2medical services outside the Panel at the employer's expense.
3Provided that, in the event the Commission shall find that a
4doctor selected by the employee is rendering improper or
5inadequate care, the Commission may order the employee to
6select another doctor certified or qualified in the medical
7field for which treatment is required. If the employee refuses
8to make such change the Commission may relieve the employer of
9his obligation to pay the doctor's charges from the date of
10refusal to the date of compliance.
11    Any vocational rehabilitation counselors who provide
12service under this Act shall have appropriate certifications
13which designate the counselor as qualified to render opinions
14relating to vocational rehabilitation. Vocational
15rehabilitation may include, but is not limited to, counseling
16for job searches, supervising a job search program, and
17vocational retraining including education at an accredited
18learning institution. The employee or employer may petition to
19the Commission to decide disputes relating to vocational
20rehabilitation and the Commission shall resolve any such
21dispute, including payment of the vocational rehabilitation
22program by the employer.
23    The maintenance benefit shall not be less than the
24temporary total disability rate determined for the employee. In
25addition, maintenance shall include costs and expenses
26incidental to the vocational rehabilitation program.

 

 

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1    When the employee is working light duty on a part-time
2basis or full-time basis and earns less than he or she would be
3earning if employed in the full capacity of the job or jobs,
4then the employee shall be entitled to temporary partial
5disability benefits. Temporary partial disability benefits
6shall be equal to two-thirds of the difference between the
7average amount that the employee would be able to earn in the
8full performance of his or her duties in the occupation in
9which he or she was engaged at the time of accident and the
10gross amount which he or she is earning in the modified job
11provided to the employee by the employer or in any other job
12that the employee is working.
13    Every hospital, physician, surgeon or other person
14rendering treatment or services in accordance with the
15provisions of this Section shall upon written request furnish
16full and complete reports thereof to, and permit their records
17to be copied by, the employer, the employee or his dependents,
18as the case may be, or any other party to any proceeding for
19compensation before the Commission, or their attorneys.
20    Notwithstanding the foregoing, the employer's liability to
21pay for such medical services selected by the employee shall be
22limited to:
23        (1) all first aid and emergency treatment; plus
24        (2) all medical, surgical and hospital services
25    provided by the physician, surgeon or hospital initially
26    chosen by the employee or by any other physician,

 

 

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1    consultant, expert, institution or other provider of
2    services recommended by said initial service provider or
3    any subsequent provider of medical services in the chain of
4    referrals from said initial service provider; plus
5        (3) all medical, surgical and hospital services
6    provided by any second physician, surgeon or hospital
7    subsequently chosen by the employee or by any other
8    physician, consultant, expert, institution or other
9    provider of services recommended by said second service
10    provider or any subsequent provider of medical services in
11    the chain of referrals from said second service provider.
12    Thereafter the employer shall select and pay for all
13    necessary medical, surgical and hospital treatment and the
14    employee may not select a provider of medical services at
15    the employer's expense unless the employer agrees to such
16    selection. At any time the employee may obtain any medical
17    treatment he desires at his own expense. This paragraph
18    shall not affect the duty to pay for rehabilitation
19    referred to above.
20        (4) The following shall apply for injuries occurring on
21    or after June 28, 2011 (the effective date of Public Act
22    97-18) and only when an employer has an approved preferred
23    provider program pursuant to Section 8.1a on the date the
24    employee sustained his or her accidental injuries:
25            (A) The employer shall, in writing, on a form
26        promulgated by the Commission, inform the employee of

 

 

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1        the preferred provider program;
2            (B) Subsequent to the report of an injury by an
3        employee, the employee may choose in writing at any
4        time to decline the preferred provider program, in
5        which case that would constitute one of the two choices
6        of medical providers to which the employee is entitled
7        under subsection (a)(2) or (a)(3); and
8            (C) Prior to the report of an injury by an
9        employee, when an employee chooses non-emergency
10        treatment from a provider not within the preferred
11        provider program, that would constitute the employee's
12        one choice of medical providers to which the employee
13        is entitled under subsection (a)(2) or (a)(3).
14    When an employer and employee so agree in writing, nothing
15in this Act prevents an employee whose injury or disability has
16been established under this Act, from relying in good faith, on
17treatment by prayer or spiritual means alone, in accordance
18with the tenets and practice of a recognized church or
19religious denomination, by a duly accredited practitioner
20thereof, and having nursing services appropriate therewith,
21without suffering loss or diminution of the compensation
22benefits under this Act. However, the employee shall submit to
23all physical examinations required by this Act. The cost of
24such treatment and nursing care shall be paid by the employee
25unless the employer agrees to make such payment.
26    Where the accidental injury results in the amputation of an

 

 

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1arm, hand, leg or foot, or the enucleation of an eye, or the
2loss of any of the natural teeth, the employer shall furnish an
3artificial of any such members lost or damaged in accidental
4injury arising out of and in the course of employment, and
5shall also furnish the necessary braces in all proper and
6necessary cases. In cases of the loss of a member or members by
7amputation, the employer shall, whenever necessary, maintain
8in good repair, refit or replace the artificial limbs during
9the lifetime of the employee. Where the accidental injury
10accompanied by physical injury results in damage to a denture,
11eye glasses or contact eye lenses, or where the accidental
12injury results in damage to an artificial member, the employer
13shall replace or repair such denture, glasses, lenses, or
14artificial member.
15    The furnishing by the employer of any such services or
16appliances is not an admission of liability on the part of the
17employer to pay compensation.
18    The furnishing of any such services or appliances or the
19servicing thereof by the employer is not the payment of
20compensation.
21    (b) If the period of temporary total incapacity for work
22lasts more than 3 working days, weekly compensation as
23hereinafter provided shall be paid beginning on the 4th day of
24such temporary total incapacity and continuing as long as the
25total temporary incapacity lasts. The foregoing
26notwithstanding, in the case of an employee who is employed as

 

 

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1a volunteer, paid-on-call, or part-time firefighter, emergency
2medical technician, or paramedic or in In cases where the
3temporary total incapacity for work continues for a period of
414 days or more from the day of the accident compensation shall
5commence on the day after the accident.
6        1. The compensation rate for temporary total
7    incapacity under this paragraph (b) of this Section shall
8    be equal to 66 2/3% of the employee's average weekly wage
9    computed in accordance with Section 10, provided that it
10    shall be not less than 66 2/3% of the sum of the Federal
11    minimum wage under the Fair Labor Standards Act, or the
12    Illinois minimum wage under the Minimum Wage Law, whichever
13    is more, multiplied by 40 hours. This percentage rate shall
14    be increased by 10% for each spouse and child, not to
15    exceed 100% of the total minimum wage calculation, nor
16    exceed the employee's average weekly wage computed in
17    accordance with the provisions of Section 10, whichever is
18    less.
19        2. The compensation rate in all cases other than for
20    temporary total disability under this paragraph (b), and
21    other than for serious and permanent disfigurement under
22    paragraph (c) and other than for permanent partial
23    disability under subparagraph (2) of paragraph (d) or under
24    paragraph (e), of this Section shall be equal to 66 2/3% of
25    the employee's average weekly wage computed in accordance
26    with the provisions of Section 10, provided that it shall

 

 

HB2525 Enrolled- 27 -LRB100 06927 JLS 16978 b

1    be not less than 66 2/3% of the sum of the Federal minimum
2    wage under the Fair Labor Standards Act, or the Illinois
3    minimum wage under the Minimum Wage Law, whichever is more,
4    multiplied by 40 hours. This percentage rate shall be
5    increased by 10% for each spouse and child, not to exceed
6    100% of the total minimum wage calculation, nor exceed the
7    employee's average weekly wage computed in accordance with
8    the provisions of Section 10, whichever is less.
9        2.1. The compensation rate in all cases of serious and
10    permanent disfigurement under paragraph (c) and of
11    permanent partial disability under subparagraph (2) of
12    paragraph (d) or under paragraph (e) of this Section shall
13    be equal to 60% of the employee's average weekly wage
14    computed in accordance with the provisions of Section 10,
15    provided that it shall be not less than 66 2/3% of the sum
16    of the Federal minimum wage under the Fair Labor Standards
17    Act, or the Illinois minimum wage under the Minimum Wage
18    Law, whichever is more, multiplied by 40 hours. This
19    percentage rate shall be increased by 10% for each spouse
20    and child, not to exceed 100% of the total minimum wage
21    calculation, nor exceed the employee's average weekly wage
22    computed in accordance with the provisions of Section 10,
23    whichever is less.
24        3. As used in this Section the term "child" means a
25    child of the employee including any child legally adopted
26    before the accident or whom at the time of the accident the

 

 

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1    employee was under legal obligation to support or to whom
2    the employee stood in loco parentis, and who at the time of
3    the accident was under 18 years of age and not emancipated.
4    The term "children" means the plural of "child".
5        4. All weekly compensation rates provided under
6    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
7    Section shall be subject to the following limitations:
8        The maximum weekly compensation rate from July 1, 1975,
9    except as hereinafter provided, shall be 100% of the
10    State's average weekly wage in covered industries under the
11    Unemployment Insurance Act, that being the wage that most
12    closely approximates the State's average weekly wage.
13        The maximum weekly compensation rate, for the period
14    July 1, 1984, through June 30, 1987, except as hereinafter
15    provided, shall be $293.61. Effective July 1, 1987 and on
16    July 1 of each year thereafter the maximum weekly
17    compensation rate, except as hereinafter provided, shall
18    be determined as follows: if during the preceding 12 month
19    period there shall have been an increase in the State's
20    average weekly wage in covered industries under the
21    Unemployment Insurance Act, the weekly compensation rate
22    shall be proportionately increased by the same percentage
23    as the percentage of increase in the State's average weekly
24    wage in covered industries under the Unemployment
25    Insurance Act during such period.
26        The maximum weekly compensation rate, for the period

 

 

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1    January 1, 1981 through December 31, 1983, except as
2    hereinafter provided, shall be 100% of the State's average
3    weekly wage in covered industries under the Unemployment
4    Insurance Act in effect on January 1, 1981. Effective
5    January 1, 1984 and on January 1, of each year thereafter
6    the maximum weekly compensation rate, except as
7    hereinafter provided, shall be determined as follows: if
8    during the preceding 12 month period there shall have been
9    an increase in the State's average weekly wage in covered
10    industries under the Unemployment Insurance Act, the
11    weekly compensation rate shall be proportionately
12    increased by the same percentage as the percentage of
13    increase in the State's average weekly wage in covered
14    industries under the Unemployment Insurance Act during
15    such period.
16        From July 1, 1977 and thereafter such maximum weekly
17    compensation rate in death cases under Section 7, and
18    permanent total disability cases under paragraph (f) or
19    subparagraph 18 of paragraph (3) of this Section and for
20    temporary total disability under paragraph (b) of this
21    Section and for amputation of a member or enucleation of an
22    eye under paragraph (e) of this Section shall be increased
23    to 133-1/3% of the State's average weekly wage in covered
24    industries under the Unemployment Insurance Act.
25        For injuries occurring on or after February 1, 2006,
26    the maximum weekly benefit under paragraph (d)1 of this

 

 

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1    Section shall be 100% of the State's average weekly wage in
2    covered industries under the Unemployment Insurance Act.
3        4.1. Any provision herein to the contrary
4    notwithstanding, the weekly compensation rate for
5    compensation payments under subparagraph 18 of paragraph
6    (e) of this Section and under paragraph (f) of this Section
7    and under paragraph (a) of Section 7 and for amputation of
8    a member or enucleation of an eye under paragraph (e) of
9    this Section, shall in no event be less than 50% of the
10    State's average weekly wage in covered industries under the
11    Unemployment Insurance Act.
12        4.2. Any provision to the contrary notwithstanding,
13    the total compensation payable under Section 7 shall not
14    exceed the greater of $500,000 or 25 years.
15        5. For the purpose of this Section this State's average
16    weekly wage in covered industries under the Unemployment
17    Insurance Act on July 1, 1975 is hereby fixed at $228.16
18    per week and the computation of compensation rates shall be
19    based on the aforesaid average weekly wage until modified
20    as hereinafter provided.
21        6. The Department of Employment Security of the State
22    shall on or before the first day of December, 1977, and on
23    or before the first day of June, 1978, and on the first day
24    of each December and June of each year thereafter, publish
25    the State's average weekly wage in covered industries under
26    the Unemployment Insurance Act and the Illinois Workers'

 

 

HB2525 Enrolled- 31 -LRB100 06927 JLS 16978 b

1    Compensation Commission shall on the 15th day of January,
2    1978 and on the 15th day of July, 1978 and on the 15th day
3    of each January and July of each year thereafter, post and
4    publish the State's average weekly wage in covered
5    industries under the Unemployment Insurance Act as last
6    determined and published by the Department of Employment
7    Security. The amount when so posted and published shall be
8    conclusive and shall be applicable as the basis of
9    computation of compensation rates until the next posting
10    and publication as aforesaid.
11        7. The payment of compensation by an employer or his
12    insurance carrier to an injured employee shall not
13    constitute an admission of the employer's liability to pay
14    compensation.
15    (c) For any serious and permanent disfigurement to the
16hand, head, face, neck, arm, leg below the knee or the chest
17above the axillary line, the employee is entitled to
18compensation for such disfigurement, the amount determined by
19agreement at any time or by arbitration under this Act, at a
20hearing not less than 6 months after the date of the accidental
21injury, which amount shall not exceed 150 weeks (if the
22accidental injury occurs on or after the effective date of this
23amendatory Act of the 94th General Assembly but before February
241, 2006) or 162 weeks (if the accidental injury occurs on or
25after February 1, 2006) at the applicable rate provided in
26subparagraph 2.1 of paragraph (b) of this Section.

 

 

HB2525 Enrolled- 32 -LRB100 06927 JLS 16978 b

1    No compensation is payable under this paragraph where
2compensation is payable under paragraphs (d), (e) or (f) of
3this Section.
4    A duly appointed member of a fire department in a city, the
5population of which exceeds 500,000 according to the last
6federal or State census, is eligible for compensation under
7this paragraph only where such serious and permanent
8disfigurement results from burns.
9    (d) 1. If, after the accidental injury has been sustained,
10the employee as a result thereof becomes partially
11incapacitated from pursuing his usual and customary line of
12employment, he shall, except in cases compensated under the
13specific schedule set forth in paragraph (e) of this Section,
14receive compensation for the duration of his disability,
15subject to the limitations as to maximum amounts fixed in
16paragraph (b) of this Section, equal to 66-2/3% of the
17difference between the average amount which he would be able to
18earn in the full performance of his duties in the occupation in
19which he was engaged at the time of the accident and the
20average amount which he is earning or is able to earn in some
21suitable employment or business after the accident. For
22accidental injuries that occur on or after September 1, 2011,
23an award for wage differential under this subsection shall be
24effective only until the employee reaches the age of 67 or 5
25years from the date the award becomes final, whichever is
26later.

 

 

HB2525 Enrolled- 33 -LRB100 06927 JLS 16978 b

1    2. If, as a result of the accident, the employee sustains
2serious and permanent injuries not covered by paragraphs (c)
3and (e) of this Section or having sustained injuries covered by
4the aforesaid paragraphs (c) and (e), he shall have sustained
5in addition thereto other injuries which injuries do not
6incapacitate him from pursuing the duties of his employment but
7which would disable him from pursuing other suitable
8occupations, or which have otherwise resulted in physical
9impairment; or if such injuries partially incapacitate him from
10pursuing the duties of his usual and customary line of
11employment but do not result in an impairment of earning
12capacity, or having resulted in an impairment of earning
13capacity, the employee elects to waive his right to recover
14under the foregoing subparagraph 1 of paragraph (d) of this
15Section then in any of the foregoing events, he shall receive
16in addition to compensation for temporary total disability
17under paragraph (b) of this Section, compensation at the rate
18provided in subparagraph 2.1 of paragraph (b) of this Section
19for that percentage of 500 weeks that the partial disability
20resulting from the injuries covered by this paragraph bears to
21total disability. If the employee shall have sustained a
22fracture of one or more vertebra or fracture of the skull, the
23amount of compensation allowed under this Section shall be not
24less than 6 weeks for a fractured skull and 6 weeks for each
25fractured vertebra, and in the event the employee shall have
26sustained a fracture of any of the following facial bones:

 

 

HB2525 Enrolled- 34 -LRB100 06927 JLS 16978 b

1nasal, lachrymal, vomer, zygoma, maxilla, palatine or
2mandible, the amount of compensation allowed under this Section
3shall be not less than 2 weeks for each such fractured bone,
4and for a fracture of each transverse process not less than 3
5weeks. In the event such injuries shall result in the loss of a
6kidney, spleen or lung, the amount of compensation allowed
7under this Section shall be not less than 10 weeks for each
8such organ. Compensation awarded under this subparagraph 2
9shall not take into consideration injuries covered under
10paragraphs (c) and (e) of this Section and the compensation
11provided in this paragraph shall not affect the employee's
12right to compensation payable under paragraphs (b), (c) and (e)
13of this Section for the disabilities therein covered.
14    (e) For accidental injuries in the following schedule, the
15employee shall receive compensation for the period of temporary
16total incapacity for work resulting from such accidental
17injury, under subparagraph 1 of paragraph (b) of this Section,
18and shall receive in addition thereto compensation for a
19further period for the specific loss herein mentioned, but
20shall not receive any compensation under any other provisions
21of this Act. The following listed amounts apply to either the
22loss of or the permanent and complete loss of use of the member
23specified, such compensation for the length of time as follows:
24        1. Thumb-
25            70 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

HB2525 Enrolled- 35 -LRB100 06927 JLS 16978 b

1        94th General Assembly but before February 1, 2006.
2            76 weeks if the accidental injury occurs on or
3        after February 1, 2006.
4        2. First, or index finger-
5            40 weeks if the accidental injury occurs on or
6        after the effective date of this amendatory Act of the
7        94th General Assembly but before February 1, 2006.
8            43 weeks if the accidental injury occurs on or
9        after February 1, 2006.
10        3. Second, or middle finger-
11            35 weeks if the accidental injury occurs on or
12        after the effective date of this amendatory Act of the
13        94th General Assembly but before February 1, 2006.
14            38 weeks if the accidental injury occurs on or
15        after February 1, 2006.
16        4. Third, or ring finger-
17            25 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            27 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        5. Fourth, or little finger-
23            20 weeks if the accidental injury occurs on or
24        after the effective date of this amendatory Act of the
25        94th General Assembly but before February 1, 2006.
26            22 weeks if the accidental injury occurs on or

 

 

HB2525 Enrolled- 36 -LRB100 06927 JLS 16978 b

1        after February 1, 2006.
2        6. Great toe-
3            35 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            38 weeks if the accidental injury occurs on or
7        after February 1, 2006.
8        7. Each toe other than great toe-
9            12 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            13 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        8. The loss of the first or distal phalanx of the thumb
15    or of any finger or toe shall be considered to be equal to
16    the loss of one-half of such thumb, finger or toe and the
17    compensation payable shall be one-half of the amount above
18    specified. The loss of more than one phalanx shall be
19    considered as the loss of the entire thumb, finger or toe.
20    In no case shall the amount received for more than one
21    finger exceed the amount provided in this schedule for the
22    loss of a hand.
23        9. Hand-
24            190 weeks if the accidental injury occurs on or
25        after the effective date of this amendatory Act of the
26        94th General Assembly but before February 1, 2006.

 

 

HB2525 Enrolled- 37 -LRB100 06927 JLS 16978 b

1            205 weeks if the accidental injury occurs on or
2        after February 1, 2006.
3            190 weeks if the accidental injury occurs on or
4        after June 28, 2011 (the effective date of Public Act
5        97-18) and if the accidental injury involves carpal
6        tunnel syndrome due to repetitive or cumulative
7        trauma, in which case the permanent partial disability
8        shall not exceed 15% loss of use of the hand, except
9        for cause shown by clear and convincing evidence and in
10        which case the award shall not exceed 30% loss of use
11        of the hand.
12        The loss of 2 or more digits, or one or more phalanges
13    of 2 or more digits, of a hand may be compensated on the
14    basis of partial loss of use of a hand, provided, further,
15    that the loss of 4 digits, or the loss of use of 4 digits,
16    in the same hand shall constitute the complete loss of a
17    hand.
18        10. Arm-
19            235 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            253 weeks if the accidental injury occurs on or
23        after February 1, 2006.
24        Where an accidental injury results in the amputation of
25    an arm below the elbow, such injury shall be compensated as
26    a loss of an arm. Where an accidental injury results in the

 

 

HB2525 Enrolled- 38 -LRB100 06927 JLS 16978 b

1    amputation of an arm above the elbow, compensation for an
2    additional 15 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 17 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 an arm at
8    the shoulder joint, or so close to shoulder joint that an
9    artificial arm cannot be used, or results in the
10    disarticulation of an arm at the shoulder joint, in which
11    case compensation for an additional 65 weeks (if the
12    accidental injury occurs on or after the effective date of
13    this amendatory Act of the 94th General Assembly but before
14    February 1, 2006) or an additional 70 weeks (if the
15    accidental injury occurs on or after February 1, 2006)
16    shall be paid.
17        For purposes of awards under this subdivision (e),
18    injuries to the shoulder shall be considered injuries to
19    part of the arm.
20        11. Foot-
21            155 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            167 weeks if the accidental injury occurs on or
25        after February 1, 2006.
26        12. Leg-

 

 

HB2525 Enrolled- 39 -LRB100 06927 JLS 16978 b

1            200 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            215 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        Where an accidental injury results in the amputation of
7    a leg below the knee, such injury shall be compensated as
8    loss of a leg. Where an accidental injury results in the
9    amputation of a leg above the knee, compensation for an
10    additional 25 weeks (if the accidental injury occurs on or
11    after the effective date of this amendatory Act of the 94th
12    General Assembly but before February 1, 2006) or an
13    additional 27 weeks (if the accidental injury occurs on or
14    after February 1, 2006) shall be paid, except where the
15    accidental injury results in the amputation of a leg at the
16    hip joint, or so close to the hip joint that an artificial
17    leg cannot be used, or results in the disarticulation of a
18    leg at the hip joint, in which case compensation for an
19    additional 75 weeks (if the accidental injury occurs on or
20    after the effective date of this amendatory Act of the 94th
21    General Assembly but before February 1, 2006) or an
22    additional 81 weeks (if the accidental injury occurs on or
23    after February 1, 2006) shall be paid.
24        For purposes of awards under this subdivision (e),
25    injuries to the hip shall be considered injuries to part of
26    the leg.

 

 

HB2525 Enrolled- 40 -LRB100 06927 JLS 16978 b

1        13. Eye-
2            150 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            162 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        Where an accidental injury results in the enucleation
8    of an eye, compensation for an additional 10 weeks (if the
9    accidental injury occurs on or after the effective date of
10    this amendatory Act of the 94th General Assembly but before
11    February 1, 2006) or an additional 11 weeks (if the
12    accidental injury occurs on or after February 1, 2006)
13    shall be paid.
14        14. Loss of hearing of one ear-
15            50 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            54 weeks if the accidental injury occurs on or
19        after February 1, 2006.
20        Total and permanent loss of hearing of both ears-
21            200 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            215 weeks if the accidental injury occurs on or
25        after February 1, 2006.
26        15. Testicle-

 

 

HB2525 Enrolled- 41 -LRB100 06927 JLS 16978 b

1            50 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            54 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        Both testicles-
7            150 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            162 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        16. For the permanent partial loss of use of a member
13    or sight of an eye, or hearing of an ear, compensation
14    during that proportion of the number of weeks in the
15    foregoing schedule provided for the loss of such member or
16    sight of an eye, or hearing of an ear, which the partial
17    loss of use thereof bears to the total loss of use of such
18    member, or sight of eye, or hearing of an ear.
19            (a) Loss of hearing for compensation purposes
20        shall be confined to the frequencies of 1,000, 2,000
21        and 3,000 cycles per second. Loss of hearing ability
22        for frequency tones above 3,000 cycles per second are
23        not to be considered as constituting disability for
24        hearing.
25            (b) The percent of hearing loss, for purposes of
26        the determination of compensation claims for

 

 

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1        occupational deafness, shall be calculated as the
2        average in decibels for the thresholds of hearing for
3        the frequencies of 1,000, 2,000 and 3,000 cycles per
4        second. Pure tone air conduction audiometric
5        instruments, approved by nationally recognized
6        authorities in this field, shall be used for measuring
7        hearing loss. If the losses of hearing average 30
8        decibels or less in the 3 frequencies, such losses of
9        hearing shall not then constitute any compensable
10        hearing disability. If the losses of hearing average 85
11        decibels or more in the 3 frequencies, then the same
12        shall constitute and be total or 100% compensable
13        hearing loss.
14            (c) In measuring hearing impairment, the lowest
15        measured losses in each of the 3 frequencies shall be
16        added together and divided by 3 to determine the
17        average decibel loss. For every decibel of loss
18        exceeding 30 decibels an allowance of 1.82% shall be
19        made up to the maximum of 100% which is reached at 85
20        decibels.
21            (d) If a hearing loss is established to have
22        existed on July 1, 1975 by audiometric testing the
23        employer shall not be liable for the previous loss so
24        established nor shall he be liable for any loss for
25        which compensation has been paid or awarded.
26            (e) No consideration shall be given to the question

 

 

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1        of whether or not the ability of an employee to
2        understand speech is improved by the use of a hearing
3        aid.
4            (f) No claim for loss of hearing due to industrial
5        noise shall be brought against an employer or allowed
6        unless the employee has been exposed for a period of
7        time sufficient to cause permanent impairment to noise
8        levels in excess of the following:
9Sound Level DBA
10Slow ResponseHours Per Day
11908
12926
13954
14973
151002
161021-1/2
171051
181101/2
191151/4
20        This subparagraph (f) shall not be applied in cases of
21    hearing loss resulting from trauma or explosion.
22        17. In computing the compensation to be paid to any
23    employee who, before the accident for which he claims
24    compensation, had before that time sustained an injury
25    resulting in the loss by amputation or partial loss by
26    amputation of any member, including hand, arm, thumb or

 

 

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1    fingers, leg, foot, or any toes, or loss under Section
2    8(d)2 due to accidental injuries to the same part of the
3    spine, such loss or partial loss of any such member or loss
4    under Section 8(d)2 due to accidental injuries to the same
5    part of the spine shall be deducted from any award made for
6    the subsequent injury. For the permanent loss of use or the
7    permanent partial loss of use of any such member or the
8    partial loss of sight of an eye or loss under Section 8(d)2
9    due to accidental injuries to the same part of the spine,
10    for which compensation has been paid, then such loss shall
11    be taken into consideration and deducted from any award for
12    the subsequent injury. For purposes of this subdivision
13    (e)17 only, "same part of the spine" means: (1) cervical
14    spine and thoracic spine from vertebra C1 through T12 and
15    (2) lumbar and sacral spine and coccyx from vertebra L1
16    through S5.
17        18. The specific case of loss of both hands, both arms,
18    or both feet, or both legs, or both eyes, or of any two
19    thereof, or the permanent and complete loss of the use
20    thereof, constitutes total and permanent disability, to be
21    compensated according to the compensation fixed by
22    paragraph (f) of this Section. These specific cases of
23    total and permanent disability do not exclude other cases.
24        Any employee who has previously suffered the loss or
25    permanent and complete loss of the use of any of such
26    members, and in a subsequent independent accident loses

 

 

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1    another or suffers the permanent and complete loss of the
2    use of any one of such members the employer for whom the
3    injured employee is working at the time of the last
4    independent accident is liable to pay compensation only for
5    the loss or permanent and complete loss of the use of the
6    member occasioned by the last independent accident.
7        19. In a case of specific loss and the subsequent death
8    of such injured employee from other causes than such injury
9    leaving a widow, widower, or dependents surviving before
10    payment or payment in full for such injury, then the amount
11    due for such injury is payable to the widow or widower and,
12    if there be no widow or widower, then to such dependents,
13    in the proportion which such dependency bears to total
14    dependency.
15    Beginning July 1, 1980, and every 6 months thereafter, the
16Commission shall examine the Second Injury Fund and when, after
17deducting all advances or loans made to such Fund, the amount
18therein is $500,000 then the amount required to be paid by
19employers pursuant to paragraph (f) of Section 7 shall be
20reduced by one-half. When the Second Injury Fund reaches the
21sum of $600,000 then the payments shall cease entirely.
22However, when the Second Injury Fund has been reduced to
23$400,000, payment of one-half of the amounts required by
24paragraph (f) of Section 7 shall be resumed, in the manner
25herein provided, and when the Second Injury Fund has been
26reduced to $300,000, payment of the full amounts required by

 

 

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1paragraph (f) of Section 7 shall be resumed, in the manner
2herein provided. The Commission shall make the changes in
3payment effective by general order, and the changes in payment
4become immediately effective for all cases coming before the
5Commission thereafter either by settlement agreement or final
6order, irrespective of the date of the accidental injury.
7    On August 1, 1996 and on February 1 and August 1 of each
8subsequent year, the Commission shall examine the special fund
9designated as the "Rate Adjustment Fund" and when, after
10deducting all advances or loans made to said fund, the amount
11therein is $4,000,000, the amount required to be paid by
12employers pursuant to paragraph (f) of Section 7 shall be
13reduced by one-half. When the Rate Adjustment Fund reaches the
14sum of $5,000,000 the payment therein shall cease entirely.
15However, when said Rate Adjustment Fund has been reduced to
16$3,000,000 the amounts required by paragraph (f) of Section 7
17shall be resumed in the manner herein provided.
18    (f) In case of complete disability, which renders the
19employee wholly and permanently incapable of work, or in the
20specific case of total and permanent disability as provided in
21subparagraph 18 of paragraph (e) of this Section, compensation
22shall be payable at the rate provided in subparagraph 2 of
23paragraph (b) of this Section for life.
24    An employee entitled to benefits under paragraph (f) of
25this Section shall also be entitled to receive from the Rate
26Adjustment Fund provided in paragraph (f) of Section 7 of the

 

 

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1supplementary benefits provided in paragraph (g) of this
2Section 8.
3    If any employee who receives an award under this paragraph
4afterwards returns to work or is able to do so, and earns or is
5able to earn as much as before the accident, payments under
6such award shall cease. If such employee returns to work, or is
7able to do so, and earns or is able to earn part but not as much
8as before the accident, such award shall be modified so as to
9conform to an award under paragraph (d) of this Section. If
10such award is terminated or reduced under the provisions of
11this paragraph, such employees have the right at any time
12within 30 months after the date of such termination or
13reduction to file petition with the Commission for the purpose
14of determining whether any disability exists as a result of the
15original accidental injury and the extent thereof.
16    Disability as enumerated in subdivision 18, paragraph (e)
17of this Section is considered complete disability.
18    If an employee who had previously incurred loss or the
19permanent and complete loss of use of one member, through the
20loss or the permanent and complete loss of the use of one hand,
21one arm, one foot, one leg, or one eye, incurs permanent and
22complete disability through the loss or the permanent and
23complete loss of the use of another member, he shall receive,
24in addition to the compensation payable by the employer and
25after such payments have ceased, an amount from the Second
26Injury Fund provided for in paragraph (f) of Section 7, which,

 

 

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1together with the compensation payable from the employer in
2whose employ he was when the last accidental injury was
3incurred, will equal the amount payable for permanent and
4complete disability as provided in this paragraph of this
5Section.
6    The custodian of the Second Injury Fund provided for in
7paragraph (f) of Section 7 shall be joined with the employer as
8a party respondent in the application for adjustment of claim.
9The application for adjustment of claim shall state briefly and
10in general terms the approximate time and place and manner of
11the loss of the first member.
12    In its award the Commission or the Arbitrator shall
13specifically find the amount the injured employee shall be
14weekly paid, the number of weeks compensation which shall be
15paid by the employer, the date upon which payments begin out of
16the Second Injury Fund provided for in paragraph (f) of Section
177 of this Act, the length of time the weekly payments continue,
18the date upon which the pension payments commence and the
19monthly amount of the payments. The Commission shall 30 days
20after the date upon which payments out of the Second Injury
21Fund have begun as provided in the award, and every month
22thereafter, prepare and submit to the State Comptroller a
23voucher for payment for all compensation accrued to that date
24at the rate fixed by the Commission. The State Comptroller
25shall draw a warrant to the injured employee along with a
26receipt to be executed by the injured employee and returned to

 

 

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1the Commission. The endorsed warrant and receipt is a full and
2complete acquittance to the Commission for the payment out of
3the Second Injury Fund. No other appropriation or warrant is
4necessary for payment out of the Second Injury Fund. The Second
5Injury Fund is appropriated for the purpose of making payments
6according to the terms of the awards.
7    As of July 1, 1980 to July 1, 1982, all claims against and
8obligations of the Second Injury Fund shall become claims
9against and obligations of the Rate Adjustment Fund to the
10extent there is insufficient money in the Second Injury Fund to
11pay such claims and obligations. In that case, all references
12to "Second Injury Fund" in this Section shall also include the
13Rate Adjustment Fund.
14    (g) Every award for permanent total disability entered by
15the Commission on and after July 1, 1965 under which
16compensation payments shall become due and payable after the
17effective date of this amendatory Act, and every award for
18death benefits or permanent total disability entered by the
19Commission on and after the effective date of this amendatory
20Act shall be subject to annual adjustments as to the amount of
21the compensation rate therein provided. Such adjustments shall
22first be made on July 15, 1977, and all awards made and entered
23prior to July 1, 1975 and on July 15 of each year thereafter.
24In all other cases such adjustment shall be made on July 15 of
25the second year next following the date of the entry of the
26award and shall further be made on July 15 annually thereafter.

 

 

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1If during the intervening period from the date of the entry of
2the award, or the last periodic adjustment, there shall have
3been an increase in the State's average weekly wage in covered
4industries under the Unemployment Insurance Act, the weekly
5compensation rate shall be proportionately increased by the
6same percentage as the percentage of increase in the State's
7average weekly wage in covered industries under the
8Unemployment Insurance Act. The increase in the compensation
9rate under this paragraph shall in no event bring the total
10compensation rate to an amount greater than the prevailing
11maximum rate at the time that the annual adjustment is made.
12Such increase shall be paid in the same manner as herein
13provided for payments under the Second Injury Fund to the
14injured employee, or his dependents, as the case may be, out of
15the Rate Adjustment Fund provided in paragraph (f) of Section 7
16of this Act. Payments shall be made at the same intervals as
17provided in the award or, at the option of the Commission, may
18be made in quarterly payment on the 15th day of January, April,
19July and October of each year. In the event of a decrease in
20such average weekly wage there shall be no change in the then
21existing compensation rate. The within paragraph shall not
22apply to cases where there is disputed liability and in which a
23compromise lump sum settlement between the employer and the
24injured employee, or his dependents, as the case may be, has
25been duly approved by the Illinois Workers' Compensation
26Commission.

 

 

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1    Provided, that in cases of awards entered by the Commission
2for injuries occurring before July 1, 1975, the increases in
3the compensation rate adjusted under the foregoing provision of
4this paragraph (g) shall be limited to increases in the State's
5average weekly wage in covered industries under the
6Unemployment Insurance Act occurring after July 1, 1975.
7    For every accident occurring on or after July 20, 2005 but
8before the effective date of this amendatory Act of the 94th
9General Assembly (Senate Bill 1283 of the 94th General
10Assembly), the annual adjustments to the compensation rate in
11awards for death benefits or permanent total disability, as
12provided in this Act, shall be paid by the employer. The
13adjustment shall be made by the employer on July 15 of the
14second year next following the date of the entry of the award
15and shall further be made on July 15 annually thereafter. If
16during the intervening period from the date of the entry of the
17award, or the last periodic adjustment, there shall have been
18an increase in the State's average weekly wage in covered
19industries under the Unemployment Insurance Act, the employer
20shall increase the weekly compensation rate proportionately by
21the same percentage as the percentage of increase in the
22State's average weekly wage in covered industries under the
23Unemployment Insurance Act. The increase in the compensation
24rate under this paragraph shall in no event bring the total
25compensation rate to an amount greater than the prevailing
26maximum rate at the time that the annual adjustment is made. In

 

 

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1the event of a decrease in such average weekly wage there shall
2be no change in the then existing compensation rate. Such
3increase shall be paid by the employer in the same manner and
4at the same intervals as the payment of compensation in the
5award. This paragraph shall not apply to cases where there is
6disputed liability and in which a compromise lump sum
7settlement between the employer and the injured employee, or
8his or her dependents, as the case may be, has been duly
9approved by the Illinois Workers' Compensation Commission.
10    The annual adjustments for every award of death benefits or
11permanent total disability involving accidents occurring
12before July 20, 2005 and accidents occurring on or after the
13effective date of this amendatory Act of the 94th General
14Assembly (Senate Bill 1283 of the 94th General Assembly) shall
15continue to be paid from the Rate Adjustment Fund pursuant to
16this paragraph and Section 7(f) of this Act.
17    (h) In case death occurs from any cause before the total
18compensation to which the employee would have been entitled has
19been paid, then in case the employee leaves any widow, widower,
20child, parent (or any grandchild, grandparent or other lineal
21heir or any collateral heir dependent at the time of the
22accident upon the earnings of the employee to the extent of 50%
23or more of total dependency) such compensation shall be paid to
24the beneficiaries of the deceased employee and distributed as
25provided in paragraph (g) of Section 7.
26    (h-1) In case an injured employee is under legal disability

 

 

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1at the time when any right or privilege accrues to him or her
2under this Act, a guardian may be appointed pursuant to law,
3and may, on behalf of such person under legal disability, claim
4and exercise any such right or privilege with the same effect
5as if the employee himself or herself had claimed or exercised
6the right or privilege. No limitations of time provided by this
7Act run so long as the employee who is under legal disability
8is without a conservator or guardian.
9    (i) In case the injured employee is under 16 years of age
10at the time of the accident and is illegally employed, the
11amount of compensation payable under paragraphs (b), (c), (d),
12(e) and (f) of this Section is increased 50%.
13    However, where an employer has on file an employment
14certificate issued pursuant to the Child Labor Law or work
15permit issued pursuant to the Federal Fair Labor Standards Act,
16as amended, or a birth certificate properly and duly issued,
17such certificate, permit or birth certificate is conclusive
18evidence as to the age of the injured minor employee for the
19purposes of this Section.
20    Nothing herein contained repeals or amends the provisions
21of the Child Labor Law relating to the employment of minors
22under the age of 16 years.
23    (j) 1. In the event the injured employee receives benefits,
24including medical, surgical or hospital benefits under any
25group plan covering non-occupational disabilities contributed
26to wholly or partially by the employer, which benefits should

 

 

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1not have been payable if any rights of recovery existed under
2this Act, then such amounts so paid to the employee from any
3such group plan as shall be consistent with, and limited to,
4the provisions of paragraph 2 hereof, shall be credited to or
5against any compensation payment for temporary total
6incapacity for work or any medical, surgical or hospital
7benefits made or to be made under this Act. In such event, the
8period of time for giving notice of accidental injury and
9filing application for adjustment of claim does not commence to
10run until the termination of such payments. This paragraph does
11not apply to payments made under any group plan which would
12have been payable irrespective of an accidental injury under
13this Act. Any employer receiving such credit shall keep such
14employee safe and harmless from any and all claims or
15liabilities that may be made against him by reason of having
16received such payments only to the extent of such credit.
17    Any excess benefits paid to or on behalf of a State
18employee by the State Employees' Retirement System under
19Article 14 of the Illinois Pension Code on a death claim or
20disputed disability claim shall be credited against any
21payments made or to be made by the State of Illinois to or on
22behalf of such employee under this Act, except for payments for
23medical expenses which have already been incurred at the time
24of the award. The State of Illinois shall directly reimburse
25the State Employees' Retirement System to the extent of such
26credit.

 

 

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1    2. Nothing contained in this Act shall be construed to give
2the employer or the insurance carrier the right to credit for
3any benefits or payments received by the employee other than
4compensation payments provided by this Act, and where the
5employee receives payments other than compensation payments,
6whether as full or partial salary, group insurance benefits,
7bonuses, annuities or any other payments, the employer or
8insurance carrier shall receive credit for each such payment
9only to the extent of the compensation that would have been
10payable during the period covered by such payment.
11    3. The extension of time for the filing of an Application
12for Adjustment of Claim as provided in paragraph 1 above shall
13not apply to those cases where the time for such filing had
14expired prior to the date on which payments or benefits
15enumerated herein have been initiated or resumed. Provided
16however that this paragraph 3 shall apply only to cases wherein
17the payments or benefits hereinabove enumerated shall be
18received after July 1, 1969.
19(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
20eff. 7-13-12.)
 
21    (820 ILCS 305/8.1 new)
22    Sec. 8.1. Repetitive and cumulative injuries; right of
23contribution.
24    (a) Any accidental injury which results from repetitive or
25cumulative trauma and occurs within 3 months after the employee

 

 

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1begins his or her employment shall not be considered by a
2workers' compensation insurer in setting the premium rate for
3the employer.
4    (b) If an award is made for benefits in connection with
5repetitive or cumulative injury resulting from employment with
6more than one employer, the employer liable for award or its
7insurer is entitled to contributions or reimbursement from each
8of the employee's prior employers which are subject to this Act
9or their insurers for the prior employer's pro rata share of
10responsibility as determined by the Commission. The right to
11contribution or reimbursement under this Section shall not
12delay, diminish, restrict, or alter in any way the benefits to
13which the employee or his or her dependents are entitled under
14this Act. At any time within one year after the Commission or
15the Arbitrator has made an award for benefits in connection
16with repetitive or cumulative injury, the employer liable under
17the award or its insurer may institute proceedings before the
18Commission for the purpose of determining the right of
19contribution or reimbursement. The proceeding shall not delay,
20diminish, restrict, or alter in any way the benefits to which
21the employee or his or her dependents are entitled under this
22Act, but shall be limited to a determination of the respective
23contribution or reimbursement rights and the responsibilities
24of all the employers joined in the proceeding. The employee has
25the duty of rendering reasonable cooperation in any of such
26proceeding.

 

 

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1    (c) No contribution or reimbursement may be sought for any
2payment of benefits more than 2 years after the employer
3seeking contribution or reimbursement has made the payment.
4    (d) This Section shall apply only to injuries occurring on
5or after the effective date of this amendatory Act of the 100th
6General Assembly.
7    (e) The Commission shall adopt emergency rules under
8Section 5-45 of the Illinois Administrative Procedure Act to
9implement the provisions of this Section to implement this
10Section.
 
11    (820 ILCS 305/8.1b)
12    Sec. 8.1b. Determination of permanent partial disability.
13For accidental injuries that occur on or after September 1,
142011, permanent partial disability shall be established using
15the following criteria:
16    (a) A physician licensed to practice medicine in all of its
17branches preparing a permanent partial disability impairment
18report shall report the level of impairment in writing. The
19report shall include an evaluation of medically defined and
20professionally appropriate measurements of impairment that
21include, but are not limited to: loss of range of motion; loss
22of strength; measured atrophy of tissue mass consistent with
23the injury; and any other measurements that establish the
24nature and extent of the impairment. The most current edition
25of the American Medical Association's "Guides to the Evaluation

 

 

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1of Permanent Impairment" shall be used by the physician in
2determining the level of impairment.
3    (b) In determining the level of permanent partial
4disability, the Commission shall base its determination on the
5following factors: (i) the reported level of impairment
6pursuant to subsection (a) if such a report exists and is
7admitted into evidence; (ii) the occupation of the injured
8employee; (iii) the age of the employee at the time of the
9injury; (iv) the employee's future earning capacity; and (v)
10evidence of disability corroborated by the treating medical
11records or examination under Section 12 of this Act. Where an
12impairment report exists and is admitted into evidence, it must
13be considered by the Commission in its determination. No single
14enumerated factor shall be the sole determinant of disability.
15In determining the level of disability, the relevance and
16weight of any factors used in addition to the level of
17impairment as reported by the physician must be explained in a
18written order.
19    (c) A report of impairment prepared pursuant to subsection
20(a) is not required for an arbitrator or the Commission to make
21an award for permanent partial disability or permanent total
22disability benefits or any award for benefits under subsection
23(c) of Section 8 or subsection (d) of Section 8 of this Act or
24to approve a Settlement Contract Lump Sum Petition.
25(Source: P.A. 97-18, eff. 6-28-11.)
 

 

 

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1    (820 ILCS 305/8.2)
2    Sec. 8.2. Fee schedule.
3    (a) Except as provided for in subsection (c), for
4procedures, treatments, or services covered under this Act and
5rendered or to be rendered on and after February 1, 2006, the
6maximum allowable payment shall be 90% of the 80th percentile
7of charges and fees as determined by the Commission utilizing
8information provided by employers' and insurers' national
9databases, with a minimum of 12,000,000 Illinois line item
10charges and fees comprised of health care provider and hospital
11charges and fees as of August 1, 2004 but not earlier than
12August 1, 2002. These charges and fees are provider billed
13amounts and shall not include discounted charges. The 80th
14percentile is the point on an ordered data set from low to high
15such that 80% of the cases are below or equal to that point and
16at most 20% are above or equal to that point. The Commission
17shall adjust these historical charges and fees as of August 1,
182004 by the Consumer Price Index-U for the period August 1,
192004 through September 30, 2005. The Commission shall establish
20fee schedules for procedures, treatments, or services for
21hospital inpatient, hospital outpatient, emergency room and
22trauma, ambulatory surgical treatment centers, and
23professional services. These charges and fees shall be
24designated by geozip or any smaller geographic unit. The data
25shall in no way identify or tend to identify any patient,
26employer, or health care provider. As used in this Section,

 

 

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1"geozip" means a three-digit zip code based on data
2similarities, geographical similarities, and frequencies. A
3geozip does not cross state boundaries. As used in this
4Section, "three-digit zip code" means a geographic area in
5which all zip codes have the same first 3 digits. If a geozip
6does not have the necessary number of charges and fees to
7calculate a valid percentile for a specific procedure,
8treatment, or service, the Commission may combine data from the
9geozip with up to 4 other geozips that are demographically and
10economically similar and exhibit similarities in data and
11frequencies until the Commission reaches 9 charges or fees for
12that specific procedure, treatment, or service. In cases where
13the compiled data contains less than 9 charges or fees for a
14procedure, treatment, or service, reimbursement shall occur at
1576% of charges and fees as determined by the Commission in a
16manner consistent with the provisions of this paragraph.
17Providers of out-of-state procedures, treatments, services,
18products, or supplies shall be reimbursed at the lesser of that
19state's fee schedule amount or the fee schedule amount for the
20region in which the employee resides. If no fee schedule exists
21in that state, the provider shall be reimbursed at the lesser
22of the actual charge or the fee schedule amount for the region
23in which the employee resides. Not later than September 30 in
242006 and each year thereafter, the Commission shall
25automatically increase or decrease the maximum allowable
26payment for a procedure, treatment, or service established and

 

 

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1in effect on January 1 of that year by the percentage change in
2the Consumer Price Index-U for the 12 month period ending
3August 31 of that year. The increase or decrease shall become
4effective on January 1 of the following year. As used in this
5Section, "Consumer Price Index-U" means the index published by
6the Bureau of Labor Statistics of the U.S. Department of Labor,
7that measures the average change in prices of all goods and
8services purchased by all urban consumers, U.S. city average,
9all items, 1982-84=100.
10    (a-1) Notwithstanding the provisions of subsection (a) and
11unless otherwise indicated, the following provisions shall
12apply to the medical fee schedule starting on September 1,
132011:
14        (1) The Commission shall establish and maintain fee
15    schedules for procedures, treatments, products, services,
16    or supplies for hospital inpatient, hospital outpatient,
17    emergency room, ambulatory surgical treatment centers,
18    accredited ambulatory surgical treatment facilities,
19    prescriptions filled and dispensed outside of a licensed
20    pharmacy, dental services, and professional services. This
21    fee schedule shall be based on the fee schedule amounts
22    already established by the Commission pursuant to
23    subsection (a) of this Section. However, starting on
24    January 1, 2012, these fee schedule amounts shall be
25    grouped into geographic regions in the following manner:
26            (A) Four regions for non-hospital fee schedule

 

 

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1        amounts shall be utilized:
2                (i) Cook County;
3                (ii) DuPage, Kane, Lake, and Will Counties;
4                (iii) Bond, Calhoun, Clinton, Jersey,
5            Macoupin, Madison, Monroe, Montgomery, Randolph,
6            St. Clair, and Washington Counties; and
7                (iv) All other counties of the State.
8            (B) Fourteen regions for hospital fee schedule
9        amounts shall be utilized:
10                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
11            Kendall, and Grundy Counties;
12                (ii) Kankakee County;
13                (iii) Madison, St. Clair, Macoupin, Clinton,
14            Monroe, Jersey, Bond, and Calhoun Counties;
15                (iv) Winnebago and Boone Counties;
16                (v) Peoria, Tazewell, Woodford, Marshall, and
17            Stark Counties;
18                (vi) Champaign, Piatt, and Ford Counties;
19                (vii) Rock Island, Henry, and Mercer Counties;
20                (viii) Sangamon and Menard Counties;
21                (ix) McLean County;
22                (x) Lake County;
23                (xi) Macon County;
24                (xii) Vermilion County;
25                (xiii) Alexander County; and
26                (xiv) All other counties of the State.

 

 

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1        (2) If a geozip, as defined in subsection (a) of this
2    Section, overlaps into one or more of the regions set forth
3    in this Section, then the Commission shall average or
4    repeat the charges and fees in a geozip in order to
5    designate charges and fees for each region.
6        (3) In cases where the compiled data contains less than
7    9 charges or fees for a procedure, treatment, product,
8    supply, or service or where the fee schedule amount cannot
9    be determined by the non-discounted charge data,
10    non-Medicare relative values and conversion factors
11    derived from established fee schedule amounts, coding
12    crosswalks, or other data as determined by the Commission,
13    reimbursement shall occur at 76% of charges and fees until
14    September 1, 2011 and 53.2% of charges and fees thereafter
15    as determined by the Commission in a manner consistent with
16    the provisions of this paragraph.
17        (4) To establish additional fee schedule amounts, the
18    Commission shall utilize provider non-discounted charge
19    data, non-Medicare relative values and conversion factors
20    derived from established fee schedule amounts, and coding
21    crosswalks. The Commission may establish additional fee
22    schedule amounts based on either the charge or cost of the
23    procedure, treatment, product, supply, or service.
24        (5) Implants shall be reimbursed at 25% above the net
25    manufacturer's invoice price less rebates, plus actual
26    reasonable and customary shipping charges whether or not

 

 

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1    the implant charge is submitted by a provider in
2    conjunction with a bill for all other services associated
3    with the implant, submitted by a provider on a separate
4    claim form, submitted by a distributor, or submitted by the
5    manufacturer of the implant. "Implants" include the
6    following codes or any substantially similar updated code
7    as determined by the Commission: 0274
8    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
9    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
10    (investigational devices); and 0636 (drugs requiring
11    detailed coding). Non-implantable devices or supplies
12    within these codes shall be reimbursed at 65% of actual
13    charge, which is the provider's normal rates under its
14    standard chargemaster. A standard chargemaster is the
15    provider's list of charges for procedures, treatments,
16    products, supplies, or services used to bill payers in a
17    consistent manner.
18        (6) The Commission shall automatically update all
19    codes and associated rules with the version of the codes
20    and rules valid on January 1 of that year.
21    (a-2) For procedures, treatments, services, or supplies
22covered under this Act and rendered or to be rendered on or
23after September 1, 2011, the maximum allowable payment shall be
2470% of the fee schedule amounts, which shall be adjusted yearly
25by the Consumer Price Index-U, as described in subsection (a)
26of this Section.

 

 

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1    (a-3) Prescriptions filled and dispensed outside of a
2licensed pharmacy shall be subject to a fee schedule that shall
3not exceed the Average Wholesale Price (AWP) plus a dispensing
4fee of $4.18. AWP or its equivalent as registered by the
5National Drug Code shall be set forth for that drug on that
6date as published in Medispan.
7    (a-4) The Commission, in consultation with the Workers'
8Compensation Medical Fee Advisory Board, shall promulgate by
9rule an evidence-based drug formulary and any rules necessary
10for its administration. Prescriptions prescribed for workers'
11compensation cases shall be limited to those prescription and
12non-prescription drugs and doses on the closed formulary.
13    A request for a prescription that is not on the closed
14formulary shall be reviewed pursuant to Section 8.7 of this
15Act.
16    (a-5) Notwithstanding any other provision of this Section,
17on or before March 1, 2018 and on or before March 1 of each
18subsequent year, the Commission must investigate all
19procedures, treatments, and services covered under this Act for
20ambulatory surgical treatment centers and accredited
21ambulatory surgical treatment facilities and establish fee
22schedule amounts for procedures, treatments, and services for
23which fee schedule amounts have not been established. The
24Commission must adopt, in a timely and ongoing manner, all
25rules necessary to ensure that its responsibilities under this
26subsection are carried out.

 

 

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1    (b) Notwithstanding the provisions of subsection (a), if
2the Commission finds that there is a significant limitation on
3access to quality health care in either a specific field of
4health care services or a specific geographic limitation on
5access to health care, it may change the Consumer Price Index-U
6increase or decrease for that specific field or specific
7geographic limitation on access to health care to address that
8limitation.
9    (c) The Commission shall establish by rule a process to
10review those medical cases or outliers that involve
11extra-ordinary treatment to determine whether to make an
12additional adjustment to the maximum payment within a fee
13schedule for a procedure, treatment, or service.
14    (d) When a patient notifies a provider that the treatment,
15procedure, or service being sought is for a work-related
16illness or injury and furnishes the provider the name and
17address of the responsible employer, the provider shall bill
18the employer directly. The employer shall make payment and
19providers shall submit bills and records in accordance with the
20provisions of this Section.
21        (1) All payments to providers for treatment provided
22    pursuant to this Act shall be made within 30 days of
23    receipt of the bills as long as the claim contains
24    substantially all the required data elements necessary to
25    adjudicate the bills.
26        (2) If the claim does not contain substantially all the

 

 

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1    required data elements necessary to adjudicate the bill, or
2    the claim is denied for any other reason, in whole or in
3    part, the employer or insurer shall provide written
4    notification, explaining the basis for the denial and
5    describing any additional necessary data elements, to the
6    provider within 30 days of receipt of the bill.
7        (3) In the case of nonpayment to a provider within 30
8    days of receipt of the bill which contained substantially
9    all of the required data elements necessary to adjudicate
10    the bill or nonpayment to a provider of a portion of such a
11    bill up to the lesser of the actual charge or the payment
12    level set by the Commission in the fee schedule established
13    in this Section, the bill, or portion of the bill, shall
14    incur interest at a rate of 1% per month payable to the
15    provider. Any required interest payments shall be made
16    within 30 days after payment.
17    (e) Except as provided in subsections (e-5), (e-10), and
18(e-15), a provider shall not hold an employee liable for costs
19related to a non-disputed procedure, treatment, or service
20rendered in connection with a compensable injury. The
21provisions of subsections (e-5), (e-10), (e-15), and (e-20)
22shall not apply if an employee provides information to the
23provider regarding participation in a group health plan. If the
24employee participates in a group health plan, the provider may
25submit a claim for services to the group health plan. If the
26claim for service is covered by the group health plan, the

 

 

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1employee's responsibility shall be limited to applicable
2deductibles, co-payments, or co-insurance. Except as provided
3under subsections (e-5), (e-10), (e-15), and (e-20), a provider
4shall not bill or otherwise attempt to recover from the
5employee the difference between the provider's charge and the
6amount paid by the employer or the insurer on a compensable
7injury, or for medical services or treatment determined by the
8Commission to be excessive or unnecessary.
9    (e-5) If an employer notifies a provider that the employer
10does not consider the illness or injury to be compensable under
11this Act, the provider may seek payment of the provider's
12actual charges from the employee for any procedure, treatment,
13or service rendered. Once an employee informs the provider that
14there is an application filed with the Commission to resolve a
15dispute over payment of such charges, the provider shall cease
16any and all efforts to collect payment for the services that
17are the subject of the dispute. Any statute of limitations or
18statute of repose applicable to the provider's efforts to
19collect payment from the employee shall be tolled from the date
20that the employee files the application with the Commission
21until the date that the provider is permitted to resume
22collection efforts under the provisions of this Section.
23    (e-10) If an employer notifies a provider that the employer
24will pay only a portion of a bill for any procedure, treatment,
25or service rendered in connection with a compensable illness or
26disease, the provider may seek payment from the employee for

 

 

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1the remainder of the amount of the bill up to the lesser of the
2actual charge, negotiated rate, if applicable, or the payment
3level set by the Commission in the fee schedule established in
4this Section. Once an employee informs the provider that there
5is an application filed with the Commission to resolve a
6dispute over payment of such charges, the provider shall cease
7any and all efforts to collect payment for the services that
8are the subject of the dispute. Any statute of limitations or
9statute of repose applicable to the provider's efforts to
10collect payment from the employee shall be tolled from the date
11that the employee files the application with the Commission
12until the date that the provider is permitted to resume
13collection efforts under the provisions of this Section.
14    (e-15) When there is a dispute over the compensability of
15or amount of payment for a procedure, treatment, or service,
16and a case is pending or proceeding before an Arbitrator or the
17Commission, the provider may mail the employee reminders that
18the employee will be responsible for payment of any procedure,
19treatment or service rendered by the provider. The reminders
20must state that they are not bills, to the extent practicable
21include itemized information, and state that the employee need
22not pay until such time as the provider is permitted to resume
23collection efforts under this Section. The reminders shall not
24be provided to any credit rating agency. The reminders may
25request that the employee furnish the provider with information
26about the proceeding under this Act, such as the file number,

 

 

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1names of parties, and status of the case. If an employee fails
2to respond to such request for information or fails to furnish
3the information requested within 90 days of the date of the
4reminder, the provider is entitled to resume any and all
5efforts to collect payment from the employee for the services
6rendered to the employee and the employee shall be responsible
7for payment of any outstanding bills for a procedure,
8treatment, or service rendered by a provider.
9    (e-20) Upon a final award or judgment by an Arbitrator or
10the Commission, or a settlement agreed to by the employer and
11the employee, a provider may resume any and all efforts to
12collect payment from the employee for the services rendered to
13the employee and the employee shall be responsible for payment
14of any outstanding bills for a procedure, treatment, or service
15rendered by a provider as well as the interest awarded under
16subsection (d) of this Section. In the case of a procedure,
17treatment, or service deemed compensable, the provider shall
18not require a payment rate, excluding the interest provisions
19under subsection (d), greater than the lesser of the actual
20charge or the payment level set by the Commission in the fee
21schedule established in this Section. Payment for services
22deemed not covered or not compensable under this Act is the
23responsibility of the employee unless a provider and employee
24have agreed otherwise in writing. Services not covered or not
25compensable under this Act are not subject to the fee schedule
26in this Section.

 

 

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1    (f) Nothing in this Act shall prohibit an employer or
2insurer from contracting with a health care provider or group
3of health care providers for reimbursement levels for benefits
4under this Act different from those provided in this Section.
5    (g) On or before January 1, 2010 the Commission shall
6provide to the Governor and General Assembly a report regarding
7the implementation of the medical fee schedule and the index
8used for annual adjustment to that schedule as described in
9this Section.
10(Source: P.A. 97-18, eff. 6-28-11.)
 
11    (820 ILCS 305/8.2a)
12    Sec. 8.2a. Electronic claims.
13    (a) The Director of Insurance shall adopt rules to do all
14of the following:
15        (1) Ensure that all health care providers and
16    facilities submit medical bills for payment on
17    standardized forms.
18        (2) Require acceptance by employers and insurers of
19    electronic claims for payment of medical services.
20        (3) Ensure confidentiality of medical information
21    submitted on electronic claims for payment of medical
22    services.
23        (4) Ensure that health care providers have at least 15
24    business days to comply with records requested by employers
25    and insurers for the authorization of the payment of

 

 

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1    workers' compensation claims.
2        (5) Ensure that health care providers are responsible
3    for supplying only those medical records pertaining to the
4    provider's own claims that are minimally necessary under
5    the federal Health Insurance Portability and
6    Accountability Act of 1996.
7        (6) Provide that any electronically submitted bill
8    determined to be complete but not paid or objected to
9    within 30 days shall be subject to penalties pursuant to
10    Section 8.2(d)(3) of this Act to be entered by the
11    Commission.
12        (7) Provide that the Department of Insurance shall
13    impose an administrative fine if it determines that an
14    employer or insurer has failed to comply with the
15    electronic claims acceptance and response process. The
16    amount of the administrative fine shall be no greater than
17    $1,000 per each violation, but shall not exceed $10,000 for
18    identical violations during a calendar year.
19    (b) To the extent feasible, standards adopted pursuant to
20subdivision (a) shall be consistent with existing standards
21under the federal Health Insurance Portability and
22Accountability Act of 1996 and standards adopted under the
23Illinois Health Information Exchange and Technology Act.
24    (c) The rules requiring employers and insurers to accept
25electronic claims for payment of medical services shall be
26proposed on or before January 1, 2012, and shall require all

 

 

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1employers and insurers to accept electronic claims for payment
2of medical services on or before June 30, 2012. The Director of
3Insurance shall adopt rules by June 30, 2017 to implement the
4changes to this Section made by this amendatory Act of the
5100th General Assembly. The Commission, with assistance from
6the Department and the Medical Fee Advisory Board, shall
7publish on its Internet website a companion guide to assist
8with compliance with electronic claims rules. The Medical Fee
9Advisory Board shall periodically review the companion guide.
10    (d) The Director of Insurance shall by rule establish
11criteria for granting exceptions to employers, insurance
12carriers, and health care providers who are unable to submit or
13accept medical bills electronically.
14(Source: P.A. 97-18, eff. 6-28-11.)
 
15    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
16    Sec. 14. The Commission shall appoint a secretary, an
17assistant secretary, and arbitrators and shall employ such
18assistants and clerical help as may be necessary. Arbitrators
19shall be appointed pursuant to this Section, notwithstanding
20any provision of the Personnel Code.
21    Each arbitrator appointed after June 28, 2011 shall be
22required to demonstrate in writing his or her knowledge of and
23expertise in the law of and judicial processes of the Workers'
24Compensation Act and the Workers' Occupational Diseases Act.
25    A formal training program for newly-hired arbitrators

 

 

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1shall be implemented. The training program shall include the
2following:
3        (a) substantive and procedural aspects of the
4    arbitrator position;
5        (b) current issues in workers' compensation law and
6    practice;
7        (c) medical lectures by specialists in areas such as
8    orthopedics, ophthalmology, psychiatry, rehabilitation
9    counseling;
10        (d) orientation to each operational unit of the
11    Illinois Workers' Compensation Commission;
12        (e) observation of experienced arbitrators conducting
13    hearings of cases, combined with the opportunity to discuss
14    evidence presented and rulings made;
15        (f) the use of hypothetical cases requiring the trainee
16    to issue judgments as a means to evaluating knowledge and
17    writing ability;
18        (g) writing skills;
19        (h) professional and ethical standards pursuant to
20    Section 1.1 of this Act;
21        (i) detection of workers' compensation fraud and
22    reporting obligations of Commission employees and
23    appointees;
24        (j) standards of evidence-based medical treatment and
25    best practices for measuring and improving quality and
26    health care outcomes in the workers' compensation system,

 

 

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1    including but not limited to the use of the American
2    Medical Association's "Guides to the Evaluation of
3    Permanent Impairment" and the practice of utilization
4    review; and
5        (k) substantive and procedural aspects of coal
6    workers' pneumoconiosis (black lung) cases.
7    A formal and ongoing professional development program
8including, but not limited to, the above-noted areas shall be
9implemented to keep arbitrators informed of recent
10developments and issues and to assist them in maintaining and
11enhancing their professional competence. Each arbitrator shall
12complete 20 hours of training in the above-noted areas during
13every 2 years such arbitrator shall remain in office.
14    Each arbitrator shall devote full time to his or her duties
15and shall serve when assigned as an acting Commissioner when a
16Commissioner is unavailable in accordance with the provisions
17of Section 13 of this Act. Any arbitrator who is an
18attorney-at-law shall not engage in the practice of law, nor
19shall any arbitrator hold any other office or position of
20profit under the United States or this State or any municipal
21corporation or political subdivision of this State.
22Notwithstanding any other provision of this Act to the
23contrary, an arbitrator who serves as an acting Commissioner in
24accordance with the provisions of Section 13 of this Act shall
25continue to serve in the capacity of Commissioner until a
26decision is reached in every case heard by that arbitrator

 

 

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1while serving as an acting Commissioner.
2    Notwithstanding any other provision of this Section, the
3term of all arbitrators serving on June 28, 2011 (the effective
4date of Public Act 97-18), including any arbitrators on
5administrative leave, shall terminate at the close of business
6on July 1, 2011, but the incumbents shall continue to exercise
7all of their duties until they are reappointed or their
8successors are appointed.
9    On and after June 28, 2011 (the effective date of Public
10Act 97-18), arbitrators shall be appointed to 3-year terms as
11follows:
12        (1) All appointments shall be made by the Governor with
13    the advice and consent of the Senate.
14        (2) For their initial appointments, 12 arbitrators
15    shall be appointed to terms expiring July 1, 2012; 12
16    arbitrators shall be appointed to terms expiring July 1,
17    2013; and all additional arbitrators shall be appointed to
18    terms expiring July 1, 2014. Thereafter, all arbitrators
19    shall be appointed to 3-year terms.
20    Upon the expiration of a term, the Chairman shall evaluate
21the performance of the arbitrator and may recommend to the
22Governor that he or she be reappointed to a second or
23subsequent term by the Governor with the advice and consent of
24the Senate.
25    Each arbitrator appointed on or after June 28, 2011 (the
26effective date of Public Act 97-18) and who has not previously

 

 

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1served as an arbitrator for the Commission shall be required to
2be authorized to practice law in this State by the Supreme
3Court, and to maintain this authorization throughout his or her
4term of employment.
5    The performance of all arbitrators shall be reviewed by the
6Chairman on an annual basis. The Chairman shall allow input
7from the Commissioners in all such reviews.
8    The Commission shall assign no fewer than 3 arbitrators to
9each hearing site. The Commission shall establish a procedure
10to ensure that the arbitrators assigned to each hearing site
11are assigned cases on a random basis. The Chairman of the
12Commission shall have discretion to assign and reassign
13arbitrators to each hearing sites as needed. No arbitrator
14shall hear cases in any county, other than Cook County, for
15more than 2 years in each 3-year term.
16    The Secretary and each arbitrator shall receive a per annum
17salary of $4,000 less than the per annum salary of members of
18The Illinois Workers' Compensation Commission as provided in
19Section 13 of this Act, payable in equal monthly installments.
20    The members of the Commission, Arbitrators and other
21employees whose duties require them to travel, shall have
22reimbursed to them their actual traveling expenses and
23disbursements made or incurred by them in the discharge of
24their official duties while away from their place of residence
25in the performance of their duties.
26    The Commission shall provide itself with a seal for the

 

 

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1authentication of its orders, awards and proceedings upon which
2shall be inscribed the name of the Commission and the words
3"Illinois--Seal".
4    The Secretary or Assistant Secretary, under the direction
5of the Commission, shall have charge and custody of the seal of
6the Commission and also have charge and custody of all records,
7files, orders, proceedings, decisions, awards and other
8documents on file with the Commission. He shall furnish
9certified copies, under the seal of the Commission, of any such
10records, files, orders, proceedings, decisions, awards and
11other documents on file with the Commission as may be required.
12Certified copies so furnished by the Secretary or Assistant
13Secretary shall be received in evidence before the Commission
14or any Arbitrator thereof, and in all courts, provided that the
15original of such certified copy is otherwise competent and
16admissible in evidence. The Secretary or Assistant Secretary
17shall perform such other duties as may be prescribed from time
18to time by the Commission.
19(Source: P.A. 98-40, eff. 6-28-13; 99-642, eff. 7-28-16.)
 
20    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
21    Sec. 19. Any disputed questions of law or fact shall be
22determined as herein provided.
23    (a) It shall be the duty of the Commission upon
24notification that the parties have failed to reach an
25agreement, to designate an Arbitrator.

 

 

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1        1. Whenever any claimant misconceives his remedy and
2    files an application for adjustment of claim under this Act
3    and it is subsequently discovered, at any time before final
4    disposition of such cause, that the claim for disability or
5    death which was the basis for such application should
6    properly have been made under the Workers' Occupational
7    Diseases Act, then the provisions of Section 19, paragraph
8    (a-1) of the Workers' Occupational Diseases Act having
9    reference to such application shall apply.
10        2. Whenever any claimant misconceives his remedy and
11    files an application for adjustment of claim under the
12    Workers' Occupational Diseases Act and it is subsequently
13    discovered, at any time before final disposition of such
14    cause that the claim for injury or death which was the
15    basis for such application should properly have been made
16    under this Act, then the application so filed under the
17    Workers' Occupational Diseases Act may be amended in form,
18    substance or both to assert claim for such disability or
19    death under this Act and it shall be deemed to have been so
20    filed as amended on the date of the original filing
21    thereof, and such compensation may be awarded as is
22    warranted by the whole evidence pursuant to this Act. When
23    such amendment is submitted, further or additional
24    evidence may be heard by the Arbitrator or Commission when
25    deemed necessary. Nothing in this Section contained shall
26    be construed to be or permit a waiver of any provisions of

 

 

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1    this Act with reference to notice but notice if given shall
2    be deemed to be a notice under the provisions of this Act
3    if given within the time required herein.
4    (b) The Arbitrator shall make such inquiries and
5investigations as he or they shall deem necessary and may
6examine and inspect all books, papers, records, places, or
7premises relating to the questions in dispute and hear such
8proper evidence as the parties may submit.
9    The hearings before the Arbitrator shall be held in the
10vicinity where the injury occurred after 10 days' notice of the
11time and place of such hearing shall have been given to each of
12the parties or their attorneys of record.
13    The Arbitrator may find that the disabling condition is
14temporary and has not yet reached a permanent condition and may
15order the payment of compensation up to the date of the
16hearing, which award shall be reviewable and enforceable in the
17same manner as other awards, and in no instance be a bar to a
18further hearing and determination of a further amount of
19temporary total compensation or of compensation for permanent
20disability, but shall be conclusive as to all other questions
21except the nature and extent of said disability.
22    The decision of the Arbitrator shall be filed with the
23Commission which Commission shall immediately send to each
24party or his attorney a copy of such decision, together with a
25notification of the time when it was filed. As of the effective
26date of this amendatory Act of the 94th General Assembly, all

 

 

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1decisions of the Arbitrator shall set forth in writing findings
2of fact and conclusions of law, separately stated, if requested
3by either party. Unless a petition for review is filed by
4either party within 30 days after the receipt by such party of
5the copy of the decision and notification of time when filed,
6and unless such party petitioning for a review shall within 35
7days after the receipt by him of the copy of the decision, file
8with the Commission either an agreed statement of the facts
9appearing upon the hearing before the Arbitrator, or if such
10party shall so elect a correct transcript of evidence of the
11proceedings at such hearings, then the decision shall become
12the decision of the Commission and in the absence of fraud
13shall be conclusive. The Petition for Review shall contain a
14statement of the petitioning party's specific exceptions to the
15decision of the arbitrator. The jurisdiction of the Commission
16to review the decision of the arbitrator shall not be limited
17to the exceptions stated in the Petition for Review. The
18Commission, or any member thereof, may grant further time not
19exceeding 30 days, in which to file such agreed statement or
20transcript of evidence. Such agreed statement of facts or
21correct transcript of evidence, as the case may be, shall be
22authenticated by the signatures of the parties or their
23attorneys, and in the event they do not agree as to the
24correctness of the transcript of evidence it shall be
25authenticated by the signature of the Arbitrator designated by
26the Commission.

 

 

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1    Whether the employee is working or not, if the employee is
2not receiving or has not received medical, surgical, or
3hospital services or other services or compensation as provided
4in paragraph (a) of Section 8, or compensation as provided in
5paragraph (b) of Section 8, the employee may at any time
6petition for an expedited hearing by an Arbitrator on the issue
7of whether or not he or she is entitled to receive payment of
8the services or compensation. Provided the employer continues
9to pay compensation pursuant to paragraph (b) of Section 8, the
10employer may at any time petition for an expedited hearing on
11the issue of whether or not the employee is entitled to receive
12medical, surgical, or hospital services or other services or
13compensation as provided in paragraph (a) of Section 8, or
14compensation as provided in paragraph (b) of Section 8. When an
15employer has petitioned for an expedited hearing, the employer
16shall continue to pay compensation as provided in paragraph (b)
17of Section 8 unless the arbitrator renders a decision that the
18employee is not entitled to the benefits that are the subject
19of the expedited hearing or unless the employee's treating
20physician has released the employee to return to work at his or
21her regular job with the employer or the employee actually
22returns to work at any other job. If the arbitrator renders a
23decision that the employee is not entitled to the benefits that
24are the subject of the expedited hearing, a petition for review
25filed by the employee shall receive the same priority as if the
26employee had filed a petition for an expedited hearing by an

 

 

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1Arbitrator. Neither party shall be entitled to an expedited
2hearing when the employee has returned to work and the sole
3issue in dispute amounts to less than 12 weeks of unpaid
4compensation pursuant to paragraph (b) of Section 8.
5    Expedited hearings shall have priority over all other
6petitions and shall be heard by the Arbitrator and Commission
7with all convenient speed. Any party requesting an expedited
8hearing shall give notice of a request for an expedited hearing
9under this paragraph. A copy of the Application for Adjustment
10of Claim shall be attached to the notice. The Commission shall
11adopt rules and procedures under which the final decision of
12the Commission under this paragraph is filed not later than 180
13days from the date that the Petition for Review is filed with
14the Commission.
15    Where 2 or more insurance carriers, private self-insureds,
16or a group workers' compensation pool under Article V 3/4 of
17the Illinois Insurance Code dispute coverage for the same
18injury, any such insurance carrier, private self-insured, or
19group workers' compensation pool may request an expedited
20hearing pursuant to this paragraph to determine the issue of
21coverage, provided coverage is the only issue in dispute and
22all other issues are stipulated and agreed to and further
23provided that all compensation benefits including medical
24benefits pursuant to Section 8(a) continue to be paid to or on
25behalf of petitioner. Any insurance carrier, private
26self-insured, or group workers' compensation pool that is

 

 

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1determined to be liable for coverage for the injury in issue
2shall reimburse any insurance carrier, private self-insured,
3or group workers' compensation pool that has paid benefits to
4or on behalf of petitioner for the injury.
5    (b-1) If the employee is not receiving medical, surgical or
6hospital services as provided in paragraph (a) of Section 8 or
7compensation as provided in paragraph (b) of Section 8, the
8employee, in accordance with Commission Rules, may file a
9petition for an emergency hearing by an Arbitrator on the issue
10of whether or not he is entitled to receive payment of such
11compensation or services as provided therein. Such petition
12shall have priority over all other petitions and shall be heard
13by the Arbitrator and Commission with all convenient speed.
14    Such petition shall contain the following information and
15shall be served on the employer at least 15 days before it is
16filed:
17        (i) the date and approximate time of accident;
18        (ii) the approximate location of the accident;
19        (iii) a description of the accident;
20        (iv) the nature of the injury incurred by the employee;
21        (v) the identity of the person, if known, to whom the
22    accident was reported and the date on which it was
23    reported;
24        (vi) the name and title of the person, if known,
25    representing the employer with whom the employee conferred
26    in any effort to obtain compensation pursuant to paragraph

 

 

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1    (b) of Section 8 of this Act or medical, surgical or
2    hospital services pursuant to paragraph (a) of Section 8 of
3    this Act and the date of such conference;
4        (vii) a statement that the employer has refused to pay
5    compensation pursuant to paragraph (b) of Section 8 of this
6    Act or for medical, surgical or hospital services pursuant
7    to paragraph (a) of Section 8 of this Act;
8        (viii) the name and address, if known, of each witness
9    to the accident and of each other person upon whom the
10    employee will rely to support his allegations;
11        (ix) the dates of treatment related to the accident by
12    medical practitioners, and the names and addresses of such
13    practitioners, including the dates of treatment related to
14    the accident at any hospitals and the names and addresses
15    of such hospitals, and a signed authorization permitting
16    the employer to examine all medical records of all
17    practitioners and hospitals named pursuant to this
18    paragraph;
19        (x) a copy of a signed report by a medical
20    practitioner, relating to the employee's current inability
21    to return to work because of the injuries incurred as a
22    result of the accident or such other documents or
23    affidavits which show that the employee is entitled to
24    receive compensation pursuant to paragraph (b) of Section 8
25    of this Act or medical, surgical or hospital services
26    pursuant to paragraph (a) of Section 8 of this Act. Such

 

 

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1    reports, documents or affidavits shall state, if possible,
2    the history of the accident given by the employee, and
3    describe the injury and medical diagnosis, the medical
4    services for such injury which the employee has received
5    and is receiving, the physical activities which the
6    employee cannot currently perform as a result of any
7    impairment or disability due to such injury, and the
8    prognosis for recovery;
9        (xi) complete copies of any reports, records,
10    documents and affidavits in the possession of the employee
11    on which the employee will rely to support his allegations,
12    provided that the employer shall pay the reasonable cost of
13    reproduction thereof;
14        (xii) a list of any reports, records, documents and
15    affidavits which the employee has demanded by subpoena and
16    on which he intends to rely to support his allegations;
17        (xiii) a certification signed by the employee or his
18    representative that the employer has received the petition
19    with the required information 15 days before filing.
20    Fifteen days after receipt by the employer of the petition
21with the required information the employee may file said
22petition and required information and shall serve notice of the
23filing upon the employer. The employer may file a motion
24addressed to the sufficiency of the petition. If an objection
25has been filed to the sufficiency of the petition, the
26arbitrator shall rule on the objection within 2 working days.

 

 

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1If such an objection is filed, the time for filing the final
2decision of the Commission as provided in this paragraph shall
3be tolled until the arbitrator has determined that the petition
4is sufficient.
5    The employer shall, within 15 days after receipt of the
6notice that such petition is filed, file with the Commission
7and serve on the employee or his representative a written
8response to each claim set forth in the petition, including the
9legal and factual basis for each disputed allegation and the
10following information: (i) complete copies of any reports,
11records, documents and affidavits in the possession of the
12employer on which the employer intends to rely in support of
13his response, (ii) a list of any reports, records, documents
14and affidavits which the employer has demanded by subpoena and
15on which the employer intends to rely in support of his
16response, (iii) the name and address of each witness on whom
17the employer will rely to support his response, and (iv) the
18names and addresses of any medical practitioners selected by
19the employer pursuant to Section 12 of this Act and the time
20and place of any examination scheduled to be made pursuant to
21such Section.
22    Any employer who does not timely file and serve a written
23response without good cause may not introduce any evidence to
24dispute any claim of the employee but may cross examine the
25employee or any witness brought by the employee and otherwise
26be heard.

 

 

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1    No document or other evidence not previously identified by
2either party with the petition or written response, or by any
3other means before the hearing, may be introduced into evidence
4without good cause. If, at the hearing, material information is
5discovered which was not previously disclosed, the Arbitrator
6may extend the time for closing proof on the motion of a party
7for a reasonable period of time which may be more than 30 days.
8No evidence may be introduced pursuant to this paragraph as to
9permanent disability. No award may be entered for permanent
10disability pursuant to this paragraph. Either party may
11introduce into evidence the testimony taken by deposition of
12any medical practitioner.
13    The Commission shall adopt rules, regulations and
14procedures whereby the final decision of the Commission is
15filed not later than 90 days from the date the petition for
16review is filed but in no event later than 180 days from the
17date the petition for an emergency hearing is filed with the
18Illinois Workers' Compensation Commission.
19    All service required pursuant to this paragraph (b-1) must
20be by personal service or by certified mail and with evidence
21of receipt. In addition for the purposes of this paragraph, all
22service on the employer must be at the premises where the
23accident occurred if the premises are owned or operated by the
24employer. Otherwise service must be at the employee's principal
25place of employment by the employer. If service on the employer
26is not possible at either of the above, then service shall be

 

 

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1at the employer's principal place of business. After initial
2service in each case, service shall be made on the employer's
3attorney or designated representative.
4    (c)(1) At a reasonable time in advance of and in connection
5with the hearing under Section 19(e) or 19(h), the Commission
6may on its own motion order an impartial physical or mental
7examination of a petitioner whose mental or physical condition
8is in issue, when in the Commission's discretion it appears
9that such an examination will materially aid in the just
10determination of the case. The examination shall be made by a
11member or members of a panel of physicians chosen for their
12special qualifications by the Illinois State Medical Society.
13The Commission shall establish procedures by which a physician
14shall be selected from such list.
15    (2) Should the Commission at any time during the hearing
16find that compelling considerations make it advisable to have
17an examination and report at that time, the commission may in
18its discretion so order.
19    (3) A copy of the report of examination shall be given to
20the Commission and to the attorneys for the parties.
21    (4) Either party or the Commission may call the examining
22physician or physicians to testify. Any physician so called
23shall be subject to cross-examination.
24    (5) The examination shall be made, and the physician or
25physicians, if called, shall testify, without cost to the
26parties. The Commission shall determine the compensation and

 

 

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1the pay of the physician or physicians. The compensation for
2this service shall not exceed the usual and customary amount
3for such service.
4    (6) The fees and payment thereof of all attorneys and
5physicians for services authorized by the Commission under this
6Act shall, upon request of either the employer or the employee
7or the beneficiary affected, be subject to the review and
8decision of the Commission.
9    (d) If any employee shall persist in insanitary or
10injurious practices which tend to either imperil or retard his
11recovery or shall refuse to submit to such medical, surgical,
12or hospital treatment as is reasonably essential to promote his
13recovery, the Commission may, in its discretion, reduce or
14suspend the compensation of any such injured employee. However,
15when an employer and employee so agree in writing, the
16foregoing provision shall not be construed to authorize the
17reduction or suspension of compensation of an employee who is
18relying in good faith, on treatment by prayer or spiritual
19means alone, in accordance with the tenets and practice of a
20recognized church or religious denomination, by a duly
21accredited practitioner thereof.
22    (e) This paragraph shall apply to all hearings before the
23Commission. Such hearings may be held in its office or
24elsewhere as the Commission may deem advisable. The taking of
25testimony on such hearings may be had before any member of the
26Commission. If a petition for review and agreed statement of

 

 

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1facts or transcript of evidence is filed, as provided herein,
2the Commission shall promptly review the decision of the
3Arbitrator and all questions of law or fact which appear from
4the statement of facts or transcript of evidence.
5    In all cases in which the hearing before the arbitrator is
6held after December 18, 1989, no additional evidence shall be
7introduced by the parties before the Commission on review of
8the decision of the Arbitrator. In reviewing decisions of an
9arbitrator the Commission shall award such temporary
10compensation, permanent compensation and other payments as are
11due under this Act. The Commission shall file in its office its
12decision thereon, and shall immediately send to each party or
13his attorney a copy of such decision and a notification of the
14time when it was filed. Decisions shall be filed within 60 days
15after the Statement of Exceptions and Supporting Brief and
16Response thereto are required to be filed or oral argument
17whichever is later.
18    In the event either party requests oral argument, such
19argument shall be had before a panel of 3 members of the
20Commission (or before all available members pursuant to the
21determination of 7 members of the Commission that such argument
22be held before all available members of the Commission)
23pursuant to the rules and regulations of the Commission. A
24panel of 3 members, which shall be comprised of not more than
25one representative citizen of the employing class and not more
26than one representative citizen of the employee class, shall

 

 

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1hear the argument; provided that if all the issues in dispute
2are solely the nature and extent of the permanent partial
3disability, if any, a majority of the panel may deny the
4request for such argument and such argument shall not be held;
5and provided further that 7 members of the Commission may
6determine that the argument be held before all available
7members of the Commission. A decision of the Commission shall
8be approved by a majority of Commissioners present at such
9hearing if any; provided, if no such hearing is held, a
10decision of the Commission shall be approved by a majority of a
11panel of 3 members of the Commission as described in this
12Section. The Commission shall give 10 days' notice to the
13parties or their attorneys of the time and place of such taking
14of testimony and of such argument.
15    In any case the Commission in its decision may find
16specially upon any question or questions of law or fact which
17shall be submitted in writing by either party whether ultimate
18or otherwise; provided that on issues other than nature and
19extent of the disability, if any, the Commission in its
20decision shall find specially upon any question or questions of
21law or fact, whether ultimate or otherwise, which are submitted
22in writing by either party; provided further that not more than
235 such questions may be submitted by either party. Any party
24may, within 20 days after receipt of notice of the Commission's
25decision, or within such further time, not exceeding 30 days,
26as the Commission may grant, file with the Commission either an

 

 

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1agreed statement of the facts appearing upon the hearing, or,
2if such party shall so elect, a correct transcript of evidence
3of the additional proceedings presented before the Commission,
4in which report the party may embody a correct statement of
5such other proceedings in the case as such party may desire to
6have reviewed, such statement of facts or transcript of
7evidence to be authenticated by the signature of the parties or
8their attorneys, and in the event that they do not agree, then
9the authentication of such transcript of evidence shall be by
10the signature of any member of the Commission.
11    If a reporter does not for any reason furnish a transcript
12of the proceedings before the Arbitrator in any case for use on
13a hearing for review before the Commission, within the
14limitations of time as fixed in this Section, the Commission
15may, in its discretion, order a trial de novo before the
16Commission in such case upon application of either party. The
17applications for adjustment of claim and other documents in the
18nature of pleadings filed by either party, together with the
19decisions of the Arbitrator and of the Commission and the
20statement of facts or transcript of evidence hereinbefore
21provided for in paragraphs (b) and (c) shall be the record of
22the proceedings of the Commission, and shall be subject to
23review as hereinafter provided.
24    At the request of either party or on its own motion, the
25Commission shall set forth in writing the reasons for the
26decision, including findings of fact and conclusions of law

 

 

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1separately stated. The Commission shall by rule adopt a format
2for written decisions for the Commission and arbitrators. The
3written decisions shall be concise and shall succinctly state
4the facts and reasons for the decision. The Commission may
5adopt in whole or in part, the decision of the arbitrator as
6the decision of the Commission. When the Commission does so
7adopt the decision of the arbitrator, it shall do so by order.
8Whenever the Commission adopts part of the arbitrator's
9decision, but not all, it shall include in the order the
10reasons for not adopting all of the arbitrator's decision. When
11a majority of a panel, after deliberation, has arrived at its
12decision, the decision shall be filed as provided in this
13Section without unnecessary delay, and without regard to the
14fact that a member of the panel has expressed an intention to
15dissent. Any member of the panel may file a dissent. Any
16dissent shall be filed no later than 10 days after the decision
17of the majority has been filed.
18    Decisions rendered by the Commission and dissents, if any,
19shall be published together by the Commission. The conclusions
20of law set out in such decisions shall be regarded as
21precedents by arbitrators for the purpose of achieving a more
22uniform administration of this Act.
23    (f) The decision of the Commission acting within its
24powers, according to the provisions of paragraph (e) of this
25Section shall, in the absence of fraud, be conclusive unless
26reviewed as in this paragraph hereinafter provided. However,

 

 

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1the Arbitrator or the Commission may on his or its own motion,
2or on the motion of either party, correct any clerical error or
3errors in computation within 15 days after the date of receipt
4of any award by such Arbitrator or any decision on review of
5the Commission and shall have the power to recall the original
6award on arbitration or decision on review, and issue in lieu
7thereof such corrected award or decision. Where such correction
8is made the time for review herein specified shall begin to run
9from the date of the receipt of the corrected award or
10decision.
11        (1) Except in cases of claims against the State of
12    Illinois other than those claims under Section 18.1, in
13    which case the decision of the Commission shall not be
14    subject to judicial review, the Circuit Court of the county
15    where any of the parties defendant may be found, or if none
16    of the parties defendant can be found in this State then
17    the Circuit Court of the county where the accident
18    occurred, shall by summons to the Commission have power to
19    review all questions of law and fact presented by such
20    record.
21        A proceeding for review shall be commenced within 20
22    days of the receipt of notice of the decision of the
23    Commission. The summons shall be issued by the clerk of
24    such court upon written request returnable on a designated
25    return day, not less than 10 or more than 60 days from the
26    date of issuance thereof, and the written request shall

 

 

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1    contain the last known address of other parties in interest
2    and their attorneys of record who are to be served by
3    summons. Service upon any member of the Commission or the
4    Secretary or the Assistant Secretary thereof shall be
5    service upon the Commission, and service upon other parties
6    in interest and their attorneys of record shall be by
7    summons, and such service shall be made upon the Commission
8    and other parties in interest by mailing notices of the
9    commencement of the proceedings and the return day of the
10    summons to the office of the Commission and to the last
11    known place of residence of other parties in interest or
12    their attorney or attorneys of record. The clerk of the
13    court issuing the summons shall on the day of issue mail
14    notice of the commencement of the proceedings which shall
15    be done by mailing a copy of the summons to the office of
16    the Commission, and a copy of the summons to the other
17    parties in interest or their attorney or attorneys of
18    record and the clerk of the court shall make certificate
19    that he has so sent said notices in pursuance of this
20    Section, which shall be evidence of service on the
21    Commission and other parties in interest.
22        The Commission shall not be required to certify the
23    record of their proceedings to the Circuit Court, unless
24    the party commencing the proceedings for review in the
25    Circuit Court as above provided, shall file with the
26    Commission notice of intent to file for review in Circuit

 

 

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1    Court. It shall be the duty of the Commission upon such
2    filing of notice of intent to file for review in the
3    Circuit Court to prepare a true and correct copy of such
4    testimony and a true and correct copy of all other matters
5    contained in such record and certified to by the Secretary
6    or Assistant Secretary thereof. The changes made to this
7    subdivision (f)(1) by this amendatory Act of the 98th
8    General Assembly apply to any Commission decision entered
9    after the effective date of this amendatory Act of the 98th
10    General Assembly.
11        No request for a summons may be filed and no summons
12    shall issue unless the party seeking to review the decision
13    of the Commission shall exhibit to the clerk of the Circuit
14    Court proof of filing with the Commission of the notice of
15    the intent to file for review in the Circuit Court or an
16    affidavit of the attorney setting forth that notice of
17    intent to file for review in the Circuit Court has been
18    given in writing to the Secretary or Assistant Secretary of
19    the Commission.
20        (2) No such summons shall issue unless the one against
21    whom the Commission shall have rendered an award for the
22    payment of money shall upon the filing of his written
23    request for such summons file with the clerk of the court a
24    bond conditioned that if he shall not successfully
25    prosecute the review, he will pay the award and the costs
26    of the proceedings in the courts. The amount of the bond

 

 

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1    shall be fixed by any member of the Commission and the
2    surety or sureties of the bond shall be approved by the
3    clerk of the court. The acceptance of the bond by the clerk
4    of the court shall constitute evidence of his approval of
5    the bond.
6        The State of Illinois, including its constitutional
7    officers, boards, commissions, agencies, public
8    institutions of higher learning, and funds administered by
9    the treasurer ex officio, and every Every county, city,
10    town, township, incorporated village, school district,
11    body politic or municipal corporation against whom the
12    Commission shall have rendered an award for the payment of
13    money shall not be required to file a bond to secure the
14    payment of the award and the costs of the proceedings in
15    the court to authorize the court to issue such summons.
16        The court may confirm or set aside the decision of the
17    Commission. If the decision is set aside and the facts
18    found in the proceedings before the Commission are
19    sufficient, the court may enter such decision as is
20    justified by law, or may remand the cause to the Commission
21    for further proceedings and may state the questions
22    requiring further hearing, and give such other
23    instructions as may be proper. Appeals shall be taken to
24    the Appellate Court in accordance with Supreme Court Rules
25    22(g) and 303. Appeals shall be taken from the Appellate
26    Court to the Supreme Court in accordance with Supreme Court

 

 

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1    Rule 315.
2        It shall be the duty of the clerk of any court
3    rendering a decision affecting or affirming an award of the
4    Commission to promptly furnish the Commission with a copy
5    of such decision, without charge.
6        The decision of a majority of the members of the panel
7    of the Commission, shall be considered the decision of the
8    Commission.
9    (g) Except in the case of a claim against the State of
10Illinois, either party may present a certified copy of the
11award of the Arbitrator, or a certified copy of the decision of
12the Commission when the same has become final, when no
13proceedings for review are pending, providing for the payment
14of compensation according to this Act, to the Circuit Court of
15the county in which such accident occurred or either of the
16parties are residents, whereupon the court shall enter a
17judgment in accordance therewith. In a case where the employer
18refuses to pay compensation according to such final award or
19such final decision upon which such judgment is entered the
20court shall in entering judgment thereon, tax as costs against
21him the reasonable costs and attorney fees in the arbitration
22proceedings and in the court entering the judgment for the
23person in whose favor the judgment is entered, which judgment
24and costs taxed as therein provided shall, until and unless set
25aside, have the same effect as though duly entered in an action
26duly tried and determined by the court, and shall with like

 

 

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1effect, be entered and docketed. The Circuit Court shall have
2power at any time upon application to make any such judgment
3conform to any modification required by any subsequent decision
4of the Supreme Court upon appeal, or as the result of any
5subsequent proceedings for review, as provided in this Act.
6    Judgment shall not be entered until 15 days' notice of the
7time and place of the application for the entry of judgment
8shall be served upon the employer by filing such notice with
9the Commission, which Commission shall, in case it has on file
10the address of the employer or the name and address of its
11agent upon whom notices may be served, immediately send a copy
12of the notice to the employer or such designated agent.
13    (h) An agreement or award under this Act providing for
14compensation in installments, may at any time within 18 months
15after such agreement or award be reviewed by the Commission at
16the request of either the employer or the employee, on the
17ground that the disability of the employee has subsequently
18recurred, increased, diminished or ended.
19    However, as to accidents occurring subsequent to July 1,
201955, which are covered by any agreement or award under this
21Act providing for compensation in installments made as a result
22of such accident, such agreement or award may at any time
23within 30 months, or 60 months in the case of an award under
24Section 8(d)1, after such agreement or award be reviewed by the
25Commission at the request of either the employer or the
26employee on the ground that the disability of the employee has

 

 

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1subsequently recurred, increased, diminished or ended.
2    On such review, compensation payments may be
3re-established, increased, diminished or ended. The Commission
4shall give 15 days' notice to the parties of the hearing for
5review. Any employee, upon any petition for such review being
6filed by the employer, shall be entitled to one day's notice
7for each 100 miles necessary to be traveled by him in attending
8the hearing of the Commission upon the petition, and 3 days in
9addition thereto. Such employee shall, at the discretion of the
10Commission, also be entitled to 5 cents per mile necessarily
11traveled by him within the State of Illinois in attending such
12hearing, not to exceed a distance of 300 miles, to be taxed by
13the Commission as costs and deposited with the petition of the
14employer.
15    When compensation which is payable in accordance with an
16award or settlement contract approved by the Commission, is
17ordered paid in a lump sum by the Commission, no review shall
18be had as in this paragraph mentioned.
19    (i) Each party, upon taking any proceedings or steps
20whatsoever before any Arbitrator, Commission or court, shall
21file with the Commission his address, or the name and address
22of any agent upon whom all notices to be given to such party
23shall be served, either personally or by registered mail,
24addressed to such party or agent at the last address so filed
25with the Commission. In the event such party has not filed his
26address, or the name and address of an agent as above provided,

 

 

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1service of any notice may be had by filing such notice with the
2Commission.
3    (j) Whenever in any proceeding testimony has been taken or
4a final decision has been rendered and after the taking of such
5testimony or after such decision has become final, the injured
6employee dies, then in any subsequent proceedings brought by
7the personal representative or beneficiaries of the deceased
8employee, such testimony in the former proceeding may be
9introduced with the same force and effect as though the witness
10having so testified were present in person in such subsequent
11proceedings and such final decision, if any, shall be taken as
12final adjudication of any of the issues which are the same in
13both proceedings.
14    (k) In case where there has been any unreasonable or
15vexatious delay of payment or intentional underpayment of
16compensation, or proceedings have been instituted or carried on
17by the one liable to pay the compensation, which do not present
18a real controversy, but are merely frivolous or for delay, then
19the Commission may award compensation additional to that
20otherwise payable under this Act equal to 50% of the amount
21payable at the time of such award. Failure to pay compensation
22in accordance with the provisions of Section 8, paragraph (b)
23of this Act, shall be considered unreasonable delay.
24    When determining whether this subsection (k) shall apply,
25the Commission shall consider whether an Arbitrator has
26determined that the claim is not compensable or whether the

 

 

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1employer has made payments under Section 8(j).
2    (k-1) In a case where there has been unreasonable or
3vexatious delay of authorization of medical treatment, the
4Commission may award compensation additional to that otherwise
5payable under this Act in the sum of $30 per day for each day
6that the benefits under Section 8(a) have been so withheld or
7refused, not to exceed $10,000 or the total amount due per
8Section 8.2 for treatment to be rendered whichever is less.
9    Unless utilization review under Section 8.7 or Section 12
10examination is, or has been, requested, a delay in
11authorization of 14 days or more from the employer's receipt of
12all appropriate records and data elements needed to allow the
13employer to make a determination whether to authorize such care
14shall create a rebuttable presumption of unreasonable delay.
15    This subsection (k-1) is the only penalty provision within
16the Act applicable to delay of authorization of medical
17treatment and shall apply only to health care services provided
18or proposed to be provided on or after the effective date of
19this amendatory Act of the 100th General Assembly.
20    (l) If the employee has made written demand for payment of
21benefits under Section 8(a) or Section 8(b), the employer shall
22have 14 days after receipt of the demand to set forth in
23writing the reason for the delay. In the case of demand for
24payment of medical benefits under Section 8(a), the time for
25the employer to respond shall not commence until the expiration
26of the allotted 30 days specified under Section 8.2(d). In case

 

 

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1the employer or his or her insurance carrier shall without good
2and just cause fail, neglect, refuse, or unreasonably delay the
3payment of benefits under Section 8(a) or Section 8(b), the
4Arbitrator or the Commission shall allow to the employee
5additional compensation in the sum of $30 per day for each day
6that the benefits under Section 8(a) or Section 8(b) have been
7so withheld or refused, not to exceed $10,000. A delay in
8payment of 14 days or more shall create a rebuttable
9presumption of unreasonable delay.
10    (m) If the commission finds that an accidental injury was
11directly and proximately caused by the employer's wilful
12violation of a health and safety standard under the Health and
13Safety Act or the Occupational Safety and Health Act in force
14at the time of the accident, the arbitrator or the Commission
15shall allow to the injured employee or his dependents, as the
16case may be, additional compensation equal to 25% of the amount
17which otherwise would be payable under the provisions of this
18Act exclusive of this paragraph. The additional compensation
19herein provided shall be allowed by an appropriate increase in
20the applicable weekly compensation rate.
21    (n) After June 30, 1984, decisions of the Illinois Workers'
22Compensation Commission reviewing an award of an arbitrator of
23the Commission shall draw interest at a rate equal to the yield
24on indebtedness issued by the United States Government with a
2526-week maturity next previously auctioned on the day on which
26the decision is filed. Said rate of interest shall be set forth

 

 

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1in the Arbitrator's Decision. Interest shall be drawn from the
2date of the arbitrator's award on all accrued compensation due
3the employee through the day prior to the date of payments.
4However, when an employee appeals an award of an Arbitrator or
5the Commission, and the appeal results in no change or a
6decrease in the award, interest shall not further accrue from
7the date of such appeal.
8    The employer or his insurance carrier may tender the
9payments due under the award to stop the further accrual of
10interest on such award notwithstanding the prosecution by
11either party of review, certiorari, appeal to the Supreme Court
12or other steps to reverse, vacate or modify the award.
13    (o) By the 15th day of each month each insurer providing
14coverage for losses under this Act shall notify each insured
15employer of any compensable claim incurred during the preceding
16month and the amounts paid or reserved on the claim including a
17summary of the claim and a brief statement of the reasons for
18compensability. A cumulative report of all claims incurred
19during a calendar year or continued from the previous year
20shall be furnished to the insured employer by the insurer
21within 30 days after the end of that calendar year.
22    The insured employer may challenge, in proceeding before
23the Commission, payments made by the insurer without
24arbitration and payments made after a case is determined to be
25noncompensable. If the Commission finds that the case was not
26compensable, the insurer shall purge its records as to that

 

 

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1employer of any loss or expense associated with the claim,
2reimburse the employer for attorneys' fees arising from the
3challenge and for any payment required of the employer to the
4Rate Adjustment Fund or the Second Injury Fund, and may not
5reflect the loss or expense for rate making purposes. The
6employee shall not be required to refund the challenged
7payment. The decision of the Commission may be reviewed in the
8same manner as in arbitrated cases. No challenge may be
9initiated under this paragraph more than 3 years after the
10payment is made. An employer may waive the right of challenge
11under this paragraph on a case by case basis.
12    (p) After filing an application for adjustment of claim but
13prior to the hearing on arbitration the parties may voluntarily
14agree to submit such application for adjustment of claim for
15decision by an arbitrator under this subsection (p) where such
16application for adjustment of claim raises only a dispute over
17temporary total disability, permanent partial disability or
18medical expenses. Such agreement shall be in writing in such
19form as provided by the Commission. Applications for adjustment
20of claim submitted for decision by an arbitrator under this
21subsection (p) shall proceed according to rule as established
22by the Commission. The Commission shall promulgate rules
23including, but not limited to, rules to ensure that the parties
24are adequately informed of their rights under this subsection
25(p) and of the voluntary nature of proceedings under this
26subsection (p). The findings of fact made by an arbitrator

 

 

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1acting within his or her powers under this subsection (p) in
2the absence of fraud shall be conclusive. However, the
3arbitrator may on his own motion, or the motion of either
4party, correct any clerical errors or errors in computation
5within 15 days after the date of receipt of such award of the
6arbitrator and shall have the power to recall the original
7award on arbitration, and issue in lieu thereof such corrected
8award. The decision of the arbitrator under this subsection (p)
9shall be considered the decision of the Commission and
10proceedings for review of questions of law arising from the
11decision may be commenced by either party pursuant to
12subsection (f) of Section 19. The Advisory Board established
13under Section 13.1 shall compile a list of certified Commission
14arbitrators, each of whom shall be approved by at least 7
15members of the Advisory Board. The chairman shall select 5
16persons from such list to serve as arbitrators under this
17subsection (p). By agreement, the parties shall select one
18arbitrator from among the 5 persons selected by the chairman
19except that if the parties do not agree on an arbitrator from
20among the 5 persons, the parties may, by agreement, select an
21arbitrator of the American Arbitration Association, whose fee
22shall be paid by the State in accordance with rules promulgated
23by the Commission. Arbitration under this subsection (p) shall
24be voluntary.
25(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
26eff. 1-1-15.)
 

 

 

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1    (820 ILCS 305/25.5)
2    Sec. 25.5. Unlawful acts; penalties.
3    (a) It is unlawful for any person, company, corporation,
4insurance carrier, healthcare provider, or other entity to:
5        (1) Intentionally present or cause to be presented any
6    false or fraudulent claim for the payment of any workers'
7    compensation benefit.
8        (2) Intentionally make or cause to be made any false or
9    fraudulent material statement or material representation
10    for the purpose of obtaining or denying any workers'
11    compensation benefit.
12        (3) Intentionally make or cause to be made any false or
13    fraudulent statements with regard to entitlement to
14    workers' compensation benefits with the intent to prevent
15    an injured worker from making a legitimate claim for any
16    workers' compensation benefits.
17        (4) Intentionally prepare or provide an invalid,
18    false, or counterfeit certificate of insurance as proof of
19    workers' compensation insurance.
20        (5) Intentionally make or cause to be made any false or
21    fraudulent material statement or material representation
22    for the purpose of obtaining workers' compensation
23    insurance at less than the proper amount rate for that
24    insurance.
25        (6) Intentionally make or cause to be made any false or

 

 

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1    fraudulent material statement or material representation
2    on an initial or renewal self-insurance application or
3    accompanying financial statement for the purpose of
4    obtaining self-insurance status or reducing the amount of
5    security that may be required to be furnished pursuant to
6    Section 4 of this Act.
7        (7) Intentionally make or cause to be made any false or
8    fraudulent material statement to the Department of
9    Insurance's fraud and insurance non-compliance unit in the
10    course of an investigation of fraud or insurance
11    non-compliance.
12        (8) Intentionally assist, abet, solicit, or conspire
13    with any person, company, or other entity to commit any of
14    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
15    of this subsection (a).
16        (9) Intentionally present a bill or statement for the
17    payment for medical services that were not provided.
18    For the purposes of paragraphs (2), (3), (5), (6), (7), and
19(9), the term "statement" includes any writing, notice, proof
20of injury, bill for services, hospital or doctor records and
21reports, or X-ray and test results.
22    (b) Sentences for violations of subsection (a) are as
23follows:
24        (1) A violation in which the value of the property
25    obtained or attempted to be obtained is $300 or less is a
26    Class A misdemeanor.

 

 

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1        (2) A violation in which the value of the property
2    obtained or attempted to be obtained is more than $300 but
3    not more than $10,000 is a Class 3 felony.
4        (3) A violation in which the value of the property
5    obtained or attempted to be obtained is more than $10,000
6    but not more than $100,000 is a Class 2 felony.
7        (4) A violation in which the value of the property
8    obtained or attempted to be obtained is more than $100,000
9    is a Class 1 felony.
10        (4.5) A violation of paragraph (3), (4), or (7) of
11    subsection (a) in which the offender did not attempt to
12    obtain any workers' compensation benefits or other
13    property of value is a Class A misdemeanor.
14        (4.7) A violation of paragraph (8) of subsection (a)
15    shall be subject to the same penalty as the offense to
16    which the offender assisted, abetted, solicited, or
17    conspired.
18        (5) A person convicted under this Section shall be
19    ordered to pay monetary restitution to the insurance
20    company or self-insured entity or any other person for any
21    financial loss sustained as a result of a violation of this
22    Section, including any court costs and attorney fees. An
23    order of restitution also includes expenses incurred and
24    paid by the State of Illinois or an insurance company or
25    self-insured entity in connection with any medical
26    evaluation or treatment services.

 

 

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1    For the purposes of this Section, where the exact value of
2property obtained or attempted to be obtained is either not
3alleged or is not specifically set by the terms of a policy of
4insurance, the value of the property shall be the fair market
5replacement value of the property claimed to be lost, the
6reasonable costs of reimbursing a vendor or other claimant for
7services to be rendered, or both. Notwithstanding the
8foregoing, an insurance company, self-insured entity, or any
9other person suffering financial loss sustained as a result of
10violation of this Section may seek restitution, including court
11costs and attorney's fees in a civil action in a court of
12competent jurisdiction.
13    (c) The Department of Insurance shall establish a fraud and
14insurance non-compliance unit responsible for investigating
15incidences of fraud and insurance non-compliance pursuant to
16this Section. The size of the staff of the unit shall be
17subject to appropriation by the General Assembly. It shall be
18the duty of the fraud and insurance non-compliance unit to
19determine the identity of insurance carriers, employers,
20employees, or other persons or entities who have violated the
21fraud and insurance non-compliance provisions of this Section.
22The fraud and insurance non-compliance unit shall report
23violations of the fraud and insurance non-compliance
24provisions of this Section to the Special Prosecutions Bureau
25of the Criminal Division of the Office of the Attorney General
26or to the State's Attorney of the county in which the offense

 

 

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1allegedly occurred, either of whom has the authority to
2prosecute violations under this Section.
3    With respect to the subject of any investigation being
4conducted, the fraud and insurance non-compliance unit shall
5have the general power of subpoena of the Department of
6Insurance, including the authority to issue a subpoena to a
7medical provider, pursuant to Section 8-802 of the Code of
8Civil Procedure.
9    (d) Any person may report allegations of insurance
10non-compliance and fraud pursuant to this Section to the
11Department of Insurance's fraud and insurance non-compliance
12unit whose duty it shall be to investigate the report. The unit
13shall notify the Commission of reports of insurance
14non-compliance. Any person reporting an allegation of
15insurance non-compliance or fraud against either an employee or
16employer under this Section must identify himself. Except as
17provided in this subsection and in subsection (e), all reports
18shall remain confidential except to refer an investigation to
19the Attorney General or State's Attorney for prosecution or if
20the fraud and insurance non-compliance unit's investigation
21reveals that the conduct reported may be in violation of other
22laws or regulations of the State of Illinois, the unit may
23report such conduct to the appropriate governmental agency
24charged with administering such laws and regulations. Any
25person who intentionally makes a false report under this
26Section to the fraud and insurance non-compliance unit is

 

 

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1guilty of a Class A misdemeanor.
2    (e) In order for the fraud and insurance non-compliance
3unit to investigate a report of fraud related to an employee's
4claim, (i) the employee must have filed with the Commission an
5Application for Adjustment of Claim and the employee must have
6either received or attempted to receive benefits under this Act
7that are related to the reported fraud or (ii) the employee
8must have made a written demand for the payment of benefits
9that are related to the reported fraud. There shall be no
10immunity, under this Act or otherwise, for any person who files
11a false report or who files a report without good and just
12cause. Confidentiality of medical information shall be
13strictly maintained. Investigations that are not referred for
14prosecution shall be destroyed upon the expiration of the
15statute of limitations for the acts under investigation and
16shall not be disclosed except that the person making the report
17shall be notified that the investigation is being closed. It is
18unlawful for any employer, insurance carrier, service
19adjustment company, third party administrator, self-insured,
20or similar entity to file or threaten to file a report of fraud
21against an employee because of the exercise by the employee of
22the rights and remedies granted to the employee by this Act.
23    (e-5) The fraud and insurance non-compliance unit shall
24procure and implement a system utilizing advanced analytics
25inclusive of predictive modeling, data mining, social network
26analysis, and scoring algorithms for the detection and

 

 

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1prevention of fraud, waste, and abuse on or before January 1,
22012. The fraud and insurance non-compliance unit shall procure
3this system using a request for proposals process governed by
4the Illinois Procurement Code and rules adopted under that
5Code. The fraud and insurance non-compliance unit shall provide
6a report to the President of the Senate, Speaker of the House
7of Representatives, Minority Leader of the House of
8Representatives, Minority Leader of the Senate, Governor,
9Chairman of the Commission, and Director of Insurance on or
10before July 1, 2012 and annually thereafter detailing its
11activities and providing recommendations regarding
12opportunities for additional fraud waste and abuse detection
13and prevention.
14    (e-7) By July 1, 2017 and thereafter, the fraud and
15insurance non-compliance unit shall employ at least 10
16investigators to investigate insurance non-compliance and
17fraud pursuant to this Section.
18    (f) Any person convicted of fraud related to workers'
19compensation pursuant to this Section shall be subject to the
20penalties prescribed in the Criminal Code of 2012 and shall be
21ineligible to receive or retain any compensation, disability,
22or medical benefits as defined in this Act if the compensation,
23disability, or medical benefits were owed or received as a
24result of fraud for which the recipient of the compensation,
25disability, or medical benefit was convicted. This subsection
26applies to accidental injuries or diseases that occur on or

 

 

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1after the effective date of this amendatory Act of the 94th
2General Assembly.
3    (g) Civil liability. Any person convicted of fraud who
4knowingly obtains, attempts to obtain, or causes to be obtained
5any benefits under this Act by the making of a false claim or
6who knowingly misrepresents any material fact shall be civilly
7liable to the payor of benefits or the insurer or the payor's
8or insurer's subrogee or assignee in an amount equal to 3 times
9the value of the benefits or insurance coverage wrongfully
10obtained or twice the value of the benefits or insurance
11coverage attempted to be obtained, plus reasonable attorney's
12fees and expenses incurred by the payor or the payor's subrogee
13or assignee who successfully brings a claim under this
14subsection. This subsection applies to accidental injuries or
15diseases that occur on or after the effective date of this
16amendatory Act of the 94th General Assembly.
17    (h) The fraud and insurance non-compliance unit shall
18submit a written report on an annual basis to the Chairman of
19the Commission, the Workers' Compensation Advisory Board, the
20General Assembly, the Governor, and the Attorney General by
21January 1 and July 1 of each year. This report shall include,
22at the minimum, the following information:
23        (1) The number of allegations of insurance
24    non-compliance and fraud reported to the fraud and
25    insurance non-compliance unit.
26        (2) The source of the reported allegations

 

 

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1    (individual, employer, or other).
2        (3) The number of allegations investigated by the fraud
3    and insurance non-compliance unit.
4        (4) The number of criminal referrals made in accordance
5    with this Section and the entity to which the referral was
6    made.
7        (5) All proceedings under this Section.
8(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
 
9    (820 ILCS 305/29.2)
10    Sec. 29.2. Insurance and self-insurance oversight.
11    (a) The Department of Insurance shall annually submit to
12the Governor, the Chairman of the Commission, the President of
13the Senate, the Speaker of the House of Representatives, the
14Minority Leader of the Senate, and the Minority Leader of the
15House of Representatives a written report that details the
16state of the workers' compensation insurance market in
17Illinois. The report shall be completed by April 1 of each
18year, beginning in 2012, or later if necessary data or analyses
19are only available to the Department at a later date. The
20report shall be posted on the Department of Insurance's
21Internet website. Information to be included in the report
22shall be for the preceding calendar year. The report shall
23include, at a minimum, the following:
24        (1) Gross premiums collected by workers' compensation
25    carriers in Illinois and the national rank of Illinois

 

 

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1    based on premium volume.
2        (2) The number of insurance companies actively engaged
3    in Illinois in the workers' compensation insurance market,
4    including both holding companies and subsidiaries or
5    affiliates, and the national rank of Illinois based on
6    number of competing insurers.
7        (3) The total number of insured participants in the
8    Illinois workers' compensation assigned risk insurance
9    pool, and the size of the assigned risk pool as a
10    proportion of the total Illinois workers' compensation
11    insurance market.
12        (4) The advisory organization premium rate for
13    workers' compensation insurance in Illinois for the
14    previous year.
15        (5) The advisory organization prescribed assigned risk
16    pool premium rate.
17        (6) The total amount of indemnity payments made by
18    workers' compensation insurers in Illinois.
19        (7) The total amount of medical payments made by
20    workers' compensation insurers in Illinois, and the
21    national rank of Illinois based on average cost of medical
22    claims per injured worker.
23        (8) The gross profitability of workers' compensation
24    insurers in Illinois, and the national rank of Illinois
25    based on profitability of workers' compensation insurers.
26        (9) The loss ratio of workers' compensation insurers in

 

 

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1    Illinois and the national rank of Illinois based on the
2    loss ratio of workers' compensation insurers. For purposes
3    of this loss ratio calculation, the denominator shall
4    include all premiums and other fees collected by workers'
5    compensation insurers and the numerator shall include the
6    total amount paid by the insurer for care or compensation
7    to injured workers.
8        (10) The growth of total paid indemnity benefits by
9    temporary total disability, scheduled and non-scheduled
10    permanent partial disability, and total disability.
11        (11) The number of injured workers receiving wage loss
12    differential awards and the average wage loss differential
13    award payout.
14        (12) Illinois' rank, relative to other states, for:
15            (i) the maximum and minimum temporary total
16        disability benefit level;
17            (ii) the maximum and minimum scheduled and
18        non-scheduled permanent partial disability benefit
19        level;
20            (iii) the maximum and minimum total disability
21        benefit level; and
22            (iv) the maximum and minimum death benefit level.
23        (13) The aggregate growth of medical benefit payout by
24    non-hospital providers and hospitals.
25        (14) The aggregate growth of medical utilization for
26    the top 10 most common injuries to specific body parts by

 

 

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1    non-hospital providers and hospitals.
2        (15) The percentage of injured workers filing claims at
3    the Commission that are represented by an attorney.
4        (16) The total amount paid by injured workers for
5    attorney representation.
6    (a-5) The Commission shall annually submit to the Governor
7and the General Assembly a written report that details the
8state of self-insurance for workers' compensation in Illinois.
9The report shall be based on the types of information collected
10by the Commission or the Department of Insurance from
11self-insurers, as of the effective date of this amendatory Act
12of the 100th General Assembly. The report shall be completed by
13April 1 of each year, beginning in 2017. The report shall be
14posted on the Commission's Internet website. Information to be
15included in the report shall be for the preceding calendar
16year. The report shall include, at a minimum, the following in
17the aggregate:
18        (1) The number of employers that self-insure for
19    workers' compensation;
20        (2) The total number of employees covered by
21    self-insurance;
22        (3) The total amount of indemnity payments made by
23    self-insureds;
24        (4) The total number of claims on which indemnity
25    payments were made by self-insureds;
26        (5) The total amount of medical payments made by

 

 

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1    self-insureds;
2        (6) The total number of claims on which medical
3    payments were made by self-insureds;
4        (7) The total number of claims on which both indemnity
5    and medical payments were made by self-insureds;
6        (8) The median of the injured workers' weekly wage of
7    self-insureds employees;
8        (9) The growth of total paid indemnity benefits by
9    temporary total disability, scheduled and non-scheduled
10    permanent partial disability, and total disability;
11        (10) Illinois' rank, relative to other states, for:
12            (i) the maximum and minimum temporary total
13        disability benefit levels;
14            (ii) the maximum and minimum scheduled and
15        non-scheduled permanent partial disability benefit
16        levels;
17            (iii) the maximum and minimum total disability
18        benefit levels; and
19            (iv) the maximum and minimum death benefit levels;
20        and
21        (11) The aggregate growth of medical benefit payouts by
22    non-hospital providers and hospitals.
23    (b) The Director of Insurance shall promulgate rules
24requiring each insurer licensed to write workers' compensation
25coverage in the State to record and report the following
26information on an aggregate basis to the Department of

 

 

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1Insurance before March 1 of each year, relating to claims in
2the State opened within the prior calendar year:
3        (1) The number of claims opened.
4        (2) The number of reported medical only claims.
5        (3) The number of contested claims.
6        (4) The number of claims for which the employee has
7    attorney representation.
8        (5) The number of claims with lost time and the number
9    of claims for which temporary total disability was paid.
10        (6) The number of claim adjusters employed to adjust
11    workers' compensation claims.
12        (7) The number of claims for which temporary total
13    disability was not paid within 14 days from the first full
14    day off, regardless of reason.
15        (8) The number of medical bills paid 60 days or later
16    from date of service and the average days paid on those
17    paid after 60 days for the previous calendar year.
18        (9) The number of claims in which in-house defense
19    counsel participated, and the total amount spent on
20    in-house legal services.
21        (10) The number of claims in which outside defense
22    counsel participated, and the total amount paid to outside
23    defense counsel.
24        (11) The total amount billed to employers for bill
25    review.
26        (12) The total amount billed to employers for fee

 

 

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1    schedule savings.
2        (13) The total amount charged to employers for any and
3    all managed care fees.
4        (14) The number of claims involving in-house medical
5    nurse case management, and the total amount spent on
6    in-house medical nurse case management.
7        (15) The number of claims involving outside medical
8    nurse case management, and the total amount paid for
9    outside medical nurse case management.
10        (16) The total amount paid for Independent Medical
11    exams.
12        (17) The total amount spent on in-house Utilization
13    Review for the previous calendar year.
14        (18) The total amount paid for outside Utilization
15    Review for the previous calendar year.
16    The Department shall make the submitted information
17publicly available on the Department's Internet website or such
18other media as appropriate in a form useful for consumers.
19(Source: P.A. 97-18, eff. 6-28-11.)
 
20    (820 ILCS 305/29.3 new)
21    Sec. 29.3. Workers' Compensation Premium Rates Task Force.
22    (a) There is created the Workers' Compensation Premium
23Rates Task Force consisting of 12 members appointed as follows:
242 legislative members appointed by the Speaker of the House of
25Representatives; 2 legislative members appointed by the

 

 

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1Minority Leader of the House of Representatives; 2 legislative
2members appointed by the President of the Senate; 2 legislative
3members appointed by the Minority Leader of the Senate; and one
4member appointed by the Governor from each of the following
5organizations: (i) a statewide association representing
6retailers; (ii) a statewide association representing
7manufacturers; (iii) a statewide association representing
8labor interests; and (iv) a statewide association representing
9injured workers. The members of the Task Force shall be
10appointed by April 1, 2017. Two co-chairpersons, representing
11different political parties, shall be selected by the members
12of the Task Force. Members of the Task Force shall receive no
13compensation for their service on the Task Force.
14    (b) The Task Force shall study the National Council on
15Compensation Insurance's recommendations for workers'
16compensation premium rates, the extent to which Illinois
17employers' actual premiums reflect these recommended rates.
18The Task Force shall also study the feasibility of establishing
19a competitive nonprofit, independent public corporation to
20provide workers' compensation insurance and the impact that the
21corporation would have on insurance rates and premiums. The
22Department of Insurance shall provide administrative support
23to the Task Force.
24    (c) The Task Force shall report its findings and
25recommendations to the General Assembly no later than December
2631, 2017.

 

 

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1    (d) This Section is repealed December 31, 2018.
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    215 ILCS 5/456from Ch. 73, par. 1065.3
4    215 ILCS 5/457from Ch. 73, par. 1065.4
5    215 ILCS 5/458from Ch. 73, par. 1065.5
6    215 ILCS 5/462a new
7    215 ILCS 5/460 rep.
8    820 ILCS 305/1from Ch. 48, par. 138.1
9    820 ILCS 305/4e new
10    820 ILCS 305/8from Ch. 48, par. 138.8
11    820 ILCS 305/8.1 new
12    820 ILCS 305/8.1b
13    820 ILCS 305/8.2a
14    820 ILCS 305/14from Ch. 48, par. 138.14
15    820 ILCS 305/19from Ch. 48, par. 138.19
16    820 ILCS 305/25.5
17    820 ILCS 305/29.2
18    820 ILCS 305/29.3 new