Full Text of HB2947 102nd General Assembly
HB2947eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Department of Insurance Law of the
Civil | 5 | | Administrative Code of Illinois is amended by adding Section | 6 | | 1405-40 as follows: | 7 | | (20 ILCS 1405/1405-40 new) | 8 | | Sec. 1405-40. Transfer of functions. | 9 | | (a) On the effective date of this amendatory Act of the | 10 | | 102nd General Assembly, all powers, duties, rights, and | 11 | | responsibilities of the Insurance Compliance Division within | 12 | | the Illinois Workers' Compensation Commission are transferred | 13 | | to the Department of Insurance. The personnel of the Insurance | 14 | | Compliance Division are transferred to the Department of | 15 | | Insurance. The status and rights of such personnel under the | 16 | | Personnel Code are not affected by the transfer. The rights of | 17 | | the employees and the State of Illinois and its agencies under | 18 | | the Personnel Code and applicable collective bargaining | 19 | | agreements or under any pension, retirement, or annuity plan | 20 | | are not affected by this amendatory Act of the 102nd General | 21 | | Assembly. All books, records, papers, documents, property | 22 | | (real and personal), contracts, causes of action, and pending | 23 | | business pertaining to the powers, duties, rights, and |
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| 1 | | responsibilities transferred by this amendatory Act of the | 2 | | 102nd General Assembly from the Insurance Compliance Division | 3 | | to the Department of Insurance, including, but not limited to, | 4 | | material in electronic or magnetic format and necessary | 5 | | computer hardware and software, are transferred to the | 6 | | Department of Insurance. The powers, duties, rights, and | 7 | | responsibilities relating to the Insurance Compliance Division | 8 | | transferred by this amendatory Act of the 102nd General | 9 | | Assembly are vested in the Department of Insurance. | 10 | | (b) Whenever reports or notices are required to be made or | 11 | | given or papers or documents furnished or served by any person | 12 | | to or upon the Insurance Compliance Division in connection | 13 | | with any of the powers, duties, rights, and responsibilities | 14 | | transferred by this amendatory Act of the 102nd General | 15 | | Assembly, the Department of Insurance shall make, give, | 16 | | furnish, or serve them. | 17 | | (c) This amendatory Act of the 102nd General Assembly does | 18 | | not affect any act done, ratified, or canceled, any right | 19 | | occurring or established, or any action or proceeding had or | 20 | | commenced in an administrative, civil, or criminal cause by | 21 | | the Insurance Compliance Division before the effective date of | 22 | | this amendatory Act of the 102nd General Assembly. Such | 23 | | actions or proceedings may be prosecuted and continued by the | 24 | | Department of Insurance. | 25 | | (d) Any rules that relate to its powers, duties, rights, | 26 | | and responsibilities of the Insurance Compliance Division and |
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| 1 | | are in force on the effective date of this amendatory Act of | 2 | | the 102nd General Assembly become the rules of the Department | 3 | | of Insurance. This amendatory Act of the 102nd General | 4 | | Assembly does not affect the legality of any such rules. | 5 | | (e) Any proposed rules filed with the Secretary of State | 6 | | by the Illinois Workers' Compensation Commission that are | 7 | | pending in the rulemaking process on the effective date of | 8 | | this amendatory Act of the 102nd General Assembly and pertain | 9 | | to the transferred powers, duties, rights, and | 10 | | responsibilities are deemed to have been filed by the | 11 | | Department of Insurance. As soon as practicable, the | 12 | | Department of Insurance shall revise and clarify the rules | 13 | | transferred to it under this amendatory Act of the 102nd | 14 | | General Assembly to reflect the reorganization of powers, | 15 | | duties, rights, and responsibilities affected by this | 16 | | amendatory Act of the 102nd General Assembly, using the | 17 | | procedures for recodification of rules available under the | 18 | | Illinois Administrative Procedure Act, except that existing | 19 | | title, part, and section numbering for the affected rules may | 20 | | be retained. The Department of Insurance may propose and adopt | 21 | | under the Illinois Administrative Procedure Act other rules of | 22 | | the Illinois Workers' Compensation Commission pertaining to | 23 | | this amendatory Act of the 102nd General Assembly that are | 24 | | administered by the Department of Insurance. | 25 | | Section 10. The Workers' Compensation Act is amended by |
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| 1 | | changing Sections 4, 25.5, and 29.2 as follows:
| 2 | | (820 ILCS 305/4) (from Ch. 48, par. 138.4)
| 3 | | (Text of Section from P.A. 101-40) | 4 | | Sec. 4. (a) Any employer, including but not limited to | 5 | | general contractors
and their subcontractors, who shall come | 6 | | within the provisions of
Section 3 of this Act, and any other | 7 | | employer who shall elect to provide
and pay the compensation | 8 | | provided for in this Act shall:
| 9 | | (1) File with the Commission annually an application | 10 | | for approval as a
self-insurer which shall include a | 11 | | current financial statement, and
annually, thereafter, an | 12 | | application for renewal of self-insurance, which
shall | 13 | | include a current financial statement. Said
application | 14 | | and financial statement shall be signed and sworn to by | 15 | | the
president or vice president and secretary or assistant | 16 | | secretary of the
employer if it be a corporation, or by all | 17 | | of the partners, if it be a
copartnership, or by the owner | 18 | | if it be neither a copartnership nor a
corporation. All | 19 | | initial applications and all applications for renewal of
| 20 | | self-insurance must be submitted at least 60 days prior to | 21 | | the requested
effective date of self-insurance. An | 22 | | employer may elect to provide and pay
compensation as | 23 | | provided
for in this Act as a member of a group workers' | 24 | | compensation pool under Article
V 3/4 of the Illinois | 25 | | Insurance Code. If an employer becomes a member of a
group |
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| 1 | | workers' compensation pool, the employer shall not be | 2 | | relieved of any
obligations imposed by this Act.
| 3 | | If the sworn application and financial statement of | 4 | | any such employer
does not satisfy the Commission of the | 5 | | financial ability of the employer
who has filed it, the | 6 | | Commission shall require such employer to,
| 7 | | (2) Furnish security, indemnity or a bond guaranteeing | 8 | | the payment
by the employer of the compensation provided | 9 | | for in this Act, provided
that any such employer whose | 10 | | application and financial statement shall
not have | 11 | | satisfied the commission of his or her financial ability | 12 | | and
who shall have secured his liability in part by excess | 13 | | liability insurance
shall be required to furnish to the | 14 | | Commission security, indemnity or bond
guaranteeing his or | 15 | | her payment up to the effective limits of the excess
| 16 | | coverage, or
| 17 | | (3) Insure his entire liability to pay such | 18 | | compensation in some
insurance carrier authorized, | 19 | | licensed, or permitted to do such
insurance business in | 20 | | this State. Every policy of an insurance carrier,
insuring | 21 | | the payment of compensation under this Act shall cover all | 22 | | the
employees and the entire compensation liability of the | 23 | | insured:
Provided, however, that any employer may insure | 24 | | his or her compensation
liability with 2 or more insurance | 25 | | carriers or may insure a part and
qualify under subsection | 26 | | 1, 2, or 4 for the remainder of his or her
liability to pay |
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| 1 | | such compensation, subject to the following two | 2 | | provisions:
| 3 | | Firstly, the entire compensation liability of the | 4 | | employer to
employees working at or from one location | 5 | | shall be insured in one such
insurance carrier or | 6 | | shall be self-insured, and
| 7 | | Secondly, the employer shall submit evidence | 8 | | satisfactorily to the
Commission that his or her | 9 | | entire liability for the compensation provided
for in | 10 | | this Act will be secured. Any provisions in any | 11 | | policy, or in any
endorsement attached thereto, | 12 | | attempting to limit or modify in any way,
the | 13 | | liability of the insurance carriers issuing the same | 14 | | except as
otherwise provided herein shall be wholly | 15 | | void.
| 16 | | Nothing herein contained shall apply to policies of | 17 | | excess liability
carriage secured by employers who have | 18 | | been approved by the Commission
as self-insurers, or
| 19 | | (4) Make some other provision, satisfactory to the | 20 | | Commission, for
the securing of the payment of | 21 | | compensation provided for in this Act,
and
| 22 | | (5) Upon becoming subject to this Act and thereafter | 23 | | as often as the
Commission may in writing demand, file | 24 | | with the Commission in form prescribed
by it evidence of | 25 | | his or her compliance with the provision of this Section.
| 26 | | (a-1) Regardless of its state of domicile or its principal |
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| 1 | | place of
business, an employer shall make payments to its | 2 | | insurance carrier or group
self-insurance fund, where | 3 | | applicable, based upon the premium rates of the
situs where | 4 | | the work or project is located in Illinois if:
| 5 | | (A) the employer is engaged primarily in the building | 6 | | and
construction industry; and
| 7 | | (B) subdivision (a)(3) of this Section applies to the | 8 | | employer or
the employer is a member of a group | 9 | | self-insurance plan as defined in
subsection (1) of | 10 | | Section 4a.
| 11 | | The Illinois Workers' Compensation Commission shall impose | 12 | | a penalty upon an employer
for violation of this subsection | 13 | | (a-1) if:
| 14 | | (i) the employer is given an opportunity at a hearing | 15 | | to present
evidence of its compliance with this subsection | 16 | | (a-1); and
| 17 | | (ii) after the hearing, the Commission finds that the | 18 | | employer
failed to make payments upon the premium rates of | 19 | | the situs where the work or
project is located in | 20 | | Illinois.
| 21 | | The penalty shall not exceed $1,000 for each day of work | 22 | | for which
the employer failed to make payments upon the | 23 | | premium rates of the situs where
the
work or project is located | 24 | | in Illinois, but the total penalty shall not exceed
$50,000 | 25 | | for each project or each contract under which the work was
| 26 | | performed.
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| 1 | | Any penalty under this subsection (a-1) must be imposed | 2 | | not later
than one year after the expiration of the applicable | 3 | | limitation period
specified in subsection (d) of Section 6 of | 4 | | this Act. Penalties imposed under
this subsection (a-1) shall | 5 | | be deposited into the Illinois Workers' Compensation | 6 | | Commission
Operations Fund, a special fund that is created in | 7 | | the State treasury. Subject
to appropriation, moneys in the | 8 | | Fund shall be used solely for the operations
of the Illinois | 9 | | Workers' Compensation Commission, the salaries and benefits of | 10 | | the Self-Insurers Advisory Board employees, the operating | 11 | | costs of the Self-Insurers Advisory Board, and by the | 12 | | Department of Insurance for the purposes authorized in | 13 | | subsection (c) of Section 25.5 of this Act.
| 14 | | (a-2) Every Employee Leasing Company (ELC), as defined in | 15 | | Section 15 of the Employee Leasing Company Act, shall at a | 16 | | minimum provide the following information to the Commission or | 17 | | any entity designated by the Commission regarding each | 18 | | workers' compensation insurance policy issued to the ELC: | 19 | | (1) Any client company of the ELC listed as an | 20 | | additional named insured. | 21 | | (2) Any informational schedule attached to the master | 22 | | policy that identifies any individual client company's | 23 | | name, FEIN, and job location. | 24 | | (3) Any certificate of insurance coverage document | 25 | | issued to a client company specifying its rights and | 26 | | obligations under the master policy that establishes both |
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| 1 | | the identity and status of the client, as well as the dates | 2 | | of inception and termination of coverage, if applicable. | 3 | | (b) The sworn application and financial statement, or | 4 | | security,
indemnity or bond, or amount of insurance, or other | 5 | | provisions, filed,
furnished, carried, or made by the | 6 | | employer, as the case may be, shall
be subject to the approval | 7 | | of the Commission.
| 8 | | Deposits under escrow agreements shall be cash, negotiable | 9 | | United
States government bonds or negotiable general | 10 | | obligation bonds of the
State of Illinois. Such cash or bonds | 11 | | shall be deposited in
escrow with any State or National Bank or | 12 | | Trust Company having trust
authority in the State of Illinois.
| 13 | | Upon the approval of the sworn application and financial | 14 | | statement,
security, indemnity or bond or amount of insurance, | 15 | | filed, furnished or
carried, as the case may be, the | 16 | | Commission shall send to the employer
written notice of its | 17 | | approval thereof. The certificate of compliance
by the | 18 | | employer with the provisions of subparagraphs (2) and (3) of
| 19 | | paragraph (a) of this Section shall be delivered by the | 20 | | insurance
carrier to the Illinois Workers' Compensation | 21 | | Commission within five days after the
effective date of the | 22 | | policy so certified. The insurance so certified
shall cover | 23 | | all compensation liability occurring during the time that
the | 24 | | insurance is in effect and no further certificate need be | 25 | | filed in case
such insurance is renewed, extended or otherwise | 26 | | continued by such
carrier. The insurance so certified shall |
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| 1 | | not be cancelled or in the
event that such insurance is not | 2 | | renewed, extended or otherwise
continued, such insurance shall | 3 | | not be terminated until at least 10
days after receipt by the | 4 | | Illinois Workers' Compensation Commission of notice of the
| 5 | | cancellation or termination of said insurance; provided, | 6 | | however, that
if the employer has secured insurance from | 7 | | another insurance carrier, or
has otherwise secured the | 8 | | payment of compensation in accordance with
this Section, and | 9 | | such insurance or other security becomes effective
prior to | 10 | | the expiration of the 10 days, cancellation or termination | 11 | | may, at
the option of the insurance carrier indicated in such | 12 | | notice, be effective
as of the effective date of such other | 13 | | insurance or security.
| 14 | | (c) Whenever the Commission shall find that any | 15 | | corporation,
company, association, aggregation of individuals, | 16 | | reciprocal or
interinsurers exchange, or other insurer | 17 | | effecting workers' compensation
insurance in this State shall | 18 | | be insolvent, financially unsound, or
unable to fully meet all | 19 | | payments and liabilities assumed or to be
assumed for | 20 | | compensation insurance in this State, or shall practice a
| 21 | | policy of delay or unfairness toward employees in the | 22 | | adjustment,
settlement, or payment of benefits due such | 23 | | employees, the Commission
may after reasonable notice and | 24 | | hearing order and direct that such
corporation, company, | 25 | | association, aggregation of individuals,
reciprocal or | 26 | | interinsurers exchange, or insurer, shall from and after a
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| 1 | | date fixed in such order discontinue the writing of any such | 2 | | workers'
compensation insurance in this State. Subject to such | 3 | | modification of
the order as the Commission may later make on | 4 | | review of the order,
as herein provided, it shall thereupon be | 5 | | unlawful for any such
corporation, company, association, | 6 | | aggregation of individuals,
reciprocal or interinsurers | 7 | | exchange, or insurer to effect any workers'
compensation | 8 | | insurance in this State. A copy of the order shall be served
| 9 | | upon the Director of Insurance by registered mail. Whenever | 10 | | the Commission
finds that any service or adjustment company | 11 | | used or employed
by a self-insured employer or by an insurance | 12 | | carrier to process,
adjust, investigate, compromise or | 13 | | otherwise handle claims under this
Act, has practiced or is | 14 | | practicing a policy of delay or unfairness
toward employees in | 15 | | the adjustment, settlement or payment of benefits
due such | 16 | | employees, the Commission may after reasonable notice and
| 17 | | hearing order and direct that such service or adjustment | 18 | | company shall
from and after a date fixed in such order be | 19 | | prohibited from processing,
adjusting, investigating, | 20 | | compromising or otherwise handling claims
under this Act.
| 21 | | Whenever the Commission finds that any self-insured | 22 | | employer has
practiced or is practicing delay or unfairness | 23 | | toward employees in the
adjustment, settlement or payment of | 24 | | benefits due such employees, the
Commission may, after | 25 | | reasonable notice and hearing, order and direct
that after a | 26 | | date fixed in the order such self-insured employer shall be
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| 1 | | disqualified to operate as a self-insurer and shall be | 2 | | required to
insure his entire liability to pay compensation in | 3 | | some insurance
carrier authorized, licensed and permitted to | 4 | | do such insurance business
in this State, as provided in | 5 | | subparagraph 3 of paragraph (a) of this
Section.
| 6 | | All orders made by the Commission under this Section shall | 7 | | be subject
to review by the courts, said review to be taken in | 8 | | the same manner and
within the same time as provided by Section | 9 | | 19 of this Act for review of
awards and decisions of the | 10 | | Commission, upon the party seeking the
review filing with the | 11 | | clerk of the court to which said review is taken
a bond in an | 12 | | amount to be fixed and approved by the court to which the
| 13 | | review is taken, conditioned upon the payment of all | 14 | | compensation awarded
against the person taking said review | 15 | | pending a decision thereof and
further conditioned upon such | 16 | | other obligations as the court may impose.
Upon the review the | 17 | | Circuit Court shall have power to review all questions
of fact | 18 | | as well as of law. The penalty hereinafter provided for in this
| 19 | | paragraph shall not attach and shall not begin to run until the | 20 | | final
determination of the order of the Commission.
| 21 | | (d) Whenever a Commissioner, with due process and after a | 22 | | hearing, determines an employer has knowingly failed to | 23 | | provide coverage as required by paragraph (a) of this Section, | 24 | | the failure shall be deemed an immediate serious danger to | 25 | | public health, safety, and welfare sufficient to justify | 26 | | service by the Commission of a work-stop order on such |
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| 1 | | employer, requiring the cessation of all business operations | 2 | | of such employer at the place of employment or job site. If a | 3 | | business is declared to be extra hazardous, as defined in | 4 | | Section 3, a Commissioner may issue an emergency work-stop | 5 | | order on such an employer ex parte, prior to holding a hearing, | 6 | | requiring the cessation of all business operations of such | 7 | | employer at the place of employment or job site while awaiting | 8 | | the ruling of the Commission. Whenever a Commissioner issues | 9 | | an emergency work-stop order, the Commission shall issue a | 10 | | notice of emergency work-stop hearing to be posted at the | 11 | | employer's places of employment and job sites. Any law | 12 | | enforcement agency in the State shall, at the request of the | 13 | | Commission, render any assistance necessary to carry out the | 14 | | provisions of this Section, including, but not limited to, | 15 | | preventing any employee of such employer from remaining at a | 16 | | place of employment or job site after a work-stop order has | 17 | | taken effect. Any work-stop order shall be lifted upon proof | 18 | | of insurance as required by this Act. Any orders under this | 19 | | Section are appealable under Section 19(f) to the Circuit | 20 | | Court.
| 21 | | Any individual employer, corporate officer or director of | 22 | | a corporate employer, partner of an employer partnership, or | 23 | | member of an employer limited liability company who knowingly | 24 | | fails to provide coverage as required by paragraph (a) of this | 25 | | Section is guilty of a Class 4 felony. This provision shall not | 26 | | apply to any corporate officer or director of any |
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| 1 | | publicly-owned corporation. Each day's violation constitutes a | 2 | | separate offense. The State's Attorney of the county in which | 3 | | the violation occurred, or the Attorney General, shall bring | 4 | | such actions in the name of the People of the State of | 5 | | Illinois, or may, in addition to other remedies provided in | 6 | | this Section, bring an action for an injunction to restrain | 7 | | the violation or to enjoin the operation of any such employer.
| 8 | | Any individual employer, corporate officer or director of | 9 | | a corporate employer, partner of an employer partnership, or | 10 | | member of an employer limited liability company who | 11 | | negligently fails to provide coverage as required by paragraph | 12 | | (a) of this Section is guilty of a Class A misdemeanor. This | 13 | | provision shall not apply to any corporate officer or director | 14 | | of any publicly-owned corporation. Each day's violation | 15 | | constitutes a separate offense. The State's Attorney of the | 16 | | county in which the violation occurred, or the Attorney | 17 | | General, shall bring such actions in the name of the People of | 18 | | the State of Illinois.
| 19 | | The criminal penalties in this subsection (d) shall not | 20 | | apply where
there exists a good faith dispute as to the | 21 | | existence of an
employment relationship. Evidence of good | 22 | | faith shall
include, but not be limited to, compliance with | 23 | | the definition
of employee as used by the Internal Revenue | 24 | | Service.
| 25 | | All investigative actions must be acted upon within 90 | 26 | | days of the issuance of the complaint. Employers who are |
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| 1 | | subject to and who knowingly fail to comply with this Section | 2 | | shall not be entitled to the benefits of this Act during the | 3 | | period of noncompliance, but shall be liable in an action | 4 | | under any other applicable law of this State. In the action, | 5 | | such employer shall not avail himself or herself of the | 6 | | defenses of assumption of risk or negligence or that the | 7 | | injury was due to a co-employee. In the action, proof of the | 8 | | injury shall constitute prima facie evidence of negligence on | 9 | | the part of such employer and the burden shall be on such | 10 | | employer to show freedom of negligence resulting in the | 11 | | injury. The employer shall not join any other defendant in any | 12 | | such civil action. Nothing in this amendatory Act of the 94th | 13 | | General Assembly shall affect the employee's rights under | 14 | | subdivision (a)3 of Section 1 of this Act. Any employer or | 15 | | carrier who makes payments under subdivision (a)3 of Section 1 | 16 | | of this Act shall have a right of reimbursement from the | 17 | | proceeds of any recovery under this Section.
| 18 | | An employee of an uninsured employer, or the employee's | 19 | | dependents in case death ensued, may, instead of proceeding | 20 | | against the employer in a civil action in court, file an | 21 | | application for adjustment of claim with the Commission in | 22 | | accordance with the provisions of this Act and the Commission | 23 | | shall hear and determine the application for adjustment of | 24 | | claim in the manner in which other claims are heard and | 25 | | determined before the Commission.
| 26 | | All proceedings under this subsection (d) shall be |
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| 1 | | reported on an annual basis to the Workers' Compensation | 2 | | Advisory Board.
| 3 | | An investigator with the Department of Insurance Illinois | 4 | | Workers' Compensation Commission Insurance Compliance Division | 5 | | may issue a citation to any employer that is not in compliance | 6 | | with its obligation to have workers' compensation insurance | 7 | | under this Act. The amount of the fine shall be based on the | 8 | | period of time the employer was in non-compliance, but shall | 9 | | be no less than $500, and shall not exceed $10,000. An employer | 10 | | that has been issued a citation shall pay the fine to the | 11 | | Department of Insurance Commission and provide to the | 12 | | Department of Insurance Commission proof that it obtained the | 13 | | required workers' compensation insurance within 10 days after | 14 | | the citation was issued. This Section does not affect any | 15 | | other obligations this Act imposes on employers. | 16 | | Upon a finding by the Commission, after reasonable notice | 17 | | and
hearing, of the knowing and willful failure or refusal of | 18 | | an employer to
comply with
any of the provisions of paragraph | 19 | | (a) of this Section, the failure or
refusal of an employer, | 20 | | service or adjustment company, or an insurance
carrier to | 21 | | comply with any order of the Illinois Workers' Compensation | 22 | | Commission pursuant to
paragraph (c) of this Section | 23 | | disqualifying him or her to operate as a self
insurer and | 24 | | requiring him or her to insure his or her liability, or the | 25 | | knowing and willful failure of an employer to comply with a | 26 | | citation issued by an investigator with the Department of |
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| 1 | | Insurance Illinois Workers' Compensation Commission Insurance | 2 | | Compliance Division , the
Commission may assess a civil penalty | 3 | | of up to $500 per day for each day of
such failure or refusal | 4 | | after the effective date of this amendatory Act of
1989. The | 5 | | minimum penalty under this Section shall be the sum of | 6 | | $10,000.
Each day of such failure or refusal shall constitute | 7 | | a separate offense.
The Commission may assess the civil | 8 | | penalty personally and individually
against the corporate | 9 | | officers and directors of a corporate employer, the
partners | 10 | | of an employer partnership, and the members of an employer | 11 | | limited
liability company, after a finding of a knowing and | 12 | | willful refusal or failure
of each such named corporate | 13 | | officer, director, partner, or member to comply
with this | 14 | | Section. The liability for the assessed penalty shall be
| 15 | | against the named employer first, and
if the named employer | 16 | | fails or refuses to pay the penalty to the
Commission within 30 | 17 | | days after the final order of the Commission, then the
named
| 18 | | corporate officers, directors, partners, or members who have | 19 | | been found to have
knowingly and willfully refused or failed | 20 | | to comply with this Section shall be
liable for the unpaid | 21 | | penalty or any unpaid portion of the penalty. Upon | 22 | | investigation by the Department of Insurance insurance | 23 | | non-compliance unit of the Commission , the Attorney General | 24 | | shall have the authority to prosecute all proceedings to | 25 | | enforce the civil and administrative provisions of this | 26 | | Section before the Commission. The Commission and the |
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| 1 | | Department of Insurance shall promulgate procedural rules for | 2 | | enforcing this Section relating to their respective duties | 3 | | prescribed herein .
| 4 | | If an employer is found to be in non-compliance with any | 5 | | provisions of paragraph (a) of this Section more than once, | 6 | | all minimum penalties will double. Therefore, upon the failure | 7 | | or refusal of an employer, service or adjustment company, or | 8 | | insurance carrier to comply with any order of the Commission | 9 | | pursuant to paragraph (c) of this Section disqualifying him or | 10 | | her to operate as a self-insurer and requiring him or her to | 11 | | insure his or her liability, or the knowing and willful | 12 | | failure of an employer to comply with a citation issued by an | 13 | | investigator with the Department of Insurance Illinois | 14 | | Workers' Compensation Commission Insurance Compliance | 15 | | Division , the Commission may assess a civil penalty of up to | 16 | | $1,000 per day for each day of such failure or refusal after | 17 | | the effective date of this amendatory Act of the 101st General | 18 | | Assembly. The minimum penalty under this Section shall be the | 19 | | sum of $20,000. In addition, employers with 2 or more | 20 | | violations of any provisions of paragraph (a) of this Section | 21 | | may not self-insure for one year or until all penalties are | 22 | | paid. | 23 | | Upon the failure or refusal of any employer, service or | 24 | | adjustment
company or insurance carrier to comply with the | 25 | | provisions of this Section
and with the orders of the | 26 | | Commission under this Section, or the order of
the court on |
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| 1 | | review after final adjudication, the Commission may bring a
| 2 | | civil action to recover the amount of the penalty in Cook | 3 | | County or in
Sangamon County in which litigation the | 4 | | Commission shall be represented by
the Attorney General. The | 5 | | Commission shall send notice of its finding of
non-compliance | 6 | | and assessment of the civil penalty to the Attorney General.
| 7 | | It shall be the duty of the Attorney General within 30 days | 8 | | after receipt
of the notice, to institute prosecutions and | 9 | | promptly prosecute all
reported violations of this Section.
| 10 | | Any individual employer, corporate officer or director of | 11 | | a corporate employer, partner of an employer partnership, or | 12 | | member of an employer limited liability company who, with the | 13 | | intent to avoid payment of compensation under this Act to an | 14 | | injured employee or the employee's dependents, knowingly | 15 | | transfers, sells, encumbers, assigns, or in any manner | 16 | | disposes of, conceals, secretes, or destroys any property | 17 | | belonging to the employer, officer, director, partner, or | 18 | | member is guilty of a Class 4 felony.
| 19 | | Penalties and fines collected pursuant to this paragraph | 20 | | (d) shall be deposited upon receipt into a special fund which | 21 | | shall be designated the Injured Workers' Benefit Fund, of | 22 | | which the State Treasurer is ex-officio custodian, such | 23 | | special fund to be held and disbursed in accordance with this | 24 | | paragraph (d) for the purposes hereinafter stated in this | 25 | | paragraph (d), upon the final order of the Commission. The | 26 | | Injured Workers' Benefit Fund shall be deposited the same as |
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| 1 | | are State funds and any interest accruing thereon shall be | 2 | | added thereto every 6 months. The Injured Workers' Benefit | 3 | | Fund is subject to audit the same as State funds and accounts | 4 | | and is protected by the general bond given by the State | 5 | | Treasurer. The Injured Workers' Benefit Fund is considered | 6 | | always appropriated for the purposes of disbursements as | 7 | | provided in this paragraph, and shall be paid out and | 8 | | disbursed as herein provided and shall not at any time be | 9 | | appropriated or diverted to any other use or purpose. Moneys | 10 | | in the Injured Workers' Benefit Fund shall be used only for | 11 | | payment of workers' compensation benefits for injured | 12 | | employees when the employer has failed to provide coverage as | 13 | | determined under this paragraph (d) and has failed to pay the | 14 | | benefits due to the injured employee. The Commission shall | 15 | | have the right to obtain reimbursement from the employer for | 16 | | compensation obligations paid by the Injured Workers' Benefit | 17 | | Fund. Any such amounts obtained shall be deposited by the | 18 | | Commission into the Injured Workers' Benefit Fund. If an | 19 | | injured employee or his or her personal representative | 20 | | receives payment from the Injured Workers' Benefit Fund, the | 21 | | State of Illinois has the same rights under paragraph (b) of | 22 | | Section 5 that the employer who failed to pay the benefits due | 23 | | to the injured employee would have had if the employer had paid | 24 | | those benefits, and any moneys recovered by the State as a | 25 | | result of the State's exercise of its rights under paragraph | 26 | | (b) of Section 5 shall be deposited into the Injured Workers' |
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| 1 | | Benefit Fund. The custodian of the Injured Workers' Benefit | 2 | | Fund shall be joined with the employer as a party respondent in | 3 | | the application for adjustment of claim. After July 1, 2006, | 4 | | the Commission shall make disbursements from the Fund once | 5 | | each year to each eligible claimant. An eligible claimant is | 6 | | an injured worker who has within the previous fiscal year | 7 | | obtained a final award for benefits from the Commission | 8 | | against the employer and the Injured Workers' Benefit Fund and | 9 | | has notified the Commission within 90 days of receipt of such | 10 | | award. Within a reasonable time after the end of each fiscal | 11 | | year, the Commission shall make a disbursement to each | 12 | | eligible claimant. At the time of disbursement, if there are | 13 | | insufficient moneys in the Fund to pay all claims, each | 14 | | eligible claimant shall receive a pro-rata share, as | 15 | | determined by the Commission, of the available moneys in the | 16 | | Fund for that year. Payment from the Injured Workers' Benefit | 17 | | Fund to an eligible claimant pursuant to this provision shall | 18 | | discharge the obligations of the Injured Workers' Benefit Fund | 19 | | regarding the award entered by the Commission.
| 20 | | (e) This Act shall not affect or disturb the continuance | 21 | | of any
existing insurance, mutual aid, benefit, or relief | 22 | | association or
department, whether maintained in whole or in | 23 | | part by the employer or
whether maintained by the employees, | 24 | | the payment of benefits of such
association or department | 25 | | being guaranteed by the employer or by some
person, firm or | 26 | | corporation for him or her: Provided, the employer contributes
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| 1 | | to such association or department an amount not less than the | 2 | | full
compensation herein provided, exclusive of the cost of | 3 | | the maintenance
of such association or department and without | 4 | | any expense to the
employee. This Act shall not prevent the | 5 | | organization and maintaining
under the insurance laws of this | 6 | | State of any benefit or insurance
company for the purpose of | 7 | | insuring against the compensation provided
for in this Act, | 8 | | the expense of which is maintained by the employer.
This Act | 9 | | shall not prevent the organization or maintaining under the
| 10 | | insurance laws of this State of any voluntary mutual aid, | 11 | | benefit or
relief association among employees for the payment | 12 | | of additional
accident or sick benefits.
| 13 | | (f) No existing insurance, mutual aid, benefit or relief | 14 | | association
or department shall, by reason of anything herein | 15 | | contained, be
authorized to discontinue its operation without | 16 | | first discharging its
obligations to any and all persons | 17 | | carrying insurance in the same or
entitled to relief or | 18 | | benefits therein.
| 19 | | (g) Any contract, oral, written or implied, of employment | 20 | | providing
for relief benefit, or insurance or any other device | 21 | | whereby the
employee is required to pay any premium or | 22 | | premiums for insurance
against the compensation provided for | 23 | | in this Act shall be null and
void. Any employer withholding | 24 | | from the wages of any employee any
amount for the purpose of | 25 | | paying any such premium shall be guilty of a
Class B | 26 | | misdemeanor.
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| 1 | | In the event the employer does not pay the compensation | 2 | | for which he or
she is liable, then an insurance company, | 3 | | association or insurer which may
have insured such employer | 4 | | against such liability shall become primarily
liable to pay to | 5 | | the employee, his or her personal representative or
| 6 | | beneficiary the compensation required by the provisions of | 7 | | this Act to
be paid by such employer. The insurance carrier may | 8 | | be made a party to
the proceedings in which the employer is a | 9 | | party and an award may be
entered jointly against the employer | 10 | | and the insurance carrier.
| 11 | | (h) It shall be unlawful for any employer, insurance | 12 | | company or
service or adjustment company to interfere with, | 13 | | restrain or coerce an
employee in any manner whatsoever in the | 14 | | exercise of the rights or
remedies granted to him or her by | 15 | | this Act or to discriminate, attempt to
discriminate, or | 16 | | threaten to discriminate against an employee in any way
| 17 | | because of his or her exercise of the rights or remedies | 18 | | granted to
him or her by this Act.
| 19 | | It shall be unlawful for any employer, individually or | 20 | | through any
insurance company or service or adjustment | 21 | | company, to discharge or to
threaten to discharge, or to | 22 | | refuse to rehire or recall to active
service in a suitable | 23 | | capacity an employee because of the exercise of
his or her | 24 | | rights or remedies granted to him or her by this Act.
| 25 | | (i) If an employer elects to obtain a life insurance | 26 | | policy on his
employees, he may also elect to apply such |
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| 1 | | benefits in satisfaction of all
or a portion of the death | 2 | | benefits payable under this Act, in which case,
the employer's | 3 | | compensation premium shall be reduced accordingly.
| 4 | | (j) Within 45 days of receipt of an initial application or | 5 | | application
to renew self-insurance privileges the | 6 | | Self-Insurers Advisory Board shall
review and submit for | 7 | | approval by the Chairman of the Commission
recommendations of | 8 | | disposition of all initial applications to self-insure
and all | 9 | | applications to renew self-insurance privileges filed by | 10 | | private
self-insurers pursuant to the provisions of this | 11 | | Section and Section 4a-9
of this Act. Each private | 12 | | self-insurer shall submit with its initial and
renewal | 13 | | applications the application fee required by Section 4a-4 of | 14 | | this Act.
| 15 | | The Chairman of the Commission shall promptly act upon all | 16 | | initial
applications and applications for renewal in full | 17 | | accordance with the
recommendations of the Board or, should | 18 | | the Chairman disagree with any
recommendation of disposition | 19 | | of the Self-Insurer's Advisory Board, he
shall within 30 days | 20 | | of receipt of such recommendation provide to the Board
in | 21 | | writing the reasons supporting his decision. The Chairman | 22 | | shall also
promptly notify the employer of his decision within | 23 | | 15 days of receipt of
the recommendation of the Board.
| 24 | | If an employer is denied a renewal of self-insurance | 25 | | privileges pursuant
to application it shall retain said | 26 | | privilege for 120 days after receipt of
a notice of |
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| 1 | | cancellation of the privilege from the Chairman of the | 2 | | Commission.
| 3 | | All orders made by the Chairman under this Section shall | 4 | | be subject to
review by the courts, such review to be taken in | 5 | | the same manner and within
the same time as provided by | 6 | | subsection (f) of Section 19 of this Act for
review of awards | 7 | | and decisions of the Commission, upon the party seeking
the | 8 | | review filing with the clerk of the court to which such review | 9 | | is taken
a bond in an amount to be fixed and approved by the | 10 | | court to which the
review is taken, conditioned upon the | 11 | | payment of all compensation awarded
against the person taking | 12 | | such review pending a decision thereof and
further conditioned | 13 | | upon such other obligations as the court may impose.
Upon the | 14 | | review the Circuit Court shall have power to review all | 15 | | questions
of fact as well as of law.
| 16 | | (Source: P.A. 101-40, eff. 1-1-20.)
| 17 | | (Text of Section from P.A. 101-384)
| 18 | | Sec. 4. (a) Any employer, including but not limited to | 19 | | general contractors
and their subcontractors, who shall come | 20 | | within the provisions of
Section 3 of this Act, and any other | 21 | | employer who shall elect to provide
and pay the compensation | 22 | | provided for in this Act shall:
| 23 | | (1) File with the Commission annually an application | 24 | | for approval as a
self-insurer which shall include a | 25 | | current financial statement, and
annually, thereafter, an |
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| 1 | | application for renewal of self-insurance, which
shall | 2 | | include a current financial statement. Said
application | 3 | | and financial statement shall be signed and sworn to by | 4 | | the
president or vice president and secretary or assistant | 5 | | secretary of the
employer if it be a corporation, or by all | 6 | | of the partners, if it be a
copartnership, or by the owner | 7 | | if it be neither a copartnership nor a
corporation. All | 8 | | initial applications and all applications for renewal of
| 9 | | self-insurance must be submitted at least 60 days prior to | 10 | | the requested
effective date of self-insurance. An | 11 | | employer may elect to provide and pay
compensation as | 12 | | provided
for in this Act as a member of a group workers' | 13 | | compensation pool under Article
V 3/4 of the Illinois | 14 | | Insurance Code. If an employer becomes a member of a
group | 15 | | workers' compensation pool, the employer shall not be | 16 | | relieved of any
obligations imposed by this Act.
| 17 | | If the sworn application and financial statement of | 18 | | any such employer
does not satisfy the Commission of the | 19 | | financial ability of the employer
who has filed it, the | 20 | | Commission shall require such employer to,
| 21 | | (2) Furnish security, indemnity or a bond guaranteeing | 22 | | the payment
by the employer of the compensation provided | 23 | | for in this Act, provided
that any such employer whose | 24 | | application and financial statement shall
not have | 25 | | satisfied the commission of his or her financial ability | 26 | | and
who shall have secured his liability in part by excess |
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| 1 | | liability insurance
shall be required to furnish to the | 2 | | Commission security, indemnity or bond
guaranteeing his or | 3 | | her payment up to the effective limits of the excess
| 4 | | coverage, or
| 5 | | (3) Insure his entire liability to pay such | 6 | | compensation in some
insurance carrier authorized, | 7 | | licensed, or permitted to do such
insurance business in | 8 | | this State. Every policy of an insurance carrier,
insuring | 9 | | the payment of compensation under this Act shall cover all | 10 | | the
employees and the entire compensation liability of the | 11 | | insured:
Provided, however, that any employer may insure | 12 | | his or her compensation
liability with 2 or more insurance | 13 | | carriers or may insure a part and
qualify under subsection | 14 | | 1, 2, or 4 for the remainder of his or her
liability to pay | 15 | | such compensation, subject to the following two | 16 | | provisions:
| 17 | | Firstly, the entire compensation liability of the | 18 | | employer to
employees working at or from one location | 19 | | shall be insured in one such
insurance carrier or | 20 | | shall be self-insured, and
| 21 | | Secondly, the employer shall submit evidence | 22 | | satisfactorily to the
Commission that his or her | 23 | | entire liability for the compensation provided
for in | 24 | | this Act will be secured. Any provisions in any | 25 | | policy, or in any
endorsement attached thereto, | 26 | | attempting to limit or modify in any way,
the |
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| 1 | | liability of the insurance carriers issuing the same | 2 | | except as
otherwise provided herein shall be wholly | 3 | | void.
| 4 | | Nothing herein contained shall apply to policies of | 5 | | excess liability
carriage secured by employers who have | 6 | | been approved by the Commission
as self-insurers, or
| 7 | | (4) Make some other provision, satisfactory to the | 8 | | Commission, for
the securing of the payment of | 9 | | compensation provided for in this Act,
and
| 10 | | (5) Upon becoming subject to this Act and thereafter | 11 | | as often as the
Commission may in writing demand, file | 12 | | with the Commission in form prescribed
by it evidence of | 13 | | his or her compliance with the provision of this Section.
| 14 | | (a-1) Regardless of its state of domicile or its principal | 15 | | place of
business, an employer shall make payments to its | 16 | | insurance carrier or group
self-insurance fund, where | 17 | | applicable, based upon the premium rates of the
situs where | 18 | | the work or project is located in Illinois if:
| 19 | | (A) the employer is engaged primarily in the building | 20 | | and
construction industry; and
| 21 | | (B) subdivision (a)(3) of this Section applies to the | 22 | | employer or
the employer is a member of a group | 23 | | self-insurance plan as defined in
subsection (1) of | 24 | | Section 4a.
| 25 | | The Illinois Workers' Compensation Commission shall impose | 26 | | a penalty upon an employer
for violation of this subsection |
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| 1 | | (a-1) if:
| 2 | | (i) the employer is given an opportunity at a hearing | 3 | | to present
evidence of its compliance with this subsection | 4 | | (a-1); and
| 5 | | (ii) after the hearing, the Commission finds that the | 6 | | employer
failed to make payments upon the premium rates of | 7 | | the situs where the work or
project is located in | 8 | | Illinois.
| 9 | | The penalty shall not exceed $1,000 for each day of work | 10 | | for which
the employer failed to make payments upon the | 11 | | premium rates of the situs where
the
work or project is located | 12 | | in Illinois, but the total penalty shall not exceed
$50,000 | 13 | | for each project or each contract under which the work was
| 14 | | performed.
| 15 | | Any penalty under this subsection (a-1) must be imposed | 16 | | not later
than one year after the expiration of the applicable | 17 | | limitation period
specified in subsection (d) of Section 6 of | 18 | | this Act. Penalties imposed under
this subsection (a-1) shall | 19 | | be deposited into the Illinois Workers' Compensation | 20 | | Commission
Operations Fund, a special fund that is created in | 21 | | the State treasury. Subject
to appropriation, moneys in the | 22 | | Fund shall be used solely for the operations
of the Illinois | 23 | | Workers' Compensation Commission and by the Department of | 24 | | Insurance for the purposes authorized in subsection (c) of | 25 | | Section 25.5 of this Act.
| 26 | | (a-2) Every Employee Leasing Company (ELC), as defined in |
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| 1 | | Section 15 of the Employee Leasing Company Act, shall at a | 2 | | minimum provide the following information to the Commission or | 3 | | any entity designated by the Commission regarding each | 4 | | workers' compensation insurance policy issued to the ELC: | 5 | | (1) Any client company of the ELC listed as an | 6 | | additional named insured. | 7 | | (2) Any informational schedule attached to the master | 8 | | policy that identifies any individual client company's | 9 | | name, FEIN, and job location. | 10 | | (3) Any certificate of insurance coverage document | 11 | | issued to a client company specifying its rights and | 12 | | obligations under the master policy that establishes both | 13 | | the identity and status of the client, as well as the dates | 14 | | of inception and termination of coverage, if applicable. | 15 | | (b) The sworn application and financial statement, or | 16 | | security,
indemnity or bond, or amount of insurance, or other | 17 | | provisions, filed,
furnished, carried, or made by the | 18 | | employer, as the case may be, shall
be subject to the approval | 19 | | of the Commission.
| 20 | | Deposits under escrow agreements shall be cash, negotiable | 21 | | United
States government bonds or negotiable general | 22 | | obligation bonds of the
State of Illinois. Such cash or bonds | 23 | | shall be deposited in
escrow with any State or National Bank or | 24 | | Trust Company having trust
authority in the State of Illinois.
| 25 | | Upon the approval of the sworn application and financial | 26 | | statement,
security, indemnity or bond or amount of insurance, |
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| 1 | | filed, furnished or
carried, as the case may be, the | 2 | | Commission shall send to the employer
written notice of its | 3 | | approval thereof. The certificate of compliance
by the | 4 | | employer with the provisions of subparagraphs (2) and (3) of
| 5 | | paragraph (a) of this Section shall be delivered by the | 6 | | insurance
carrier to the Illinois Workers' Compensation | 7 | | Commission within five days after the
effective date of the | 8 | | policy so certified. The insurance so certified
shall cover | 9 | | all compensation liability occurring during the time that
the | 10 | | insurance is in effect and no further certificate need be | 11 | | filed in case
such insurance is renewed, extended or otherwise | 12 | | continued by such
carrier. The insurance so certified shall | 13 | | not be cancelled or in the
event that such insurance is not | 14 | | renewed, extended or otherwise
continued, such insurance shall | 15 | | not be terminated until at least 10
days after receipt by the | 16 | | Illinois Workers' Compensation Commission of notice of the
| 17 | | cancellation or termination of said insurance; provided, | 18 | | however, that
if the employer has secured insurance from | 19 | | another insurance carrier, or
has otherwise secured the | 20 | | payment of compensation in accordance with
this Section, and | 21 | | such insurance or other security becomes effective
prior to | 22 | | the expiration of the 10 days, cancellation or termination | 23 | | may, at
the option of the insurance carrier indicated in such | 24 | | notice, be effective
as of the effective date of such other | 25 | | insurance or security.
| 26 | | (c) Whenever the Commission shall find that any |
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| 1 | | corporation,
company, association, aggregation of individuals, | 2 | | reciprocal or
interinsurers exchange, or other insurer | 3 | | effecting workers' compensation
insurance in this State shall | 4 | | be insolvent, financially unsound, or
unable to fully meet all | 5 | | payments and liabilities assumed or to be
assumed for | 6 | | compensation insurance in this State, or shall practice a
| 7 | | policy of delay or unfairness toward employees in the | 8 | | adjustment,
settlement, or payment of benefits due such | 9 | | employees, the Commission
may after reasonable notice and | 10 | | hearing order and direct that such
corporation, company, | 11 | | association, aggregation of individuals,
reciprocal or | 12 | | interinsurers exchange, or insurer, shall from and after a
| 13 | | date fixed in such order discontinue the writing of any such | 14 | | workers'
compensation insurance in this State. Subject to such | 15 | | modification of
the order as the Commission may later make on | 16 | | review of the order,
as herein provided, it shall thereupon be | 17 | | unlawful for any such
corporation, company, association, | 18 | | aggregation of individuals,
reciprocal or interinsurers | 19 | | exchange, or insurer to effect any workers'
compensation | 20 | | insurance in this State. A copy of the order shall be served
| 21 | | upon the Director of Insurance by registered mail. Whenever | 22 | | the Commission
finds that any service or adjustment company | 23 | | used or employed
by a self-insured employer or by an insurance | 24 | | carrier to process,
adjust, investigate, compromise or | 25 | | otherwise handle claims under this
Act, has practiced or is | 26 | | practicing a policy of delay or unfairness
toward employees in |
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| 1 | | the adjustment, settlement or payment of benefits
due such | 2 | | employees, the Commission may after reasonable notice and
| 3 | | hearing order and direct that such service or adjustment | 4 | | company shall
from and after a date fixed in such order be | 5 | | prohibited from processing,
adjusting, investigating, | 6 | | compromising or otherwise handling claims
under this Act.
| 7 | | Whenever the Commission finds that any self-insured | 8 | | employer has
practiced or is practicing delay or unfairness | 9 | | toward employees in the
adjustment, settlement or payment of | 10 | | benefits due such employees, the
Commission may, after | 11 | | reasonable notice and hearing, order and direct
that after a | 12 | | date fixed in the order such self-insured employer shall be
| 13 | | disqualified to operate as a self-insurer and shall be | 14 | | required to
insure his entire liability to pay compensation in | 15 | | some insurance
carrier authorized, licensed and permitted to | 16 | | do such insurance business
in this State, as provided in | 17 | | subparagraph 3 of paragraph (a) of this
Section.
| 18 | | All orders made by the Commission under this Section shall | 19 | | be subject
to review by the courts, said review to be taken in | 20 | | the same manner and
within the same time as provided by Section | 21 | | 19 of this Act for review of
awards and decisions of the | 22 | | Commission, upon the party seeking the
review filing with the | 23 | | clerk of the court to which said review is taken
a bond in an | 24 | | amount to be fixed and approved by the court to which the
| 25 | | review is taken, conditioned upon the payment of all | 26 | | compensation awarded
against the person taking said review |
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| 1 | | pending a decision thereof and
further conditioned upon such | 2 | | other obligations as the court may impose.
Upon the review the | 3 | | Circuit Court shall have power to review all questions
of fact | 4 | | as well as of law. The penalty hereinafter provided for in this
| 5 | | paragraph shall not attach and shall not begin to run until the | 6 | | final
determination of the order of the Commission.
| 7 | | (d) Whenever a panel of 3 Commissioners comprised of one | 8 | | member of the employing class, one representative of a labor | 9 | | organization recognized under the National Labor Relations Act | 10 | | or an attorney who has represented labor organizations or has | 11 | | represented employees in workers' compensation cases, and one | 12 | | member not identified with either the employing class or a | 13 | | labor organization, with due process and after a hearing, | 14 | | determines an employer has knowingly failed to provide | 15 | | coverage as required by paragraph (a) of this Section, the | 16 | | failure shall be deemed an immediate serious danger to public | 17 | | health, safety, and welfare sufficient to justify service by | 18 | | the Commission of a work-stop order on such employer, | 19 | | requiring the cessation of all business operations of such | 20 | | employer at the place of employment or job site. Any law | 21 | | enforcement agency in the State shall, at the request of the | 22 | | Commission, render any assistance necessary to carry out the | 23 | | provisions of this Section, including, but not limited to, | 24 | | preventing any employee of such employer from remaining at a | 25 | | place of employment or job site after a work-stop order has | 26 | | taken effect. Any work-stop order shall be lifted upon proof |
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| 1 | | of insurance as required by this Act. Any orders under this | 2 | | Section are appealable under Section 19(f) to the Circuit | 3 | | Court.
| 4 | | Any individual employer, corporate officer or director of | 5 | | a corporate employer, partner of an employer partnership, or | 6 | | member of an employer limited liability company who knowingly | 7 | | fails to provide coverage as required by paragraph (a) of this | 8 | | Section is guilty of a Class 4 felony. This provision shall not | 9 | | apply to any corporate officer or director of any | 10 | | publicly-owned corporation. Each day's violation constitutes a | 11 | | separate offense. The State's Attorney of the county in which | 12 | | the violation occurred, or the Attorney General, shall bring | 13 | | such actions in the name of the People of the State of | 14 | | Illinois, or may, in addition to other remedies provided in | 15 | | this Section, bring an action for an injunction to restrain | 16 | | the violation or to enjoin the operation of any such employer.
| 17 | | Any individual employer, corporate officer or director of | 18 | | a corporate employer, partner of an employer partnership, or | 19 | | member of an employer limited liability company who | 20 | | negligently fails to provide coverage as required by paragraph | 21 | | (a) of this Section is guilty of a Class A misdemeanor. This | 22 | | provision shall not apply to any corporate officer or director | 23 | | of any publicly-owned corporation. Each day's violation | 24 | | constitutes a separate offense. The State's Attorney of the | 25 | | county in which the violation occurred, or the Attorney | 26 | | General, shall bring such actions in the name of the People of |
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| 1 | | the State of Illinois.
| 2 | | The criminal penalties in this subsection (d) shall not | 3 | | apply where
there exists a good faith dispute as to the | 4 | | existence of an
employment relationship. Evidence of good | 5 | | faith shall
include, but not be limited to, compliance with | 6 | | the definition
of employee as used by the Internal Revenue | 7 | | Service.
| 8 | | Employers who are subject to and who knowingly fail to | 9 | | comply with this Section shall not be entitled to the benefits | 10 | | of this Act during the period of noncompliance, but shall be | 11 | | liable in an action under any other applicable law of this | 12 | | State. In the action, such employer shall not avail himself or | 13 | | herself of the defenses of assumption of risk or negligence or | 14 | | that the injury was due to a co-employee. In the action, proof | 15 | | of the injury shall constitute prima facie evidence of | 16 | | negligence on the part of such employer and the burden shall be | 17 | | on such employer to show freedom of negligence resulting in | 18 | | the injury. The employer shall not join any other defendant in | 19 | | any such civil action. Nothing in this amendatory Act of the | 20 | | 94th General Assembly shall affect the employee's rights under | 21 | | subdivision (a)3 of Section 1 of this Act. Any employer or | 22 | | carrier who makes payments under subdivision (a)3 of Section 1 | 23 | | of this Act shall have a right of reimbursement from the | 24 | | proceeds of any recovery under this Section.
| 25 | | An employee of an uninsured employer, or the employee's | 26 | | dependents in case death ensued, may, instead of proceeding |
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| 1 | | against the employer in a civil action in court, file an | 2 | | application for adjustment of claim with the Commission in | 3 | | accordance with the provisions of this Act and the Commission | 4 | | shall hear and determine the application for adjustment of | 5 | | claim in the manner in which other claims are heard and | 6 | | determined before the Commission.
| 7 | | All proceedings under this subsection (d) shall be | 8 | | reported on an annual basis to the Workers' Compensation | 9 | | Advisory Board.
| 10 | | An investigator with the Department of Insurance Illinois | 11 | | Workers' Compensation Commission Insurance Compliance Division | 12 | | may issue a citation to any employer that is not in compliance | 13 | | with its obligation to have workers' compensation insurance | 14 | | under this Act. The amount of the fine shall be based on the | 15 | | period of time the employer was in non-compliance, but shall | 16 | | be no less than $500, and shall not exceed $2,500. An employer | 17 | | that has been issued a citation shall pay the fine to the | 18 | | Department of Insurance Commission and provide to the | 19 | | Department of Insurance Commission proof that it obtained the | 20 | | required workers' compensation insurance within 10 days after | 21 | | the citation was issued. This Section does not affect any | 22 | | other obligations this Act imposes on employers. | 23 | | Upon a finding by the Commission, after reasonable notice | 24 | | and
hearing, of the knowing and wilful failure or refusal of an | 25 | | employer to
comply with
any of the provisions of paragraph (a) | 26 | | of this Section, the failure or
refusal of an employer, |
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| 1 | | service or adjustment company, or an insurance
carrier to | 2 | | comply with any order of the Illinois Workers' Compensation | 3 | | Commission pursuant to
paragraph (c) of this Section | 4 | | disqualifying him or her to operate as a self
insurer and | 5 | | requiring him or her to insure his or her liability, or the | 6 | | knowing and willful failure of an employer to comply with a | 7 | | citation issued by an investigator with the Department of | 8 | | Insurance Illinois Workers' Compensation Commission Insurance | 9 | | Compliance Division , the
Commission may assess a civil penalty | 10 | | of up to $500 per day for each day of
such failure or refusal | 11 | | after the effective date of this amendatory Act of
1989. The | 12 | | minimum penalty under this Section shall be the sum of | 13 | | $10,000.
Each day of such failure or refusal shall constitute | 14 | | a separate offense.
The Commission may assess the civil | 15 | | penalty personally and individually
against the corporate | 16 | | officers and directors of a corporate employer, the
partners | 17 | | of an employer partnership, and the members of an employer | 18 | | limited
liability company, after a finding of a knowing and | 19 | | willful refusal or failure
of each such named corporate | 20 | | officer, director, partner, or member to comply
with this | 21 | | Section. The liability for the assessed penalty shall be
| 22 | | against the named employer first, and
if the named employer | 23 | | fails or refuses to pay the penalty to the
Commission within 30 | 24 | | days after the final order of the Commission, then the
named
| 25 | | corporate officers, directors, partners, or members who have | 26 | | been found to have
knowingly and willfully refused or failed |
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| 1 | | to comply with this Section shall be
liable for the unpaid | 2 | | penalty or any unpaid portion of the penalty. Upon | 3 | | investigation by the Department of Insurance insurance | 4 | | non-compliance unit of the Commission , the Attorney General | 5 | | shall have the authority to prosecute all proceedings to | 6 | | enforce the civil and administrative provisions of this | 7 | | Section before the Commission. The Commission and the | 8 | | Department of Insurance shall promulgate procedural rules for | 9 | | enforcing this Section relating to their respective duties | 10 | | prescribed herein .
| 11 | | Upon the failure or refusal of any employer, service or | 12 | | adjustment
company or insurance carrier to comply with the | 13 | | provisions of this Section
and with the orders of the | 14 | | Commission under this Section, or the order of
the court on | 15 | | review after final adjudication, the Commission may bring a
| 16 | | civil action to recover the amount of the penalty in Cook | 17 | | County or in
Sangamon County in which litigation the | 18 | | Commission shall be represented by
the Attorney General. The | 19 | | Commission shall send notice of its finding of
non-compliance | 20 | | and assessment of the civil penalty to the Attorney General.
| 21 | | It shall be the duty of the Attorney General within 30 days | 22 | | after receipt
of the notice, to institute prosecutions and | 23 | | promptly prosecute all
reported violations of this Section.
| 24 | | Any individual employer, corporate officer or director of | 25 | | a corporate employer, partner of an employer partnership, or | 26 | | member of an employer limited liability company who, with the |
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| 1 | | intent to avoid payment of compensation under this Act to an | 2 | | injured employee or the employee's dependents, knowingly | 3 | | transfers, sells, encumbers, assigns, or in any manner | 4 | | disposes of, conceals, secretes, or destroys any property | 5 | | belonging to the employer, officer, director, partner, or | 6 | | member is guilty of a Class 4 felony.
| 7 | | Penalties and fines collected pursuant to this paragraph | 8 | | (d) shall be deposited upon receipt into a special fund which | 9 | | shall be designated the Injured Workers' Benefit Fund, of | 10 | | which the State Treasurer is ex-officio custodian, such | 11 | | special fund to be held and disbursed in accordance with this | 12 | | paragraph (d) for the purposes hereinafter stated in this | 13 | | paragraph (d), upon the final order of the Commission. The | 14 | | Injured Workers' Benefit Fund shall be deposited the same as | 15 | | are State funds and any interest accruing thereon shall be | 16 | | added thereto every 6 months. The Injured Workers' Benefit | 17 | | Fund is subject to audit the same as State funds and accounts | 18 | | and is protected by the general bond given by the State | 19 | | Treasurer. The Injured Workers' Benefit Fund is considered | 20 | | always appropriated for the purposes of disbursements as | 21 | | provided in this paragraph, and shall be paid out and | 22 | | disbursed as herein provided and shall not at any time be | 23 | | appropriated or diverted to any other use or purpose. Moneys | 24 | | in the Injured Workers' Benefit Fund shall be used only for | 25 | | payment of workers' compensation benefits for injured | 26 | | employees when the employer has failed to provide coverage as |
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| 1 | | determined under this paragraph (d) and has failed to pay the | 2 | | benefits due to the injured employee. The Commission shall | 3 | | have the right to obtain reimbursement from the employer for | 4 | | compensation obligations paid by the Injured Workers' Benefit | 5 | | Fund. Any such amounts obtained shall be deposited by the | 6 | | Commission into the Injured Workers' Benefit Fund. If an | 7 | | injured employee or his or her personal representative | 8 | | receives payment from the Injured Workers' Benefit Fund, the | 9 | | State of Illinois has the same rights under paragraph (b) of | 10 | | Section 5 that the employer who failed to pay the benefits due | 11 | | to the injured employee would have had if the employer had paid | 12 | | those benefits, and any moneys recovered by the State as a | 13 | | result of the State's exercise of its rights under paragraph | 14 | | (b) of Section 5 shall be deposited into the Injured Workers' | 15 | | Benefit Fund. The custodian of the Injured Workers' Benefit | 16 | | Fund shall be joined with the employer as a party respondent in | 17 | | the application for adjustment of claim. After July 1, 2006, | 18 | | the Commission shall make disbursements from the Fund once | 19 | | each year to each eligible claimant. An eligible claimant is | 20 | | an injured worker who has within the previous fiscal year | 21 | | obtained a final award for benefits from the Commission | 22 | | against the employer and the Injured Workers' Benefit Fund and | 23 | | has notified the Commission within 90 days of receipt of such | 24 | | award. Within a reasonable time after the end of each fiscal | 25 | | year, the Commission shall make a disbursement to each | 26 | | eligible claimant. At the time of disbursement, if there are |
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| 1 | | insufficient moneys in the Fund to pay all claims, each | 2 | | eligible claimant shall receive a pro-rata share, as | 3 | | determined by the Commission, of the available moneys in the | 4 | | Fund for that year. Payment from the Injured Workers' Benefit | 5 | | Fund to an eligible claimant pursuant to this provision shall | 6 | | discharge the obligations of the Injured Workers' Benefit Fund | 7 | | regarding the award entered by the Commission.
| 8 | | (e) This Act shall not affect or disturb the continuance | 9 | | of any
existing insurance, mutual aid, benefit, or relief | 10 | | association or
department, whether maintained in whole or in | 11 | | part by the employer or
whether maintained by the employees, | 12 | | the payment of benefits of such
association or department | 13 | | being guaranteed by the employer or by some
person, firm or | 14 | | corporation for him or her: Provided, the employer contributes
| 15 | | to such association or department an amount not less than the | 16 | | full
compensation herein provided, exclusive of the cost of | 17 | | the maintenance
of such association or department and without | 18 | | any expense to the
employee. This Act shall not prevent the | 19 | | organization and maintaining
under the insurance laws of this | 20 | | State of any benefit or insurance
company for the purpose of | 21 | | insuring against the compensation provided
for in this Act, | 22 | | the expense of which is maintained by the employer.
This Act | 23 | | shall not prevent the organization or maintaining under the
| 24 | | insurance laws of this State of any voluntary mutual aid, | 25 | | benefit or
relief association among employees for the payment | 26 | | of additional
accident or sick benefits.
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| 1 | | (f) No existing insurance, mutual aid, benefit or relief | 2 | | association
or department shall, by reason of anything herein | 3 | | contained, be
authorized to discontinue its operation without | 4 | | first discharging its
obligations to any and all persons | 5 | | carrying insurance in the same or
entitled to relief or | 6 | | benefits therein.
| 7 | | (g) Any contract, oral, written or implied, of employment | 8 | | providing
for relief benefit, or insurance or any other device | 9 | | whereby the
employee is required to pay any premium or | 10 | | premiums for insurance
against the compensation provided for | 11 | | in this Act shall be null and
void. Any employer withholding | 12 | | from the wages of any employee any
amount for the purpose of | 13 | | paying any such premium shall be guilty of a
Class B | 14 | | misdemeanor.
| 15 | | In the event the employer does not pay the compensation | 16 | | for which he or
she is liable, then an insurance company, | 17 | | association or insurer which may
have insured such employer | 18 | | against such liability shall become primarily
liable to pay to | 19 | | the employee, his or her personal representative or
| 20 | | beneficiary the compensation required by the provisions of | 21 | | this Act to
be paid by such employer. The insurance carrier may | 22 | | be made a party to
the proceedings in which the employer is a | 23 | | party and an award may be
entered jointly against the employer | 24 | | and the insurance carrier.
| 25 | | (h) It shall be unlawful for any employer, insurance | 26 | | company or
service or adjustment company to interfere with, |
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| 1 | | restrain or coerce an
employee in any manner whatsoever in the | 2 | | exercise of the rights or
remedies granted to him or her by | 3 | | this Act or to discriminate, attempt to
discriminate, or | 4 | | threaten to discriminate against an employee in any way
| 5 | | because of his or her exercise of the rights or remedies | 6 | | granted to
him or her by this Act.
| 7 | | It shall be unlawful for any employer, individually or | 8 | | through any
insurance company or service or adjustment | 9 | | company, to discharge or to
threaten to discharge, or to | 10 | | refuse to rehire or recall to active
service in a suitable | 11 | | capacity an employee because of the exercise of
his or her | 12 | | rights or remedies granted to him or her by this Act.
| 13 | | (i) If an employer elects to obtain a life insurance | 14 | | policy on his
employees, he may also elect to apply such | 15 | | benefits in satisfaction of all
or a portion of the death | 16 | | benefits payable under this Act, in which case,
the employer's | 17 | | compensation premium shall be reduced accordingly.
| 18 | | (j) Within 45 days of receipt of an initial application or | 19 | | application
to renew self-insurance privileges the | 20 | | Self-Insurers Advisory Board shall
review and submit for | 21 | | approval by the Chairman of the Commission
recommendations of | 22 | | disposition of all initial applications to self-insure
and all | 23 | | applications to renew self-insurance privileges filed by | 24 | | private
self-insurers pursuant to the provisions of this | 25 | | Section and Section 4a-9
of this Act. Each private | 26 | | self-insurer shall submit with its initial and
renewal |
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| 1 | | applications the application fee required by Section 4a-4 of | 2 | | this Act.
| 3 | | The Chairman of the Commission shall promptly act upon all | 4 | | initial
applications and applications for renewal in full | 5 | | accordance with the
recommendations of the Board or, should | 6 | | the Chairman disagree with any
recommendation of disposition | 7 | | of the Self-Insurer's Advisory Board, he
shall within 30 days | 8 | | of receipt of such recommendation provide to the Board
in | 9 | | writing the reasons supporting his decision. The Chairman | 10 | | shall also
promptly notify the employer of his decision within | 11 | | 15 days of receipt of
the recommendation of the Board.
| 12 | | If an employer is denied a renewal of self-insurance | 13 | | privileges pursuant
to application it shall retain said | 14 | | privilege for 120 days after receipt of
a notice of | 15 | | cancellation of the privilege from the Chairman of the | 16 | | Commission.
| 17 | | All orders made by the Chairman under this Section shall | 18 | | be subject to
review by the courts, such review to be taken in | 19 | | the same manner and within
the same time as provided by | 20 | | subsection (f) of Section 19 of this Act for
review of awards | 21 | | and decisions of the Commission, upon the party seeking
the | 22 | | review filing with the clerk of the court to which such review | 23 | | is taken
a bond in an amount to be fixed and approved by the | 24 | | court to which the
review is taken, conditioned upon the | 25 | | payment of all compensation awarded
against the person taking | 26 | | such review pending a decision thereof and
further conditioned |
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| 1 | | upon such other obligations as the court may impose.
Upon the | 2 | | review the Circuit Court shall have power to review all | 3 | | questions
of fact as well as of law.
| 4 | | (Source: P.A. 101-384, eff. 1-1-20 .)
| 5 | | (820 ILCS 305/25.5)
| 6 | | Sec. 25.5. Unlawful acts; penalties. | 7 | | (a) It is unlawful for any person, company, corporation, | 8 | | insurance carrier, healthcare provider, or other entity to: | 9 | | (1) Intentionally present or cause to be presented any | 10 | | false or
fraudulent claim for the payment of any workers' | 11 | | compensation
benefit.
| 12 | | (2) Intentionally make or cause to be made any false | 13 | | or
fraudulent material statement or material | 14 | | representation for the
purpose of obtaining or denying any | 15 | | workers' compensation
benefit.
| 16 | | (3) Intentionally make or cause to be made any false | 17 | | or
fraudulent statements with regard to entitlement to | 18 | | workers'
compensation benefits with the intent to prevent | 19 | | an injured
worker from making a legitimate claim for any | 20 | | workers'
compensation benefits.
| 21 | | (4) Intentionally prepare or provide an invalid, | 22 | | false, or
counterfeit certificate of insurance as proof of | 23 | | workers'
compensation insurance.
| 24 | | (5) Intentionally make or cause to be made any false | 25 | | or
fraudulent material statement or material |
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| 1 | | representation for the
purpose of obtaining workers' | 2 | | compensation insurance at less
than the proper amount rate | 3 | | for that insurance.
| 4 | | (6) Intentionally make or cause to be made any false | 5 | | or
fraudulent material statement or material | 6 | | representation on an
initial or renewal self-insurance | 7 | | application or accompanying
financial statement for the | 8 | | purpose of obtaining self-insurance
status or reducing the | 9 | | amount of security that may be required
to be furnished | 10 | | pursuant to Section 4 of this Act.
| 11 | | (7) Intentionally make or cause to be made any false | 12 | | or
fraudulent material statement to the Department of | 13 | | Insurance's
fraud and insurance non-compliance unit in the | 14 | | course of an
investigation of fraud or insurance | 15 | | non-compliance.
| 16 | | (8) Intentionally assist, abet, solicit, or conspire | 17 | | with any
person, company, or other entity to commit any of | 18 | | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | 19 | | of this subsection (a).
| 20 | | (9) Intentionally present a bill or statement for the | 21 | | payment for medical services that were not provided. | 22 | | For the purposes of paragraphs (2), (3), (5), (6), (7), | 23 | | and (9), the term "statement" includes any writing, notice, | 24 | | proof of injury, bill for services, hospital or doctor records | 25 | | and reports, or X-ray and test results.
| 26 | | (b) Sentences for violations of subsection (a) are as |
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| 1 | | follows:
| 2 | | (1) A violation in which the value of the property | 3 | | obtained or attempted to be obtained is $300 or less is a | 4 | | Class A misdemeanor. | 5 | | (2) A violation in which the value of the property | 6 | | obtained or attempted to be obtained is more than $300 but | 7 | | not more than $10,000 is a Class 3 felony. | 8 | | (3) A violation in which the value of the property | 9 | | obtained or attempted to be obtained is more than $10,000 | 10 | | but not more than $100,000 is a Class 2 felony. | 11 | | (4) A violation in which the value of the property | 12 | | obtained or attempted to be obtained is more than $100,000 | 13 | | is a Class 1 felony. | 14 | | (5) A person convicted under this Section shall be | 15 | | ordered to pay monetary restitution to the insurance | 16 | | company or self-insured entity or any other person for any | 17 | | financial loss sustained as a result of a violation of | 18 | | this Section, including any court costs and attorney fees. | 19 | | An order of restitution also includes expenses incurred | 20 | | and paid by the State of Illinois or an insurance company | 21 | | or self-insured entity in connection with any medical | 22 | | evaluation or treatment services. | 23 | | For the purposes of this Section, where the exact value of | 24 | | property obtained or attempted to be obtained is either not | 25 | | alleged or is not specifically set by the terms of a policy of | 26 | | insurance, the value of the property shall be the fair market |
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| 1 | | replacement value of the property claimed to be lost, the | 2 | | reasonable costs of reimbursing a vendor or other claimant for | 3 | | services to be rendered, or both. Notwithstanding the | 4 | | foregoing, an insurance company, self-insured entity, or any | 5 | | other person suffering financial loss sustained as a result of | 6 | | violation of this Section may seek restitution, including | 7 | | court costs and attorney's fees in a civil action in a court of | 8 | | competent jurisdiction. | 9 | | (c) The Department of Insurance shall establish a fraud | 10 | | and insurance non-compliance unit responsible for | 11 | | investigating incidences of fraud and insurance non-compliance | 12 | | pursuant to this Section. The size of the staff of the unit | 13 | | shall be subject to appropriation by the General Assembly. It | 14 | | shall be the duty of the fraud and insurance non-compliance | 15 | | unit to determine the identity of insurance carriers, | 16 | | employers, employees, or other persons or entities who have | 17 | | violated the fraud and insurance non-compliance provisions of | 18 | | this Section. The fraud and insurance non-compliance unit | 19 | | shall report violations of the fraud and insurance | 20 | | non-compliance provisions of this Section to the Special | 21 | | Prosecutions Bureau of the Criminal Division of the Office of | 22 | | the Attorney General or to the State's Attorney of the county | 23 | | in which the offense allegedly occurred, either of whom has | 24 | | the authority to prosecute violations under this Section.
| 25 | | With respect to the subject of any investigation being | 26 | | conducted, the fraud and insurance non-compliance unit shall |
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| 1 | | have the general power of subpoena of the Department of | 2 | | Insurance, including the authority to issue a subpoena to a | 3 | | medical provider, pursuant to Section 8-802 of the Code of | 4 | | Civil Procedure.
| 5 | | (d) Any person may report allegations of insurance | 6 | | non-compliance and fraud pursuant to this Section to the | 7 | | Department of Insurance's fraud and insurance non-compliance | 8 | | unit whose duty it shall be to investigate the report. The unit | 9 | | shall notify the Commission of reports of insurance | 10 | | non-compliance. Any person reporting an allegation of | 11 | | insurance non-compliance or fraud against either an employee | 12 | | or employer under this Section must identify himself. Except | 13 | | as provided in this subsection and in subsection (e), all | 14 | | reports shall remain confidential except to refer an | 15 | | investigation to the Attorney General or State's Attorney for | 16 | | prosecution or if the fraud and insurance non-compliance | 17 | | unit's investigation reveals that the conduct reported may be | 18 | | in violation of other laws or regulations of the State of | 19 | | Illinois, the unit may report such conduct to the appropriate | 20 | | governmental agency charged with administering such laws and | 21 | | regulations. Any person who intentionally makes a false report | 22 | | under this Section to the fraud and insurance non-compliance | 23 | | unit is guilty of a Class A misdemeanor.
| 24 | | (e) In order for the fraud and insurance non-compliance | 25 | | unit to investigate a report of fraud related to an employee's | 26 | | claim, (i) the employee must have filed with the Commission an |
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| 1 | | Application for Adjustment of Claim and the employee must have | 2 | | either received or attempted to receive benefits under this | 3 | | Act that are related to the reported fraud or (ii) the employee | 4 | | must have made a written demand for the payment of benefits | 5 | | that are related to the reported fraud. There shall be no | 6 | | immunity, under this Act or otherwise, for any person who | 7 | | files a false report or who files a report without good and | 8 | | just cause. Confidentiality of medical information shall be | 9 | | strictly maintained. Investigations that are not referred for | 10 | | prosecution shall be destroyed upon the expiration of the | 11 | | statute of limitations for the acts under investigation and | 12 | | shall not be disclosed except that the person making the | 13 | | report shall be notified that the investigation is being | 14 | | closed. It is unlawful for any employer, insurance carrier, | 15 | | service adjustment company, third party administrator, | 16 | | self-insured, or similar entity to file or threaten to file a | 17 | | report of fraud against an employee because of the exercise by | 18 | | the employee of the rights and remedies granted to the | 19 | | employee by this Act.
| 20 | | (e-5) (Blank). The fraud and insurance non-compliance unit | 21 | | shall procure and implement a system utilizing advanced | 22 | | analytics inclusive of predictive modeling, data mining, | 23 | | social network analysis, and scoring algorithms for the | 24 | | detection and prevention of fraud, waste, and abuse on or | 25 | | before January 1, 2012. The fraud and insurance non-compliance | 26 | | unit shall procure this system using a request for proposals |
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| 1 | | process governed by the Illinois Procurement Code and rules | 2 | | adopted under that Code. The fraud and insurance | 3 | | non-compliance unit shall provide a report to the President of | 4 | | the Senate, Speaker of the House of Representatives, Minority | 5 | | Leader of the House of Representatives, Minority Leader of the | 6 | | Senate, Governor, Chairman of the Commission, and Director of | 7 | | Insurance on or before July 1, 2012 and annually thereafter | 8 | | detailing its activities and providing recommendations | 9 | | regarding opportunities for additional fraud waste and abuse | 10 | | detection and prevention. | 11 | | (f) Any person convicted of fraud related to workers' | 12 | | compensation pursuant to this Section shall be subject to the | 13 | | penalties prescribed in the Criminal Code of 2012 and shall be | 14 | | ineligible to receive or retain any compensation, disability, | 15 | | or medical benefits as defined in this Act if the | 16 | | compensation, disability, or medical benefits were owed or | 17 | | received as a result of fraud for which the recipient of the | 18 | | compensation, disability, or medical benefit was convicted. | 19 | | This subsection applies to accidental injuries or diseases | 20 | | that occur on or after the effective date of this amendatory | 21 | | Act of the 94th General Assembly.
| 22 | | (g) Civil liability. Any person convicted of fraud who | 23 | | knowingly obtains, attempts to obtain, or causes to be | 24 | | obtained any benefits under this Act by the making of a false | 25 | | claim or who knowingly misrepresents any material fact shall | 26 | | be civilly liable to the payor of benefits or the insurer or |
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| 1 | | the payor's or insurer's subrogee or assignee in an amount | 2 | | equal to 3 times the value of the benefits or insurance | 3 | | coverage wrongfully obtained or twice the value of the | 4 | | benefits or insurance coverage attempted to be obtained, plus | 5 | | reasonable attorney's fees and expenses incurred by the payor | 6 | | or the payor's subrogee or assignee who successfully brings a | 7 | | claim under this subsection. This subsection applies to | 8 | | accidental injuries or diseases that occur on or after the | 9 | | effective date of this amendatory Act of the 94th General | 10 | | Assembly.
| 11 | | (h) The fraud and insurance non-compliance unit shall | 12 | | submit a written report on an annual basis to the Chairman of | 13 | | the Commission, the Workers' Compensation Advisory Board, the | 14 | | General Assembly, the Governor, and the Attorney General by | 15 | | January 1 and July 1 of each year. This report shall include, | 16 | | at the minimum, the following information: | 17 | | (1) The number of allegations of insurance | 18 | | non-compliance and fraud reported to the fraud and | 19 | | insurance non-compliance unit. | 20 | | (2) The source of the reported allegations | 21 | | (individual, employer, or other). | 22 | | (3) The number of allegations investigated by the | 23 | | fraud and insurance non-compliance unit. | 24 | | (4) The number of criminal referrals made in | 25 | | accordance with this Section and the entity to which the | 26 | | referral was made. |
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| 1 | | (5) All proceedings under this Section.
| 2 | | (6) Recommendations regarding opportunities for | 3 | | additional fraud detection. | 4 | | (Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.) | 5 | | (820 ILCS 305/29.2) | 6 | | Sec. 29.2. Insurance oversight. | 7 | | (a) The Department of Insurance shall annually submit to | 8 | | the Governor, the Chairman of the Commission, the President of | 9 | | the Senate, the Speaker of the House of Representatives, the | 10 | | Minority Leader of the Senate, and the Minority Leader of the | 11 | | House of Representatives a written report that details the | 12 | | state of the workers' compensation insurance market in | 13 | | Illinois. The report shall be completed by April 1 of each | 14 | | year, beginning in 2012, or later if necessary data or | 15 | | analyses are only available to the Department at a later date. | 16 | | The report shall be posted on the Department of Insurance's | 17 | | Internet website. Information to be included in the report | 18 | | shall be for the preceding calendar year. The report shall | 19 | | include, at a minimum, the following: | 20 | | (1) Gross premiums collected by workers' compensation | 21 | | carriers in Illinois and the national rank of Illinois | 22 | | based on premium volume. | 23 | | (2) The number of insurance companies actively engaged | 24 | | in Illinois in the workers' compensation insurance market, | 25 | | including both holding companies and subsidiaries or |
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| 1 | | affiliates, and the national rank of Illinois based on | 2 | | number of competing insurers. | 3 | | (3) The total number of insured participants in the | 4 | | Illinois workers' compensation assigned risk insurance | 5 | | pool, and the size of the assigned risk pool as a | 6 | | proportion of the total Illinois workers' compensation | 7 | | insurance market. | 8 | | (4) The advisory organization premium rate for | 9 | | workers' compensation insurance in Illinois for the | 10 | | previous year. | 11 | | (5) The advisory organization prescribed assigned risk | 12 | | pool premium rate. | 13 | | (6) The total amount of indemnity payments made by | 14 | | workers' compensation insurers in Illinois. | 15 | | (7) The total amount of medical payments made by | 16 | | workers' compensation insurers in Illinois, and the | 17 | | national rank of Illinois based on average cost of medical | 18 | | claims per injured worker. | 19 | | (8) The gross profitability of workers' compensation | 20 | | insurers in Illinois, and the national rank of Illinois | 21 | | based on profitability of workers' compensation insurers. | 22 | | (9) The loss ratio of workers' compensation insurers | 23 | | in Illinois and the national rank of Illinois based on the | 24 | | loss ratio of workers' compensation insurers. For purposes | 25 | | of this loss ratio calculation, the denominator shall | 26 | | include all premiums and other fees collected by workers' |
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| 1 | | compensation insurers and the numerator shall include the | 2 | | total amount paid by the insurer for care or compensation | 3 | | to injured workers. | 4 | | (10) The growth of total paid indemnity benefits by | 5 | | temporary total disability, scheduled and non-scheduled | 6 | | permanent partial disability, and total disability. | 7 | | (11) The number of injured workers receiving wage loss | 8 | | differential awards and the average wage loss differential | 9 | | award payout. | 10 | | (12) Illinois' rank, relative to other states, for: | 11 | | (i) the maximum and minimum temporary total | 12 | | disability benefit level; | 13 | | (ii) the maximum and minimum scheduled and | 14 | | non-scheduled permanent partial disability benefit | 15 | | level; | 16 | | (iii) the maximum and minimum total disability | 17 | | benefit level; and | 18 | | (iv) the maximum and minimum death benefit level. | 19 | | (13) The aggregate growth of medical benefit payout by | 20 | | non-hospital providers and hospitals. | 21 | | (14) The aggregate growth of medical utilization for | 22 | | the top 10 most common injuries to specific body parts by | 23 | | non-hospital providers and hospitals. | 24 | | (15) The percentage of injured workers filing claims | 25 | | at the Commission that are represented by an attorney. | 26 | | (16) The total amount paid by injured workers for |
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| 1 | | attorney representation. | 2 | | (b) The Director of Insurance shall promulgate rules | 3 | | requiring each insurer licensed to write workers' compensation | 4 | | coverage in the State to record and report the following | 5 | | information on an aggregate basis to the Department of | 6 | | Insurance before June 1 March 1 of each year, relating to | 7 | | claims in the State opened within the prior calendar year: | 8 | | (1) The number of claims opened. | 9 | | (2) The number of reported medical only claims. | 10 | | (3) The number of contested claims. | 11 | | (4) The number of claims for which the employee has | 12 | | attorney representation. | 13 | | (5) The number of claims with lost time and the number | 14 | | of claims for which temporary total disability was paid. | 15 | | (6) The number of claim adjusters employed to adjust | 16 | | workers' compensation claims. | 17 | | (7) The number of claims for which temporary total | 18 | | disability was not paid within 14 days from the first full | 19 | | day off, regardless of reason. | 20 | | (8) The number of medical bills paid 60 days or later | 21 | | from date of service and the average days paid on those | 22 | | paid after 60 days for the previous calendar year. | 23 | | (9) The number of claims in which in-house defense | 24 | | counsel participated, and the total amount spent on | 25 | | in-house legal services. | 26 | | (10) The number of claims in which outside defense |
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| 1 | | counsel participated, and the total amount paid to outside | 2 | | defense counsel. | 3 | | (11) The total amount billed to employers for bill | 4 | | review. | 5 | | (12) The total amount billed to employers for fee | 6 | | schedule savings. | 7 | | (13) The total amount charged to employers for any and | 8 | | all managed care fees. | 9 | | (14) The number of claims involving in-house medical | 10 | | nurse case management, and the total amount spent on | 11 | | in-house medical nurse case management. | 12 | | (15) The number of claims involving outside medical | 13 | | nurse case management, and the total amount paid for | 14 | | outside medical nurse case management. | 15 | | (16) The total amount paid for Independent Medical | 16 | | exams. | 17 | | (17) The total amount spent on in-house Utilization | 18 | | Review for the previous calendar year. | 19 | | (18) The total amount paid for outside Utilization | 20 | | Review for the previous calendar year. | 21 | | The Department shall make the submitted information | 22 | | publicly available on the Department's Internet website or | 23 | | such other media as appropriate in a form useful for | 24 | | consumers.
| 25 | | (Source: P.A. 97-18, eff. 6-28-11.)
| 26 | | Section 99. Effective date. This Act takes effect July 1, |
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| 1 | | 2021.
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