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Public Act 097-0018 | ||||
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AN ACT concerning civil law.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Department of Central Management Services | ||||
Law of the
Civil Administrative Code of Illinois is amended by | ||||
changing Sections 405-105 and 405-411 as follows:
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(20 ILCS 405/405-105) (was 20 ILCS 405/64.1)
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Sec. 405-105. Fidelity, surety, property, and casualty | ||||
insurance. The Department
shall establish and implement a | ||||
program to coordinate
the handling of all fidelity, surety, | ||||
property, and casualty insurance
exposures of the State and the | ||||
departments, divisions, agencies,
branches,
and universities | ||||
of the State. In performing this responsibility, the
Department | ||||
shall have the power and duty to do the following:
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(1) Develop and maintain loss and exposure data on all | ||||
State
property.
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(2) Study the feasibility of establishing a | ||||
self-insurance plan
for
State property and prepare | ||||
estimates of the costs of reinsurance for
risks beyond the | ||||
realistic limits of the self-insurance.
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(3) Prepare a plan for centralizing the purchase of | ||||
property and
casualty insurance on State property under a | ||||
master policy or policies
and purchase the insurance |
contracted for as provided in the
Illinois Purchasing Act.
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(4) Evaluate existing provisions for fidelity bonds | ||
required of
State employees and recommend changes that are | ||
appropriate
commensurate with risk experience and the | ||
determinations respecting
self-insurance or reinsurance so | ||
as to permit reduction of costs without
loss of coverage.
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(5) Investigate procedures for inclusion of school | ||
districts,
public community
college districts, and other | ||
units of local government in programs for
the centralized | ||
purchase of insurance.
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(6) Implement recommendations of the State Property
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Insurance
Study Commission that the Department finds | ||
necessary or desirable in
the
performance of its powers and | ||
duties under this Section to achieve
efficient and | ||
comprehensive risk management.
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(7) Prepare and, in the discretion of the Director, | ||
implement a plan providing for the purchase of public
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liability insurance or for self-insurance for public | ||
liability or for a
combination of purchased insurance and | ||
self-insurance for public
liability (i) covering the State | ||
and drivers of motor vehicles
owned,
leased, or controlled | ||
by the State of Illinois pursuant to the provisions
and | ||
limitations contained in the Illinois Vehicle Code, (ii)
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covering
other public liability exposures of the State and | ||
its employees within
the scope of their employment, and | ||
(iii) covering drivers of motor
vehicles not owned, leased, |
or controlled by the State but used by a
State employee on | ||
State business, in excess of liability covered by an
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insurance policy obtained by the owner of the motor vehicle | ||
or in
excess of the dollar amounts that the Department | ||
shall
determine to be
reasonable. Any contract of insurance | ||
let under this Law shall be
by
bid in accordance with the | ||
procedure set forth in the Illinois
Purchasing Act. Any | ||
provisions for self-insurance shall conform to
subdivision | ||
(11).
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The term "employee" as used in this subdivision (7) and | ||
in subdivision
(11)
means a person while in the employ of | ||
the State who is a member of the
staff or personnel of a | ||
State agency, bureau, board, commission,
committee, | ||
department, university, or college or who is a State | ||
officer,
elected official, commissioner, member of or ex | ||
officio member of a
State agency, bureau, board, | ||
commission, committee, department,
university, or college, | ||
or a member of the National Guard while on active
duty | ||
pursuant to orders of the Governor of the State of | ||
Illinois, or any
other person while using a licensed motor | ||
vehicle owned, leased, or
controlled by the State of | ||
Illinois with the authorization of the State
of Illinois, | ||
provided the actual use of the motor vehicle is
within the | ||
scope of that
authorization and within the course of State | ||
service.
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Subsequent to payment of a claim on behalf of an |
employee pursuant to this
Section and after reasonable | ||
advance written notice to the employee, the
Director may | ||
exclude the employee from future coverage or limit the
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coverage under the plan if (i) the Director determines that | ||
the
claim
resulted from an incident in which the employee | ||
was grossly negligent or
had engaged in willful and wanton | ||
misconduct or (ii) the
Director
determines that the | ||
employee is no longer an acceptable risk based on a
review | ||
of prior accidents in which the employee was at fault and | ||
for which
payments were made pursuant to this Section.
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The Director is authorized to
promulgate | ||
administrative rules that may be necessary to
establish and
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administer the plan.
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Appropriations from the Road Fund shall be used to pay | ||
auto liability claims
and related expenses involving | ||
employees of the Department of Transportation,
the | ||
Illinois State Police, and the Secretary of State.
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(8) Charge, collect, and receive from all other | ||
agencies of
the State
government fees or monies equivalent | ||
to the cost of purchasing the insurance.
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(9) Establish, through the Director, charges for risk
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management
services
rendered to State agencies by the | ||
Department.
The State agencies so charged shall reimburse | ||
the Department by vouchers drawn
against their respective
| ||
appropriations. The reimbursement shall be determined by | ||
the Director as
amounts sufficient to reimburse the |
Department
for expenditures incurred in rendering the | ||
service.
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The Department shall charge the
employing State agency | ||
or university for workers' compensation payments for
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temporary total disability paid to any employee after the | ||
employee has
received temporary total disability payments | ||
for 120 days if the employee's
treating physician has | ||
issued a release to return to work with restrictions
and | ||
the employee is able to perform modified duty work but the | ||
employing
State agency or
university does not return the | ||
employee to work at modified duty. Modified
duty shall be | ||
duties assigned that may or may not be delineated
as part | ||
of the duties regularly performed by the employee. Modified | ||
duties
shall be assigned within the prescribed | ||
restrictions established by the
treating physician and the | ||
physician who performed the independent medical
| ||
examination. The amount of all reimbursements
shall be | ||
deposited into the Workers' Compensation Revolving Fund | ||
which is
hereby created as a revolving fund in the State | ||
treasury. In addition to any other purpose authorized by | ||
law, moneys in the Fund
shall be used, subject to | ||
appropriation, to pay these or other temporary
total | ||
disability claims of employees of State agencies and | ||
universities.
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Beginning with fiscal year 1996, all amounts recovered | ||
by the
Department through subrogation in workers' |
compensation and workers'
occupational disease cases shall | ||
be
deposited into the Workers' Compensation Revolving Fund | ||
created under
this subdivision (9).
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(10) Establish rules, procedures, and forms to be used | ||
by
State agencies
in the administration and payment of | ||
workers' compensation claims.
The Department shall | ||
initially evaluate and determine the compensability of
any | ||
injury that is
the subject of a workers' compensation claim | ||
and provide for the
administration and payment of such a | ||
claim for all State agencies. The
Director may delegate to | ||
any agency with the agreement of the agency head
the | ||
responsibility for evaluation, administration, and payment | ||
of that
agency's claims.
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(10a) If the Director determines it would be in the | ||
best interests of the State and its employees, prepare and | ||
implement a plan providing for: (i) the purchase of | ||
workers' compensation insurance for workers' compensation | ||
liability; (ii) third-party administration of | ||
self-insurance, in whole or in part, for workers' | ||
compensation liability; or (iii) a combination of | ||
purchased insurance and self-insurance for workers' | ||
compensation liability, including reinsurance or stop-loss | ||
insurance. Any contract for insurance or third-party | ||
administration shall be on terms consistent with State | ||
policy; awarded in compliance with the Illinois | ||
Procurement Code; and based on, but not limited to, the |
following criteria: administrative cost, service | ||
capabilities of the carrier or other contractor and | ||
premiums, fees, or charges. By April 1 of each year, the | ||
Director must report and provide information to the State | ||
Workers' Compensation Program Advisory Board concerning | ||
the status of the State workers' compensation program for | ||
the next fiscal year. Information includes, but is not | ||
limited to, documents, reports of negotiations, bid | ||
invitations, requests for proposals, specifications, | ||
copies of proposed and final contracts or agreements, and | ||
any other materials concerning contracts or agreements for | ||
the program. By the first of each month thereafter, the | ||
Director must provide updated, and any new, information to | ||
the State Workers' Compensation Program Advisory Board | ||
until the State workers' compensation program for the next | ||
fiscal year is determined. | ||
(11) Any plan for public liability self-insurance | ||
implemented
under this
Section shall provide that (i) the | ||
Department
shall attempt to settle and may settle any | ||
public liability claim filed
against the State of Illinois | ||
or any public liability claim filed
against a State | ||
employee on the basis of an occurrence in the course of
the | ||
employee's State employment; (ii) any settlement of
such a | ||
claim is not subject to fiscal year limitations and must be
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approved by the Director and, in cases of
settlements | ||
exceeding $100,000, by the Governor; and (iii) a
settlement |
of
any public liability claim against the State or a State | ||
employee shall
require an unqualified release of any right | ||
of action against the State
and the employee for acts | ||
within the scope of the employee's employment
giving rise | ||
to the claim.
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Whenever and to the extent that a State
employee | ||
operates a motor vehicle or engages in other activity | ||
covered
by self-insurance under this Section, the State of | ||
Illinois shall
defend, indemnify, and hold harmless the | ||
employee against any claim in
tort filed against the | ||
employee for acts or omissions within the scope
of the | ||
employee's employment in any proper judicial forum and not
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settled pursuant
to this subdivision (11), provided that | ||
this obligation of
the State of
Illinois shall not exceed a | ||
maximum liability of $2,000,000 for any
single occurrence | ||
in connection with the operation of a motor vehicle or
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$100,000 per person per occurrence for any other single | ||
occurrence,
or $500,000 for any single occurrence in | ||
connection with the provision of
medical care by a licensed | ||
physician employee.
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Any
claims against the State of Illinois under a | ||
self-insurance plan that
are not settled pursuant to this | ||
subdivision (11) shall be
heard and
determined by the Court | ||
of Claims and may not be filed or adjudicated
in any other | ||
forum. The Attorney General of the State of Illinois or
the | ||
Attorney General's designee shall be the attorney with |
respect
to all public liability
self-insurance claims that | ||
are not settled pursuant to this
subdivision (11)
and | ||
therefore result in litigation. The payment of any award of | ||
the
Court of Claims entered against the State relating to | ||
any public
liability self-insurance claim shall act as a | ||
release against any State
employee involved in the | ||
occurrence.
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(12) Administer a plan the purpose of which is to make | ||
payments
on final
settlements or final judgments in | ||
accordance with the State Employee
Indemnification Act. | ||
The plan shall be funded through appropriations from the
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General Revenue Fund specifically designated for that | ||
purpose, except that
indemnification expenses for | ||
employees of the Department of Transportation,
the | ||
Illinois State Police, and the Secretary of State
shall be | ||
paid
from the Road
Fund. The term "employee" as used in | ||
this subdivision (12) has the same
meaning as under | ||
subsection (b) of Section 1 of the State Employee
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Indemnification Act. Subject to sufficient appropriation, | ||
the Director shall approve payment of any claim, without | ||
regard to fiscal year limitations, presented to
the | ||
Director
that is supported by a final settlement or final | ||
judgment when the Attorney
General and the chief officer of | ||
the public body against whose employee the
claim or cause | ||
of action is asserted certify to the Director that
the | ||
claim is in
accordance with the State Employee |
Indemnification Act and that they
approve
of the payment. | ||
In no event shall an amount in excess of $150,000 be paid | ||
from
this plan to or for the benefit of any claimant.
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(13) Administer a plan the purpose of which is to make | ||
payments
on final
settlements or final judgments for | ||
employee wage claims in situations where
there was an | ||
appropriation relevant to the wage claim, the fiscal year
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and lapse period have expired, and sufficient funds were | ||
available
to
pay the claim. The plan shall be funded | ||
through
appropriations from the General Revenue Fund | ||
specifically designated for
that purpose.
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Subject to sufficient appropriation, the Director is | ||
authorized to pay any wage claim presented to the
Director
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that is supported by a final settlement or final judgment | ||
when the chief
officer of the State agency employing the | ||
claimant certifies to the
Director that
the claim is a | ||
valid wage claim and that the fiscal year and lapse period
| ||
have expired. Payment for claims that are properly | ||
submitted and certified
as valid by the Director
shall | ||
include interest accrued at the rate of 7% per annum from | ||
the
forty-fifth day after the claims are received by the | ||
Department or 45 days from the date on which the amount of | ||
payment
is agreed upon, whichever is later, until the date | ||
the claims are submitted
to the Comptroller for payment. | ||
When the Attorney General has filed an
appearance in any | ||
proceeding concerning a wage claim settlement or
judgment, |
the Attorney General shall certify to the Director that the | ||
wage claim is valid before any payment is
made. In no event | ||
shall an amount in excess of $150,000 be paid from this
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plan to or for the benefit of any claimant.
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Nothing in Public Act 84-961 shall be construed to | ||
affect in any manner the jurisdiction of the
Court of | ||
Claims concerning wage claims made against the State of | ||
Illinois.
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(14) Prepare and, in the discretion of the Director, | ||
implement a program for
self-insurance for official
| ||
fidelity and surety bonds for officers and employees as | ||
authorized by the
Official Bond Act.
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(Source: P.A. 96-928, eff. 6-15-10.)
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(20 ILCS 405/405-411) | ||
Sec. 405-411. Consolidation of workers' compensation | ||
functions. | ||
(a) Notwithstanding any other law to the contrary, the | ||
Director of Central Management Services, working in | ||
cooperation with the Director of any other agency, department, | ||
board, or commission directly responsible to the Governor, may | ||
direct the consolidation, within the Department of Central | ||
Management Services, of those workers' compensation functions | ||
at that agency, department, board, or commission that are | ||
suitable for centralization. | ||
Upon receipt of the written direction to transfer workers' |
compensation functions to the Department of Central Management | ||
Services, the personnel, equipment, and property (both real and | ||
personal) directly relating to the transferred functions shall | ||
be transferred to the Department of Central Management | ||
Services, and the relevant documents, records, and | ||
correspondence shall be transferred or copied, as the Director | ||
may prescribe. | ||
(b) Upon receiving written direction from the Director of | ||
Central Management Services, the Comptroller and Treasurer are | ||
authorized to transfer the unexpended balance of any | ||
appropriations related to the workers' compensation functions | ||
transferred to the Department of Central Management Services | ||
and shall make the necessary fund transfers from the General | ||
Revenue Fund, any special fund in the State treasury, or any | ||
other federal or State trust fund held by the Treasurer to the | ||
Workers' Compensation Revolving Fund for use by the Department | ||
of Central Management Services in support of workers' | ||
compensation functions or any other related costs or expenses | ||
of the Department of Central Management Services. | ||
(c) The rights of employees and the State and its agencies | ||
under the Personnel Code and applicable collective bargaining | ||
agreements or under any pension, retirement, or annuity plan | ||
shall not be affected by any transfer under this Section. | ||
(d) The functions transferred to the Department of Central | ||
Management Services by this Section shall be vested in and | ||
shall be exercised by the Department of Central Management |
Services. Each act done in the exercise of those functions | ||
shall have the same legal effect as if done by the agencies, | ||
offices, divisions, departments, bureaus, boards and | ||
commissions from which they were transferred. | ||
Every person or other entity shall be subject to the same | ||
obligations and duties and any penalties, civil or criminal, | ||
arising therefrom, and shall have the same rights arising from | ||
the exercise of such rights, powers, and duties as had been | ||
exercised by the agencies, offices, divisions, departments, | ||
bureaus, boards, and commissions from which they were | ||
transferred. | ||
Whenever reports or notices are now required to be made or | ||
given or papers or documents furnished or served by any person | ||
in regards to the functions transferred to or upon the | ||
agencies, offices, divisions, departments, bureaus, boards, | ||
and commissions from which the functions were transferred, the | ||
same shall be made, given, furnished or served in the same | ||
manner to or upon the Department of Central Management | ||
Services. | ||
This Section does not affect any act done, ratified, or | ||
cancelled or any right occurring or established or any action | ||
or proceeding had or commenced in an administrative, civil, or | ||
criminal cause regarding the functions transferred, but those | ||
proceedings may be continued by the Department of Central | ||
Management Services. | ||
This Section does not affect the legality of any rules in |
the Illinois Administrative Code regarding the functions | ||
transferred in this Section that are in force on the effective | ||
date of this Section. If necessary, however, the affected | ||
agencies shall propose, adopt, or repeal rules, rule | ||
amendments, and rule recodifications as appropriate to | ||
effectuate this Section.
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(e) There is hereby created within the Department of | ||
Central Management Services an advisory body to be known as the | ||
State Workers' Compensation Program Advisory Board to review, | ||
assess, and provide recommendations to improve the State | ||
workers' compensation program and to ensure that the State | ||
manages the program in the interests of injured workers and | ||
taxpayers. The Governor shall appoint one person to the Board, | ||
who shall serve as the Chairperson. The Speaker of the House of | ||
Representatives, the Minority Leader of the House of | ||
Representatives, the President of the Senate, and the Minority | ||
Leader of the Senate shall each appoint one person to the | ||
Board. Each member initially appointed to the Board shall serve | ||
a term ending December 31, 2013, and each Board member | ||
appointed thereafter shall serve a 3-year term. A Board member | ||
shall continue to serve on the Board until his or her successor | ||
is appointed. In addition, the Director of the Department of | ||
Central Management Services, the Attorney General, the | ||
Director of the Department of Insurance, the Secretary of the | ||
Department of Transportation, the Director of the Department of | ||
Corrections, the Secretary of the Department of Human Services, |
the Director of the Department of Revenue, and the Chairman of | ||
the Illinois Workers' Compensation Commission, or their | ||
designees, shall serve as ex officio, non-voting members of the | ||
Board. Members of the Board shall not receive compensation but | ||
shall be reimbursed from the Workers' Compensation Revolving | ||
Fund for reasonable expenses incurred in the necessary | ||
performance of their duties, and the Department of Central | ||
Management Services shall provide administrative support to | ||
the Board. The Board shall meet at least 3 times per year or | ||
more often if the Board deems it necessary or proper. By | ||
September 30, 2011, the Board shall issue a written report, to | ||
be delivered to the Governor, the Director of the Department of | ||
Central Management Services, and the General Assembly, with a | ||
recommended set of best practices for the State workers' | ||
compensation program. By July 1 of each year thereafter, the | ||
Board shall issue a written report, to be delivered to those | ||
same persons or entities, with recommendations on how to | ||
improve upon such practices. | ||
(Source: P.A. 93-839, eff. 7-30-04.) | ||
Section 10. The Code of Civil Procedure is amended by | ||
changing Section 8-802 as follows:
| ||
(735 ILCS 5/8-802) (from Ch. 110, par. 8-802)
| ||
Sec. 8-802. Physician and patient. No physician or surgeon | ||
shall be
permitted to disclose any information he or she may |
have acquired in
attending any patient in a professional | ||
character, necessary to enable him
or her professionally to | ||
serve the patient, except only (1) in trials for
homicide when | ||
the disclosure relates directly to the fact or immediate
| ||
circumstances of the homicide, (2) in actions, civil or | ||
criminal, against
the physician for malpractice, (3) with the | ||
expressed consent of the
patient, or in case of his or her | ||
death or disability, of his or her
personal representative or | ||
other person authorized to sue for personal
injury or of the | ||
beneficiary of an insurance policy on his or her life,
health, | ||
or physical condition, (4) in all actions brought by or against | ||
the
patient, his or her personal representative, a beneficiary | ||
under a policy
of insurance, or the executor or administrator | ||
of his or her estate wherein
the patient's physical or mental | ||
condition is an issue, (5) upon an issue
as to the validity of | ||
a document as a will of the patient, (6) in any
criminal action | ||
where the charge is either first degree murder by abortion,
| ||
attempted abortion or abortion, (7) in actions, civil or | ||
criminal, arising
from the filing of a report in compliance | ||
with the Abused and Neglected
Child Reporting Act, (8) to any | ||
department, agency, institution
or facility which has custody | ||
of the patient pursuant to State statute
or any court order of | ||
commitment, (9) in prosecutions where written
results of blood | ||
alcohol tests are admissible pursuant to Section 11-501.4
of | ||
the Illinois Vehicle Code, (10) in prosecutions where written
| ||
results of blood alcohol tests are admissible under Section |
5-11a of the
Boat Registration and Safety Act,
(11) in criminal | ||
actions arising from the filing of a report of suspected
| ||
terrorist offense in compliance with Section 29D-10(p)(7) of | ||
the Criminal Code
of 1961, or (12) upon the issuance of a | ||
subpoena pursuant to Section 38 of the Medical Practice Act of | ||
1987; the issuance of a subpoena pursuant to Section 25.1 of | ||
the Illinois Dental Practice Act; or the issuance of a subpoena | ||
pursuant to Section 22 of the Nursing Home Administrators | ||
Licensing and Disciplinary Act ; or the issuance of a subpoena | ||
pursuant to Section 25.5 of the Workers' Compensation Act .
| ||
In the event of a conflict between the application of this | ||
Section
and the Mental Health and Developmental Disabilities | ||
Confidentiality
Act to a specific situation, the provisions of | ||
the Mental Health and
Developmental Disabilities | ||
Confidentiality Act shall control.
| ||
(Source: P.A. 95-478, eff. 8-27-07.)
| ||
Section 15. The Workers' Compensation Act is amended by | ||
changing Sections 1, 4, 8, 8.2, 8.7, 11, 13, 13.1, 14, 18, 19, | ||
and 25.5 and by adding Sections 1.1, 4b, 8.1a, 8.1b, 8.2a, 16b, | ||
18.1, 29.1, and 29.2 as follows:
| ||
(820 ILCS 305/1) (from Ch. 48, par. 138.1)
| ||
Sec. 1. This Act may be cited as the Workers' Compensation | ||
Act.
| ||
(a) The term "employer" as used in this Act means:
|
1. The State and each county, city, town, township, | ||
incorporated
village, school district, body politic, or | ||
municipal corporation
therein.
| ||
2. Every person, firm, public or private corporation, | ||
including
hospitals, public service, eleemosynary, religious | ||
or charitable
corporations or associations who has any person | ||
in service or under any
contract for hire, express or implied, | ||
oral or written, and who is
engaged in any of the enterprises | ||
or businesses enumerated in Section 3
of this Act, or who at or | ||
prior to the time of the accident to the
employee for which | ||
compensation under this Act may be claimed, has in
the manner | ||
provided in this Act elected to become subject to the
| ||
provisions of this Act, and who has not, prior to such | ||
accident,
effected a withdrawal of such election in the manner | ||
provided in this Act.
| ||
3. Any one engaging in any business or enterprise referred | ||
to in
subsections 1 and 2 of Section 3 of this Act who | ||
undertakes to do any
work enumerated therein, is liable to pay | ||
compensation to his own
immediate employees in accordance with | ||
the provisions of this Act, and
in addition thereto if he | ||
directly or indirectly engages any contractor
whether | ||
principal or sub-contractor to do any such work, he is liable | ||
to
pay compensation to the employees of any such contractor or
| ||
sub-contractor unless such contractor or sub-contractor has | ||
insured, in
any company or association authorized under the | ||
laws of this State to
insure the liability to pay compensation |
under this Act, or guaranteed
his liability to pay such | ||
compensation. With respect to any time
limitation on the filing | ||
of claims provided by this Act, the timely
filing of a claim | ||
against a contractor or subcontractor, as the case may
be, | ||
shall be deemed to be a timely filing with respect to all | ||
persons
upon whom liability is imposed by this paragraph.
| ||
In the event any such person pays compensation under this | ||
subsection
he may recover the amount thereof from the | ||
contractor or sub-contractor,
if any, and in the event the | ||
contractor pays compensation under this
subsection he may | ||
recover the amount thereof from the sub-contractor, if any.
| ||
This subsection does not apply in any case where the | ||
accident occurs
elsewhere than on, in or about the immediate | ||
premises on which the
principal has contracted that the work be | ||
done.
| ||
4. Where an employer operating under and subject to the | ||
provisions
of this Act loans an employee to another such | ||
employer and such loaned
employee sustains a compensable | ||
accidental injury in the employment of
such borrowing employer | ||
and where such borrowing employer does not
provide or pay the | ||
benefits or payments due such injured employee, such
loaning | ||
employer is liable to provide or pay all benefits or payments
| ||
due such employee under this Act and as to such employee the | ||
liability
of such loaning and borrowing employers is joint and | ||
several, provided
that such loaning employer is in the absence | ||
of agreement to the
contrary entitled to receive from such |
borrowing employer full
reimbursement for all sums paid or | ||
incurred pursuant to this paragraph
together with reasonable | ||
attorneys' fees and expenses in any hearings
before the | ||
Illinois Workers' Compensation Commission or in any action to | ||
secure such
reimbursement. Where any benefit is provided or | ||
paid by such loaning
employer the employee has the duty of | ||
rendering reasonable cooperation
in any hearings, trials or | ||
proceedings in the case, including such
proceedings for | ||
reimbursement.
| ||
Where an employee files an Application for Adjustment of | ||
Claim with
the Illinois Workers' Compensation
Commission | ||
alleging that his claim is covered by the
provisions of the | ||
preceding paragraph, and joining both the alleged
loaning and | ||
borrowing employers, they and each of them, upon written
demand | ||
by the employee and within 7 days after receipt of such demand,
| ||
shall have the duty of filing with the Illinois Workers' | ||
Compensation Commission a written
admission or denial of the | ||
allegation that the claim is covered by the
provisions of the | ||
preceding paragraph and in default of such filing or
if any | ||
such denial be ultimately determined not to have been bona fide
| ||
then the provisions of Paragraph K of Section 19 of this Act | ||
shall apply.
| ||
An employer whose business or enterprise or a substantial | ||
part
thereof consists of hiring, procuring or furnishing | ||
employees to or for
other employers operating under and subject | ||
to the provisions of this
Act for the performance of the work |
of such other employers and who pays
such employees their | ||
salary or wages notwithstanding that they are doing
the work of | ||
such other employers shall be deemed a loaning employer
within | ||
the meaning and provisions of this Section.
| ||
(b) The term "employee" as used in this Act means:
| ||
1. Every person in the service of the State, including | ||
members of
the General Assembly, members of the Commerce | ||
Commission, members of the
Illinois Workers' Compensation | ||
Commission, and all persons in the service of the University
of | ||
Illinois, county, including deputy sheriffs and assistant | ||
state's
attorneys, city, town, township, incorporated village | ||
or school
district, body politic, or municipal corporation | ||
therein, whether by
election, under appointment or contract of | ||
hire, express or implied,
oral or written, including all | ||
members of the Illinois National Guard
while on active duty in | ||
the service of the State, and all probation
personnel of the | ||
Juvenile Court appointed pursuant to Article VI
of the Juvenile | ||
Court Act of 1987, and including any official of the
State, any | ||
county, city, town, township, incorporated village, school
| ||
district, body politic or municipal corporation therein except | ||
any duly
appointed member of a police department in any city | ||
whose
population exceeds 200,000 according to the last Federal | ||
or State
census, and except any member of a fire insurance | ||
patrol maintained by a
board of underwriters in this State. A | ||
duly appointed member of a fire
department in any city, the | ||
population of which exceeds 200,000 according
to the last |
federal or State census, is an employee under this Act only
| ||
with respect to claims brought under paragraph (c) of Section | ||
8.
| ||
One employed by a contractor who has contracted with the | ||
State, or a
county, city, town, township, incorporated village, | ||
school district,
body politic or municipal corporation | ||
therein, through its
representatives, is not considered as an | ||
employee of the State, county,
city, town, township, | ||
incorporated village, school district, body
politic or | ||
municipal corporation which made the contract.
| ||
2. Every person in the service of another under any | ||
contract of
hire, express or implied, oral or written, | ||
including persons whose
employment is outside of the State of | ||
Illinois where the contract of
hire is made within the State of | ||
Illinois, persons whose employment
results in fatal or | ||
non-fatal injuries within the State of Illinois
where the | ||
contract of hire is made outside of the State of Illinois, and
| ||
persons whose employment is principally localized within the | ||
State of
Illinois, regardless of the place of the accident or | ||
the place where the
contract of hire was made, and including | ||
aliens, and minors who, for the
purpose of this Act are | ||
considered the same and have the same power to
contract, | ||
receive payments and give quittances therefor, as adult | ||
employees.
| ||
3. Every sole proprietor and every partner of a business | ||
may elect to
be covered by this Act.
|
An employee or his dependents under this Act who shall have | ||
a cause
of action by reason of any injury, disablement or death | ||
arising out of
and in the course of his employment may elect to | ||
pursue his remedy in
the State where injured or disabled, or in | ||
the State where the contract
of hire is made, or in the State | ||
where the employment is principally
localized.
| ||
However, any employer may elect to provide and pay | ||
compensation to
any employee other than those engaged in the | ||
usual course of the trade,
business, profession or occupation | ||
of the employer by complying with
Sections 2 and 4 of this Act. | ||
Employees are not included within the
provisions of this Act | ||
when excluded by the laws of the United States
relating to | ||
liability of employers to their employees for personal
injuries | ||
where such laws are held to be exclusive.
| ||
The term "employee" does not include persons performing | ||
services as real
estate broker, broker-salesman, or salesman | ||
when such persons are paid by
commission only.
| ||
(c) "Commission" means the Industrial Commission created | ||
by Section
5 of "The Civil Administrative Code of Illinois", | ||
approved March 7,
1917, as amended, or the Illinois Workers' | ||
Compensation Commission created by Section 13 of
this Act.
| ||
(d) To obtain compensation under this Act, an employee | ||
bears the burden of showing, by a preponderance of the | ||
evidence, that he or she has sustained accidental injuries | ||
arising out of and in the course of the employment. | ||
(Source: P.A. 93-721, eff. 1-1-05.)
|
(820 ILCS 305/1.1 new) | ||
Sec. 1.1. Standards of conduct. | ||
(a) Commissioners and arbitrators shall dispose of all | ||
Workers' Compensation matters promptly, officially and fairly, | ||
without bias or prejudice. Commissioners and arbitrators shall | ||
be faithful to the law and maintain professional competence in | ||
it. They shall be unswayed by partisan interests, public | ||
clamor, or fear of criticism. Commissioners and arbitrators | ||
shall take appropriate action or initiate appropriate | ||
disciplinary measures against a Commissioner, arbitrator, | ||
lawyer, or others for unprofessional conduct of which the | ||
Commissioner or arbitrator may become aware. | ||
(b) Except as otherwise provided in this Act, the Canons of | ||
the Code of Judicial Conduct as adopted by the Supreme Court of | ||
Illinois govern the hearing and non-hearing conduct of members | ||
of the Commission and arbitrators under this Act. The | ||
Commission may set additional rules and standards, not less | ||
stringent than those rules and standards established by the | ||
Code of Judicial Conduct, for the conduct of arbitrators. | ||
(c) The following provisions of the Code of Judicial | ||
Conduct do not apply under this Section: | ||
(1) Canon 3(B), relating to administrative | ||
responsibilities of Judges. | ||
(2) Canon 6(C), relating to annual filings of economic | ||
interests. Instead of filing declarations of economic |
interests with the Clerk of the Illinois Supreme Court | ||
under Illinois Supreme Court Rule 68, members of the | ||
Commission and arbitrators shall make filings | ||
substantially similar to those required by Rule 68 with the | ||
Chairman, and such filings shall be made available for | ||
examination by the public. | ||
(d) An arbitrator or a Commissioner may accept an | ||
uncompensated appointment to a governmental committee, | ||
commission or other position that is concerned with issues of | ||
policy on matters which may come before the arbitrator or | ||
Commissioner if such appointment neither affects his or her | ||
independent professional judgment nor the conduct of his or her | ||
duties. | ||
(e) Decisions of an arbitrator or a Commissioner shall be | ||
based exclusively on evidence in the record of the proceeding | ||
and material that has been officially noticed. Any findings of | ||
fact made by the arbitrator based on inquiries, investigations, | ||
examinations, or inspections undertaken by the arbitrator | ||
shall be entered into the record of the proceeding. | ||
(f) Nothing in this Section shall prohibit an arbitrator | ||
from holding a pre-trial conference in accordance with the | ||
rules of the Commission.
| ||
(820 ILCS 305/4) (from Ch. 48, par. 138.4)
| ||
Sec. 4. (a) Any employer, including but not limited to | ||
general contractors
and their subcontractors, who shall come |
within the provisions of
Section 3 of this Act, and any other | ||
employer who shall elect to provide
and pay the compensation | ||
provided for in this Act shall:
| ||
(1) File with the Commission annually an application | ||
for approval as a
self-insurer which shall include a | ||
current financial statement, and
annually, thereafter, an | ||
application for renewal of self-insurance, which
shall | ||
include a current financial statement. Said
application | ||
and financial statement shall be signed and sworn to by the
| ||
president or vice president and secretary or assistant | ||
secretary of the
employer if it be a corporation, or by all | ||
of the partners, if it be a
copartnership, or by the owner | ||
if it be neither a copartnership nor a
corporation. All | ||
initial applications and all applications for renewal of
| ||
self-insurance must be submitted at least 60 days prior to | ||
the requested
effective date of self-insurance. An | ||
employer may elect to provide and pay
compensation as | ||
provided
for in this Act as a member of a group workers' | ||
compensation pool under Article
V 3/4 of the Illinois | ||
Insurance Code. If an employer becomes a member of a
group | ||
workers' compensation pool, the employer shall not be | ||
relieved of any
obligations imposed by this Act.
| ||
If the sworn application and financial statement of any | ||
such employer
does not satisfy the Commission of the | ||
financial ability of the employer
who has filed it, the | ||
Commission shall require such employer to,
|
(2) Furnish security, indemnity or a bond guaranteeing | ||
the payment
by the employer of the compensation provided | ||
for in this Act, provided
that any such employer whose | ||
application and financial statement shall
not have | ||
satisfied the commission of his or her financial ability | ||
and
who shall have secured his liability in part by excess | ||
liability insurance
shall be required to furnish to the | ||
Commission security, indemnity or bond
guaranteeing his or | ||
her payment up to the effective limits of the excess
| ||
coverage, or
| ||
(3) Insure his entire liability to pay such | ||
compensation in some
insurance carrier authorized, | ||
licensed, or permitted to do such
insurance business in | ||
this State. Every policy of an insurance carrier,
insuring | ||
the payment of compensation under this Act shall cover all | ||
the
employees and the entire compensation liability of the | ||
insured:
Provided, however, that any employer may insure | ||
his or her compensation
liability with 2 or more insurance | ||
carriers or may insure a part and
qualify under subsection | ||
1, 2, or 4 for the remainder of his or her
liability to pay | ||
such compensation, subject to the following two | ||
provisions:
| ||
Firstly, the entire compensation liability of the | ||
employer to
employees working at or from one location | ||
shall be insured in one such
insurance carrier or shall | ||
be self-insured, and
|
Secondly, the employer shall submit evidence | ||
satisfactorily to the
Commission that his or her entire | ||
liability for the compensation provided
for in this Act | ||
will be secured. Any provisions in any policy, or in | ||
any
endorsement attached thereto, attempting to limit | ||
or modify in any way,
the liability of the insurance | ||
carriers issuing the same except as
otherwise provided | ||
herein shall be wholly void.
| ||
Nothing herein contained shall apply to policies of | ||
excess liability
carriage secured by employers who have | ||
been approved by the Commission
as self-insurers, or
| ||
(4) Make some other provision, satisfactory to the | ||
Commission, for
the securing of the payment of compensation | ||
provided for in this Act,
and
| ||
(5) Upon becoming subject to this Act and thereafter as | ||
often as the
Commission may in writing demand, file with | ||
the Commission in form prescribed
by it evidence of his or | ||
her compliance with the provision of this Section.
| ||
(a-1) Regardless of its state of domicile or its principal | ||
place of
business, an employer shall make payments to its | ||
insurance carrier or group
self-insurance fund, where | ||
applicable, based upon the premium rates of the
situs where the | ||
work or project is located in Illinois if:
| ||
(A) the employer is engaged primarily in the building | ||
and
construction industry; and
| ||
(B) subdivision (a)(3) of this Section applies to the |
employer or
the employer is a member of a group | ||
self-insurance plan as defined in
subsection (1) of Section | ||
4a.
| ||
The Illinois Workers' Compensation Commission shall impose | ||
a penalty upon an employer
for violation of this subsection | ||
(a-1) if:
| ||
(i) the employer is given an opportunity at a hearing | ||
to present
evidence of its compliance with this subsection | ||
(a-1); and
| ||
(ii) after the hearing, the Commission finds that the | ||
employer
failed to make payments upon the premium rates of | ||
the situs where the work or
project is located in Illinois.
| ||
The penalty shall not exceed $1,000 for each day of work | ||
for which
the employer failed to make payments upon the premium | ||
rates of the situs where
the
work or project is located in | ||
Illinois, but the total penalty shall not exceed
$50,000 for | ||
each project or each contract under which the work was
| ||
performed.
| ||
Any penalty under this subsection (a-1) must be imposed not | ||
later
than one year after the expiration of the applicable | ||
limitation period
specified in subsection (d) of Section 6 of | ||
this Act. Penalties imposed under
this subsection (a-1) shall | ||
be deposited into the Illinois Workers' Compensation | ||
Commission
Operations Fund, a special fund that is created in | ||
the State treasury. Subject
to appropriation, moneys in the | ||
Fund shall be used solely for the operations
of the Illinois |
Workers' Compensation Commission and by the Department of | ||
Insurance Financial and Professional Regulation for the | ||
purposes authorized in subsection (c) of Section 25.5 of this | ||
Act.
| ||
(a-2) Every Employee Leasing Company (ELC), as defined in | ||
Section 15 of the Employee Leasing Company Act, shall at a | ||
minimum provide the following information to the Commission or | ||
any entity designated by the Commission regarding each workers' | ||
compensation insurance policy issued to the ELC: | ||
(1) Any client company of the ELC listed as an | ||
additional named insured. | ||
(2) Any informational schedule attached to the master | ||
policy that identifies any individual client company's | ||
name, FEIN, and job location. | ||
(3) Any certificate of insurance coverage document | ||
issued to a client company specifying its rights and | ||
obligations under the master policy that establishes both | ||
the identity and status of the client, as well as the dates | ||
of inception and termination of coverage, if applicable. | ||
(b) The sworn application and financial statement, or | ||
security,
indemnity or bond, or amount of insurance, or other | ||
provisions, filed,
furnished, carried, or made by the employer, | ||
as the case may be, shall
be subject to the approval of the | ||
Commission.
| ||
Deposits under escrow agreements shall be cash, negotiable | ||
United
States government bonds or negotiable general |
obligation bonds of the
State of Illinois. Such cash or bonds | ||
shall be deposited in
escrow with any State or National Bank or | ||
Trust Company having trust
authority in the State of Illinois.
| ||
Upon the approval of the sworn application and financial | ||
statement,
security, indemnity or bond or amount of insurance, | ||
filed, furnished or
carried, as the case may be, the Commission | ||
shall send to the employer
written notice of its approval | ||
thereof. The certificate of compliance
by the employer with the | ||
provisions of subparagraphs (2) and (3) of
paragraph (a) of | ||
this Section shall be delivered by the insurance
carrier to the | ||
Illinois Workers' Compensation Commission within five days | ||
after the
effective date of the policy so certified. The | ||
insurance so certified
shall cover all compensation liability | ||
occurring during the time that
the insurance is in effect and | ||
no further certificate need be filed in case
such insurance is | ||
renewed, extended or otherwise continued by such
carrier. The | ||
insurance so certified shall not be cancelled or in the
event | ||
that such insurance is not renewed, extended or otherwise
| ||
continued, such insurance shall not be terminated until at | ||
least 10
days after receipt by the Illinois Workers' | ||
Compensation Commission of notice of the
cancellation or | ||
termination of said insurance; provided, however, that
if the | ||
employer has secured insurance from another insurance carrier, | ||
or
has otherwise secured the payment of compensation in | ||
accordance with
this Section, and such insurance or other | ||
security becomes effective
prior to the expiration of the 10 |
days, cancellation or termination may, at
the option of the | ||
insurance carrier indicated in such notice, be effective
as of | ||
the effective date of such other insurance or security.
| ||
(c) Whenever the Commission shall find that any | ||
corporation,
company, association, aggregation of individuals, | ||
reciprocal or
interinsurers exchange, or other insurer | ||
effecting workers' compensation
insurance in this State shall | ||
be insolvent, financially unsound, or
unable to fully meet all | ||
payments and liabilities assumed or to be
assumed for | ||
compensation insurance in this State, or shall practice a
| ||
policy of delay or unfairness toward employees in the | ||
adjustment,
settlement, or payment of benefits due such | ||
employees, the Commission
may after reasonable notice and | ||
hearing order and direct that such
corporation, company, | ||
association, aggregation of individuals,
reciprocal or | ||
interinsurers exchange, or insurer, shall from and after a
date | ||
fixed in such order discontinue the writing of any such | ||
workers'
compensation insurance in this State. Subject to such | ||
modification of
the order as the Commission may later make on | ||
review of the order,
as herein provided, it shall thereupon be | ||
unlawful for any such
corporation, company, association, | ||
aggregation of individuals,
reciprocal or interinsurers | ||
exchange, or insurer to effect any workers'
compensation | ||
insurance in this State. A copy of the order shall be served
| ||
upon the Director of Insurance by registered mail. Whenever the | ||
Commission
finds that any service or adjustment company used or |
employed
by a self-insured employer or by an insurance carrier | ||
to process,
adjust, investigate, compromise or otherwise | ||
handle claims under this
Act, has practiced or is practicing a | ||
policy of delay or unfairness
toward employees in the | ||
adjustment, settlement or payment of benefits
due such | ||
employees, the Commission may after reasonable notice and
| ||
hearing order and direct that such service or adjustment | ||
company shall
from and after a date fixed in such order be | ||
prohibited from processing,
adjusting, investigating, | ||
compromising or otherwise handling claims
under this Act.
| ||
Whenever the Commission finds that any self-insured | ||
employer has
practiced or is practicing delay or unfairness | ||
toward employees in the
adjustment, settlement or payment of | ||
benefits due such employees, the
Commission may, after | ||
reasonable notice and hearing, order and direct
that after a | ||
date fixed in the order such self-insured employer shall be
| ||
disqualified to operate as a self-insurer and shall be required | ||
to
insure his entire liability to pay compensation in some | ||
insurance
carrier authorized, licensed and permitted to do such | ||
insurance business
in this State, as provided in subparagraph 3 | ||
of paragraph (a) of this
Section.
| ||
All orders made by the Commission under this Section shall | ||
be subject
to review by the courts, said review to be taken in | ||
the same manner and
within the same time as provided by Section | ||
19 of this Act for review of
awards and decisions of the | ||
Commission, upon the party seeking the
review filing with the |
clerk of the court to which said review is taken
a bond in an | ||
amount to be fixed and approved by the court to which the
| ||
review is taken, conditioned upon the payment of all | ||
compensation awarded
against the person taking said review | ||
pending a decision thereof and
further conditioned upon such | ||
other obligations as the court may impose.
Upon the review the | ||
Circuit Court shall have power to review all questions
of fact | ||
as well as of law. The penalty hereinafter provided for in this
| ||
paragraph shall not attach and shall not begin to run until the | ||
final
determination of the order of the Commission.
| ||
(d) Whenever a panel of 3 Commissioners comprised of one | ||
member of the employing class, one member of the employee | ||
class, and one member not identified with either the employing | ||
or employee class, with due process and after a hearing, | ||
determines an employer has knowingly failed to provide coverage | ||
as required by paragraph (a) of this Section, the failure shall | ||
be deemed an immediate serious danger to public health, safety, | ||
and welfare sufficient to justify service by the Commission of | ||
a work-stop order on such employer, requiring the cessation of | ||
all business operations of such employer at the place of | ||
employment or job site. Any law enforcement agency in the State | ||
shall, at the request of the Commission, render any assistance | ||
necessary to carry out the provisions of this Section, | ||
including, but not limited to, preventing any employee of such | ||
employer from remaining at a place of employment or job site | ||
after a work-stop order has taken effect. Any work-stop order |
shall be lifted upon proof of insurance as required by this | ||
Act. Any orders under this Section are appealable under Section | ||
19(f) to the Circuit Court.
| ||
Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or | ||
member of an employer limited liability company who knowingly | ||
fails to provide coverage as required by paragraph (a) of this | ||
Section is guilty of a Class 4 felony. This provision shall not | ||
apply to any corporate officer or director of any | ||
publicly-owned corporation. Each day's violation constitutes a | ||
separate offense. The State's Attorney of the county in which | ||
the violation occurred, or the Attorney General, shall bring | ||
such actions in the name of the People of the State of | ||
Illinois, or may, in addition to other remedies provided in | ||
this Section, bring an action for an injunction to restrain the | ||
violation or to enjoin the operation of any such employer.
| ||
Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or | ||
member of an employer limited liability company who negligently | ||
fails to provide coverage as required by paragraph (a) of this | ||
Section is guilty of a Class A misdemeanor. This provision | ||
shall not apply to any corporate officer or director of any | ||
publicly-owned corporation. Each day's violation constitutes a | ||
separate offense. The State's Attorney of the county in which | ||
the violation occurred, or the Attorney General, shall bring | ||
such actions in the name of the People of the State of |
Illinois.
| ||
The criminal penalties in this subsection (d) shall not | ||
apply where
there exists a good faith dispute as to the | ||
existence of an
employment relationship. Evidence of good faith | ||
shall
include, but not be limited to, compliance with the | ||
definition
of employee as used by the Internal Revenue Service.
| ||
Employers who are subject to and who knowingly fail to | ||
comply with this Section shall not be entitled to the benefits | ||
of this Act during the period of noncompliance, but shall be | ||
liable in an action under any other applicable law of this | ||
State. In the action, such employer shall not avail himself or | ||
herself of the defenses of assumption of risk or negligence or | ||
that the injury was due to a co-employee. In the action, proof | ||
of the injury shall constitute prima facie evidence of | ||
negligence on the part of such employer and the burden shall be | ||
on such employer to show freedom of negligence resulting in the | ||
injury. The employer shall not join any other defendant in any | ||
such civil action. Nothing in this amendatory Act of the 94th | ||
General Assembly shall affect the employee's rights under | ||
subdivision (a)3 of Section 1 of this Act. Any employer or | ||
carrier who makes payments under subdivision (a)3 of Section 1 | ||
of this Act shall have a right of reimbursement from the | ||
proceeds of any recovery under this Section.
| ||
An employee of an uninsured employer, or the employee's | ||
dependents in case death ensued, may, instead of proceeding | ||
against the employer in a civil action in court, file an |
application for adjustment of claim with the Commission in | ||
accordance with the provisions of this Act and the Commission | ||
shall hear and determine the application for adjustment of | ||
claim in the manner in which other claims are heard and | ||
determined before the Commission.
| ||
All proceedings under this subsection (d) shall be reported | ||
on an annual basis to the Workers' Compensation Advisory Board.
| ||
An investigator with the Illinois Workers' Compensation | ||
Commission Insurance Compliance Division may issue a citation | ||
to any employer that is not in compliance with its obligation | ||
to have workers' compensation insurance under this Act. The | ||
amount of the fine shall be based on the period of time the | ||
employer was in non-compliance, but shall be no less than $500, | ||
and shall not exceed $2,500. An employer that has been issued a | ||
citation shall pay the fine to the Commission and provide to | ||
the Commission proof that it obtained the required workers' | ||
compensation insurance within 10 days after the citation was | ||
issued. This Section does not affect any other obligations this | ||
Act imposes on employers. | ||
Upon a finding by the Commission, after reasonable notice | ||
and
hearing, of the knowing and wilful failure or refusal of an | ||
employer to
comply with
any of the provisions of paragraph (a) | ||
of this Section , or the failure or
refusal of an employer, | ||
service or adjustment company, or an insurance
carrier to | ||
comply with any order of the Illinois Workers' Compensation | ||
Commission pursuant to
paragraph (c) of this Section |
disqualifying him or her to operate as a self
insurer and | ||
requiring him or her to insure his or her liability, or the | ||
knowing and willful failure of an employer to comply with a | ||
citation issued by an investigator with the Illinois Workers' | ||
Compensation Commission Insurance Compliance Division, the
| ||
Commission may assess a civil penalty of up to $500 per day for | ||
each day of
such failure or refusal after the effective date of | ||
this amendatory Act of
1989. The minimum penalty under this | ||
Section shall be the sum of $10,000.
Each day of such failure | ||
or refusal shall constitute a separate offense.
The Commission | ||
may assess the civil penalty personally and individually
| ||
against the corporate officers and directors of a corporate | ||
employer, the
partners of an employer partnership, and the | ||
members of an employer limited
liability company, after a | ||
finding of a knowing and willful refusal or failure
of each | ||
such named corporate officer, director, partner, or member to | ||
comply
with this Section. The liability for the assessed | ||
penalty shall be
against the named employer first, and
if the | ||
named employer fails or refuses to pay the penalty to the
| ||
Commission within 30 days after the final order of the | ||
Commission, then the
named
corporate officers, directors, | ||
partners, or members who have been found to have
knowingly and | ||
willfully refused or failed to comply with this Section shall | ||
be
liable for the unpaid penalty or any unpaid portion of the | ||
penalty. Upon investigation by the insurance non-compliance | ||
unit of the Commission, the Attorney General shall have the |
authority to prosecute all proceedings to enforce the civil and | ||
administrative provisions of this Section before the | ||
Commission. The Commission shall promulgate procedural rules | ||
for enforcing this Section.
| ||
Upon the failure or refusal of any employer, service or | ||
adjustment
company or insurance carrier to comply with the | ||
provisions of this Section
and with the orders of the | ||
Commission under this Section, or the order of
the court on | ||
review after final adjudication, the Commission may bring a
| ||
civil action to recover the amount of the penalty in Cook | ||
County or in
Sangamon County in which litigation the Commission | ||
shall be represented by
the Attorney General. The Commission | ||
shall send notice of its finding of
non-compliance and | ||
assessment of the civil penalty to the Attorney General.
It | ||
shall be the duty of the Attorney General within 30 days after | ||
receipt
of the notice, to institute prosecutions and promptly | ||
prosecute all
reported violations of this Section.
| ||
Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or | ||
member of an employer limited liability company who, with the | ||
intent to avoid payment of compensation under this Act to an | ||
injured employee or the employee's dependents, knowingly | ||
transfers, sells, encumbers, assigns, or in any manner disposes | ||
of, conceals, secretes, or destroys any property belonging to | ||
the employer, officer, director, partner, or member is guilty | ||
of a Class 4 felony.
|
Penalties and fines collected pursuant to this paragraph | ||
(d) shall be deposited upon receipt into a special fund which | ||
shall be designated the Injured Workers' Benefit Fund, of which | ||
the State Treasurer is ex-officio custodian, such special fund | ||
to be held and disbursed in accordance with this paragraph (d) | ||
for the purposes hereinafter stated in this paragraph (d), upon | ||
the final order of the Commission. The Injured Workers' Benefit | ||
Fund shall be deposited the same as are State funds and any | ||
interest accruing thereon shall be added thereto every 6 | ||
months. The Injured Workers' Benefit Fund is subject to audit | ||
the same as State funds and accounts and is protected by the | ||
general bond given by the State Treasurer. The Injured Workers' | ||
Benefit Fund is considered always appropriated for the purposes | ||
of disbursements as provided in this paragraph, and shall be | ||
paid out and disbursed as herein provided and shall not at any | ||
time be appropriated or diverted to any other use or purpose. | ||
Moneys in the Injured Workers' Benefit Fund shall be used only | ||
for payment of workers' compensation benefits for injured | ||
employees when the employer has failed to provide coverage as | ||
determined under this paragraph (d) and has failed to pay the | ||
benefits due to the injured employee. The Commission shall have | ||
the right to obtain reimbursement from the employer for | ||
compensation obligations paid by the Injured Workers' Benefit | ||
Fund. Any such amounts obtained shall be deposited by the | ||
Commission into the Injured Workers' Benefit Fund. If an | ||
injured employee or his or her personal representative receives |
payment from the Injured Workers' Benefit Fund, the State of | ||
Illinois has the same rights under paragraph (b) of Section 5 | ||
that the employer who failed to pay the benefits due to the | ||
injured employee would have had if the employer had paid those | ||
benefits, and any moneys recovered by the State as a result of | ||
the State's exercise of its rights under paragraph (b) of | ||
Section 5 shall be deposited into the Injured Workers' Benefit | ||
Fund. The custodian of the Injured Workers' Benefit Fund shall | ||
be joined with the employer as a party respondent in the | ||
application for adjustment of claim. After July 1, 2006, the | ||
Commission shall make disbursements from the Fund once each | ||
year to each eligible claimant. An eligible claimant is an | ||
injured worker who has within the previous fiscal year obtained | ||
a final award for benefits from the Commission against the | ||
employer and the Injured Workers' Benefit Fund and has notified | ||
the Commission within 90 days of receipt of such award. Within | ||
a reasonable time after the end of each fiscal year, the | ||
Commission shall make a disbursement to each eligible claimant. | ||
At the time of disbursement, if there are insufficient moneys | ||
in the Fund to pay all claims, each eligible claimant shall | ||
receive a pro-rata share, as determined by the Commission, of | ||
the available moneys in the Fund for that year. Payment from | ||
the Injured Workers' Benefit Fund to an eligible claimant | ||
pursuant to this provision shall discharge the obligations of | ||
the Injured Workers' Benefit Fund regarding the award entered | ||
by the Commission.
|
(e) This Act shall not affect or disturb the continuance of | ||
any
existing insurance, mutual aid, benefit, or relief | ||
association or
department, whether maintained in whole or in | ||
part by the employer or
whether maintained by the employees, | ||
the payment of benefits of such
association or department being | ||
guaranteed by the employer or by some
person, firm or | ||
corporation for him or her: Provided, the employer contributes
| ||
to such association or department an amount not less than the | ||
full
compensation herein provided, exclusive of the cost of the | ||
maintenance
of such association or department and without any | ||
expense to the
employee. This Act shall not prevent the | ||
organization and maintaining
under the insurance laws of this | ||
State of any benefit or insurance
company for the purpose of | ||
insuring against the compensation provided
for in this Act, the | ||
expense of which is maintained by the employer.
This Act shall | ||
not prevent the organization or maintaining under the
insurance | ||
laws of this State of any voluntary mutual aid, benefit or
| ||
relief association among employees for the payment of | ||
additional
accident or sick benefits.
| ||
(f) No existing insurance, mutual aid, benefit or relief | ||
association
or department shall, by reason of anything herein | ||
contained, be
authorized to discontinue its operation without | ||
first discharging its
obligations to any and all persons | ||
carrying insurance in the same or
entitled to relief or | ||
benefits therein.
| ||
(g) Any contract, oral, written or implied, of employment |
providing
for relief benefit, or insurance or any other device | ||
whereby the
employee is required to pay any premium or premiums | ||
for insurance
against the compensation provided for in this Act | ||
shall be null and
void. Any employer withholding from the wages | ||
of any employee any
amount for the purpose of paying any such | ||
premium shall be guilty of a
Class B misdemeanor.
| ||
In the event the employer does not pay the compensation for | ||
which he or
she is liable, then an insurance company, | ||
association or insurer which may
have insured such employer | ||
against such liability shall become primarily
liable to pay to | ||
the employee, his or her personal representative or
beneficiary | ||
the compensation required by the provisions of this Act to
be | ||
paid by such employer. The insurance carrier may be made a | ||
party to
the proceedings in which the employer is a party and | ||
an award may be
entered jointly against the employer and the | ||
insurance carrier.
| ||
(h) It shall be unlawful for any employer, insurance | ||
company or
service or adjustment company to interfere with, | ||
restrain or coerce an
employee in any manner whatsoever in the | ||
exercise of the rights or
remedies granted to him or her by | ||
this Act or to discriminate, attempt to
discriminate, or | ||
threaten to discriminate against an employee in any way
because | ||
of his or her exercise of the rights or remedies granted to
him | ||
or her by this Act.
| ||
It shall be unlawful for any employer, individually or | ||
through any
insurance company or service or adjustment company, |
to discharge or to
threaten to discharge, or to refuse to | ||
rehire or recall to active
service in a suitable capacity an | ||
employee because of the exercise of
his or her rights or | ||
remedies granted to him or her by this Act.
| ||
(i) If an employer elects to obtain a life insurance policy | ||
on his
employees, he may also elect to apply such benefits in | ||
satisfaction of all
or a portion of the death benefits payable | ||
under this Act, in which case,
the employer's compensation | ||
premium shall be reduced accordingly.
| ||
(j) Within 45 days of receipt of an initial application or | ||
application
to renew self-insurance privileges the | ||
Self-Insurers Advisory Board shall
review and submit for | ||
approval by the Chairman of the Commission
recommendations of | ||
disposition of all initial applications to self-insure
and all | ||
applications to renew self-insurance privileges filed by | ||
private
self-insurers pursuant to the provisions of this | ||
Section and Section 4a-9
of this Act. Each private self-insurer | ||
shall submit with its initial and
renewal applications the | ||
application fee required by Section 4a-4 of this Act.
| ||
The Chairman of the Commission shall promptly act upon all | ||
initial
applications and applications for renewal in full | ||
accordance with the
recommendations of the Board or, should the | ||
Chairman disagree with any
recommendation of disposition of the | ||
Self-Insurer's Advisory Board, he
shall within 30 days of | ||
receipt of such recommendation provide to the Board
in writing | ||
the reasons supporting his decision. The Chairman shall also
|
promptly notify the employer of his decision within 15 days of | ||
receipt of
the recommendation of the Board.
| ||
If an employer is denied a renewal of self-insurance | ||
privileges pursuant
to application it shall retain said | ||
privilege for 120 days after receipt of
a notice of | ||
cancellation of the privilege from the Chairman of the | ||
Commission.
| ||
All orders made by the Chairman under this Section shall be | ||
subject to
review by the courts, such review to be taken in the | ||
same manner and within
the same time as provided by subsection | ||
(f) of Section 19 of this Act for
review of awards and | ||
decisions of the Commission, upon the party seeking
the review | ||
filing with the clerk of the court to which such review is | ||
taken
a bond in an amount to be fixed and approved by the court | ||
to which the
review is taken, conditioned upon the payment of | ||
all compensation awarded
against the person taking such review | ||
pending a decision thereof and
further conditioned upon such | ||
other obligations as the court may impose.
Upon the review the | ||
Circuit Court shall have power to review all questions
of fact | ||
as well as of law.
| ||
(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||
94-839, eff. 6-6-06.)
| ||
(820 ILCS 305/4b new) | ||
Sec. 4b. Collective bargaining pilot program. | ||
(a) The Director of the Department of Labor shall adopt a |
selection process to designate 2 international, national, or | ||
statewide organizations made up of affiliates who are the | ||
exclusive representatives of construction employer employees | ||
recognized or certified pursuant to the National Labor | ||
Relations Act
to
participate in the collective bargaining pilot | ||
program provided for in this Section. | ||
(a-5) For purposes of this Section, the term "construction | ||
employer" means any person or legal entity or group of persons | ||
or legal entities engaging in or planning to engage in any | ||
constructing, altering, reconstructing, repairing, | ||
rehabilitating, refinishing, refurbishing, remodeling, | ||
remediating, renovating, custom fabricating, maintaining, | ||
landscaping, improving, wrecking, painting, decorating, | ||
demolishing, and adding to or subtracting from any building, | ||
structure, airport facility, highway, roadway, street, alley, | ||
bridge, sewer, drain, ditch, sewage disposal plant, water | ||
works, parking facility, railroad, excavation or other | ||
project, structure, development, real property or improvement, | ||
or to do any part thereof, whether or not the performance of | ||
the work herein described involves the addition to, or | ||
fabrication into, any project, structure, development, real | ||
property or improvement herein described, and shall also | ||
include any moving of construction-related materials on the job | ||
site or to or from the job site. | ||
For purposes of this Section, "labor organization" means an | ||
affiliate of an international, national, or statewide |
organization that has been selected by the Department of Labor | ||
to participate in the collective bargaining pilot program as | ||
provided for in this Section. | ||
(b) Upon appropriate filing, the Commission and the courts | ||
of this State shall recognize as valid and binding any | ||
provision in a collective bargaining agreement between any | ||
construction employer or group of construction employers and a | ||
labor organization, which contains certain obligations and | ||
procedures relating to workers' compensation. This agreement | ||
must be limited to, but need not include, all of the following: | ||
(1) An alternative dispute resolution ("ADR") system | ||
to supplement, modify or replace the procedural or dispute | ||
resolution provisions of this Act. The system may include | ||
mediation, arbitration, or other dispute resolution | ||
proceedings, the results of which shall be final and | ||
binding upon the parties; | ||
(2) An agreed list of medical treatment providers that | ||
may be the exclusive source of all medical and related | ||
treatment provided under this Act; | ||
(3) The use of a limited list of impartial physicians | ||
to conduct independent medical examinations; | ||
(4) The creation of a light duty, modified job, or | ||
return to work program; | ||
(5) The use of a limited list of individuals and | ||
companies for the establishment of vocational | ||
rehabilitation or retraining programs that may be the |
exclusive source of rehabilitation and retraining services | ||
provided under this Act; or | ||
(6) The establishment of joint labor management safety | ||
committees and safety procedures. | ||
(c) Void agreements. Nothing in this Section shall be | ||
construed to authorize any provision in a collective bargaining | ||
agreement that diminishes or increases a construction | ||
employer's entitlements under this Act or an employee's | ||
entitlement to benefits as otherwise set forth in this Act. For | ||
the purposes of this Section, the procedural rights and dispute | ||
resolution agreements under subparagraphs (1) through (6) of | ||
subsection (b) of this Section are not agreements which | ||
diminish or increase a construction employer's entitlements | ||
under this Act or an employee's entitlement to benefits under | ||
this Act. Any agreement that diminishes or increases a | ||
construction employer's entitlements under this Act or an | ||
employee's entitlement to benefits as set forth in this Act is | ||
null and void. Nothing in this Section shall be construed as | ||
creating a mandatory subject of bargaining. | ||
(d) Form of agreement. The agreement reached herein shall | ||
demonstrate that: | ||
(1) The construction employer or group of construction | ||
employers and the recognized or certified exclusive | ||
bargaining representative have entered into a binding | ||
collective bargaining agreement adopting the ADR plan for a | ||
period of no less than 2 years; |
(2) Contractual agreements have been reached with the | ||
construction employer's workers' compensation carrier, | ||
group self-insurance fund, and any excess carriers | ||
relating to the ADR plan; | ||
(3) Procedures have been established by which claims | ||
for benefits by employees will be lodged, administered, and | ||
decided while affording procedural due process; | ||
(4) The plan has designated forms upon which claims for | ||
benefits shall be made; | ||
(5) The system and means by which the construction | ||
employer's obligation to furnish medical services and | ||
vocational rehabilitation and retraining benefits shall be | ||
fulfilled and provider selected; | ||
(6) The method by which mediators or arbitrators are to | ||
be selected. | ||
(e) Filing. A copy of the agreement and a statement | ||
identifying the parties to the agreement shall be filed with | ||
the Commission. Within 21 days of receipt of an agreement, the | ||
Chairman shall review the agreement for compliance with this | ||
Section and notify the parties of its acceptance or notify the | ||
parties of any additional information required or any | ||
recommended modification that would bring the agreement into | ||
compliance. If no additional information or modification is | ||
required, the agreement shall be valid and binding from the | ||
time the parties receive acceptance of the agreement from the | ||
Chairman. Upon receipt of any requested information or |
modification, the Chairman shall notify the parties within 21 | ||
days whether the agreement is in compliance with this Section. | ||
All rejections made by the Chairman under this subsection shall | ||
be subject to review by the courts of this State, said review | ||
to be taken in the same manner and within the same time as | ||
provided by Section 19 of this Act for review of awards and | ||
decisions of the Commission. Upon the review, the Circuit Court | ||
shall have power to review all questions of fact as well as of | ||
law. | ||
(f) Notice to insurance carrier. If the construction | ||
employer is insured under this Act, it shall provide notice to | ||
and obtain consent from its insurance carrier, in the manner | ||
provided in the insurance contract, of its intent to enter into | ||
an agreement as provided in this Section with its employees. | ||
(g) Employees' claims for workers' compensation benefits. | ||
(1) Claims for benefits shall be filed with the ADR | ||
plan administrator within those periods of limitation | ||
prescribed by this Act. Within 10 days of the filing of a | ||
claim, the ADR plan administrator shall serve a copy of the | ||
claim application upon the Commission, which shall | ||
maintain records of all ADR claims and resolutions. | ||
(2) Settlements of claims presented to the ADR plan | ||
administrator shall be evidenced by a settlement | ||
agreement. All such settlements shall be filed with the ADR | ||
plan administrator, who within 10 days shall forward a copy | ||
to the Commission for recording. |
(3) Upon assignment of claims, unless settled, | ||
mediators and arbitrators shall render final orders | ||
containing essential findings of fact, rulings of law and | ||
referring to other matters as pertinent to the questions at | ||
issue. The ADR plan administrator shall maintain a record | ||
of the proceedings. | ||
(h) Reporting requirements. Annually, each ADR plan | ||
administrator shall submit a report to the Commission | ||
containing the following information: | ||
(1) The number of employees within the ADR program; | ||
(2) The number of occurrences of work-related injuries | ||
or diseases; | ||
(3) The breakdown within the ADR program of injuries | ||
and diseases treated; | ||
(4) The total amount of disability benefits paid within | ||
the ADR program; | ||
(5) The total medical treatment cost paid within the | ||
ADR program; | ||
(6) The number of claims filed within the ADR program; | ||
and | ||
(7) The disposition of all claims.
| ||
(820 ILCS 305/8) (from Ch. 48, par. 138.8)
| ||
Sec. 8. The amount of compensation which shall be paid to | ||
the
employee for an accidental injury not resulting in death | ||
is:
|
(a) The employer shall provide and pay the negotiated rate, | ||
if applicable, or the lesser of the health care provider's | ||
actual charges or according to a fee schedule, subject to | ||
Section 8.2, in effect at the time the service was rendered for | ||
all the necessary first
aid, medical and surgical services, and | ||
all necessary medical, surgical
and hospital services | ||
thereafter incurred, limited, however, to that
which is | ||
reasonably required to cure or relieve from the effects of the
| ||
accidental injury , even if a health care provider sells, | ||
transfers, or otherwise assigns an account receivable for | ||
procedures, treatments, or services covered under this Act . If | ||
the employer does not dispute payment of first aid, medical, | ||
surgical,
and hospital services, the employer shall make such | ||
payment to the provider on behalf of the employee. The employer | ||
shall also pay for treatment,
instruction and training | ||
necessary for the physical, mental and
vocational | ||
rehabilitation of the employee, including all maintenance
| ||
costs and expenses incidental thereto. If as a result of the | ||
injury the
employee is unable to be self-sufficient the | ||
employer shall further pay
for such maintenance or | ||
institutional care as shall be required.
| ||
The employee may at any time elect to secure his own | ||
physician,
surgeon and hospital services at the employer's | ||
expense, or, | ||
Upon agreement between the employer and the employees, or | ||
the employees'
exclusive representative, and subject to the |
approval of the Illinois Workers' Compensation
Commission, the | ||
employer shall maintain a list of physicians, to be
known as a | ||
Panel of Physicians, who are accessible to the employees.
The | ||
employer shall post this list in a place or places easily | ||
accessible
to his employees. The employee shall have the right | ||
to make an
alternative choice of physician from such Panel if | ||
he is not satisfied
with the physician first selected. If, due | ||
to the nature of the injury
or its occurrence away from the | ||
employer's place of business, the
employee is unable to make a | ||
selection from the Panel, the selection
process from the Panel | ||
shall not apply. The physician selected from the
Panel may | ||
arrange for any consultation, referral or other specialized
| ||
medical services outside the Panel at the employer's expense. | ||
Provided
that, in the event the Commission shall find that a | ||
doctor selected by
the employee is rendering improper or | ||
inadequate care, the Commission
may order the employee to | ||
select another doctor certified or qualified
in the medical | ||
field for which treatment is required. If the employee
refuses | ||
to make such change the Commission may relieve the employer of
| ||
his obligation to pay the doctor's charges from the date of | ||
refusal to
the date of compliance.
| ||
Any vocational rehabilitation counselors who provide | ||
service under this Act shall have
appropriate certifications | ||
which designate the counselor as qualified to render
opinions | ||
relating to vocational rehabilitation. Vocational | ||
rehabilitation
may include, but is not limited to, counseling |
for job searches, supervising
a job search program, and | ||
vocational retraining including education at an
accredited | ||
learning institution. The employee or employer may petition to | ||
the Commission to decide disputes relating to vocational | ||
rehabilitation and the Commission shall resolve any such | ||
dispute, including payment of the vocational rehabilitation | ||
program by the employer. | ||
The maintenance benefit shall not be less than the | ||
temporary total disability
rate determined for the employee. In | ||
addition, maintenance shall include costs
and expenses | ||
incidental to the vocational rehabilitation program. | ||
When the employee is working light duty on a part-time | ||
basis or full-time
basis
and earns less than he or she would be | ||
earning if employed in the full capacity
of the job or jobs, | ||
then the employee shall be entitled to temporary partial | ||
disability benefits. Temporary partial disability benefits | ||
shall be
equal to two-thirds of
the difference between the | ||
average amount that the employee would be able to
earn in the | ||
full performance of his or her duties in the occupation in | ||
which he
or she was engaged at the time of accident and the | ||
gross net amount which he or she
is
earning in the modified job | ||
provided to the employee by the employer or in any other job | ||
that the employee is working. | ||
Every hospital, physician, surgeon or other person | ||
rendering
treatment or services in accordance with the | ||
provisions of this Section
shall upon written request furnish |
full and complete reports thereof to,
and permit their records | ||
to be copied by, the employer, the employee or
his dependents, | ||
as the case may be, or any other party to any proceeding
for | ||
compensation before the Commission, or their attorneys.
| ||
Notwithstanding the foregoing, the employer's liability to | ||
pay for such
medical services selected by the employee shall be | ||
limited to:
| ||
(1) all first aid and emergency treatment; plus
| ||
(2) all medical, surgical and hospital services | ||
provided by the
physician, surgeon or hospital initially | ||
chosen by the employee or by any
other physician, | ||
consultant, expert, institution or other provider of
| ||
services recommended by said initial service provider or | ||
any subsequent
provider of medical services in the chain of | ||
referrals from said
initial service provider; plus
| ||
(3) all medical, surgical and hospital services | ||
provided by any second
physician, surgeon or hospital | ||
subsequently chosen by the employee or by
any other | ||
physician, consultant, expert, institution or other | ||
provider of
services recommended by said second service | ||
provider or any subsequent provider
of medical services in | ||
the chain of referrals
from said second service provider. | ||
Thereafter the employer shall select
and pay for all | ||
necessary medical, surgical and hospital treatment and the
| ||
employee may not select a provider of medical services at | ||
the employer's
expense unless the employer agrees to such |
selection. At any time the employee
may obtain any medical | ||
treatment he desires at his own expense. This paragraph
| ||
shall not affect the duty to pay for rehabilitation | ||
referred to above.
| ||
(4) The following shall apply for injuries occurring on | ||
or after the effective date of this amendatory Act of the | ||
97th General Assembly and only when an employer has an | ||
approved preferred provider program pursuant to Section | ||
8.1a on the date the employee sustained his or her | ||
accidental injuries: | ||
(A) The employer shall, in writing, on a form | ||
promulgated by the Commission, inform the employee of | ||
the preferred provider program; | ||
(B) Subsequent to the report of an injury by an | ||
employee, the employee may choose in writing at any | ||
time to decline the preferred provider program, in | ||
which case that would constitute one of the two choices | ||
of medical providers to which the employee is entitled | ||
under subsection (a)(2) or (a)(3); and | ||
(C) Prior to the report of an injury by an | ||
employee, when an employee chooses non-emergency | ||
treatment from a provider not within the preferred | ||
provider program, that would constitute the employee's | ||
one choice of medical providers to which the employee | ||
is entitled under subsection (a)(2) or (a)(3). | ||
When an employer and employee so agree in writing, nothing |
in this
Act prevents an employee whose injury or disability has | ||
been established
under this Act, from relying in good faith, on | ||
treatment by prayer or
spiritual means alone, in accordance | ||
with the tenets and practice of a
recognized church or | ||
religious denomination, by a duly accredited
practitioner | ||
thereof, and having nursing services appropriate therewith,
| ||
without suffering loss or diminution of the compensation | ||
benefits under
this Act. However, the employee shall submit to | ||
all physical
examinations required by this Act. The cost of | ||
such treatment and
nursing care shall be paid by the employee | ||
unless the employer agrees to
make such payment.
| ||
Where the accidental injury results in the amputation of an | ||
arm,
hand, leg or foot, or the enucleation of an eye, or the | ||
loss of any of
the natural teeth, the employer shall furnish an | ||
artificial of any such
members lost or damaged in accidental | ||
injury arising out of and in the
course of employment, and | ||
shall also furnish the necessary braces in all
proper and | ||
necessary cases. In cases of the loss of a member or members
by | ||
amputation, the employer shall, whenever necessary, maintain | ||
in good
repair, refit or replace the artificial limbs during | ||
the lifetime of the
employee. Where the accidental injury | ||
accompanied by physical injury
results in damage to a denture, | ||
eye glasses or contact eye lenses, or
where the accidental | ||
injury results in damage to an artificial member,
the employer | ||
shall replace or repair such denture, glasses, lenses, or
| ||
artificial member.
|
The furnishing by the employer of any such services or | ||
appliances is
not an admission of liability on the part of the | ||
employer to pay
compensation.
| ||
The furnishing of any such services or appliances or the | ||
servicing
thereof by the employer is not the payment of | ||
compensation.
| ||
(b) If the period of temporary total incapacity for work | ||
lasts more
than 3 working days, weekly compensation as | ||
hereinafter provided shall
be paid beginning on the 4th day of | ||
such temporary total incapacity and
continuing as long as the | ||
total temporary incapacity lasts. In cases
where the temporary | ||
total incapacity for work continues for a period of
14 days or | ||
more from the day of the accident compensation shall commence
| ||
on the day after the accident.
| ||
1. The compensation rate for temporary total | ||
incapacity under this
paragraph (b) of this Section shall | ||
be equal to 66 2/3% of the
employee's average weekly wage | ||
computed in accordance with Section 10,
provided that it | ||
shall be not less than 66 2/3% of the sum of the Federal | ||
minimum wage under the Fair Labor
Standards Act, or the | ||
Illinois minimum wage under the Minimum Wage Law,
whichever | ||
is more, multiplied by 40 hours. This percentage rate shall | ||
be
increased by 10% for each spouse and child, not to | ||
exceed 100% of the total
minimum wage calculation,
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is |
less.
| ||
2. The compensation rate in all cases other than for | ||
temporary total
disability under this paragraph (b), and | ||
other than for serious and
permanent disfigurement under | ||
paragraph (c) and other than for permanent
partial | ||
disability under subparagraph (2) of paragraph (d) or under
| ||
paragraph (e), of this Section shall be equal to 66
2/3% of | ||
the employee's average weekly wage computed in accordance | ||
with
the provisions of Section 10, provided that it shall | ||
be not less than
66 2/3% of the sum of the Federal minimum | ||
wage under the Fair Labor Standards Act, or the Illinois | ||
minimum wage under the Minimum Wage Law, whichever is more, | ||
multiplied by 40 hours. This percentage rate shall be | ||
increased by 10% for each spouse and child, not to exceed | ||
100% of the total minimum wage calculation,
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is | ||
less.
| ||
2.1. The compensation rate in all cases of serious and | ||
permanent
disfigurement under paragraph (c) and of | ||
permanent partial disability
under subparagraph (2) of | ||
paragraph (d) or under paragraph (e) of this
Section shall | ||
be equal to
60% of the employee's average
weekly wage | ||
computed in accordance with
the provisions of Section 10, | ||
provided that it shall be not less than
66 2/3% of the sum | ||
of the Federal minimum wage under the Fair Labor Standards |
Act, or the Illinois minimum wage under the Minimum Wage | ||
Law, whichever is more, multiplied by 40 hours. This | ||
percentage rate shall be increased by 10% for each spouse | ||
and child, not to exceed 100% of the total minimum wage | ||
calculation,
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is | ||
less.
| ||
3. As used in this Section the term "child" means a | ||
child of the
employee including any child legally adopted | ||
before the accident or whom
at the time of the accident the | ||
employee was under legal obligation to
support or to whom | ||
the employee stood in loco parentis, and who at the
time of | ||
the accident was under 18 years of age and not emancipated. | ||
The
term "children" means the plural of "child".
| ||
4. All weekly compensation rates provided under | ||
subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||
Section shall be subject to the
following limitations:
| ||
The maximum weekly compensation rate from July 1, 1975, | ||
except as
hereinafter provided, shall be 100% of the | ||
State's average weekly wage in
covered industries under the | ||
Unemployment Insurance Act, that being the
wage that most | ||
closely approximates the State's average weekly wage.
| ||
The maximum weekly compensation rate, for the period | ||
July 1, 1984,
through June 30, 1987, except as hereinafter | ||
provided, shall be $293.61.
Effective July 1, 1987 and on |
July 1 of each year thereafter the maximum
weekly | ||
compensation rate, except as hereinafter provided, shall | ||
be
determined as follows: if during the preceding 12 month | ||
period there shall
have been an increase in the State's | ||
average weekly wage in covered
industries under the | ||
Unemployment Insurance Act, the weekly compensation
rate | ||
shall be proportionately increased by the same percentage | ||
as the
percentage of increase in the State's average weekly | ||
wage in covered
industries under the Unemployment | ||
Insurance Act during such period.
| ||
The maximum weekly compensation rate, for the period | ||
January 1, 1981
through December 31, 1983, except as | ||
hereinafter provided, shall be 100% of
the State's average | ||
weekly wage in covered industries under the
Unemployment | ||
Insurance Act in effect on January 1, 1981. Effective | ||
January
1, 1984 and on January 1, of each year thereafter | ||
the maximum weekly
compensation rate, except as | ||
hereinafter provided, shall be determined as
follows: if | ||
during the preceding 12 month period there shall have been | ||
an
increase in the State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act, the | ||
weekly compensation rate shall be
proportionately | ||
increased by the same percentage as the percentage of
| ||
increase in the State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act during | ||
such period.
|
From July 1, 1977 and thereafter such maximum weekly | ||
compensation
rate in death cases under Section 7, and | ||
permanent total disability
cases under paragraph (f) or | ||
subparagraph 18 of paragraph (3) of this
Section and for | ||
temporary total disability under paragraph (b) of this
| ||
Section and for amputation of a member or enucleation of an | ||
eye under
paragraph (e) of this Section shall be increased | ||
to 133-1/3% of the
State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act.
| ||
For injuries occurring on or after February 1, 2006, | ||
the maximum weekly benefit under paragraph (d)1 of this | ||
Section shall be 100% of the State's average weekly wage in | ||
covered industries under the Unemployment Insurance Act.
| ||
4.1. Any provision herein to the contrary | ||
notwithstanding, the
weekly compensation rate for | ||
compensation payments under subparagraph 18
of paragraph | ||
(e) of this Section and under paragraph (f) of this
Section | ||
and under paragraph (a) of Section 7 and for amputation of | ||
a member or enucleation of an eye under paragraph (e) of | ||
this Section, shall in no event be less
than 50% of the | ||
State's average weekly wage in covered industries under
the | ||
Unemployment Insurance Act.
| ||
4.2. Any provision to the contrary notwithstanding, | ||
the total
compensation payable under Section 7 shall not | ||
exceed the greater of $500,000
or 25
years.
| ||
5. For the purpose of this Section this State's average |
weekly wage
in covered industries under the Unemployment | ||
Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | ||
per
week and the computation of compensation rates shall be | ||
based on the
aforesaid average weekly wage until modified | ||
as hereinafter provided.
| ||
6. The Department of Employment Security of the State | ||
shall
on or before the first day of December, 1977, and on | ||
or before the first
day of June, 1978, and on the first day | ||
of each December and June of each
year thereafter, publish | ||
the State's average weekly wage in covered
industries under | ||
the Unemployment Insurance Act and the Illinois Workers' | ||
Compensation
Commission shall on the 15th day of January, | ||
1978 and on the 15th day of
July, 1978 and on the 15th day | ||
of each January and July of each year
thereafter, post and | ||
publish the State's average weekly wage in covered
| ||
industries under the Unemployment Insurance Act as last | ||
determined and
published by the Department of Employment | ||
Security. The amount when so
posted and published shall be | ||
conclusive and shall be applicable as the
basis of | ||
computation of compensation rates until the next posting | ||
and
publication as aforesaid.
| ||
7. The payment of compensation by an employer or his | ||
insurance
carrier to an injured employee shall not | ||
constitute an admission of the
employer's liability to pay | ||
compensation.
| ||
(c) For any serious and permanent disfigurement to the |
hand, head,
face, neck, arm, leg below the knee or the chest | ||
above the axillary
line, the employee is entitled to | ||
compensation for such disfigurement,
the amount determined by | ||
agreement at any time or by arbitration under
this Act, at a | ||
hearing not less than 6 months after the date of the
accidental | ||
injury, which amount shall not exceed 150 weeks (if the | ||
accidental injury occurs on or after the effective date of this | ||
amendatory Act of the 94th General Assembly
but before February
| ||
1, 2006) or 162
weeks (if the accidental injury occurs on or | ||
after February
1, 2006) at the
applicable rate provided in | ||
subparagraph 2.1 of paragraph (b) of this Section.
| ||
No compensation is payable under this paragraph where | ||
compensation is
payable under paragraphs (d), (e) or (f) of | ||
this Section.
| ||
A duly appointed member of a fire department in a city, the | ||
population of
which exceeds 200,000 according to the last | ||
federal or State census, is
eligible for compensation under | ||
this paragraph only where such serious and
permanent | ||
disfigurement results from burns.
| ||
(d) 1. If, after the accidental injury has been sustained, | ||
the
employee as a result thereof becomes partially | ||
incapacitated from
pursuing his usual and customary line of | ||
employment, he shall, except in
cases compensated under the | ||
specific schedule set forth in paragraph (e)
of this Section, | ||
receive compensation for the duration of his
disability, | ||
subject to the limitations as to maximum amounts fixed in
|
paragraph (b) of this Section, equal to 66-2/3% of the | ||
difference
between the average amount which he would be able to | ||
earn in the full
performance of his duties in the occupation in | ||
which he was engaged at
the time of the accident and the | ||
average amount which he is earning or
is able to earn in some | ||
suitable employment or business after the accident. For | ||
accidental injuries that occur on or after September 1, 2011, | ||
an award for wage differential under this subsection shall be | ||
effective only until the employee reaches the age of 67 or 5 | ||
years from the date the award becomes final, whichever is | ||
later.
| ||
2. If, as a result of the accident, the employee sustains | ||
serious
and permanent injuries not covered by paragraphs (c) | ||
and (e) of this
Section or having sustained injuries covered by | ||
the aforesaid
paragraphs (c) and (e), he shall have sustained | ||
in addition thereto
other injuries which injuries do not | ||
incapacitate him from pursuing the
duties of his employment but | ||
which would disable him from pursuing other
suitable | ||
occupations, or which have otherwise resulted in physical
| ||
impairment; or if such injuries partially incapacitate him from | ||
pursuing
the duties of his usual and customary line of | ||
employment but do not
result in an impairment of earning | ||
capacity, or having resulted in an
impairment of earning | ||
capacity, the employee elects to waive his right
to recover | ||
under the foregoing subparagraph 1 of paragraph (d) of this
| ||
Section then in any of the foregoing events, he shall receive |
in
addition to compensation for temporary total disability | ||
under paragraph
(b) of this Section, compensation at the rate | ||
provided in subparagraph 2.1
of paragraph (b) of this Section | ||
for that percentage of 500 weeks that
the partial disability | ||
resulting from the injuries covered by this
paragraph bears to | ||
total disability. If the employee shall have
sustained a | ||
fracture of one or more vertebra or fracture of the skull,
the | ||
amount of compensation allowed under this Section shall be not | ||
less
than 6 weeks for a fractured skull and 6 weeks for each | ||
fractured
vertebra, and in the event the employee shall have | ||
sustained a fracture
of any of the following facial bones: | ||
nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||
mandible, the amount of compensation allowed under
this Section | ||
shall be not less than 2 weeks for each such fractured
bone, | ||
and for a fracture of each transverse process not less than 3
| ||
weeks. In the event such injuries shall result in the loss of a | ||
kidney,
spleen or lung, the amount of compensation allowed | ||
under this Section
shall be not less than 10 weeks for each | ||
such organ. Compensation
awarded under this subparagraph 2 | ||
shall not take into consideration
injuries covered under | ||
paragraphs (c) and (e) of this Section and the
compensation | ||
provided in this paragraph shall not affect the employee's
| ||
right to compensation payable under paragraphs (b), (c) and (e) | ||
of this
Section for the disabilities therein covered.
| ||
(e) For accidental injuries in the following schedule, the | ||
employee
shall receive compensation for the period of temporary |
total incapacity
for work resulting from such accidental | ||
injury, under subparagraph 1 of
paragraph (b) of this Section, | ||
and shall receive in addition thereto
compensation for a | ||
further period for the specific loss herein
mentioned, but | ||
shall not receive any compensation under any other
provisions | ||
of this Act. The following listed amounts apply to either
the | ||
loss of or the permanent and complete loss of use of the member
| ||
specified, such compensation for the length of time as follows:
| ||
1. Thumb- | ||
70 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
76
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
2. First, or index finger- | ||
40 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
43
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
3. Second, or middle finger- | ||
35 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
38
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
|
4. Third, or ring finger- | ||
25 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
27
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
5. Fourth, or little finger- | ||
20 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
22
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
6. Great toe- | ||
35 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
38
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
7. Each toe other than great toe- | ||
12 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
13
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
8. The loss of the first or distal phalanx of the thumb | ||
or of any
finger or toe shall be considered to be equal to |
the loss of one-half of
such thumb, finger or toe and the | ||
compensation payable shall be one-half
of the amount above | ||
specified. The loss of more than one phalanx shall
be | ||
considered as the loss of the entire thumb, finger or toe. | ||
In no
case shall the amount received for more than one | ||
finger exceed the
amount provided in this schedule for the | ||
loss of a hand.
| ||
9. Hand- | ||
190 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
205
weeks if the accidental injury occurs on or | ||
after February
1, 2006. | ||
190 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
97th General Assembly and if the accidental injury | ||
involves carpal tunnel syndrome due to repetitive or | ||
cumulative trauma, in which case the permanent partial | ||
disability shall not exceed 15% loss of use of the | ||
hand, except for cause shown by clear and convincing | ||
evidence and in which case the award shall not exceed | ||
30% loss of use of the hand. | ||
The loss of 2 or more digits, or one or more
phalanges | ||
of 2 or more digits, of a hand may be compensated on the | ||
basis
of partial loss of use of a hand, provided, further, | ||
that the loss of 4
digits, or the loss of use of 4 digits, |
in the same hand shall
constitute the complete loss of a | ||
hand.
| ||
10. Arm- | ||
235 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
253
weeks if the accidental injury occurs on or | ||
after February
1, 2006. | ||
Where an accidental injury results in the
amputation of | ||
an arm below the elbow, such injury shall be compensated
as | ||
a loss of an arm. Where an accidental injury results in the
| ||
amputation of an arm above the elbow, compensation for an | ||
additional 15 weeks (if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the 94th | ||
General Assembly
but before February
1, 2006) or an | ||
additional 17
weeks (if the accidental injury occurs on or | ||
after February
1, 2006) shall be paid, except where the | ||
accidental injury results in the
amputation of an arm at | ||
the shoulder joint, or so close to shoulder
joint that an | ||
artificial arm cannot be used, or results in the
| ||
disarticulation of an arm at the shoulder joint, in which | ||
case
compensation for an additional 65 weeks (if the | ||
accidental injury occurs on or after the effective date of | ||
this amendatory Act of the 94th General Assembly
but before | ||
February
1, 2006) or an additional 70
weeks (if the | ||
accidental injury occurs on or after February
1, 2006)
|
shall be paid.
| ||
11. Foot- | ||
155 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
167
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
12. Leg- | ||
200 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
215
weeks if the accidental injury occurs on or | ||
after February
1, 2006. | ||
Where an accidental injury results in the
amputation of | ||
a leg below the knee, such injury shall be compensated as
| ||
loss of a leg. Where an accidental injury results in the | ||
amputation of a
leg above the knee, compensation for an | ||
additional 25 weeks (if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the 94th | ||
General Assembly
but before February
1, 2006) or an | ||
additional 27
weeks (if the accidental injury occurs on or | ||
after February
1, 2006) shall be
paid, except where the | ||
accidental injury results in the amputation of a
leg at the | ||
hip joint, or so close to the hip joint that an artificial
| ||
leg cannot be used, or results in the disarticulation of a | ||
leg at the
hip joint, in which case compensation for an |
additional 75 weeks (if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the 94th | ||
General Assembly
but before February
1, 2006) or an | ||
additional 81
weeks (if the accidental injury occurs on or | ||
after February
1, 2006) shall
be paid.
| ||
13. Eye- | ||
150 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
162
weeks if the accidental injury occurs on or | ||
after February
1, 2006. | ||
Where an accidental injury results in the
enucleation | ||
of an eye, compensation for an additional 10 weeks (if the | ||
accidental injury occurs on or after the effective date of | ||
this amendatory Act of the 94th General Assembly
but before | ||
February
1, 2006) or an additional 11
weeks (if the | ||
accidental injury occurs on or after February
1, 2006)
| ||
shall be
paid.
| ||
14. Loss of hearing of one ear- | ||
50 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
54
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
Total and permanent loss of
hearing of both ears- | ||
200 weeks if the accidental injury occurs on or |
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006. | ||
215
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
15. Testicle- | ||
50 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
54
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
Both testicles- | ||
150 weeks if the accidental injury occurs on or | ||
after the effective date of this amendatory Act of the | ||
94th General Assembly
but before February
1, 2006.
| ||
162
weeks if the accidental injury occurs on or | ||
after February
1, 2006.
| ||
16. For the permanent partial loss of use of a member | ||
or sight of an
eye, or hearing of an ear, compensation | ||
during that proportion of the
number of weeks in the | ||
foregoing schedule provided for the loss of such
member or | ||
sight of an eye, or hearing of an ear, which the partial | ||
loss
of use thereof bears to the total loss of use of such | ||
member, or sight
of eye, or hearing of an ear.
| ||
(a) Loss of hearing for compensation purposes | ||
shall be
confined to the frequencies of 1,000, 2,000 | ||
and 3,000 cycles per second.
Loss of hearing ability |
for frequency tones above 3,000 cycles per second
are | ||
not to be considered as constituting disability for | ||
hearing.
| ||
(b) The percent of hearing loss, for purposes of | ||
the
determination of compensation claims for | ||
occupational deafness,
shall be calculated as the | ||
average in decibels for the thresholds
of hearing for | ||
the frequencies of 1,000, 2,000 and 3,000 cycles per | ||
second.
Pure tone air conduction audiometric | ||
instruments, approved by
nationally recognized | ||
authorities in this field, shall be used for measuring
| ||
hearing loss. If the losses of hearing average 30 | ||
decibels or less in the
3 frequencies, such losses of | ||
hearing shall not then constitute any
compensable | ||
hearing disability. If the losses of hearing average 85
| ||
decibels or more in the 3 frequencies, then the same | ||
shall constitute and
be total or 100% compensable | ||
hearing loss.
| ||
(c) In measuring hearing impairment, the lowest | ||
measured
losses in each of the 3 frequencies shall be | ||
added together and
divided by 3 to determine the | ||
average decibel loss. For every decibel
of loss | ||
exceeding 30 decibels an allowance of 1.82% shall be | ||
made up to
the maximum of 100% which is reached at 85 | ||
decibels.
| ||
(d) If a hearing loss is established to have |
existed on July 1, 1975 by
audiometric testing the | ||||||||||||||||||||||||
employer shall not be liable for the previous loss
so | ||||||||||||||||||||||||
established nor shall he be liable for any loss for | ||||||||||||||||||||||||
which compensation
has been paid or awarded.
| ||||||||||||||||||||||||
(e) No consideration shall be given to the question | ||||||||||||||||||||||||
of
whether or not the ability of an employee to | ||||||||||||||||||||||||
understand speech
is improved by the use of a hearing | ||||||||||||||||||||||||
aid.
| ||||||||||||||||||||||||
(f) No claim for loss of hearing due to industrial | ||||||||||||||||||||||||
noise
shall be brought against an employer or allowed | ||||||||||||||||||||||||
unless the employee has
been exposed for a period of | ||||||||||||||||||||||||
time sufficient to cause permanent impairment
to noise | ||||||||||||||||||||||||
levels in excess of the following:
| ||||||||||||||||||||||||
| ||||||||||||||||||||||||
This subparagraph (f) shall not be applied in cases of | ||||||||||||||||||||||||
hearing loss
resulting from trauma or explosion.
|
17. In computing the compensation to be paid to any | ||
employee who,
before the accident for which he claims | ||
compensation, had before that
time sustained an injury | ||
resulting in the loss by amputation or partial
loss by | ||
amputation of any member, including hand, arm, thumb or | ||
fingers,
leg, foot or any toes, such loss or partial loss | ||
of any such member
shall be deducted from any award made | ||
for the subsequent injury. For
the permanent loss of use or | ||
the permanent partial loss of use of any
such member or the | ||
partial loss of sight of an eye, for which
compensation has | ||
been paid, then such loss shall be taken into
consideration | ||
and deducted from any award for the subsequent injury.
| ||
18. The specific case of loss of both hands, both arms, | ||
or both
feet, or both legs, or both eyes, or of any two | ||
thereof, or the
permanent and complete loss of the use | ||
thereof, constitutes total and
permanent disability, to be | ||
compensated according to the compensation
fixed by | ||
paragraph (f) of this Section. These specific cases of | ||
total
and permanent disability do not exclude other cases.
| ||
Any employee who has previously suffered the loss or | ||
permanent and
complete loss of the use of any of such | ||
members, and in a subsequent
independent accident loses | ||
another or suffers the permanent and complete
loss of the | ||
use of any one of such members the employer for whom the
| ||
injured employee is working at the time of the last | ||
independent accident
is liable to pay compensation only for |
the loss or permanent and
complete loss of the use of the | ||
member occasioned by the last
independent accident.
| ||
19. In a case of specific loss and the subsequent death | ||
of such
injured employee from other causes than such injury | ||
leaving a widow,
widower, or dependents surviving before | ||
payment or payment in full for
such injury, then the amount | ||
due for such injury is payable to the widow
or widower and, | ||
if there be no widow or widower, then to such
dependents, | ||
in the proportion which such dependency bears to total
| ||
dependency.
| ||
Beginning July 1, 1980, and every 6 months thereafter, the | ||
Commission
shall examine the Second Injury Fund and when, after | ||
deducting all
advances or loans made to such Fund, the amount | ||
therein is $500,000
then the amount required to be paid by | ||
employers pursuant to paragraph
(f) of Section 7 shall be | ||
reduced by one-half. When the Second Injury Fund
reaches the | ||
sum of $600,000 then the payments shall cease entirely.
| ||
However, when the Second Injury Fund has been reduced to | ||
$400,000, payment
of one-half of the amounts required by | ||
paragraph (f) of Section 7
shall be resumed, in the manner | ||
herein provided, and when the Second Injury
Fund has been | ||
reduced to $300,000, payment of the full amounts required by
| ||
paragraph (f) of Section 7 shall be resumed, in the manner | ||
herein provided.
The Commission shall make the changes in | ||
payment effective by
general order, and the changes in payment | ||
become immediately effective
for all cases coming before the |
Commission thereafter either by
settlement agreement or final | ||
order, irrespective of the date of the
accidental injury.
| ||
On August 1, 1996 and on February 1 and August 1 of each | ||
subsequent year, the Commission
shall examine the special fund | ||
designated as the "Rate
Adjustment Fund" and when, after | ||
deducting all advances or loans made to
said fund, the amount | ||
therein is $4,000,000, the amount required to be
paid by | ||
employers pursuant to paragraph (f) of Section 7 shall be
| ||
reduced by one-half. When the Rate Adjustment Fund reaches the | ||
sum of
$5,000,000 the payment therein shall cease entirely. | ||
However, when said
Rate Adjustment Fund has been reduced to | ||
$3,000,000 the amounts required by
paragraph (f) of Section 7 | ||
shall be resumed in the manner herein provided.
| ||
(f) In case of complete disability, which renders the | ||
employee
wholly and permanently incapable of work, or in the | ||
specific case of
total and permanent disability as provided in | ||
subparagraph 18 of
paragraph (e) of this Section, compensation | ||
shall be payable at the rate
provided in subparagraph 2 of | ||
paragraph (b) of this Section for life.
| ||
An employee entitled to benefits under paragraph (f) of | ||
this Section
shall also be entitled to receive from the Rate | ||
Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||
supplementary benefits
provided in paragraph (g) of this | ||
Section 8.
| ||
If any employee who receives an award under this paragraph | ||
afterwards
returns to work or is able to do so, and earns or is |
able to earn as
much as before the accident, payments under | ||
such award shall cease. If
such employee returns to work, or is | ||
able to do so, and earns or is able
to earn part but not as much | ||
as before the accident, such award shall be
modified so as to | ||
conform to an award under paragraph (d) of this
Section. If | ||
such award is terminated or reduced under the provisions of
| ||
this paragraph, such employees have the right at any time | ||
within 30
months after the date of such termination or | ||
reduction to file petition
with the Commission for the purpose | ||
of determining whether any
disability exists as a result of the | ||
original accidental injury and the
extent thereof.
| ||
Disability as enumerated in subdivision 18, paragraph (e) | ||
of this
Section is considered complete disability.
| ||
If an employee who had previously incurred loss or the | ||
permanent and
complete loss of use of one member, through the | ||
loss or the permanent
and complete loss of the use of one hand, | ||
one arm, one foot, one leg, or
one eye, incurs permanent and | ||
complete disability through the loss or
the permanent and | ||
complete loss of the use of another member, he shall
receive, | ||
in addition to the compensation payable by the employer and
| ||
after such payments have ceased, an amount from the Second | ||
Injury Fund
provided for in paragraph (f) of Section 7, which, | ||
together with the
compensation payable from the employer in | ||
whose employ he was when the
last accidental injury was | ||
incurred, will equal the amount payable for
permanent and | ||
complete disability as provided in this paragraph of this
|
Section.
| ||
The custodian of the Second Injury Fund provided for in | ||
paragraph (f)
of Section 7 shall be joined with the employer as | ||
a party respondent in
the application for adjustment of claim. | ||
The application for adjustment
of claim shall state briefly and | ||
in general terms the approximate time
and place and manner of | ||
the loss of the first member.
| ||
In its award the Commission or the Arbitrator shall | ||
specifically find
the amount the injured employee shall be | ||
weekly paid, the number of
weeks compensation which shall be | ||
paid by the employer, the date upon
which payments begin out of | ||
the Second Injury Fund provided for in
paragraph (f) of Section | ||
7 of this Act, the length of time the weekly
payments continue, | ||
the date upon which the pension payments commence and
the | ||
monthly amount of the payments. The Commission shall 30 days | ||
after
the date upon which payments out of the Second Injury | ||
Fund have begun as
provided in the award, and every month | ||
thereafter, prepare and submit to
the State Comptroller a | ||
voucher for payment for all compensation accrued
to that date | ||
at the rate fixed by the Commission. The State Comptroller
| ||
shall draw a warrant to the injured employee along with a | ||
receipt to be
executed by the injured employee and returned to | ||
the Commission. The
endorsed warrant and receipt is a full and | ||
complete acquittance to the
Commission for the payment out of | ||
the Second Injury Fund. No other
appropriation or warrant is | ||
necessary for payment out of the Second
Injury Fund. The Second |
Injury Fund is appropriated for the purpose of
making payments | ||
according to the terms of the awards.
| ||
As of July 1, 1980 to July 1, 1982, all claims against and | ||
obligations
of the Second Injury Fund shall become claims | ||
against and obligations of
the Rate Adjustment Fund to the | ||
extent there is insufficient money in the
Second Injury Fund to | ||
pay such claims and obligations. In that case, all
references | ||
to "Second Injury Fund" in this Section shall also include the
| ||
Rate Adjustment Fund.
| ||
(g) Every award for permanent total disability entered by | ||
the
Commission on and after July 1, 1965 under which | ||
compensation payments
shall become due and payable after the | ||
effective date of this amendatory
Act, and every award for | ||
death benefits or permanent total disability
entered by the | ||
Commission on and after the effective date of this
amendatory | ||
Act shall be subject to annual adjustments as to the amount
of | ||
the compensation rate therein provided. Such adjustments shall | ||
first
be made on July 15, 1977, and all awards made and entered | ||
prior to July
1, 1975 and on July 15 of each year
thereafter. | ||
In all other cases such adjustment shall be made on July 15
of | ||
the second year next following the date of the entry of the | ||
award and
shall further be made on July 15 annually thereafter. | ||
If during the
intervening period from the date of the entry of | ||
the award, or the last
periodic adjustment, there shall have | ||
been an increase in the State's
average weekly wage in covered | ||
industries under the Unemployment
Insurance Act, the weekly |
compensation rate shall be proportionately
increased by the | ||
same percentage as the percentage of increase in the
State's | ||
average weekly wage in covered industries under the
| ||
Unemployment Insurance Act. The increase in the compensation | ||
rate
under this paragraph shall in no event bring the total | ||
compensation rate
to an amount greater than the prevailing | ||
maximum rate at the time that the annual adjustment is made. | ||
Such increase
shall be paid in the same manner as herein | ||
provided for payments under
the Second Injury Fund to the | ||
injured employee, or his dependents, as
the case may be, out of | ||
the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||
of this Act. Payments shall be made at
the same intervals as | ||
provided in the award or, at the option of the
Commission, may | ||
be made in quarterly payment on the 15th day of January,
April, | ||
July and October of each year. In the event of a decrease in
| ||
such average weekly wage there shall be no change in the then | ||
existing
compensation rate. The within paragraph shall not | ||
apply to cases where
there is disputed liability and in which a | ||
compromise lump sum settlement
between the employer and the | ||
injured employee, or his dependents, as the
case may be, has | ||
been duly approved by the Illinois Workers' Compensation
| ||
Commission.
| ||
Provided, that in cases of awards entered by the Commission | ||
for
injuries occurring before July 1, 1975, the increases in | ||
the
compensation rate adjusted under the foregoing provision of | ||
this
paragraph (g) shall be limited to increases in the State's |
average
weekly wage in covered industries under the | ||
Unemployment Insurance Act
occurring after July 1, 1975.
| ||
For every accident occurring on or after July 20, 2005 but | ||
before the effective date of this amendatory Act of the 94th | ||
General Assembly (Senate Bill 1283 of the 94th General | ||
Assembly), the annual adjustments to the compensation rate in | ||
awards for death benefits or permanent total disability, as | ||
provided in this Act, shall be paid by the employer. The | ||
adjustment shall be made by the employer on July 15 of the | ||
second year next following the date of the entry of the award | ||
and shall further be made on July 15 annually thereafter. If | ||
during the intervening period from the date of the entry of the | ||
award, or the last periodic adjustment, there shall have been | ||
an increase in the State's average weekly wage in covered | ||
industries under the Unemployment Insurance Act, the employer | ||
shall increase the weekly compensation rate proportionately by | ||
the same percentage as the percentage of increase in the | ||
State's average weekly wage in covered industries under the | ||
Unemployment Insurance Act. The increase in the compensation | ||
rate under this paragraph shall in no event bring the total | ||
compensation rate to an amount greater than the prevailing | ||
maximum rate at the time that the annual adjustment is made. In | ||
the event of a decrease in such average weekly wage there shall | ||
be no change in the then existing compensation rate. Such | ||
increase shall be paid by the employer in the same manner and | ||
at the same intervals as the payment of compensation in the |
award. This paragraph shall not apply to cases where there is | ||
disputed liability and in which a compromise lump sum | ||
settlement between the employer and the injured employee, or | ||
his or her dependents, as the case may be, has been duly | ||
approved by the Illinois Workers' Compensation Commission. | ||
The annual adjustments for every award of death benefits or | ||
permanent total disability involving accidents occurring | ||
before July 20, 2005 and accidents occurring on or after the | ||
effective date of this amendatory Act of the 94th General | ||
Assembly (Senate Bill 1283 of the 94th General Assembly) shall | ||
continue to be paid from the Rate Adjustment Fund pursuant to | ||
this paragraph and Section 7(f) of this Act.
| ||
(h) In case death occurs from any cause before the total
| ||
compensation to which the employee would have been entitled has | ||
been
paid, then in case the employee leaves any widow, widower, | ||
child, parent
(or any grandchild, grandparent or other lineal | ||
heir or any collateral
heir dependent at the time of the | ||
accident upon the earnings of the
employee to the extent of 50% | ||
or more of total dependency) such
compensation shall be paid to | ||
the beneficiaries of the deceased employee
and distributed as | ||
provided in paragraph (g) of Section 7.
| ||
(h-1) In case an injured employee is under legal disability
| ||
at the time when any right or privilege accrues to him or her | ||
under this
Act, a guardian may be appointed pursuant to law, | ||
and may, on behalf
of such person under legal disability, claim | ||
and exercise any
such right or privilege with the same effect |
as if the employee himself
or herself had claimed or exercised | ||
the right or privilege. No limitations
of time provided by this | ||
Act run so long as the employee who is under legal
disability | ||
is without a conservator or guardian.
| ||
(i) In case the injured employee is under 16 years of age | ||
at the
time of the accident and is illegally employed, the | ||
amount of
compensation payable under paragraphs (b), (c), (d), | ||
(e) and (f) of this
Section is increased 50%.
| ||
However, where an employer has on file an employment | ||
certificate
issued pursuant to the Child Labor Law or work | ||
permit issued pursuant
to the Federal Fair Labor Standards Act, | ||
as amended, or a birth
certificate properly and duly issued, | ||
such certificate, permit or birth
certificate is conclusive | ||
evidence as to the age of the injured minor
employee for the | ||
purposes of this Section.
| ||
Nothing herein contained repeals or amends the provisions | ||
of the
Child Labor Law relating to the employment of minors | ||
under the age of 16 years.
| ||
(j) 1. In the event the injured employee receives benefits,
| ||
including medical, surgical or hospital benefits under any | ||
group plan
covering non-occupational disabilities contributed | ||
to wholly or
partially by the employer, which benefits should | ||
not have been payable
if any rights of recovery existed under | ||
this Act, then such amounts so
paid to the employee from any | ||
such group plan as shall be consistent
with, and limited to, | ||
the provisions of paragraph 2 hereof, shall be
credited to or |
against any compensation payment for temporary total
| ||
incapacity for work or any medical, surgical or hospital | ||
benefits made
or to be made under this Act. In such event, the | ||
period of time for
giving notice of accidental injury and | ||
filing application for adjustment
of claim does not commence to | ||
run until the termination of such
payments. This paragraph does | ||
not apply to payments made under any
group plan which would | ||
have been payable irrespective of an accidental
injury under | ||
this Act. Any employer receiving such credit shall keep
such | ||
employee safe and harmless from any and all claims or | ||
liabilities
that may be made against him by reason of having | ||
received such payments
only to the extent of such credit.
| ||
Any excess benefits paid to or on behalf of a State | ||
employee by the
State Employees' Retirement System under | ||
Article 14 of the Illinois Pension
Code on a death claim or | ||
disputed disability claim shall be credited
against any | ||
payments made or to be made by the State of Illinois to or on
| ||
behalf of such employee under this Act, except for payments for | ||
medical
expenses which have already been incurred at the time | ||
of the award. The
State of Illinois shall directly reimburse | ||
the State Employees' Retirement
System to the extent of such | ||
credit.
| ||
2. Nothing contained in this Act shall be construed to give | ||
the
employer or the insurance carrier the right to credit for | ||
any benefits
or payments received by the employee other than | ||
compensation payments
provided by this Act, and where the |
employee receives payments other
than compensation payments, | ||
whether as full or partial salary, group
insurance benefits, | ||
bonuses, annuities or any other payments, the
employer or | ||
insurance carrier shall receive credit for each such payment
| ||
only to the extent of the compensation that would have been | ||
payable
during the period covered by such payment.
| ||
3. The extension of time for the filing of an Application | ||
for
Adjustment of Claim as provided in paragraph 1 above shall | ||
not apply to
those cases where the time for such filing had | ||
expired prior to the date
on which payments or benefits | ||
enumerated herein have been initiated or
resumed. Provided | ||
however that this paragraph 3 shall apply only to
cases wherein | ||
the payments or benefits hereinabove enumerated shall be
| ||
received after July 1, 1969.
| ||
(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||
94-695, eff. 11-16-05.)
| ||
(820 ILCS 305/8.1a new) | ||
Sec. 8.1a. Preferred provider programs. Starting on the | ||
effective date of this amendatory Act of the 97th General | ||
Assembly, to satisfy its liabilities under this Act for the | ||
provision of medical treatment to injured employees, an | ||
employer may utilize a preferred provider program approved by | ||
the Illinois Department of Insurance as in compliance with | ||
Sections 370k, 370l, 370m, and 370p of Article XX-1/2 of the | ||
Illinois Insurance Code. For the purposes of compliance with |
these Sections, the employee shall be considered the | ||
"beneficiary" and the employer shall be considered the | ||
"insured". Employers and insurers contracting directly with | ||
providers or utilizing multiple preferred provider programs to | ||
implement a preferred provider program providing workers' | ||
compensation benefits shall be subject to the above | ||
requirements of Article XX-1/2 applicable to administrators | ||
with regard to such program, with the exception of Section 370l | ||
of the Illinois Insurance Code. | ||
(a) In addition to the above requirements of Article XX-1/2 | ||
of the Illinois Insurance Code, all preferred provider programs | ||
under this Section shall meet the following requirements: | ||
(1) The provider network shall include an adequate | ||
number of occupational and non-occupational providers. | ||
(2) The provider network shall include an adequate | ||
number and type of physicians or other providers to treat | ||
common injuries experienced by injured workers in the | ||
geographic area where the employees reside. | ||
(3) Medical treatment for injuries shall be readily | ||
available at reasonable times to all employees. To the | ||
extent feasible, all medical treatment for injuries shall | ||
be readily accessible to all employees. | ||
(4) Physician compensation shall not be structured in | ||
order to achieve the goal of inappropriately reducing, | ||
delaying, or denying medical treatment or restricting | ||
access to medical treatment. |
(5) Before entering into any agreement under this | ||
Section, a program shall establish terms and conditions | ||
that must be met by noninstitutional providers wishing to | ||
enter into an agreement with the program. These terms and | ||
conditions may not discriminate unreasonably against or | ||
among noninstitutional providers. Neither difference in | ||
prices among noninstitutional providers produced by a | ||
process of individual negotiation nor price differences | ||
among other noninstitutional providers in different | ||
geographical areas or different specialties constitutes | ||
unreasonable discrimination. | ||
(b) The administrator of any preferred provider program | ||
under this Act that uses economic evaluation shall file with | ||
the Director of Insurance a description of any policies and | ||
procedures related to economic evaluation utilized by the | ||
program. The filing shall describe how these policies and | ||
procedures are used in utilization review, peer review, | ||
incentive and penalty programs, and in provider retention and | ||
termination decisions. The Director of Insurance may deny | ||
approval of any preferred provider program that uses any policy | ||
or procedure of economic evaluation to inappropriately reduce, | ||
delay or deny medical treatment, or to restrict access to | ||
medical treatment. Evaluation of providers based upon | ||
objective medical quality and patient outcome measurements, | ||
appropriate use of best clinical practices and evidence based | ||
medicine, and use of health information technology shall be |
permitted. If approved, the employer shall provide a copy of | ||
the filing to all participating providers. | ||
(1) The Director of the Department of Insurance shall | ||
make each administrator's filing available to the public | ||
upon request. The Director of the Department of Insurance | ||
may not publicly disclose any information submitted | ||
pursuant to this Section that is determined by the Director | ||
of the Department of Insurance to be confidential, | ||
proprietary, or trade secret information pursuant to State | ||
or federal law. | ||
(2) For the purposes of this subsection (b), "economic | ||
evaluation" shall mean any evaluation of a particular | ||
physician, provider, medical group, or individual practice | ||
association based in whole or in part on the economic costs | ||
or utilization of services associated with medical care | ||
provided or authorized by the physician, provider, medical | ||
group, or individual practice association. Economic | ||
evaluation shall not include negotiated rates with a | ||
provider. | ||
(c) Except for the provisions of subsection (a)(4) of | ||
Section 8 and for injuries occurring on or after the effective | ||
date of this amendatory Act of the 97th General Assembly, an | ||
employee of an employer utilizing a preferred provider program | ||
shall only be allowed to select a participating network | ||
provider from the network. An employer shall be responsible | ||
for: (i) all first aid and emergency treatment; (ii) all |
medical, surgical, and hospital services provided by the | ||
participating network provider initially selected by the | ||
employee or by any other participating network provider | ||
recommended by the initial participating network provider or | ||
any subsequent participating network provider in the chain of | ||
referrals from the initial participating network provider; and | ||
(iii) all medical, surgical, and hospital services provided by | ||
the participating network provider subsequently chosen by the | ||
employee or by any other participating network provider | ||
recommended by the subsequent participating network provider | ||
or any subsequent participating network provider in the chain | ||
of referrals from the second participating network provider. An | ||
employer shall not be liable for services determined by the | ||
Commission not to be compensable. An employer shall not be | ||
liable for medical services provided by a non-authorized | ||
provider when proper notice is provided to the injured worker. | ||
(1) When the injured employee notifies the employer of | ||
the injury or files a claim for workers' compensation with | ||
the employer, the employer shall notify the employee of his | ||
or her right to be treated by a physician of his or her | ||
choice from the preferred provider network established | ||
pursuant to this Section, and the method by which the list | ||
of participating network providers may be accessed by the | ||
employee, except as provided in subsection (a)(4) of | ||
Section 8. | ||
(2) Consistent with Article XX-1/2 of the Illinois |
Insurance Code, treatment by a specialist who is not a | ||
member of the preferred provider network shall be permitted | ||
on a case-by-case basis if the medical provider network | ||
does not contain a physician who can provide the approved | ||
treatment, and if the employee has complied with any | ||
pre-authorization requirements of the preferred provider | ||
network. Consent for the employee to visit an | ||
out-of-network provider may not be unreasonably withheld. | ||
When a non-network provider is authorized pursuant to this | ||
subparagraph (2), the non-network provider shall not hold | ||
an employee liable for costs except as provided in | ||
subsection (e) of Section 8.2. | ||
(3) The Director shall not approve, and may withdraw | ||
prior approval of, a preferred provider program that fails | ||
to provide an injured employee with sufficient access to | ||
necessary treating physicians, surgeons, and specialists. | ||
(d) Except as provided in subsection (a)(4) of Section 8, | ||
upon a finding by the Commission that the care being rendered | ||
by the employee's second choice of provider within the | ||
employer's network is improper or inadequate, the employee may | ||
then choose a provider outside of the network at the employer's | ||
expense. The Commission shall issue a decision on any petition | ||
filed pursuant to this Section within 5 working days. | ||
(e) The Director of the Department of Insurance may | ||
promulgate such rules as are necessary to carry out the | ||
provisions of this Section relating to approval and regulation |
of preferred provider programs. | ||
(820 ILCS 305/8.1b new) | ||
Sec. 8.1b. Determination of permanent partial disability. | ||
For accidental injuries that occur on or after September 1, | ||
2011, permanent partial disability shall be established using | ||
the following criteria: | ||
(a) A physician licensed to practice medicine in all of its | ||
branches preparing a permanent partial disability impairment | ||
report shall report the level of impairment in writing. The | ||
report shall include an evaluation of medically defined and | ||
professionally appropriate measurements of impairment that | ||
include, but are not limited to: loss of range of motion; loss | ||
of strength; measured atrophy of tissue mass consistent with | ||
the injury; and any other measurements that establish the | ||
nature and extent of the impairment. The most current edition | ||
of the American Medical Association's "Guides to the Evaluation | ||
of Permanent Impairment" shall be used by the physician in | ||
determining the level of impairment. | ||
(b) In determining the level of permanent partial | ||
disability, the Commission shall base its determination on the | ||
following factors: (i) the reported level of impairment | ||
pursuant to subsection (a); (ii) the occupation of the injured | ||
employee; (iii) the age of the employee at the time of the | ||
injury; (iv) the employee's future earning capacity; and (v) | ||
evidence of disability corroborated by the treating medical |
records. No single enumerated factor shall be the sole | ||
determinant of disability. In determining the level of | ||
disability, the relevance and weight of any factors used in | ||
addition to the level of impairment as reported by the | ||
physician must be explained in a written order. | ||
(820 ILCS 305/8.2)
| ||
Sec. 8.2. Fee schedule.
| ||
(a) Except as provided for in subsection (c), for | ||
procedures, treatments, or services covered under this Act and | ||
rendered or to be rendered on and after February 1, 2006, the | ||
maximum allowable payment shall be 90% of the 80th percentile | ||
of charges and fees as determined by the Commission utilizing | ||
information provided by employers' and insurers' national | ||
databases, with a minimum of 12,000,000 Illinois line item | ||
charges and fees comprised of health care provider and hospital | ||
charges and fees as of August 1, 2004 but not earlier than | ||
August 1, 2002. These charges and fees are provider billed | ||
amounts and shall not include discounted charges. The 80th | ||
percentile is the point on an ordered data set from low to high | ||
such that 80% of the cases are below or equal to that point and | ||
at most 20% are above or equal to that point. The Commission | ||
shall adjust these historical charges and fees as of August 1, | ||
2004 by the Consumer Price Index-U for the period August 1, | ||
2004 through September 30, 2005. The Commission shall establish | ||
fee schedules for procedures, treatments, or services for |
hospital inpatient, hospital outpatient, emergency room and | ||
trauma, ambulatory surgical treatment centers, and | ||
professional services. These charges and fees shall be | ||
designated by geozip or any smaller geographic unit. The data | ||
shall in no way identify or tend to identify any patient, | ||
employer, or health care provider. As used in this Section, | ||
"geozip" means a three-digit zip code based on data | ||
similarities, geographical similarities, and frequencies. A | ||
geozip does not cross state boundaries. As used in this | ||
Section, "three-digit zip code" means a geographic area in | ||
which all zip codes have the same first 3 digits. If a geozip | ||
does not have the necessary number of charges and fees to | ||
calculate a valid percentile for a specific procedure, | ||
treatment, or service, the Commission may combine data from the | ||
geozip with up to 4 other geozips that are demographically and | ||
economically similar and exhibit similarities in data and | ||
frequencies until the Commission reaches 9 charges or fees for | ||
that specific procedure, treatment, or service. In cases where | ||
the compiled data contains less than 9 charges or fees for a | ||
procedure, treatment, or service, reimbursement shall occur at | ||
76% of charges and fees as determined by the Commission in a | ||
manner consistent with the provisions of this paragraph. | ||
Providers of out-of-state procedures, treatments, services, | ||
products, or supplies shall be reimbursed at the lesser of that | ||
state's fee schedule amount or the fee schedule amount for the | ||
region in which the employee resides. If no fee schedule exists |
in that state, the provider shall be reimbursed at the lesser | ||
of the actual charge or the fee schedule amount for the region | ||
in which the employee resides. The Commission has the authority | ||
to set the maximum allowable payment to providers of | ||
out-of-state procedures, treatments, or services covered under | ||
this Act in a manner consistent with this Section. Not later | ||
than September 30 in 2006 and each year thereafter, the | ||
Commission shall automatically increase or decrease the | ||
maximum allowable payment for a procedure, treatment, or | ||
service established and in effect on January 1 of that year by | ||
the percentage change in the Consumer Price Index-U for the 12 | ||
month period ending August 31 of that year. The increase or | ||
decrease shall become effective on January 1 of the following | ||
year. As used in this Section, "Consumer Price Index-U" means | ||
the index published by the Bureau of Labor Statistics of the | ||
U.S. Department of Labor, that measures the average change in | ||
prices of all goods and services purchased by all urban | ||
consumers, U.S. city average, all items, 1982-84=100. | ||
(a-1) Notwithstanding the provisions of subsection (a) and | ||
unless otherwise indicated, the following provisions shall | ||
apply to the medical fee schedule starting on September 1, | ||
2011: | ||
(1) The Commission shall establish and maintain fee | ||
schedules for procedures, treatments, products, services, | ||
or supplies for hospital inpatient, hospital outpatient, | ||
emergency room, ambulatory surgical treatment centers, |
accredited ambulatory surgical treatment facilities, | ||
prescriptions filled and dispensed outside of a licensed | ||
pharmacy, dental services, and professional services. This | ||
fee schedule shall be based on the fee schedule amounts | ||
already established by the Commission pursuant to | ||
subsection (a) of this Section. However, starting on | ||
January 1, 2012, these fee schedule amounts shall be | ||
grouped into geographic regions in the following manner: | ||
(A) Four regions for non-hospital fee schedule | ||
amounts shall be utilized: | ||
(i) Cook County; | ||
(ii) DuPage, Kane, Lake, and Will Counties; | ||
(iii) Bond, Calhoun, Clinton, Jersey, | ||
Macoupin, Madison, Monroe, Montgomery, Randolph, | ||
St. Clair, and Washington Counties; and | ||
(iv) All other counties of the State. | ||
(B) Fourteen regions for hospital fee schedule | ||
amounts shall be utilized: | ||
(i) Cook, DuPage, Will, Kane, McHenry, DeKalb, | ||
Kendall, and Grundy Counties; | ||
(ii) Kankakee County; | ||
(iii) Madison, St. Clair, Macoupin, Clinton, | ||
Monroe, Jersey, Bond, and Calhoun Counties; | ||
(iv) Winnebago and Boone Counties; | ||
(v) Peoria, Tazewell, Woodford, Marshall, and | ||
Stark Counties; |
(vi) Champaign, Piatt, and Ford Counties; | ||
(vii) Rock Island, Henry, and Mercer Counties; | ||
(viii) Sangamon and Menard Counties; | ||
(ix) McLean County; | ||
(x) Lake County; | ||
(xi) Macon County; | ||
(xii) Vermilion County; | ||
(xiii) Alexander County; and | ||
(xiv) All other counties of the State. | ||
(2) If a geozip, as defined in subsection (a) of this | ||
Section, overlaps into one or more of the regions set forth | ||
in this Section, then the Commission shall average or | ||
repeat the charges and fees in a geozip in order to | ||
designate charges and fees for each region. | ||
(3) In cases where the compiled data contains less than | ||
9 charges or fees for a procedure, treatment, product, | ||
supply, or service or where the fee schedule amount cannot | ||
be determined by the non-discounted charge data, | ||
non-Medicare relative values and conversion factors | ||
derived from established fee schedule amounts, coding | ||
crosswalks, or other data as determined by the Commission, | ||
reimbursement shall occur at 76% of charges and fees until | ||
September 1, 2011 and 53.2% of charges and fees thereafter | ||
as determined by the Commission in a manner consistent with | ||
the provisions of this paragraph. | ||
(4) To establish additional fee schedule amounts, the |
Commission shall utilize provider non-discounted charge | ||
data, non-Medicare relative values and conversion factors | ||
derived from established fee schedule amounts, and coding | ||
crosswalks. The Commission may establish additional fee | ||
schedule amounts based on either the charge or cost of the | ||
procedure, treatment, product, supply, or service. | ||
(5) Implants shall be reimbursed at 25% above the net | ||
manufacturer's invoice price less rebates, plus actual | ||
reasonable and customary shipping charges whether or not | ||
the implant charge is submitted by a provider in | ||
conjunction with a bill for all other services associated | ||
with the implant, submitted by a provider on a separate | ||
claim form, submitted by a distributor, or submitted by the | ||
manufacturer of the implant. "Implants" include the | ||
following codes or any substantially similar updated code | ||
as determined by the Commission: 0274 | ||
(prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | ||
implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | ||
(investigational devices); and 0636 (drugs requiring | ||
detailed coding). Non-implantable devices or supplies | ||
within these codes shall be reimbursed at 65% of actual | ||
charge, which is the provider's normal rates under its | ||
standard chargemaster. A standard chargemaster is the | ||
provider's list of charges for procedures, treatments, | ||
products, supplies, or services used to bill payers in a | ||
consistent manner. |
(6) The Commission shall automatically update all | ||
codes and associated rules with the version of the codes | ||
and rules valid on January 1 of that year. | ||
(a-2) For procedures, treatments, services, or supplies | ||
covered under this Act and rendered or to be rendered on or | ||
after September 1, 2011, the maximum allowable payment shall be | ||
70% of the fee schedule amounts, which shall be adjusted yearly | ||
by the Consumer Price Index-U, as described in subsection (a) | ||
of this Section. | ||
(a-3) Prescriptions filled and dispensed outside of a | ||
licensed pharmacy shall be subject to a fee schedule that shall | ||
not exceed the Average Wholesale Price (AWP) plus a dispensing | ||
fee of $4.18. AWP or its equivalent as registered by the | ||
National Drug Code shall be set forth for that drug on that | ||
date as published in Medispan. | ||
(b) Notwithstanding the provisions of subsection (a), if
| ||
the Commission finds that there is a significant limitation on
| ||
access to quality health care in either a specific field of
| ||
health care services or a specific geographic limitation on
| ||
access to health care, it may change the Consumer Price Index-U
| ||
increase or decrease for that specific field or specific
| ||
geographic limitation on access to health care to address that
| ||
limitation. | ||
(c) The Commission shall establish by rule a process to | ||
review those medical cases or outliers that involve | ||
extra-ordinary treatment to determine whether to make an |
additional adjustment to the maximum payment within a fee | ||
schedule for a procedure, treatment, or service. | ||
(d) When a patient notifies a provider that the treatment, | ||
procedure, or service being sought is for a work-related | ||
illness or injury and furnishes the provider the name and | ||
address of the responsible employer, the provider shall bill | ||
the employer directly. The employer shall make payment and | ||
providers shall submit bills and records in accordance with the | ||
provisions of this Section. | ||
(1) All payments to providers for treatment provided | ||
pursuant to this Act shall be made within 30 60 days of | ||
receipt of the bills as long as the claim contains | ||
substantially all the required data elements necessary to | ||
adjudicate the bills. | ||
(2) If the claim does not contain substantially all the | ||
required data elements necessary to adjudicate the bill, or | ||
the claim is denied for any other reason, in whole or in | ||
part, the employer or insurer shall provide written | ||
notification, explaining the basis for the denial and | ||
describing any additional necessary data elements, to the | ||
provider within 30 days of receipt of the bill. | ||
(3) In the case of nonpayment to a provider within 30 | ||
60 days of receipt of the bill which contained | ||
substantially all of the required data elements necessary | ||
to adjudicate the bill or nonpayment to a provider of a | ||
portion of such a bill up to the lesser of the actual |
charge or the payment level set by the Commission in the | ||
fee schedule established in this Section, the bill, or | ||
portion of the bill, shall incur interest at a rate of 1% | ||
per month payable to the provider. Any required interest | ||
payments shall be made within 30 days after payment. | ||
(e) Except as provided in subsections (e-5), (e-10), and | ||
(e-15), a provider shall not hold an employee liable for costs | ||
related to a non-disputed procedure, treatment, or service | ||
rendered in connection with a compensable injury. The | ||
provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||
shall not apply if an employee provides information to the | ||
provider regarding participation in a group health plan. If the | ||
employee participates in a group health plan, the provider may | ||
submit a claim for services to the group health plan. If the | ||
claim for service is covered by the group health plan, the | ||
employee's responsibility shall be limited to applicable | ||
deductibles, co-payments, or co-insurance. Except as provided | ||
under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||
shall not bill or otherwise attempt to recover from the | ||
employee the difference between the provider's charge and the | ||
amount paid by the employer or the insurer on a compensable | ||
injury , or for medical services or treatment determined by the | ||
Commission to be excessive or unnecessary . | ||
(e-5) If an employer notifies a provider that the employer | ||
does not consider the illness or injury to be compensable under | ||
this Act, the provider may seek payment of the provider's |
actual charges from the employee for any procedure, treatment, | ||
or service rendered. Once an employee informs the provider that | ||
there is an application filed with the Commission to resolve a | ||
dispute over payment of such charges, the provider shall cease | ||
any and all efforts to collect payment for the services that | ||
are the subject of the dispute. Any statute of limitations or | ||
statute of repose applicable to the provider's efforts to | ||
collect payment from the employee shall be tolled from the date | ||
that the employee files the application with the Commission | ||
until the date that the provider is permitted to resume | ||
collection efforts under the provisions of this Section. | ||
(e-10) If an employer notifies a provider that the employer | ||
will pay only a portion of a bill for any procedure, treatment, | ||
or service rendered in connection with a compensable illness or | ||
disease, the provider may seek payment from the employee for | ||
the remainder of the amount of the bill up to the lesser of the | ||
actual charge, negotiated rate, if applicable, or the payment | ||
level set by the Commission in the fee schedule established in | ||
this Section. Once an employee informs the provider that there | ||
is an application filed with the Commission to resolve a | ||
dispute over payment of such charges, the provider shall cease | ||
any and all efforts to collect payment for the services that | ||
are the subject of the dispute. Any statute of limitations or | ||
statute of repose applicable to the provider's efforts to | ||
collect payment from the employee shall be tolled from the date | ||
that the employee files the application with the Commission |
until the date that the provider is permitted to resume | ||
collection efforts under the provisions of this Section. | ||
(e-15) When there is a dispute over the compensability of | ||
or amount of payment for a procedure, treatment, or service, | ||
and a case is pending or proceeding before an Arbitrator or the | ||
Commission, the provider may mail the employee reminders that | ||
the employee will be responsible for payment of any procedure, | ||
treatment or service rendered by the provider. The reminders | ||
must state that they are not bills, to the extent practicable | ||
include itemized information, and state that the employee need | ||
not pay until such time as the provider is permitted to resume | ||
collection efforts under this Section. The reminders shall not | ||
be provided to any credit rating agency. The reminders may | ||
request that the employee furnish the provider with information | ||
about the proceeding under this Act, such as the file number, | ||
names of parties, and status of the case. If an employee fails | ||
to respond to such request for information or fails to furnish | ||
the information requested within 90 days of the date of the | ||
reminder, the provider is entitled to resume any and all | ||
efforts to collect payment from the employee for the services | ||
rendered to the employee and the employee shall be responsible | ||
for payment of any outstanding bills for a procedure, | ||
treatment, or service rendered by a provider. | ||
(e-20) Upon a final award or judgment by an Arbitrator or | ||
the Commission, or a settlement agreed to by the employer and | ||
the employee, a provider may resume any and all efforts to |
collect payment from the employee for the services rendered to | ||
the employee and the employee shall be responsible for payment | ||
of any outstanding bills for a procedure, treatment, or service | ||
rendered by a provider as well as the interest awarded under | ||
subsection (d) of this Section. In the case of a procedure, | ||
treatment, or service deemed compensable, the provider shall | ||
not require a payment rate, excluding the interest provisions | ||
under subsection (d), greater than the lesser of the actual | ||
charge or the payment level set by the Commission in the fee | ||
schedule established in this Section. Payment for services | ||
deemed not covered or not compensable under this Act is the | ||
responsibility of the employee unless a provider and employee | ||
have agreed otherwise in writing. Services not covered or not | ||
compensable under this Act are not subject to the fee schedule | ||
in this Section. | ||
(f) Nothing in this Act shall prohibit an employer or
| ||
insurer from contracting with a health care provider or group
| ||
of health care providers for reimbursement levels for benefits | ||
under this Act different
from those provided in this Section. | ||
(g) On or before January 1, 2010 the Commission shall | ||
provide to the Governor and General Assembly a report regarding | ||
the implementation of the medical fee schedule and the index | ||
used for annual adjustment to that schedule as described in | ||
this Section.
| ||
(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.) |
(820 ILCS 305/8.2a new) | ||
Sec. 8.2a. Electronic claims. | ||
(a) The Director of Insurance shall adopt rules to do all | ||
of the following: | ||
(1) Ensure that all health care providers and | ||
facilities submit medical bills for payment on | ||
standardized forms. | ||
(2) Require acceptance by employers and insurers of | ||
electronic claims for payment of medical services. | ||
(3) Ensure confidentiality of medical information | ||
submitted on electronic claims for payment of medical | ||
services. | ||
(b) To the extent feasible, standards adopted pursuant to | ||
subdivision (a) shall be consistent with existing standards | ||
under the federal Health Insurance Portability and | ||
Accountability Act of 1996 and standards adopted under the | ||
Illinois Health Information Exchange and Technology Act. | ||
(c) The rules requiring employers and insurers to accept | ||
electronic claims for payment of medical services shall be | ||
proposed on or before January 1, 2012, and shall require all | ||
employers and insurers to accept electronic claims for payment | ||
of medical services on or before June 30, 2012. | ||
(d) The Director of Insurance shall by rule establish | ||
criteria for granting exceptions to employers, insurance | ||
carriers, and health care providers who are unable to submit or | ||
accept medical bills electronically. |
(820 ILCS 305/8.7) | ||
Sec. 8.7. Utilization review programs. | ||
(a) As used in this Section: | ||
"Utilization review" means the evaluation of proposed or | ||
provided health care services to determine the appropriateness | ||
of both the level of health care services medically necessary | ||
and the quality of health care services provided to a patient, | ||
including evaluation of their efficiency, efficacy, and | ||
appropriateness of treatment, hospitalization, or office | ||
visits based on medically accepted standards. The evaluation | ||
must be accomplished by means of a system that identifies the | ||
utilization of health care services based on standards of care | ||
of or nationally recognized peer review guidelines as well as | ||
nationally recognized treatment guidelines and evidence-based | ||
medicine evidence based upon standards as provided in this Act. | ||
Utilization techniques may include prospective review, second | ||
opinions, concurrent review, discharge planning, peer review, | ||
independent medical examinations, and retrospective review | ||
(for purposes of this sentence, retrospective review shall be | ||
applicable to services rendered on or after July 20, 2005). | ||
Nothing in this Section applies to prospective review of | ||
necessary first aid or emergency treatment. | ||
(b) No person may conduct a utilization review program for | ||
workers' compensation services in this State unless once every | ||
2 years the person registers the utilization review program |
with the Department of Insurance Financial and Professional | ||
Regulation and certifies compliance with the Workers' | ||
Compensation Utilization Management standards or Health | ||
Utilization Management Standards of URAC sufficient to achieve | ||
URAC accreditation or submits evidence of accreditation by URAC | ||
for its Workers' Compensation Utilization Management Standards | ||
or Health Utilization Management Standards. Nothing in this Act | ||
shall be construed to require an employer or insurer or its | ||
subcontractors to become URAC accredited. | ||
(c) In addition, the Director Secretary of Insurance | ||
Financial and Professional Regulation may certify alternative | ||
utilization review standards of national accreditation | ||
organizations or entities in order for plans to comply with | ||
this Section. Any alternative utilization review standards | ||
shall meet or exceed those standards required under subsection | ||
(b). | ||
(d) This registration shall include submission of all of | ||
the following information regarding utilization review program | ||
activities: | ||
(1) The name, address, and telephone number of the | ||
utilization review programs. | ||
(2) The organization and governing structure of the | ||
utilization review programs. | ||
(3) The number of lives for which utilization review is | ||
conducted by each utilization review program. | ||
(4) Hours of operation of each utilization review |
program. | ||
(5) Description of the grievance process for each | ||
utilization review program. | ||
(6) Number of covered lives for which utilization | ||
review was conducted for the previous calendar year for | ||
each utilization review program. | ||
(7) Written policies and procedures for protecting | ||
confidential information according to applicable State and | ||
federal laws for each utilization review program. | ||
(e) A utilization review program shall have written | ||
procedures to ensure that patient-specific information | ||
obtained during the process of utilization review will be: | ||
(1) kept confidential in accordance with applicable | ||
State and federal laws; and | ||
(2) shared only with the employee, the employee's | ||
designee, and the employee's health care provider, and | ||
those who are authorized by law to receive the information. | ||
Summary data shall not be considered confidential if it | ||
does not provide information to allow identification of | ||
individual patients or health care providers. | ||
Only a health care professional may make determinations | ||
regarding the medical necessity of health care services during | ||
the course of utilization review. | ||
When making retrospective reviews, utilization review | ||
programs shall base reviews solely on the medical information | ||
available to the attending physician or ordering provider at |
the time the health care services were provided. | ||
(f) If the Department of Insurance Financial and | ||
Professional Regulation finds that a utilization review | ||
program is not in compliance with this Section, the Department | ||
shall issue a corrective action plan and allow a reasonable | ||
amount of time for compliance with the plan. If the utilization | ||
review program does not come into compliance, the Department | ||
may issue a cease and desist order. Before issuing a cease and | ||
desist order under this Section, the Department shall provide | ||
the utilization review program with a written notice of the | ||
reasons for the order and allow a reasonable amount of time to | ||
supply additional information demonstrating compliance with | ||
the requirements of this Section and to request a hearing. The | ||
hearing notice shall be sent by certified mail, return receipt | ||
requested, and the hearing shall be conducted in accordance | ||
with the Illinois Administrative Procedure Act. | ||
(g) A utilization review program subject to a corrective | ||
action may continue to conduct business until a final decision | ||
has been issued by the Department. | ||
(h) The Department of Insurance Secretary of Financial and | ||
Professional Regulation may by rule establish a registration | ||
fee for each person conducting a utilization review program. | ||
(i) Upon receipt of written notice that the employer or the | ||
employer's agent or insurer wishes to invoke the utilization | ||
review process, the provider of medical, surgical, or hospital | ||
services shall submit to the utilization review, following |
accredited procedural guidelines. | ||
(1) The provider shall make reasonable efforts to | ||
provide timely and complete reports of clinical | ||
information needed to support a request for treatment. If | ||
the provider fails to make such reasonable efforts, the | ||
charges for the treatment or service may not be compensable | ||
nor collectible by the provider or claimant from the | ||
employer, the employer's agent, or the employee. The | ||
reporting obligations of providers shall not be | ||
unreasonable or unduly burdensome. | ||
(2) Written notice of utilization review decisions, | ||
including the clinical rationale for certification or | ||
non-certification and references to applicable standards | ||
of care or evidence-based medical guidelines, shall be | ||
furnished to the provider and employee. | ||
(3) An employer may only deny payment of or refuse to | ||
authorize payment of medical services rendered or proposed | ||
to be rendered on the grounds that the extent and scope of | ||
medical treatment is excessive and unnecessary in | ||
compliance with an accredited utilization review program | ||
under this Section. | ||
(4) When a payment for medical services has been denied | ||
or not authorized by an employer or when authorization for | ||
medical services is denied pursuant to utilization review, | ||
the employee has the burden of proof to show by a | ||
preponderance of the evidence that a variance from the |
standards of care used by the person or entity performing | ||
the utilization review pursuant to subsection (a) is | ||
reasonably required to cure or relieve the effects of his | ||
or her injury. | ||
(5) The medical professional responsible for review in | ||
the final stage of utilization review or appeal must be | ||
available in this State for interview or deposition; or | ||
must be available for deposition by telephone, video | ||
conference, or other remote electronic means. A medical | ||
professional who works or resides in this State or outside | ||
of this State may comply with this requirement by making | ||
himself or herself available for an interview or deposition | ||
in person or by making himself or herself available by | ||
telephone, video conference, or other remote electronic | ||
means. The remote interview or deposition shall be | ||
conducted in a fair, open, and cost-effective manner. The | ||
expense of interview and the deposition method shall be | ||
paid by the employer. The deponent shall be in the presence | ||
of the officer administering the oath and recording the | ||
deposition, unless otherwise agreed by the parties. Any | ||
exhibits or other demonstrative evidence to be presented to | ||
the deponent by any party at the deposition shall be | ||
provided to the officer administering the oath and all | ||
other parties within a reasonable period of time prior to | ||
the deposition. Nothing shall prohibit any party from being | ||
with the deponent during the deposition, at that party's |
expense; provided, however, that a party attending a | ||
deposition shall give written notice of that party's | ||
intention to appear at the deposition to all other parties | ||
within a reasonable time prior to the deposition. | ||
An admissible A utilization review shall will be considered | ||
by the Commission, along with all other evidence and in the | ||
same manner as all other evidence, and must be addressed along | ||
with all other evidence in the determination of the | ||
reasonableness and necessity of the medical bills or treatment. | ||
Nothing in this Section shall be construed to diminish the | ||
rights of employees to reasonable and necessary medical | ||
treatment or employee choice of health care provider under | ||
Section 8(a) or the rights of employers to medical examinations | ||
under Section 12. | ||
(j) When an employer denies payment of or refuses to | ||
authorize payment of first aid, medical, surgical, or hospital | ||
services under Section 8(a) of this Act, if that denial or | ||
refusal to authorize complies with a utilization review program | ||
registered under this Section and complies with all other | ||
requirements of this Section, then there shall be a rebuttable | ||
presumption that the employer shall not be responsible for | ||
payment of additional compensation pursuant to Section 19(k) of | ||
this Act and if that denial or refusal to authorize does not | ||
comply with a utilization review program registered under this | ||
Section and does not comply with all other requirements of this | ||
Section, then that will be considered by the Commission, along |
with all other evidence and in the same manner as all other | ||
evidence, in the determination of whether the employer may be | ||
responsible for the payment of additional compensation | ||
pursuant to Section 19(k) of this Act.
| ||
The changes to this Section made by this amendatory Act of | ||
the 97th General Assembly apply only to health care services | ||
provided or proposed to be provided on or after September 1, | ||
2011. | ||
(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
| ||
(820 ILCS 305/11) (from Ch. 48, par. 138.11)
| ||
Sec. 11. The compensation herein provided, together with | ||
the
provisions of this Act, shall be the measure of the | ||
responsibility of
any employer engaged in any of the | ||
enterprises or businesses enumerated
in Section 3 of this Act, | ||
or of any employer who is not engaged in any
such enterprises | ||
or businesses, but who has elected to provide and pay
| ||
compensation for accidental injuries sustained by any employee | ||
arising
out of and in the course of the employment according to | ||
the provisions
of this Act, and whose election to continue | ||
under this Act, has not been
nullified by any action of his | ||
employees as provided for in this Act.
| ||
Accidental injuries incurred while participating in | ||
voluntary recreational
programs including but not limited to | ||
athletic events, parties and picnics
do not arise out of and in | ||
the course of the employment even though the
employer pays some |
or all of the cost thereof. This exclusion shall not apply
in | ||
the event that the injured employee was ordered or assigned by | ||
his employer
to participate in the program.
| ||
Accidental injuries incurred while participating as a | ||
patient in a drug
or alcohol rehabilitation program do not | ||
arise out of and in the course
of employment even though the | ||
employer pays some or all of the costs thereof. | ||
Any injury to or disease or death of an employee arising | ||
from the administration of a vaccine, including without | ||
limitation smallpox vaccine, to prepare for, or as a response | ||
to, a threatened or potential bioterrorist incident to the | ||
employee as part of a voluntary inoculation program in | ||
connection with the person's employment or in connection with | ||
any governmental program or recommendation for the inoculation | ||
of workers in the employee's occupation, geographical area, or | ||
other category that includes the employee is deemed to arise | ||
out of and in the course of the employment for all purposes | ||
under this Act. This paragraph added by this amendatory Act of | ||
the 93rd General Assembly is declarative of existing law and is | ||
not a new enactment.
| ||
No compensation shall be payable if (i) the employee's | ||
intoxication is the proximate cause of the employee's | ||
accidental injury or (ii) at the time the employee incurred the | ||
accidental injury, the employee was so intoxicated that the | ||
intoxication constituted a departure from the employment. | ||
Admissible evidence of the concentration of (1) alcohol, (2) |
cannabis as defined in the Cannabis Control Act, (3) a | ||
controlled substance listed in the Illinois Controlled | ||
Substances Act, or (4) an intoxicating compound listed in the | ||
Use of Intoxicating Compounds Act in the employee's blood, | ||
breath, or urine at the time the employee incurred the | ||
accidental injury shall be considered in any hearing under this | ||
Act to determine whether the employee was intoxicated at the | ||
time the employee incurred the accidental injuries. If at the | ||
time of the accidental injuries, there was 0.08% or more by | ||
weight of alcohol in the employee's blood, breath, or urine or | ||
if there is any evidence of impairment due to the unlawful or | ||
unauthorized use of (1) cannabis as defined in the Cannabis | ||
Control Act, (2) a controlled substance listed in the Illinois | ||
Controlled Substances Act, or (3) an intoxicating compound | ||
listed in the Use of Intoxicating Compounds Act or if the | ||
employee refuses to submit to testing of blood, breath, or | ||
urine, then there shall be a rebuttable presumption that the | ||
employee was intoxicated and that the intoxication was the | ||
proximate cause of the employee's injury. The employee may | ||
overcome the rebuttable presumption by the preponderance of the | ||
admissible evidence that the intoxication was not the sole | ||
proximate cause or proximate cause of the accidental injuries. | ||
Percentage by weight of alcohol in the blood shall be based on | ||
grams of alcohol per 100 milliliters of blood. Percentage by | ||
weight of alcohol in the breath shall be based upon grams of | ||
alcohol per 210 liters of breath. Any testing that has not been |
performed by an accredited or certified testing laboratory | ||
shall not be admissible in any hearing under this Act to | ||
determine whether the employee was intoxicated at the time the | ||
employee incurred the accidental injury. | ||
All sample collection and testing for alcohol and drugs | ||
under this Section shall be performed in accordance with rules | ||
to be adopted by the Commission. These rules shall ensure: | ||
(1) compliance with the National Labor Relations Act | ||
regarding collective bargaining agreements or regulations | ||
promulgated by the United States Department of | ||
Transportation; | ||
(2) that samples are collected and tested in | ||
conformance with national and State legal and regulatory | ||
standards for the privacy of the individual being tested, | ||
and in a manner reasonably calculated to prevent | ||
substitutions or interference with the collection or | ||
testing of reliable sample; | ||
(3) that split testing procedures are utilized; | ||
(4) that sample collection is documented, and the | ||
documentation procedures include: | ||
(A) the labeling of samples in a manner so as to | ||
reasonably preclude the probability of erroneous | ||
identification of test result; and | ||
(B) an opportunity for the employee to provide | ||
notification of any information which he or she | ||
considers relevant to the test, including |
identification of currently or recently used | ||
prescription or nonprescription drugs and other | ||
relevant medical information; | ||
(5) that sample collection, storage, and | ||
transportation to the place of testing is performed in a | ||
manner so as to reasonably preclude the probability of | ||
sample contamination or adulteration; and | ||
(6) that chemical analyses of blood, urine, breath, or | ||
other bodily substance are performed according to | ||
nationally scientifically accepted analytical methods and | ||
procedures. | ||
The changes to this Section made by this amendatory Act of | ||
the 97th General Assembly apply only to accidental injuries | ||
that occur on or after September 1, 2011. | ||
(Source: P.A. 93-829, eff. 7-28-04.)
| ||
(820 ILCS 305/13) (from Ch. 48, par. 138.13)
| ||
Sec. 13. There is created an Illinois Workers' Compensation | ||
Commission consisting of 10
members to be appointed by the | ||
Governor, by and with the consent of the
Senate, 3 of whom | ||
shall be representative citizens of the
employing class | ||
operating under this Act and 3 of whom shall
be representative | ||
citizens of the class of employees covered under this
Act, and | ||
4 of whom shall be representative citizens not identified
with | ||
either the employing or employee classes. Not more than 6 | ||
members
of the Commission shall be of the same political party.
|
One of the
members not identified with either the employing | ||
or employee classes shall
be designated by the Governor as | ||
Chairman. The Chairman shall be the chief
administrative and | ||
executive officer of the Commission; and he or she shall
have | ||
general supervisory authority over all personnel of the | ||
Commission,
including arbitrators and Commissioners, and the | ||
final authority in all
administrative matters relating to the | ||
Commissioners, including but not
limited to the assignment and | ||
distribution of cases and assignment of
Commissioners to the | ||
panels, except in the promulgation of procedural rules
and | ||
orders under Section 16 and in the determination of cases under | ||
this Act.
| ||
Notwithstanding the general supervisory authority of the | ||
Chairman, each
Commissioner, except those assigned to the | ||
temporary panel, shall have the
authority to hire and supervise | ||
2 staff attorneys each. Such staff attorneys
shall report | ||
directly to the individual Commissioner.
| ||
A formal training program for newly-appointed | ||
Commissioners shall be
implemented. The training program shall | ||
include the following:
| ||
(a) substantive and procedural aspects of the office of | ||
Commissioner;
| ||
(b) current issues in workers' compensation law and | ||
practice;
| ||
(c) medical lectures by specialists in areas such as | ||
orthopedics,
ophthalmology, psychiatry, rehabilitation |
counseling;
| ||
(d) orientation to each operational unit of the | ||
Illinois Workers' Compensation Commission;
| ||
(e) observation of experienced arbitrators and | ||
Commissioners conducting
hearings of cases, combined with | ||
the opportunity to discuss evidence
presented and rulings | ||
made;
| ||
(f) the use of hypothetical cases requiring the | ||
newly-appointed
Commissioner to issue judgments as a means | ||
to evaluating knowledge and
writing ability;
| ||
(g) writing skills ; .
| ||
(h) professional and ethical standards pursuant to | ||
Section 1.1 of this Act; | ||
(i) detection of workers' compensation fraud and | ||
reporting obligations of Commission employees and | ||
appointees; | ||
(j) standards of evidence-based medical treatment and | ||
best practices for measuring and improving quality and | ||
health care outcomes in the workers' compensation system, | ||
including but not limited to the use of the American | ||
Medical Association's "Guides to the Evaluation of | ||
Permanent Impairment" and the practice of utilization | ||
review; and | ||
(k) substantive and procedural aspects of coal | ||
workers' pneumoconiosis (black lung) cases. | ||
A formal and ongoing professional development program |
including, but not
limited to, the above-noted areas shall be | ||
implemented to keep
Commissioners informed of recent | ||
developments and issues and to assist them
in maintaining and | ||
enhancing their professional competence. Each Commissioner | ||
shall complete 20 hours of training in the above-noted areas | ||
during every 2 years such Commissioner shall remain in office.
| ||
The Commissioner candidates, other than the Chairman, must | ||
meet one of
the following qualifications: (a) licensed to | ||
practice law in the State of
Illinois; or (b) served as an | ||
arbitrator at the Illinois Workers' Compensation
Commission | ||
for at least 3 years; or (c) has at least 4 years of
| ||
professional labor relations experience. The Chairman | ||
candidate must have
public or private sector management and | ||
budget experience, as determined
by the Governor.
| ||
Each Commissioner shall devote full time to his duties and | ||
any
Commissioner who is an attorney-at-law shall not engage in | ||
the practice
of law, nor shall any Commissioner hold any other | ||
office or position of
profit under the United States or this | ||
State or any municipal
corporation or political subdivision of | ||
this State, nor engage in any other
business, employment, or | ||
vocation.
| ||
The term of office of each member of the Commission holding | ||
office on
the effective date of this amendatory Act of 1989 is | ||
abolished, but
the incumbents shall continue to exercise all of | ||
the powers and be subject
to all of the duties of Commissioners | ||
until their respective successors are
appointed and qualified.
|
The Illinois Workers' Compensation Commission shall | ||
administer this Act.
| ||
In the promulgation of procedural rules, the determination | ||
of cases heard en banc, and other matters determined by the | ||
full Commission, the Chairman's vote shall break a tie in the | ||
event of a tie vote.
| ||
The members shall be appointed by the Governor, with the | ||
advice and
consent of the Senate, as follows:
| ||
(a) After the effective date of this amendatory Act of | ||
1989, 3
members, at least one of
each political party, and | ||
one of whom shall be a representative citizen
of the | ||
employing class operating under this Act, one of whom shall | ||
be
a representative citizen of the class of employees | ||
covered under this
Act, and one of whom shall be a | ||
representative citizen not identified
with either the | ||
employing or employee classes, shall be appointed
to hold | ||
office until the third Monday in January of 1993, and until | ||
their
successors are appointed and qualified, and 4 | ||
members, one of whom shall be
a representative citizen of | ||
the employing class operating under this Act,
one of whom | ||
shall be a representative citizen of the class of employees
| ||
covered in this Act, and two of whom shall be | ||
representative citizens not
identified with either the | ||
employing or employee classes, one of whom shall
be | ||
designated by the Governor as Chairman (at least one of | ||
each of the two
major political parties) shall be appointed |
to hold office until the third
Monday of January in 1991, | ||
and until their successors are appointed and
qualified.
| ||
(a-5) Notwithstanding any other provision of this | ||
Section,
the term of each member of the Commission
who was | ||
appointed by the Governor and is in office on June 30, 2003 | ||
shall
terminate at the close of business on that date or | ||
when all of the successor
members to be appointed pursuant | ||
to this amendatory Act of the 93rd General
Assembly have | ||
been appointed by the Governor, whichever occurs later. As | ||
soon
as possible, the Governor shall appoint persons to | ||
fill the vacancies created
by this amendatory Act. Of the | ||
initial commissioners appointed pursuant to
this | ||
amendatory Act of the 93rd General Assembly, 3 shall be | ||
appointed for
terms ending on the third Monday in January, | ||
2005, and 4 shall be appointed
for terms ending on the | ||
third Monday in January, 2007.
| ||
(a-10) After the effective date of this amendatory Act | ||
of the 94th General Assembly, the Commission shall be | ||
increased to 10 members. As soon as possible after the | ||
effective date of this amendatory Act of the 94th General | ||
Assembly, the Governor shall appoint, by and with the | ||
consent of the
Senate, the 3 members added to the | ||
Commission under this amendatory Act of the 94th General | ||
Assembly, one of whom shall be a representative citizen of | ||
the employing class operating under this Act, one of whom | ||
shall be a representative of the class of employees covered |
under this Act, and one of whom shall be a representative | ||
citizen not identified with either the employing or | ||
employee classes. Of the members appointed under this | ||
amendatory Act of the 94th General Assembly, one shall be | ||
appointed for a term ending on the third Monday in January, | ||
2007, and 2 shall be appointed for terms ending on the | ||
third Monday in January, 2009, and until their successors | ||
are appointed and qualified.
| ||
(b) Members shall thereafter be appointed to hold | ||
office for terms of 4
years from the third Monday in | ||
January of the year of their appointment,
and until their | ||
successors are appointed and qualified. All such
| ||
appointments shall be made so that the composition of the | ||
Commission is in
accordance with the provisions of the | ||
first paragraph of this Section.
| ||
The Chairman shall receive an annual salary of $42,500, or
| ||
a salary set by the Compensation Review Board, whichever is | ||
greater,
and each other member shall receive an annual salary | ||
of $38,000, or a
salary set by the Compensation Review Board, | ||
whichever is greater.
| ||
In case of a vacancy in the office of a Commissioner during | ||
the
recess of the Senate, the Governor shall make a temporary | ||
appointment
until the next meeting of the Senate, when he shall | ||
nominate some person
to fill such office. Any person so | ||
nominated who is confirmed by the
Senate shall hold office | ||
during the remainder of the term and until his
successor is |
appointed and qualified.
| ||
The Illinois Workers' Compensation Commission created by | ||
this amendatory Act of 1989
shall succeed to all the rights, | ||
powers, duties, obligations, records
and other property and | ||
employees of the Industrial Commission which it
replaces as | ||
modified by this amendatory Act of 1989 and all applications
| ||
and reports to actions and proceedings of such prior Industrial | ||
Commission
shall be considered as applications and reports to | ||
actions and proceedings
of the Illinois Workers' Compensation | ||
Commission created by this amendatory Act of 1989.
| ||
Notwithstanding any other provision of this Act, in the | ||
event the
Chairman shall make a finding that a member is or | ||
will be unavailable to
fulfill the responsibilities of his or | ||
her office, the Chairman shall
advise the Governor and the | ||
member in writing and shall designate a
certified arbitrator to | ||
serve as acting Commissioner. The certified
arbitrator shall | ||
act as a Commissioner until the member resumes the duties
of | ||
his or her office or until a new member is appointed by the | ||
Governor, by
and with the consent of the Senate, if a vacancy | ||
occurs in the office of
the Commissioner, but in no event shall | ||
a certified arbitrator serve in the
capacity of Commissioner | ||
for more than 6 months from the date of
appointment by the | ||
Chairman. A finding by the Chairman that a member is or
will be | ||
unavailable to fulfill the responsibilities of his or her | ||
office
shall be based upon notice to the Chairman by a member | ||
that he or she will
be unavailable or facts and circumstances |
made known to the Chairman which
lead him to reasonably find | ||
that a member is unavailable to fulfill the
responsibilities of | ||
his or her office. The designation of a certified
arbitrator to | ||
act as a Commissioner shall be considered representative of
| ||
citizens not identified with either the employing or employee | ||
classes and
the arbitrator shall serve regardless of his or her | ||
political affiliation.
A certified arbitrator who serves as an | ||
acting Commissioner shall have all
the rights and powers of a | ||
Commissioner, including salary.
| ||
Notwithstanding any other provision of this Act, the | ||
Governor shall appoint
a special panel of Commissioners | ||
comprised of 3 members who shall be chosen
by the Governor, by | ||
and with the consent of the Senate, from among the
current | ||
ranks of certified arbitrators. Three members shall hold office
| ||
until the Commission in consultation with the Governor | ||
determines that the
caseload on review has been reduced | ||
sufficiently to allow cases to proceed
in a timely manner or | ||
for a term of 18 months from the effective date of
their | ||
appointment by the Governor, whichever shall be earlier. The 3
| ||
members shall be considered representative of citizens not | ||
identified with
either the employing or employee classes and | ||
shall serve regardless of
political affiliation. Each of the 3 | ||
members shall have only such rights
and powers of a | ||
Commissioner necessary to dispose of those cases assigned
to | ||
the special panel. Each of the 3 members appointed to the | ||
special panel
shall receive the same salary as other |
Commissioners for the duration of
the panel.
| ||
The Commission may have an Executive Director; if so, the | ||
Executive
Director shall be appointed by the Governor with the | ||
advice and consent of the
Senate. The salary and duties of the | ||
Executive Director shall be fixed by the
Commission.
| ||
On the effective date of this amendatory Act of
the 93rd | ||
General Assembly, the name of the Industrial Commission is | ||
changed to the Illinois Workers' Compensation Commission. | ||
References in any law, appropriation, rule, form, or other
| ||
document: (i) to the Industrial Commission
are deemed, in | ||
appropriate contexts, to be references to the Illinois Workers' | ||
Compensation Commission for all purposes; (ii) to the | ||
Industrial Commission Operations Fund
are deemed, in | ||
appropriate contexts, to be references to the Illinois Workers' | ||
Compensation Commission Operations Fund for all purposes; | ||
(iii) to the Industrial Commission Operations Fund Fee are | ||
deemed, in appropriate contexts, to be
references to the | ||
Illinois Workers' Compensation Commission Operations Fund Fee | ||
for all
purposes; and (iv) to the Industrial Commission | ||
Operations Fund Surcharge are deemed, in appropriate contexts, | ||
to be
references to the Illinois Workers' Compensation | ||
Commission Operations Fund Surcharge for all
purposes. | ||
(Source: P.A. 93-509, eff. 8-11-03; 93-721, eff. 1-1-05; | ||
94-277, eff. 7-20-05.)
| ||
(820 ILCS 305/13.1) (from Ch. 48, par. 138.13-1)
|
Sec. 13.1. (a) There is created a Workers' Compensation | ||
Advisory Board
hereinafter referred to as the Advisory Board. | ||
After the effective date of this amendatory Act of the 94th | ||
General Assembly, the Advisory Board shall consist of 12 | ||
members
appointed by the Governor with the advice and consent | ||
of the Senate. Six
members of the Advisory Board shall be
| ||
representative citizens chosen from the employee class, and 6 | ||
members shall be
representative citizens chosen from the | ||
employing class. The Chairman of the Commission shall serve as | ||
the ex officio Chairman of the Advisory Board. After the | ||
effective date of this amendatory Act of the 94th General | ||
Assembly, each member of the Advisory Board shall serve a
term | ||
ending on the third Monday in January 2007 and shall continue | ||
to serve until his or her successor is appointed and qualified. | ||
Members of the Advisory Board shall thereafter be appointed for | ||
4 year terms from the third Monday in January of the year of | ||
their appointment, and until their successors are appointed and | ||
qualified.
Seven members
of the Advisory Board shall constitute | ||
a quorum to do business, but in no
case shall there be less | ||
than one representative from each class. A vacancy on the | ||
Advisory Board shall be
filled by the Governor for the | ||
unexpired term.
| ||
(b) Members of the Advisory Board shall receive no | ||
compensation for
their services but shall be reimbursed for | ||
expenses incurred in the
performance of their duties by the | ||
Commission from appropriations made to
the Commission for such |
purpose.
| ||
(c) The Advisory Board shall aid the Commission in | ||
formulating policies,
discussing problems, setting priorities | ||
of expenditures, reviewing advisory rates filed by an advisory | ||
organization as defined in Section 463 of the Illinois | ||
Insurance Code, and establishing
short and long range | ||
administrative goals. Prior to making the (1) initial set of | ||
arbitrator appointments pursuant to this amendatory Act of the | ||
97th General Assembly and (2) appointment of Commissioners, | ||
appointments to the Commission, the Governor shall request that | ||
the Advisory Board make recommendations as to candidates to | ||
consider for appointment and the Advisory Board may then make | ||
such recommendations.
| ||
(d) The terms of all Advisory Board members serving on the | ||
effective date of this amendatory Act of the 97th General | ||
Assembly are terminated. The Governor shall appoint new members | ||
to the Advisory Board within 30 days after the effective date | ||
of the amendatory Act of the 97th General Assembly, subject to | ||
the advice and consent of the Senate. | ||
(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
| ||
(820 ILCS 305/14) (from Ch. 48, par. 138.14)
| ||
Sec. 14. The Commission shall appoint a secretary, an | ||
assistant
secretary, and arbitrators and shall employ such
| ||
assistants and clerical help as may be necessary. Arbitrators | ||
shall be appointed pursuant to this Section, notwithstanding |
any provision of the Personnel Code.
| ||
Each arbitrator appointed after November 22, 1977 shall be | ||
required
to demonstrate in writing and in accordance with
the | ||
rules and regulations of the Illinois Department of Central | ||
Management
Services his or
her knowledge of and expertise in | ||
the law of and judicial processes of
the Workers' Compensation | ||
Act and the Occupational Diseases Act.
| ||
A formal training program for newly-hired arbitrators | ||
shall be
implemented. The training program shall include the | ||
following:
| ||
(a) substantive and procedural aspects of the | ||
arbitrator position;
| ||
(b) current issues in workers' compensation law and | ||
practice;
| ||
(c) medical lectures by specialists in areas such as | ||
orthopedics,
ophthalmology, psychiatry, rehabilitation | ||
counseling;
| ||
(d) orientation to each operational unit of the | ||
Illinois Workers' Compensation Commission;
| ||
(e) observation of experienced arbitrators conducting | ||
hearings of cases,
combined with the opportunity to discuss | ||
evidence presented and rulings made;
| ||
(f) the use of hypothetical cases requiring the trainee | ||
to issue
judgments as a means to evaluating knowledge and | ||
writing ability;
| ||
(g) writing skills ; .
|
(h) professional and ethical standards pursuant to | ||
Section 1.1 of this Act; | ||
(i) detection of workers' compensation fraud and | ||
reporting obligations of Commission employees and | ||
appointees; | ||
(j) standards of evidence-based medical treatment and | ||
best practices for measuring and improving quality and | ||
health care outcomes in the workers' compensation system, | ||
including but not limited to the use of the American | ||
Medical Association's "Guides to the Evaluation of | ||
Permanent Impairment" and the practice of utilization | ||
review; and | ||
(k) substantive and procedural aspects of coal | ||
workers' pneumoconiosis (black lung) cases. | ||
A formal and ongoing professional development program | ||
including, but not
limited to, the above-noted areas shall be | ||
implemented to keep arbitrators
informed of recent | ||
developments and issues and to assist them in
maintaining and | ||
enhancing their professional competence. Each arbitrator shall | ||
complete 20 hours of training in the above-noted areas during | ||
every 2 years such arbitrator shall remain in office.
| ||
Each
arbitrator shall devote full time to his or her duties | ||
and shall serve when
assigned as
an acting Commissioner when a | ||
Commissioner is unavailable in accordance
with the provisions | ||
of Section 13 of this Act. Any
arbitrator who is an | ||
attorney-at-law shall not engage in the practice of
law, nor |
shall any arbitrator hold any other office or position of
| ||
profit under the United States or this State or any municipal
| ||
corporation or political subdivision of this State.
| ||
Notwithstanding any other provision of this Act to the | ||
contrary, an arbitrator
who serves as an acting Commissioner in | ||
accordance with the provisions of
Section 13 of this Act shall | ||
continue to serve in the capacity of Commissioner
until a | ||
decision is reached in every case heard by that arbitrator | ||
while
serving as an acting Commissioner.
| ||
Notwithstanding any other provision of this Section, the | ||
term of all arbitrators serving on the effective date of this | ||
amendatory Act of the 97th General Assembly, including any | ||
arbitrators on administrative leave, shall terminate at the | ||
close of business on July 1, 2011, but the incumbents shall | ||
continue to exercise all of their duties until they are | ||
reappointed or their successors are appointed. | ||
On and after the effective date of this amendatory Act of | ||
the 97th General Assembly, arbitrators shall be appointed to | ||
3-year terms by the full Commission, except that initial | ||
appointments made on and after the effective date of this | ||
amendatory Act of the 97th General Assembly shall be made as | ||
follows: | ||
(1) All appointments shall be made by the Governor with | ||
the advice and consent of the Senate. | ||
(2) 12 arbitrators shall be appointed to terms expiring | ||
July 1, 2012; 12 arbitrators shall be appointed to terms |
expiring July 1, 2013; and all additional arbitrators shall | ||
be appointed to terms expiring July 1, 2014. | ||
Upon the expiration of a term, the Chairman shall evaluate | ||
the performance of the arbitrator and may recommend that he or | ||
she be reappointed to a second or subsequent term by the full | ||
Commission. | ||
Each arbitrator appointed on or after the effective date of | ||
this amendatory Act of the 97th General Assembly and who has | ||
not previously served as an arbitrator for the Commission shall | ||
be required to be authorized to practice law in this State by | ||
the Supreme Court, and to maintain this authorization | ||
throughout his or her term of employment. | ||
Each arbitrator appointed after the effective date of this | ||
amendatory
Act of 1989 shall be appointed for a term of 6 | ||
years. Each arbitrator
shall be appointed for a subsequent term | ||
unless the Chairman makes a
recommendation to the Commission, | ||
no later than 60 days prior to the
expiration of the term, not | ||
to reappoint the arbitrator. Notice of such a
recommendation | ||
shall also be given to the arbitrator no later than 60 days
| ||
prior to the expiration of the term. Upon
such recommendation | ||
by the Chairman, the arbitrator shall be appointed for
a | ||
subsequent term unless 8 of 10 members of the Commission, | ||
including the
Chairman, vote not to reappoint the arbitrator.
| ||
All arbitrators shall be subject to the provisions of the | ||
Personnel Code,
and the performance of all arbitrators shall be | ||
reviewed by the Chairman on
an annual basis. The changes made |
to this Section by this amendatory Act of the 97th General | ||
Assembly shall prevail over any conflict with the Personnel | ||
Code. The Chairman shall allow input from the Commissioners in
| ||
all such reviews.
| ||
The Commission shall assign no fewer than 3 arbitrators to | ||
each hearing site. The Commission shall establish a procedure | ||
to ensure that the arbitrators assigned to each hearing site | ||
are assigned cases on a random basis. No arbitrator shall hear | ||
cases in any county, other than Cook County, for more than 2 | ||
years in each 3-year term. | ||
The Secretary and each arbitrator shall receive a per annum | ||
salary of
$4,000 less than the per annum salary of members of | ||
The
Illinois Workers' Compensation Commission as
provided in | ||
Section 13 of this Act, payable in equal monthly installments.
| ||
The members of the Commission, Arbitrators and other | ||
employees whose
duties require them to travel, shall have | ||
reimbursed to them their
actual traveling expenses and | ||
disbursements made or incurred by them in
the discharge of | ||
their official duties while away from their place of
residence | ||
in the performance of their duties.
| ||
The Commission shall provide itself with a seal for the
| ||
authentication of its orders, awards and proceedings upon which | ||
shall be
inscribed the name of the Commission and the words | ||
"Illinois--Seal".
| ||
The Secretary or Assistant Secretary, under the direction | ||
of the
Commission, shall have charge and custody of the seal of |
the Commission
and also have charge and custody of all records, | ||
files, orders,
proceedings, decisions, awards and other | ||
documents on file with the
Commission. He shall furnish | ||
certified copies, under the seal of the
Commission, of any such | ||
records, files, orders, proceedings, decisions,
awards and | ||
other documents on file with the Commission as may be
required. | ||
Certified copies so furnished by the Secretary or Assistant
| ||
Secretary shall be received in evidence before the Commission | ||
or any
Arbitrator thereof, and in all courts, provided that the | ||
original of
such certified copy is otherwise competent and | ||
admissible in evidence.
The Secretary or Assistant Secretary | ||
shall perform such other duties as
may be prescribed from time | ||
to time by the Commission.
| ||
(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||
(820 ILCS 305/16b new) | ||
Sec. 16b. Gift ban. | ||
(a) An attorney appearing before the Commission shall not | ||
provide compensation or any gift to any person in exchange for | ||
the referral of a client involving a matter to be heard before | ||
the Commission except for a division of a fee between lawyers | ||
who are not in the same firm in accordance with Rule 1.5 of the | ||
Code of Professional Responsibility. For purposes of this | ||
Section, "gift" means any gratuity, discount, entertainment, | ||
hospitality, loan, forbearance, or any other tangible or | ||
intangible item having monetary value including, but not |
limited to, cash, food and drink, and honoraria except for food | ||
or refreshments not exceeding $75 per person in value on a | ||
single calendar day, provided that the food or refreshments are | ||
(1) consumed on the premises from which they were purchased or | ||
prepared or (2) catered. "Catered" means food or refreshments | ||
that are purchased ready to eat and delivered by any means. | ||
(b) Violation of this Section is a Class A misdemeanor.
| ||
(820 ILCS 305/18) (from Ch. 48, par. 138.18)
| ||
Sec. 18.
All questions arising under this Act, if not | ||
settled by
agreement of the parties interested therein, shall, | ||
except as otherwise
provided, be determined by the Commission. | ||
Claims from current and former employees of the Commission | ||
shall be determined in accordance with Section 18.1 of this | ||
Act.
| ||
(Source: Laws 1951, p. 1060.)
| ||
(820 ILCS 305/18.1 new) | ||
Sec. 18.1. Claims by former and current employees of the | ||
Commission. All claims by current and former employees and | ||
appointees of the Commission shall be assigned to a certified | ||
independent arbitrator not employed by the Commission | ||
designated by the Chairman. The Chairman shall designate an | ||
arbitrator from a list of approved certified arbitrators | ||
provided by the Commission Review Board. If the Chairman is the | ||
claimant, then the independent arbitrator from the approved |
list shall be designated by the longest serving Commissioner. | ||
The designated independent arbitrator shall have the authority | ||
of arbitrators of the Commission regarding settlement and | ||
adjudication of the claim of the current and former employees | ||
and appointees of the Commission. The decision of the | ||
independent arbitrator shall become the decision of the | ||
Commission. An appeal of the independent arbitrator's decision | ||
shall be subject to judicial review in accordance with | ||
subsection (f) of Section 19.
| ||
(820 ILCS 305/19) (from Ch. 48, par. 138.19)
| ||
Sec. 19. Any disputed questions of law or fact shall be | ||
determined
as herein provided.
| ||
(a) It shall be the duty of the Commission upon | ||
notification that
the parties have failed to reach an | ||
agreement, to designate an Arbitrator.
| ||
1. Whenever any claimant misconceives his remedy and | ||
files an
application for adjustment of claim under this Act | ||
and it is
subsequently discovered, at any time before final | ||
disposition of such
cause, that the claim for disability or | ||
death which was the basis for
such application should | ||
properly have been made under the Workers'
Occupational | ||
Diseases Act, then the provisions of Section 19, paragraph
| ||
(a-1) of the Workers' Occupational Diseases Act having | ||
reference to such
application shall apply.
| ||
2. Whenever any claimant misconceives his remedy and |
files an
application for adjustment of claim under the | ||
Workers' Occupational
Diseases Act and it is subsequently | ||
discovered, at any time before final
disposition of such | ||
cause that the claim for injury or death which was
the | ||
basis for such application should properly have been made | ||
under this
Act, then the application so filed under the | ||
Workers' Occupational
Diseases Act may be amended in form, | ||
substance or both to assert claim
for such disability or | ||
death under this Act and it shall be deemed to
have been so | ||
filed as amended on the date of the original filing
| ||
thereof, and such compensation may be awarded as is | ||
warranted by the
whole evidence pursuant to this Act. When | ||
such amendment is submitted,
further or additional | ||
evidence may be heard by the Arbitrator or
Commission when | ||
deemed necessary. Nothing in this Section contained
shall | ||
be construed to be or permit a waiver of any provisions of | ||
this
Act with reference to notice but notice if given shall | ||
be deemed to be a
notice under the provisions of this Act | ||
if given within the time
required herein.
| ||
(b) The Arbitrator shall make such inquiries and | ||
investigations as he or
they shall deem necessary and may | ||
examine and inspect all books, papers,
records, places, or | ||
premises relating to the questions in dispute and hear
such | ||
proper evidence as the parties may submit.
| ||
The hearings before the Arbitrator shall be held in the | ||
vicinity where
the injury occurred after 10 days' notice of the |
time and place of such
hearing shall have been given to each of | ||
the parties or their attorneys
of record.
| ||
The Arbitrator may find that the disabling condition is | ||
temporary and has
not yet reached a permanent condition and may | ||
order the payment of
compensation up to the date of the | ||
hearing, which award shall be reviewable
and enforceable in the | ||
same manner as other awards, and in no instance be a
bar to a | ||
further hearing and determination of a further amount of | ||
temporary
total compensation or of compensation for permanent | ||
disability, but shall
be conclusive as to all other questions | ||
except the nature and extent of said
disability.
| ||
The decision of the Arbitrator shall be filed with the | ||
Commission which
Commission shall immediately send to each | ||
party or his attorney a copy of
such decision, together with a | ||
notification of the time when it was filed.
As of the effective | ||
date of this amendatory Act of the 94th General Assembly, all | ||
decisions of the Arbitrator shall set forth
in writing findings | ||
of fact and conclusions of law, separately stated, if requested | ||
by either party.
Unless a petition for review is filed by | ||
either party within 30 days after
the receipt by such party of | ||
the copy of the decision and notification of
time when filed, | ||
and unless such party petitioning for a review shall
within 35 | ||
days after the receipt by him of the copy of the decision, file
| ||
with the Commission either an agreed statement of the facts | ||
appearing upon
the hearing before the Arbitrator, or if such
| ||
party shall so elect a correct transcript of evidence of the |
proceedings
at such hearings, then the decision shall become | ||
the decision of the
Commission and in the absence of fraud | ||
shall be conclusive.
The Petition for Review shall contain a | ||
statement of the petitioning party's
specific exceptions to the | ||
decision of the arbitrator. The jurisdiction
of the Commission | ||
to review the decision of the arbitrator shall not be
limited | ||
to the exceptions stated in the Petition for Review.
The | ||
Commission, or any member thereof, may grant further time not | ||
exceeding
30 days, in which to file such agreed statement or | ||
transcript of
evidence. Such agreed statement of facts or | ||
correct transcript of
evidence, as the case may be, shall be | ||
authenticated by the signatures
of the parties or their | ||
attorneys, and in the event they do not agree as
to the | ||
correctness of the transcript of evidence it shall be | ||
authenticated
by the signature of the Arbitrator designated by | ||
the Commission.
| ||
Whether the employee is working or not, if the employee is | ||
not receiving or has not received medical, surgical, or | ||
hospital services or other services or compensation as provided | ||
in paragraph (a) of Section 8, or compensation as provided in | ||
paragraph (b) of Section 8, the employee may at any time | ||
petition for an expedited hearing by an Arbitrator on the issue | ||
of whether or not he or she is entitled to receive payment of | ||
the services or compensation. Provided the employer continues | ||
to pay compensation pursuant to paragraph (b) of Section 8, the | ||
employer may at any time petition for an expedited hearing on |
the issue of whether or not the employee is entitled to receive | ||
medical, surgical, or hospital services or other services or | ||
compensation as provided in paragraph (a) of Section 8, or | ||
compensation as provided in paragraph (b) of Section 8. When an | ||
employer has petitioned for an expedited hearing, the employer | ||
shall continue to pay compensation as provided in paragraph (b) | ||
of Section 8 unless the arbitrator renders a decision that the | ||
employee is not entitled to the benefits that are the subject | ||
of the expedited hearing or unless the employee's treating | ||
physician has released the employee to return to work at his or | ||
her regular job with the employer or the employee actually | ||
returns to work at any other job. If the arbitrator renders a | ||
decision that the employee is not entitled to the benefits that | ||
are the subject of the expedited hearing, a petition for review | ||
filed by the employee shall receive the same priority as if the | ||
employee had filed a petition for an expedited hearing by an | ||
Arbitrator. Neither party shall be entitled to an expedited | ||
hearing when the employee has returned to work and the sole | ||
issue in dispute amounts to less than 12 weeks of unpaid | ||
compensation pursuant to paragraph (b) of Section 8. | ||
Expedited hearings shall have priority over all other | ||
petitions and shall be heard by the Arbitrator and Commission | ||
with all convenient speed. Any party requesting an expedited | ||
hearing shall give notice of a request for an expedited hearing | ||
under this paragraph. A copy of the Application for Adjustment | ||
of Claim shall be attached to the notice. The Commission shall |
adopt rules and procedures under which the final decision of | ||
the Commission under this paragraph is filed not later than 180 | ||
days from the date that the Petition for Review is filed with | ||
the Commission. | ||
Where 2 or more insurance carriers, private self-insureds, | ||
or a group workers' compensation pool under Article V 3/4 of | ||
the Illinois Insurance Code dispute coverage for the same | ||
injury, any such insurance carrier, private self-insured, or | ||
group workers' compensation pool may request an expedited | ||
hearing pursuant to this paragraph to determine the issue of | ||
coverage, provided coverage is the only issue in dispute and | ||
all other issues are stipulated and agreed to and further | ||
provided that all compensation benefits including medical | ||
benefits pursuant to Section 8(a) continue to be paid to or on | ||
behalf of petitioner. Any insurance carrier, private | ||
self-insured, or group workers' compensation pool that is | ||
determined to be liable for coverage for the injury in issue | ||
shall reimburse any insurance carrier, private self-insured, | ||
or group workers' compensation pool that has paid benefits to | ||
or on behalf of petitioner for the injury.
| ||
(b-1) If the employee is not receiving medical, surgical or | ||
hospital
services as provided in paragraph (a) of Section 8 or | ||
compensation as
provided in paragraph (b) of Section 8, the | ||
employee, in accordance with
Commission Rules, may file a | ||
petition for an emergency hearing by an
Arbitrator on the issue | ||
of whether or not he is entitled to receive payment
of such |
compensation or services as provided therein. Such petition | ||
shall
have priority over all other petitions and shall be heard | ||
by the Arbitrator
and Commission with all convenient speed.
| ||
Such petition shall contain the following information and | ||
shall be served
on the employer at least 15 days before it is | ||
filed:
| ||
(i) the date and approximate time of accident;
| ||
(ii) the approximate location of the accident;
| ||
(iii) a description of the accident;
| ||
(iv) the nature of the injury incurred by the employee;
| ||
(v) the identity of the person, if known, to whom the | ||
accident was
reported and the date on which it was | ||
reported;
| ||
(vi) the name and title of the person, if known, | ||
representing the
employer with whom the employee conferred | ||
in any effort to obtain
compensation pursuant to paragraph | ||
(b) of Section 8 of this Act or medical,
surgical or | ||
hospital services pursuant to paragraph (a) of Section 8 of
| ||
this Act and the date of such conference;
| ||
(vii) a statement that the employer has refused to pay | ||
compensation
pursuant to paragraph (b) of Section 8 of this | ||
Act or for medical, surgical
or hospital services pursuant | ||
to paragraph (a) of Section 8 of this Act;
| ||
(viii) the name and address, if known, of each witness | ||
to the accident
and of each other person upon whom the | ||
employee will rely to support his
allegations;
|
(ix) the dates of treatment related to the accident by | ||
medical
practitioners, and the names and addresses of such | ||
practitioners, including
the dates of treatment related to | ||
the accident at any hospitals and the
names and addresses | ||
of such hospitals, and a signed authorization
permitting | ||
the employer to examine all medical records of all | ||
practitioners
and hospitals named pursuant to this | ||
paragraph;
| ||
(x) a copy of a signed report by a medical | ||
practitioner, relating to the
employee's current inability | ||
to return to work because of the injuries
incurred as a | ||
result of the accident or such other documents or | ||
affidavits
which show that the employee is entitled to | ||
receive compensation pursuant
to paragraph (b) of Section 8 | ||
of this Act or medical, surgical or hospital
services | ||
pursuant to paragraph (a) of Section 8 of this Act. Such | ||
reports,
documents or affidavits shall state, if possible, | ||
the history of the
accident given by the employee, and | ||
describe the injury and medical
diagnosis, the medical | ||
services for such injury which the employee has
received | ||
and is receiving, the physical activities which the | ||
employee
cannot currently perform as a result of any | ||
impairment or disability due to
such injury, and the | ||
prognosis for recovery;
| ||
(xi) complete copies of any reports, records, | ||
documents and affidavits
in the possession of the employee |
on which the employee will rely to
support his allegations, | ||
provided that the employer shall pay the
reasonable cost of | ||
reproduction thereof;
| ||
(xii) a list of any reports, records, documents and | ||
affidavits which
the employee has demanded by subpoena and | ||
on which he intends to
rely to support his allegations;
| ||
(xiii) a certification signed by the employee or his | ||
representative that
the employer has received the petition | ||
with the required information 15
days before filing.
| ||
Fifteen days after receipt by the employer of the petition | ||
with the
required information the employee may file said | ||
petition and required
information and shall serve notice of the | ||
filing upon the employer. The
employer may file a motion | ||
addressed to the sufficiency of the petition.
If an objection | ||
has been filed to the sufficiency of the petition, the
| ||
arbitrator shall rule on the objection within 2 working days. | ||
If such an
objection is filed, the time for filing the final | ||
decision of the
Commission as provided in this paragraph shall | ||
be tolled until the
arbitrator has determined that the petition | ||
is sufficient.
| ||
The employer shall, within 15 days after receipt of the | ||
notice that such
petition is filed, file with the Commission | ||
and serve on the employee or
his representative a written | ||
response to each claim set forth in the
petition, including the | ||
legal and factual basis for each disputed
allegation and the | ||
following information: (i) complete copies of any
reports, |
records, documents and affidavits in the possession of the
| ||
employer on which the employer intends to rely in support of | ||
his response,
(ii) a list of any reports, records, documents | ||
and affidavits which the
employer has demanded by subpoena and | ||
on which the employer intends to rely
in support of his | ||
response, (iii) the name and address of each witness on
whom | ||
the employer will rely to support his response, and (iv) the | ||
names and
addresses of any medical practitioners selected by | ||
the employer pursuant to
Section 12 of this Act and the time | ||
and place of any examination scheduled
to be made pursuant to | ||
such Section.
| ||
Any employer who does not timely file and serve a written | ||
response
without good cause may not introduce any evidence to | ||
dispute any claim of
the employee but may cross examine the | ||
employee or any witness brought by
the employee and otherwise | ||
be heard.
| ||
No document or other evidence not previously identified by | ||
either party
with the petition or written response, or by any | ||
other means before the
hearing, may be introduced into evidence | ||
without good cause.
If, at the hearing, material information is | ||
discovered which was
not previously disclosed, the Arbitrator | ||
may extend the time for closing
proof on the motion of a party | ||
for a reasonable period of time which may
be more than 30 days. | ||
No evidence may be introduced pursuant
to this paragraph as to | ||
permanent disability. No award may be entered for
permanent | ||
disability pursuant to this paragraph. Either party may |
introduce
into evidence the testimony taken by deposition of | ||
any medical practitioner.
| ||
The Commission shall adopt rules, regulations and | ||
procedures whereby the
final decision of the Commission is | ||
filed not later than 90 days from the
date the petition for | ||
review is filed but in no event later than 180 days from
the | ||
date the petition for an emergency hearing is filed with the | ||
Illinois Workers' Compensation
Commission.
| ||
All service required pursuant to this paragraph (b-1) must | ||
be by personal
service or by certified mail and with evidence | ||
of receipt. In addition for
the purposes of this paragraph, all | ||
service on the employer must be at the
premises where the | ||
accident occurred if the premises are owned or operated
by the | ||
employer. Otherwise service must be at the employee's principal
| ||
place of employment by the employer. If service on the employer | ||
is not
possible at either of the above, then service shall be | ||
at the employer's
principal place of business. After initial | ||
service in each case, service
shall be made on the employer's | ||
attorney or designated representative.
| ||
(c) (1) At a reasonable time in advance of and in | ||
connection with the
hearing under Section 19(e) or 19(h), the | ||
Commission may on its own motion
order an impartial physical or | ||
mental examination of a petitioner whose
mental or physical | ||
condition is in issue, when in the Commission's
discretion it | ||
appears that such an examination will materially aid in the
| ||
just determination of the case. The examination shall be made |
by a member
or members of a panel of physicians chosen for | ||
their special qualifications
by the Illinois State Medical | ||
Society. The Commission shall establish
procedures by which a | ||
physician shall be selected from such list.
| ||
(2) Should the Commission at any time during the hearing | ||
find that
compelling considerations make it advisable to have | ||
an examination and
report at that time, the commission may in | ||
its discretion so order.
| ||
(3) A copy of the report of examination shall be given to | ||
the Commission
and to the attorneys for the parties.
| ||
(4) Either party or the Commission may call the examining | ||
physician or
physicians to testify. Any physician so called | ||
shall be subject to
cross-examination.
| ||
(5) The examination shall be made, and the physician or | ||
physicians, if
called, shall testify, without cost to the | ||
parties. The Commission shall
determine the compensation and | ||
the pay of the physician or physicians. The
compensation for | ||
this service shall not exceed the usual and customary amount
| ||
for such service.
| ||
(6) The fees and payment thereof of all attorneys and | ||
physicians for
services authorized by the Commission under this | ||
Act shall, upon request
of either the employer or the employee | ||
or the beneficiary affected, be
subject to the review and | ||
decision of the Commission.
| ||
(d) If any employee shall persist in insanitary or | ||
injurious
practices which tend to either imperil or retard his |
recovery or shall
refuse to submit to such medical, surgical, | ||
or hospital treatment as is
reasonably essential to promote his | ||
recovery, the Commission may, in its
discretion, reduce or | ||
suspend the compensation of any such injured
employee. However, | ||
when an employer and employee so agree in writing,
the | ||
foregoing provision shall not be construed to authorize the
| ||
reduction or suspension of compensation of an employee who is | ||
relying in
good faith, on treatment by prayer or spiritual | ||
means alone, in
accordance with the tenets and practice of a | ||
recognized church or
religious denomination, by a duly | ||
accredited practitioner thereof.
| ||
(e) This paragraph shall apply to all hearings before the | ||
Commission.
Such hearings may be held in its office or | ||
elsewhere as the Commission
may deem advisable. The taking of | ||
testimony on such hearings may be had
before any member of the | ||
Commission. If a petition for review and agreed
statement of | ||
facts or transcript of evidence is filed, as provided herein,
| ||
the Commission shall promptly review the decision of the | ||
Arbitrator and all
questions of law or fact which appear from | ||
the statement of facts or
transcript of evidence.
| ||
In all cases in which the hearing before the arbitrator is | ||
held after
December 18, 1989, no additional evidence shall be | ||
introduced by the
parties before the Commission on review of | ||
the decision of the Arbitrator.
In reviewing decisions of an | ||
arbitrator the Commission shall award such
temporary | ||
compensation, permanent compensation and other payments as are
|
due under this Act. The Commission shall file in its office its | ||
decision
thereon, and shall immediately send to each party or | ||
his attorney a copy of
such decision and a notification of the | ||
time when it was filed. Decisions
shall be filed within 60 days | ||
after the Statement of Exceptions and
Supporting Brief and | ||
Response thereto are required to be filed or oral
argument | ||
whichever is later.
| ||
In the event either party requests oral argument, such | ||
argument shall be
had before a panel of 3 members of the | ||
Commission (or before all available
members pursuant to the | ||
determination of 7 members of the Commission that
such argument | ||
be held before all available members of the Commission)
| ||
pursuant to the rules and regulations of the Commission. A | ||
panel of 3
members, which shall be comprised of not more than | ||
one representative
citizen of the employing class and not more | ||
than one representative citizen
of the employee class, shall | ||
hear the argument; provided that if all the
issues in dispute | ||
are solely the nature and extent of the permanent partial
| ||
disability, if any, a majority of the panel may deny the | ||
request for such
argument and such argument shall not be held; | ||
and provided further that 7
members of the Commission may | ||
determine that the argument be held before
all available | ||
members of the Commission. A decision of the Commission
shall | ||
be approved by a majority of Commissioners present at such | ||
hearing if
any; provided, if no such hearing is held, a | ||
decision of the Commission
shall be approved by a majority of a |
panel of 3 members of the Commission
as described in this | ||
Section. The Commission shall give 10 days' notice to
the | ||
parties or their attorneys of the time and place of such taking | ||
of
testimony and of such argument.
| ||
In any case the Commission in its decision may find | ||
specially
upon any question or questions of law or fact which | ||
shall be submitted
in writing by either party whether ultimate | ||
or otherwise;
provided that on issues other than nature and | ||
extent of the disability,
if any, the Commission in its | ||
decision shall find specially upon any
question or questions of | ||
law or fact, whether ultimate or otherwise,
which are submitted | ||
in writing by either party; provided further that
not more than | ||
5 such questions may be submitted by either party. Any
party | ||
may, within 20 days after receipt of notice of the Commission's
| ||
decision, or within such further time, not exceeding 30 days, | ||
as the
Commission may grant, file with the Commission either an | ||
agreed
statement of the facts appearing upon the hearing, or, | ||
if such party
shall so elect, a correct transcript of evidence | ||
of the additional
proceedings presented before the Commission, | ||
in which report the party
may embody a correct statement of | ||
such other proceedings in the case as
such party may desire to | ||
have reviewed, such statement of facts or
transcript of | ||
evidence to be authenticated by the signature of the
parties or | ||
their attorneys, and in the event that they do not agree,
then | ||
the authentication of such transcript of evidence shall be by | ||
the
signature of any member of the Commission.
|
If a reporter does not for any reason furnish a transcript | ||
of the
proceedings before the Arbitrator in any case for use on | ||
a hearing for
review before the Commission, within the | ||
limitations of time as fixed in
this Section, the Commission | ||
may, in its discretion, order a trial de
novo before the | ||
Commission in such case upon application of either
party. The | ||
applications for adjustment of claim and other documents in
the | ||
nature of pleadings filed by either party, together with the
| ||
decisions of the Arbitrator and of the Commission and the | ||
statement of
facts or transcript of evidence hereinbefore | ||
provided for in paragraphs
(b) and (c) shall be the record of | ||
the proceedings of the Commission,
and shall be subject to | ||
review as hereinafter provided.
| ||
At the request of either party or on its own motion, the | ||
Commission shall
set forth in writing the reasons for the | ||
decision, including findings of
fact and conclusions of law | ||
separately stated. The Commission shall by rule
adopt a format | ||
for written decisions for the Commission and arbitrators.
The | ||
written decisions shall be concise and shall succinctly state | ||
the facts
and reasons for the decision. The Commission may | ||
adopt in whole or in part,
the decision of the arbitrator as | ||
the decision of the Commission. When the
Commission does so | ||
adopt the decision of the arbitrator, it shall do so by
order. | ||
Whenever the Commission adopts part of the arbitrator's | ||
decision,
but not all, it shall include in the order the | ||
reasons for not adopting all
of the arbitrator's decision. When |
a majority of a panel, after
deliberation, has arrived at its | ||
decision, the decision shall be filed as
provided in this | ||
Section without unnecessary delay, and without regard to
the | ||
fact that a member of the panel has expressed an intention to | ||
dissent.
Any member of the panel may file a dissent. Any | ||
dissent shall be filed no
later than 10 days after the decision | ||
of the majority has been filed.
| ||
Decisions rendered by the Commission and dissents, if any, | ||
shall be
published together by the Commission. The conclusions | ||
of law set out in
such decisions shall be regarded as | ||
precedents by arbitrators for the purpose
of achieving a more | ||
uniform administration of this Act.
| ||
(f) The decision of the Commission acting within its | ||
powers,
according to the provisions of paragraph (e) of this | ||
Section shall, in
the absence of fraud, be conclusive unless | ||
reviewed as in this paragraph
hereinafter provided. However, | ||
the Arbitrator or the Commission may on
his or its own motion, | ||
or on the motion of either party, correct any
clerical error or | ||
errors in computation within 15 days after the date of
receipt | ||
of any award by such Arbitrator or any decision on review of | ||
the
Commission and shall have the power to recall the original | ||
award on
arbitration or decision on review, and issue in lieu | ||
thereof such
corrected award or decision. Where such correction | ||
is made the time for
review herein specified shall begin to run | ||
from the date of
the receipt of the corrected award or | ||
decision.
|
(1) Except in cases of claims against the State of | ||
Illinois other than those claims under Section 18.1 , in
| ||
which case the decision of the Commission shall not be | ||
subject to
judicial review, the Circuit Court of the county | ||
where any of the
parties defendant may be found, or if none | ||
of the parties defendant can
be found in this State then | ||
the Circuit Court of the county where the
accident | ||
occurred, shall by summons to the Commission have
power to | ||
review all questions of law and fact presented by such | ||
record.
| ||
A proceeding for review shall be commenced within 20 | ||
days of
the receipt of notice of the decision of the | ||
Commission. The summons shall
be issued by the clerk of | ||
such court upon written request returnable on a
designated | ||
return day, not less than 10 or more than 60 days from the | ||
date
of issuance thereof, and the written request shall | ||
contain the last known
address of other parties in interest | ||
and their attorneys of record who are
to be served by | ||
summons. Service upon any member of the Commission or the
| ||
Secretary or the Assistant Secretary thereof shall be | ||
service upon the
Commission, and service upon other parties | ||
in interest and their attorneys
of record shall be by | ||
summons, and such service shall be made upon the
Commission | ||
and other parties in interest by mailing notices of the
| ||
commencement of the proceedings and the return day of the | ||
summons to the
office of the Commission and to the last |
known place of residence of other
parties in interest or | ||
their attorney or attorneys of record. The clerk of
the | ||
court issuing the summons shall on the day of issue mail | ||
notice of the
commencement of the proceedings which shall | ||
be done by mailing a copy of
the summons to the office of | ||
the Commission, and a copy of the summons to
the other | ||
parties in interest or their attorney or attorneys of | ||
record and
the clerk of the court shall make certificate | ||
that he has so sent said
notices in pursuance of this | ||
Section, which shall be evidence of service on
the | ||
Commission and other parties in interest.
| ||
The Commission shall not be required to certify the | ||
record of their
proceedings to the Circuit Court, unless | ||
the party commencing the
proceedings for review in the | ||
Circuit Court as above provided, shall pay
to the | ||
Commission the sum of 80¢ per page of testimony taken | ||
before the
Commission, and 35¢ per page of all other | ||
matters contained in such
record, except as otherwise | ||
provided by Section 20 of this Act. Payment
for photostatic | ||
copies of exhibit shall be extra. It shall be the duty
of | ||
the Commission upon such payment, or failure to pay as | ||
permitted
under Section 20 of this Act, to prepare a true | ||
and correct typewritten
copy of such testimony and a true | ||
and correct copy of all other matters
contained in such | ||
record and certified to by the Secretary or Assistant
| ||
Secretary thereof.
|
In its decision on review the Commission shall | ||
determine in each
particular case the amount of the | ||
probable cost of the record to be
filed as a part of the | ||
summons in that case and no request for a summons
may be | ||
filed and no summons shall issue unless the party seeking | ||
to review
the decision of the Commission shall exhibit to | ||
the clerk of the Circuit
Court proof of payment by filing a | ||
receipt showing payment or an affidavit
of the attorney | ||
setting forth that payment has been made of the sums so
| ||
determined to the Secretary or Assistant Secretary of the | ||
Commission,
except as otherwise provided by Section 20 of | ||
this Act.
| ||
(2) No such summons shall issue unless the one against | ||
whom the
Commission shall have rendered an award for the | ||
payment of money shall upon
the filing of his written | ||
request for such summons file with the clerk of
the court a | ||
bond conditioned that if he shall not successfully
| ||
prosecute the review, he will pay the award and the costs | ||
of the
proceedings in the courts. The amount of the bond | ||
shall be fixed by any
member of the Commission and the | ||
surety or sureties of the bond shall be
approved by the | ||
clerk of the court. The acceptance of the bond by the
clerk | ||
of the court shall constitute evidence of his approval of | ||
the bond.
| ||
Every county, city, town, township, incorporated | ||
village, school
district, body politic or municipal |
corporation against whom the
Commission shall have | ||
rendered an award for the payment of money shall
not be | ||
required to file a bond to secure the payment of the award | ||
and
the costs of the proceedings in the court to authorize | ||
the court to
issue such summons.
| ||
The court may confirm or set aside the decision of the | ||
Commission. If
the decision is set aside and the facts | ||
found in the proceedings before
the Commission are | ||
sufficient, the court may enter such decision as is
| ||
justified by law, or may remand the cause to the Commission | ||
for further
proceedings and may state the questions | ||
requiring further hearing, and
give such other | ||
instructions as may be proper. Appeals shall be taken
to | ||
the Appellate Court in accordance
with Supreme Court Rules | ||
22(g) and 303. Appeals
shall be taken from the Appellate
| ||
Court to the Supreme Court in accordance with Supreme Court | ||
Rule 315.
| ||
It shall be the duty of the clerk of any court | ||
rendering a decision
affecting or affirming an award of the | ||
Commission to promptly furnish
the Commission with a copy | ||
of such decision, without charge.
| ||
The decision of a majority of the members of the panel | ||
of the Commission,
shall be considered the decision of the | ||
Commission.
| ||
(g) Except in the case of a claim against the State of | ||
Illinois,
either party may present a certified copy of the |
award of the
Arbitrator, or a certified copy of the decision of | ||
the Commission when
the same has become final, when no | ||
proceedings for review are pending,
providing for the payment | ||
of compensation according to this Act, to the
Circuit Court of | ||
the county in which such accident occurred or either of
the | ||
parties are residents, whereupon the court shall enter a | ||
judgment
in accordance therewith. In a case where the employer | ||
refuses to pay
compensation according to such final award or | ||
such final decision upon
which such judgment is entered the | ||
court shall in entering judgment
thereon, tax as costs against | ||
him the reasonable costs and attorney fees
in the arbitration | ||
proceedings and in the court entering the judgment
for the | ||
person in whose favor the judgment is entered, which judgment
| ||
and costs taxed as therein provided shall, until and unless set | ||
aside,
have the same effect as though duly entered in an action | ||
duly tried and
determined by the court, and shall with like | ||
effect, be entered and
docketed. The Circuit Court shall have | ||
power at any time upon
application to make any such judgment | ||
conform to any modification
required by any subsequent decision | ||
of the Supreme Court upon appeal, or
as the result of any | ||
subsequent proceedings for review, as provided in
this Act.
| ||
Judgment shall not be entered until 15 days' notice of the | ||
time and
place of the application for the entry of judgment | ||
shall be served upon
the employer by filing such notice with | ||
the Commission, which Commission
shall, in case it has on file | ||
the address of the employer or the name
and address of its |
agent upon whom notices may be served, immediately
send a copy | ||
of the notice to the employer or such designated agent.
| ||
(h) An agreement or award under this Act providing for | ||
compensation
in installments, may at any time within 18 months | ||
after such agreement
or award be reviewed by the Commission at | ||
the request of either the
employer or the employee, on the | ||
ground that the disability of the
employee has subsequently | ||
recurred, increased, diminished or ended.
| ||
However, as to accidents occurring subsequent to July 1, | ||
1955, which
are covered by any agreement or award under this | ||
Act providing for
compensation in installments made as a result | ||
of such accident, such
agreement or award may at any time | ||
within 30 months, or 60 months in the case of an award under | ||
Section 8(d)1, after such agreement
or award be reviewed by the | ||
Commission at the request of either the
employer or the | ||
employee on the ground that the disability of the
employee has | ||
subsequently recurred, increased, diminished or ended.
| ||
On such review, compensation payments may be | ||
re-established,
increased, diminished or ended. The Commission | ||
shall give 15 days'
notice to the parties of the hearing for | ||
review. Any employee, upon any
petition for such review being | ||
filed by the employer, shall be entitled
to one day's notice | ||
for each 100 miles necessary to be traveled by him in
attending | ||
the hearing of the Commission upon the petition, and 3 days in
| ||
addition thereto. Such employee shall, at the discretion of the
| ||
Commission, also be entitled to 5 cents per mile necessarily |
traveled by
him within the State of Illinois in attending such | ||
hearing, not to
exceed a distance of 300 miles, to be taxed by | ||
the Commission as costs
and deposited with the petition of the | ||
employer.
| ||
When compensation which is payable in accordance with an | ||
award or
settlement contract approved by the Commission, is | ||
ordered paid in a
lump sum by the Commission, no review shall | ||
be had as in this paragraph
mentioned.
| ||
(i) Each party, upon taking any proceedings or steps | ||
whatsoever
before any Arbitrator, Commission or court, shall | ||
file with the Commission
his address, or the name and address | ||
of any agent upon whom all notices to
be given to such party | ||
shall be served, either personally or by registered
mail, | ||
addressed to such party or agent at the last address so filed | ||
with
the Commission. In the event such party has not filed his | ||
address, or the
name and address of an agent as above provided, | ||
service of any notice may
be had by filing such notice with the | ||
Commission.
| ||
(j) Whenever in any proceeding testimony has been taken or | ||
a final
decision has been rendered and after the taking of such | ||
testimony or
after such decision has become final, the injured | ||
employee dies, then in
any subsequent proceedings brought by | ||
the personal representative or
beneficiaries of the deceased | ||
employee, such testimony in the former
proceeding may be | ||
introduced with the same force and effect as though
the witness | ||
having so testified were present in person in such
subsequent |
proceedings and such final decision, if any, shall be taken
as | ||
final adjudication of any of the issues which are the same in | ||
both
proceedings.
| ||
(k) In case where there has been any unreasonable or | ||
vexatious delay
of payment or intentional underpayment of | ||
compensation, or proceedings
have been instituted or carried on | ||
by the one liable to pay the
compensation, which do not present | ||
a real controversy, but are merely
frivolous or for delay, then | ||
the Commission may award compensation
additional to that | ||
otherwise payable under this Act equal to 50% of the
amount | ||
payable at the time of such award. Failure to pay compensation
| ||
in accordance with the provisions of Section 8, paragraph (b) | ||
of this
Act, shall be considered unreasonable delay.
| ||
When determining whether this subsection (k) shall apply, | ||
the
Commission shall consider whether an Arbitrator has | ||
determined
that the claim is not compensable or whether the | ||
employer has
made payments under Section 8(j). | ||
(l) If the employee has made written demand for payment of
| ||
benefits under Section 8(a) or Section 8(b), the employer shall
| ||
have 14 days after receipt of the demand to set forth in
| ||
writing the reason for the delay. In the case of demand for
| ||
payment of medical benefits under Section 8(a), the time for
| ||
the employer to respond shall not commence until the expiration
| ||
of the allotted 30 60 days specified under Section 8.2(d). In | ||
case
the employer or his or her insurance carrier shall without | ||
good and
just cause fail, neglect, refuse, or unreasonably |
delay the
payment of benefits under Section 8(a) or Section | ||
8(b), the
Arbitrator or the Commission shall allow to the | ||
employee
additional compensation in the sum of $30 per day for | ||
each day
that the benefits under Section 8(a) or Section 8(b) | ||
have been
so withheld or refused, not to exceed $10,000.
A | ||
delay in payment of 14 days or more
shall create a rebuttable | ||
presumption of unreasonable delay.
| ||
(m) If the commission finds that an accidental injury was | ||
directly
and proximately caused by the employer's wilful | ||
violation of a health
and safety standard under the Health and | ||
Safety Act in force at the time of the
accident, the arbitrator | ||
or the Commission shall allow to the injured
employee or his | ||
dependents, as the case may be, additional compensation
equal | ||
to 25% of the amount which otherwise would be payable under the
| ||
provisions of this Act exclusive of this paragraph. The | ||
additional
compensation herein provided shall be allowed by an | ||
appropriate increase
in the applicable weekly compensation | ||
rate.
| ||
(n) After June 30, 1984, decisions of the Illinois Workers' | ||
Compensation Commission
reviewing an award of an arbitrator of | ||
the Commission shall draw interest
at a rate equal to the yield | ||
on indebtedness issued by the United States
Government with a | ||
26-week maturity next previously auctioned on the day on
which | ||
the decision is filed. Said rate of interest shall be set forth | ||
in
the Arbitrator's Decision. Interest shall be drawn from the | ||
date of the
arbitrator's award on all accrued compensation due |
the employee through the
day prior to the date of payments. | ||
However, when an employee appeals an
award of an Arbitrator or | ||
the Commission, and the appeal results in no
change or a | ||
decrease in the award, interest shall not further accrue from
| ||
the date of such appeal.
| ||
The employer or his insurance carrier may tender the | ||
payments due under
the award to stop the further accrual of | ||
interest on such award
notwithstanding the prosecution by | ||
either party of review, certiorari,
appeal to the Supreme Court | ||
or other steps to reverse, vacate or modify
the award.
| ||
(o) By the 15th day of each month each insurer providing | ||
coverage for
losses under this Act shall notify each insured | ||
employer of any compensable
claim incurred during the preceding | ||
month and the amounts paid or reserved
on the claim including a | ||
summary of the claim and a brief statement of the
reasons for | ||
compensability. A cumulative report of all claims incurred
| ||
during a calendar year or continued from the previous year | ||
shall be
furnished to the insured employer by the insurer | ||
within 30 days after the
end of that calendar year.
| ||
The insured employer may challenge, in proceeding before | ||
the Commission,
payments made by the insurer without | ||
arbitration and payments
made after a case is determined to be | ||
noncompensable. If the Commission
finds that the case was not | ||
compensable, the insurer shall purge its records
as to that | ||
employer of any loss or expense associated with the claim, | ||
reimburse
the employer for attorneys' fees arising from the |
challenge and for any
payment required of the employer to the | ||
Rate Adjustment Fund or the
Second Injury Fund, and may not | ||
reflect the loss or expense for rate making
purposes. The | ||
employee shall not be required to refund the challenged
| ||
payment. The decision of the Commission may be reviewed in the | ||
same manner
as in arbitrated cases. No challenge may be | ||
initiated under this paragraph
more than 3 years after the | ||
payment is made. An employer may waive the
right of challenge | ||
under this paragraph on a case by case basis.
| ||
(p) After filing an application for adjustment of claim but | ||
prior to
the hearing on arbitration the parties may voluntarily | ||
agree to submit such
application for adjustment of claim for | ||
decision by an arbitrator under
this subsection (p) where such | ||
application for adjustment of claim raises
only a dispute over | ||
temporary total disability, permanent partial
disability or | ||
medical expenses. Such agreement shall be in writing in such
| ||
form as provided by the Commission. Applications for adjustment | ||
of claim
submitted for decision by an arbitrator under this | ||
subsection (p) shall
proceed according to rule as established | ||
by the Commission. The Commission
shall promulgate rules | ||
including, but not limited to, rules to ensure that
the parties | ||
are adequately informed of their rights under this subsection
| ||
(p) and of the voluntary nature of proceedings under this | ||
subsection (p).
The findings of fact made by an arbitrator | ||
acting within his or her powers
under this subsection (p) in | ||
the absence of fraud shall be conclusive.
However, the |
arbitrator may on his own motion, or the motion of either
| ||
party, correct any clerical errors or errors in computation | ||
within 15 days
after the date of receipt of such award of the | ||
arbitrator
and shall have the power to recall the original | ||
award on arbitration, and
issue in lieu thereof such corrected | ||
award.
The decision of the arbitrator under this subsection (p) | ||
shall be
considered the decision of the Commission and | ||
proceedings for review of
questions of law arising from the | ||
decision may be commenced by either party
pursuant to | ||
subsection (f) of Section 19. The Advisory Board established
| ||
under Section 13.1 shall compile a list of certified Commission
| ||
arbitrators, each of whom shall be approved by at least 7 | ||
members of the
Advisory Board. The chairman shall select 5 | ||
persons from such list to
serve as arbitrators under this | ||
subsection (p). By agreement, the parties
shall select one | ||
arbitrator from among the 5 persons selected by the
chairman | ||
except that if the parties do not agree on an arbitrator from
| ||
among the 5 persons, the parties may, by agreement, select an | ||
arbitrator of
the American Arbitration Association, whose fee | ||
shall be paid by the State
in accordance with rules promulgated | ||
by the Commission. Arbitration under
this subsection (p) shall | ||
be voluntary.
| ||
(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||
(820 ILCS 305/25.5)
| ||
Sec. 25.5. Unlawful acts; penalties. |
(a) It is unlawful for any person, company, corporation, | ||
insurance carrier, healthcare provider, or other entity to: | ||
(1) Intentionally present or cause to be presented any | ||
false or
fraudulent claim for the payment of any workers' | ||
compensation
benefit.
| ||
(2) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
for the
purpose of obtaining or denying any workers' | ||
compensation
benefit.
| ||
(3) Intentionally make or cause to be made any false or
| ||
fraudulent statements with regard to entitlement to | ||
workers'
compensation benefits with the intent to prevent | ||
an injured
worker from making a legitimate claim for any | ||
workers'
compensation benefits.
| ||
(4) Intentionally prepare or provide an invalid, | ||
false, or
counterfeit certificate of insurance as proof of | ||
workers'
compensation insurance.
| ||
(5) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
for the
purpose of obtaining workers' compensation | ||
insurance at less
than the proper rate for that insurance.
| ||
(6) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
on an
initial or renewal self-insurance application or | ||
accompanying
financial statement for the purpose of | ||
obtaining self-insurance
status or reducing the amount of |
security that may be required
to be furnished pursuant to | ||
Section 4 of this Act.
| ||
(7) Intentionally make or cause to be made any false or
| ||
fraudulent material statement to the Department Division | ||
of Insurance's
fraud and insurance non-compliance unit in | ||
the course of an
investigation of fraud or insurance | ||
non-compliance.
| ||
(8) Intentionally assist, abet, solicit, or conspire | ||
with any
person, company, or other entity to commit any of | ||
the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||
of this subsection (a).
| ||
(9) Intentionally present a bill or statement for the | ||
payment for medical services that were not provided. | ||
For the purposes of paragraphs (2), (3), (5), (6), and (7), | ||
and (9), the term "statement" includes any writing, notice, | ||
proof of injury, bill for services, hospital or doctor records | ||
and reports, or X-ray and test results.
| ||
(b) Sentences for violations of subsection (a) are as | ||
follows: Any person violating subsection (a) is guilty of a | ||
Class 4 felony. Any person or entity convicted of any violation | ||
of this Section shall be ordered to pay complete restitution to | ||
any person or entity so defrauded in addition to any fine or | ||
sentence imposed as a result of the conviction.
| ||
(1) A violation in which the value of the property | ||
obtained or attempted to be obtained is $300 or less is a | ||
Class A misdemeanor. |
(2) A violation in which the value of the property | ||
obtained or attempted to be obtained is more than $300 but | ||
not more than $10,000 is a Class 3 felony. | ||
(3) A violation in which the value of the property | ||
obtained or attempted to be obtained is more than $10,000 | ||
but not more than $100,000 is a Class 2 felony. | ||
(4) A violation in which the value of the property | ||
obtained or attempted to be obtained is more than $100,000 | ||
is a Class 1 felony. | ||
(5) A person convicted under this Section shall be | ||
ordered to pay monetary restitution to the insurance | ||
company or self-insured entity or any other person for any | ||
financial loss sustained as a result of a violation of this | ||
Section, including any court costs and attorney fees. An | ||
order of restitution also includes expenses incurred and | ||
paid by the State of Illinois or an insurance company or | ||
self-insured entity in connection with any medical | ||
evaluation or treatment services. | ||
For the purposes of this Section, where the exact value of | ||
property obtained or attempted to be obtained is either not | ||
alleged or is not specifically set by the terms of a policy of | ||
insurance, the value of the property shall be the fair market | ||
replacement value of the property claimed to be lost, the | ||
reasonable costs of reimbursing a vendor or other claimant for | ||
services to be rendered, or both. Notwithstanding the | ||
foregoing, an insurance company, self-insured entity, or any |
other person suffering financial loss sustained as a result of | ||
violation of this Section may seek restitution, including court | ||
costs and attorney's fees in a civil action in a court of | ||
competent jurisdiction. | ||
(c) The Department Division of Insurance of the Department | ||
of Financial and Professional Regulation shall establish a | ||
fraud and insurance non-compliance unit responsible for | ||
investigating incidences of fraud and insurance non-compliance | ||
pursuant to this Section. The size of the staff of the unit | ||
shall be subject to appropriation by the General Assembly. It | ||
shall be the duty of the fraud and insurance non-compliance | ||
unit to determine the identity of insurance carriers, | ||
employers, employees, or other persons or entities who have | ||
violated the fraud and insurance non-compliance provisions of | ||
this Section. The fraud and insurance non-compliance unit shall | ||
report violations of the fraud and insurance non-compliance | ||
provisions of this Section to the Special Prosecutions Bureau | ||
of the Criminal Division of the Office of the Attorney General | ||
or to the State's Attorney of the county in which the offense | ||
allegedly occurred, either of whom has the authority to | ||
prosecute violations under this Section.
| ||
With respect to the subject of any investigation being | ||
conducted, the fraud and insurance non-compliance unit shall | ||
have the general power of subpoena of the Department Division | ||
of Insurance , including the authority to issue a subpoena to a | ||
medical provider, pursuant to Section 8-802 of the Code of |
Civil Procedure .
| ||
(d) Any person may report allegations of insurance | ||
non-compliance and fraud pursuant to this Section to the | ||
Department Division of Insurance's fraud and insurance | ||
non-compliance unit whose duty it shall be to investigate the | ||
report. The unit shall notify the Commission of reports of | ||
insurance non-compliance. Any person reporting an allegation | ||
of insurance non-compliance or fraud against either an employee | ||
or employer under this Section must identify himself. Except as | ||
provided in this subsection and in subsection (e), all reports | ||
shall remain confidential except to refer an investigation to | ||
the Attorney General or State's Attorney for prosecution or if | ||
the fraud and insurance non-compliance unit's investigation | ||
reveals that the conduct reported may be in violation of other | ||
laws or regulations of the State of Illinois, the unit may | ||
report such conduct to the appropriate governmental agency | ||
charged with administering such laws and regulations. Any | ||
person who intentionally makes a false report under this | ||
Section to the fraud and insurance non-compliance unit is | ||
guilty of a Class A misdemeanor.
| ||
(e) In order for the fraud and insurance non-compliance | ||
unit to investigate a report of fraud related to an employee's | ||
claim by an employee , (i) the employee must have filed with the | ||
Commission an Application for Adjustment of Claim and the | ||
employee must have either received or attempted to receive | ||
benefits under this Act that are related to the reported fraud |
or (ii) the employee must have made a written demand for the | ||
payment of benefits that are related to the reported fraud. | ||
Upon receipt of a report of fraud, the employee or employer | ||
shall receive immediate notice of the reported conduct, | ||
including the verified name and address of the complainant if | ||
that complainant is connected to the case and the nature of the | ||
reported conduct. The fraud and insurance non-compliance unit | ||
shall resolve all reports of fraud against employees or | ||
employers within 120 days of receipt of the report. There shall | ||
be no immunity, under this Act or otherwise, for any person who | ||
files a false report or who files a report without good and | ||
just cause. Confidentiality of medical information shall be | ||
strictly maintained. Investigations that are not referred for | ||
prosecution shall be destroyed upon the expiration of the | ||
statute of limitations for the acts under investigation | ||
immediately expunged and shall not be disclosed except that the | ||
employee or employer who was the subject of the report and the | ||
person making the report shall be notified that the | ||
investigation is being closed , at which time the name of any | ||
complainant not connected to the case shall be disclosed to the | ||
employee or the employer . It is unlawful for any employer, | ||
insurance carrier, or service adjustment company , third party | ||
administrator, self-insured, or similar entity to file or | ||
threaten to file a report of fraud against an employee because | ||
of the exercise by the employee of the rights and remedies | ||
granted to the employee by this Act.
|
(e-5) The fraud and insurance non-compliance unit shall | ||
procure and implement a system utilizing advanced analytics | ||
inclusive of predictive modeling, data mining, social network | ||
analysis, and scoring algorithms for the detection and | ||
prevention of fraud, waste, and abuse on or before January 1, | ||
2012. The fraud and insurance non-compliance unit shall procure | ||
this system using a request for proposals process governed by | ||
the Illinois Procurement Code and rules adopted under that | ||
Code. The fraud and insurance non-compliance unit shall provide | ||
a report to the President of the Senate, Speaker of the House | ||
of Representatives, Minority Leader of the House of | ||
Representatives, Minority Leader of the Senate, Governor, | ||
Chairman of the Commission, and Director of Insurance on or | ||
before July 1, 2012 and annually thereafter detailing its | ||
activities and providing recommendations regarding | ||
opportunities for additional fraud waste and abuse detection | ||
and prevention. | ||
For purposes of this subsection (e), "employer" means any | ||
employer, insurance carrier, third party administrator, | ||
self-insured, or similar entity.
| ||
For purposes of this subsection (e), "complainant" refers | ||
to the person contacting the fraud and insurance non-compliance | ||
unit to initiate the complaint.
| ||
(f) Any person convicted of fraud related to workers' | ||
compensation pursuant to this Section shall be subject to the | ||
penalties prescribed in the Criminal Code of 1961 and shall be |
ineligible to receive or retain any compensation, disability, | ||
or medical benefits as defined in this Act if the compensation, | ||
disability, or medical benefits were owed or received as a | ||
result of fraud for which the recipient of the compensation, | ||
disability, or medical benefit was convicted. This subsection | ||
applies to accidental injuries or diseases that occur on or | ||
after the effective date of this amendatory Act of the 94th | ||
General Assembly.
| ||
(g) Civil liability. Any person convicted of fraud who | ||
knowingly obtains, attempts to obtain, or causes to be obtained | ||
any benefits under this Act by the making of a false claim or | ||
who knowingly misrepresents any material fact shall be civilly | ||
liable to the payor of benefits or the insurer or the payor's | ||
or insurer's subrogee or assignee in an amount equal to 3 times | ||
the value of the benefits or insurance coverage wrongfully | ||
obtained or twice the value of the benefits or insurance | ||
coverage attempted to be obtained, plus reasonable attorney's | ||
fees and expenses incurred by the payor or the payor's subrogee | ||
or assignee who successfully brings a claim under this | ||
subsection. This subsection applies to accidental injuries or | ||
diseases that occur on or after the effective date of this | ||
amendatory Act of the 94th General Assembly.
| ||
(h) The All proceedings under this Section shall be | ||
reported by the fraud and insurance non-compliance unit shall | ||
submit a written report on an annual basis to the Chairman of | ||
the Commission, the Workers' Compensation Advisory Board , the |
General Assembly, the Governor, and the Attorney General by | ||
January 1 and July 1 of each year. This report shall include, | ||
at the minimum, the following information: | ||
(1) The number of allegations of insurance | ||
non-compliance and fraud reported to the fraud and | ||
insurance non-compliance unit. | ||
(2) The source of the reported allegations | ||
(individual, employer, or other). | ||
(3) The number of allegations investigated by the fraud | ||
and insurance non-compliance unit. | ||
(4) The number of criminal referrals made in accordance | ||
with this Section and the entity to which the referral was | ||
made. | ||
(5) All proceedings under this Section .
| ||
(Source: P.A. 94-277, eff. 7-20-05.) | ||
(820 ILCS 305/29.1 new) | ||
Sec. 29.1. Recalculation of premiums. On the effective date | ||
of this amendatory Act of the 97th General Assembly, the | ||
Director of Insurance shall immediately direct in writing any | ||
workers' compensation rate setting advisory organization to | ||
recalculate workers' compensation advisory premium rates and | ||
assigned risk pool premium rates so that those premiums | ||
incorporate the provisions of this amendatory Act of the 97th | ||
General Assembly, and to publish such rates on or before | ||
September 1, 2011. |
(820 ILCS 305/29.2 new) | ||
Sec. 29.2. Insurance oversight. | ||
(a) The Department of Insurance shall annually submit to | ||
the Governor, the Chairman of the Commission, the President of | ||
the Senate, the Speaker of the House of Representatives, the | ||
Minority Leader of the Senate, and the Minority Leader of the | ||
House of Representatives a written report that details the | ||
state of the workers' compensation insurance market in | ||
Illinois. The report shall be completed by April 1 of each | ||
year, beginning in 2012, or later if necessary data or analyses | ||
are only available to the Department at a later date. The | ||
report shall be posted on the Department of Insurance's | ||
Internet website. Information to be included in the report | ||
shall be for the preceding calendar year. The report shall | ||
include, at a minimum, the following: | ||
(1) Gross premiums collected by workers' compensation | ||
carriers in Illinois and the national rank of Illinois | ||
based on premium volume. | ||
(2) The number of insurance companies actively engaged | ||
in Illinois in the workers' compensation insurance market, | ||
including both holding companies and subsidiaries or | ||
affiliates, and the national rank of Illinois based on | ||
number of competing insurers. | ||
(3) The total number of insured participants in the | ||
Illinois workers' compensation assigned risk insurance |
pool, and the size of the assigned risk pool as a | ||
proportion of the total Illinois workers' compensation | ||
insurance market. | ||
(4) The advisory organization premium rate for | ||
workers' compensation insurance in Illinois for the | ||
previous year. | ||
(5) The advisory organization prescribed assigned risk | ||
pool premium rate. | ||
(6) The total amount of indemnity payments made by | ||
workers' compensation insurers in Illinois. | ||
(7) The total amount of medical payments made by | ||
workers' compensation insurers in Illinois, and the | ||
national rank of Illinois based on average cost of medical | ||
claims per injured worker. | ||
(8) The gross profitability of workers' compensation | ||
insurers in Illinois, and the national rank of Illinois | ||
based on profitability of workers' compensation insurers. | ||
(9) The loss ratio of workers' compensation insurers in | ||
Illinois and the national rank of Illinois based on the | ||
loss ratio of workers' compensation insurers. For purposes | ||
of this loss ratio calculation, the denominator shall | ||
include all premiums and other fees collected by workers' | ||
compensation insurers and the numerator shall include the | ||
total amount paid by the insurer for care or compensation | ||
to injured workers. | ||
(10) The growth of total paid indemnity benefits by |
temporary total disability, scheduled and non-scheduled | ||
permanent partial disability, and total disability. | ||
(11) The number of injured workers receiving wage loss | ||
differential awards and the average wage loss differential | ||
award payout. | ||
(12) Illinois' rank, relative to other states, for: | ||
(i) the maximum and minimum temporary total | ||
disability benefit level; | ||
(ii) the maximum and minimum scheduled and | ||
non-scheduled permanent partial disability benefit | ||
level; | ||
(iii) the maximum and minimum total disability | ||
benefit level; and | ||
(iv) the maximum and minimum death benefit level. | ||
(13) The aggregate growth of medical benefit payout by | ||
non-hospital providers and hospitals. | ||
(14) The aggregate growth of medical utilization for | ||
the top 10 most common injuries to specific body parts by | ||
non-hospital providers and hospitals. | ||
(15) The percentage of injured workers filing claims at | ||
the Commission that are represented by an attorney. | ||
(16) The total amount paid by injured workers for | ||
attorney representation. | ||
(b) The Director of Insurance shall promulgate rules | ||
requiring each insurer licensed to write workers' compensation | ||
coverage in the State to record and report the following |
information on an aggregate basis to the Department of | ||
Insurance before March 1 of each year, relating to claims in | ||
the State opened within the prior calendar year: | ||
(1) The number of claims opened. | ||
(2) The number of reported medical only claims. | ||
(3) The number of contested claims. | ||
(4) The number of claims for which the employee has | ||
attorney representation. | ||
(5) The number of claims with lost time and the number | ||
of claims for which temporary total disability was paid. | ||
(6) The number of claim adjusters employed to adjust | ||
workers' compensation claims. | ||
(7) The number of claims for which temporary total | ||
disability was not paid within 14 days from the first full | ||
day off, regardless of reason. | ||
(8) The number of medical bills paid 60 days or later | ||
from date of service and the average days paid on those | ||
paid after 60 days for the previous calendar year. | ||
(9) The number of claims in which in-house defense | ||
counsel participated, and the total amount spent on | ||
in-house legal services. | ||
(10) The number of claims in which outside defense | ||
counsel participated, and the total amount paid to outside | ||
defense counsel. | ||
(11) The total amount billed to employers for bill | ||
review. |
(12) The total amount billed to employers for fee | ||
schedule savings. | ||
(13) The total amount charged to employers for any and | ||
all managed care fees. | ||
(14) The number of claims involving in-house medical | ||
nurse case management, and the total amount spent on | ||
in-house medical nurse case management. | ||
(15) The number of claims involving outside medical | ||
nurse case management, and the total amount paid for | ||
outside medical nurse case management. | ||
(16) The total amount paid for Independent Medical | ||
exams. | ||
(17) The total amount spent on in-house Utilization | ||
Review for the previous calendar year. | ||
(18) The total amount paid for outside Utilization | ||
Review for the previous calendar year. | ||
The Department shall make the submitted information | ||
publicly available on the Department's Internet website or such | ||
other media as appropriate in a form useful for consumers. | ||
Section 97. Severability. The provisions of this Act are | ||
severable under Section 1.31 of the Statute on Statutes.
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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