100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB3526

 

Introduced , by Rep. Grant Wehrli

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/6  from Ch. 48, par. 138.6
820 ILCS 305/8  from Ch. 48, par. 138.8
820 ILCS 305/8.1b
820 ILCS 305/8.2

    Amends the Workers' Compensation Act. Provides that the 500 week limit on compensation includes weeks paid for certain prior injuries. Eliminates certain rebuttable presumptions applicable to emergency personnel. Reduces compensation for injuries to specific parts of the body. Requires Commission decisions to be based upon the guidelines provided in the most current edition of the American Medical Association guidelines. In fee schedule requirements, changes limits to apply to maximum amount billed rather than maximum allowable payments. Effective immediately.


LRB100 10567 JLS 20784 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3526LRB100 10567 JLS 20784 b

1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 6, 8, 8.1b, and 8.2 as follows:
 
6    (820 ILCS 305/6)  (from Ch. 48, par. 138.6)
7    Sec. 6. (a) Every employer within the provisions of this
8Act, shall, under the rules and regulations prescribed by the
9Commission, post printed notices in their respective places of
10employment in such number and at such places as may be
11determined by the Commission, containing such information
12relative to this Act as in the judgment of the Commission may
13be necessary to aid employees to safeguard their rights under
14this Act in event of injury.
15    In addition thereto, the employer shall post in a
16conspicuous place on the place of the employment a printed or
17typewritten notice stating whether he is insured or whether he
18has qualified and is operating as a self-insured employer. In
19the event the employer is insured, the notice shall state the
20name and address of his insurance carrier, the number of the
21insurance policy, its effective date and the date of
22termination. In the event of the termination of the policy for
23any reason prior to the termination date stated, the posted

 

 

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1notice shall promptly be corrected accordingly. In the event
2the employer is operating as a self-insured employer the notice
3shall state the name and address of the company, if any,
4servicing the compensation payments of the employer, and the
5name and address of the person in charge of making compensation
6payments.
7    (b) Every employer subject to this Act shall maintain
8accurate records of work-related deaths, injuries and illness
9other than minor injuries requiring only first aid treatment
10and which do not involve medical treatment, loss of
11consciousness, restriction of work or motion, or transfer to
12another job and file with the Commission, in writing, a report
13of all accidental deaths, injuries and illnesses arising out of
14and in the course of the employment resulting in the loss of
15more than 3 scheduled work days. In the case of death such
16report shall be made no later than 2 working days following the
17accidental death. In all other cases such report shall be made
18between the 15th and 25th of each month unless required to be
19made sooner by rule of the Commission. In case the injury
20results in permanent disability, a further report shall be made
21as soon as it is determined that such permanent disability has
22resulted or will result from the injury. All reports shall
23state the date of the injury, including the time of day or
24night, the nature of the employer's business, the name,
25address, age, sex, conjugal condition of the injured person,
26the specific occupation of the injured person, the direct cause

 

 

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1of the injury and the nature of the accident, the character of
2the injury, the length of disability, and in case of death the
3length of disability before death, the wages of the injured
4person, whether compensation has been paid to the injured
5person, or to his or her legal representative or his heirs or
6next of kin, the amount of compensation paid, the amount paid
7for physicians', surgeons' and hospital bills, and by whom
8paid, and the amount paid for funeral or burial expenses if
9known. The reports shall be made on forms and in the manner as
10prescribed by the Commission and shall contain such further
11information as the Commission shall deem necessary and require.
12The making of these reports releases the employer from making
13such reports to any other officer of the State and shall
14satisfy the reporting provisions as contained in the Safety
15Inspection and Education Act, the Health and Safety Act, and
16the Occupational Safety and Health Act. The reports filed with
17the Commission pursuant to this Section shall be made available
18by the Commission to the Director of Labor or his
19representatives and to all other departments of the State of
20Illinois which shall require such information for the proper
21discharge of their official duties. Failure to file with the
22Commission any of the reports required in this Section is a
23petty offense.
24    Except as provided in this paragraph, all reports filed
25hereunder shall be confidential and any person having access to
26such records filed with the Illinois Workers' Compensation

 

 

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1Commission as herein required, who shall release any
2information therein contained including the names or otherwise
3identify any persons sustaining injuries or disabilities, or
4give access to such information to any unauthorized person,
5shall be subject to discipline or discharge, and in addition
6shall be guilty of a Class B misdemeanor. The Commission shall
7compile and distribute to interested persons aggregate
8statistics, taken from the reports filed hereunder. The
9aggregate statistics shall not give the names or otherwise
10identify persons sustaining injuries or disabilities or the
11employer of any injured person or person with a disability.
12    (c) Notice of the accident shall be given to the employer
13as soon as practicable, but not later than 45 days after the
14accident. Provided:
15        (1) In case of the legal disability of the employee or
16    any dependent of a deceased employee who may be entitled to
17    compensation under the provisions of this Act, the
18    limitations of time by this Act provided do not begin to
19    run against such person under legal disability until a
20    guardian has been appointed.
21        (2) In cases of injuries sustained by exposure to
22    radiological materials or equipment, notice shall be given
23    to the employer within 90 days subsequent to the time that
24    the employee knows or suspects that he has received an
25    excessive dose of radiation.
26    No defect or inaccuracy of such notice shall be a bar to

 

 

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1the maintenance of proceedings on arbitration or otherwise by
2the employee unless the employer proves that he is unduly
3prejudiced in such proceedings by such defect or inaccuracy.
4    Notice of the accident shall give the approximate date and
5place of the accident, if known, and may be given orally or in
6writing.
7    (d) Every employer shall notify each injured employee who
8has been granted compensation under the provisions of Section 8
9of this Act of his rights to rehabilitation services and advise
10him of the locations of available public rehabilitation centers
11and any other such services of which the employer has
12knowledge.
13    In any case, other than one where the injury was caused by
14exposure to radiological materials or equipment or asbestos
15unless the application for compensation is filed with the
16Commission within 3 years after the date of the accident, where
17no compensation has been paid, or within 2 years after the date
18of the last payment of compensation, where any has been paid,
19whichever shall be later, the right to file such application
20shall be barred.
21    In any case of injury caused by exposure to radiological
22materials or equipment or asbestos, unless application for
23compensation is filed with the Commission within 25 years after
24the last day that the employee was employed in an environment
25of hazardous radiological activity or asbestos, the right to
26file such application shall be barred.

 

 

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1    If in any case except one where the injury was caused by
2exposure to radiological materials or equipment or asbestos,
3the accidental injury results in death application for
4compensation for death may be filed with the Commission within
53 years after the date of death where no compensation has been
6paid or within 2 years after the date of the last payment of
7compensation where any has been paid, whichever shall be later,
8but not thereafter.
9    If an accidental injury caused by exposure to radiological
10material or equipment or asbestos results in death within 25
11years after the last day that the employee was so exposed
12application for compensation for death may be filed with the
13Commission within 3 years after the date of death, where no
14compensation has been paid, or within 2 years after the date of
15the last payment of compensation where any has been paid,
16whichever shall be later, but not thereafter.
17    (e) Any contract or agreement made by any employer or his
18agent or attorney with any employee or any other beneficiary of
19any claim under the provisions of this Act within 7 days after
20the injury shall be presumed to be fraudulent.
21    (f) (Blank). Any condition or impairment of health of an
22employee employed as a firefighter, emergency medical
23technician (EMT), emergency medical technician-intermediate
24(EMT-I), advanced emergency medical technician (A-EMT), or
25paramedic which results directly or indirectly from any
26bloodborne pathogen, lung or respiratory disease or condition,

 

 

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1heart or vascular disease or condition, hypertension,
2tuberculosis, or cancer resulting in any disability
3(temporary, permanent, total, or partial) to the employee shall
4be rebuttably presumed to arise out of and in the course of the
5employee's firefighting, EMT, or paramedic employment and,
6further, shall be rebuttably presumed to be causally connected
7to the hazards or exposures of the employment. This presumption
8shall also apply to any hernia or hearing loss suffered by an
9employee employed as a firefighter, EMT, EMT-I, A-EMT, or
10paramedic. However, this presumption shall not apply to any
11employee who has been employed as a firefighter, EMT, or
12paramedic for less than 5 years at the time he or she files an
13Application for Adjustment of Claim concerning this condition
14or impairment with the Illinois Workers' Compensation
15Commission. The rebuttable presumption established under this
16subsection, however, does not apply to an emergency medical
17technician (EMT), emergency medical technician-intermediate
18(EMT-I), advanced emergency medical technician (A-EMT), or
19paramedic employed by a private employer if the employee spends
20the preponderance of his or her work time for that employer
21engaged in medical transfers between medical care facilities or
22non-emergency medical transfers to or from medical care
23facilities. The changes made to this subsection by Public Act
2498-291 shall be narrowly construed. The Finding and Decision of
25the Illinois Workers' Compensation Commission under only the
26rebuttable presumption provision of this subsection shall not

 

 

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1be admissible or be deemed res judicata in any disability claim
2under the Illinois Pension Code arising out of the same medical
3condition; however, this sentence makes no change to the law
4set forth in Krohe v. City of Bloomington, 204 Ill.2d 392.
5(Source: P.A. 98-291, eff. 1-1-14; 98-874, eff. 1-1-15; 98-973,
6eff. 8-15-14; 99-78, eff. 7-20-15; 99-143, eff. 7-27-15.)
 
7    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
8    Sec. 8. The amount of compensation which shall be paid to
9the employee for an accidental injury not resulting in death
10is:
11    (a) The employer shall provide and pay the negotiated rate,
12if applicable, or the lesser of the health care provider's
13actual charges or according to a fee schedule, subject to
14Section 8.2, in effect at the time the service was rendered for
15all the necessary first aid, medical and surgical services, and
16all necessary medical, surgical and hospital services
17thereafter incurred, limited, however, to that which is
18reasonably required to cure or relieve from the effects of the
19accidental injury, even if a health care provider sells,
20transfers, or otherwise assigns an account receivable for
21procedures, treatments, or services covered under this Act. If
22the employer does not dispute payment of first aid, medical,
23surgical, and hospital services, the employer shall make such
24payment to the provider on behalf of the employee. The employer
25shall also pay for treatment, instruction and training

 

 

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

 

 

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1inadequate care, the Commission may order the employee to
2select another doctor certified or qualified in the medical
3field for which treatment is required. If the employee refuses
4to make such change the Commission may relieve the employer of
5his obligation to pay the doctor's charges from the date of
6refusal to the date of compliance.
7    Any vocational rehabilitation counselors who provide
8service under this Act shall have appropriate certifications
9which designate the counselor as qualified to render opinions
10relating to vocational rehabilitation. Vocational
11rehabilitation may include, but is not limited to, counseling
12for job searches, supervising a job search program, and
13vocational retraining including education at an accredited
14learning institution. The employee or employer may petition to
15the Commission to decide disputes relating to vocational
16rehabilitation and the Commission shall resolve any such
17dispute, including payment of the vocational rehabilitation
18program by the employer.
19    The maintenance benefit shall not be less than the
20temporary total disability rate determined for the employee. In
21addition, maintenance shall include costs and expenses
22incidental to the vocational rehabilitation program.
23    When the employee is working light duty on a part-time
24basis or full-time basis and earns less than he or she would be
25earning if employed in the full capacity of the job or jobs,
26then the employee shall be entitled to temporary partial

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1        The maximum weekly compensation rate from July 1, 1975,
2    except as hereinafter provided, shall be 100% of the
3    State's average weekly wage in covered industries under the
4    Unemployment Insurance Act, that being the wage that most
5    closely approximates the State's average weekly wage.
6        The maximum weekly compensation rate, for the period
7    July 1, 1984, through June 30, 1987, except as hereinafter
8    provided, shall be $293.61. Effective July 1, 1987 and on
9    July 1 of each year thereafter the maximum weekly
10    compensation rate, except as hereinafter provided, shall
11    be determined as follows: if during the preceding 12 month
12    period there shall have been an increase in the State's
13    average weekly wage in covered industries under the
14    Unemployment Insurance Act, the weekly compensation rate
15    shall be proportionately increased by the same percentage
16    as the percentage of increase in the State's average weekly
17    wage in covered industries under the Unemployment
18    Insurance Act during such period.
19        The maximum weekly compensation rate, for the period
20    January 1, 1981 through December 31, 1983, except as
21    hereinafter provided, shall be 100% of the State's average
22    weekly wage in covered industries under the Unemployment
23    Insurance Act in effect on January 1, 1981. Effective
24    January 1, 1984 and on January 1, of each year thereafter
25    the maximum weekly compensation rate, except as
26    hereinafter provided, shall be determined as follows: if

 

 

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1    during the preceding 12 month period there shall have been
2    an increase in the State's average weekly wage in covered
3    industries under the Unemployment Insurance Act, the
4    weekly compensation rate shall be proportionately
5    increased by the same percentage as the percentage of
6    increase in the State's average weekly wage in covered
7    industries under the Unemployment Insurance Act during
8    such period.
9        From July 1, 1977 and thereafter such maximum weekly
10    compensation rate in death cases under Section 7, and
11    permanent total disability cases under paragraph (f) or
12    subparagraph 18 of paragraph (3) of this Section and for
13    temporary total disability under paragraph (b) of this
14    Section and for amputation of a member or enucleation of an
15    eye under paragraph (e) of this Section shall be increased
16    to 133-1/3% of the State's average weekly wage in covered
17    industries under the Unemployment Insurance Act.
18        For injuries occurring on or after February 1, 2006,
19    the maximum weekly benefit under paragraph (d)1 of this
20    Section shall be 100% of the State's average weekly wage in
21    covered industries under the Unemployment Insurance Act.
22        4.1. Any provision herein to the contrary
23    notwithstanding, the weekly compensation rate for
24    compensation payments under subparagraph 18 of paragraph
25    (e) of this Section and under paragraph (f) of this Section
26    and under paragraph (a) of Section 7 and for amputation of

 

 

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

 

 

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1    conclusive and shall be applicable as the basis of
2    computation of compensation rates until the next posting
3    and publication as aforesaid.
4        7. The payment of compensation by an employer or his
5    insurance carrier to an injured employee shall not
6    constitute an admission of the employer's liability to pay
7    compensation.
8    (c) For any serious and permanent disfigurement to the
9hand, head, face, neck, arm, leg below the knee or the chest
10above the axillary line, the employee is entitled to
11compensation for such disfigurement, the amount determined by
12agreement at any time or by arbitration under this Act, at a
13hearing not less than 6 months after the date of the accidental
14injury, which amount shall not exceed 150 weeks (if the
15accidental injury occurs on or after the effective date of this
16amendatory Act of the 94th General Assembly but before February
171, 2006) or 162 weeks (if the accidental injury occurs on or
18after February 1, 2006 but before January 1, 2018) or 150 weeks
19(if the accidental injury occurs on or after January 1, 2018)
20at the applicable rate provided in subparagraph 2.1 of
21paragraph (b) of this Section.
22    No compensation is payable under this paragraph where
23compensation is payable under paragraphs (d), (e) or (f) of
24this Section.
25    A duly appointed member of a fire department in a city, the
26population of which exceeds 500,000 according to the last

 

 

HB3526- 21 -LRB100 10567 JLS 20784 b

1federal or State census, is eligible for compensation under
2this paragraph only where such serious and permanent
3disfigurement results from burns.
4    (d) 1. If, after the accidental injury has been sustained,
5the employee as a result thereof becomes partially
6incapacitated from pursuing his usual and customary line of
7employment, he shall, except in cases compensated under the
8specific schedule set forth in paragraph (e) of this Section,
9receive compensation for the duration of his disability,
10subject to the limitations as to maximum amounts fixed in
11paragraph (b) of this Section, equal to 66-2/3% of the
12difference between the average amount which he would be able to
13earn in the full performance of his duties in the occupation in
14which he was engaged at the time of the accident and the
15average amount which he is earning or is able to earn in some
16suitable employment or business after the accident. For
17accidental injuries that occur on or after September 1, 2011,
18an award for wage differential under this subsection shall be
19effective only until the employee reaches the age of 67 or 5
20years from the date the award becomes final, whichever is
21later.
22    2. If, as a result of the accident, the employee sustains
23serious and permanent injuries not covered by paragraphs (c)
24and (e) of this Section or having sustained injuries covered by
25the aforesaid paragraphs (c) and (e), he shall have sustained
26in addition thereto other injuries which injuries do not

 

 

HB3526- 22 -LRB100 10567 JLS 20784 b

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

 

 

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1kidney, spleen or lung, the amount of compensation allowed
2under this Section shall be not less than 10 weeks for each
3such organ. Compensation awarded under this subparagraph 2
4shall not take into consideration injuries covered under
5paragraphs (c) and (e) of this Section and the compensation
6provided in this paragraph shall not affect the employee's
7right to compensation payable under paragraphs (b), (c) and (e)
8of this Section for the disabilities therein covered, except
9that in no case shall total compensation for all injuries to an
10individual employee be greater than 500 weeks, and any
11compensation for prior injuries shall be considered in
12determining this 500 week limit on total compensation.
13    (e) For accidental injuries in the following schedule, the
14employee shall receive compensation for the period of temporary
15total incapacity for work resulting from such accidental
16injury, under subparagraph 1 of paragraph (b) of this Section,
17and shall receive in addition thereto compensation for a
18further period for the specific loss herein mentioned, but
19shall not receive any compensation under any other provisions
20of this Act. The following listed amounts apply to either the
21loss of or the permanent and complete loss of use of the member
22specified, such compensation for the length of time as follows:
23        1. Thumb-
24            70 weeks if the accidental injury occurs on or
25        after the effective date of this amendatory Act of the
26        94th General Assembly but before February 1, 2006.

 

 

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1            76 weeks if the accidental injury occurs on or
2            after February 1, 2006 but before January 1, 2018.
3            70 weeks if the accidental injury occurs on or
4        after January 1, 2018.
5        2. First, or index finger-
6            40 weeks if the accidental injury occurs on or
7        after the effective date of this amendatory Act of the
8        94th General Assembly but before February 1, 2006.
9            43 weeks if the accidental injury occurs on or
10        after February 1, 2006 but before January 1, 2018.
11            40 weeks if the accidental injury occurs on or
12        after January 1, 2018.
13        3. Second, or middle finger-
14            35 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            38 weeks if the accidental injury occurs on or
18        after February 1, 2006 but before January 1, 2018.
19            35 weeks if the accidental injury occurs on or
20        after January 1, 2018.
21        4. Third, or ring finger-
22            25 weeks if the accidental injury occurs on or
23        after the effective date of this amendatory Act of the
24        94th General Assembly but before February 1, 2006.
25            27 weeks if the accidental injury occurs on or
26        after February 1, 2006 but before January 1, 2018.

 

 

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1            25 weeks if the accidental injury occurs on or
2        after January 1, 2018.
3        5. Fourth, or little finger-
4            20 weeks if the accidental injury occurs on or
5        after the effective date of this amendatory Act of the
6        94th General Assembly but before February 1, 2006.
7            22 weeks if the accidental injury occurs on or
8        after February 1, 2006 but before January 1, 2018.
9            20 weeks if the accidental injury occurs on or
10        after January 1, 2018.
11        6. Great toe-
12            35 weeks if the accidental injury occurs on or
13        after the effective date of this amendatory Act of the
14        94th General Assembly but before February 1, 2006.
15            38 weeks if the accidental injury occurs on or
16        after February 1, 2006 but before January 1, 2018.
17            35 weeks if the accidental injury occurs on or
18        after January 1, 2018.
19        7. Each toe other than great toe-
20            12 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            13 weeks if the accidental injury occurs on or
24        after February 1, 2006 but before January 1, 2018.
25            12 weeks if the accidental injury occurs on or
26        after January 1, 2018.

 

 

HB3526- 26 -LRB100 10567 JLS 20784 b

1        8. The loss of the first or distal phalanx of the thumb
2    or of any finger or toe shall be considered to be equal to
3    the loss of one-half of such thumb, finger or toe and the
4    compensation payable shall be one-half of the amount above
5    specified. The loss of more than one phalanx shall be
6    considered as the loss of the entire thumb, finger or toe.
7    In no case shall the amount received for more than one
8    finger exceed the amount provided in this schedule for the
9    loss of a hand.
10        9. Hand-
11            190 weeks if the accidental injury occurs on or
12        after the effective date of this amendatory Act of the
13        94th General Assembly but before February 1, 2006.
14            205 weeks if the accidental injury occurs on or
15        after February 1, 2006 but before January 1, 2018.
16            190 weeks if the accidental injury occurs on or
17        after January 1, 2018.
18            190 weeks if the accidental injury occurs on or
19        after June 28, 2011 (the effective date of Public Act
20        97-18) and if the accidental injury involves carpal
21        tunnel syndrome due to repetitive or cumulative
22        trauma, in which case the permanent partial disability
23        shall not exceed 15% loss of use of the hand, except
24        for cause shown by clear and convincing evidence and in
25        which case the award shall not exceed 30% loss of use
26        of the hand.

 

 

HB3526- 27 -LRB100 10567 JLS 20784 b

1        The loss of 2 or more digits, or one or more phalanges
2    of 2 or more digits, of a hand may be compensated on the
3    basis of partial loss of use of a hand, provided, further,
4    that the loss of 4 digits, or the loss of use of 4 digits,
5    in the same hand shall constitute the complete loss of a
6    hand.
7        10. Arm-
8            235 weeks if the accidental injury occurs on or
9        after the effective date of this amendatory Act of the
10        94th General Assembly but before February 1, 2006.
11            253 weeks if the accidental injury occurs on or
12        after February 1, 2006 but before January 1, 2018.
13            235 weeks if the accidental injury occurs on or
14        after January 1, 2018.
15        Where an accidental injury results in the amputation of
16    an arm below the elbow, such injury shall be compensated as
17    a loss of an arm. Where an accidental injury results in the
18    amputation of an arm above the elbow, compensation for an
19    additional 15 weeks (if the accidental injury occurs on or
20    after the effective date of this amendatory Act of the 94th
21    General Assembly but before February 1, 2006) or an
22    additional 17 weeks (if the accidental injury occurs on or
23    after February 1, 2006, but before January 1, 2018) or an
24    additional 15 weeks (if the accidental injury occurs on or
25    after January 1, 2018) shall be paid, except where the
26    accidental injury results in the amputation of an arm at

 

 

HB3526- 28 -LRB100 10567 JLS 20784 b

1    the shoulder joint, or so close to shoulder joint that an
2    artificial arm cannot be used, or results in the
3    disarticulation of an arm at the shoulder joint, in which
4    case compensation for an additional 65 weeks (if the
5    accidental injury occurs on or after the effective date of
6    this amendatory Act of the 94th General Assembly but before
7    February 1, 2006) or an additional 70 weeks (if the
8    accidental injury occurs on or after February 1, 2006 but
9    before January 1, 2018) or an additional 65 weeks (if the
10    accidental injury occurs on or after January 1, 2018) shall
11    be paid.
12        (10.5) Shoulder-
13            253 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        100th General Assembly.
16        11. Foot-
17            155 weeks if the accidental injury occurs on or
18        after the effective date of this amendatory Act of the
19        94th General Assembly but before February 1, 2006.
20            167 weeks if the accidental injury occurs on or
21        after February 1, 2006 but before January 1, 2018.
22            155 weeks if the accidental injury occurs on or
23        after January 1, 2018.
24        12. Leg-
25            200 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

HB3526- 29 -LRB100 10567 JLS 20784 b

1        94th General Assembly but before February 1, 2006.
2            215 weeks if the accidental injury occurs on or
3        after February 1, 2006 but before January 1, 2018.
4            200 weeks if the accidental injury occurs on or
5        after January 1, 2018.
6        Where an accidental injury results in the amputation of
7    a leg below the knee, such injury shall be compensated as
8    loss of a leg. Where an accidental injury results in the
9    amputation of a leg above the knee, compensation for an
10    additional 25 weeks (if the accidental injury occurs on or
11    after the effective date of this amendatory Act of the 94th
12    General Assembly but before February 1, 2006) or an
13    additional 27 weeks (if the accidental injury occurs on or
14    after February 1, 2006 but before January 1, 2018) or an
15    additional 25 weeks (if the accidental injury occurs on or
16    after January 1, 2018) shall be paid, except where the
17    accidental injury results in the amputation of a leg at the
18    hip joint, or so close to the hip joint that an artificial
19    leg cannot be used, or results in the disarticulation of a
20    leg at the hip joint, in which case compensation for an
21    additional 75 weeks (if the accidental injury occurs on or
22    after the effective date of this amendatory Act of the 94th
23    General Assembly but before February 1, 2006) or an
24    additional 81 weeks (if the accidental injury occurs on or
25    after February 1, 2006 but before January 1, 2018) or an
26    additional 75 weeks (if the accidental injury occurs on or

 

 

HB3526- 30 -LRB100 10567 JLS 20784 b

1    after January 1, 2018) shall be paid.
2        13. Eye-
3            150 weeks if the accidental injury occurs on or
4        after the effective date of this amendatory Act of the
5        94th General Assembly but before February 1, 2006.
6            162 weeks if the accidental injury occurs on or
7        after February 1, 2006 but before January 1, 2018.
8            150 weeks if the accidental injury occurs on or
9        after January 1, 2018.
10        Where an accidental injury results in the enucleation
11    of an eye, compensation for an additional 10 weeks (if the
12    accidental injury occurs on or after the effective date of
13    this amendatory Act of the 94th General Assembly but before
14    February 1, 2006) or an additional 11 weeks (if the
15    accidental injury occurs on or after February 1, 2006 but
16    before January 1, 2018) or an additional 10 weeks (if the
17    accidental injury occurs on or after January 1, 2018) shall
18    be paid.
19        14. Loss of hearing of one ear-
20            50 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            54 weeks if the accidental injury occurs on or
24        after February 1, 2006 but before January 1, 2018.
25            50 weeks if the accidental injury occurs on or
26        after January 1, 2018.

 

 

HB3526- 31 -LRB100 10567 JLS 20784 b

1        Total and permanent loss of hearing of both ears-
2            200 weeks if the accidental injury occurs on or
3        after the effective date of this amendatory Act of the
4        94th General Assembly but before February 1, 2006.
5            215 weeks if the accidental injury occurs on or
6        after February 1, 2006 but before January 1, 2018.
7            200 weeks if the accidental injury occurs on or
8        after January 1, 2018.
9        15. Testicle-
10            50 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            54 weeks if the accidental injury occurs on or
14        after February 1, 2006 but before January 1, 2018.
15            50 weeks if the accidental injury occurs on or
16        after January 1, 2018.
17        Both testicles-
18            150 weeks if the accidental injury occurs on or
19        after the effective date of this amendatory Act of the
20        94th General Assembly but before February 1, 2006.
21            162 weeks if the accidental injury occurs on or
22        after February 1, 2006 but before January 1, 2018.
23            150 weeks if the accidental injury occurs on or
24        after January 1, 2018.
25        16. For the permanent partial loss of use of a member
26    or sight of an eye, or hearing of an ear, compensation

 

 

HB3526- 32 -LRB100 10567 JLS 20784 b

1    during that proportion of the number of weeks in the
2    foregoing schedule provided for the loss of such member or
3    sight of an eye, or hearing of an ear, which the partial
4    loss of use thereof bears to the total loss of use of such
5    member, or sight of eye, or hearing of an ear.
6            (a) Loss of hearing for compensation purposes
7        shall be confined to the frequencies of 1,000, 2,000
8        and 3,000 cycles per second. Loss of hearing ability
9        for frequency tones above 3,000 cycles per second are
10        not to be considered as constituting disability for
11        hearing.
12            (b) The percent of hearing loss, for purposes of
13        the determination of compensation claims for
14        occupational deafness, shall be calculated as the
15        average in decibels for the thresholds of hearing for
16        the frequencies of 1,000, 2,000 and 3,000 cycles per
17        second. Pure tone air conduction audiometric
18        instruments, approved by nationally recognized
19        authorities in this field, shall be used for measuring
20        hearing loss. If the losses of hearing average 30
21        decibels or less in the 3 frequencies, such losses of
22        hearing shall not then constitute any compensable
23        hearing disability. If the losses of hearing average 85
24        decibels or more in the 3 frequencies, then the same
25        shall constitute and be total or 100% compensable
26        hearing loss.

 

 

HB3526- 33 -LRB100 10567 JLS 20784 b

1            (c) In measuring hearing impairment, the lowest
2        measured losses in each of the 3 frequencies shall be
3        added together and divided by 3 to determine the
4        average decibel loss. For every decibel of loss
5        exceeding 30 decibels an allowance of 1.82% shall be
6        made up to the maximum of 100% which is reached at 85
7        decibels.
8            (d) If a hearing loss is established to have
9        existed on July 1, 1975 by audiometric testing the
10        employer shall not be liable for the previous loss so
11        established nor shall he be liable for any loss for
12        which compensation has been paid or awarded.
13            (e) No consideration shall be given to the question
14        of whether or not the ability of an employee to
15        understand speech is improved by the use of a hearing
16        aid.
17            (f) No claim for loss of hearing due to industrial
18        noise shall be brought against an employer or allowed
19        unless the employee has been exposed for a period of
20        time sufficient to cause permanent impairment to noise
21        levels in excess of the following:
22Sound Level DBA
23Slow ResponseHours Per Day
24908
25926
26954

 

 

HB3526- 34 -LRB100 10567 JLS 20784 b

1973
21002
31021-1/2
41051
51101/2
61151/4
7        This subparagraph (f) shall not be applied in cases of
8    hearing loss resulting from trauma or explosion.
9        17. In computing the compensation to be paid to any
10    employee who, before the accident for which he claims
11    compensation, had before that time sustained an injury
12    resulting in the loss by amputation or partial loss by
13    amputation of any member, including hand, arm, thumb or
14    fingers, leg, foot or any toes, such loss or partial loss
15    of any such member shall be deducted from any award made
16    for the subsequent injury. For the permanent loss of use or
17    the permanent partial loss of use of any such member or the
18    partial loss of sight of an eye, for which compensation has
19    been paid, then such loss shall be taken into consideration
20    and deducted from any award for the subsequent injury.
21        18. The specific case of loss of both hands, both arms,
22    or both feet, or both legs, or both eyes, or of any two
23    thereof, or the permanent and complete loss of the use
24    thereof, constitutes total and permanent disability, to be
25    compensated according to the compensation fixed by
26    paragraph (f) of this Section. These specific cases of

 

 

HB3526- 35 -LRB100 10567 JLS 20784 b

1    total and permanent disability do not exclude other cases.
2        Any employee who has previously suffered the loss or
3    permanent and complete loss of the use of any of such
4    members, and in a subsequent independent accident loses
5    another or suffers the permanent and complete loss of the
6    use of any one of such members the employer for whom the
7    injured employee is working at the time of the last
8    independent accident is liable to pay compensation only for
9    the loss or permanent and complete loss of the use of the
10    member occasioned by the last independent accident.
11        19. In a case of specific loss and the subsequent death
12    of such injured employee from other causes than such injury
13    leaving a widow, widower, or dependents surviving before
14    payment or payment in full for such injury, then the amount
15    due for such injury is payable to the widow or widower and,
16    if there be no widow or widower, then to such dependents,
17    in the proportion which such dependency bears to total
18    dependency.
19    Beginning July 1, 1980, and every 6 months thereafter, the
20Commission shall examine the Second Injury Fund and when, after
21deducting all advances or loans made to such Fund, the amount
22therein is $500,000 then the amount required to be paid by
23employers pursuant to paragraph (f) of Section 7 shall be
24reduced by one-half. When the Second Injury Fund reaches the
25sum of $600,000 then the payments shall cease entirely.
26However, when the Second Injury Fund has been reduced to

 

 

HB3526- 36 -LRB100 10567 JLS 20784 b

1$400,000, payment of one-half of the amounts required by
2paragraph (f) of Section 7 shall be resumed, in the manner
3herein provided, and when the Second Injury Fund has been
4reduced to $300,000, payment of the full amounts required by
5paragraph (f) of Section 7 shall be resumed, in the manner
6herein provided. The Commission shall make the changes in
7payment effective by general order, and the changes in payment
8become immediately effective for all cases coming before the
9Commission thereafter either by settlement agreement or final
10order, irrespective of the date of the accidental injury.
11    On August 1, 1996 and on February 1 and August 1 of each
12subsequent year, the Commission shall examine the special fund
13designated as the "Rate Adjustment Fund" and when, after
14deducting all advances or loans made to said fund, the amount
15therein is $4,000,000, the amount required to be paid by
16employers pursuant to paragraph (f) of Section 7 shall be
17reduced by one-half. When the Rate Adjustment Fund reaches the
18sum of $5,000,000 the payment therein shall cease entirely.
19However, when said Rate Adjustment Fund has been reduced to
20$3,000,000 the amounts required by paragraph (f) of Section 7
21shall be resumed in the manner herein provided.
22    (f) In case of complete disability, which renders the
23employee wholly and permanently incapable of work, or in the
24specific case of total and permanent disability as provided in
25subparagraph 18 of paragraph (e) of this Section, compensation
26shall be payable at the rate provided in subparagraph 2 of

 

 

HB3526- 37 -LRB100 10567 JLS 20784 b

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

 

 

HB3526- 38 -LRB100 10567 JLS 20784 b

1complete loss of the use of another member, he shall receive,
2in addition to the compensation payable by the employer and
3after such payments have ceased, an amount from the Second
4Injury Fund provided for in paragraph (f) of Section 7, which,
5together with the compensation payable from the employer in
6whose employ he was when the last accidental injury was
7incurred, will equal the amount payable for permanent and
8complete disability as provided in this paragraph of this
9Section.
10    The custodian of the Second Injury Fund provided for in
11paragraph (f) of Section 7 shall be joined with the employer as
12a party respondent in the application for adjustment of claim.
13The application for adjustment of claim shall state briefly and
14in general terms the approximate time and place and manner of
15the loss of the first member.
16    In its award the Commission or the Arbitrator shall
17specifically find the amount the injured employee shall be
18weekly paid, the number of weeks compensation which shall be
19paid by the employer, the date upon which payments begin out of
20the Second Injury Fund provided for in paragraph (f) of Section
217 of this Act, the length of time the weekly payments continue,
22the date upon which the pension payments commence and the
23monthly amount of the payments. The Commission shall 30 days
24after the date upon which payments out of the Second Injury
25Fund have begun as provided in the award, and every month
26thereafter, prepare and submit to the State Comptroller a

 

 

HB3526- 39 -LRB100 10567 JLS 20784 b

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

 

 

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1prior to July 1, 1975 and on July 15 of each year thereafter.
2In all other cases such adjustment shall be made on July 15 of
3the second year next following the date of the entry of the
4award and shall further be made on July 15 annually thereafter.
5If during the intervening period from the date of the entry of
6the award, or the last periodic adjustment, there shall have
7been an increase in the State's average weekly wage in covered
8industries under the Unemployment Insurance Act, the weekly
9compensation rate shall be proportionately increased by the
10same percentage as the percentage of increase in the State's
11average weekly wage in covered industries under the
12Unemployment Insurance Act. The increase in the compensation
13rate under this paragraph shall in no event bring the total
14compensation rate to an amount greater than the prevailing
15maximum rate at the time that the annual adjustment is made.
16Such increase shall be paid in the same manner as herein
17provided for payments under the Second Injury Fund to the
18injured employee, or his dependents, as the case may be, out of
19the Rate Adjustment Fund provided in paragraph (f) of Section 7
20of this Act. Payments shall be made at the same intervals as
21provided in the award or, at the option of the Commission, may
22be made in quarterly payment on the 15th day of January, April,
23July and October of each year. In the event of a decrease in
24such average weekly wage there shall be no change in the then
25existing compensation rate. The within paragraph shall not
26apply to cases where there is disputed liability and in which a

 

 

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1compromise lump sum settlement between the employer and the
2injured employee, or his dependents, as the case may be, has
3been duly approved by the Illinois Workers' Compensation
4Commission.
5    Provided, that in cases of awards entered by the Commission
6for injuries occurring before July 1, 1975, the increases in
7the compensation rate adjusted under the foregoing provision of
8this paragraph (g) shall be limited to increases in the State's
9average weekly wage in covered industries under the
10Unemployment Insurance Act occurring after July 1, 1975.
11    For every accident occurring on or after July 20, 2005 but
12before the effective date of this amendatory Act of the 94th
13General Assembly (Senate Bill 1283 of the 94th General
14Assembly), the annual adjustments to the compensation rate in
15awards for death benefits or permanent total disability, as
16provided in this Act, shall be paid by the employer. The
17adjustment shall be made by the employer on July 15 of the
18second year next following the date of the entry of the award
19and shall further be made on July 15 annually thereafter. If
20during the intervening period from the date of the entry of the
21award, or the last periodic adjustment, there shall have been
22an increase in the State's average weekly wage in covered
23industries under the Unemployment Insurance Act, the employer
24shall increase the weekly compensation rate proportionately by
25the same percentage as the percentage of increase in the
26State's average weekly wage in covered industries under the

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    Sec. 8.1b. Determination of permanent partial disability.
2For accidental injuries that occur on or after September 1,
32011, permanent partial disability shall be established using
4the following criteria:
5    (a) A physician licensed to practice medicine in all of its
6branches preparing a permanent partial disability impairment
7report shall report the level of impairment in writing. The
8report shall include an evaluation of medically defined and
9professionally appropriate measurements of impairment that
10include, but are not limited to: loss of range of motion; loss
11of strength; measured atrophy of tissue mass consistent with
12the injury; and any other measurements that establish the
13nature and extent of the impairment. The most current edition
14of the American Medical Association's "Guides to the Evaluation
15of Permanent Impairment" shall be used by the physician in
16determining the level of impairment.
17    (b) In determining the level of permanent partial
18disability, the Commission shall base its determination on the
19guidelines provided in the most current edition of the American
20Medical Association's "Guides to the Evaluation of Permanent
21Impairment". following factors: (i) the reported level of
22impairment pursuant to subsection (a); (ii) the occupation of
23the injured employee; (iii) the age of the employee at the time
24of the injury; (iv) the employee's future earning capacity; and
25(v) evidence of disability corroborated by the treating medical
26records. No single enumerated factor shall be the sole

 

 

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1determinant of disability. In determining the level of
2disability, the relevance and weight of any factors used in
3addition to the level of impairment as reported by the
4physician must be explained in a written order.
5(Source: P.A. 97-18, eff. 6-28-11.)
 
6    (820 ILCS 305/8.2)
7    Sec. 8.2. Fee schedule.
8    (a) Except as provided for in subsection (c), for
9procedures, treatments, or services covered under this Act and
10rendered or to be rendered on and after February 1, 2006, the
11maximum amount billed allowable payment shall be 90% of the
1280th percentile of charges and fees as determined by the
13Commission utilizing information provided by employers' and
14insurers' national databases, with a minimum of 12,000,000
15Illinois line item charges and fees comprised of health care
16provider and hospital charges and fees as of August 1, 2004 but
17not earlier than August 1, 2002. These charges and fees are
18provider billed amounts and shall not include discounted
19charges. The 80th percentile is the point on an ordered data
20set from low to high such that 80% of the cases are below or
21equal to that point and at most 20% are above or equal to that
22point. The Commission shall adjust these historical charges and
23fees as of August 1, 2004 by the Consumer Price Index-U for the
24period August 1, 2004 through September 30, 2005. The
25Commission shall establish fee schedules for the billing of

 

 

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1procedures, treatments, or services for hospital inpatient,
2hospital outpatient, emergency room and trauma, ambulatory
3surgical treatment centers, and professional services. These
4charges and fees shall be designated by geozip or any smaller
5geographic unit. The data shall in no way identify or tend to
6identify any patient, employer, or health care provider. As
7used in this Section, "geozip" means a three-digit zip code
8based on data similarities, geographical similarities, and
9frequencies. A geozip does not cross state boundaries. As used
10in this Section, "three-digit zip code" means a geographic area
11in which all zip codes have the same first 3 digits. If a
12geozip does not have the necessary number of charges and fees
13to calculate a valid percentile for a specific procedure,
14treatment, or service, the Commission may combine data from the
15geozip with up to 4 other geozips that are demographically and
16economically similar and exhibit similarities in data and
17frequencies until the Commission reaches 9 charges or fees for
18that specific procedure, treatment, or service. In cases where
19the compiled data contains less than 9 charges or fees for a
20procedure, treatment, or service, reimbursement shall occur at
2176% of charges and fees as determined by the Commission in a
22manner consistent with the provisions of this paragraph.
23Providers of out-of-state procedures, treatments, services,
24products, or supplies shall be reimbursed at the lesser of that
25state's fee schedule amount or the fee schedule amount for the
26region in which the employee resides. If no fee schedule exists

 

 

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1in that state, the provider shall be reimbursed at the lesser
2of the actual charge or the fee schedule amount for the region
3in which the employee resides. Not later than September 30 in
42006 and each year thereafter, the Commission shall
5automatically increase or decrease the maximum amount billed
6allowable payment for a procedure, treatment, or service
7established and in effect on January 1 of that year by the
8percentage change in the Consumer Price Index-U for the 12
9month period ending August 31 of that year. The increase or
10decrease shall become effective on January 1 of the following
11year. As used in this Section, "Consumer Price Index-U" means
12the index published by the Bureau of Labor Statistics of the
13U.S. Department of Labor, that measures the average change in
14prices of all goods and services purchased by all urban
15consumers, U.S. city average, all items, 1982-84=100.
16    (a-1) Notwithstanding the provisions of subsection (a) and
17unless otherwise indicated, the following provisions shall
18apply to the medical fee schedule starting on September 1,
192011:
20        (1) The Commission shall establish and maintain fee
21    schedules for the maximum amount changed for procedures,
22    treatments, products, services, or supplies for hospital
23    inpatient, hospital outpatient, emergency room, ambulatory
24    surgical treatment centers, accredited ambulatory surgical
25    treatment facilities, prescriptions filled and dispensed
26    outside of a licensed pharmacy, dental services, and

 

 

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1    professional services. This fee schedule shall be based on
2    the fee schedule amounts already established by the
3    Commission pursuant to subsection (a) of this Section.
4    However, starting on January 1, 2012, these fee schedule
5    amounts shall be grouped into geographic regions in the
6    following manner:
7            (A) Four regions for non-hospital fee schedule
8        amounts shall be utilized:
9                (i) Cook County;
10                (ii) DuPage, Kane, Lake, and Will Counties;
11                (iii) Bond, Calhoun, Clinton, Jersey,
12            Macoupin, Madison, Monroe, Montgomery, Randolph,
13            St. Clair, and Washington Counties; and
14                (iv) All other counties of the State.
15            (B) Fourteen regions for hospital fee schedule
16        amounts shall be utilized:
17                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
18            Kendall, and Grundy Counties;
19                (ii) Kankakee County;
20                (iii) Madison, St. Clair, Macoupin, Clinton,
21            Monroe, Jersey, Bond, and Calhoun Counties;
22                (iv) Winnebago and Boone Counties;
23                (v) Peoria, Tazewell, Woodford, Marshall, and
24            Stark Counties;
25                (vi) Champaign, Piatt, and Ford Counties;
26                (vii) Rock Island, Henry, and Mercer Counties;

 

 

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1                (viii) Sangamon and Menard Counties;
2                (ix) McLean County;
3                (x) Lake County;
4                (xi) Macon County;
5                (xii) Vermilion County;
6                (xiii) Alexander County; and
7                (xiv) All other counties of the State.
8        (2) If a geozip, as defined in subsection (a) of this
9    Section, overlaps into one or more of the regions set forth
10    in this Section, then the Commission shall average or
11    repeat the charges and fees in a geozip in order to
12    designate charges and fees for each region.
13        (3) In cases where the compiled data contains less than
14    9 charges or fees for a procedure, treatment, product,
15    supply, or service or where the fee schedule amount cannot
16    be determined by the non-discounted charge data,
17    non-Medicare relative values and conversion factors
18    derived from established fee schedule amounts, coding
19    crosswalks, or other data as determined by the Commission,
20    billing reimbursement shall occur at 76% of charges and
21    fees until September 1, 2011 and 53.2% of charges and fees
22    thereafter as determined by the Commission in a manner
23    consistent with the provisions of this paragraph.
24        (4) To establish additional fee schedule amounts, the
25    Commission shall utilize provider non-discounted charge
26    data, non-Medicare relative values and conversion factors

 

 

HB3526- 52 -LRB100 10567 JLS 20784 b

1    derived from established fee schedule amounts, and coding
2    crosswalks. The Commission may establish additional fee
3    schedule amounts based on either the charge or cost of the
4    procedure, treatment, product, supply, or service.
5        (5) Implants shall be billed reimbursed at 25% above
6    the net manufacturer's invoice price less rebates, plus
7    actual reasonable and customary shipping charges whether
8    or not the implant charge is submitted by a provider in
9    conjunction with a bill for all other services associated
10    with the implant, submitted by a provider on a separate
11    claim form, submitted by a distributor, or submitted by the
12    manufacturer of the implant. "Implants" include the
13    following codes or any substantially similar updated code
14    as determined by the Commission: 0274
15    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
16    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
17    (investigational devices); and 0636 (drugs requiring
18    detailed coding). Non-implantable devices or supplies
19    within these codes shall be billed reimbursed at 65% of
20    actual charge, which is the provider's normal rates under
21    its standard chargemaster. A standard chargemaster is the
22    provider's list of charges for procedures, treatments,
23    products, supplies, or services used to bill payers in a
24    consistent manner.
25        (6) The Commission shall automatically update all
26    codes and associated rules with the version of the codes

 

 

HB3526- 53 -LRB100 10567 JLS 20784 b

1    and rules valid on January 1 of that year.
2    (a-2) For procedures, treatments, services, or supplies
3covered under this Act and rendered or to be rendered on or
4after September 1, 2011, the maximum amount billed allowable
5payment shall be 70% of the fee schedule amounts, which shall
6be adjusted yearly by the Consumer Price Index-U, as described
7in subsection (a) of this Section.
8    (a-3) Prescriptions filled and dispensed outside of a
9licensed pharmacy shall be subject to a fee schedule that shall
10not exceed the Average Wholesale Price (AWP) plus a dispensing
11fee of $4.18. AWP or its equivalent as registered by the
12National Drug Code shall be set forth for that drug on that
13date as published in Medispan.
14    (b) Notwithstanding the provisions of subsection (a), if
15the Commission finds that there is a significant limitation on
16access to quality health care in either a specific field of
17health care services or a specific geographic limitation on
18access to health care, it may change the Consumer Price Index-U
19increase or decrease for that specific field or specific
20geographic limitation on access to health care to address that
21limitation.
22    (c) The Commission shall establish by rule a process to
23review those medical cases or outliers that involve
24extra-ordinary treatment to determine whether to make an
25additional adjustment to the maximum charge payment within a
26fee schedule for a procedure, treatment, or service.

 

 

HB3526- 54 -LRB100 10567 JLS 20784 b

1    (d) When a patient notifies a provider that the treatment,
2procedure, or service being sought is for a work-related
3illness or injury and furnishes the provider the name and
4address of the responsible employer, the provider shall bill
5the employer directly. The employer shall make payment and
6providers shall submit bills and records in accordance with the
7provisions of this Section.
8        (1) All payments to providers for treatment provided
9    pursuant to this Act shall be made within 30 days of
10    receipt of the bills as long as the claim contains
11    substantially all the required data elements necessary to
12    adjudicate the bills and the correct fee schedule amount is
13    charged for medical services.
14        (2) If the claim does not contain substantially all the
15    required data elements necessary to adjudicate the bill or
16    if the amount charged is incorrect or above the fee
17    schedule, or the claim is denied for any other reason, in
18    whole or in part, the employer or insurer shall provide
19    written notification, explaining the basis for the denial
20    and describing any additional necessary data elements, to
21    the provider within 30 days of receipt of the bill.
22        (3) In the case of nonpayment to a provider within 30
23    days of receipt of the bill which charged the correct fee
24    schedule amount and contained substantially all of the
25    required data elements necessary to adjudicate the bill or
26    nonpayment to a provider of a portion of such a bill up to

 

 

HB3526- 55 -LRB100 10567 JLS 20784 b

1    the lesser of the actual charge or the payment level set by
2    the Commission in the fee schedule established in this
3    Section, the bill, or portion of the bill, shall incur
4    interest at a rate of 1% per month payable to the provider.
5    Any required interest payments shall be made within 30 days
6    after payment.
7    (e) Except as provided in subsections (e-5), (e-10), and
8(e-15), a provider shall not hold an employee liable for costs
9related to a non-disputed procedure, treatment, or service
10rendered in connection with a compensable injury. The
11provisions of subsections (e-5), (e-10), (e-15), and (e-20)
12shall not apply if an employee provides information to the
13provider regarding participation in a group health plan. If the
14employee participates in a group health plan, the provider may
15submit a claim for services to the group health plan. If the
16claim for service is covered by the group health plan, the
17employee's responsibility shall be limited to applicable
18deductibles, co-payments, or co-insurance. Except as provided
19under subsections (e-5), (e-10), (e-15), and (e-20), a provider
20shall not bill or otherwise attempt to recover from the
21employee the difference between the provider's charge and the
22amount paid by the employer or the insurer on a compensable
23injury, or for medical services or treatment determined by the
24Commission to be excessive or unnecessary.
25    (e-5) If an employer notifies a provider that the employer
26does not consider the illness or injury to be compensable under

 

 

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1this Act, the provider may seek payment of the provider's
2actual charges from the employee for any procedure, treatment,
3or service rendered. Once an employee informs the provider that
4there is an application filed with the Commission to resolve a
5dispute over payment of such charges, the provider shall cease
6any and all efforts to collect payment for the services that
7are the subject of the dispute. Any statute of limitations or
8statute of repose applicable to the provider's efforts to
9collect payment from the employee shall be tolled from the date
10that the employee files the application with the Commission
11until the date that the provider is permitted to resume
12collection efforts under the provisions of this Section.
13    (e-10) If an employer notifies a provider that the employer
14will pay only a portion of a bill for any procedure, treatment,
15or service rendered in connection with a compensable illness or
16disease, the provider may seek payment from the employee for
17the remainder of the amount of the bill up to the lesser of the
18actual charge, negotiated rate, if applicable, or the payment
19level set by the Commission in the fee schedule established in
20this Section. Once an employee informs the provider that there
21is an application filed with the Commission to resolve a
22dispute over payment of such charges, the provider shall cease
23any and all efforts to collect payment for the services that
24are the subject of the dispute. Any statute of limitations or
25statute of repose applicable to the provider's efforts to
26collect payment from the employee shall be tolled from the date

 

 

HB3526- 57 -LRB100 10567 JLS 20784 b

1that the employee files the application with the Commission
2until the date that the provider is permitted to resume
3collection efforts under the provisions of this Section.
4    (e-15) When there is a dispute over the compensability of
5or amount of payment for a procedure, treatment, or service,
6and a case is pending or proceeding before an Arbitrator or the
7Commission, the provider may mail the employee reminders that
8the employee will be responsible for payment of any procedure,
9treatment or service rendered by the provider. The reminders
10must state that they are not bills, to the extent practicable
11include itemized information, and state that the employee need
12not pay until such time as the provider is permitted to resume
13collection efforts under this Section. The reminders shall not
14be provided to any credit rating agency. The reminders may
15request that the employee furnish the provider with information
16about the proceeding under this Act, such as the file number,
17names of parties, and status of the case. If an employee fails
18to respond to such request for information or fails to furnish
19the information requested within 90 days of the date of the
20reminder, the provider is entitled to resume any and all
21efforts to collect payment from the employee for the services
22rendered to the employee and the employee shall be responsible
23for payment of any outstanding bills for a procedure,
24treatment, or service rendered by a provider.
25    (e-20) Upon a final award or judgment by an Arbitrator or
26the Commission, or a settlement agreed to by the employer and

 

 

HB3526- 58 -LRB100 10567 JLS 20784 b

1the employee, a provider may resume any and all efforts to
2collect payment from the employee for the services rendered to
3the employee and the employee shall be responsible for payment
4of any outstanding bills for a procedure, treatment, or service
5rendered by a provider as well as the interest awarded under
6subsection (d) of this Section. In the case of a procedure,
7treatment, or service deemed compensable, the provider shall
8not require a payment rate, excluding the interest provisions
9under subsection (d), greater than the lesser of the actual
10charge or the payment level set by the Commission in the fee
11schedule established in this Section. Payment for services
12deemed not covered or not compensable under this Act is the
13responsibility of the employee unless a provider and employee
14have agreed otherwise in writing. Services not covered or not
15compensable under this Act are not subject to the fee schedule
16in this Section.
17    (f) Nothing in this Act shall prohibit an employer or
18insurer from contracting with a health care provider or group
19of health care providers for reimbursement levels for benefits
20under this Act different from those provided in this Section.
21    (g) On or before January 1, 2010 the Commission shall
22provide to the Governor and General Assembly a report regarding
23the implementation of the medical fee schedule and the index
24used for annual adjustment to that schedule as described in
25this Section.
26(Source: P.A. 97-18, eff. 6-28-11.)
 

 

 

HB3526- 59 -LRB100 10567 JLS 20784 b

1    Section 99. Effective date. This Act takes effect upon
2becoming law.