100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5354

 

Introduced , by Rep. Michael D. Unes

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 140/7.5
215 ILCS 5/457  from Ch. 73, par. 1065.4
720 ILCS 5/17-10.4 new
820 ILCS 305/1  from Ch. 48, par. 138.1
820 ILCS 305/8  from Ch. 48, par. 138.8
820 ILCS 305/8.2
820 ILCS 305/8.2a
820 ILCS 305/19  from Ch. 48, par. 138.19
820 ILCS 305/25.5
820 ILCS 305/29.2

    Amends the Workers' Compensation Act. Limits the scope of the term "arising out of and in the course of employment". Makes changes regarding recovery when an employee is travelling. Increases the duration of the period of temporary total incapacity necessary for recovery. Provides that injuries to the shoulder and hip are to be considered to be injuries to the arm and leg, respectfully. Provides for the implementation of a closed formulary for prescription medicine. Provides for electronic claims. Requires the posting of collateral when seeking judicial review. Provides for a penalty for vexatious delay in payment of benefits. Increases criminal penalties for specified unlawful acts. Requires the Workers' Compensation Commission to provide annual reports to the Governor and General Assembly regarding self-insurance. Amends the Freedom of Information Act to exempt certain workers' compensation related information from the scope of that Act. Amends the Criminal Code of 2012 create the offense of workers' compensation fraud and prescribe penalties.


LRB100 17830 JLS 33010 b

CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY
FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5354LRB100 17830 JLS 33010 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 Freedom of Information Act is amended by
5changing Section 7.5 as follows:
 
6    (5 ILCS 140/7.5)
7    (Text of Section before amendment by P.A. 100-512 and
8100-517)
9    Sec. 7.5. Statutory exemptions. To the extent provided for
10by the statutes referenced below, the following shall be exempt
11from inspection and copying:
12        (a) All information determined to be confidential
13    under Section 4002 of the Technology Advancement and
14    Development Act.
15        (b) Library circulation and order records identifying
16    library users with specific materials under the Library
17    Records Confidentiality Act.
18        (c) Applications, related documents, and medical
19    records received by the Experimental Organ Transplantation
20    Procedures Board and any and all documents or other records
21    prepared by the Experimental Organ Transplantation
22    Procedures Board or its staff relating to applications it
23    has received.

 

 

HB5354- 2 -LRB100 17830 JLS 33010 b

1        (d) Information and records held by the Department of
2    Public Health and its authorized representatives relating
3    to known or suspected cases of sexually transmissible
4    disease or any information the disclosure of which is
5    restricted under the Illinois Sexually Transmissible
6    Disease Control Act.
7        (e) Information the disclosure of which is exempted
8    under Section 30 of the Radon Industry Licensing Act.
9        (f) Firm performance evaluations under Section 55 of
10    the Architectural, Engineering, and Land Surveying
11    Qualifications Based Selection Act.
12        (g) Information the disclosure of which is restricted
13    and exempted under Section 50 of the Illinois Prepaid
14    Tuition Act.
15        (h) Information the disclosure of which is exempted
16    under the State Officials and Employees Ethics Act, and
17    records of any lawfully created State or local inspector
18    general's office that would be exempt if created or
19    obtained by an Executive Inspector General's office under
20    that Act.
21        (i) Information contained in a local emergency energy
22    plan submitted to a municipality in accordance with a local
23    emergency energy plan ordinance that is adopted under
24    Section 11-21.5-5 of the Illinois Municipal Code.
25        (j) Information and data concerning the distribution
26    of surcharge moneys collected and remitted by carriers

 

 

HB5354- 3 -LRB100 17830 JLS 33010 b

1    under the Emergency Telephone System Act.
2        (k) Law enforcement officer identification information
3    or driver identification information compiled by a law
4    enforcement agency or the Department of Transportation
5    under Section 11-212 of the Illinois Vehicle Code.
6        (l) Records and information provided to a residential
7    health care facility resident sexual assault and death
8    review team or the Executive Council under the Abuse
9    Prevention Review Team Act.
10        (m) Information provided to the predatory lending
11    database created pursuant to Article 3 of the Residential
12    Real Property Disclosure Act, except to the extent
13    authorized under that Article.
14        (n) Defense budgets and petitions for certification of
15    compensation and expenses for court appointed trial
16    counsel as provided under Sections 10 and 15 of the Capital
17    Crimes Litigation Act. This subsection (n) shall apply
18    until the conclusion of the trial of the case, even if the
19    prosecution chooses not to pursue the death penalty prior
20    to trial or sentencing.
21        (o) Information that is prohibited from being
22    disclosed under Section 4 of the Illinois Health and
23    Hazardous Substances Registry Act.
24        (p) Security portions of system safety program plans,
25    investigation reports, surveys, schedules, lists, data, or
26    information compiled, collected, or prepared by or for the

 

 

HB5354- 4 -LRB100 17830 JLS 33010 b

1    Regional Transportation Authority under Section 2.11 of
2    the Regional Transportation Authority Act or the St. Clair
3    County Transit District under the Bi-State Transit Safety
4    Act.
5        (q) Information prohibited from being disclosed by the
6    Personnel Records Review Act.
7        (r) Information prohibited from being disclosed by the
8    Illinois School Student Records Act.
9        (s) Information the disclosure of which is restricted
10    under Section 5-108 of the Public Utilities Act.
11        (t) All identified or deidentified health information
12    in the form of health data or medical records contained in,
13    stored in, submitted to, transferred by, or released from
14    the Illinois Health Information Exchange, and identified
15    or deidentified health information in the form of health
16    data and medical records of the Illinois Health Information
17    Exchange in the possession of the Illinois Health
18    Information Exchange Authority due to its administration
19    of the Illinois Health Information Exchange. The terms
20    "identified" and "deidentified" shall be given the same
21    meaning as in the Health Insurance Portability and
22    Accountability Act of 1996, Public Law 104-191, or any
23    subsequent amendments thereto, and any regulations
24    promulgated thereunder.
25        (u) Records and information provided to an independent
26    team of experts under Brian's Law.

 

 

HB5354- 5 -LRB100 17830 JLS 33010 b

1        (v) Names and information of people who have applied
2    for or received Firearm Owner's Identification Cards under
3    the Firearm Owners Identification Card Act or applied for
4    or received a concealed carry license under the Firearm
5    Concealed Carry Act, unless otherwise authorized by the
6    Firearm Concealed Carry Act; and databases under the
7    Firearm Concealed Carry Act, records of the Concealed Carry
8    Licensing Review Board under the Firearm Concealed Carry
9    Act, and law enforcement agency objections under the
10    Firearm Concealed Carry Act.
11        (w) Personally identifiable information which is
12    exempted from disclosure under subsection (g) of Section
13    19.1 of the Toll Highway Act.
14        (x) Information which is exempted from disclosure
15    under Section 5-1014.3 of the Counties Code or Section
16    8-11-21 of the Illinois Municipal Code.
17        (y) Confidential information under the Adult
18    Protective Services Act and its predecessor enabling
19    statute, the Elder Abuse and Neglect Act, including
20    information about the identity and administrative finding
21    against any caregiver of a verified and substantiated
22    decision of abuse, neglect, or financial exploitation of an
23    eligible adult maintained in the Registry established
24    under Section 7.5 of the Adult Protective Services Act.
25        (z) Records and information provided to a fatality
26    review team or the Illinois Fatality Review Team Advisory

 

 

HB5354- 6 -LRB100 17830 JLS 33010 b

1    Council under Section 15 of the Adult Protective Services
2    Act.
3        (aa) Information which is exempted from disclosure
4    under Section 2.37 of the Wildlife Code.
5        (bb) Information which is or was prohibited from
6    disclosure by the Juvenile Court Act of 1987.
7        (cc) Recordings made under the Law Enforcement
8    Officer-Worn Body Camera Act, except to the extent
9    authorized under that Act.
10        (dd) Information that is prohibited from being
11    disclosed under Section 45 of the Condominium and Common
12    Interest Community Ombudsperson Act.
13        (ee) Information that is exempted from disclosure
14    under Section 30.1 of the Pharmacy Practice Act.
15        (ff) Information that is exempted from disclosure
16    under the Revised Uniform Unclaimed Property Act.
17        (gg) (ff) Information that is prohibited from being
18    disclosed under Section 7-603.5 of the Illinois Vehicle
19    Code.
20        (hh) (ff) Records that are exempt from disclosure under
21    Section 1A-16.7 of the Election Code.
22        (ii) (ff) Information which is exempted from
23    disclosure under Section 2505-800 of the Department of
24    Revenue Law of the Civil Administrative Code of Illinois.
25(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
26eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;

 

 

HB5354- 7 -LRB100 17830 JLS 33010 b

199-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
2100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
38-28-17; 100-465, eff. 8-31-17; revised 11-2-17.)
 
4    (Text of Section after amendment by P.A. 100-517 but before
5amendment by P.A. 100-512)
6    Sec. 7.5. Statutory exemptions. To the extent provided for
7by the statutes referenced below, the following shall be exempt
8from inspection and copying:
9        (a) All information determined to be confidential
10    under Section 4002 of the Technology Advancement and
11    Development Act.
12        (b) Library circulation and order records identifying
13    library users with specific materials under the Library
14    Records Confidentiality Act.
15        (c) Applications, related documents, and medical
16    records received by the Experimental Organ Transplantation
17    Procedures Board and any and all documents or other records
18    prepared by the Experimental Organ Transplantation
19    Procedures Board or its staff relating to applications it
20    has received.
21        (d) Information and records held by the Department of
22    Public Health and its authorized representatives relating
23    to known or suspected cases of sexually transmissible
24    disease or any information the disclosure of which is
25    restricted under the Illinois Sexually Transmissible

 

 

HB5354- 8 -LRB100 17830 JLS 33010 b

1    Disease Control Act.
2        (e) Information the disclosure of which is exempted
3    under Section 30 of the Radon Industry Licensing Act.
4        (f) Firm performance evaluations under Section 55 of
5    the Architectural, Engineering, and Land Surveying
6    Qualifications Based Selection Act.
7        (g) Information the disclosure of which is restricted
8    and exempted under Section 50 of the Illinois Prepaid
9    Tuition Act.
10        (h) Information the disclosure of which is exempted
11    under the State Officials and Employees Ethics Act, and
12    records of any lawfully created State or local inspector
13    general's office that would be exempt if created or
14    obtained by an Executive Inspector General's office under
15    that Act.
16        (i) Information contained in a local emergency energy
17    plan submitted to a municipality in accordance with a local
18    emergency energy plan ordinance that is adopted under
19    Section 11-21.5-5 of the Illinois Municipal Code.
20        (j) Information and data concerning the distribution
21    of surcharge moneys collected and remitted by carriers
22    under the Emergency Telephone System Act.
23        (k) Law enforcement officer identification information
24    or driver identification information compiled by a law
25    enforcement agency or the Department of Transportation
26    under Section 11-212 of the Illinois Vehicle Code.

 

 

HB5354- 9 -LRB100 17830 JLS 33010 b

1        (l) Records and information provided to a residential
2    health care facility resident sexual assault and death
3    review team or the Executive Council under the Abuse
4    Prevention Review Team Act.
5        (m) Information provided to the predatory lending
6    database created pursuant to Article 3 of the Residential
7    Real Property Disclosure Act, except to the extent
8    authorized under that Article.
9        (n) Defense budgets and petitions for certification of
10    compensation and expenses for court appointed trial
11    counsel as provided under Sections 10 and 15 of the Capital
12    Crimes Litigation Act. This subsection (n) shall apply
13    until the conclusion of the trial of the case, even if the
14    prosecution chooses not to pursue the death penalty prior
15    to trial or sentencing.
16        (o) Information that is prohibited from being
17    disclosed under Section 4 of the Illinois Health and
18    Hazardous Substances Registry Act.
19        (p) Security portions of system safety program plans,
20    investigation reports, surveys, schedules, lists, data, or
21    information compiled, collected, or prepared by or for the
22    Regional Transportation Authority under Section 2.11 of
23    the Regional Transportation Authority Act or the St. Clair
24    County Transit District under the Bi-State Transit Safety
25    Act.
26        (q) Information prohibited from being disclosed by the

 

 

HB5354- 10 -LRB100 17830 JLS 33010 b

1    Personnel Records Review Act.
2        (r) Information prohibited from being disclosed by the
3    Illinois School Student Records Act.
4        (s) Information the disclosure of which is restricted
5    under Section 5-108 of the Public Utilities Act.
6        (t) All identified or deidentified health information
7    in the form of health data or medical records contained in,
8    stored in, submitted to, transferred by, or released from
9    the Illinois Health Information Exchange, and identified
10    or deidentified health information in the form of health
11    data and medical records of the Illinois Health Information
12    Exchange in the possession of the Illinois Health
13    Information Exchange Authority due to its administration
14    of the Illinois Health Information Exchange. The terms
15    "identified" and "deidentified" shall be given the same
16    meaning as in the Health Insurance Portability and
17    Accountability Act of 1996, Public Law 104-191, or any
18    subsequent amendments thereto, and any regulations
19    promulgated thereunder.
20        (u) Records and information provided to an independent
21    team of experts under Brian's Law.
22        (v) Names and information of people who have applied
23    for or received Firearm Owner's Identification Cards under
24    the Firearm Owners Identification Card Act or applied for
25    or received a concealed carry license under the Firearm
26    Concealed Carry Act, unless otherwise authorized by the

 

 

HB5354- 11 -LRB100 17830 JLS 33010 b

1    Firearm Concealed Carry Act; and databases under the
2    Firearm Concealed Carry Act, records of the Concealed Carry
3    Licensing Review Board under the Firearm Concealed Carry
4    Act, and law enforcement agency objections under the
5    Firearm Concealed Carry Act.
6        (w) Personally identifiable information which is
7    exempted from disclosure under subsection (g) of Section
8    19.1 of the Toll Highway Act.
9        (x) Information which is exempted from disclosure
10    under Section 5-1014.3 of the Counties Code or Section
11    8-11-21 of the Illinois Municipal Code.
12        (y) Confidential information under the Adult
13    Protective Services Act and its predecessor enabling
14    statute, the Elder Abuse and Neglect Act, including
15    information about the identity and administrative finding
16    against any caregiver of a verified and substantiated
17    decision of abuse, neglect, or financial exploitation of an
18    eligible adult maintained in the Registry established
19    under Section 7.5 of the Adult Protective Services Act.
20        (z) Records and information provided to a fatality
21    review team or the Illinois Fatality Review Team Advisory
22    Council under Section 15 of the Adult Protective Services
23    Act.
24        (aa) Information which is exempted from disclosure
25    under Section 2.37 of the Wildlife Code.
26        (bb) Information which is or was prohibited from

 

 

HB5354- 12 -LRB100 17830 JLS 33010 b

1    disclosure by the Juvenile Court Act of 1987.
2        (cc) Recordings made under the Law Enforcement
3    Officer-Worn Body Camera Act, except to the extent
4    authorized under that Act.
5        (dd) Information that is prohibited from being
6    disclosed under Section 45 of the Condominium and Common
7    Interest Community Ombudsperson Act.
8        (ee) Information that is exempted from disclosure
9    under Section 30.1 of the Pharmacy Practice Act.
10        (ff) Information that is exempted from disclosure
11    under the Revised Uniform Unclaimed Property Act.
12        (gg) (ff) Information that is prohibited from being
13    disclosed under Section 7-603.5 of the Illinois Vehicle
14    Code.
15        (hh) (ff) Records that are exempt from disclosure under
16    Section 1A-16.7 of the Election Code.
17        (ii) (ff) Information which is exempted from
18    disclosure under Section 2505-800 of the Department of
19    Revenue Law of the Civil Administrative Code of Illinois.
20        (jj) (ff) Information and reports that are required to
21    be submitted to the Department of Labor by registering day
22    and temporary labor service agencies but are exempt from
23    disclosure under subsection (a-1) of Section 45 of the Day
24    and Temporary Labor Services Act.
25(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
26eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;

 

 

HB5354- 13 -LRB100 17830 JLS 33010 b

199-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
2100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
38-28-17; 100-465, eff. 8-31-17; 100-517, eff. 6-1-18; revised
411-2-17.)
 
5    (Text of Section after amendment by P.A. 100-512)
6    Sec. 7.5. Statutory exemptions. To the extent provided for
7by the statutes referenced below, the following shall be exempt
8from inspection and copying:
9        (a) All information determined to be confidential
10    under Section 4002 of the Technology Advancement and
11    Development Act.
12        (b) Library circulation and order records identifying
13    library users with specific materials under the Library
14    Records Confidentiality Act.
15        (c) Applications, related documents, and medical
16    records received by the Experimental Organ Transplantation
17    Procedures Board and any and all documents or other records
18    prepared by the Experimental Organ Transplantation
19    Procedures Board or its staff relating to applications it
20    has received.
21        (d) Information and records held by the Department of
22    Public Health and its authorized representatives relating
23    to known or suspected cases of sexually transmissible
24    disease or any information the disclosure of which is
25    restricted under the Illinois Sexually Transmissible

 

 

HB5354- 14 -LRB100 17830 JLS 33010 b

1    Disease Control Act.
2        (e) Information the disclosure of which is exempted
3    under Section 30 of the Radon Industry Licensing Act.
4        (f) Firm performance evaluations under Section 55 of
5    the Architectural, Engineering, and Land Surveying
6    Qualifications Based Selection Act.
7        (g) Information the disclosure of which is restricted
8    and exempted under Section 50 of the Illinois Prepaid
9    Tuition Act.
10        (h) Information the disclosure of which is exempted
11    under the State Officials and Employees Ethics Act, and
12    records of any lawfully created State or local inspector
13    general's office that would be exempt if created or
14    obtained by an Executive Inspector General's office under
15    that Act.
16        (i) Information contained in a local emergency energy
17    plan submitted to a municipality in accordance with a local
18    emergency energy plan ordinance that is adopted under
19    Section 11-21.5-5 of the Illinois Municipal Code.
20        (j) Information and data concerning the distribution
21    of surcharge moneys collected and remitted by carriers
22    under the Emergency Telephone System Act.
23        (k) Law enforcement officer identification information
24    or driver identification information compiled by a law
25    enforcement agency or the Department of Transportation
26    under Section 11-212 of the Illinois Vehicle Code.

 

 

HB5354- 15 -LRB100 17830 JLS 33010 b

1        (l) Records and information provided to a residential
2    health care facility resident sexual assault and death
3    review team or the Executive Council under the Abuse
4    Prevention Review Team Act.
5        (m) Information provided to the predatory lending
6    database created pursuant to Article 3 of the Residential
7    Real Property Disclosure Act, except to the extent
8    authorized under that Article.
9        (n) Defense budgets and petitions for certification of
10    compensation and expenses for court appointed trial
11    counsel as provided under Sections 10 and 15 of the Capital
12    Crimes Litigation Act. This subsection (n) shall apply
13    until the conclusion of the trial of the case, even if the
14    prosecution chooses not to pursue the death penalty prior
15    to trial or sentencing.
16        (o) Information that is prohibited from being
17    disclosed under Section 4 of the Illinois Health and
18    Hazardous Substances Registry Act.
19        (p) Security portions of system safety program plans,
20    investigation reports, surveys, schedules, lists, data, or
21    information compiled, collected, or prepared by or for the
22    Regional Transportation Authority under Section 2.11 of
23    the Regional Transportation Authority Act or the St. Clair
24    County Transit District under the Bi-State Transit Safety
25    Act.
26        (q) Information prohibited from being disclosed by the

 

 

HB5354- 16 -LRB100 17830 JLS 33010 b

1    Personnel Records Review Act.
2        (r) Information prohibited from being disclosed by the
3    Illinois School Student Records Act.
4        (s) Information the disclosure of which is restricted
5    under Section 5-108 of the Public Utilities Act.
6        (t) All identified or deidentified health information
7    in the form of health data or medical records contained in,
8    stored in, submitted to, transferred by, or released from
9    the Illinois Health Information Exchange, and identified
10    or deidentified health information in the form of health
11    data and medical records of the Illinois Health Information
12    Exchange in the possession of the Illinois Health
13    Information Exchange Authority due to its administration
14    of the Illinois Health Information Exchange. The terms
15    "identified" and "deidentified" shall be given the same
16    meaning as in the Health Insurance Portability and
17    Accountability Act of 1996, Public Law 104-191, or any
18    subsequent amendments thereto, and any regulations
19    promulgated thereunder.
20        (u) Records and information provided to an independent
21    team of experts under Brian's Law.
22        (v) Names and information of people who have applied
23    for or received Firearm Owner's Identification Cards under
24    the Firearm Owners Identification Card Act or applied for
25    or received a concealed carry license under the Firearm
26    Concealed Carry Act, unless otherwise authorized by the

 

 

HB5354- 17 -LRB100 17830 JLS 33010 b

1    Firearm Concealed Carry Act; and databases under the
2    Firearm Concealed Carry Act, records of the Concealed Carry
3    Licensing Review Board under the Firearm Concealed Carry
4    Act, and law enforcement agency objections under the
5    Firearm Concealed Carry Act.
6        (w) Personally identifiable information which is
7    exempted from disclosure under subsection (g) of Section
8    19.1 of the Toll Highway Act.
9        (x) Information which is exempted from disclosure
10    under Section 5-1014.3 of the Counties Code or Section
11    8-11-21 of the Illinois Municipal Code.
12        (y) Confidential information under the Adult
13    Protective Services Act and its predecessor enabling
14    statute, the Elder Abuse and Neglect Act, including
15    information about the identity and administrative finding
16    against any caregiver of a verified and substantiated
17    decision of abuse, neglect, or financial exploitation of an
18    eligible adult maintained in the Registry established
19    under Section 7.5 of the Adult Protective Services Act.
20        (z) Records and information provided to a fatality
21    review team or the Illinois Fatality Review Team Advisory
22    Council under Section 15 of the Adult Protective Services
23    Act.
24        (aa) Information which is exempted from disclosure
25    under Section 2.37 of the Wildlife Code.
26        (bb) Information which is or was prohibited from

 

 

HB5354- 18 -LRB100 17830 JLS 33010 b

1    disclosure by the Juvenile Court Act of 1987.
2        (cc) Recordings made under the Law Enforcement
3    Officer-Worn Body Camera Act, except to the extent
4    authorized under that Act.
5        (dd) Information that is prohibited from being
6    disclosed under Section 45 of the Condominium and Common
7    Interest Community Ombudsperson Act.
8        (ee) Information that is exempted from disclosure
9    under Section 30.1 of the Pharmacy Practice Act.
10        (ff) Information that is exempted from disclosure
11    under the Revised Uniform Unclaimed Property Act.
12        (gg) (ff) Information that is prohibited from being
13    disclosed under Section 7-603.5 of the Illinois Vehicle
14    Code.
15        (hh) (ff) Records that are exempt from disclosure under
16    Section 1A-16.7 of the Election Code.
17        (ii) (ff) Information which is exempted from disclosure
18    under Section 2505-800 of the Department of Revenue Law of
19    the Civil Administrative Code of Illinois.
20        (jj) (ff) Information and reports that are required to
21    be submitted to the Department of Labor by registering day
22    and temporary labor service agencies but are exempt from
23    disclosure under subsection (a-1) of Section 45 of the Day
24    and Temporary Labor Services Act.
25        (kk) (ff) Information prohibited from disclosure under
26    the Seizure and Forfeiture Reporting Act.

 

 

HB5354- 19 -LRB100 17830 JLS 33010 b

1        (ll) Information the disclosure of which is restricted
2    and exempted under Sections 25.5 and 29.2 of the Workers'
3    Compensation Act.
4(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352,
5eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16;
699-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18;
7100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff.
88-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517,
9eff. 6-1-18; revised 11-2-17.)
 
10    Section 10. The Illinois Insurance Code is amended by
11changing Section 457 as follows:
 
12    (215 ILCS 5/457)  (from Ch. 73, par. 1065.4)
13    Sec. 457. Rate filings. (1) Beginning January 1, 1983,
14every company shall file with the Director every manual of
15classifications, every manual of rules and rates, every rating
16plan and every modification of the foregoing which it intends
17to use. Such filings shall be made not later than 30 days after
18they become effective. A company may satisfy its obligation to
19make such filings by adopting the filing of a licensed rating
20organization of which it is a member or subscriber, filed
21pursuant to subsection (2) of this Section, in total or by
22notifying the Director in what respects it intends to deviate
23from such filing. Any company adopting a pure premium filed by
24a rating organization pursuant to subsection (2) must file with

 

 

HB5354- 20 -LRB100 17830 JLS 33010 b

1the Director the modification factor it is using for expenses
2and profit so that the final rates in use by such company can
3be determined.
4    (1.5) Beginning within 30 days of the effective date of
5this amendatory Act of the 100th General Assembly, an insurer
6deviating from the workers' compensation loss cost or rate
7filing of a licensed rating organization of which it is a
8member shall provide to the Director, within 5 business days of
9adoption of the deviation, supporting information that
10specifies the basis and justification for the deviation.
11    (2) Beginning January 1, 1983, each licensed rating
12organization must file with the Director every manual of
13classification, every manual of rules and advisory rates, every
14pure premium which has been fully adjusted and fully developed,
15every rating plan and every modification of any of the
16foregoing which it intends to recommend for use to its members
17and subscribers, not later than 30 days after such manual,
18premium, plan or modification thereof takes effect. Every
19licensed rating organization shall also file with the Director
20the rate classification system, all rating rules, rating plans,
21policy forms, underwriting rules or similar materials, and each
22modification of any of the foregoing which it requires its
23members and subscribers to adhere to not later than 30 days
24before such filings or modifications thereof are to take
25effect. Every such filing shall state the proposed effective
26date thereof and shall indicate the character and extent of the

 

 

HB5354- 21 -LRB100 17830 JLS 33010 b

1coverage contemplated.
2    (2.5) On and after January 1, 2019, the Director shall
3conduct or authorize an independent actuarial review of any
4workers' compensation loss cost or rate filing by a licensed
5rating organization. The review must be completed within 30
6days of the filing. The cost of the review shall be paid by the
7rating organization.
8    (3) A filing and any supporting information made pursuant
9to this Section shall be open to public inspection after the
10filing becomes effective.
11(Source: P.A. 82-939.)
 
12    Section 15. The Criminal Code of 2012 is amended by adding
13Section 17-10.4 as follows:
 
14    (720 ILCS 5/17-10.4 new)
15    Sec. 17-10.4. Workers' compensation fraud.
16    (a) It is unlawful for any person, company, corporation,
17insurance carrier, health care provider, or other entity to:
18        (1) Intentionally present or cause to be presented any
19    false or fraudulent claim for the payment of any workers'
20    compensation benefit.
21        (2) Intentionally make or cause to be made any false or
22    fraudulent material statement or material representation
23    for the purpose of obtaining or denying any workers'
24    compensation benefit.

 

 

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1        (3) Intentionally make or cause to be made any false or
2    fraudulent statements with regard to entitlement to
3    workers' compensation benefits with the intent to prevent
4    an injured worker from making a legitimate claim for any
5    workers' compensation benefit.
6        (4) Intentionally prepare or provide an invalid,
7    false, or counterfeit certificate of insurance as proof of
8    workers' compensation insurance.
9        (5) Intentionally make or cause to be made any false or
10    fraudulent material statement or material representation
11    for the purpose of obtaining workers' compensation
12    insurance at less than the proper amount for that
13    insurance.
14        (6) Intentionally make or cause to be made any false or
15    fraudulent material statement or material representation
16    on an initial or renewal self-insurance application or
17    accompanying financial statement for the purpose of
18    obtaining self-insurance status or reducing the amount of
19    security that may be required to be furnished pursuant to
20    Section 4 of the Workers' Compensation Act.
21        (7) Intentionally make or cause to be made any false or
22    fraudulent material statement to the Department of
23    Insurance's fraud and insurance non-compliance unit in the
24    course of an investigation of fraud or insurance
25    non-compliance.
26        (8) Intentionally present a bill or statement for the

 

 

HB5354- 23 -LRB100 17830 JLS 33010 b

1    payment for medical services that were not provided.
2        (9) Intentionally assist, abet, solicit, or conspire
3    with any person, company, or other entity to commit any of
4    the acts in paragraph (1), (2), (3), (4), (5), (6), (7), or
5    (8) of this subsection (a).
6    As used in paragraphs (2), (3), (5), (6), (7), and (8),
7"statement" includes any writing, notice, proof of injury, bill
8for services, hospital and doctor records and reports, and
9X-ray and test results.
10    (b) Sentence.
11        (1) A violation of paragraph (a)(3) is a Class 4
12    felony.
13        (2) A violation of paragraph (a)(4) or (a)(7) is a
14    Class 3 felony.
15        (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
16    (a)(6), or (a)(8) in which the value of the property
17    obtained or attempted to be obtained is $500 or less is a
18    Class A misdemeanor.
19        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
20    (a)(6), or (a)(8) in which the value of the property
21    obtained or attempted to be obtained is more than $500 but
22    not more than $10,000 is a Class 3 felony.
23        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
24    (a)(6), or (a)(8) in which the value of the property
25    obtained or attempted to be obtained is more than $10,000
26    but not more than $100,000 is a Class 2 felony.

 

 

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1        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
2    (a)(6), or (a)(8) in which the value of the property
3    obtained or attempted to be obtained is more than $100,000
4    is a Class 1 felony.
5        (7) A violation of paragraph (9) of subsection (a)
6    shall be punishable as the Class of offense for which the
7    person convicted assisted, abetted, solicited, or
8    conspired to commit, as set forth in paragraphs (1) through
9    (6) of this subsection.
10        (8) A person convicted under this Section shall be
11    ordered to pay monetary restitution to the insurance
12    company or self-insured entity or any other person for any
13    financial loss sustained as a result of a violation of this
14    Section, including any court costs and attorney fees. An
15    order of restitution also includes expenses incurred and
16    paid by the State of Illinois or an insurance company or
17    self-insured entity in connection with any medical
18    evaluation or treatment services.
19    For a violation of paragraph (a)(1) or (a)(2), the value of
20the property obtained or attempted to be obtained includes
21payments pursuant to the provisions of the Workers'
22Compensation Act as well as the amount paid for medical
23expenses. For a violation of paragraph (a)(5), the value of the
24property obtained or attempted to be obtained is the difference
25between the proper amount for the coverage sought or provided
26and the actual amount billed for workers' compensation

 

 

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1insurance. For a violation of paragraph (a)(6), the value of
2the property obtained or attempted to be obtained is the
3difference between the proper amount of security required
4pursuant to Section 4 of the Workers' Compensation Act and the
5amount furnished pursuant to the false or fraudulent statements
6or representations. Notwithstanding the foregoing, an
7insurance company, self-insured entity, or any other person
8suffering financial loss sustained as a result of violation of
9this Section may seek restitution, including court costs and
10attorney's fees, in a civil action in a court of competent
11jurisdiction.
 
12    Section 20. The Workers' Compensation Act is amended by
13changing Sections 1, 8, 8.2, 8.2a, 19, 25.5, and 29.2 as
14follows:
 
15    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
16    Sec. 1. This Act may be cited as the Workers' Compensation
17Act.
18    (a) The term "employer" as used in this Act means:
19    1. The State and each county, city, town, township,
20incorporated village, school district, body politic, or
21municipal corporation therein.
22    2. Every person, firm, public or private corporation,
23including hospitals, public service, eleemosynary, religious
24or charitable corporations or associations who has any person

 

 

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1in service or under any contract for hire, express or implied,
2oral or written, and who is engaged in any of the enterprises
3or businesses enumerated in Section 3 of this Act, or who at or
4prior to the time of the accident to the employee for which
5compensation under this Act may be claimed, has in the manner
6provided in this Act elected to become subject to the
7provisions of this Act, and who has not, prior to such
8accident, effected a withdrawal of such election in the manner
9provided in this Act.
10    3. Any one engaging in any business or enterprise referred
11to in subsections 1 and 2 of Section 3 of this Act who
12undertakes to do any work enumerated therein, is liable to pay
13compensation to his own immediate employees in accordance with
14the provisions of this Act, and in addition thereto if he
15directly or indirectly engages any contractor whether
16principal or sub-contractor to do any such work, he is liable
17to pay compensation to the employees of any such contractor or
18sub-contractor unless such contractor or sub-contractor has
19insured, in any company or association authorized under the
20laws of this State to insure the liability to pay compensation
21under this Act, or guaranteed his liability to pay such
22compensation. With respect to any time limitation on the filing
23of claims provided by this Act, the timely filing of a claim
24against a contractor or subcontractor, as the case may be,
25shall be deemed to be a timely filing with respect to all
26persons upon whom liability is imposed by this paragraph.

 

 

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1    In the event any such person pays compensation under this
2subsection he may recover the amount thereof from the
3contractor or sub-contractor, if any, and in the event the
4contractor pays compensation under this subsection he may
5recover the amount thereof from the sub-contractor, if any.
6    This subsection does not apply in any case where the
7accident occurs elsewhere than on, in or about the immediate
8premises on which the principal has contracted that the work be
9done.
10    4. Where an employer operating under and subject to the
11provisions of this Act loans an employee to another such
12employer and such loaned employee sustains a compensable
13accidental injury in the employment of such borrowing employer
14and where such borrowing employer does not provide or pay the
15benefits or payments due such injured employee, such loaning
16employer is liable to provide or pay all benefits or payments
17due such employee under this Act and as to such employee the
18liability of such loaning and borrowing employers is joint and
19several, provided that such loaning employer is in the absence
20of agreement to the contrary entitled to receive from such
21borrowing employer full reimbursement for all sums paid or
22incurred pursuant to this paragraph together with reasonable
23attorneys' fees and expenses in any hearings before the
24Illinois Workers' Compensation Commission or in any action to
25secure such reimbursement. Where any benefit is provided or
26paid by such loaning employer the employee has the duty of

 

 

HB5354- 28 -LRB100 17830 JLS 33010 b

1rendering reasonable cooperation in any hearings, trials or
2proceedings in the case, including such proceedings for
3reimbursement.
4    Where an employee files an Application for Adjustment of
5Claim with the Illinois Workers' Compensation Commission
6alleging that his claim is covered by the provisions of the
7preceding paragraph, and joining both the alleged loaning and
8borrowing employers, they and each of them, upon written demand
9by the employee and within 7 days after receipt of such demand,
10shall have the duty of filing with the Illinois Workers'
11Compensation Commission a written admission or denial of the
12allegation that the claim is covered by the provisions of the
13preceding paragraph and in default of such filing or if any
14such denial be ultimately determined not to have been bona fide
15then the provisions of Paragraph K of Section 19 of this Act
16shall apply.
17    An employer whose business or enterprise or a substantial
18part thereof consists of hiring, procuring or furnishing
19employees to or for other employers operating under and subject
20to the provisions of this Act for the performance of the work
21of such other employers and who pays such employees their
22salary or wages notwithstanding that they are doing the work of
23such other employers shall be deemed a loaning employer within
24the meaning and provisions of this Section.
25    (b) The term "employee" as used in this Act means:
26    1. Every person in the service of the State, including

 

 

HB5354- 29 -LRB100 17830 JLS 33010 b

1members of the General Assembly, members of the Commerce
2Commission, members of the Illinois Workers' Compensation
3Commission, and all persons in the service of the University of
4Illinois, county, including deputy sheriffs and assistant
5state's attorneys, city, town, township, incorporated village
6or school district, body politic, or municipal corporation
7therein, whether by election, under appointment or contract of
8hire, express or implied, oral or written, including all
9members of the Illinois National Guard while on active duty in
10the service of the State, and all probation personnel of the
11Juvenile Court appointed pursuant to Article VI of the Juvenile
12Court Act of 1987, and including any official of the State, any
13county, city, town, township, incorporated village, school
14district, body politic or municipal corporation therein except
15any duly appointed member of a police department in any city
16whose population exceeds 500,000 according to the last Federal
17or State census, and except any member of a fire insurance
18patrol maintained by a board of underwriters in this State. A
19duly appointed member of a fire department in any city, the
20population of which exceeds 500,000 according to the last
21federal or State census, is an employee under this Act only
22with respect to claims brought under paragraph (c) of Section
238.
24    One employed by a contractor who has contracted with the
25State, or a county, city, town, township, incorporated village,
26school district, body politic or municipal corporation

 

 

HB5354- 30 -LRB100 17830 JLS 33010 b

1therein, through its representatives, is not considered as an
2employee of the State, county, city, town, township,
3incorporated village, school district, body politic or
4municipal corporation which made the contract.
5    2. Every person in the service of another under any
6contract of hire, express or implied, oral or written,
7including persons whose employment is outside of the State of
8Illinois where the contract of hire is made within the State of
9Illinois, persons whose employment results in fatal or
10non-fatal injuries within the State of Illinois where the
11contract of hire is made outside of the State of Illinois, and
12persons whose employment is principally localized within the
13State of Illinois, regardless of the place of the accident or
14the place where the contract of hire was made, and including
15aliens, and minors who, for the purpose of this Act are
16considered the same and have the same power to contract,
17receive payments and give quittances therefor, as adult
18employees.
19    3. Every sole proprietor and every partner of a business
20may elect to be covered by this Act.
21    An employee or his dependents under this Act who shall have
22a cause of action by reason of any injury, disablement or death
23arising out of and in the course of his employment may elect to
24pursue his remedy in the State where injured or disabled, or in
25the State where the contract of hire is made, or in the State
26where the employment is principally localized.

 

 

HB5354- 31 -LRB100 17830 JLS 33010 b

1    However, any employer may elect to provide and pay
2compensation to any employee other than those engaged in the
3usual course of the trade, business, profession or occupation
4of the employer by complying with Sections 2 and 4 of this Act.
5Employees are not included within the provisions of this Act
6when excluded by the laws of the United States relating to
7liability of employers to their employees for personal injuries
8where such laws are held to be exclusive.
9    The term "employee" does not include persons performing
10services as real estate broker, broker-salesman, or salesman
11when such persons are paid by commission only.
12    (c) "Commission" means the Industrial Commission created
13by Section 5 of "The Civil Administrative Code of Illinois",
14approved March 7, 1917, as amended, or the Illinois Workers'
15Compensation Commission created by Section 13 of this Act.
16    (d) To obtain compensation under this Act, an employee
17bears the burden of showing, by a preponderance of the
18evidence, that he or she has sustained accidental injuries
19arising out of and in the course of the employment.
20        (1) An accidental injury shall not be considered to be
21    "arising out of and in the course of employment" if,
22    without limitation, the accidental injury or the medical
23    condition for which compensation is sought:
24            (A) resulted from a hazard or risk that was not
25        incidental to the employment or did not occur at a time
26        and place and under circumstances reasonably required

 

 

HB5354- 32 -LRB100 17830 JLS 33010 b

1        by the employment;
2            (B) resulted from a personal or neutral risk
3        including, in the case of an employee who is required
4        to travel for performance of job duties, a personal or
5        neutral risk associated with travel;
6            (C) occurred (i) while the claimant was traveling
7        away from the employer's premises and the travel was
8        not required for the performance of job duties or (ii)
9        during the claimant's commute to and from the
10        employer's premises; or
11            (D) occurred while the claimant, including a
12        claimant who is required to travel for performance of
13        job duties is (i) on a paid or unpaid break and is not
14        performing any specific tasks for the employer during
15        the break or (ii) is on a personal detour or deviation,
16        regardless of whether or not the claimant is otherwise
17        traveling for employment purposes.
18        (2) A hazard or risk is not incidental to the
19    employment if it is a risk of everyday living commonly
20    faced by members of the general public or is associated
21    with an activity of everyday life, regardless of whether
22    the employee was performing an activity required by the
23    employment at the time of the injury or an activity
24    connected with what the employee has to do in fulfilling
25    his duties. A risk commonly faced by members of the general
26    public or associated with an activity of everyday life is a

 

 

HB5354- 33 -LRB100 17830 JLS 33010 b

1    neutral risk.
2        (3) In determining whether an employee is required to
3    travel for the performance of job duties, the following
4    factors shall be considered: (i)whether the employer had
5    knowledge that the employee may be required to travel to
6    perform the job; (ii) whether the employer furnished any
7    mode of transportation to or from the employee; (iii)
8    whether the employee received, or the employer paid or
9    agreed to pay, any remuneration or reimbursement for costs
10    or expenses of any form of travel; (iv) whether the
11    employer in any way directed the course or method of
12    travel; (v) whether the employer in any way assisted the
13    employee in making any travel arrangements; and (vi)
14    whether the employer furnished lodging or in any way
15    reimbursed the employee for lodging.
16        (4) Notwithstanding any provision of this Act to the
17    contrary, if an employee, who sustained an accidental
18    injury compensable under this Act that results in a
19    responsibility to pay compensation on the part of the
20    employer, subsequently sustains another injury due to his
21    own intentional conduct or negligence that accelerates,
22    aggravates or worsens the effects or disability of the
23    first injury in any manner, regardless of whether or not he
24    has fully recovered from the effects of the first injury,
25    the employer's responsibility to pay compensation to the
26    employee or his or her dependents shall not be increased

 

 

HB5354- 34 -LRB100 17830 JLS 33010 b

1    due to the effects or disability resulting from the
2    subsequent injury, unless the subsequent injury arose out
3    of and in the course of employment.
4        (5) An injury, its occupational cause, and any
5    resulting manifestations or disability must be established
6    a reasonable degree of medical certainty, based on
7    objective relevant medical findings.
8(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
9eff. 7-13-12.)
 
10    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
11    Sec. 8. The amount of compensation which shall be paid to
12the employee for an accidental injury not resulting in death
13is:
14    (a) The employer shall provide and pay the negotiated rate,
15if applicable, or the lesser of the health care provider's
16actual charges or according to a fee schedule, subject to
17Section 8.2, in effect at the time the service was rendered for
18all the necessary first aid, medical and surgical services, and
19all necessary medical, surgical and hospital services
20thereafter incurred, limited, however, to that which is
21reasonably required to cure or relieve from the effects of the
22accidental injury, even if a health care provider sells,
23transfers, or otherwise assigns an account receivable for
24procedures, treatments, or services covered under this Act. If
25the employer does not dispute payment of first aid, medical,

 

 

HB5354- 35 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 36 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 37 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 38 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 39 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 40 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 41 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 42 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 43 -LRB100 17830 JLS 33010 b

1    The term "children" means the plural of "child".
2        4. All weekly compensation rates provided under
3    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
4    Section shall be subject to the following limitations:
5        The maximum weekly compensation rate from July 1, 1975,
6    except as hereinafter provided, shall be 100% of the
7    State's average weekly wage in covered industries under the
8    Unemployment Insurance Act, that being the wage that most
9    closely approximates the State's average weekly wage.
10        The maximum weekly compensation rate, for the period
11    July 1, 1984, through June 30, 1987, except as hereinafter
12    provided, shall be $293.61. Effective July 1, 1987 and on
13    July 1 of each year thereafter the maximum weekly
14    compensation rate, except as hereinafter provided, shall
15    be determined as follows: if during the preceding 12 month
16    period there shall have been an increase in the State's
17    average weekly wage in covered industries under the
18    Unemployment Insurance Act, the weekly compensation rate
19    shall be proportionately increased by the same percentage
20    as the percentage of increase in the State's average weekly
21    wage in covered industries under the Unemployment
22    Insurance Act during such period.
23        The maximum weekly compensation rate, for the period
24    January 1, 1981 through December 31, 1983, except as
25    hereinafter provided, shall be 100% of the State's average
26    weekly wage in covered industries under the Unemployment

 

 

HB5354- 44 -LRB100 17830 JLS 33010 b

1    Insurance Act in effect on January 1, 1981. Effective
2    January 1, 1984 and on January 1, of each year thereafter
3    the maximum weekly compensation rate, except as
4    hereinafter provided, shall be determined as follows: if
5    during the preceding 12 month period there shall have been
6    an increase in the State's average weekly wage in covered
7    industries under the Unemployment Insurance Act, the
8    weekly compensation rate shall be proportionately
9    increased by the same percentage as the percentage of
10    increase in the State's average weekly wage in covered
11    industries under the Unemployment Insurance Act during
12    such period.
13        From July 1, 1977 and thereafter such maximum weekly
14    compensation rate in death cases under Section 7, and
15    permanent total disability cases under paragraph (f) or
16    subparagraph 18 of paragraph (3) of this Section and for
17    temporary total disability under paragraph (b) of this
18    Section and for amputation of a member or enucleation of an
19    eye under paragraph (e) of this Section shall be increased
20    to 133-1/3% of the State's average weekly wage in covered
21    industries under the Unemployment Insurance Act.
22        For injuries occurring on or after February 1, 2006,
23    the maximum weekly benefit under paragraph (d)1 of this
24    Section shall be 100% of the State's average weekly wage in
25    covered industries under the Unemployment Insurance Act.
26        4.1. Any provision herein to the contrary

 

 

HB5354- 45 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 46 -LRB100 17830 JLS 33010 b

1    publish the State's average weekly wage in covered
2    industries under the Unemployment Insurance Act as last
3    determined and published by the Department of Employment
4    Security. The amount when so posted and published shall be
5    conclusive and shall be applicable as the basis of
6    computation of compensation rates until the next posting
7    and publication as aforesaid.
8        7. The payment of compensation by an employer or his
9    insurance carrier to an injured employee shall not
10    constitute an admission of the employer's liability to pay
11    compensation.
12    (c) For any serious and permanent disfigurement to the
13hand, head, face, neck, arm, leg below the knee or the chest
14above the axillary line, the employee is entitled to
15compensation for such disfigurement, the amount determined by
16agreement at any time or by arbitration under this Act, at a
17hearing not less than 6 months after the date of the accidental
18injury, which amount shall not exceed 150 weeks (if the
19accidental injury occurs on or after the effective date of this
20amendatory Act of the 94th General Assembly but before February
211, 2006) or 162 weeks (if the accidental injury occurs on or
22after February 1, 2006) at the applicable rate provided in
23subparagraph 2.1 of paragraph (b) of this Section.
24    No compensation is payable under this paragraph where
25compensation is payable under paragraphs (d), (e) or (f) of
26this Section.

 

 

HB5354- 47 -LRB100 17830 JLS 33010 b

1    A duly appointed member of a fire department in a city, the
2population of which exceeds 500,000 according to the last
3federal or State census, is eligible for compensation under
4this paragraph only where such serious and permanent
5disfigurement results from burns.
6    (d) 1. If, after the accidental injury has been sustained,
7the employee as a result thereof becomes partially
8incapacitated from pursuing his usual and customary line of
9employment, he shall, except in cases compensated under the
10specific schedule set forth in paragraph (e) of this Section,
11receive compensation for the duration of his disability,
12subject to the limitations as to maximum amounts fixed in
13paragraph (b) of this Section, equal to 66-2/3% of the
14difference between the average amount which he would be able to
15earn in the full performance of his duties in the occupation in
16which he was engaged at the time of the accident and the
17average amount which he is earning or is able to earn in some
18suitable employment or business after the accident. For
19accidental injuries that occur on or after September 1, 2011,
20an award for wage differential under this subsection shall be
21effective only until the employee reaches the age of 67 or 5
22years from the date the award becomes final, whichever is
23later.
24    2. If, as a result of the accident, the employee sustains
25serious and permanent injuries not covered by paragraphs (c)
26and (e) of this Section or having sustained injuries covered by

 

 

HB5354- 48 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 49 -LRB100 17830 JLS 33010 b

1and for a fracture of each transverse process not less than 3
2weeks. In the event such injuries shall result in the loss of a
3kidney, spleen or lung, the amount of compensation allowed
4under this Section shall be not less than 10 weeks for each
5such organ. Compensation awarded under this subparagraph 2
6shall not take into consideration injuries covered under
7paragraphs (c) and (e) of this Section and the compensation
8provided in this paragraph shall not affect the employee's
9right to compensation payable under paragraphs (b), (c) and (e)
10of this Section for the disabilities therein covered.
11    (e) For accidental injuries in the following schedule, the
12employee shall receive compensation for the period of temporary
13total incapacity for work resulting from such accidental
14injury, under subparagraph 1 of paragraph (b) of this Section,
15and shall receive in addition thereto compensation for a
16further period for the specific loss herein mentioned, but
17shall not receive any compensation under any other provisions
18of this Act. The following listed amounts apply to either the
19loss of or the permanent and complete loss of use of the member
20specified, such compensation for the length of time as follows:
21        1. Thumb-
22            70 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            76 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

HB5354- 50 -LRB100 17830 JLS 33010 b

1        2. First, or index finger-
2            40 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            43 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        3. Second, or middle finger-
8            35 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            38 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        4. Third, or ring finger-
14            25 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            27 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        5. Fourth, or little finger-
20            20 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            22 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        6. Great toe-
26            35 weeks if the accidental injury occurs on or

 

 

HB5354- 51 -LRB100 17830 JLS 33010 b

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            38 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        7. Each toe other than great toe-
6            12 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            13 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        8. The loss of the first or distal phalanx of the thumb
12    or of any finger or toe shall be considered to be equal to
13    the loss of one-half of such thumb, finger or toe and the
14    compensation payable shall be one-half of the amount above
15    specified. The loss of more than one phalanx shall be
16    considered as the loss of the entire thumb, finger or toe.
17    In no case shall the amount received for more than one
18    finger exceed the amount provided in this schedule for the
19    loss of a hand.
20        9. Hand-
21            190 weeks if the accidental injury occurs on or
22        after the effective date of this amendatory Act of the
23        94th General Assembly but before February 1, 2006.
24            205 weeks if the accidental injury occurs on or
25        after February 1, 2006.
26            190 weeks if the accidental injury occurs on or

 

 

HB5354- 52 -LRB100 17830 JLS 33010 b

1        after June 28, 2011 (the effective date of Public Act
2        97-18) and if the accidental injury involves carpal
3        tunnel syndrome due to repetitive or cumulative
4        trauma, in which case the permanent partial disability
5        shall not exceed 15% loss of use of the hand, except
6        for cause shown by clear and convincing evidence and in
7        which case the award shall not exceed 30% loss of use
8        of the hand.
9        The loss of 2 or more digits, or one or more phalanges
10    of 2 or more digits, of a hand may be compensated on the
11    basis of partial loss of use of a hand, provided, further,
12    that the loss of 4 digits, or the loss of use of 4 digits,
13    in the same hand shall constitute the complete loss of a
14    hand.
15        10. Arm-
16            235 weeks if the accidental injury occurs on or
17        after the effective date of this amendatory Act of the
18        94th General Assembly but before February 1, 2006.
19            253 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        Where an accidental injury results in the amputation of
22    an arm below the elbow, such injury shall be compensated as
23    a loss of an arm. Where an accidental injury results in the
24    amputation of an arm above the elbow, compensation for an
25    additional 15 weeks (if the accidental injury occurs on or
26    after the effective date of this amendatory Act of the 94th

 

 

HB5354- 53 -LRB100 17830 JLS 33010 b

1    General Assembly but before February 1, 2006) or an
2    additional 17 weeks (if the accidental injury occurs on or
3    after February 1, 2006) shall be paid, except where the
4    accidental injury results in the amputation of an arm at
5    the shoulder joint, or so close to shoulder joint that an
6    artificial arm cannot be used, or results in the
7    disarticulation of an arm at the shoulder joint, in which
8    case compensation for an additional 65 weeks (if the
9    accidental injury occurs on or after the effective date of
10    this amendatory Act of the 94th General Assembly but before
11    February 1, 2006) or an additional 70 weeks (if the
12    accidental injury occurs on or after February 1, 2006)
13    shall be paid.
14        For purposes of awards under this subdivision (e),
15    injuries to the shoulder shall be considered injuries to
16    part of the arm.
17        11. Foot-
18            155 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            167 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        12. Leg-
24            200 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.

 

 

HB5354- 54 -LRB100 17830 JLS 33010 b

1            215 weeks if the accidental injury occurs on or
2        after February 1, 2006.
3        Where an accidental injury results in the amputation of
4    a leg below the knee, such injury shall be compensated as
5    loss of a leg. Where an accidental injury results in the
6    amputation of a leg above the knee, compensation for an
7    additional 25 weeks (if the accidental injury occurs on or
8    after the effective date of this amendatory Act of the 94th
9    General Assembly but before February 1, 2006) or an
10    additional 27 weeks (if the accidental injury occurs on or
11    after February 1, 2006) shall be paid, except where the
12    accidental injury results in the amputation of a leg at the
13    hip joint, or so close to the hip joint that an artificial
14    leg cannot be used, or results in the disarticulation of a
15    leg at the hip joint, in which case compensation for an
16    additional 75 weeks (if the accidental injury occurs on or
17    after the effective date of this amendatory Act of the 94th
18    General Assembly but before February 1, 2006) or an
19    additional 81 weeks (if the accidental injury occurs on or
20    after February 1, 2006) shall be paid.
21        For purposes of awards under this subdivision (e),
22    injuries to the hip shall be considered injuries to part of
23    the leg.
24        13. Eye-
25            150 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

HB5354- 55 -LRB100 17830 JLS 33010 b

1        94th General Assembly but before February 1, 2006.
2            162 weeks if the accidental injury occurs on or
3        after February 1, 2006.
4        Where an accidental injury results in the enucleation
5    of an eye, compensation for an additional 10 weeks (if the
6    accidental injury occurs on or after the effective date of
7    this amendatory Act of the 94th General Assembly but before
8    February 1, 2006) or an additional 11 weeks (if the
9    accidental injury occurs on or after February 1, 2006)
10    shall be paid.
11        14. Loss of hearing of one ear-
12            50 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            54 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        Total and permanent loss of hearing of both ears-
18            200 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            215 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        15. Testicle-
24            50 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.

 

 

HB5354- 56 -LRB100 17830 JLS 33010 b

1            54 weeks if the accidental injury occurs on or
2        after February 1, 2006.
3        Both testicles-
4            150 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            162 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        16. For the permanent partial loss of use of a member
10    or sight of an eye, or hearing of an ear, compensation
11    during that proportion of the number of weeks in the
12    foregoing schedule provided for the loss of such member or
13    sight of an eye, or hearing of an ear, which the partial
14    loss of use thereof bears to the total loss of use of such
15    member, or sight of eye, or hearing of an ear.
16            (a) Loss of hearing for compensation purposes
17        shall be confined to the frequencies of 1,000, 2,000
18        and 3,000 cycles per second. Loss of hearing ability
19        for frequency tones above 3,000 cycles per second are
20        not to be considered as constituting disability for
21        hearing.
22            (b) The percent of hearing loss, for purposes of
23        the determination of compensation claims for
24        occupational deafness, shall be calculated as the
25        average in decibels for the thresholds of hearing for
26        the frequencies of 1,000, 2,000 and 3,000 cycles per

 

 

HB5354- 57 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 58 -LRB100 17830 JLS 33010 b

1            (f) No claim for loss of hearing due to industrial
2        noise shall be brought against an employer or allowed
3        unless the employee has been exposed for a period of
4        time sufficient to cause permanent impairment to noise
5        levels in excess of the following:
6Sound Level DBA
7Slow ResponseHours Per Day
8908
9926
10954
11973
121002
131021-1/2
141051
151101/2
161151/4
17        This subparagraph (f) shall not be applied in cases of
18    hearing loss resulting from trauma or explosion.
19        17. In computing the compensation to be paid to any
20    employee who, before the accident for which he claims
21    compensation, had before that time sustained an injury
22    resulting in the loss by amputation or partial loss by
23    amputation of any member, including hand, arm, thumb, or
24    fingers, leg, foot, or any toes, or loss under Section
25    8(d)2 due to accidental injuries to the same part of the
26    spine, such loss or partial loss of any such member or loss

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1complete disability as provided in this paragraph of this
2Section.
3    The custodian of the Second Injury Fund provided for in
4paragraph (f) of Section 7 shall be joined with the employer as
5a party respondent in the application for adjustment of claim.
6The application for adjustment of claim shall state briefly and
7in general terms the approximate time and place and manner of
8the loss of the first member.
9    In its award the Commission or the Arbitrator shall
10specifically find the amount the injured employee shall be
11weekly paid, the number of weeks compensation which shall be
12paid by the employer, the date upon which payments begin out of
13the Second Injury Fund provided for in paragraph (f) of Section
147 of this Act, the length of time the weekly payments continue,
15the date upon which the pension payments commence and the
16monthly amount of the payments. The Commission shall 30 days
17after the date upon which payments out of the Second Injury
18Fund have begun as provided in the award, and every month
19thereafter, prepare and submit to the State Comptroller a
20voucher for payment for all compensation accrued to that date
21at the rate fixed by the Commission. The State Comptroller
22shall draw a warrant to the injured employee along with a
23receipt to be executed by the injured employee and returned to
24the Commission. The endorsed warrant and receipt is a full and
25complete acquittance to the Commission for the payment out of
26the Second Injury Fund. No other appropriation or warrant is

 

 

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1necessary for payment out of the Second Injury Fund. The Second
2Injury Fund is appropriated for the purpose of making payments
3according to the terms of the awards.
4    As of July 1, 1980 to July 1, 1982, all claims against and
5obligations of the Second Injury Fund shall become claims
6against and obligations of the Rate Adjustment Fund to the
7extent there is insufficient money in the Second Injury Fund to
8pay such claims and obligations. In that case, all references
9to "Second Injury Fund" in this Section shall also include the
10Rate Adjustment Fund.
11    (g) Every award for permanent total disability entered by
12the Commission on and after July 1, 1965 under which
13compensation payments shall become due and payable after the
14effective date of this amendatory Act, and every award for
15death benefits or permanent total disability entered by the
16Commission on and after the effective date of this amendatory
17Act shall be subject to annual adjustments as to the amount of
18the compensation rate therein provided. Such adjustments shall
19first be made on July 15, 1977, and all awards made and entered
20prior to July 1, 1975 and on July 15 of each year thereafter.
21In all other cases such adjustment shall be made on July 15 of
22the second year next following the date of the entry of the
23award and shall further be made on July 15 annually thereafter.
24If during the intervening period from the date of the entry of
25the award, or the last periodic adjustment, there shall have
26been an increase in the State's average weekly wage in covered

 

 

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1industries under the Unemployment Insurance Act, the weekly
2compensation rate shall be proportionately increased by the
3same percentage as the percentage of increase in the State's
4average weekly wage in covered industries under the
5Unemployment Insurance Act. The increase in the compensation
6rate under this paragraph shall in no event bring the total
7compensation rate to an amount greater than the prevailing
8maximum rate at the time that the annual adjustment is made.
9Such increase shall be paid in the same manner as herein
10provided for payments under the Second Injury Fund to the
11injured employee, or his dependents, as the case may be, out of
12the Rate Adjustment Fund provided in paragraph (f) of Section 7
13of this Act. Payments shall be made at the same intervals as
14provided in the award or, at the option of the Commission, may
15be made in quarterly payment on the 15th day of January, April,
16July and October of each year. In the event of a decrease in
17such average weekly wage there shall be no change in the then
18existing compensation rate. The within paragraph shall not
19apply to cases where there is disputed liability and in which a
20compromise lump sum settlement between the employer and the
21injured employee, or his dependents, as the case may be, has
22been duly approved by the Illinois Workers' Compensation
23Commission.
24    Provided, that in cases of awards entered by the Commission
25for injuries occurring before July 1, 1975, the increases in
26the compensation rate adjusted under the foregoing provision of

 

 

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

 

 

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1at the same intervals as the payment of compensation in the
2award. This paragraph shall not apply to cases where there is
3disputed liability and in which a compromise lump sum
4settlement between the employer and the injured employee, or
5his or her dependents, as the case may be, has been duly
6approved by the Illinois Workers' Compensation Commission.
7    The annual adjustments for every award of death benefits or
8permanent total disability involving accidents occurring
9before July 20, 2005 and accidents occurring on or after the
10effective date of this amendatory Act of the 94th General
11Assembly (Senate Bill 1283 of the 94th General Assembly) shall
12continue to be paid from the Rate Adjustment Fund pursuant to
13this paragraph and Section 7(f) of this Act.
14    (h) In case death occurs from any cause before the total
15compensation to which the employee would have been entitled has
16been paid, then in case the employee leaves any widow, widower,
17child, parent (or any grandchild, grandparent or other lineal
18heir or any collateral heir dependent at the time of the
19accident upon the earnings of the employee to the extent of 50%
20or more of total dependency) such compensation shall be paid to
21the beneficiaries of the deceased employee and distributed as
22provided in paragraph (g) of Section 7.
23    (h-1) In case an injured employee is under legal disability
24at the time when any right or privilege accrues to him or her
25under this Act, a guardian may be appointed pursuant to law,
26and may, on behalf of such person under legal disability, claim

 

 

HB5354- 68 -LRB100 17830 JLS 33010 b

1and exercise any such right or privilege with the same effect
2as if the employee himself or herself had claimed or exercised
3the right or privilege. No limitations of time provided by this
4Act run so long as the employee who is under legal disability
5is without a conservator or guardian.
6    (i) In case the injured employee is under 16 years of age
7at the time of the accident and is illegally employed, the
8amount of compensation payable under paragraphs (b), (c), (d),
9(e) and (f) of this Section is increased 50%.
10    However, where an employer has on file an employment
11certificate issued pursuant to the Child Labor Law or work
12permit issued pursuant to the Federal Fair Labor Standards Act,
13as amended, or a birth certificate properly and duly issued,
14such certificate, permit or birth certificate is conclusive
15evidence as to the age of the injured minor employee for the
16purposes of this Section.
17    Nothing herein contained repeals or amends the provisions
18of the Child Labor Law relating to the employment of minors
19under the age of 16 years.
20    (j) 1. In the event the injured employee receives benefits,
21including medical, surgical or hospital benefits under any
22group plan covering non-occupational disabilities contributed
23to wholly or partially by the employer, which benefits should
24not have been payable if any rights of recovery existed under
25this Act, then such amounts so paid to the employee from any
26such group plan as shall be consistent with, and limited to,

 

 

HB5354- 69 -LRB100 17830 JLS 33010 b

1the provisions of paragraph 2 hereof, shall be credited to or
2against any compensation payment for temporary total
3incapacity for work or any medical, surgical or hospital
4benefits made or to be made under this Act. In such event, the
5period of time for giving notice of accidental injury and
6filing application for adjustment of claim does not commence to
7run until the termination of such payments. This paragraph does
8not apply to payments made under any group plan which would
9have been payable irrespective of an accidental injury under
10this Act. Any employer receiving such credit shall keep such
11employee safe and harmless from any and all claims or
12liabilities that may be made against him by reason of having
13received such payments only to the extent of such credit.
14    Any excess benefits paid to or on behalf of a State
15employee by the State Employees' Retirement System under
16Article 14 of the Illinois Pension Code on a death claim or
17disputed disability claim shall be credited against any
18payments made or to be made by the State of Illinois to or on
19behalf of such employee under this Act, except for payments for
20medical expenses which have already been incurred at the time
21of the award. The State of Illinois shall directly reimburse
22the State Employees' Retirement System to the extent of such
23credit.
24    2. Nothing contained in this Act shall be construed to give
25the employer or the insurance carrier the right to credit for
26any benefits or payments received by the employee other than

 

 

HB5354- 70 -LRB100 17830 JLS 33010 b

1compensation payments provided by this Act, and where the
2employee receives payments other than compensation payments,
3whether as full or partial salary, group insurance benefits,
4bonuses, annuities or any other payments, the employer or
5insurance carrier shall receive credit for each such payment
6only to the extent of the compensation that would have been
7payable during the period covered by such payment.
8    3. The extension of time for the filing of an Application
9for Adjustment of Claim as provided in paragraph 1 above shall
10not apply to those cases where the time for such filing had
11expired prior to the date on which payments or benefits
12enumerated herein have been initiated or resumed. Provided
13however that this paragraph 3 shall apply only to cases wherein
14the payments or benefits hereinabove enumerated shall be
15received after July 1, 1969.
16(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
17eff. 7-13-12.)
 
18    (820 ILCS 305/8.2)
19    Sec. 8.2. Fee schedule.
20    (a) Except as provided for in subsection (c), for
21procedures, treatments, or services covered under this Act and
22rendered or to be rendered on and after February 1, 2006, the
23maximum allowable payment shall be 90% of the 80th percentile
24of charges and fees as determined by the Commission utilizing
25information provided by employers' and insurers' national

 

 

HB5354- 71 -LRB100 17830 JLS 33010 b

1databases, with a minimum of 12,000,000 Illinois line item
2charges and fees comprised of health care provider and hospital
3charges and fees as of August 1, 2004 but not earlier than
4August 1, 2002. These charges and fees are provider billed
5amounts and shall not include discounted charges. The 80th
6percentile is the point on an ordered data set from low to high
7such that 80% of the cases are below or equal to that point and
8at most 20% are above or equal to that point. The Commission
9shall adjust these historical charges and fees as of August 1,
102004 by the Consumer Price Index-U for the period August 1,
112004 through September 30, 2005. The Commission shall establish
12fee schedules for procedures, treatments, or services for
13hospital inpatient, hospital outpatient, emergency room and
14trauma, ambulatory surgical treatment centers, and
15professional services. These charges and fees shall be
16designated by geozip or any smaller geographic unit. The data
17shall in no way identify or tend to identify any patient,
18employer, or health care provider. As used in this Section,
19"geozip" means a three-digit zip code based on data
20similarities, geographical similarities, and frequencies. A
21geozip does not cross state boundaries. As used in this
22Section, "three-digit zip code" means a geographic area in
23which all zip codes have the same first 3 digits. If a geozip
24does not have the necessary number of charges and fees to
25calculate a valid percentile for a specific procedure,
26treatment, or service, the Commission may combine data from the

 

 

HB5354- 72 -LRB100 17830 JLS 33010 b

1geozip with up to 4 other geozips that are demographically and
2economically similar and exhibit similarities in data and
3frequencies until the Commission reaches 9 charges or fees for
4that specific procedure, treatment, or service. In cases where
5the compiled data contains less than 9 charges or fees for a
6procedure, treatment, or service, reimbursement shall occur at
776% of charges and fees as determined by the Commission in a
8manner consistent with the provisions of this paragraph.
9Providers of out-of-state procedures, treatments, services,
10products, or supplies shall be reimbursed at the lesser of that
11state's fee schedule amount or the fee schedule amount for the
12region in which the employee resides. If no fee schedule exists
13in that state, the provider shall be reimbursed at the lesser
14of the actual charge or the fee schedule amount for the region
15in which the employee resides. Not later than September 30 in
162006 and each year thereafter, the Commission shall
17automatically increase or decrease the maximum allowable
18payment for a procedure, treatment, or service established and
19in effect on January 1 of that year by the percentage change in
20the Consumer Price Index-U for the 12 month period ending
21August 31 of that year. The increase or decrease shall become
22effective on January 1 of the following year. As used in this
23Section, "Consumer Price Index-U" means the index published by
24the Bureau of Labor Statistics of the U.S. Department of Labor,
25that measures the average change in prices of all goods and
26services purchased by all urban consumers, U.S. city average,

 

 

HB5354- 73 -LRB100 17830 JLS 33010 b

1all items, 1982-84=100.
2    (a-1) Notwithstanding the provisions of subsection (a) and
3unless otherwise indicated, the following provisions shall
4apply to the medical fee schedule starting on September 1,
52011:
6        (1) The Commission shall establish and maintain fee
7    schedules for procedures, treatments, products, services,
8    or supplies for hospital inpatient, hospital outpatient,
9    emergency room, ambulatory surgical treatment centers,
10    accredited ambulatory surgical treatment facilities,
11    prescriptions filled and dispensed outside of a licensed
12    pharmacy, dental services, and professional services. This
13    fee schedule shall be based on the fee schedule amounts
14    already established by the Commission pursuant to
15    subsection (a) of this Section. However, starting on
16    January 1, 2012, these fee schedule amounts shall be
17    grouped into geographic regions in the following manner:
18            (A) Four regions for non-hospital fee schedule
19        amounts shall be utilized:
20                (i) Cook County;
21                (ii) DuPage, Kane, Lake, and Will Counties;
22                (iii) Bond, Calhoun, Clinton, Jersey,
23            Macoupin, Madison, Monroe, Montgomery, Randolph,
24            St. Clair, and Washington Counties; and
25                (iv) All other counties of the State.
26            (B) Fourteen regions for hospital fee schedule

 

 

HB5354- 74 -LRB100 17830 JLS 33010 b

1        amounts shall be utilized:
2                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
3            Kendall, and Grundy Counties;
4                (ii) Kankakee County;
5                (iii) Madison, St. Clair, Macoupin, Clinton,
6            Monroe, Jersey, Bond, and Calhoun Counties;
7                (iv) Winnebago and Boone Counties;
8                (v) Peoria, Tazewell, Woodford, Marshall, and
9            Stark Counties;
10                (vi) Champaign, Piatt, and Ford Counties;
11                (vii) Rock Island, Henry, and Mercer Counties;
12                (viii) Sangamon and Menard Counties;
13                (ix) McLean County;
14                (x) Lake County;
15                (xi) Macon County;
16                (xii) Vermilion County;
17                (xiii) Alexander County; and
18                (xiv) All other counties of the State.
19        (2) If a geozip, as defined in subsection (a) of this
20    Section, overlaps into one or more of the regions set forth
21    in this Section, then the Commission shall average or
22    repeat the charges and fees in a geozip in order to
23    designate charges and fees for each region.
24        (3) In cases where the compiled data contains less than
25    9 charges or fees for a procedure, treatment, product,
26    supply, or service or where the fee schedule amount cannot

 

 

HB5354- 75 -LRB100 17830 JLS 33010 b

1    be determined by the non-discounted charge data,
2    non-Medicare relative values and conversion factors
3    derived from established fee schedule amounts, coding
4    crosswalks, or other data as determined by the Commission,
5    reimbursement shall occur at 76% of charges and fees until
6    September 1, 2011 and 53.2% of charges and fees thereafter
7    as determined by the Commission in a manner consistent with
8    the provisions of this paragraph.
9        (4) To establish additional fee schedule amounts, the
10    Commission shall utilize provider non-discounted charge
11    data, non-Medicare relative values and conversion factors
12    derived from established fee schedule amounts, and coding
13    crosswalks. The Commission may establish additional fee
14    schedule amounts based on either the charge or cost of the
15    procedure, treatment, product, supply, or service.
16        (5) Implants shall be reimbursed at 25% above the net
17    manufacturer's invoice price less rebates, plus actual
18    reasonable and customary shipping charges whether or not
19    the implant charge is submitted by a provider in
20    conjunction with a bill for all other services associated
21    with the implant, submitted by a provider on a separate
22    claim form, submitted by a distributor, or submitted by the
23    manufacturer of the implant. "Implants" include the
24    following codes or any substantially similar updated code
25    as determined by the Commission: 0274
26    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens

 

 

HB5354- 76 -LRB100 17830 JLS 33010 b

1    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
2    (investigational devices); and 0636 (drugs requiring
3    detailed coding). Non-implantable devices or supplies
4    within these codes shall be reimbursed at 65% of actual
5    charge, which is the provider's normal rates under its
6    standard chargemaster. A standard chargemaster is the
7    provider's list of charges for procedures, treatments,
8    products, supplies, or services used to bill payers in a
9    consistent manner.
10        (6) The Commission shall automatically update all
11    codes and associated rules with the version of the codes
12    and rules valid on January 1 of that year.
13    (a-2) For procedures, treatments, services, or supplies
14covered under this Act and rendered or to be rendered on or
15after September 1, 2011, the maximum allowable payment shall be
1670% of the fee schedule amounts, which shall be adjusted yearly
17by the Consumer Price Index-U, as described in subsection (a)
18of this Section.
19    (a-3) Prescriptions, other than custom compound
20medications, filled and dispensed outside of a licensed
21pharmacy shall be subject to a fee schedule that shall not
22exceed the Average Wholesale Price (AWP) plus a dispensing fee
23of $4.18. AWP or its equivalent as registered by the National
24Drug Code shall be set forth for that drug on that date as
25published in Medi-Span Medispan.
26    (a-4) The Commission shall, by July 1, 2019, adopt by rule

 

 

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1the most recent version of the Workers' Compensation Formulary
2of the Official Disability Guidelines Appendix A; Treatment in
3Workers' Compensation, published by Work Loss Data Institute.
4The closed pharmacy formulary shall only include the applicable
5portions of the particular Official Disability Guidelines;
6Treatment in Workers' Compensation guideline provisions that
7are specific to the drugs in the formulary in Appendix A.
8    Prescriptions prescribed for workers' compensation cases
9shall be limited to those prescription drugs and doses on the
10closed formulary. A request for: (i) a prescription not on the
11closed formulary; (ii) a dosage prescribed not included in the
12closed formulary; (iii) any compound drug; and, (iv) any
13investigational or experimental drug for which there is early,
14developing scientific or clinical evidence demonstrating the
15potential efficacy of the treatment, but which is not yet
16broadly accepted as the prevailing standard of care, shall
17require prior authorization by the employer and be reviewed
18pursuant to Section 8.7 of this Act.
19    Nothing in this Act prohibits an employer or insurer from
20contracting with a health care provider or group of health care
21providers for reimbursement levels for benefits under this Act
22different from those provided in this Section.
23    (a-5) As used in this Section:
24        "Custom compound medication" means a customized
25    medication prescribed or ordered by a duly licensed
26    prescriber for the specific patient that is prepared in a

 

 

HB5354- 78 -LRB100 17830 JLS 33010 b

1    pharmacy by a licensed pharmacist in response to a licensed
2    prescriber's prescription or order by combining, mixing,
3    or altering of ingredients, but not reconstituting, to meet
4    the unique needs of an individual patient. A custom
5    compound medication does not include a drug reconstituted
6    pursuant to a manufacturer's direction nor does it include
7    the sole act of tablet splitting or crushing, capsule
8    opening, or the addition of a flavoring agent to enhance
9    palatability.
10    (a-6) A custom compound medication shall be approved for
11payment only if the custom compound medication meets all of the
12following standards:
13        (1) there is no readily available commercially
14    manufactured therapeutically equivalent product;
15        (2) no other Food and Drug Administration approved
16    alternative drug or combination of readily available drugs
17    is appropriate for the patient;
18        (3) the active ingredients of the custom compound
19    medication each have a National Drug Code (NDC) number, are
20    components of drugs approved by the Food and Drug
21    Administration, and the active ingredients in the custom
22    compound medication are being used to treat conditions for
23    which the component drugs have been approved for use by the
24    Food and Drug Administration;
25        (4) no component of the custom compound medication has
26    been withdrawn or removed from the market for safety

 

 

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1    reasons; and
2        (5) the prescriber is able to demonstrate to the payer
3    that the custom compound medication is reasonable and
4    necessary.
5    (a-7) The Average Wholesale Price (AWP) for the specific
6amount of each component, as identified by its National Drug
7Code (NDC) from the original labeler, shall be used to
8determine the maximum reimbursement of a custom compound
9medication meeting the standards of subsection (a-5). A single
10dispensing fee for a custom compound medication shall be based
11on the actual costs of preparing and dispensing the custom
12compound medication as determined by the Commission. The
13dispensing fee for a custom compound medication shall be billed
14with code WC 700-C.
15    (a-8) This Section is subject to the other provisions of
16this Act including, but not limited to, Section 8.7.
17    (a-9) The changes to this Section made by this amendatory
18Act of the 100th General Assembly apply to compounding
19medications provided on or after the effective date of this
20amendatory Act of the 100th General Assembly.
21    (b) Notwithstanding the provisions of subsection (a), if
22the Commission finds that there is a significant limitation on
23access to quality health care in either a specific field of
24health care services or a specific geographic limitation on
25access to health care, it may change the Consumer Price Index-U
26increase or decrease for that specific field or specific

 

 

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1geographic limitation on access to health care to address that
2limitation.
3    (c) The Commission shall establish by rule a process to
4review those medical cases or outliers that involve
5extra-ordinary treatment to determine whether to make an
6additional adjustment to the maximum payment within a fee
7schedule for a procedure, treatment, or service.
8    (d) When a patient notifies a provider that the treatment,
9procedure, or service being sought is for a work-related
10illness or injury and furnishes the provider the name and
11address of the responsible employer, the provider shall bill
12the employer directly. The employer shall make payment and
13providers shall submit bills and records in accordance with the
14provisions of this Section.
15        (1) All payments to providers for treatment provided
16    pursuant to this Act shall be made within 30 days of
17    receipt of the bills as long as the claim contains
18    substantially all the required data elements necessary to
19    adjudicate the bills.
20        (2) If the claim does not contain substantially all the
21    required data elements necessary to adjudicate the bill, or
22    the claim is denied for any other reason, in whole or in
23    part, the employer or insurer shall provide written
24    notification, explaining the basis for the denial and
25    describing any additional necessary data elements, to the
26    provider within 30 days of receipt of the bill.

 

 

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1        (3) An employer or its insurer shall provide to an
2    injured worker or an injured worker's medical provider,
3    upon written request, a mailing and an electronic address
4    to which medical bills should be sent. An employer or its
5    insurer shall within 30 days after receiving a bill
6    containing all the required data elements necessary to
7    determine whether to pay or not pay all or a portion of the
8    bill provide to the medical provider payment of all or a
9    portion of the bill determined to be compensable at the
10    lesser of the bill charge, fee schedule rate, or negotiated
11    rate. Any amounts unpaid and determined to be compensable
12    by the Commission shall incur interest at a rate of 1% per
13    month from the date of the Commission's final decision
14    exclusive of Section 19 (n) or Section 2-1303 of the Code
15    of Civil Procedure. The medical provider has the burden of
16    proof that the bill was received at the address provided by
17    the employer or its insurer In the case of nonpayment to a
18    provider within 30 days of receipt of the bill which
19    contained substantially all of the required data elements
20    necessary to adjudicate the bill or nonpayment to a
21    provider of a portion of such a bill up to the lesser of
22    the actual charge or the payment level set by the
23    Commission in the fee schedule established in this Section,
24    the bill, or portion of the bill, shall incur interest at a
25    rate of 1% per month payable to the provider. Any required
26    interest payments shall be made within 30 days after

 

 

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1    payment.
2    (e) Except as provided in subsections (e-5), (e-10), and
3(e-15), a provider shall not hold an employee liable for costs
4related to a non-disputed procedure, treatment, or service
5rendered in connection with a compensable injury. The
6provisions of subsections (e-5), (e-10), (e-15), and (e-20)
7shall not apply if an employee provides information to the
8provider regarding participation in a group health plan. If the
9employee participates in a group health plan, the provider may
10submit a claim for services to the group health plan. If the
11claim for service is covered by the group health plan, the
12employee's responsibility shall be limited to applicable
13deductibles, co-payments, or co-insurance. Except as provided
14under subsections (e-5), (e-10), (e-15), and (e-20), a provider
15shall not bill or otherwise attempt to recover from the
16employee the difference between the provider's charge and the
17amount paid by the employer or the insurer on a compensable
18injury, or for medical services or treatment determined by the
19Commission to be excessive or unnecessary.
20    (e-5) If an employer notifies a provider that the employer
21does not consider the illness or injury to be compensable under
22this Act, the provider may seek payment of the provider's
23actual charges from the employee for any procedure, treatment,
24or service rendered. Once an employee informs the provider that
25there is an application filed with the Commission to resolve a
26dispute over payment of such charges, the provider shall cease

 

 

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

 

 

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

 

 

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1subsection (d) of this Section. In the case of a procedure,
2treatment, or service deemed compensable, the provider shall
3not require a payment rate, excluding the interest provisions
4under subsection (d), greater than the lesser of the actual
5charge or the payment level set by the Commission in the fee
6schedule established in this Section. Payment for services
7deemed not covered or not compensable under this Act is the
8responsibility of the employee unless a provider and employee
9have agreed otherwise in writing. Services not covered or not
10compensable under this Act are not subject to the fee schedule
11in this Section.
12    (f) Nothing in this Act shall prohibit an employer or
13insurer from contracting with a health care provider or group
14of health care providers for reimbursement levels for benefits
15under this Act different from those provided in this Section.
16    (g) On or before January 1, 2010 the Commission shall
17provide to the Governor and General Assembly a report regarding
18the implementation of the medical fee schedule and the index
19used for annual adjustment to that schedule as described in
20this Section.
21(Source: P.A. 97-18, eff. 6-28-11.)
 
22    (820 ILCS 305/8.2a)
23    Sec. 8.2a. Electronic claims.
24    (a) The Director of Insurance shall adopt rules to do all
25of the following:

 

 

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1        (1) Ensure that all health care providers and
2    facilities submit medical bills for payment on
3    standardized forms.
4        (2) Require acceptance by employers and insurers of
5    electronic claims for payment of medical services.
6        (3) Ensure confidentiality of medical information
7    submitted on electronic claims for payment of medical
8    services.
9        (4) Ensure that health care providers have at least 15
10    business days to comply with records requested by employers
11    and insurers.
12        (5) Provide that an electronically submitted bill
13    containing substantially all of the required data elements
14    necessary to adjudicate the bill, but not paid or objected
15    to within 30 days, shall be subject to interest at 1% per
16    month as provided in Section 8.2(d)(3) of this Act.
17        (6) Provide that the Department of Insurance may impose
18    an administrative fine if it determines that an employer or
19    insurer has intentionally failed to comply or demonstrates
20    a repeated pattern of failing to comply with the electronic
21    claims acceptance and response process. The amount of the
22    administrative fine shall be no greater than $1,000 per
23    each violation, but shall not exceed $10,000 for all
24    violations during a calendar year.
25    (b) To the extent feasible, standards adopted pursuant to
26subdivision (a) shall be consistent with existing standards

 

 

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1under the federal Health Insurance Portability and
2Accountability Act of 1996 and standards adopted under the
3Illinois Health Information Exchange and Technology Act.
4    (c) The rules requiring employers and insurers to accept
5electronic claims for payment of medical services shall be
6proposed on or before January 1, 2012, and shall require all
7employers and insurers to accept electronic claims for payment
8of medical services on or before June 30, 2012.
9    The Director of Insurance shall adopt rules by June 30,
102019 to implement the changes to this Section made by this
11amendatory Act of the 100th General Assembly. The Commission,
12with assistance from the Department and the Commission's
13Medical Fee Advisory Board, shall publish on its Internet
14website a companion guide to assist with compliance with
15electronic claims rules. The Medical Fee Advisory Board shall
16periodically review the companion guide.
17    (d) The Director of Insurance shall by rule establish
18criteria for granting exceptions to employers, insurance
19carriers, and health care providers who are unable to submit or
20accept medical bills electronically.
21(Source: P.A. 97-18, eff. 6-28-11.)
 
22    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
23    Sec. 19. Any disputed questions of law or fact shall be
24determined as herein provided.
25    (a) It shall be the duty of the Commission upon

 

 

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1notification that the parties have failed to reach an
2agreement, to designate an Arbitrator.
3        1. Whenever any claimant misconceives his remedy and
4    files an application for adjustment of claim under this Act
5    and it is subsequently discovered, at any time before final
6    disposition of such cause, that the claim for disability or
7    death which was the basis for such application should
8    properly have been made under the Workers' Occupational
9    Diseases Act, then the provisions of Section 19, paragraph
10    (a-1) of the Workers' Occupational Diseases Act having
11    reference to such application shall apply.
12        2. Whenever any claimant misconceives his remedy and
13    files an application for adjustment of claim under the
14    Workers' Occupational Diseases Act and it is subsequently
15    discovered, at any time before final disposition of such
16    cause that the claim for injury or death which was the
17    basis for such application should properly have been made
18    under this Act, then the application so filed under the
19    Workers' Occupational Diseases Act may be amended in form,
20    substance or both to assert claim for such disability or
21    death under this Act and it shall be deemed to have been so
22    filed as amended on the date of the original filing
23    thereof, and such compensation may be awarded as is
24    warranted by the whole evidence pursuant to this Act. When
25    such amendment is submitted, further or additional
26    evidence may be heard by the Arbitrator or Commission when

 

 

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1    deemed necessary. Nothing in this Section contained shall
2    be construed to be or permit a waiver of any provisions of
3    this Act with reference to notice but notice if given shall
4    be deemed to be a notice under the provisions of this Act
5    if given within the time required herein.
6    (b) The Arbitrator shall make such inquiries and
7investigations as he or they shall deem necessary and may
8examine and inspect all books, papers, records, places, or
9premises relating to the questions in dispute and hear such
10proper evidence as the parties may submit.
11    The hearings before the Arbitrator shall be held in the
12vicinity where the injury occurred after 10 days' notice of the
13time and place of such hearing shall have been given to each of
14the parties or their attorneys of record.
15    The Arbitrator may find that the disabling condition is
16temporary and has not yet reached a permanent condition and may
17order the payment of compensation up to the date of the
18hearing, which award shall be reviewable and enforceable in the
19same manner as other awards, and in no instance be a bar to a
20further hearing and determination of a further amount of
21temporary total compensation or of compensation for permanent
22disability, but shall be conclusive as to all other questions
23except the nature and extent of said disability.
24    The decision of the Arbitrator shall be filed with the
25Commission which Commission shall immediately send to each
26party or his attorney a copy of such decision, together with a

 

 

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1notification of the time when it was filed. As of the effective
2date of this amendatory Act of the 94th General Assembly, all
3decisions of the Arbitrator shall set forth in writing findings
4of fact and conclusions of law, separately stated, if requested
5by either party. Unless a petition for review is filed by
6either party within 30 days after the receipt by such party of
7the copy of the decision and notification of time when filed,
8and unless such party petitioning for a review shall within 35
9days after the receipt by him of the copy of the decision, file
10with the Commission either an agreed statement of the facts
11appearing upon the hearing before the Arbitrator, or if such
12party shall so elect a correct transcript of evidence of the
13proceedings at such hearings, then the decision shall become
14the decision of the Commission and in the absence of fraud
15shall be conclusive. The Petition for Review shall contain a
16statement of the petitioning party's specific exceptions to the
17decision of the arbitrator. The jurisdiction of the Commission
18to review the decision of the arbitrator shall not be limited
19to the exceptions stated in the Petition for Review. The
20Commission, or any member thereof, may grant further time not
21exceeding 30 days, in which to file such agreed statement or
22transcript of evidence. Such agreed statement of facts or
23correct transcript of evidence, as the case may be, shall be
24authenticated by the signatures of the parties or their
25attorneys, and in the event they do not agree as to the
26correctness of the transcript of evidence it shall be

 

 

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

 

 

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

 

 

HB5354- 93 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 94 -LRB100 17830 JLS 33010 b

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

 

 

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

 

 

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

 

 

HB5354- 97 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 98 -LRB100 17830 JLS 33010 b

1place of employment by the employer. If service on the employer
2is not possible at either of the above, then service shall be
3at the employer's principal place of business. After initial
4service in each case, service shall be made on the employer's
5attorney or designated representative.
6    (c)(1) At a reasonable time in advance of and in connection
7with the hearing under Section 19(e) or 19(h), the Commission
8may on its own motion order an impartial physical or mental
9examination of a petitioner whose mental or physical condition
10is in issue, when in the Commission's discretion it appears
11that such an examination will materially aid in the just
12determination of the case. The examination shall be made by a
13member or members of a panel of physicians chosen for their
14special qualifications by the Illinois State Medical Society.
15The Commission shall establish procedures by which a physician
16shall be selected from such list.
17    (2) Should the Commission at any time during the hearing
18find that compelling considerations make it advisable to have
19an examination and report at that time, the commission may in
20its discretion so order.
21    (3) A copy of the report of examination shall be given to
22the Commission and to the attorneys for the parties.
23    (4) Either party or the Commission may call the examining
24physician or physicians to testify. Any physician so called
25shall be subject to cross-examination.
26    (5) The examination shall be made, and the physician or

 

 

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1physicians, if called, shall testify, without cost to the
2parties. The Commission shall determine the compensation and
3the pay of the physician or physicians. The compensation for
4this service shall not exceed the usual and customary amount
5for such service.
6    (6) The fees and payment thereof of all attorneys and
7physicians for services authorized by the Commission under this
8Act shall, upon request of either the employer or the employee
9or the beneficiary affected, be subject to the review and
10decision of the Commission.
11    (d) If any employee shall persist in insanitary or
12injurious practices which tend to either imperil or retard his
13recovery or shall refuse to submit to such medical, surgical,
14or hospital treatment as is reasonably essential to promote his
15recovery, the Commission may, in its discretion, reduce or
16suspend the compensation of any such injured employee. However,
17when an employer and employee so agree in writing, the
18foregoing provision shall not be construed to authorize the
19reduction or suspension of compensation of an employee who is
20relying in good faith, on treatment by prayer or spiritual
21means alone, in accordance with the tenets and practice of a
22recognized church or religious denomination, by a duly
23accredited practitioner thereof.
24    (e) This paragraph shall apply to all hearings before the
25Commission. Such hearings may be held in its office or
26elsewhere as the Commission may deem advisable. The taking of

 

 

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

 

 

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1one representative citizen of the employing class and not more
2than one representative citizen of the employee class, shall
3hear the argument; provided that if all the issues in dispute
4are solely the nature and extent of the permanent partial
5disability, if any, a majority of the panel may deny the
6request for such argument and such argument shall not be held;
7and provided further that 7 members of the Commission may
8determine that the argument be held before all available
9members of the Commission. A decision of the Commission shall
10be approved by a majority of Commissioners present at such
11hearing if any; provided, if no such hearing is held, a
12decision of the Commission shall be approved by a majority of a
13panel of 3 members of the Commission as described in this
14Section. The Commission shall give 10 days' notice to the
15parties or their attorneys of the time and place of such taking
16of testimony and of such argument.
17    In any case the Commission in its decision may find
18specially upon any question or questions of law or fact which
19shall be submitted in writing by either party whether ultimate
20or otherwise; provided that on issues other than nature and
21extent of the disability, if any, the Commission in its
22decision shall find specially upon any question or questions of
23law or fact, whether ultimate or otherwise, which are submitted
24in writing by either party; provided further that not more than
255 such questions may be submitted by either party. Any party
26may, within 20 days after receipt of notice of the Commission's

 

 

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1decision, or within such further time, not exceeding 30 days,
2as the Commission may grant, file with the Commission either an
3agreed statement of the facts appearing upon the hearing, or,
4if such party shall so elect, a correct transcript of evidence
5of the additional proceedings presented before the Commission,
6in which report the party may embody a correct statement of
7such other proceedings in the case as such party may desire to
8have reviewed, such statement of facts or transcript of
9evidence to be authenticated by the signature of the parties or
10their attorneys, and in the event that they do not agree, then
11the authentication of such transcript of evidence shall be by
12the signature of any member of the Commission.
13    If a reporter does not for any reason furnish a transcript
14of the proceedings before the Arbitrator in any case for use on
15a hearing for review before the Commission, within the
16limitations of time as fixed in this Section, the Commission
17may, in its discretion, order a trial de novo before the
18Commission in such case upon application of either party. The
19applications for adjustment of claim and other documents in the
20nature of pleadings filed by either party, together with the
21decisions of the Arbitrator and of the Commission and the
22statement of facts or transcript of evidence hereinbefore
23provided for in paragraphs (b) and (c) shall be the record of
24the proceedings of the Commission, and shall be subject to
25review as hereinafter provided.
26    At the request of either party or on its own motion, the

 

 

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

 

 

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

 

 

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1    return day, not less than 10 or more than 60 days from the
2    date of issuance thereof, and the written request shall
3    contain the last known address of other parties in interest
4    and their attorneys of record who are to be served by
5    summons. Service upon any member of the Commission or the
6    Secretary or the Assistant Secretary thereof shall be
7    service upon the Commission, and service upon other parties
8    in interest and their attorneys of record shall be by
9    summons, and such service shall be made upon the Commission
10    and other parties in interest by mailing notices of the
11    commencement of the proceedings and the return day of the
12    summons to the office of the Commission and to the last
13    known place of residence of other parties in interest or
14    their attorney or attorneys of record. The clerk of the
15    court issuing the summons shall on the day of issue mail
16    notice of the commencement of the proceedings which shall
17    be done by mailing a copy of the summons to the office of
18    the Commission, and a copy of the summons to the other
19    parties in interest or their attorney or attorneys of
20    record and the clerk of the court shall make certificate
21    that he has so sent said notices in pursuance of this
22    Section, which shall be evidence of service on the
23    Commission and other parties in interest.
24        The Commission shall not be required to certify the
25    record of their proceedings to the Circuit Court, unless
26    the party commencing the proceedings for review in the

 

 

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1    Circuit Court as above provided, shall file with the
2    Commission notice of intent to file for review in Circuit
3    Court. It shall be the duty of the Commission upon such
4    filing of notice of intent to file for review in the
5    Circuit Court to prepare a true and correct copy of such
6    testimony and a true and correct copy of all other matters
7    contained in such record and certified to by the Secretary
8    or Assistant Secretary thereof. The changes made to this
9    subdivision (f)(1) by this amendatory Act of the 98th
10    General Assembly apply to any Commission decision entered
11    after the effective date of this amendatory Act of the 98th
12    General Assembly.
13        No request for a summons may be filed and no summons
14    shall issue unless the party seeking to review the decision
15    of the Commission shall exhibit to the clerk of the Circuit
16    Court proof of filing with the Commission of the notice of
17    the intent to file for review in the Circuit Court or an
18    affidavit of the attorney setting forth that notice of
19    intent to file for review in the Circuit Court has been
20    given in writing to the Secretary or Assistant Secretary of
21    the Commission.
22        (2) If the party seeking judicial review is the party
23    against whom the Commission rendered an award for payment
24    of money, then within the timeframe for the commencement of
25    proceedings, the party shall provide to the Circuit Court
26    collateral or guarantee of payment of the award if the

 

 

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1    review is not successfully prosecuted.
2            (A) Collateral or guarantee may be provided in the
3        following ways:
4                (i) filing an insurance policy pursuant to
5            Section 392.1 of the Illinois Insurance Code;
6                (ii) filing a certificate of self-insurance;
7                (iii) placing sufficient funds in an escrow
8            account; or
9                (iv) filing a bond signed by the employer or
10        any duly designated representative of the employer,
11        and in the event the employer is insured, any
12        representative of the insurer.
13            (B) The amount of the bond, if necessary, shall be
14        fixed by any member of the Commission and the surety or
15        sureties of the bond shall be approved by the clerk of
16        the court.
17            (C) The acceptance by the clerk of the Circuit
18        Court of the collateral or guarantee shall constitute
19        evidence of the Circuit Court's approval of the
20        collateral or guarantee.
21            (D) If an insurance policy or certificate of
22        self-insurance is filed as collateral or guarantee,
23        the party respondent has 20 days in which to object,
24        and if the objection is sustained, the party so filing
25        the insurance policy or certificate of self-insurance
26        has 10 days to cure the defect or otherwise file

 

 

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1        another appropriate form of collateral or guarantee.
2        If no objection is filed within the 20 days, all
3        objections are waived.
4            (E) On motion supported by good cause made within
5        the timeframe for the commencement of proceedings or
6        within any extension granted pursuant to this
7        subsection, the time for filing and approval of the
8        collateral or guarantee may be extended by the Circuit
9        Court, but the total extensions of time granted by the
10        Circuit Court may not aggregate more than 45 days from
11        the original due date unless the parties otherwise
12        stipulate in writing. The motion must be presented to
13        the Circuit Court at the time of filing the judicial
14        review and called for hearing and ruled upon by the
15        court within 10 days thereafter.
16            (F) No county, city, town, township, incorporated
17        village, school district, body politic, or municipal
18        corporation against whom the Commission has rendered
19        an award for the payment of money shall be required to
20        provide to the Circuit Court collateral or guarantee of
21        payment of an award for commencement of judicial
22        review.
23            (G) The Treasurer's Office shall not be required to
24        post a bond when appealing on behalf of the Injured
25        Workers' Benefit Fund. No such summons shall issue
26        unless the one against whom the Commission shall have

 

 

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1        rendered an award for the payment of money shall upon
2        the filing of his written request for such summons file
3        with the clerk of the court a bond conditioned that if
4        he shall not successfully prosecute the review, he will
5        pay the award and the costs of the proceedings in the
6        courts. The amount of the bond shall be fixed by any
7        member of the Commission and the surety or sureties of
8        the bond shall be approved by the clerk of the court.
9        The acceptance of the bond by the clerk of the court
10        shall constitute evidence of his approval of the bond.
11        Every county, city, town, township, incorporated
12    village, school district, body politic or municipal
13    corporation against whom the Commission shall have
14    rendered an award for the payment of money shall not be
15    required to file a bond to secure the payment of the award
16    and the costs of the proceedings in the court to authorize
17    the court to issue such summons.
18        The court may confirm or set aside the decision of the
19    Commission. If the decision is set aside and the facts
20    found in the proceedings before the Commission are
21    sufficient, the court may enter such decision as is
22    justified by law, or may remand the cause to the Commission
23    for further proceedings and may state the questions
24    requiring further hearing, and give such other
25    instructions as may be proper. Appeals shall be taken to
26    the Appellate Court in accordance with Supreme Court Rules

 

 

HB5354- 110 -LRB100 17830 JLS 33010 b

1    22(g) and 303. Appeals shall be taken from the Appellate
2    Court to the Supreme Court in accordance with Supreme Court
3    Rule 315.
4        It shall be the duty of the clerk of any court
5    rendering a decision affecting or affirming an award of the
6    Commission to promptly furnish the Commission with a copy
7    of such decision, without charge.
8        The decision of a majority of the members of the panel
9    of the Commission, shall be considered the decision of the
10    Commission.
11    (g) Except in the case of a claim against the State of
12Illinois, either party may present a certified copy of the
13award of the Arbitrator, or a certified copy of the decision of
14the Commission when the same has become final, when no
15proceedings for review are pending, providing for the payment
16of compensation according to this Act, to the Circuit Court of
17the county in which such accident occurred or either of the
18parties are residents, whereupon the court shall enter a
19judgment in accordance therewith. In a case where the employer
20refuses to pay compensation according to such final award or
21such final decision upon which such judgment is entered the
22court shall in entering judgment thereon, tax as costs against
23him the reasonable costs and attorney fees in the arbitration
24proceedings and in the court entering the judgment for the
25person in whose favor the judgment is entered, which judgment
26and costs taxed as therein provided shall, until and unless set

 

 

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1aside, have the same effect as though duly entered in an action
2duly tried and determined by the court, and shall with like
3effect, be entered and docketed. The Circuit Court shall have
4power at any time upon application to make any such judgment
5conform to any modification required by any subsequent decision
6of the Supreme Court upon appeal, or as the result of any
7subsequent proceedings for review, as provided in this Act.
8    Judgment shall not be entered until 15 days' notice of the
9time and place of the application for the entry of judgment
10shall be served upon the employer by filing such notice with
11the Commission, which Commission shall, in case it has on file
12the address of the employer or the name and address of its
13agent upon whom notices may be served, immediately send a copy
14of the notice to the employer or such designated agent.
15    (h) An agreement or award under this Act providing for
16compensation in installments, may at any time within 18 months
17after such agreement or award be reviewed by the Commission at
18the request of either the employer or the employee, on the
19ground that the disability of the employee has subsequently
20recurred, increased, diminished or ended.
21    However, as to accidents occurring subsequent to July 1,
221955, which are covered by any agreement or award under this
23Act providing for compensation in installments made as a result
24of such accident, such agreement or award may at any time
25within 30 months, or 60 months in the case of an award under
26Section 8(d)1, after such agreement or award be reviewed by the

 

 

HB5354- 112 -LRB100 17830 JLS 33010 b

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

 

 

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

 

 

HB5354- 114 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 115 -LRB100 17830 JLS 33010 b

1the employer to respond shall not commence until the expiration
2of the allotted 30 days specified under Section 8.2(d). In case
3the employer or his or her insurance carrier shall without good
4and just cause fail, neglect, refuse, or unreasonably delay the
5payment of benefits under Section 8(a) or Section 8(b), the
6Arbitrator or the Commission shall allow to the employee
7additional compensation in the sum of $30 per day for each day
8that the benefits under Section 8(a) or Section 8(b) have been
9so withheld or refused, not to exceed $10,000. A delay in
10payment of 14 days or more shall create a rebuttable
11presumption of unreasonable delay.
12    (m) If the commission finds that an accidental injury was
13directly and proximately caused by the employer's wilful
14violation of a health and safety standard under the Health and
15Safety Act or the Occupational Safety and Health Act in force
16at the time of the accident, the arbitrator or the Commission
17shall allow to the injured employee or his dependents, as the
18case may be, additional compensation equal to 25% of the amount
19which otherwise would be payable under the provisions of this
20Act exclusive of this paragraph. The additional compensation
21herein provided shall be allowed by an appropriate increase in
22the applicable weekly compensation rate.
23    (n) After June 30, 1984, decisions of the Illinois Workers'
24Compensation Commission reviewing an award of an arbitrator of
25the Commission shall draw interest at a rate equal to the yield
26on indebtedness issued by the United States Government with a

 

 

HB5354- 116 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 117 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 118 -LRB100 17830 JLS 33010 b

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

 

 

HB5354- 119 -LRB100 17830 JLS 33010 b

1(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
2eff. 1-1-15.)
 
3    (820 ILCS 305/25.5)
4    Sec. 25.5. Unlawful acts; penalties.
5    (a) It is unlawful for any person, company, corporation,
6insurance carrier, healthcare provider, or other entity to:
7        (1) Intentionally present or cause to be presented any
8    false or fraudulent claim for the payment of any workers'
9    compensation benefit.
10        (2) Intentionally make or cause to be made any false or
11    fraudulent material statement or material representation
12    for the purpose of obtaining or denying any workers'
13    compensation benefit.
14        (3) Intentionally make or cause to be made any false or
15    fraudulent statements with regard to entitlement to
16    workers' compensation benefits with the intent to prevent
17    an injured worker from making a legitimate claim for any
18    workers' compensation benefits.
19        (4) Intentionally prepare or provide an invalid,
20    false, or counterfeit certificate of insurance as proof of
21    workers' compensation insurance.
22        (5) Intentionally make or cause to be made any false or
23    fraudulent material statement or material representation
24    for the purpose of obtaining workers' compensation
25    insurance at less than the proper amount rate for that

 

 

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

 

 

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1    A violation in which the value of the property obtained or
2    attempted to be obtained is $300 or less is a Class A
3    misdemeanor.
4        (2) A violation of paragraph (a)(4) or (a)(7) is a
5    Class 3 felony A violation in which the value of the
6    property obtained or attempted to be obtained is more than
7    $300 but not more than $10,000 is a Class 3 felony.
8        (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
9    (a)(6), or (a)(9) in which the value of the property
10    obtained or attempted to be obtained is $500 or less is a
11    Class A misdemeanor A violation in which the value of the
12    property obtained or attempted to be obtained is more than
13    $10,000 but not more than $100,000 is a Class 2 felony.
14        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
15    (a)(6), or (a)(9) in which the value of the property
16    obtained or attempted to be obtained is more than $500, but
17    not more than $10,000, is a Class 3 felony A violation in
18    which the value of the property obtained or attempted to be
19    obtained is more than $100,000 is a Class 1 felony.
20        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
21    (a)(6), or (a)(9) in which the value of the property
22    obtained or attempted to be obtained is more than $10,000,
23    but not more than $100,000, is a Class 2 felony.
24        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
25    (a)(6), or (a)(9) in which the value of the property
26    obtained or attempted to be obtained is more than $100,000

 

 

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1    is a Class 1 felony.
2        (7) A violation of paragraph (8) of subsection (a)
3    shall be punishable as the class of offense for which the
4    person convicted assisted, abetted, solicited, or
5    conspired to commit, as set forth in paragraphs (1) through
6    (6) of this subsection.
7        (8) (5) A person convicted under this Section shall be
8    ordered to pay monetary restitution to the insurance
9    company or self-insured entity or any other person for any
10    financial loss sustained as a result of a violation of this
11    Section, including any court costs and attorney fees. An
12    order of restitution also includes expenses incurred and
13    paid by the State of Illinois or an insurance company or
14    self-insured entity in connection with any medical
15    evaluation or treatment services.
16    For a violation of paragraph (a)(1) or (a)(2), the value of
17the property obtained or attempted to be obtained includes
18payments pursuant to the provisions of this Act as well as the
19amount paid for medical expenses. For a violation of paragraph
20(a)(5), the value of the property obtained or attempted to be
21obtained is the difference between the proper amount for the
22coverage sought or provided and the actual amount billed for
23workers' compensation insurance. For a violation of paragraph
24(a)(6), the value of the property obtained or attempted to be
25obtained is the difference between the proper amount of
26security required pursuant to Section 4 of this Act and the

 

 

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

 

 

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

 

 

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

 

 

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1public inspection, or to disclosure under the Freedom of
2Information Act for so long as the Director of Insurance deems
3reasonably necessary to complete the investigation, to protect
4the person investigated from unwarranted injury, or to be in
5the public interest. No officer, agent, or employee of the
6Department of Insurance is subject to subpoena in any civil or
7administrative action to testify concerning a matter of which
8they have knowledge under a pending fraud or insurance
9non-compliance investigation by the Department of Insurance.
10    No cause of action exists and no liability may be imposed,
11either civil or criminal, against the State, the Director of
12Insurance, any officer, agent, or employee of the Department of
13Insurance, or individuals employed or retained by the Director
14of Insurance, for an act or omission by them in the performance
15of a power or duty authorized by this Section, unless the act
16or omission was performed in bad faith and with intent to
17injure a particular person.
18    (e-5) The fraud and insurance non-compliance unit shall
19procure and implement a system utilizing advanced analytics
20inclusive of predictive modeling, data mining, social network
21analysis, and scoring algorithms for the detection and
22prevention of fraud, waste, and abuse on or before January 1,
232012. The fraud and insurance non-compliance unit shall procure
24this system using a request for proposals process governed by
25the Illinois Procurement Code and rules adopted under that
26Code. The fraud and insurance non-compliance unit shall provide

 

 

HB5354- 127 -LRB100 17830 JLS 33010 b

1a report to the President of the Senate, Speaker of the House
2of Representatives, Minority Leader of the House of
3Representatives, Minority Leader of the Senate, Governor,
4Chairman of the Commission, and Director of Insurance on or
5before July 1, 2012 and annually thereafter detailing its
6activities and providing recommendations regarding
7opportunities for additional fraud waste and abuse detection
8and prevention.
9    (f) Any person convicted of fraud related to workers'
10compensation pursuant to this Section shall be subject to the
11penalties prescribed in the Criminal Code of 2012 and shall be
12ineligible to receive or retain any compensation, disability,
13or medical benefits as defined in this Act if the compensation,
14disability, or medical benefits were owed or received as a
15result of fraud for which the recipient of the compensation,
16disability, or medical benefit was convicted. This subsection
17applies to accidental injuries or diseases that occur on or
18after the effective date of this amendatory Act of the 94th
19General Assembly.
20    (g) Civil liability. Any person convicted of fraud who
21knowingly obtains, attempts to obtain, or causes to be obtained
22any benefits under this Act by the making of a false claim or
23who knowingly misrepresents any material fact shall be civilly
24liable to the payor of benefits or the insurer or the payor's
25or insurer's subrogee or assignee in an amount equal to 3 times
26the value of the benefits or insurance coverage wrongfully

 

 

HB5354- 128 -LRB100 17830 JLS 33010 b

1obtained or twice the value of the benefits or insurance
2coverage attempted to be obtained, plus reasonable attorney's
3fees and expenses incurred by the payor or the payor's subrogee
4or assignee who successfully brings a claim under this
5subsection. This subsection applies to accidental injuries or
6diseases that occur on or after the effective date of this
7amendatory Act of the 94th General Assembly.
8    (h) The fraud and insurance non-compliance unit shall
9submit a written report on an annual basis to the Chairman of
10the Commission, the Workers' Compensation Advisory Board, the
11General Assembly, the Governor, and the Attorney General by
12January 1 and July 1 of each year. This report shall include,
13at the minimum, the following information:
14        (1) The number of allegations of insurance
15    non-compliance and fraud reported to the fraud and
16    insurance non-compliance unit.
17        (2) The source of the reported allegations
18    (individual, employer, or other).
19        (3) The number of allegations investigated by the fraud
20    and insurance non-compliance unit.
21        (4) The number of criminal referrals made in accordance
22    with this Section and the entity to which the referral was
23    made.
24        (5) All proceedings under this Section.
25(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
 

 

 

HB5354- 129 -LRB100 17830 JLS 33010 b

1    (820 ILCS 305/29.2)
2    Sec. 29.2. Insurance and self-insurance oversight.
3    (a) The Department of Insurance shall annually submit to
4the Governor, the Chairman of the Commission, the President of
5the Senate, the Speaker of the House of Representatives, the
6Minority Leader of the Senate, and the Minority Leader of the
7House of Representatives a written report that details the
8state of the workers' compensation insurance market in
9Illinois. The report shall be completed by April 1 of each
10year, beginning in 2012, or later if necessary data or analyses
11are only available to the Department at a later date. The
12report shall be posted on the Department of Insurance's
13Internet website. Information to be included in the report
14shall be for the preceding calendar year. The report shall
15include, at a minimum, the following:
16        (1) Gross premiums collected by workers' compensation
17    carriers in Illinois and the national rank of Illinois
18    based on premium volume.
19        (2) The number of insurance companies actively engaged
20    in Illinois in the workers' compensation insurance market
21    for the previous 10 years, including both holding companies
22    and subsidiaries or affiliates, and the national rank of
23    Illinois based on number of competing insurers.
24        (3) The total number of insured participants in the
25    Illinois workers' compensation assigned risk insurance
26    pool, and the size of the assigned risk pool as a

 

 

HB5354- 130 -LRB100 17830 JLS 33010 b

1    proportion of the total Illinois workers' compensation
2    insurance market.
3        (4) The advisory organization premium rate for
4    workers' compensation insurance in Illinois for the
5    previous 10 years, including a summary of the rates
6    utilized compared to the workers' compensation loss cost or
7    rate filing of a licensed rating organization year.
8        (5) The advisory organization prescribed assigned risk
9    pool premium rate.
10        (6) The total amount of indemnity payments made by
11    workers' compensation insurers in Illinois.
12        (7) The total amount of medical payments made by
13    workers' compensation insurers in Illinois, and the
14    national rank of Illinois based on average cost of medical
15    claims per injured worker.
16        (8) The gross profitability of workers' compensation
17    insurers in Illinois, and the national rank of Illinois
18    based on profitability of workers' compensation insurers.
19        (9) The loss ratio of workers' compensation insurers in
20    Illinois and the national rank of Illinois based on the
21    loss ratio of workers' compensation insurers. For purposes
22    of this loss ratio calculation, the denominator shall
23    include all premiums and other fees collected by workers'
24    compensation insurers and the numerator shall include the
25    total amount paid by the insurer for care or compensation
26    to injured workers.

 

 

HB5354- 131 -LRB100 17830 JLS 33010 b

1        (10) The growth of total paid indemnity benefits by
2    temporary total disability, scheduled and non-scheduled
3    permanent partial disability, and total disability.
4        (11) The number of injured workers receiving wage loss
5    differential awards and the average wage loss differential
6    award payout.
7        (12) Illinois' rank, relative to other states, for:
8            (i) the maximum and minimum temporary total
9        disability benefit level;
10            (ii) the maximum and minimum scheduled and
11        non-scheduled permanent partial disability benefit
12        level;
13            (iii) the maximum and minimum total disability
14        benefit level; and
15            (iv) the maximum and minimum death benefit level.
16        (13) The aggregate growth of medical benefit payout by
17    non-hospital providers and hospitals.
18        (14) The aggregate growth of medical utilization for
19    the top 10 most common injuries to specific body parts by
20    non-hospital providers and hospitals.
21        (15) The percentage of injured workers filing claims at
22    the Commission that are represented by an attorney.
23        (16) The total amount paid by injured workers for
24    attorney representation.
25    (a-5) The Commission shall annually submit to the Governor
26and the General Assembly a written report that details the

 

 

HB5354- 132 -LRB100 17830 JLS 33010 b

1state of self-insurance for workers' compensation in Illinois.
2The report shall be based on information currently collected by
3the Commission or the Department of Insurance from
4self-insurers as of the effective date of this amendatory Act
5of the 100th General Assembly. The report shall be completed by
6April 1 of each year, beginning in 2019. The report shall be
7posted on the Commission's Internet website. Information to be
8included in the report shall be for the preceding calendar
9year. The report shall include, at a minimum, the following in
10the aggregate:
11        (1) The number of employers that self-insure for
12    workers' compensation.
13        (2) The total number of employees covered by
14    self-insurance.
15        (3) The total amount of indemnity payments made by
16    self-insureds.
17        (4) The total amount of medical payments made by
18    self-insureds.
19        (5) The growth of total paid indemnity benefits by
20    temporary total disability, scheduled and non-scheduled
21    permanent partial disability, and total disability.
22        (6) Illinois' rank, relative to other states, for:
23            (i) the maximum and minimum temporary total
24        disability benefit levels;
25            (ii) the maximum and minimum scheduled and
26        non-scheduled permanent partial disability benefit

 

 

HB5354- 133 -LRB100 17830 JLS 33010 b

1        levels;
2            (iii) the maximum and minimum total disability
3        benefit levels; and
4            (iv) the maximum and minimum death benefit levels.
5        (7) The aggregate growth of medical benefit payouts by
6    non-hospital providers and hospitals. Any information
7    collected by the Commission from self-insureds is exempt
8    from public inspection and disclosure under the Freedom of
9    Information Act.
10    (b) The Director of Insurance shall promulgate rules
11requiring each insurer licensed to write workers' compensation
12coverage in the State to record and report the following
13information on an aggregate basis to the Department of
14Insurance before March 1 of each year, relating to claims in
15the State opened within the prior calendar year:
16        (1) The number of claims opened.
17        (2) The number of reported medical only claims.
18        (3) The number of contested claims.
19        (4) The number of claims for which the employee has
20    attorney representation.
21        (5) The number of claims with lost time and the number
22    of claims for which temporary total disability was paid.
23        (6) The number of claim adjusters employed to adjust
24    workers' compensation claims.
25        (7) The number of claims for which temporary total
26    disability was not paid within 14 days from the first full

 

 

HB5354- 134 -LRB100 17830 JLS 33010 b

1    day off, regardless of reason.
2        (8) The number of medical bills paid 60 days or later
3    from date of service and the average days paid on those
4    paid after 60 days for the previous calendar year.
5        (9) The number of claims in which in-house defense
6    counsel participated, and the total amount spent on
7    in-house legal services.
8        (10) The number of claims in which outside defense
9    counsel participated, and the total amount paid to outside
10    defense counsel.
11        (11) The total amount billed to employers for bill
12    review.
13        (12) The total amount billed to employers for fee
14    schedule savings.
15        (13) The total amount charged to employers for any and
16    all managed care fees.
17        (14) The number of claims involving in-house medical
18    nurse case management, and the total amount spent on
19    in-house medical nurse case management.
20        (15) The number of claims involving outside medical
21    nurse case management, and the total amount paid for
22    outside medical nurse case management.
23        (16) The total amount paid for Independent Medical
24    exams.
25        (17) The total amount spent on in-house Utilization
26    Review for the previous calendar year.

 

 

HB5354- 135 -LRB100 17830 JLS 33010 b

1        (18) The total amount paid for outside Utilization
2    Review for the previous calendar year.
3    The Department shall make the submitted information
4publicly available on the Department's Internet website or such
5other media as appropriate in a form useful for consumers.
6(Source: P.A. 97-18, eff. 6-28-11.)
 
7    Section 95. No acceleration or delay. Where this Act makes
8changes in a statute that is represented in this Act by text
9that is not yet or no longer in effect (for example, a Section
10represented by multiple versions), the use of that text does
11not accelerate or delay the taking effect of (i) the changes
12made by this Act or (ii) provisions derived from any other
13Public Act.