100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB0012

 

Introduced 1/11/2017, by Sen. Michael Connelly

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: accidental injuries considered to be "arising out of and in the course of the employment" if an employee is required to travel away from the employer's premises; the maximum compensation rate for a period of temporary total incapacity; wage differential benefits to professional athletes; limitations on the number of chiropractic, occupational therapy, or physical therapy visits an injured worker may receive for injuries; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; the duties of the Workers' Compensation Edit, Alignment, and Reform Commission; additional compensation awards where there has been a vexatious delay in the authorization of medical treatment or the payment or intentional underpayment of compensation; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately, but this Act does not take effect at all unless Senate Bills 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 13 of the 100th General Assembly become law.


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

 

 

A BILL FOR

 

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1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. The Freedom of Information Act is amended by
5changing Section 7.5 as follows:
 
6    (5 ILCS 140/7.5)
7    Sec. 7.5. Statutory exemptions. To the extent provided for
8by the statutes referenced below, the following shall be exempt
9from inspection and copying:
10        (a) All information determined to be confidential
11    under Section 4002 of the Technology Advancement and
12    Development Act.
13        (b) Library circulation and order records identifying
14    library users with specific materials under the Library
15    Records Confidentiality Act.
16        (c) Applications, related documents, and medical
17    records received by the Experimental Organ Transplantation
18    Procedures Board and any and all documents or other records
19    prepared by the Experimental Organ Transplantation
20    Procedures Board or its staff relating to applications it
21    has received.
22        (d) Information and records held by the Department of
23    Public Health and its authorized representatives relating

 

 

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

 

 

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1        (k) Law enforcement officer identification information
2    or driver identification information compiled by a law
3    enforcement agency or the Department of Transportation
4    under Section 11-212 of the Illinois Vehicle Code.
5        (l) Records and information provided to a residential
6    health care facility resident sexual assault and death
7    review team or the Executive Council under the Abuse
8    Prevention Review Team Act.
9        (m) Information provided to the predatory lending
10    database created pursuant to Article 3 of the Residential
11    Real Property Disclosure Act, except to the extent
12    authorized under that Article.
13        (n) Defense budgets and petitions for certification of
14    compensation and expenses for court appointed trial
15    counsel as provided under Sections 10 and 15 of the Capital
16    Crimes Litigation Act. This subsection (n) shall apply
17    until the conclusion of the trial of the case, even if the
18    prosecution chooses not to pursue the death penalty prior
19    to trial or sentencing.
20        (o) Information that is prohibited from being
21    disclosed under Section 4 of the Illinois Health and
22    Hazardous Substances Registry Act.
23        (p) Security portions of system safety program plans,
24    investigation reports, surveys, schedules, lists, data, or
25    information compiled, collected, or prepared by or for the
26    Regional Transportation Authority under Section 2.11 of

 

 

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

 

 

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

 

 

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1    Act.
2        (aa) Information which is exempted from disclosure
3    under Section 2.37 of the Wildlife Code.
4        (bb) Information which is or was prohibited from
5    disclosure by the Juvenile Court Act of 1987.
6        (cc) Recordings made under the Law Enforcement
7    Officer-Worn Body Camera Act, except to the extent
8    authorized under that Act.
9        (dd) Information that is prohibited from being
10    disclosed under Section 45 of the Condominium and Common
11    Interest Community Ombudsperson Act.
12        (ee) (dd) Information that is exempted from disclosure
13    under Section 30.1 of the Pharmacy Practice Act.
14        (ff) Information the disclosure of which is restricted
15    and exempted under Sections 25.5 and 29.2 of the Workers'
16    Compensation Act.
17(Source: P.A. 98-49, eff. 7-1-13; 98-63, eff. 7-9-13; 98-756,
18eff. 7-16-14; 98-1039, eff. 8-25-14; 98-1045, eff. 8-25-14;
1999-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, eff. 1-1-16;
2099-642, eff. 7-28-16; 99-776, eff. 8-12-16; 99-863, eff.
218-19-16; revised 9-1-16.)
 
22    Section 3. The Criminal Code of 2012 is amended by adding
23Section 17-10.4 as follows:
 
24    (720 ILCS 5/17-10.4 new)

 

 

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1    Sec. 17-10.4. Workers' compensation fraud.
2    (a) It is unlawful for any person, company, corporation,
3insurance carrier, health care provider, or other entity to:
4        (1) Intentionally present or cause to be presented any
5    false or fraudulent claim for the payment of any workers'
6    compensation benefit.
7        (2) Intentionally make or cause to be made any false or
8    fraudulent material statement or material representation
9    for the purpose of obtaining or denying any workers'
10    compensation benefit.
11        (3) Intentionally make or cause to be made any false or
12    fraudulent statements with regard to entitlement to
13    workers' compensation benefits with the intent to prevent
14    an injured worker from making a legitimate claim for any
15    workers' compensation benefit.
16        (4) Intentionally prepare or provide an invalid,
17    false, or counterfeit certificate of insurance as proof of
18    workers' compensation insurance.
19        (5) Intentionally make or cause to be made any false or
20    fraudulent material statement or material representation
21    for the purpose of obtaining workers' compensation
22    insurance at less than the proper amount for that
23    insurance.
24        (6) Intentionally make or cause to be made any false or
25    fraudulent material statement or material representation
26    on an initial or renewal self-insurance application or

 

 

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

 

 

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1    obtained or attempted to be obtained is $500 or less is a
2    Class A misdemeanor.
3        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
4    (a)(6), or (a)(8) in which the value of the property
5    obtained or attempted to be obtained is more than $500 but
6    not more than $10,000 is a Class 3 felony.
7        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
8    (a)(6), or (a)(8) in which the value of the property
9    obtained or attempted to be obtained is more than $10,000
10    but not more than $100,000 is a Class 2 felony.
11        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
12    (a)(6), or (a)(8) in which the value of the property
13    obtained or attempted to be obtained is more than $100,000
14    is a Class 1 felony.
15        (7) A violation of paragraph (9) of subsection (a)
16    shall be punishable as the Class of offense for which the
17    person convicted assisted, abetted, solicited, or
18    conspired to commit, as set forth in paragraphs (1) through
19    (6) of this subsection.
20        (8) A person convicted under this Section shall be
21    ordered to pay monetary restitution to the insurance
22    company or self-insured entity or any other person for any
23    financial loss sustained as a result of a violation of this
24    Section, including any court costs and attorney fees. An
25    order of restitution also includes expenses incurred and
26    paid by the State of Illinois or an insurance company or

 

 

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1    self-insured entity in connection with any medical
2    evaluation or treatment services.
3    For a violation of paragraph (a)(1) or (a)(2), the value of
4the property obtained or attempted to be obtained includes
5payments pursuant to the provisions of the Workers'
6Compensation Act as well as the amount paid for medical
7expenses. For a violation of paragraph (a)(5), the value of the
8property obtained or attempted to be obtained is the difference
9between the proper amount for the coverage sought or provided
10and the actual amount billed for workers' compensation
11insurance. For a violation of paragraph (a)(6), the value of
12the property obtained or attempted to be obtained is the
13difference between the proper amount of security required
14pursuant to Section 4 of the Workers' Compensation Act and the
15amount furnished pursuant the false or fraudulent statements or
16representations. Notwithstanding the foregoing, an insurance
17company, self-insured entity, or any other person suffering
18financial loss sustained as a result of violation of this
19Section may seek restitution, including court costs and
20attorney's fees, in a civil action in a court of competent
21jurisdiction.
 
22    Section 5. The Workers' Compensation Act is amended by
23changing Sections 1, 8, 8.1b, 8.2, 8.2a, 8.7, 14, 19, 25.5, and
2429.2 and by adding Section 14.3 as follows:
 

 

 

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1    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
2    Sec. 1. This Act may be cited as the Workers' Compensation
3Act.
4    (a) The term "employer" as used in this Act means:
5    1. The State and each county, city, town, township,
6incorporated village, school district, body politic, or
7municipal corporation therein.
8    2. Every person, firm, public or private corporation,
9including hospitals, public service, eleemosynary, religious
10or charitable corporations or associations who has any person
11in service or under any contract for hire, express or implied,
12oral or written, and who is engaged in any of the enterprises
13or businesses enumerated in Section 3 of this Act, or who at or
14prior to the time of the accident to the employee for which
15compensation under this Act may be claimed, has in the manner
16provided in this Act elected to become subject to the
17provisions of this Act, and who has not, prior to such
18accident, effected a withdrawal of such election in the manner
19provided in this Act.
20    3. Any one engaging in any business or enterprise referred
21to in subsections 1 and 2 of Section 3 of this Act who
22undertakes to do any work enumerated therein, is liable to pay
23compensation to his own immediate employees in accordance with
24the provisions of this Act, and in addition thereto if he
25directly or indirectly engages any contractor whether
26principal or sub-contractor to do any such work, he is liable

 

 

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

 

 

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

 

 

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1    An employer whose business or enterprise or a substantial
2part thereof consists of hiring, procuring or furnishing
3employees to or for other employers operating under and subject
4to the provisions of this Act for the performance of the work
5of such other employers and who pays such employees their
6salary or wages notwithstanding that they are doing the work of
7such other employers shall be deemed a loaning employer within
8the meaning and provisions of this Section.
9    (b) The term "employee" as used in this Act means:
10    1. Every person in the service of the State, including
11members of the General Assembly, members of the Commerce
12Commission, members of the Illinois Workers' Compensation
13Commission, and all persons in the service of the University of
14Illinois, county, including deputy sheriffs and assistant
15state's attorneys, city, town, township, incorporated village
16or school district, body politic, or municipal corporation
17therein, whether by election, under appointment or contract of
18hire, express or implied, oral or written, including all
19members of the Illinois National Guard while on active duty in
20the service of the State, and all probation personnel of the
21Juvenile Court appointed pursuant to Article VI of the Juvenile
22Court Act of 1987, and including any official of the State, any
23county, city, town, township, incorporated village, school
24district, body politic or municipal corporation therein except
25any duly appointed member of a police department in any city
26whose population exceeds 500,000 according to the last Federal

 

 

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1or State census, and except any member of a fire insurance
2patrol maintained by a board of underwriters in this State. A
3duly appointed member of a fire department in any city, the
4population of which exceeds 500,000 according to the last
5federal or State census, is an employee under this Act only
6with respect to claims brought under paragraph (c) of Section
78.
8    One employed by a contractor who has contracted with the
9State, or a county, city, town, township, incorporated village,
10school district, body politic or municipal corporation
11therein, through its representatives, is not considered as an
12employee of the State, county, city, town, township,
13incorporated village, school district, body politic or
14municipal corporation which made the contract.
15    2. Every person in the service of another under any
16contract of hire, express or implied, oral or written,
17including persons whose employment is outside of the State of
18Illinois where the contract of hire is made within the State of
19Illinois, persons whose employment results in fatal or
20non-fatal injuries within the State of Illinois where the
21contract of hire is made outside of the State of Illinois, and
22persons whose employment is principally localized within the
23State of Illinois, regardless of the place of the accident or
24the place where the contract of hire was made, and including
25aliens, and minors who, for the purpose of this Act are
26considered the same and have the same power to contract,

 

 

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1receive payments and give quittances therefor, as adult
2employees.
3    3. Every sole proprietor and every partner of a business
4may elect to be covered by this Act.
5    An employee or his dependents under this Act who shall have
6a cause of action by reason of any injury, disablement or death
7arising out of and in the course of his employment may elect to
8pursue his remedy in the State where injured or disabled, or in
9the State where the contract of hire is made, or in the State
10where the employment is principally localized.
11    However, any employer may elect to provide and pay
12compensation to any employee other than those engaged in the
13usual course of the trade, business, profession or occupation
14of the employer by complying with Sections 2 and 4 of this Act.
15Employees are not included within the provisions of this Act
16when excluded by the laws of the United States relating to
17liability of employers to their employees for personal injuries
18where such laws are held to be exclusive.
19    The term "employee" does not include persons performing
20services as real estate broker, broker-salesman, or salesman
21when such persons are paid by commission only.
22    (c) "Commission" means the Industrial Commission created
23by Section 5 of "The Civil Administrative Code of Illinois",
24approved March 7, 1917, as amended, or the Illinois Workers'
25Compensation Commission created by Section 13 of this Act.
26    (d) To obtain compensation under this Act, an employee

 

 

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1bears the burden of showing, by a preponderance of the
2evidence, that he or she has sustained accidental injuries
3arising out of and in the course of the employment.
4    (e) Traveling employees.
5        (1) Except as otherwise provided under this Section,
6    accidental injuries sustained while traveling to or from
7    work do not arise out of and in the course of employment.
8        (2) Accidental injuries are considered to be "arising
9    out of and in the course of the employment" where an
10    employee is required to travel away from his or her
11    employer's premises in order to perform his or her job and
12    when the conduct in which he or she was engaged at the time
13    of the injury is reasonable and when that conduct might
14    have been anticipated or foreseen by the employer.
15        (3) Accidental injuries while traveling do not occur in
16    the course of employment if the accident occurs during a
17    purely personal deviation or personal errand, unless such
18    deviation or errand is insubstantial.
19        (4) In determining whether an employee is required to
20    travel away from his or her employer's premises in order to
21    perform his or her job, along with all other relevant
22    factors, the following factors may be considered: whether
23    the employer had knowledge that the employee may be
24    required to travel to perform the job; whether the employer
25    furnished any mode of transportation to or from the
26    employee; whether the employee received or the employer

 

 

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1    paid or agreed to pay any remuneration or reimbursement for
2    costs or expenses of any form of travel; whether the
3    employer in any way directed the course or method of
4    travel; whether the employer in any way assisted the
5    employee in making any travel arrangements; whether the
6    employer furnished lodging or in any way reimbursed the
7    employee for lodging; or whether the employer received any
8    benefit from the employee traveling.
9    (f) Neutral risks. Accidental injuries resulting from a
10neutral risk arise out of and in the course of the employment
11if the employment quantitatively or qualitatively contributes
12in any way to the neutral risk.
13    (g) Intervening cause.
14        (1) Except as otherwise provided under this Section,
15    every natural consequence that flows from an injury that
16    arose out of and in the course of employment is compensable
17    under this Act. A work-related injury need not be the sole
18    causative factor or the primary causative factor as long as
19    it was a causative factor in the resulting condition such
20    that the condition would not have occurred but for the
21    work-related injury.
22        (2) Where an intervening cause breaks the chain of
23    causation, any subsequent consequence flowing from the
24    intervening cause is not compensable under this Act. An
25    intervening cause is a cause that completely breaks the
26    chain of causation.

 

 

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1        (3) Notwithstanding any provision of this Act to the
2    contrary, if an employee, who sustained an accidental
3    injury compensable under this Act which results in a
4    responsibility to pay compensation on the part of the
5    employer, subsequently sustains another injury due to his
6    or her own intentional conduct or negligence that
7    accelerates, aggravates, or worsens the effects or
8    disability of the first injury in any manner, regardless of
9    whether or not he or she has fully recovered from the
10    effects of the first injury, the employer's responsibility
11    to pay compensation to the employee or his or her
12    dependents shall not be increased due to the effects or
13    disability resulting from the subsequent injury.
14(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
15eff. 7-13-12.)
 
16    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
17    Sec. 8. The amount of compensation which shall be paid to
18the employee for an accidental injury not resulting in death
19is:
20    (a) The employer shall provide and pay the negotiated rate,
21if applicable, or the lesser of the health care provider's
22actual charges or according to a fee schedule, subject to
23Section 8.2, in effect at the time the service was rendered for
24all the necessary first aid, medical and surgical services, and
25all necessary medical, surgical and hospital services

 

 

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1thereafter incurred, limited, however, to that which is
2reasonably required to cure or relieve from the effects of the
3accidental injury, even if a health care provider sells,
4transfers, or otherwise assigns an account receivable for
5procedures, treatments, or services covered under this Act. If
6the employer does not dispute payment of first aid, medical,
7surgical, and hospital services, the employer shall make such
8payment to the provider on behalf of the employee. The employer
9shall also pay for treatment, instruction and training
10necessary for the physical, mental and vocational
11rehabilitation of the employee, including all maintenance
12costs and expenses incidental thereto. If as a result of the
13injury the employee is unable to be self-sufficient the
14employer shall further pay for such maintenance or
15institutional care as shall be required.
16    The employee may at any time elect to secure his own
17physician, surgeon and hospital services at the employer's
18expense, or,
19    Upon agreement between the employer and the employees, or
20the employees' exclusive representative, and subject to the
21approval of the Illinois Workers' Compensation Commission, the
22employer shall maintain a list of physicians, to be known as a
23Panel of Physicians, who are accessible to the employees. The
24employer shall post this list in a place or places easily
25accessible to his employees. The employee shall have the right
26to make an alternative choice of physician from such Panel if

 

 

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

 

 

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1program by the employer.
2    The maintenance benefit shall not be less than the
3temporary total disability rate determined for the employee. In
4addition, maintenance shall include costs and expenses
5incidental to the vocational rehabilitation program.
6    When the employee is working light duty on a part-time
7basis or full-time basis and earns less than he or she would be
8earning if employed in the full capacity of the job or jobs,
9then the employee shall be entitled to temporary partial
10disability benefits. Temporary partial disability benefits
11shall be equal to two-thirds of the difference between the
12average amount that the employee would be able to earn in the
13full performance of his or her duties in the occupation in
14which he or she was engaged at the time of accident and the
15gross amount which he or she is earning in the modified job
16provided to the employee by the employer or in any other job
17that the employee is working.
18    Every hospital, physician, surgeon or other person
19rendering treatment or services in accordance with the
20provisions of this Section shall upon written request furnish
21full and complete reports thereof to, and permit their records
22to be copied by, the employer, the employee or his dependents,
23as the case may be, or any other party to any proceeding for
24compensation before the Commission, or their attorneys.
25    Notwithstanding the foregoing, the employer's liability to
26pay for such medical services selected by the employee shall be

 

 

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

 

 

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1    97-18) and only when an employer has an approved preferred
2    provider program pursuant to Section 8.1a on the date the
3    employee sustained his or her accidental injuries:
4            (A) The employer shall, in writing, on a form
5        promulgated by the Commission, inform the employee of
6        the preferred provider program;
7            (B) Subsequent to the report of an injury by an
8        employee, the employee may choose in writing at any
9        time to decline the preferred provider program, in
10        which case that would constitute one of the two choices
11        of medical providers to which the employee is entitled
12        under subsection (a)(2) or (a)(3); and
13            (C) Prior to the report of an injury by an
14        employee, when an employee chooses non-emergency
15        treatment from a provider not within the preferred
16        provider program, that would constitute the employee's
17        one choice of medical providers to which the employee
18        is entitled under subsection (a)(2) or (a)(3).
19    When an employer and employee so agree in writing, nothing
20in this Act prevents an employee whose injury or disability has
21been established under this Act, from relying in good faith, on
22treatment by prayer or spiritual means alone, in accordance
23with the tenets and practice of a recognized church or
24religious denomination, by a duly accredited practitioner
25thereof, and having nursing services appropriate therewith,
26without suffering loss or diminution of the compensation

 

 

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1benefits under this Act. However, the employee shall submit to
2all physical examinations required by this Act. The cost of
3such treatment and nursing care shall be paid by the employee
4unless the employer agrees to make such payment.
5    Where the accidental injury results in the amputation of an
6arm, hand, leg or foot, or the enucleation of an eye, or the
7loss of any of the natural teeth, the employer shall furnish an
8artificial of any such members lost or damaged in accidental
9injury arising out of and in the course of employment, and
10shall also furnish the necessary braces in all proper and
11necessary cases. In cases of the loss of a member or members by
12amputation, the employer shall, whenever necessary, maintain
13in good repair, refit or replace the artificial limbs during
14the lifetime of the employee. Where the accidental injury
15accompanied by physical injury results in damage to a denture,
16eye glasses or contact eye lenses, or where the accidental
17injury results in damage to an artificial member, the employer
18shall replace or repair such denture, glasses, lenses, or
19artificial member.
20    The furnishing by the employer of any such services or
21appliances is not an admission of liability on the part of the
22employer to pay compensation.
23    The furnishing of any such services or appliances or the
24servicing thereof by the employer is not the payment of
25compensation.
26    (b) If the period of temporary total incapacity for work

 

 

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

 

 

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

 

 

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

 

 

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1    Insurance Act during such period.
2        The maximum weekly compensation rate, for the period
3    January 1, 1981 through December 31, 1983, except as
4    hereinafter provided, shall be 100% of the State's average
5    weekly wage in covered industries under the Unemployment
6    Insurance Act in effect on January 1, 1981. Effective
7    January 1, 1984 and on January 1, of each year thereafter
8    the maximum weekly compensation rate, except as
9    hereinafter provided, shall be determined as follows: if
10    during the preceding 12 month period there shall have been
11    an increase in the State's average weekly wage in covered
12    industries under the Unemployment Insurance Act, the
13    weekly compensation rate shall be proportionately
14    increased by the same percentage as the percentage of
15    increase in the State's average weekly wage in covered
16    industries under the Unemployment Insurance Act during
17    such period.
18        The maximum compensation rate for the period July 1,
19    2017 through June 30, 2021, except as hereinafter provided,
20    shall be $755.22. Effective July 1, 2021 and on July 1 of
21    each year thereafter the maximum weekly compensation rate,
22    except as hereinafter provided, shall be determined as
23    follows: if during the preceding 12-month period there
24    shall have been an increase in the State's average weekly
25    wage in covered industries under the Unemployment
26    Insurance Act, the weekly compensation rate shall be

 

 

SB0012- 30 -LRB100 06318 KTG 16356 b

1    proportionately increased by the same percentage as the
2    percentage of increase in the State's average weekly wage
3    in covered industries under the Unemployment Insurance Act
4    during such period.
5        From July 1, 1977 and thereafter such maximum weekly
6    compensation rate in death cases under Section 7, and
7    permanent total disability cases under paragraph (f) or
8    subparagraph 18 of paragraph (3) of this Section and for
9    temporary total disability under paragraph (b) of this
10    Section and for amputation of a member or enucleation of an
11    eye under paragraph (e) of this Section shall be increased
12    to 133-1/3% of the State's average weekly wage in covered
13    industries under the Unemployment Insurance Act.
14        For injuries occurring on or after February 1, 2006,
15    the maximum weekly benefit under paragraph (d)1 of this
16    Section shall be 100% of the State's average weekly wage in
17    covered industries under the Unemployment Insurance Act.
18        4.1. Any provision herein to the contrary
19    notwithstanding, the weekly compensation rate for
20    compensation payments under subparagraph 18 of paragraph
21    (e) of this Section and under paragraph (f) of this Section
22    and under paragraph (a) of Section 7 and for amputation of
23    a member or enucleation of an eye under paragraph (e) of
24    this Section, shall in no event be less than 50% of the
25    State's average weekly wage in covered industries under the
26    Unemployment Insurance Act.

 

 

SB0012- 31 -LRB100 06318 KTG 16356 b

1        4.2. Any provision to the contrary notwithstanding,
2    the total compensation payable under Section 7 shall not
3    exceed the greater of $500,000 or 25 years.
4        5. For the purpose of this Section this State's average
5    weekly wage in covered industries under the Unemployment
6    Insurance Act on July 1, 1975 is hereby fixed at $228.16
7    per week and the computation of compensation rates shall be
8    based on the aforesaid average weekly wage until modified
9    as hereinafter provided.
10        6. The Department of Employment Security of the State
11    shall on or before the first day of December, 1977, and on
12    or before the first day of June, 1978, and on the first day
13    of each December and June of each year thereafter, publish
14    the State's average weekly wage in covered industries under
15    the Unemployment Insurance Act and the Illinois Workers'
16    Compensation Commission shall on the 15th day of January,
17    1978 and on the 15th day of July, 1978 and on the 15th day
18    of each January and July of each year thereafter, post and
19    publish the State's average weekly wage in covered
20    industries under the Unemployment Insurance Act as last
21    determined and published by the Department of Employment
22    Security. The amount when so posted and published shall be
23    conclusive and shall be applicable as the basis of
24    computation of compensation rates until the next posting
25    and publication as aforesaid.
26        7. The payment of compensation by an employer or his

 

 

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1    insurance carrier to an injured employee shall not
2    constitute an admission of the employer's liability to pay
3    compensation.
4    (c) For any serious and permanent disfigurement to the
5hand, head, face, neck, arm, leg below the knee or the chest
6above the axillary line, the employee is entitled to
7compensation for such disfigurement, the amount determined by
8agreement at any time or by arbitration under this Act, at a
9hearing not less than 6 months after the date of the accidental
10injury, which amount shall not exceed 150 weeks (if the
11accidental injury occurs on or after the effective date of this
12amendatory Act of the 94th General Assembly but before February
131, 2006) or 162 weeks (if the accidental injury occurs on or
14after February 1, 2006) at the applicable rate provided in
15subparagraph 2.1 of paragraph (b) of this Section.
16    No compensation is payable under this paragraph where
17compensation is payable under paragraphs (d), (e) or (f) of
18this Section.
19    A duly appointed member of a fire department in a city, the
20population of which exceeds 500,000 according to the last
21federal or State census, is eligible for compensation under
22this paragraph only where such serious and permanent
23disfigurement results from burns.
24    (d) 1. If, after the accidental injury has been sustained,
25the employee as a result thereof becomes partially
26incapacitated from pursuing his usual and customary line of

 

 

SB0012- 33 -LRB100 06318 KTG 16356 b

1employment, he shall, except in cases compensated under the
2specific schedule set forth in paragraph (e) of this Section,
3receive compensation for the duration of his disability,
4subject to the limitations as to maximum amounts fixed in
5paragraph (b) of this Section, equal to 66-2/3% of the
6difference between the average amount which he would be able to
7earn in the full performance of his duties in the occupation in
8which he was engaged at the time of the accident and the
9average amount which he is earning or is able to earn in some
10suitable employment or business after the accident. For
11accidental injuries that occur on or after September 1, 2011,
12an award for wage differential under this subsection shall be
13effective only until the employee reaches the age of 67 or 5
14years from the date the award becomes final, whichever is
15later.
16    For accidental injuries involving professional athletes
17that occur on or after the effective date of this amendatory
18Act of the 100th General Assembly, an award for wage
19differential under this subsection shall be effective for the
20expected remaining duration of the employee's professional
21sports athletic career. As used in this paragraph (d)1,
22"professional athlete" means an individual whose employer is a
23professional athletic team that is based in Illinois,
24including, but not limited to, any professional baseball,
25basketball, football, soccer, or hockey team based in Illinois
26and who derives the majority of his or her income from playing

 

 

SB0012- 34 -LRB100 06318 KTG 16356 b

1athletics for the professional athletic team. The expected
2remaining duration of an employee's professional sports
3athletic career shall continue until the employee reaches the
4age of 35 or for a period of 5 years from the date of the
5injury, whichever is later, unless the employer or employee is
6able to successfully prove, by a preponderance of the evidence,
7that the expected remaining duration of such employee's
8professional sports athletic career has a shorter or longer
9duration.
10    2. If, as a result of the accident, the employee sustains
11serious and permanent injuries not covered by paragraphs (c)
12and (e) of this Section or having sustained injuries covered by
13the aforesaid paragraphs (c) and (e), he shall have sustained
14in addition thereto other injuries which injuries do not
15incapacitate him from pursuing the duties of his employment but
16which would disable him from pursuing other suitable
17occupations, or which have otherwise resulted in physical
18impairment; or if such injuries partially incapacitate him from
19pursuing the duties of his usual and customary line of
20employment but do not result in an impairment of earning
21capacity, or having resulted in an impairment of earning
22capacity, the employee elects to waive his right to recover
23under the foregoing subparagraph 1 of paragraph (d) of this
24Section then in any of the foregoing events, he shall receive
25in addition to compensation for temporary total disability
26under paragraph (b) of this Section, compensation at the rate

 

 

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1provided in subparagraph 2.1 of paragraph (b) of this Section
2for that percentage of 500 weeks that the partial disability
3resulting from the injuries covered by this paragraph bears to
4total disability. If the employee shall have sustained a
5fracture of one or more vertebra or fracture of the skull, the
6amount of compensation allowed under this Section shall be not
7less than 6 weeks for a fractured skull and 6 weeks for each
8fractured vertebra, and in the event the employee shall have
9sustained a fracture of any of the following facial bones:
10nasal, lachrymal, vomer, zygoma, maxilla, palatine or
11mandible, the amount of compensation allowed under this Section
12shall be not less than 2 weeks for each such fractured bone,
13and for a fracture of each transverse process not less than 3
14weeks. In the event such injuries shall result in the loss of a
15kidney, spleen or lung, the amount of compensation allowed
16under this Section shall be not less than 10 weeks for each
17such organ. Compensation awarded under this subparagraph 2
18shall not take into consideration injuries covered under
19paragraphs (c) and (e) of this Section and the compensation
20provided in this paragraph shall not affect the employee's
21right to compensation payable under paragraphs (b), (c) and (e)
22of this Section for the disabilities therein covered.
23    (e) For accidental injuries in the following schedule, the
24employee shall receive compensation for the period of temporary
25total incapacity for work resulting from such accidental
26injury, under subparagraph 1 of paragraph (b) of this Section,

 

 

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1and shall receive in addition thereto compensation for a
2further period for the specific loss herein mentioned, but
3shall not receive any compensation under any other provisions
4of this Act. The following listed amounts apply to either the
5loss of or the permanent and complete loss of use of the member
6specified, such compensation for the length of time as follows:
7        1. Thumb-
8            70 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            76 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        2. First, or index finger-
14            40 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            43 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        3. Second, or middle finger-
20            35 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            38 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        4. Third, or ring finger-
26            25 weeks if the accidental injury occurs on or

 

 

SB0012- 37 -LRB100 06318 KTG 16356 b

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            27 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        5. Fourth, or little finger-
6            20 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            22 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        6. Great toe-
12            35 weeks if the accidental injury occurs on or
13        after the effective date of this amendatory Act of the
14        94th General Assembly but before February 1, 2006.
15            38 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        7. Each toe other than great toe-
18            12 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            13 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        8. The loss of the first or distal phalanx of the thumb
24    or of any finger or toe shall be considered to be equal to
25    the loss of one-half of such thumb, finger or toe and the
26    compensation payable shall be one-half of the amount above

 

 

SB0012- 38 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 39 -LRB100 06318 KTG 16356 b

1        10. Arm-
2            235 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            253 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        Where an accidental injury results in the amputation of
8    an arm below the elbow, such injury shall be compensated as
9    a loss of an arm. Where an accidental injury results in the
10    amputation of an arm above the elbow, compensation for an
11    additional 15 weeks (if the accidental injury occurs on or
12    after the effective date of this amendatory Act of the 94th
13    General Assembly but before February 1, 2006) or an
14    additional 17 weeks (if the accidental injury occurs on or
15    after February 1, 2006) shall be paid, except where the
16    accidental injury results in the amputation of an arm at
17    the shoulder joint, or so close to shoulder joint that an
18    artificial arm cannot be used, or results in the
19    disarticulation of an arm at the shoulder joint, in which
20    case compensation for an additional 65 weeks (if the
21    accidental injury occurs on or after the effective date of
22    this amendatory Act of the 94th General Assembly but before
23    February 1, 2006) or an additional 70 weeks (if the
24    accidental injury occurs on or after February 1, 2006)
25    shall be paid.
26        For purposes of awards under this subdivision (e),

 

 

SB0012- 40 -LRB100 06318 KTG 16356 b

1    injuries to the shoulder shall be considered injuries to
2    part of the arm. The foregoing change made by this
3    amendatory Act of the 100th General Assembly to this
4    subdivision (e)10 of this Section 8 is declarative of
5    existing law and is not a new enactment.
6        11. Foot-
7            155 weeks if the accidental injury occurs on or
8        after the effective date of this amendatory Act of the
9        94th General Assembly but before February 1, 2006.
10            167 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        12. Leg-
13            200 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            215 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        Where an accidental injury results in the amputation of
19    a leg below the knee, such injury shall be compensated as
20    loss of a leg. Where an accidental injury results in the
21    amputation of a leg above the knee, compensation for an
22    additional 25 weeks (if the accidental injury occurs on or
23    after the effective date of this amendatory Act of the 94th
24    General Assembly but before February 1, 2006) or an
25    additional 27 weeks (if the accidental injury occurs on or
26    after February 1, 2006) shall be paid, except where the

 

 

SB0012- 41 -LRB100 06318 KTG 16356 b

1    accidental injury results in the amputation of a leg at the
2    hip joint, or so close to the hip joint that an artificial
3    leg cannot be used, or results in the disarticulation of a
4    leg at the hip joint, in which case compensation for an
5    additional 75 weeks (if the accidental injury occurs on or
6    after the effective date of this amendatory Act of the 94th
7    General Assembly but before February 1, 2006) or an
8    additional 81 weeks (if the accidental injury occurs on or
9    after February 1, 2006) shall be paid.
10        For purposes of awards under this subdivision (e),
11    injuries to the hip shall be considered injuries to part of
12    the leg. The foregoing change made by this amendatory Act
13    of the 100th General Assembly to this subdivision (e)12 of
14    this Section 8 is declarative of existing law and is not a
15    new enactment.
16        13. Eye-
17            150 weeks if the accidental injury occurs on or
18        after the effective date of this amendatory Act of the
19        94th General Assembly but before February 1, 2006.
20            162 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        Where an accidental injury results in the enucleation
23    of an eye, compensation for an additional 10 weeks (if the
24    accidental injury occurs on or after the effective date of
25    this amendatory Act of the 94th General Assembly but before
26    February 1, 2006) or an additional 11 weeks (if the

 

 

SB0012- 42 -LRB100 06318 KTG 16356 b

1    accidental injury occurs on or after February 1, 2006)
2    shall be paid.
3        14. Loss of hearing of one ear-
4            50 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            54 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        Total and permanent loss of hearing of both ears-
10            200 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            215 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        15. Testicle-
16            50 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            54 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        Both testicles-
22            150 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            162 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

SB0012- 43 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 44 -LRB100 06318 KTG 16356 b

1        shall constitute and be total or 100% compensable
2        hearing loss.
3            (c) In measuring hearing impairment, the lowest
4        measured losses in each of the 3 frequencies shall be
5        added together and divided by 3 to determine the
6        average decibel loss. For every decibel of loss
7        exceeding 30 decibels an allowance of 1.82% shall be
8        made up to the maximum of 100% which is reached at 85
9        decibels.
10            (d) If a hearing loss is established to have
11        existed on July 1, 1975 by audiometric testing the
12        employer shall not be liable for the previous loss so
13        established nor shall he be liable for any loss for
14        which compensation has been paid or awarded.
15            (e) No consideration shall be given to the question
16        of whether or not the ability of an employee to
17        understand speech is improved by the use of a hearing
18        aid.
19            (f) No claim for loss of hearing due to industrial
20        noise shall be brought against an employer or allowed
21        unless the employee has been exposed for a period of
22        time sufficient to cause permanent impairment to noise
23        levels in excess of the following:
24Sound Level DBA
25Slow ResponseHours Per Day
26908

 

 

SB0012- 45 -LRB100 06318 KTG 16356 b

1926
2954
3973
41002
51021-1/2
61051
71101/2
81151/4
9        This subparagraph (f) shall not be applied in cases of
10    hearing loss resulting from trauma or explosion.
11        17. In computing the compensation to be paid to any
12    employee who, before the accident for which he claims
13    compensation, had before that time sustained an injury
14    resulting in the loss by amputation or partial loss by
15    amputation of any member, including hand, arm, thumb or
16    fingers, leg, foot or any toes, such loss or partial loss
17    of any such member shall be deducted from any award made
18    for the subsequent injury. For the permanent loss of use or
19    the permanent partial loss of use of any such member or the
20    partial loss of sight of an eye, for which compensation has
21    been paid, then such loss shall be taken into consideration
22    and deducted from any award for the subsequent injury.
23        18. The specific case of loss of both hands, both arms,
24    or both feet, or both legs, or both eyes, or of any two
25    thereof, or the permanent and complete loss of the use
26    thereof, constitutes total and permanent disability, to be

 

 

SB0012- 46 -LRB100 06318 KTG 16356 b

1    compensated according to the compensation fixed by
2    paragraph (f) of this Section. These specific cases of
3    total and permanent disability do not exclude other cases.
4        Any employee who has previously suffered the loss or
5    permanent and complete loss of the use of any of such
6    members or loss under Section 8(d)2 due to accidental
7    injuries to the same part of the spine, and in a subsequent
8    independent accident loses another or suffers the
9    permanent and complete loss of the use of any one of such
10    members or loss under Section 8(d)2 due to accidental
11    injuries to the same part of the spine the employer for
12    whom the injured employee is working at the time of the
13    last independent accident is liable to pay compensation
14    only for the loss or permanent and complete loss of the use
15    of the member or loss under Section 8(d)2 due to accidental
16    injuries to the same part of the spine occasioned by the
17    last independent accident. For purposes of this
18    subdivision (e)18 only, "same part of the spine" means: (1)
19    cervical spine and thoracic spine from vertebra C1 through
20    T12; and (2) lumbar and sacral spine and coccyx from
21    vertebra L1 through S5.
22        19. In a case of specific loss and the subsequent death
23    of such injured employee from other causes than such injury
24    leaving a widow, widower, or dependents surviving before
25    payment or payment in full for such injury, then the amount
26    due for such injury is payable to the widow or widower and,

 

 

SB0012- 47 -LRB100 06318 KTG 16356 b

1    if there be no widow or widower, then to such dependents,
2    in the proportion which such dependency bears to total
3    dependency.
4    Beginning July 1, 1980, and every 6 months thereafter, the
5Commission shall examine the Second Injury Fund and when, after
6deducting all advances or loans made to such Fund, the amount
7therein is $500,000 then the amount required to be paid by
8employers pursuant to paragraph (f) of Section 7 shall be
9reduced by one-half. When the Second Injury Fund reaches the
10sum of $600,000 then the payments shall cease entirely.
11However, when the Second Injury Fund has been reduced to
12$400,000, payment of one-half of the amounts required by
13paragraph (f) of Section 7 shall be resumed, in the manner
14herein provided, and when the Second Injury Fund has been
15reduced to $300,000, payment of the full amounts required by
16paragraph (f) of Section 7 shall be resumed, in the manner
17herein provided. The Commission shall make the changes in
18payment effective by general order, and the changes in payment
19become immediately effective for all cases coming before the
20Commission thereafter either by settlement agreement or final
21order, irrespective of the date of the accidental injury.
22    On August 1, 1996 and on February 1 and August 1 of each
23subsequent year, the Commission shall examine the special fund
24designated as the "Rate Adjustment Fund" and when, after
25deducting all advances or loans made to said fund, the amount
26therein is $4,000,000, the amount required to be paid by

 

 

SB0012- 48 -LRB100 06318 KTG 16356 b

1employers pursuant to paragraph (f) of Section 7 shall be
2reduced by one-half. When the Rate Adjustment Fund reaches the
3sum of $5,000,000 the payment therein shall cease entirely.
4However, when said Rate Adjustment Fund has been reduced to
5$3,000,000 the amounts required by paragraph (f) of Section 7
6shall be resumed in the manner herein provided.
7    (f) In case of complete disability, which renders the
8employee wholly and permanently incapable of work, or in the
9specific case of total and permanent disability as provided in
10subparagraph 18 of paragraph (e) of this Section, compensation
11shall be payable at the rate provided in subparagraph 2 of
12paragraph (b) of this Section for life.
13    An employee entitled to benefits under paragraph (f) of
14this Section shall also be entitled to receive from the Rate
15Adjustment Fund provided in paragraph (f) of Section 7 of the
16supplementary benefits provided in paragraph (g) of this
17Section 8.
18    If any employee who receives an award under this paragraph
19afterwards returns to work or is able to do so, and earns or is
20able to earn as much as before the accident, payments under
21such award shall cease. If such employee returns to work, or is
22able to do so, and earns or is able to earn part but not as much
23as before the accident, such award shall be modified so as to
24conform to an award under paragraph (d) of this Section. If
25such award is terminated or reduced under the provisions of
26this paragraph, such employees have the right at any time

 

 

SB0012- 49 -LRB100 06318 KTG 16356 b

1within 30 months after the date of such termination or
2reduction to file petition with the Commission for the purpose
3of determining whether any disability exists as a result of the
4original accidental injury and the extent thereof.
5    Disability as enumerated in subdivision 18, paragraph (e)
6of this Section is considered complete disability.
7    If an employee who had previously incurred loss or the
8permanent and complete loss of use of one member, through the
9loss or the permanent and complete loss of the use of one hand,
10one arm, one foot, one leg, or one eye, incurs permanent and
11complete disability through the loss or the permanent and
12complete loss of the use of another member, he shall receive,
13in addition to the compensation payable by the employer and
14after such payments have ceased, an amount from the Second
15Injury Fund provided for in paragraph (f) of Section 7, which,
16together with the compensation payable from the employer in
17whose employ he was when the last accidental injury was
18incurred, will equal the amount payable for permanent and
19complete disability as provided in this paragraph of this
20Section.
21    The custodian of the Second Injury Fund provided for in
22paragraph (f) of Section 7 shall be joined with the employer as
23a party respondent in the application for adjustment of claim.
24The application for adjustment of claim shall state briefly and
25in general terms the approximate time and place and manner of
26the loss of the first member.

 

 

SB0012- 50 -LRB100 06318 KTG 16356 b

1    In its award the Commission or the Arbitrator shall
2specifically find the amount the injured employee shall be
3weekly paid, the number of weeks compensation which shall be
4paid by the employer, the date upon which payments begin out of
5the Second Injury Fund provided for in paragraph (f) of Section
67 of this Act, the length of time the weekly payments continue,
7the date upon which the pension payments commence and the
8monthly amount of the payments. The Commission shall 30 days
9after the date upon which payments out of the Second Injury
10Fund have begun as provided in the award, and every month
11thereafter, prepare and submit to the State Comptroller a
12voucher for payment for all compensation accrued to that date
13at the rate fixed by the Commission. The State Comptroller
14shall draw a warrant to the injured employee along with a
15receipt to be executed by the injured employee and returned to
16the Commission. The endorsed warrant and receipt is a full and
17complete acquittance to the Commission for the payment out of
18the Second Injury Fund. No other appropriation or warrant is
19necessary for payment out of the Second Injury Fund. The Second
20Injury Fund is appropriated for the purpose of making payments
21according to the terms of the awards.
22    As of July 1, 1980 to July 1, 1982, all claims against and
23obligations of the Second Injury Fund shall become claims
24against and obligations of the Rate Adjustment Fund to the
25extent there is insufficient money in the Second Injury Fund to
26pay such claims and obligations. In that case, all references

 

 

SB0012- 51 -LRB100 06318 KTG 16356 b

1to "Second Injury Fund" in this Section shall also include the
2Rate Adjustment Fund.
3    (g) Every award for permanent total disability entered by
4the Commission on and after July 1, 1965 under which
5compensation payments shall become due and payable after the
6effective date of this amendatory Act, and every award for
7death benefits or permanent total disability entered by the
8Commission on and after the effective date of this amendatory
9Act shall be subject to annual adjustments as to the amount of
10the compensation rate therein provided. Such adjustments shall
11first be made on July 15, 1977, and all awards made and entered
12prior to July 1, 1975 and on July 15 of each year thereafter.
13In all other cases such adjustment shall be made on July 15 of
14the second year next following the date of the entry of the
15award and shall further be made on July 15 annually thereafter.
16If during the intervening period from the date of the entry of
17the award, or the last periodic adjustment, there shall have
18been an increase in the State's average weekly wage in covered
19industries under the Unemployment Insurance Act, the weekly
20compensation rate shall be proportionately increased by the
21same percentage as the percentage of increase in the State's
22average weekly wage in covered industries under the
23Unemployment Insurance Act. The increase in the compensation
24rate under this paragraph shall in no event bring the total
25compensation rate to an amount greater than the prevailing
26maximum rate at the time that the annual adjustment is made.

 

 

SB0012- 52 -LRB100 06318 KTG 16356 b

1Such increase shall be paid in the same manner as herein
2provided for payments under the Second Injury Fund to the
3injured employee, or his dependents, as the case may be, out of
4the Rate Adjustment Fund provided in paragraph (f) of Section 7
5of this Act. Payments shall be made at the same intervals as
6provided in the award or, at the option of the Commission, may
7be made in quarterly payment on the 15th day of January, April,
8July and October of each year. In the event of a decrease in
9such average weekly wage there shall be no change in the then
10existing compensation rate. The within paragraph shall not
11apply to cases where there is disputed liability and in which a
12compromise lump sum settlement between the employer and the
13injured employee, or his dependents, as the case may be, has
14been duly approved by the Illinois Workers' Compensation
15Commission.
16    Provided, that in cases of awards entered by the Commission
17for injuries occurring before July 1, 1975, the increases in
18the compensation rate adjusted under the foregoing provision of
19this paragraph (g) shall be limited to increases in the State's
20average weekly wage in covered industries under the
21Unemployment Insurance Act occurring after July 1, 1975.
22    For every accident occurring on or after July 20, 2005 but
23before the effective date of this amendatory Act of the 94th
24General Assembly (Senate Bill 1283 of the 94th General
25Assembly), the annual adjustments to the compensation rate in
26awards for death benefits or permanent total disability, as

 

 

SB0012- 53 -LRB100 06318 KTG 16356 b

1provided in this Act, shall be paid by the employer. The
2adjustment shall be made by the employer on July 15 of the
3second year next following the date of the entry of the award
4and shall further be made on July 15 annually thereafter. If
5during the intervening period from the date of the entry of the
6award, or the last periodic adjustment, there shall have been
7an increase in the State's average weekly wage in covered
8industries under the Unemployment Insurance Act, the employer
9shall increase the weekly compensation rate proportionately by
10the same percentage as the percentage of increase in the
11State's average weekly wage in covered industries under the
12Unemployment Insurance Act. The increase in the compensation
13rate under this paragraph shall in no event bring the total
14compensation rate to an amount greater than the prevailing
15maximum rate at the time that the annual adjustment is made. In
16the event of a decrease in such average weekly wage there shall
17be no change in the then existing compensation rate. Such
18increase shall be paid by the employer in the same manner and
19at the same intervals as the payment of compensation in the
20award. This paragraph shall not apply to cases where there is
21disputed liability and in which a compromise lump sum
22settlement between the employer and the injured employee, or
23his or her dependents, as the case may be, has been duly
24approved by the Illinois Workers' Compensation Commission.
25    The annual adjustments for every award of death benefits or
26permanent total disability involving accidents occurring

 

 

SB0012- 54 -LRB100 06318 KTG 16356 b

1before July 20, 2005 and accidents occurring on or after the
2effective date of this amendatory Act of the 94th General
3Assembly (Senate Bill 1283 of the 94th General Assembly) shall
4continue to be paid from the Rate Adjustment Fund pursuant to
5this paragraph and Section 7(f) of this Act.
6    (h) In case death occurs from any cause before the total
7compensation to which the employee would have been entitled has
8been paid, then in case the employee leaves any widow, widower,
9child, parent (or any grandchild, grandparent or other lineal
10heir or any collateral heir dependent at the time of the
11accident upon the earnings of the employee to the extent of 50%
12or more of total dependency) such compensation shall be paid to
13the beneficiaries of the deceased employee and distributed as
14provided in paragraph (g) of Section 7.
15    (h-1) In case an injured employee is under legal disability
16at the time when any right or privilege accrues to him or her
17under this Act, a guardian may be appointed pursuant to law,
18and may, on behalf of such person under legal disability, claim
19and exercise any such right or privilege with the same effect
20as if the employee himself or herself had claimed or exercised
21the right or privilege. No limitations of time provided by this
22Act run so long as the employee who is under legal disability
23is without a conservator or guardian.
24    (i) In case the injured employee is under 16 years of age
25at the time of the accident and is illegally employed, the
26amount of compensation payable under paragraphs (b), (c), (d),

 

 

SB0012- 55 -LRB100 06318 KTG 16356 b

1(e) and (f) of this Section is increased 50%.
2    However, where an employer has on file an employment
3certificate issued pursuant to the Child Labor Law or work
4permit issued pursuant to the Federal Fair Labor Standards Act,
5as amended, or a birth certificate properly and duly issued,
6such certificate, permit or birth certificate is conclusive
7evidence as to the age of the injured minor employee for the
8purposes of this Section.
9    Nothing herein contained repeals or amends the provisions
10of the Child Labor Law relating to the employment of minors
11under the age of 16 years.
12    (j) 1. In the event the injured employee receives benefits,
13including medical, surgical or hospital benefits under any
14group plan covering non-occupational disabilities contributed
15to wholly or partially by the employer, which benefits should
16not have been payable if any rights of recovery existed under
17this Act, then such amounts so paid to the employee from any
18such group plan as shall be consistent with, and limited to,
19the provisions of paragraph 2 hereof, shall be credited to or
20against any compensation payment for temporary total
21incapacity for work or any medical, surgical or hospital
22benefits made or to be made under this Act. In such event, the
23period of time for giving notice of accidental injury and
24filing application for adjustment of claim does not commence to
25run until the termination of such payments. This paragraph does
26not apply to payments made under any group plan which would

 

 

SB0012- 56 -LRB100 06318 KTG 16356 b

1have been payable irrespective of an accidental injury under
2this Act. Any employer receiving such credit shall keep such
3employee safe and harmless from any and all claims or
4liabilities that may be made against him by reason of having
5received such payments only to the extent of such credit.
6    Any excess benefits paid to or on behalf of a State
7employee by the State Employees' Retirement System under
8Article 14 of the Illinois Pension Code on a death claim or
9disputed disability claim shall be credited against any
10payments made or to be made by the State of Illinois to or on
11behalf of such employee under this Act, except for payments for
12medical expenses which have already been incurred at the time
13of the award. The State of Illinois shall directly reimburse
14the State Employees' Retirement System to the extent of such
15credit.
16    2. Nothing contained in this Act shall be construed to give
17the employer or the insurance carrier the right to credit for
18any benefits or payments received by the employee other than
19compensation payments provided by this Act, and where the
20employee receives payments other than compensation payments,
21whether as full or partial salary, group insurance benefits,
22bonuses, annuities or any other payments, the employer or
23insurance carrier shall receive credit for each such payment
24only to the extent of the compensation that would have been
25payable during the period covered by such payment.
26    3. The extension of time for the filing of an Application

 

 

SB0012- 57 -LRB100 06318 KTG 16356 b

1for Adjustment of Claim as provided in paragraph 1 above shall
2not apply to those cases where the time for such filing had
3expired prior to the date on which payments or benefits
4enumerated herein have been initiated or resumed. Provided
5however that this paragraph 3 shall apply only to cases wherein
6the payments or benefits hereinabove enumerated shall be
7received after July 1, 1969.
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 305/8.1b)
11    Sec. 8.1b. Determination of permanent partial disability.
12For accidental injuries that occur on or after September 1,
132011, permanent partial disability shall be established using
14the following criteria:
15    (a) A physician licensed to practice medicine in all of its
16branches preparing a permanent partial disability impairment
17report shall report the level of impairment in writing. The
18report shall include an evaluation of medically defined and
19professionally appropriate measurements of impairment that
20include, but are not limited to: loss of range of motion; loss
21of strength; measured atrophy of tissue mass consistent with
22the injury; and any other measurements that establish the
23nature and extent of the impairment. The most current edition
24of the American Medical Association's "Guides to the Evaluation
25of Permanent Impairment" shall be used by the physician in

 

 

SB0012- 58 -LRB100 06318 KTG 16356 b

1determining the level of impairment.
2    (b) In determining the level of permanent partial
3disability, the Commission shall base its determination on the
4following factors: (i) the reported level of impairment
5pursuant to subsection (a), if such a report exists; (ii) the
6occupation of the injured employee; (iii) the age of the
7employee at the time of the injury; (iv) the employee's future
8earning capacity; and (v) evidence of disability corroborated
9by the treating medical records or examination under Section 12
10of this Act. No single enumerated factor shall be the sole
11determinant of disability. Where an impairment report exists,
12it must be considered by the Commission in its determination.
13In determining the level of disability, the relevance and
14weight of any factors used in addition to the level of
15impairment as reported by the physician must be explained in a
16written order.
17    (c) A report of impairment prepared pursuant to subsection
18(a) is not required for an arbitrator or the Commission to make
19an award for permanent partial disability or permanent total
20disability benefits or any award for benefits under subsection
21(c) of Section 8 or subsection (d) of Section 8 of this Act or
22to approve a Settlement Contract Lump Sum Petition.
23(Source: P.A. 97-18, eff. 6-28-11.)
 
24    (820 ILCS 305/8.2)
25    Sec. 8.2. Fee schedule.

 

 

SB0012- 59 -LRB100 06318 KTG 16356 b

1    (a) Except as provided for in subsection (c), for
2procedures, treatments, or services covered under this Act and
3rendered or to be rendered on and after February 1, 2006, the
4maximum allowable payment shall be 90% of the 80th percentile
5of charges and fees as determined by the Commission utilizing
6information provided by employers' and insurers' national
7databases, with a minimum of 12,000,000 Illinois line item
8charges and fees comprised of health care provider and hospital
9charges and fees as of August 1, 2004 but not earlier than
10August 1, 2002. These charges and fees are provider billed
11amounts and shall not include discounted charges. The 80th
12percentile is the point on an ordered data set from low to high
13such that 80% of the cases are below or equal to that point and
14at most 20% are above or equal to that point. The Commission
15shall adjust these historical charges and fees as of August 1,
162004 by the Consumer Price Index-U for the period August 1,
172004 through September 30, 2005. The Commission shall establish
18fee schedules for procedures, treatments, or services for
19hospital inpatient, hospital outpatient, emergency room and
20trauma, ambulatory surgical treatment centers, and
21professional services. These charges and fees shall be
22designated by geozip or any smaller geographic unit. The data
23shall in no way identify or tend to identify any patient,
24employer, or health care provider. As used in this Section,
25"geozip" means a three-digit zip code based on data
26similarities, geographical similarities, and frequencies. A

 

 

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1geozip does not cross state boundaries. As used in this
2Section, "three-digit zip code" means a geographic area in
3which all zip codes have the same first 3 digits. If a geozip
4does not have the necessary number of charges and fees to
5calculate a valid percentile for a specific procedure,
6treatment, or service, the Commission may combine data from the
7geozip with up to 4 other geozips that are demographically and
8economically similar and exhibit similarities in data and
9frequencies until the Commission reaches 9 charges or fees for
10that specific procedure, treatment, or service. In cases where
11the compiled data contains less than 9 charges or fees for a
12procedure, treatment, or service, reimbursement shall occur at
1376% of charges and fees as determined by the Commission in a
14manner consistent with the provisions of this paragraph.
15Providers of out-of-state procedures, treatments, services,
16products, or supplies shall be reimbursed at the lesser of that
17state's fee schedule amount or the fee schedule amount for the
18region in which the employee resides. If no fee schedule exists
19in that state, the provider shall be reimbursed at the lesser
20of the actual charge or the fee schedule amount for the region
21in which the employee resides. Not later than September 30 in
222006 and each year thereafter, the Commission shall
23automatically increase or decrease the maximum allowable
24payment for a procedure, treatment, or service established and
25in effect on January 1 of that year by the percentage change in
26the Consumer Price Index-U for the 12 month period ending

 

 

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1August 31 of that year. The increase or decrease shall become
2effective on January 1 of the following year. As used in this
3Section, "Consumer Price Index-U" means the index published by
4the Bureau of Labor Statistics of the U.S. Department of Labor,
5that measures the average change in prices of all goods and
6services purchased by all urban consumers, U.S. city average,
7all items, 1982-84=100.
8    (a-1) Notwithstanding the provisions of subsection (a) and
9unless otherwise indicated, the following provisions shall
10apply to the medical fee schedule starting on September 1,
112011:
12        (1) The Commission shall establish and maintain fee
13    schedules for procedures, treatments, products, services,
14    or supplies for hospital inpatient, hospital outpatient,
15    emergency room, ambulatory surgical treatment centers,
16    accredited ambulatory surgical treatment facilities,
17    prescriptions filled and dispensed outside of a licensed
18    pharmacy, dental services, and professional services. This
19    fee schedule shall be based on the fee schedule amounts
20    already established by the Commission pursuant to
21    subsection (a) of this Section. However, starting on
22    January 1, 2012, these fee schedule amounts shall be
23    grouped into geographic regions in the following manner:
24            (A) Four regions for non-hospital fee schedule
25        amounts shall be utilized:
26                (i) Cook County;

 

 

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

 

 

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

 

 

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1    with the implant, submitted by a provider on a separate
2    claim form, submitted by a distributor, or submitted by the
3    manufacturer of the implant. "Implants" include the
4    following codes or any substantially similar updated code
5    as determined by the Commission: 0274
6    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
7    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
8    (investigational devices); and 0636 (drugs requiring
9    detailed coding). Non-implantable devices or supplies
10    within these codes shall be reimbursed at 65% of actual
11    charge, which is the provider's normal rates under its
12    standard chargemaster. A standard chargemaster is the
13    provider's list of charges for procedures, treatments,
14    products, supplies, or services used to bill payers in a
15    consistent manner.
16        (6) The Commission shall automatically update all
17    codes and associated rules with the version of the codes
18    and rules valid on January 1 of that year.
19    (a-2) For procedures, treatments, services, or supplies
20covered under this Act and rendered or to be rendered on or
21after September 1, 2011, the maximum allowable payment shall be
2270% of the fee schedule amounts, which shall be adjusted yearly
23by the Consumer Price Index-U, as described in subsection (a)
24of this Section.
25    (a-2.5) For procedures, treatments, services, or supplies
26covered under this Act and rendered or to be rendered on or

 

 

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1after June 1, 2017, the maximum allowable payment for the
2following service categories set forth in Title 50, Section
37110.90 of the Illinois Administrative Code shall be 85% of the
4fee schedule amounts in effect on May 31, 2017, which shall be
5adjusted yearly by the Consumer Price Index-U, as described in
6subsection (a) of this Section:
7        (1) Section 1: Ambulatory Surgical Treatment Center
8    (ASTC) and Accredited Ambulatory Surgical Treatment
9    Facility (ASTF).
10        (2) Section 7(C): Hospital Outpatient -- Radiology.
11        (3) Section 7(D): Hospital Outpatient Pathology and
12    Laboratory.
13        (4) Section 8(F): Professional Services Pathology
14    and Laboratory.
15        (5) Section 8(G): Professional Services Radiology.
16    (a-2.6) For procedures, treatments, services, or supplies
17covered under this Act and rendered or to be rendered on or
18after June 1, 2017, the maximum allowable payment for the
19following service categories set forth in Title 50, Section
207110.90 of the Illinois Administrative Code shall be 90% of the
21fee schedule amounts in effect on May 31, 2017, which shall be
22adjusted yearly by the Consumer Price Index-U, as described in
23subsection (a) of this Section:
24        (1) Section 7(F): Hospital Outpatient Surgical
25    Facility.
26        (2) Section 8(D): Professional Services Surgery.

 

 

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1    (a-3) Prescriptions filled and dispensed outside of a
2licensed pharmacy shall be subject to a fee schedule that shall
3not exceed the Average Wholesale Price (AWP) plus a dispensing
4fee of $4.18. AWP or its equivalent as registered by the
5National Drug Code shall be set forth for that drug on that
6date as published in Medispan.
7    (a-4) The Commission, in consultation with the Workers'
8Compensation Medical Fee Advisory Board, shall promulgate by
9rule an evidence-based drug formulary and any rules necessary
10for its administration. Prescriptions prescribed for workers'
11compensation cases shall be limited to those prescription drugs
12and doses on the closed formulary.
13    A request for a prescription that is not on the closed
14formulary shall be reviewed pursuant to Section 8.7 of this
15Act.
16    (b) Notwithstanding the provisions of subsection (a), if
17the Commission finds that there is a significant limitation on
18access to quality health care in either a specific field of
19health care services or a specific geographic limitation on
20access to health care, it may change the Consumer Price Index-U
21increase or decrease for that specific field or specific
22geographic limitation on access to health care to address that
23limitation.
24    (c) The Commission shall establish by rule a process to
25review those medical cases or outliers that involve
26extra-ordinary treatment to determine whether to make an

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    (820 ILCS 305/8.2a)
2    Sec. 8.2a. Electronic claims.
3    (a) The Director of Insurance shall adopt rules to do all
4of the following:
5        (1) Ensure that all health care providers and
6    facilities submit medical bills for payment on
7    standardized forms.
8        (2) Require acceptance by employers and insurers of
9    electronic claims for payment of medical services.
10        (3) Ensure confidentiality of medical information
11    submitted on electronic claims for payment of medical
12    services.
13        (4) Ensure that health care providers have at least 15
14    business days to comply with records requested by employers
15    and insurers for the authorization of the payment of
16    workers' compensation claims.
17        (5) Ensure that health care providers are responsible
18    for supplying only those medical records pertaining to the
19    provider's own claims that are minimally necessary.
20        (6) Provide that any electronically submitted bill
21    determined to be complete but not paid or objected to
22    within 30 days shall be subject to penalties pursuant to
23    Section 8.2(d)(3) of this Act to be entered by the
24    Commission.
25        (7) Provide that the Department of Insurance may impose
26    an administrative fine if it determines that an employer or

 

 

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1    insurer has failed to comply with the electronic claims
2    acceptance and response process. The amount of the
3    administrative fine shall be no greater than $1,000 per
4    each violation, but shall not exceed $10,000 for identical
5    violations during a calendar year.
6    (b) To the extent feasible, standards adopted pursuant to
7subdivision (a) shall be consistent with existing standards
8under the federal Health Insurance Portability and
9Accountability Act of 1996 and standards adopted under the
10Illinois Health Information Exchange and Technology Act.
11    (c) The rules requiring employers and insurers to accept
12electronic claims for payment of medical services shall be
13proposed on or before March 1, 2017 January 1, 2012, and shall
14require all employers and insurers to accept electronic claims
15for payment of medical services on or before September 1, 2017
16June 30, 2012.
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 305/8.7)
23    Sec. 8.7. Utilization review programs.
24    (a) As used in this Section:
25    "Utilization review" means the evaluation of proposed or

 

 

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1provided health care services to determine the appropriateness
2of both the level of health care services medically necessary
3and the quality of health care services provided to a patient,
4including evaluation of their efficiency, efficacy, and
5appropriateness of treatment, hospitalization, or office
6visits based on medically accepted standards. The evaluation
7must be accomplished by means of a system that identifies the
8utilization of health care services based on standards of care
9of nationally recognized peer review guidelines as well as
10nationally recognized treatment guidelines and evidence-based
11medicine based upon standards as provided in this Act.
12Utilization techniques may include prospective review, second
13opinions, concurrent review, discharge planning, peer review,
14independent medical examinations, and retrospective review
15(for purposes of this sentence, retrospective review shall be
16applicable to services rendered on or after July 20, 2005).
17Nothing in this Section applies to prospective review of
18necessary first aid or emergency treatment.
19    (b) No person may conduct a utilization review program for
20workers' compensation services in this State unless once every
212 years the person registers the utilization review program
22with the Department of Insurance and certifies compliance with
23the Workers' Compensation Utilization Management standards or
24Health Utilization Management Standards of URAC sufficient to
25achieve URAC accreditation or submits evidence of
26accreditation by URAC for its Workers' Compensation

 

 

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1Utilization Management Standards or Health Utilization
2Management Standards. Nothing in this Act shall be construed to
3require an employer or insurer or its subcontractors to become
4URAC accredited.
5    (c) In addition, the Director of Insurance may certify
6alternative utilization review standards of national
7accreditation organizations or entities in order for plans to
8comply with this Section. Any alternative utilization review
9standards shall meet or exceed those standards required under
10subsection (b).
11    (d) This registration shall include submission of all of
12the following information regarding utilization review program
13activities:
14        (1) The name, address, and telephone number of the
15    utilization review programs.
16        (2) The organization and governing structure of the
17    utilization review programs.
18        (3) The number of lives for which utilization review is
19    conducted by each utilization review program.
20        (4) Hours of operation of each utilization review
21    program.
22        (5) Description of the grievance process for each
23    utilization review program.
24        (6) Number of covered lives for which utilization
25    review was conducted for the previous calendar year for
26    each utilization review program.

 

 

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1        (7) Written policies and procedures for protecting
2    confidential information according to applicable State and
3    federal laws for each utilization review program.
4    (e) A utilization review program shall have written
5procedures to ensure that patient-specific information
6obtained during the process of utilization review will be:
7        (1) kept confidential in accordance with applicable
8    State and federal laws; and
9        (2) shared only with the employee, the employee's
10    designee, and the employee's health care provider, and
11    those who are authorized by law to receive the information.
12    Summary data shall not be considered confidential if it
13    does not provide information to allow identification of
14    individual patients or health care providers.
15    Only a health care professional may make determinations
16regarding the medical necessity of health care services during
17the course of utilization review.
18    When making retrospective reviews, utilization review
19programs shall base reviews solely on the medical information
20available to the attending physician or ordering provider at
21the time the health care services were provided.
22    (f) If the Department of Insurance finds that a utilization
23review program is not in compliance with this Section, the
24Department shall issue a corrective action plan and allow a
25reasonable amount of time for compliance with the plan. If the
26utilization review program does not come into compliance, the

 

 

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1Department may issue a cease and desist order. Before issuing a
2cease and desist order under this Section, the Department shall
3provide the utilization review program with a written notice of
4the reasons for the order and allow a reasonable amount of time
5to supply additional information demonstrating compliance with
6the requirements of this Section and to request a hearing. The
7hearing notice shall be sent by certified mail, return receipt
8requested, and the hearing shall be conducted in accordance
9with the Illinois Administrative Procedure Act.
10    (g) A utilization review program subject to a corrective
11action may continue to conduct business until a final decision
12has been issued by the Department.
13    (h) The Department of Insurance may by rule establish a
14registration fee for each person conducting a utilization
15review program.
16    (i) Upon receipt of written notice that the employer or the
17employer's agent or insurer wishes to invoke the utilization
18review process, the provider of medical, surgical, or hospital
19services shall submit to the utilization review, following
20accredited procedural guidelines.
21        (1) The provider shall make reasonable efforts to
22    provide timely and complete reports of clinical
23    information needed to support a request for treatment. If
24    the provider fails to make such reasonable efforts, the
25    charges for the treatment or service may not be compensable
26    nor collectible by the provider or claimant from the

 

 

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1    employer, the employer's agent, or the employee. The
2    reporting obligations of providers shall not be
3    unreasonable or unduly burdensome.
4        (2) Written notice of utilization review decisions,
5    including the clinical rationale for certification or
6    non-certification and references to applicable standards
7    of care or evidence-based medical guidelines, shall be
8    furnished to the provider and employee.
9        (3) An employer may only deny payment of or refuse to
10    authorize payment of medical services rendered or proposed
11    to be rendered on the grounds that the extent and scope of
12    medical treatment is excessive and unnecessary in
13    compliance with an accredited utilization review program
14    under this Section.
15        (4) When a payment for medical services has been denied
16    or not authorized by an employer or when authorization for
17    medical services is denied pursuant to utilization review,
18    the employee has the burden of proof to show by a
19    preponderance of the evidence that a variance from the
20    standards of care used by the person or entity performing
21    the utilization review pursuant to subsection (a) is
22    reasonably required to cure or relieve the effects of his
23    or her injury.
24        (5) The medical professional responsible for review in
25    the final stage of utilization review or appeal must be
26    available in this State for interview or deposition; or

 

 

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1    must be available for deposition by telephone, video
2    conference, or other remote electronic means. A medical
3    professional who works or resides in this State or outside
4    of this State may comply with this requirement by making
5    himself or herself available for an interview or deposition
6    in person or by making himself or herself available by
7    telephone, video conference, or other remote electronic
8    means. The remote interview or deposition shall be
9    conducted in a fair, open, and cost-effective manner. The
10    expense of interview and the deposition method shall be
11    paid by the employer. The deponent shall be in the presence
12    of the officer administering the oath and recording the
13    deposition, unless otherwise agreed by the parties. Any
14    exhibits or other demonstrative evidence to be presented to
15    the deponent by any party at the deposition shall be
16    provided to the officer administering the oath and all
17    other parties within a reasonable period of time prior to
18    the deposition. Nothing shall prohibit any party from being
19    with the deponent during the deposition, at that party's
20    expense; provided, however, that a party attending a
21    deposition shall give written notice of that party's
22    intention to appear at the deposition to all other parties
23    within a reasonable time prior to the deposition.
24    An admissible utilization review shall be considered by the
25Commission, along with all other evidence and in the same
26manner as all other evidence, and must be addressed along with

 

 

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1all other evidence in the determination of the reasonableness
2and necessity of the medical bills or treatment. Nothing in
3this Section shall be construed to diminish the rights of
4employees to reasonable and necessary medical treatment or
5employee choice of health care provider under Section 8(a) or
6the rights of employers to medical examinations under Section
712.
8    (j) When an employer denies payment of or refuses to
9authorize payment of first aid, medical, surgical, or hospital
10services under Section 8(a) of this Act, if that denial or
11refusal to authorize complies with a utilization review program
12registered under this Section and complies with all other
13requirements of this Section, then there shall be a rebuttable
14presumption that the employer shall not be responsible for
15payment of additional compensation pursuant to Section 19(k) of
16this Act and if that denial or refusal to authorize does not
17comply with a utilization review program registered under this
18Section and does not comply with all other requirements of this
19Section, then that will be considered by the Commission, along
20with all other evidence and in the same manner as all other
21evidence, in the determination of whether the employer may be
22responsible for the payment of additional compensation
23pursuant to Section 19(k) of this Act.
24    (k) For injuries occurring on or after January 1, 2018, an
25employee shall be entitled to up to 24 chiropractic,
26occupational therapy, or physical therapy visits per claim. If

 

 

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1an employee exceeds 24 chiropractic, occupational therapy, or
2physical therapy visits per claim, an employer or insurer may
3petition to the Commission to decide whether additional
4treatment is warranted. An employer or insurer that files a
5bona fide petition in good faith under this Section shall not
6be subject to penalties under the Act. This Section does not
7apply to visits for post-surgical rehabilitation services.
8    The changes to this Section made by this amendatory Act of
9the 97th General Assembly apply only to health care services
10provided or proposed to be provided on or after September 1,
112011.
12(Source: P.A. 97-18, eff. 6-28-11.)
 
13    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
14    Sec. 14. The Commission shall appoint a secretary, an
15assistant secretary, and arbitrators and shall employ such
16assistants and clerical help as may be necessary. Arbitrators
17shall be appointed pursuant to this Section, notwithstanding
18any provision of the Personnel Code.
19    Each arbitrator appointed after June 28, 2011 shall be
20required to demonstrate in writing his or her knowledge of and
21expertise in the law of and judicial processes of the Workers'
22Compensation Act and the Workers' Occupational Diseases Act.
23    A formal training program for newly-hired arbitrators
24shall be implemented. The training program shall include the
25following:

 

 

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1        (a) substantive and procedural aspects of the
2    arbitrator position;
3        (b) current issues in workers' compensation law and
4    practice;
5        (c) medical lectures by specialists in areas such as
6    orthopedics, ophthalmology, psychiatry, rehabilitation
7    counseling;
8        (d) orientation to each operational unit of the
9    Illinois Workers' Compensation Commission;
10        (e) observation of experienced arbitrators conducting
11    hearings of cases, combined with the opportunity to discuss
12    evidence presented and rulings made;
13        (f) the use of hypothetical cases requiring the trainee
14    to issue judgments as a means to evaluating knowledge and
15    writing ability;
16        (g) writing skills;
17        (h) professional and ethical standards pursuant to
18    Section 1.1 of this Act;
19        (i) detection of workers' compensation fraud and
20    reporting obligations of Commission employees and
21    appointees;
22        (j) standards of evidence-based medical treatment and
23    best practices for measuring and improving quality and
24    health care outcomes in the workers' compensation system,
25    including but not limited to the use of the American
26    Medical Association's "Guides to the Evaluation of

 

 

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

 

 

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

 

 

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

 

 

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1"Illinois--Seal".
2    The Secretary or Assistant Secretary, under the direction
3of the Commission, shall have charge and custody of the seal of
4the Commission and also have charge and custody of all records,
5files, orders, proceedings, decisions, awards and other
6documents on file with the Commission. He shall furnish
7certified copies, under the seal of the Commission, of any such
8records, files, orders, proceedings, decisions, awards and
9other documents on file with the Commission as may be required.
10Certified copies so furnished by the Secretary or Assistant
11Secretary shall be received in evidence before the Commission
12or any Arbitrator thereof, and in all courts, provided that the
13original of such certified copy is otherwise competent and
14admissible in evidence. The Secretary or Assistant Secretary
15shall perform such other duties as may be prescribed from time
16to time by the Commission.
17(Source: P.A. 98-40, eff. 6-28-13; 99-642, eff. 7-28-16.)
 
18    (820 ILCS 305/14.3 new)
19    Sec. 14.3. Workers' Compensation Edit, Alignment, and
20Reform Commission.
21    (a) There is created the Workers' Compensation Edit,
22Alignment, and Reform Commission, which shall be known as the
23WEAR Commission. The purpose of the WEAR Commission is to
24develop a proposed recodification of the Workers' Compensation
25Act that meets the following goals:

 

 

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1        (1) to make this Act more accessible to laypeople
2    seeking benefits under this Act and employers seeking
3    insurance coverage for their responsibilities under this
4    Act;
5        (2) to aid the Commission, attorneys, and judges in
6    understanding and applying the provisions of this Act;
7        (3) to prevent disputes over interpretations of this
8    Act that can add additional costs to the function and
9    administration of the workers' compensation system;
10        (4) to reduce the size of each Section of this Act to
11    promote understanding, interpretation, and indexing of
12    this Act;
13        (5) to assist policymakers so that they can more easily
14    understand the implication of amendments to this Act that
15    may be proposed in the future;
16        (6) to replace outdated and obsolete language within
17    this Act;
18        (7) to limit the opportunity for lengthy and expensive
19    appeals due to confusion or contrary language within this
20    Act; and
21        (8) to meet the preceding objectives without changing
22    substantive law or disturbing established case law
23    precedent. Nothing in this Section 14.3 shall be construed
24    to allow or authorize the WEAR Commission to seek to or to
25    diminish, restrict, limit, expand, abrogate, alter, or
26    change in any way the current interpretation of any

 

 

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1    substantive or procedural provision of this Act by the
2    Commission or any Court.
3    (b) The members of the WEAR Commission shall be as follows:
4        (1) one Senator appointed by the President of the
5    Senate;
6        (2) one Senator appointed by the Minority Leader of the
7    Senate;
8        (3) one Representative appointed by the Speaker of the
9    House of Representatives;
10        (4) one Representative appointed by the Minority
11    Leader of the House of Representatives;
12        (5) 4 attorneys representing petitioners, one each
13    appointed by the President of the Senate, Minority Leader
14    of the Senate, Speaker of the House of Representatives, and
15    Minority Leader of the House of Representatives; and
16        (6) 4 attorneys representing respondents, one each
17    appointed by the President of the Senate, Minority Leader
18    of the Senate, Speaker of the House of Representatives, and
19    Minority Leader of the House of Representatives.
20    The members of the WEAR Commission shall serve without
21compensation. The Chairperson of the Illinois Workers'
22Compensation Commission shall serve as the Chairperson of the
23WEAR Commission.
24    (c) The Illinois Workers' Compensation Commission, the
25Workers' Compensation Insurance Compliance Unit, and the
26Legislative Reference Bureau shall provide administrative

 

 

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1support for the WEAR Commission.
2    (d) The WEAR Commission shall present a report to the
3General Assembly no later than January 1, 2018. This report
4shall include a draft of proposed legislation for the
5reorganization of the Workers' Compensation Act that
6accomplishes the goals set forth by this Section.
7    (e) This Section is repealed on January 1, 2018.
 
8    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
9    Sec. 19. Any disputed questions of law or fact shall be
10determined as herein provided.
11    (a) It shall be the duty of the Commission upon
12notification that the parties have failed to reach an
13agreement, to designate an Arbitrator.
14        1. Whenever any claimant misconceives his remedy and
15    files an application for adjustment of claim under this Act
16    and it is subsequently discovered, at any time before final
17    disposition of such cause, that the claim for disability or
18    death which was the basis for such application should
19    properly have been made under the Workers' Occupational
20    Diseases Act, then the provisions of Section 19, paragraph
21    (a-1) of the Workers' Occupational Diseases Act having
22    reference to such application shall apply.
23        2. Whenever any claimant misconceives his remedy and
24    files an application for adjustment of claim under the
25    Workers' Occupational Diseases Act and it is subsequently

 

 

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1    discovered, at any time before final disposition of such
2    cause that the claim for injury or death which was the
3    basis for such application should properly have been made
4    under this Act, then the application so filed under the
5    Workers' Occupational Diseases Act may be amended in form,
6    substance or both to assert claim for such disability or
7    death under this Act and it shall be deemed to have been so
8    filed as amended on the date of the original filing
9    thereof, and such compensation may be awarded as is
10    warranted by the whole evidence pursuant to this Act. When
11    such amendment is submitted, further or additional
12    evidence may be heard by the Arbitrator or Commission when
13    deemed necessary. Nothing in this Section contained shall
14    be construed to be or permit a waiver of any provisions of
15    this Act with reference to notice but notice if given shall
16    be deemed to be a notice under the provisions of this Act
17    if given within the time required herein.
18        3. When an Arbitrator conducts a status call of cases
19    that appear on the Arbitrator's docket in accordance with
20    the rules of the Commission, parties or their attorneys may
21    appear by telephone, video conference, or other remote
22    electronic means as prescribed by the Commission.
23    (b) The Arbitrator shall make such inquiries and
24investigations as he or they shall deem necessary and may
25examine and inspect all books, papers, records, places, or
26premises relating to the questions in dispute and hear such

 

 

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1proper evidence as the parties may submit.
2    The hearings before the Arbitrator shall be held in the
3vicinity where the injury occurred after 10 days' notice of the
4time and place of such hearing shall have been given to each of
5the parties or their attorneys of record.
6    The Arbitrator may find that the disabling condition is
7temporary and has not yet reached a permanent condition and may
8order the payment of compensation up to the date of the
9hearing, which award shall be reviewable and enforceable in the
10same manner as other awards, and in no instance be a bar to a
11further hearing and determination of a further amount of
12temporary total compensation or of compensation for permanent
13disability, but shall be conclusive as to all other questions
14except the nature and extent of said disability.
15    The decision of the Arbitrator shall be filed with the
16Commission which Commission shall immediately send to each
17party or his attorney a copy of such decision, together with a
18notification of the time when it was filed. As of the effective
19date of this amendatory Act of the 94th General Assembly, all
20decisions of the Arbitrator shall set forth in writing findings
21of fact and conclusions of law, separately stated, if requested
22by either party. Unless a petition for review is filed by
23either party within 30 days after the receipt by such party of
24the copy of the decision and notification of time when filed,
25and unless such party petitioning for a review shall within 35
26days after the receipt by him of the copy of the decision, file

 

 

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1with the Commission either an agreed statement of the facts
2appearing upon the hearing before the Arbitrator, or if such
3party shall so elect a correct transcript of evidence of the
4proceedings at such hearings, then the decision shall become
5the decision of the Commission and in the absence of fraud
6shall be conclusive. The Petition for Review shall contain a
7statement of the petitioning party's specific exceptions to the
8decision of the arbitrator. The jurisdiction of the Commission
9to review the decision of the arbitrator shall not be limited
10to the exceptions stated in the Petition for Review. The
11Commission, or any member thereof, may grant further time not
12exceeding 30 days, in which to file such agreed statement or
13transcript of evidence. Such agreed statement of facts or
14correct transcript of evidence, as the case may be, shall be
15authenticated by the signatures of the parties or their
16attorneys, and in the event they do not agree as to the
17correctness of the transcript of evidence it shall be
18authenticated by the signature of the Arbitrator designated by
19the Commission.
20    Whether the employee is working or not, if the employee is
21not receiving or has not received medical, surgical, or
22hospital services or other services or compensation as provided
23in paragraph (a) of Section 8, or compensation as provided in
24paragraph (b) of Section 8, the employee may at any time
25petition for an expedited hearing by an Arbitrator on the issue
26of whether or not he or she is entitled to receive payment of

 

 

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1the services or compensation. Provided the employer continues
2to pay compensation pursuant to paragraph (b) of Section 8, the
3employer may at any time petition for an expedited hearing on
4the issue of whether or not the employee is entitled to receive
5medical, surgical, or hospital services or other services or
6compensation as provided in paragraph (a) of Section 8, or
7compensation as provided in paragraph (b) of Section 8. When an
8employer has petitioned for an expedited hearing, the employer
9shall continue to pay compensation as provided in paragraph (b)
10of Section 8 unless the arbitrator renders a decision that the
11employee is not entitled to the benefits that are the subject
12of the expedited hearing or unless the employee's treating
13physician has released the employee to return to work at his or
14her regular job with the employer or the employee actually
15returns to work at any other job. If the arbitrator renders a
16decision that the employee is not entitled to the benefits that
17are the subject of the expedited hearing, a petition for review
18filed by the employee shall receive the same priority as if the
19employee had filed a petition for an expedited hearing by an
20Arbitrator. Neither party shall be entitled to an expedited
21hearing when the employee has returned to work and the sole
22issue in dispute amounts to less than 12 weeks of unpaid
23compensation pursuant to paragraph (b) of Section 8.
24    Expedited hearings shall have priority over all other
25petitions and shall be heard by the Arbitrator and Commission
26with all convenient speed. Any party requesting an expedited

 

 

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1hearing shall give notice of a request for an expedited hearing
2under this paragraph. A copy of the Application for Adjustment
3of Claim shall be attached to the notice. The Commission shall
4adopt rules and procedures under which the final decision of
5the Commission under this paragraph is filed not later than 180
6days from the date that the Petition for Review is filed with
7the Commission.
8    Where 2 or more insurance carriers, private self-insureds,
9or a group workers' compensation pool under Article V 3/4 of
10the Illinois Insurance Code dispute coverage for the same
11injury, any such insurance carrier, private self-insured, or
12group workers' compensation pool may request an expedited
13hearing pursuant to this paragraph to determine the issue of
14coverage, provided coverage is the only issue in dispute and
15all other issues are stipulated and agreed to and further
16provided that all compensation benefits including medical
17benefits pursuant to Section 8(a) continue to be paid to or on
18behalf of petitioner. Any insurance carrier, private
19self-insured, or group workers' compensation pool that is
20determined to be liable for coverage for the injury in issue
21shall reimburse any insurance carrier, private self-insured,
22or group workers' compensation pool that has paid benefits to
23or on behalf of petitioner for the injury.
24    (b-1) If the employee is not receiving medical, surgical or
25hospital services as provided in paragraph (a) of Section 8 or
26compensation as provided in paragraph (b) of Section 8, the

 

 

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

 

 

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1        (viii) the name and address, if known, of each witness
2    to the accident and of each other person upon whom the
3    employee will rely to support his allegations;
4        (ix) the dates of treatment related to the accident by
5    medical practitioners, and the names and addresses of such
6    practitioners, including the dates of treatment related to
7    the accident at any hospitals and the names and addresses
8    of such hospitals, and a signed authorization permitting
9    the employer to examine all medical records of all
10    practitioners and hospitals named pursuant to this
11    paragraph;
12        (x) a copy of a signed report by a medical
13    practitioner, relating to the employee's current inability
14    to return to work because of the injuries incurred as a
15    result of the accident or such other documents or
16    affidavits which show that the employee is entitled to
17    receive compensation pursuant to paragraph (b) of Section 8
18    of this Act or medical, surgical or hospital services
19    pursuant to paragraph (a) of Section 8 of this Act. Such
20    reports, documents or affidavits shall state, if possible,
21    the history of the accident given by the employee, and
22    describe the injury and medical diagnosis, the medical
23    services for such injury which the employee has received
24    and is receiving, the physical activities which the
25    employee cannot currently perform as a result of any
26    impairment or disability due to such injury, and the

 

 

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1    prognosis for recovery;
2        (xi) complete copies of any reports, records,
3    documents and affidavits in the possession of the employee
4    on which the employee will rely to support his allegations,
5    provided that the employer shall pay the reasonable cost of
6    reproduction thereof;
7        (xii) a list of any reports, records, documents and
8    affidavits which the employee has demanded by subpoena and
9    on which he intends to rely to support his allegations;
10        (xiii) a certification signed by the employee or his
11    representative that the employer has received the petition
12    with the required information 15 days before filing.
13    Fifteen days after receipt by the employer of the petition
14with the required information the employee may file said
15petition and required information and shall serve notice of the
16filing upon the employer. The employer may file a motion
17addressed to the sufficiency of the petition. If an objection
18has been filed to the sufficiency of the petition, the
19arbitrator shall rule on the objection within 2 working days.
20If such an objection is filed, the time for filing the final
21decision of the Commission as provided in this paragraph shall
22be tolled until the arbitrator has determined that the petition
23is sufficient.
24    The employer shall, within 15 days after receipt of the
25notice that such petition is filed, file with the Commission
26and serve on the employee or his representative a written

 

 

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1response to each claim set forth in the petition, including the
2legal and factual basis for each disputed allegation and the
3following information: (i) complete copies of any reports,
4records, documents and affidavits in the possession of the
5employer on which the employer intends to rely in support of
6his response, (ii) a list of any reports, records, documents
7and affidavits which the employer has demanded by subpoena and
8on which the employer intends to rely in support of his
9response, (iii) the name and address of each witness on whom
10the employer will rely to support his response, and (iv) the
11names and addresses of any medical practitioners selected by
12the employer pursuant to Section 12 of this Act and the time
13and place of any examination scheduled to be made pursuant to
14such Section.
15    Any employer who does not timely file and serve a written
16response without good cause may not introduce any evidence to
17dispute any claim of the employee but may cross examine the
18employee or any witness brought by the employee and otherwise
19be heard.
20    No document or other evidence not previously identified by
21either party with the petition or written response, or by any
22other means before the hearing, may be introduced into evidence
23without good cause. If, at the hearing, material information is
24discovered which was not previously disclosed, the Arbitrator
25may extend the time for closing proof on the motion of a party
26for a reasonable period of time which may be more than 30 days.

 

 

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1No evidence may be introduced pursuant to this paragraph as to
2permanent disability. No award may be entered for permanent
3disability pursuant to this paragraph. Either party may
4introduce into evidence the testimony taken by deposition of
5any medical practitioner.
6    The Commission shall adopt rules, regulations and
7procedures whereby the final decision of the Commission is
8filed not later than 90 days from the date the petition for
9review is filed but in no event later than 180 days from the
10date the petition for an emergency hearing is filed with the
11Illinois Workers' Compensation Commission.
12    All service required pursuant to this paragraph (b-1) must
13be by personal service or by certified mail and with evidence
14of receipt. In addition for the purposes of this paragraph, all
15service on the employer must be at the premises where the
16accident occurred if the premises are owned or operated by the
17employer. Otherwise service must be at the employee's principal
18place of employment by the employer. If service on the employer
19is not possible at either of the above, then service shall be
20at the employer's principal place of business. After initial
21service in each case, service shall be made on the employer's
22attorney or designated representative.
23    (c)(1) At a reasonable time in advance of and in connection
24with the hearing under Section 19(e) or 19(h), the Commission
25may on its own motion order an impartial physical or mental
26examination of a petitioner whose mental or physical condition

 

 

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1is in issue, when in the Commission's discretion it appears
2that such an examination will materially aid in the just
3determination of the case. The examination shall be made by a
4member or members of a panel of physicians chosen for their
5special qualifications by the Illinois State Medical Society.
6The Commission shall establish procedures by which a physician
7shall be selected from such list.
8    (2) Should the Commission at any time during the hearing
9find that compelling considerations make it advisable to have
10an examination and report at that time, the commission may in
11its discretion so order.
12    (3) A copy of the report of examination shall be given to
13the Commission and to the attorneys for the parties.
14    (4) Either party or the Commission may call the examining
15physician or physicians to testify. Any physician so called
16shall be subject to cross-examination.
17    (5) The examination shall be made, and the physician or
18physicians, if called, shall testify, without cost to the
19parties. The Commission shall determine the compensation and
20the pay of the physician or physicians. The compensation for
21this service shall not exceed the usual and customary amount
22for such service.
23    (6) The fees and payment thereof of all attorneys and
24physicians for services authorized by the Commission under this
25Act shall, upon request of either the employer or the employee
26or the beneficiary affected, be subject to the review and

 

 

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1decision of the Commission.
2    (d) If any employee shall persist in insanitary or
3injurious practices which tend to either imperil or retard his
4recovery or shall refuse to submit to such medical, surgical,
5or hospital treatment as is reasonably essential to promote his
6recovery, the Commission may, in its discretion, reduce or
7suspend the compensation of any such injured employee. However,
8when an employer and employee so agree in writing, the
9foregoing provision shall not be construed to authorize the
10reduction or suspension of compensation of an employee who is
11relying in good faith, on treatment by prayer or spiritual
12means alone, in accordance with the tenets and practice of a
13recognized church or religious denomination, by a duly
14accredited practitioner thereof.
15    (e) This paragraph shall apply to all hearings before the
16Commission. Such hearings may be held in its office or
17elsewhere as the Commission may deem advisable. The taking of
18testimony on such hearings may be had before any member of the
19Commission. If a petition for review and agreed statement of
20facts or transcript of evidence is filed, as provided herein,
21the Commission shall promptly review the decision of the
22Arbitrator and all questions of law or fact which appear from
23the statement of facts or transcript of evidence.
24    In all cases in which the hearing before the arbitrator is
25held after December 18, 1989, no additional evidence shall be
26introduced by the parties before the Commission on review of

 

 

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1the decision of the Arbitrator. In reviewing decisions of an
2arbitrator the Commission shall award such temporary
3compensation, permanent compensation and other payments as are
4due under this Act. The Commission shall file in its office its
5decision thereon, and shall immediately send to each party or
6his attorney a copy of such decision and a notification of the
7time when it was filed. Decisions shall be filed within 60 days
8after the Statement of Exceptions and Supporting Brief and
9Response thereto are required to be filed or oral argument
10whichever is later.
11    In the event either party requests oral argument, such
12argument shall be had before a panel of 3 members of the
13Commission (or before all available members pursuant to the
14determination of 7 members of the Commission that such argument
15be held before all available members of the Commission)
16pursuant to the rules and regulations of the Commission. A
17panel of 3 members, which shall be comprised of not more than
18one representative citizen of the employing class and not more
19than one representative citizen of the employee class, shall
20hear the argument; provided that if all the issues in dispute
21are solely the nature and extent of the permanent partial
22disability, if any, a majority of the panel may deny the
23request for such argument and such argument shall not be held;
24and provided further that 7 members of the Commission may
25determine that the argument be held before all available
26members of the Commission. A decision of the Commission shall

 

 

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1be approved by a majority of Commissioners present at such
2hearing if any; provided, if no such hearing is held, a
3decision of the Commission shall be approved by a majority of a
4panel of 3 members of the Commission as described in this
5Section. The Commission shall give 10 days' notice to the
6parties or their attorneys of the time and place of such taking
7of testimony and of such argument.
8    In any case the Commission in its decision may find
9specially upon any question or questions of law or fact which
10shall be submitted in writing by either party whether ultimate
11or otherwise; provided that on issues other than nature and
12extent of the disability, if any, the Commission in its
13decision shall find specially upon any question or questions of
14law or fact, whether ultimate or otherwise, which are submitted
15in writing by either party; provided further that not more than
165 such questions may be submitted by either party. Any party
17may, within 20 days after receipt of notice of the Commission's
18decision, or within such further time, not exceeding 30 days,
19as the Commission may grant, file with the Commission either an
20agreed statement of the facts appearing upon the hearing, or,
21if such party shall so elect, a correct transcript of evidence
22of the additional proceedings presented before the Commission,
23in which report the party may embody a correct statement of
24such other proceedings in the case as such party may desire to
25have reviewed, such statement of facts or transcript of
26evidence to be authenticated by the signature of the parties or

 

 

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

 

 

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1Whenever the Commission adopts part of the arbitrator's
2decision, but not all, it shall include in the order the
3reasons for not adopting all of the arbitrator's decision. When
4a majority of a panel, after deliberation, has arrived at its
5decision, the decision shall be filed as provided in this
6Section without unnecessary delay, and without regard to the
7fact that a member of the panel has expressed an intention to
8dissent. Any member of the panel may file a dissent. Any
9dissent shall be filed no later than 10 days after the decision
10of the majority has been filed.
11    Decisions rendered by the Commission and dissents, if any,
12shall be published together by the Commission. The conclusions
13of law set out in such decisions shall be regarded as
14precedents by arbitrators for the purpose of achieving a more
15uniform administration of this Act.
16    (f) The decision of the Commission acting within its
17powers, according to the provisions of paragraph (e) of this
18Section shall, in the absence of fraud, be conclusive unless
19reviewed as in this paragraph hereinafter provided. However,
20the Arbitrator or the Commission may on his or its own motion,
21or on the motion of either party, correct any clerical error or
22errors in computation within 15 days after the date of receipt
23of any award by such Arbitrator or any decision on review of
24the Commission and shall have the power to recall the original
25award on arbitration or decision on review, and issue in lieu
26thereof such corrected award or decision. Where such correction

 

 

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1is made the time for review herein specified shall begin to run
2from the date of the receipt of the corrected award or
3decision.
4        (1) Except in cases of claims against the State of
5    Illinois other than those claims under Section 18.1, in
6    which case the decision of the Commission shall not be
7    subject to judicial review, the Circuit Court of the county
8    where any of the parties defendant may be found, or if none
9    of the parties defendant can be found in this State then
10    the Circuit Court of the county where the accident
11    occurred, shall by summons to the Commission have power to
12    review all questions of law and fact presented by such
13    record.
14        A proceeding for review shall be commenced within 20
15    days of the receipt of notice of the decision of the
16    Commission. The summons shall be issued by the clerk of
17    such court upon written request returnable on a designated
18    return day, not less than 10 or more than 60 days from the
19    date of issuance thereof, and the written request shall
20    contain the last known address of other parties in interest
21    and their attorneys of record who are to be served by
22    summons. Service upon any member of the Commission or the
23    Secretary or the Assistant Secretary thereof shall be
24    service upon the Commission, and service upon other parties
25    in interest and their attorneys of record shall be by
26    summons, and such service shall be made upon the Commission

 

 

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1    and other parties in interest by mailing notices of the
2    commencement of the proceedings and the return day of the
3    summons to the office of the Commission and to the last
4    known place of residence of other parties in interest or
5    their attorney or attorneys of record. The clerk of the
6    court issuing the summons shall on the day of issue mail
7    notice of the commencement of the proceedings which shall
8    be done by mailing a copy of the summons to the office of
9    the Commission, and a copy of the summons to the other
10    parties in interest or their attorney or attorneys of
11    record and the clerk of the court shall make certificate
12    that he has so sent said notices in pursuance of this
13    Section, which shall be evidence of service on the
14    Commission and other parties in interest.
15        The Commission shall not be required to certify the
16    record of their proceedings to the Circuit Court, unless
17    the party commencing the proceedings for review in the
18    Circuit Court as above provided, shall file with the
19    Commission notice of intent to file for review in Circuit
20    Court. It shall be the duty of the Commission upon such
21    filing of notice of intent to file for review in the
22    Circuit Court to prepare a true and correct copy of such
23    testimony and a true and correct copy of all other matters
24    contained in such record and certified to by the Secretary
25    or Assistant Secretary thereof. The changes made to this
26    subdivision (f)(1) by this amendatory Act of the 98th

 

 

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1    General Assembly apply to any Commission decision entered
2    after the effective date of this amendatory Act of the 98th
3    General Assembly.
4        No request for a summons may be filed and no summons
5    shall issue unless the party seeking to review the decision
6    of the Commission shall exhibit to the clerk of the Circuit
7    Court proof of filing with the Commission of the notice of
8    the intent to file for review in the Circuit Court or an
9    affidavit of the attorney setting forth that notice of
10    intent to file for review in the Circuit Court has been
11    given in writing to the Secretary or Assistant Secretary of
12    the Commission.
13        (2) No such summons shall issue unless the one against
14    whom the Commission shall have rendered an award for the
15    payment of money shall upon the filing of his written
16    request for such summons file with the clerk of the court a
17    bond conditioned that if he shall not successfully
18    prosecute the review, he will pay the award and the costs
19    of the proceedings in the courts. The amount of the bond
20    shall be fixed by any member of the Commission and the
21    surety or sureties of the bond shall be approved by the
22    clerk of the court. The acceptance of the bond by the clerk
23    of the court shall constitute evidence of his approval of
24    the bond.
25        The State of Illinois, including its constitutional
26    officers, boards, commissions, agencies, public

 

 

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1    institutions of higher learning, and funds administered by
2    the treasurer ex officio, and every Every county, city,
3    town, township, incorporated village, school district,
4    body politic or municipal corporation against whom the
5    Commission shall have rendered an award for the payment of
6    money shall not be required to file a bond to secure the
7    payment of the award and the costs of the proceedings in
8    the court to authorize the court to issue such summons.
9        The court may confirm or set aside the decision of the
10    Commission. If the decision is set aside and the facts
11    found in the proceedings before the Commission are
12    sufficient, the court may enter such decision as is
13    justified by law, or may remand the cause to the Commission
14    for further proceedings and may state the questions
15    requiring further hearing, and give such other
16    instructions as may be proper. Appeals shall be taken to
17    the Appellate Court in accordance with Supreme Court Rules
18    22(g) and 303. Appeals shall be taken from the Appellate
19    Court to the Supreme Court in accordance with Supreme Court
20    Rule 315.
21        It shall be the duty of the clerk of any court
22    rendering a decision affecting or affirming an award of the
23    Commission to promptly furnish the Commission with a copy
24    of such decision, without charge.
25        The decision of a majority of the members of the panel
26    of the Commission, shall be considered the decision of the

 

 

SB0012- 110 -LRB100 06318 KTG 16356 b

1    Commission.
2    (g) Except in the case of a claim against the State of
3Illinois, either party may present a certified copy of the
4award of the Arbitrator, or a certified copy of the decision of
5the Commission when the same has become final, when no
6proceedings for review are pending, providing for the payment
7of compensation according to this Act, to the Circuit Court of
8the county in which such accident occurred or either of the
9parties are residents, whereupon the court shall enter a
10judgment in accordance therewith. In a case where the employer
11refuses to pay compensation according to such final award or
12such final decision upon which such judgment is entered the
13court shall in entering judgment thereon, tax as costs against
14him the reasonable costs and attorney fees in the arbitration
15proceedings and in the court entering the judgment for the
16person in whose favor the judgment is entered, which judgment
17and costs taxed as therein provided shall, until and unless set
18aside, have the same effect as though duly entered in an action
19duly tried and determined by the court, and shall with like
20effect, be entered and docketed. The Circuit Court shall have
21power at any time upon application to make any such judgment
22conform to any modification required by any subsequent decision
23of the Supreme Court upon appeal, or as the result of any
24subsequent proceedings for review, as provided in this Act.
25    Judgment shall not be entered until 15 days' notice of the
26time and place of the application for the entry of judgment

 

 

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1shall be served upon the employer by filing such notice with
2the Commission, which Commission shall, in case it has on file
3the address of the employer or the name and address of its
4agent upon whom notices may be served, immediately send a copy
5of the notice to the employer or such designated agent.
6    (h) An agreement or award under this Act providing for
7compensation in installments, may at any time within 18 months
8after such agreement or award be reviewed by the Commission at
9the request of either the employer or the employee, on the
10ground that the disability of the employee has subsequently
11recurred, increased, diminished or ended.
12    However, as to accidents occurring subsequent to July 1,
131955, which are covered by any agreement or award under this
14Act providing for compensation in installments made as a result
15of such accident, such agreement or award may at any time
16within 30 months, or 60 months in the case of an award under
17Section 8(d)1, after such agreement or award be reviewed by the
18Commission at the request of either the employer or the
19employee on the ground that the disability of the employee has
20subsequently recurred, increased, diminished or ended.
21    On such review, compensation payments may be
22re-established, increased, diminished or ended. The Commission
23shall give 15 days' notice to the parties of the hearing for
24review. Any employee, upon any petition for such review being
25filed by the employer, shall be entitled to one day's notice
26for each 100 miles necessary to be traveled by him in attending

 

 

SB0012- 112 -LRB100 06318 KTG 16356 b

1the hearing of the Commission upon the petition, and 3 days in
2addition thereto. Such employee shall, at the discretion of the
3Commission, also be entitled to 5 cents per mile necessarily
4traveled by him within the State of Illinois in attending such
5hearing, not to exceed a distance of 300 miles, to be taxed by
6the Commission as costs and deposited with the petition of the
7employer.
8    When compensation which is payable in accordance with an
9award or settlement contract approved by the Commission, is
10ordered paid in a lump sum by the Commission, no review shall
11be had as in this paragraph mentioned.
12    (i) Each party, upon taking any proceedings or steps
13whatsoever before any Arbitrator, Commission or court, shall
14file with the Commission his address, or the name and address
15of any agent upon whom all notices to be given to such party
16shall be served, either personally or by registered mail,
17addressed to such party or agent at the last address so filed
18with the Commission. In the event such party has not filed his
19address, or the name and address of an agent as above provided,
20service of any notice may be had by filing such notice with the
21Commission.
22    (j) Whenever in any proceeding testimony has been taken or
23a final decision has been rendered and after the taking of such
24testimony or after such decision has become final, the injured
25employee dies, then in any subsequent proceedings brought by
26the personal representative or beneficiaries of the deceased

 

 

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

 

 

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

 

 

SB0012- 115 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 116 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 117 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 118 -LRB100 06318 KTG 16356 b

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

 

 

SB0012- 119 -LRB100 06318 KTG 16356 b

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

 

 

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1        (1) A violation of paragraph (a)(3) is a Class 4
2    felony.
3        (2) A violation of paragraph (a)(4) or (a)(7) is a
4    Class 3 felony.
5        (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
6    (a)(6), or (a)(9) in which the value of the property
7    obtained or attempted to be obtained is $500 or less is a
8    Class A misdemeanor.
9        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
10    (a)(6), or (a)(9) in which the value of the property
11    obtained or attempted to be obtained is more than $500 but
12    not more than $10,000 is a Class 3 felony.
13        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
14    (a)(6), or (a)(9) in which the value of the property
15    obtained or attempted to be obtained is more than $10,000
16    but not more than $100,000 is a Class 2 felony.
17        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
18    (a)(6), or (a)(9) in which the value of the property
19    obtained or attempted to be obtained is more than $100,000
20    is a Class 1 felony.
21        (7) A violation of paragraph (8) of subsection (a)
22    shall be punishable as the class of offense for which the
23    person convicted assisted, abetted, solicited, or
24    conspired to commit, as set forth in paragraphs (1) through
25    (6) of this subsection.
26        (1) A violation in which the value of the property

 

 

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1    obtained or attempted to be obtained is $300 or less is a
2    Class A misdemeanor.
3        (2) A violation in which the value of the property
4    obtained or attempted to be obtained is more than $300 but
5    not more than $10,000 is a Class 3 felony.
6        (3) A violation in which the value of the property
7    obtained or attempted to be obtained is more than $10,000
8    but not more than $100,000 is a Class 2 felony.
9        (4) A violation in which the value of the property
10    obtained or attempted to be obtained is more than $100,000
11    is a Class 1 felony.
12        (8) (5) A person convicted under this Section shall be
13    ordered to pay monetary restitution to the insurance
14    company or self-insured entity or any other person for any
15    financial loss sustained as a result of a violation of this
16    Section, including any court costs and attorney fees. An
17    order of restitution also includes expenses incurred and
18    paid by the State of Illinois or an insurance company or
19    self-insured entity in connection with any medical
20    evaluation or treatment services.
21    For a violation of paragraph (a)(1) or (a)(2), the value of
22the property obtained or attempted to be obtained shall include
23payments pursuant to the provisions of this Act as well as the
24amount paid for medical expenses. For a violation of paragraph
25(a)(5), the value of the property obtained or attempted to be
26obtained shall be the difference between the proper amount for

 

 

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

 

 

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

 

 

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1the fraud and insurance non-compliance unit's investigation
2reveals that the conduct reported may be in violation of other
3laws or regulations of the State of Illinois, the unit may
4report such conduct to the appropriate governmental agency
5charged with administering such laws and regulations. Any
6person who intentionally makes a false report under this
7Section to the fraud and insurance non-compliance unit is
8guilty of a Class A misdemeanor.
9    (e) In order for the fraud and insurance non-compliance
10unit to investigate a report of fraud related to an employee's
11claim, (i) the employee must have filed with the Commission an
12Application for Adjustment of Claim and the employee must have
13either received or attempted to receive benefits under this Act
14that are related to the reported fraud or (ii) the employee
15must have made a written demand for the payment of benefits
16that are related to the reported fraud. There shall be no
17immunity, under this Act or otherwise, for any person who files
18a false report or who files a report without good and just
19cause. Confidentiality of medical information shall be
20strictly maintained. Investigations that are not referred for
21prosecution shall be destroyed upon the expiration of the
22statute of limitations for the acts under investigation and
23shall not be disclosed except that the person making the report
24shall be notified that the investigation is being closed. It is
25unlawful for any employer, insurance carrier, service
26adjustment company, third party administrator, self-insured,

 

 

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1or similar entity to file or threaten to file a report of fraud
2against an employee because of the exercise by the employee of
3the rights and remedies granted to the employee by this Act.
4    The Department of Insurance's papers, documents, reports,
5or evidence relevant to the subject of an investigation under
6this Section shall be confidential and not subject to subpoena,
7public inspection, or to disclosure under the Freedom of
8Information Act for so long as the Director deems reasonably
9necessary to complete the investigation, to protect the person
10investigated from unwarranted injury, or to be in the public
11interest. No officer, agent, or employee of the Department is
12subject to subpoena in any civil or administrative action to
13testify concerning a matter of which they have knowledge under
14a pending fraud or insurance non-compliance investigation by
15the Department.
16    No cause of action exists and no liability may be imposed,
17either civil or criminal, against the State, the Director of
18Insurance, any officer, agent, or employee of the Department of
19Insurance, or individuals employed or retained by the Director
20of Insurance, for an act or omission by them in the performance
21of a power or duty authorized by this Section, unless the act
22or omission was performed in bad faith and with intent to
23injure a particular person.
24    (e-5) The fraud and insurance non-compliance unit shall
25procure and implement a system utilizing advanced analytics
26inclusive of predictive modeling, data mining, social network

 

 

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1analysis, and scoring algorithms for the detection and
2prevention of fraud, waste, and abuse on or before January 1,
32012. The fraud and insurance non-compliance unit shall procure
4this system using a request for proposals process governed by
5the Illinois Procurement Code and rules adopted under that
6Code. The fraud and insurance non-compliance unit shall provide
7a report to the President of the Senate, Speaker of the House
8of Representatives, Minority Leader of the House of
9Representatives, Minority Leader of the Senate, Governor,
10Chairman of the Commission, and Director of Insurance on or
11before July 1, 2012 and annually thereafter detailing its
12activities and providing recommendations regarding
13opportunities for additional fraud waste and abuse detection
14and prevention.
15    (f) Any person convicted of fraud related to workers'
16compensation pursuant to this Section shall be subject to the
17penalties prescribed in the Criminal Code of 2012 and shall be
18ineligible to receive or retain any compensation, disability,
19or medical benefits as defined in this Act if the compensation,
20disability, or medical benefits were owed or received as a
21result of fraud for which the recipient of the compensation,
22disability, or medical benefit was convicted. This subsection
23applies to accidental injuries or diseases that occur on or
24after the effective date of this amendatory Act of the 94th
25General Assembly.
26    (g) Civil liability. Any person convicted of fraud who

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    permanent partial disability, and total disability.
2        (7) Illinois' rank, relative to other states, for:
3            (i) the maximum and minimum temporary total
4        disability benefit levels;
5            (ii) the maximum and minimum scheduled and
6        non-scheduled permanent partial disability benefit
7        levels; and
8            (iii) the maximum and minimum total disability
9        benefit levels.
10            (iv) the maximum and minimum death benefit levels;
11        and
12        (8) The aggregate growth of medical benefit payouts by
13    non-hospital providers and hospitals.
14    Any information collected by the Commission from
15self-insureds shall be exempt from public inspection and
16disclosure under the Freedom of Information Act.
17    (b) The Director of Insurance shall promulgate rules
18requiring each insurer licensed to write workers' compensation
19coverage in the State to record and report the following
20information on an aggregate basis to the Department of
21Insurance before March 1 of each year, relating to claims in
22the State opened within the prior calendar year:
23        (1) The number of claims opened.
24        (2) The number of reported medical only claims.
25        (3) The number of contested claims.
26        (4) The number of claims for which the employee has

 

 

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1    attorney representation.
2        (5) The number of claims with lost time and the number
3    of claims for which temporary total disability was paid.
4        (6) The number of claim adjusters employed to adjust
5    workers' compensation claims.
6        (7) The number of claims for which temporary total
7    disability was not paid within 14 days from the first full
8    day off, regardless of reason.
9        (8) The number of medical bills paid 60 days or later
10    from date of service and the average days paid on those
11    paid after 60 days for the previous calendar year.
12        (9) The number of claims in which in-house defense
13    counsel participated, and the total amount spent on
14    in-house legal services.
15        (10) The number of claims in which outside defense
16    counsel participated, and the total amount paid to outside
17    defense counsel.
18        (11) The total amount billed to employers for bill
19    review.
20        (12) The total amount billed to employers for fee
21    schedule savings.
22        (13) The total amount charged to employers for any and
23    all managed care fees.
24        (14) The number of claims involving in-house medical
25    nurse case management, and the total amount spent on
26    in-house medical nurse case management.

 

 

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1        (15) The number of claims involving outside medical
2    nurse case management, and the total amount paid for
3    outside medical nurse case management.
4        (16) The total amount paid for Independent Medical
5    exams.
6        (17) The total amount spent on in-house Utilization
7    Review for the previous calendar year.
8        (18) The total amount paid for outside Utilization
9    Review for the previous calendar year.
10    The Department shall make the submitted information
11publicly available on the Department's Internet website or such
12other media as appropriate in a form useful for consumers.
13(Source: P.A. 97-18, eff. 6-28-11.)
 
14    Section 99. Effective date. This Act takes effect upon
15becoming law, but this Act does not take effect at all unless
16Senate Bills 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 13 of the
17100th General Assembly become law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 140/7.5
4    720 ILCS 5/17-10.4 new
5    820 ILCS 305/1from Ch. 48, par. 138.1
6    820 ILCS 305/8from Ch. 48, par. 138.8
7    820 ILCS 305/8.1b
8    820 ILCS 305/8.2
9    820 ILCS 305/8.2a
10    820 ILCS 305/8.7
11    820 ILCS 305/14from Ch. 48, par. 138.14
12    820 ILCS 305/14.3 new
13    820 ILCS 305/19from Ch. 48, par. 138.19
14    820 ILCS 305/25.5
15    820 ILCS 305/29.2