Rep. John E. Bradley

Filed: 1/7/2011

 

 


 

 


 
09600SB1066ham002LRB096 07137 WGH 44843 a

1
AMENDMENT TO SENATE BILL 1066

2    AMENDMENT NO. ______. Amend Senate Bill 1066, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    Section 5. The Department of Central Management Services
6Law of the Civil Administrative Code of Illinois is amended by
7changing Section 405-411 as follows:
 
8    (20 ILCS 405/405-411)
9    Sec. 405-411. Consolidation of workers' compensation
10functions.
11    (a) Notwithstanding any other law to the contrary, the
12Director of Central Management Services, working in
13cooperation with the Director of any other agency, department,
14board, or commission directly responsible to the Governor, may
15direct the consolidation, within the Department of Central
16Management Services, of those workers' compensation functions

 

 

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1at that agency, department, board, or commission that are
2suitable for centralization.
3    Upon receipt of the written direction to transfer workers'
4compensation functions to the Department of Central Management
5Services, the personnel, equipment, and property (both real and
6personal) directly relating to the transferred functions shall
7be transferred to the Department of Central Management
8Services, and the relevant documents, records, and
9correspondence shall be transferred or copied, as the Director
10may prescribe.
11    (b) Upon receiving written direction from the Director of
12Central Management Services, the Comptroller and Treasurer are
13authorized to transfer the unexpended balance of any
14appropriations related to the workers' compensation functions
15transferred to the Department of Central Management Services
16and shall make the necessary fund transfers from the General
17Revenue Fund, any special fund in the State treasury, or any
18other federal or State trust fund held by the Treasurer to the
19Workers' Compensation Revolving Fund for use by the Department
20of Central Management Services in support of workers'
21compensation functions or any other related costs or expenses
22of the Department of Central Management Services.
23    (c) The rights of employees and the State and its agencies
24under the Personnel Code and applicable collective bargaining
25agreements or under any pension, retirement, or annuity plan
26shall not be affected by any transfer under this Section.

 

 

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1    (d) The functions transferred to the Department of Central
2Management Services by this Section shall be vested in and
3shall be exercised by the Department of Central Management
4Services. Each act done in the exercise of those functions
5shall have the same legal effect as if done by the agencies,
6offices, divisions, departments, bureaus, boards and
7commissions from which they were transferred.
8    Every person or other entity shall be subject to the same
9obligations and duties and any penalties, civil or criminal,
10arising therefrom, and shall have the same rights arising from
11the exercise of such rights, powers, and duties as had been
12exercised by the agencies, offices, divisions, departments,
13bureaus, boards, and commissions from which they were
14transferred.
15    Whenever reports or notices are now required to be made or
16given or papers or documents furnished or served by any person
17in regards to the functions transferred to or upon the
18agencies, offices, divisions, departments, bureaus, boards,
19and commissions from which the functions were transferred, the
20same shall be made, given, furnished or served in the same
21manner to or upon the Department of Central Management
22Services.
23    This Section does not affect any act done, ratified, or
24cancelled or any right occurring or established or any action
25or proceeding had or commenced in an administrative, civil, or
26criminal cause regarding the functions transferred, but those

 

 

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1proceedings may be continued by the Department of Central
2Management Services.
3    This Section does not affect the legality of any rules in
4the Illinois Administrative Code regarding the functions
5transferred in this Section that are in force on the effective
6date of this Section. If necessary, however, the affected
7agencies shall propose, adopt, or repeal rules, rule
8amendments, and rule recodifications as appropriate to
9effectuate this Section.
10    (e) There is hereby created within the Department of
11Central Management Services an advisory body to be known as the
12Workers' Compensation Advisory Board to review, assess, and
13provide recommendations to improve the State workers'
14compensation program and to ensure that the State manages the
15program in the interests of injured workers and taxpayers. The
16Governor, the Speaker of the House of Representatives, the
17Minority Leader of the House of Representatives, the President
18of the Senate, and the Minority Leader of the Senate shall each
19appoint one person to the Board. Each Board member initially
20appointed to the Board shall serve a term ending December 31,
212013. Each Board member appointed thereafter shall serve a
223-year term, and a Board member shall continue to serve on the
23Board until his or her successor is appointed. In addition, the
24Director of the Department of Central Management Services, the
25Attorney General, the Director of the Department of Insurance,
26the Director of the Department of Corrections, the Secretary of

 

 

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1the Department of Transportation, the Secretary of the
2Department of Human Services, and the Commissioner of the
3Illinois Workers' Compensation Commission, or their designees,
4shall serve on the Board. The Board shall select one of its
5members to serve as Chairperson. Members of the Board shall not
6receive compensation but shall be reimbursed from the Workers'
7Compensation Revolving Fund for reasonable expenses incurred
8in the necessary performance of their duties, and the
9Department of Central Management Services shall provide
10administrative support to the Board. The Board shall meet at
11least 3 times per year, or more often if the Board deems it
12necessary or proper. By July 1, 2011, the Board shall issue a
13written report, to be delivered to the Governor, the Director
14of the Department of Central Management Services, and the
15General Assembly, with a recommended set of best practices for
16the State workers' compensation program. By July 1st of each
17year thereafter, the Board shall issue a written report, to be
18delivered to those same persons or entities, with
19recommendations on how to improve upon such practices.
20(Source: P.A. 93-839, eff. 7-30-04.)
 
21    Section 10. The Workers' Compensation Act is amended by
22changing Sections 4, 8, 8.2, 8.3, 8.7, 11, 14, and 25.5 and
23adding Sections 16b, 29.1, and 29.2 as follows:
 
24    (820 ILCS 305/4)  (from Ch. 48, par. 138.4)

 

 

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1    Sec. 4. (a) Any employer, including but not limited to
2general contractors and their subcontractors, who shall come
3within the provisions of Section 3 of this Act, and any other
4employer who shall elect to provide and pay the compensation
5provided for in this Act shall:
6        (1) File with the Commission annually an application
7    for approval as a self-insurer which shall include a
8    current financial statement, and annually, thereafter, an
9    application for renewal of self-insurance, which shall
10    include a current financial statement. Said application
11    and financial statement shall be signed and sworn to by the
12    president or vice president and secretary or assistant
13    secretary of the employer if it be a corporation, or by all
14    of the partners, if it be a copartnership, or by the owner
15    if it be neither a copartnership nor a corporation. All
16    initial applications and all applications for renewal of
17    self-insurance must be submitted at least 60 days prior to
18    the requested effective date of self-insurance. An
19    employer may elect to provide and pay compensation as
20    provided for in this Act as a member of a group workers'
21    compensation pool under Article V 3/4 of the Illinois
22    Insurance Code. If an employer becomes a member of a group
23    workers' compensation pool, the employer shall not be
24    relieved of any obligations imposed by this Act.
25        If the sworn application and financial statement of any
26    such employer does not satisfy the Commission of the

 

 

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1    financial ability of the employer who has filed it, the
2    Commission shall require such employer to,
3        (2) Furnish security, indemnity or a bond guaranteeing
4    the payment by the employer of the compensation provided
5    for in this Act, provided that any such employer whose
6    application and financial statement shall not have
7    satisfied the commission of his or her financial ability
8    and who shall have secured his liability in part by excess
9    liability insurance shall be required to furnish to the
10    Commission security, indemnity or bond guaranteeing his or
11    her payment up to the effective limits of the excess
12    coverage, or
13        (3) Insure his entire liability to pay such
14    compensation in some insurance carrier authorized,
15    licensed, or permitted to do such insurance business in
16    this State. Every policy of an insurance carrier, insuring
17    the payment of compensation under this Act shall cover all
18    the employees and the entire compensation liability of the
19    insured: Provided, however, that any employer may insure
20    his or her compensation liability with 2 or more insurance
21    carriers or may insure a part and qualify under subsection
22    1, 2, or 4 for the remainder of his or her liability to pay
23    such compensation, subject to the following two
24    provisions:
25            Firstly, the entire compensation liability of the
26        employer to employees working at or from one location

 

 

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1        shall be insured in one such insurance carrier or shall
2        be self-insured, and
3            Secondly, the employer shall submit evidence
4        satisfactorily to the Commission that his or her entire
5        liability for the compensation provided for in this Act
6        will be secured. Any provisions in any policy, or in
7        any endorsement attached thereto, attempting to limit
8        or modify in any way, the liability of the insurance
9        carriers issuing the same except as otherwise provided
10        herein shall be wholly void.
11        Nothing herein contained shall apply to policies of
12    excess liability carriage secured by employers who have
13    been approved by the Commission as self-insurers, or
14        (4) Make some other provision, satisfactory to the
15    Commission, for the securing of the payment of compensation
16    provided for in this Act, and
17        (5) Upon becoming subject to this Act and thereafter as
18    often as the Commission may in writing demand, file with
19    the Commission in form prescribed by it evidence of his or
20    her compliance with the provision of this Section.
21    (a-1) Regardless of its state of domicile or its principal
22place of business, an employer shall make payments to its
23insurance carrier or group self-insurance fund, where
24applicable, based upon the premium rates of the situs where the
25work or project is located in Illinois if:
26        (A) the employer is engaged primarily in the building

 

 

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1    and construction industry; and
2        (B) subdivision (a)(3) of this Section applies to the
3    employer or the employer is a member of a group
4    self-insurance plan as defined in subsection (1) of Section
5    4a.
6    The Illinois Workers' Compensation Commission shall impose
7a penalty upon an employer for violation of this subsection
8(a-1) if:
9        (i) the employer is given an opportunity at a hearing
10    to present evidence of its compliance with this subsection
11    (a-1); and
12        (ii) after the hearing, the Commission finds that the
13    employer failed to make payments upon the premium rates of
14    the situs where the work or project is located in Illinois.
15    The penalty shall not exceed $1,000 for each day of work
16for which the employer failed to make payments upon the premium
17rates of the situs where the work or project is located in
18Illinois, but the total penalty shall not exceed $50,000 for
19each project or each contract under which the work was
20performed.
21    Any penalty under this subsection (a-1) must be imposed not
22later than one year after the expiration of the applicable
23limitation period specified in subsection (d) of Section 6 of
24this Act. Penalties imposed under this subsection (a-1) shall
25be deposited into the Illinois Workers' Compensation
26Commission Operations Fund, a special fund that is created in

 

 

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1the State treasury. Subject to appropriation, moneys in the
2Fund shall be used solely for the operations of the Illinois
3Workers' Compensation Commission and by the Department of
4Financial and Professional Regulation for the purposes
5authorized in subsection (c) of Section 25.5 of this Act.
6    (a-2) For purposes of this subsection, "Professional
7Employer Organization" or "PEO" means an entity or group of
8entities that provides the services of its workers to its
9client or clients through an arrangement for a fee pursuant to
10an agreement, written or otherwise. "Professional Employer
11Organization" or "PEO" also includes an employee leasing
12company or other similarly administered arrangement. Any
13workers' compensation insurance policy issued to a PEO shall at
14a minimum provide the following information to the Commission
15or any entity designated by the Commission regarding each
16policy issued to the PEO:
17        (1) Each client company of the PEO listed as an
18    additional named insured.
19        (2) Information schedules attached to the master
20    policy to identify each individual company's name, FEIN,
21    and job location.
22        (3) A certificate of insurance coverage document
23    issued to each client company specifying its rights and
24    obligations under the master policy that clearly
25    establishes both the identity and status of the client, as
26    well as the dates of inception and termination of coverage,

 

 

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1    if applicable.
2    (b) The sworn application and financial statement, or
3security, indemnity or bond, or amount of insurance, or other
4provisions, filed, furnished, carried, or made by the employer,
5as the case may be, shall be subject to the approval of the
6Commission.
7    Deposits under escrow agreements shall be cash, negotiable
8United States government bonds or negotiable general
9obligation bonds of the State of Illinois. Such cash or bonds
10shall be deposited in escrow with any State or National Bank or
11Trust Company having trust authority in the State of Illinois.
12    Upon the approval of the sworn application and financial
13statement, security, indemnity or bond or amount of insurance,
14filed, furnished or carried, as the case may be, the Commission
15shall send to the employer written notice of its approval
16thereof. The certificate of compliance by the employer with the
17provisions of subparagraphs (2) and (3) of paragraph (a) of
18this Section shall be delivered by the insurance carrier to the
19Illinois Workers' Compensation Commission within five days
20after the effective date of the policy so certified. The
21insurance so certified shall cover all compensation liability
22occurring during the time that the insurance is in effect and
23no further certificate need be filed in case such insurance is
24renewed, extended or otherwise continued by such carrier. The
25insurance so certified shall not be cancelled or in the event
26that such insurance is not renewed, extended or otherwise

 

 

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1continued, such insurance shall not be terminated until at
2least 10 days after receipt by the Illinois Workers'
3Compensation Commission of notice of the cancellation or
4termination of said insurance; provided, however, that if the
5employer has secured insurance from another insurance carrier,
6or has otherwise secured the payment of compensation in
7accordance with this Section, and such insurance or other
8security becomes effective prior to the expiration of the 10
9days, cancellation or termination may, at the option of the
10insurance carrier indicated in such notice, be effective as of
11the effective date of such other insurance or security.
12    (c) Whenever the Commission shall find that any
13corporation, company, association, aggregation of individuals,
14reciprocal or interinsurers exchange, or other insurer
15effecting workers' compensation insurance in this State shall
16be insolvent, financially unsound, or unable to fully meet all
17payments and liabilities assumed or to be assumed for
18compensation insurance in this State, or shall practice a
19policy of delay or unfairness toward employees in the
20adjustment, settlement, or payment of benefits due such
21employees, the Commission may after reasonable notice and
22hearing order and direct that such corporation, company,
23association, aggregation of individuals, reciprocal or
24interinsurers exchange, or insurer, shall from and after a date
25fixed in such order discontinue the writing of any such
26workers' compensation insurance in this State. Subject to such

 

 

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1modification of the order as the Commission may later make on
2review of the order, as herein provided, it shall thereupon be
3unlawful for any such corporation, company, association,
4aggregation of individuals, reciprocal or interinsurers
5exchange, or insurer to effect any workers' compensation
6insurance in this State. A copy of the order shall be served
7upon the Director of Insurance by registered mail. Whenever the
8Commission finds that any service or adjustment company used or
9employed by a self-insured employer or by an insurance carrier
10to process, adjust, investigate, compromise or otherwise
11handle claims under this Act, has practiced or is practicing a
12policy of delay or unfairness toward employees in the
13adjustment, settlement or payment of benefits due such
14employees, the Commission may after reasonable notice and
15hearing order and direct that such service or adjustment
16company shall from and after a date fixed in such order be
17prohibited from processing, adjusting, investigating,
18compromising or otherwise handling claims under this Act.
19    Whenever the Commission finds that any self-insured
20employer has practiced or is practicing delay or unfairness
21toward employees in the adjustment, settlement or payment of
22benefits due such employees, the Commission may, after
23reasonable notice and hearing, order and direct that after a
24date fixed in the order such self-insured employer shall be
25disqualified to operate as a self-insurer and shall be required
26to insure his entire liability to pay compensation in some

 

 

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1insurance carrier authorized, licensed and permitted to do such
2insurance business in this State, as provided in subparagraph 3
3of paragraph (a) of this Section.
4    All orders made by the Commission under this Section shall
5be subject to review by the courts, said review to be taken in
6the same manner and within the same time as provided by Section
719 of this Act for review of awards and decisions of the
8Commission, upon the party seeking the review filing with the
9clerk of the court to which said review is taken a bond in an
10amount to be fixed and approved by the court to which the
11review is taken, conditioned upon the payment of all
12compensation awarded against the person taking said review
13pending a decision thereof and further conditioned upon such
14other obligations as the court may impose. Upon the review the
15Circuit Court shall have power to review all questions of fact
16as well as of law. The penalty hereinafter provided for in this
17paragraph shall not attach and shall not begin to run until the
18final determination of the order of the Commission.
19    (d) Whenever a Commissioner panel of 3 Commissioners
20comprised of one member of the employing class, one member of
21the employee class, and one member not identified with either
22the employing or employee class, with due process and after a
23hearing, determines: (1) an employer has knowingly failed to
24provide coverage as required by paragraph (a) of this Section,
25and (2) the failure is shall be deemed an immediate serious
26danger to public health, safety, and welfare sufficient to

 

 

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1justify service by the Commission of a work-stop order on such
2employer, then a Commissioner may enter a work-stop order
3requiring the cessation of all business operations of such
4employer at the place of employment or job site. Any law
5enforcement agency in the State shall, at the request of the
6Commission, render any assistance necessary to carry out the
7provisions of this Section, including, but not limited to,
8preventing any employee of such employer from remaining at a
9place of employment or job site after a work-stop order has
10taken effect. Any work-stop order shall be lifted immediately
11upon proof of insurance as required by this Act and payment of
12any applicable fines or penalties. Any orders under this
13Section are appealable under Section 19(f) to the Circuit
14Court.
15    Any individual employer, corporate officer or director of a
16corporate employer, partner of an employer partnership, or
17member of an employer limited liability company who knowingly
18fails to provide coverage as required by paragraph (a) of this
19Section is guilty of a Class 4 felony. This provision shall not
20apply to any corporate officer or director of any
21publicly-owned corporation. Each day's violation constitutes a
22separate offense. The State's Attorney of the county in which
23the violation occurred, or the Attorney General, shall bring
24such actions in the name of the People of the State of
25Illinois, or may, in addition to other remedies provided in
26this Section, bring an action for an injunction to restrain the

 

 

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1violation or to enjoin the operation of any such employer.
2    Any individual employer, corporate officer or director of a
3corporate employer, partner of an employer partnership, or
4member of an employer limited liability company who negligently
5fails to provide coverage as required by paragraph (a) of this
6Section is guilty of a Class A misdemeanor. This provision
7shall not apply to any corporate officer or director of any
8publicly-owned corporation. Each day's violation constitutes a
9separate offense. The State's Attorney of the county in which
10the violation occurred, or the Attorney General, shall bring
11such actions in the name of the People of the State of
12Illinois.
13    The criminal penalties in this subsection (d) shall not
14apply where there exists a good faith dispute as to the
15existence of an employment relationship. Evidence of good faith
16shall include, but not be limited to, compliance with the
17definition of employee as used by the Internal Revenue Service.
18    Employers who are subject to and who knowingly fail to
19comply with this Section shall not be entitled to the benefits
20of this Act during the period of noncompliance, but shall be
21liable in an action under any other applicable law of this
22State. In the action, such employer shall not avail himself or
23herself of the defenses of assumption of risk or negligence or
24that the injury was due to a co-employee. In the action, proof
25of the injury shall constitute prima facie evidence of
26negligence on the part of such employer and the burden shall be

 

 

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1on such employer to show freedom of negligence resulting in the
2injury. The employer shall not join any other defendant in any
3such civil action. Nothing in this amendatory Act of the 94th
4General Assembly shall affect the employee's rights under
5subdivision (a)3 of Section 1 of this Act. Any employer or
6carrier who makes payments under subdivision (a)3 of Section 1
7of this Act shall have a right of reimbursement from the
8proceeds of any recovery under this Section.
9    An employee of an uninsured employer, or the employee's
10dependents in case death ensued, may, instead of proceeding
11against the employer in a civil action in court, file an
12application for adjustment of claim with the Commission in
13accordance with the provisions of this Act and the Commission
14shall hear and determine the application for adjustment of
15claim in the manner in which other claims are heard and
16determined before the Commission.
17    All proceedings under this subsection (d) shall be reported
18on an annual basis to the Workers' Compensation Advisory Board.
19    An investigator with the Illinois Workers' Compensation
20Commission Insurance Compliance Division may issue a citation
21to any employer that is not in compliance with its obligation
22to have workers' compensation insurance under this Act. The
23amount of the fine shall be based on the period of time the
24employer was in non-compliance, but shall be no less than $500,
25and shall not exceed $2,500. An employer that has been issued a
26citation shall pay the fine to the Commission and provide to

 

 

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1the Commission proof that it obtained the required workers'
2compensation insurance within 10 days after the citation was
3issued. This Section does not affect any other obligations this
4Act imposes on employers.
5    Upon a finding by the Commission, after reasonable notice
6and hearing, of the knowing and wilful failure or refusal of an
7employer to comply with any of the provisions of paragraph (a)
8of this Section, or the failure or refusal of an employer,
9service or adjustment company, or an insurance carrier to
10comply with any order of the Illinois Workers' Compensation
11Commission pursuant to paragraph (c) of this Section
12disqualifying him or her to operate as a self insurer and
13requiring him or her to insure his or her liability, or the
14knowing and willful failure of an employer to comply with a
15citation issued by an investigator with the Illinois Workers'
16Compensation Commission Insurance Compliance Division, the
17Commission may assess a civil penalty of up to $500 per day for
18each day of such failure or refusal after the effective date of
19this amendatory Act of 1989. The minimum penalty under this
20Section shall be the sum of $10,000. Each day of such failure
21or refusal shall constitute a separate offense. The Commission
22may assess the civil penalty personally and individually
23against the corporate officers and directors of a corporate
24employer, the partners of an employer partnership, and the
25members of an employer limited liability company, after a
26finding of a knowing and willful refusal or failure of each

 

 

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1such named corporate officer, director, partner, or member to
2comply with this Section. The liability for the assessed
3penalty shall be against the named employer first, and if the
4named employer fails or refuses to pay the penalty to the
5Commission within 30 days after the final order of the
6Commission, then the named corporate officers, directors,
7partners, or members who have been found to have knowingly and
8willfully refused or failed to comply with this Section shall
9be liable for the unpaid penalty or any unpaid portion of the
10penalty. Upon investigation by the insurance non-compliance
11unit of the Commission, the Attorney General shall have the
12authority to prosecute all proceedings to enforce the civil and
13administrative provisions of this Section before the
14Commission. The Commission shall promulgate procedural rules
15for enforcing this Section.
16    Upon the failure or refusal of any employer, service or
17adjustment company or insurance carrier to comply with the
18provisions of this Section and with the orders of the
19Commission under this Section, or the order of the court on
20review after final adjudication, the Commission may bring a
21civil action to recover the amount of the penalty in Cook
22County or in Sangamon County in which litigation the Commission
23shall be represented by the Attorney General. The Commission
24shall send notice of its finding of non-compliance and
25assessment of the civil penalty to the Attorney General. It
26shall be the duty of the Attorney General within 30 days after

 

 

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1receipt of the notice, to institute prosecutions and promptly
2prosecute all reported violations of this Section.
3    Any individual employer, corporate officer or director of a
4corporate employer, partner of an employer partnership, or
5member of an employer limited liability company who, with the
6intent to avoid payment of compensation under this Act to an
7injured employee or the employee's dependents, knowingly
8transfers, sells, encumbers, assigns, or in any manner disposes
9of, conceals, secretes, or destroys any property belonging to
10the employer, officer, director, partner, or member is guilty
11of a Class 4 felony.
12    Penalties and fines collected pursuant to this paragraph
13(d) shall be deposited upon receipt into a special fund which
14shall be designated the Injured Workers' Benefit Fund, of which
15the State Treasurer is ex-officio custodian, such special fund
16to be held and disbursed in accordance with this paragraph (d)
17for the purposes hereinafter stated in this paragraph (d), upon
18the final order of the Commission. The Injured Workers' Benefit
19Fund shall be deposited the same as are State funds and any
20interest accruing thereon shall be added thereto every 6
21months. The Injured Workers' Benefit Fund is subject to audit
22the same as State funds and accounts and is protected by the
23general bond given by the State Treasurer. The Injured Workers'
24Benefit Fund is considered always appropriated for the purposes
25of disbursements as provided in this paragraph, and shall be
26paid out and disbursed as herein provided and shall not at any

 

 

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1time be appropriated or diverted to any other use or purpose.
2Moneys in the Injured Workers' Benefit Fund shall be used only
3for payment of workers' compensation benefits for injured
4employees when the employer has failed to provide coverage as
5determined under this paragraph (d) and has failed to pay the
6benefits due to the injured employee. The Commission shall have
7the right to obtain reimbursement from the employer for
8compensation obligations paid by the Injured Workers' Benefit
9Fund. Any such amounts obtained shall be deposited by the
10Commission into the Injured Workers' Benefit Fund. If an
11injured employee or his or her personal representative receives
12payment from the Injured Workers' Benefit Fund, the State of
13Illinois has the same rights under paragraph (b) of Section 5
14that the employer who failed to pay the benefits due to the
15injured employee would have had if the employer had paid those
16benefits, and any moneys recovered by the State as a result of
17the State's exercise of its rights under paragraph (b) of
18Section 5 shall be deposited into the Injured Workers' Benefit
19Fund. The custodian of the Injured Workers' Benefit Fund shall
20be joined with the employer as a party respondent in the
21application for adjustment of claim. After July 1, 2006, the
22Commission shall make disbursements from the Fund once each
23year to each eligible claimant. An eligible claimant is an
24injured worker who has within the previous fiscal year obtained
25a final award for benefits from the Commission against the
26employer and the Injured Workers' Benefit Fund and has notified

 

 

09600SB1066ham002- 22 -LRB096 07137 WGH 44843 a

1the Commission within 90 days of receipt of such award. Within
2a reasonable time after the end of each fiscal year, the
3Commission shall make a disbursement to each eligible claimant.
4At the time of disbursement, if there are insufficient moneys
5in the Fund to pay all claims, each eligible claimant shall
6receive a pro-rata share, as determined by the Commission, of
7the available moneys in the Fund for that year. Payment from
8the Injured Workers' Benefit Fund to an eligible claimant
9pursuant to this provision shall discharge the obligations of
10the Injured Workers' Benefit Fund regarding the award entered
11by the Commission.
12    (e) This Act shall not affect or disturb the continuance of
13any existing insurance, mutual aid, benefit, or relief
14association or department, whether maintained in whole or in
15part by the employer or whether maintained by the employees,
16the payment of benefits of such association or department being
17guaranteed by the employer or by some person, firm or
18corporation for him or her: Provided, the employer contributes
19to such association or department an amount not less than the
20full compensation herein provided, exclusive of the cost of the
21maintenance of such association or department and without any
22expense to the employee. This Act shall not prevent the
23organization and maintaining under the insurance laws of this
24State of any benefit or insurance company for the purpose of
25insuring against the compensation provided for in this Act, the
26expense of which is maintained by the employer. This Act shall

 

 

09600SB1066ham002- 23 -LRB096 07137 WGH 44843 a

1not prevent the organization or maintaining under the insurance
2laws of this State of any voluntary mutual aid, benefit or
3relief association among employees for the payment of
4additional accident or sick benefits.
5    (f) No existing insurance, mutual aid, benefit or relief
6association or department shall, by reason of anything herein
7contained, be authorized to discontinue its operation without
8first discharging its obligations to any and all persons
9carrying insurance in the same or entitled to relief or
10benefits therein.
11    (g) Any contract, oral, written or implied, of employment
12providing for relief benefit, or insurance or any other device
13whereby the employee is required to pay any premium or premiums
14for insurance against the compensation provided for in this Act
15shall be null and void. Any employer withholding from the wages
16of any employee any amount for the purpose of paying any such
17premium shall be guilty of a Class B misdemeanor.
18    In the event the employer does not pay the compensation for
19which he or she is liable, then an insurance company,
20association or insurer which may have insured such employer
21against such liability shall become primarily liable to pay to
22the employee, his or her personal representative or beneficiary
23the compensation required by the provisions of this Act to be
24paid by such employer. The insurance carrier may be made a
25party to the proceedings in which the employer is a party and
26an award may be entered jointly against the employer and the

 

 

09600SB1066ham002- 24 -LRB096 07137 WGH 44843 a

1insurance carrier.
2    (h) It shall be unlawful for any employer, insurance
3company or service or adjustment company to interfere with,
4restrain or coerce an employee in any manner whatsoever in the
5exercise of the rights or remedies granted to him or her by
6this Act or to discriminate, attempt to discriminate, or
7threaten to discriminate against an employee in any way because
8of his or her exercise of the rights or remedies granted to him
9or her by this Act.
10    It shall be unlawful for any employer, individually or
11through any insurance company or service or adjustment company,
12to discharge or to threaten to discharge, or to refuse to
13rehire or recall to active service in a suitable capacity an
14employee because of the exercise of his or her rights or
15remedies granted to him or her by this Act.
16    (i) If an employer elects to obtain a life insurance policy
17on his employees, he may also elect to apply such benefits in
18satisfaction of all or a portion of the death benefits payable
19under this Act, in which case, the employer's compensation
20premium shall be reduced accordingly.
21    (j) Within 45 days of receipt of an initial application or
22application to renew self-insurance privileges the
23Self-Insurers Advisory Board shall review and submit for
24approval by the Chairman of the Commission recommendations of
25disposition of all initial applications to self-insure and all
26applications to renew self-insurance privileges filed by

 

 

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1private self-insurers pursuant to the provisions of this
2Section and Section 4a-9 of this Act. Each private self-insurer
3shall submit with its initial and renewal applications the
4application fee required by Section 4a-4 of this Act.
5    The Chairman of the Commission shall promptly act upon all
6initial applications and applications for renewal in full
7accordance with the recommendations of the Board or, should the
8Chairman disagree with any recommendation of disposition of the
9Self-Insurer's Advisory Board, he shall within 30 days of
10receipt of such recommendation provide to the Board in writing
11the reasons supporting his decision. The Chairman shall also
12promptly notify the employer of his decision within 15 days of
13receipt of the recommendation of the Board.
14    If an employer is denied a renewal of self-insurance
15privileges pursuant to application it shall retain said
16privilege for 120 days after receipt of a notice of
17cancellation of the privilege from the Chairman of the
18Commission.
19    All orders made by the Chairman under this Section shall be
20subject to review by the courts, such review to be taken in the
21same manner and within the same time as provided by subsection
22(f) of Section 19 of this Act for review of awards and
23decisions of the Commission, upon the party seeking the review
24filing with the clerk of the court to which such review is
25taken a bond in an amount to be fixed and approved by the court
26to which the review is taken, conditioned upon the payment of

 

 

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1all compensation awarded against the person taking such review
2pending a decision thereof and further conditioned upon such
3other obligations as the court may impose. Upon the review the
4Circuit Court shall have power to review all questions of fact
5as well as of law.
6(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
794-839, eff. 6-6-06.)
 
8    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
9    Sec. 8. The amount of compensation which shall be paid to
10the employee for an accidental injury not resulting in death
11is:
12    (a) The employer shall provide and pay the negotiated rate,
13if applicable, or the lesser of the health care provider's
14actual charges or according to a fee schedule, subject to
15Section 8.2, in effect at the time the service was rendered for
16all the necessary first aid, medical and surgical services, and
17all necessary medical, surgical and hospital services
18thereafter incurred, limited, however, to that which is
19reasonably required to cure or relieve from the effects of the
20accidental injury, even if a health care provider sells,
21transfers, or otherwise assigns an account receivable for
22procedures, treatments, or services covered under this Act. If
23the employer does not dispute payment of first aid, medical,
24surgical, and hospital services, the employer shall make such
25payment to the provider on behalf of the employee. The employer

 

 

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1shall also pay for treatment, instruction and training
2necessary for the physical, mental and vocational
3rehabilitation of the employee, including all maintenance
4costs and expenses incidental thereto. If as a result of the
5injury the employee is unable to be self-sufficient the
6employer shall further pay for such maintenance or
7institutional care as shall be required.
8    The employer shall select the employee's first physician,
9surgeon, or provider of hospital services at the employer's
10expense. However, in the event the employer fails to exercise
11his, her, or its right to select the first physician, surgeon,
12or provider of hospital services or where it is impracticable
13for the employer to exercise this right, the selection shall be
14made by the employee at the employer's expense. In the event
15the employee is dissatisfied with the first physician, surgeon,
16or provider of hospital services, the employee has an absolute
17right to select a second physician, surgeon, or provider of
18hospital services at the employer's expense. Emergency
19services and "chains-of-referral" shall not constitute a
20choice of physician, surgeon, or provider of hospital services
21by the employer or employee. The employee may at any time elect
22to secure his own physician, surgeon and hospital services at
23the employer's expense , or,
24    Notwithstanding the foregoing, upon Upon agreement between
25the employer and the employees, or the employees' exclusive
26representative, and subject to the approval of the Illinois

 

 

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1Workers' Compensation Commission, the employer shall maintain
2a list of physicians, to be known as a Panel of Physicians, who
3are accessible to the employees. The employer shall post this
4list in a place or places easily accessible to his employees.
5The employee shall have the right to make an alternative choice
6of physician from such Panel if he is not satisfied with the
7physician first selected. If, due to the nature of the injury
8or its occurrence away from the employer's place of business,
9the employee is unable to make a selection from the Panel, the
10selection process from the Panel shall not apply. The physician
11selected from the Panel may arrange for any consultation,
12referral or other specialized medical services outside the
13Panel at the employer's expense. Provided that, in the event
14the Commission shall find that a doctor selected by the
15employee is rendering improper or inadequate care, the
16Commission may order the employee to select another doctor
17certified or qualified in the medical field for which treatment
18is required. If the employee refuses to make such change the
19Commission may relieve the employer of his obligation to pay
20the doctor's charges from the date of refusal to the date of
21compliance.
22    Any vocational rehabilitation counselors who provide
23service under this Act shall have appropriate certifications
24which designate the counselor as qualified to render opinions
25relating to vocational rehabilitation. Vocational
26rehabilitation may include, but is not limited to, counseling

 

 

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1for job searches, supervising a job search program, and
2vocational retraining including education at an accredited
3learning institution. The employee or employer may petition to
4the Commission to decide disputes relating to vocational
5rehabilitation and the Commission shall resolve any such
6dispute, including payment of the vocational rehabilitation
7program by the employer.
8    The maintenance benefit shall not be less than the
9temporary total disability rate determined for the employee. In
10addition, maintenance shall include costs and expenses
11incidental to the vocational rehabilitation program.
12    When the employee is working light duty on a part-time
13basis or full-time basis and earns less than he or she would be
14earning if employed in the full capacity of the job or jobs,
15then the employee shall be entitled to temporary partial
16disability benefits. Temporary partial disability benefits
17shall be equal to two-thirds of the difference between the
18average amount that the employee would be able to earn in the
19full performance of his or her duties in the occupation in
20which he or she was engaged at the time of accident and the net
21amount which he or she is earning in the modified job provided
22to the employee by the employer or in any other job that the
23employee is working.
24    Every hospital, physician, surgeon or other person
25rendering treatment or services in accordance with the
26provisions of this Section shall upon written request furnish

 

 

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1full and complete reports thereof to, and permit their records
2to be copied by, the employer, the employee or his dependents,
3as the case may be, or any other party to any proceeding for
4compensation before the Commission, or their attorneys.
5    Notwithstanding the foregoing, the employer's liability to
6pay for such medical services selected by the employee shall be
7limited to:
8        (1) all first aid and emergency treatment; plus
9        (2) all medical, surgical and hospital services
10    provided by the first physician, surgeon or hospital
11    initially chosen by the employee or by any other physician,
12    consultant, expert, institution or other provider of
13    services recommended by said initial service provider or
14    any subsequent provider of medical services in the chain of
15    referrals from said initial service provider; plus
16        (3) all medical, surgical and hospital services
17    provided by any second physician, surgeon or hospital
18    subsequently chosen by the employee or by any other
19    physician, consultant, expert, institution or other
20    provider of services recommended by said second service
21    provider or any subsequent provider of medical services in
22    the chain of referrals from said second service provider.
23    Thereafter the employer shall select and pay for all
24    necessary medical, surgical and hospital treatment and the
25    employee may not select a provider of medical services at
26    the employer's expense unless the employer agrees to such

 

 

09600SB1066ham002- 31 -LRB096 07137 WGH 44843 a

1    selection.
2    At any time the employee may obtain any medical treatment
3he desires at his own expense. This paragraph shall not affect
4the duty to pay for rehabilitation referred to above.
5    When an employer and employee so agree in writing, nothing
6in this Act prevents an employee whose injury or disability has
7been established under this Act, from relying in good faith, on
8treatment by prayer or spiritual means alone, in accordance
9with the tenets and practice of a recognized church or
10religious denomination, by a duly accredited practitioner
11thereof, and having nursing services appropriate therewith,
12without suffering loss or diminution of the compensation
13benefits under this Act. However, the employee shall submit to
14all physical examinations required by this Act. The cost of
15such treatment and nursing care shall be paid by the employee
16unless the employer agrees to make such payment.
17    Where the accidental injury results in the amputation of an
18arm, hand, leg or foot, or the enucleation of an eye, or the
19loss of any of the natural teeth, the employer shall furnish an
20artificial of any such members lost or damaged in accidental
21injury arising out of and in the course of employment, and
22shall also furnish the necessary braces in all proper and
23necessary cases. In cases of the loss of a member or members by
24amputation, the employer shall, whenever necessary, maintain
25in good repair, refit or replace the artificial limbs during
26the lifetime of the employee. Where the accidental injury

 

 

09600SB1066ham002- 32 -LRB096 07137 WGH 44843 a

1accompanied by physical injury results in damage to a denture,
2eye glasses or contact eye lenses, or where the accidental
3injury results in damage to an artificial member, the employer
4shall replace or repair such denture, glasses, lenses, or
5artificial member.
6    The furnishing by the employer of any such services or
7appliances is not an admission of liability on the part of the
8employer to pay compensation.
9    The furnishing of any such services or appliances or the
10servicing thereof by the employer is not the payment of
11compensation.
12    (b) If the period of temporary total incapacity for work
13lasts more than 3 working days, weekly compensation as
14hereinafter provided shall be paid beginning on the 4th day of
15such temporary total incapacity and continuing as long as the
16total temporary incapacity lasts. In cases where the temporary
17total incapacity for work continues for a period of 14 days or
18more from the day of the accident compensation shall commence
19on the day after the accident.
20        1. The compensation rate for temporary total
21    incapacity under this paragraph (b) of this Section shall
22    be equal to 66 2/3% of the employee's average weekly wage
23    computed in accordance with Section 10, provided that it
24    shall be not less than 66 2/3% of the sum of the Federal
25    minimum wage under the Fair Labor Standards Act, or the
26    Illinois minimum wage under the Minimum Wage Law, whichever

 

 

09600SB1066ham002- 33 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 34 -LRB096 07137 WGH 44843 a

1    paragraph (d) or under paragraph (e) of this Section shall
2    be equal to 60% of the employee's average weekly wage
3    computed in accordance with the provisions of Section 10,
4    provided that it shall be not less than 66 2/3% of the sum
5    of the Federal minimum wage under the Fair Labor Standards
6    Act, or the Illinois minimum wage under the Minimum Wage
7    Law, whichever is more, multiplied by 40 hours. This
8    percentage rate shall be increased by 10% for each spouse
9    and child, not to exceed 100% of the total minimum wage
10    calculation,
11    nor exceed the employee's average weekly wage computed in
12    accordance with the provisions of Section 10, whichever is
13    less.
14        3. As used in this Section the term "child" means a
15    child of the employee including any child legally adopted
16    before the accident or whom at the time of the accident the
17    employee was under legal obligation to support or to whom
18    the employee stood in loco parentis, and who at the time of
19    the accident was under 18 years of age and not emancipated.
20    The term "children" means the plural of "child".
21        4. All weekly compensation rates provided under
22    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
23    Section shall be subject to the following limitations:
24        The maximum weekly compensation rate from July 1, 1975,
25    except as hereinafter provided, shall be 100% of the
26    State's average weekly wage in covered industries under the

 

 

09600SB1066ham002- 35 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 36 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 37 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 38 -LRB096 07137 WGH 44843 a

1        7. The payment of compensation by an employer or his
2    insurance carrier to an injured employee shall not
3    constitute an admission of the employer's liability to pay
4    compensation.
5    (c) For any serious and permanent disfigurement to the
6hand, head, face, neck, arm, leg below the knee or the chest
7above the axillary line, the employee is entitled to
8compensation for such disfigurement, the amount determined by
9agreement at any time or by arbitration under this Act, at a
10hearing not less than 6 months after the date of the accidental
11injury, which amount shall not exceed 150 weeks (if the
12accidental injury occurs on or after the effective date of this
13amendatory Act of the 94th General Assembly but before February
141, 2006) or 162 weeks (if the accidental injury occurs on or
15after February 1, 2006) at the applicable rate provided in
16subparagraph 2.1 of paragraph (b) of this Section.
17    No compensation is payable under this paragraph where
18compensation is payable under paragraphs (d), (e) or (f) of
19this Section.
20    A duly appointed member of a fire department in a city, the
21population of which exceeds 200,000 according to the last
22federal or State census, is eligible for compensation under
23this paragraph only where such serious and permanent
24disfigurement results from burns.
25    (d) 1. If, after the accidental injury has been sustained,
26the employee as a result thereof becomes partially

 

 

09600SB1066ham002- 39 -LRB096 07137 WGH 44843 a

1incapacitated from pursuing his usual and customary line of
2employment, he shall, except in cases compensated under the
3specific schedule set forth in paragraph (e) of this Section,
4receive compensation for the duration of his disability,
5subject to the limitations as to maximum amounts fixed in
6paragraph (b) of this Section, equal to 66-2/3% of the
7difference between the average amount which he would be able to
8earn in the full performance of his duties in the occupation in
9which he was engaged at the time of the accident and the
10average amount which he is earning or is able to earn in some
11suitable employment or business after the accident. An award
12for wage differential under this subsection shall be effective
13only until the employee reaches the age of 67 or 5 years from
14the date the award becomes final, whichever is later. In
15addition, after a wage differential award under this paragraph
16(d)1 becomes final, the employer shall, on no more than a
17quarter annual basis, upon written request to the employee, be
18entitled to verification of an employee's current employment
19status and earnings, including the name and address of the
20employee's current employer, rate of pay or method of
21compensation, duration of such employment, and true copies of
22the employee's paychecks or other evidence of payment for the
23duration of such employment. An employer may also request that
24the employee sign an authorization to permit the employer to
25then obtain from the employee's current employer the employee's
26earnings and payroll documentation. Notwithstanding and in

 

 

09600SB1066ham002- 40 -LRB096 07137 WGH 44843 a

1addition to Section 19(h), a final award for wage differential
2under this paragraph (d)1 may at any time be reviewed by the
3Commission in an evidentiary hearing at the request of the
4employer or employee on the grounds that there has been a
5subsequent material change in the difference between the
6average amount the employee would be able to earn currently in
7the full performance of his or her duties in the occupation in
8which the employee was engaged at the time of the accident and
9the average amount the employee is earning currently in some
10suitable employment or business after the accident. After
11review under this paragraph (d)1, the Commission may modify or
12vacate a final wage differential award. Such modification or
13vacation shall be based on a material change in the employee's
14current job earnings or a material change in the job earnings
15the employee would be receiving currently in the full
16performance of his or her duties in the occupation in which the
17employee was engaged at the time of the accident.
18    2. If, as a result of the accident, the employee sustains
19serious and permanent injuries not covered by paragraphs (c)
20and (e) of this Section or having sustained injuries covered by
21the aforesaid paragraphs (c) and (e), he shall have sustained
22in addition thereto other injuries which injuries do not
23incapacitate him from pursuing the duties of his employment but
24which would disable him from pursuing other suitable
25occupations, or which have otherwise resulted in physical
26impairment; or if such injuries partially incapacitate him from

 

 

09600SB1066ham002- 41 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 42 -LRB096 07137 WGH 44843 a

1paragraphs (c) and (e) of this Section and the compensation
2provided in this paragraph shall not affect the employee's
3right to compensation payable under paragraphs (b), (c) and (e)
4of this Section for the disabilities therein covered.
5    (e) For accidental injuries in the following schedule, the
6employee shall receive compensation for the period of temporary
7total incapacity for work resulting from such accidental
8injury, under subparagraph 1 of paragraph (b) of this Section,
9and shall receive in addition thereto compensation for a
10further period for the specific loss herein mentioned, but
11shall not receive any compensation under any other provisions
12of this Act. The following listed amounts apply to either the
13loss of or the permanent and complete loss of use of the member
14specified, such compensation for the length of time as follows:
15        1. Thumb-
16            70 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            76 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        2. First, or index finger-
22            40 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            43 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

09600SB1066ham002- 43 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 44 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 45 -LRB096 07137 WGH 44843 a

1            235 weeks if the accidental injury occurs on or
2        after the effective date of this amendatory Act of the
3        94th General Assembly but before February 1, 2006.
4            253 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        Where an accidental injury results in the amputation of
7    an arm below the elbow, such injury shall be compensated as
8    a loss of an arm. Where an accidental injury results in the
9    amputation of an arm above the elbow, compensation for an
10    additional 15 weeks (if the accidental injury occurs on or
11    after the effective date of this amendatory Act of the 94th
12    General Assembly but before February 1, 2006) or an
13    additional 17 weeks (if the accidental injury occurs on or
14    after February 1, 2006) shall be paid, except where the
15    accidental injury results in the amputation of an arm at
16    the shoulder joint, or so close to shoulder joint that an
17    artificial arm cannot be used, or results in the
18    disarticulation of an arm at the shoulder joint, in which
19    case compensation for an additional 65 weeks (if the
20    accidental injury occurs on or after the effective date of
21    this amendatory Act of the 94th General Assembly but before
22    February 1, 2006) or an additional 70 weeks (if the
23    accidental injury occurs on or after February 1, 2006)
24    shall be paid.
25        11. Foot-
26            155 weeks if the accidental injury occurs on or

 

 

09600SB1066ham002- 46 -LRB096 07137 WGH 44843 a

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            167 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        12. Leg-
6            200 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            215 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        Where an accidental injury results in the amputation of
12    a leg below the knee, such injury shall be compensated as
13    loss of a leg. Where an accidental injury results in the
14    amputation of a leg above the knee, compensation for an
15    additional 25 weeks (if the accidental injury occurs on or
16    after the effective date of this amendatory Act of the 94th
17    General Assembly but before February 1, 2006) or an
18    additional 27 weeks (if the accidental injury occurs on or
19    after February 1, 2006) shall be paid, except where the
20    accidental injury results in the amputation of a leg at the
21    hip joint, or so close to the hip joint that an artificial
22    leg cannot be used, or results in the disarticulation of a
23    leg at the hip joint, in which case compensation for an
24    additional 75 weeks (if the accidental injury occurs on or
25    after the effective date of this amendatory Act of the 94th
26    General Assembly but before February 1, 2006) or an

 

 

09600SB1066ham002- 47 -LRB096 07137 WGH 44843 a

1    additional 81 weeks (if the accidental injury occurs on or
2    after February 1, 2006) shall be paid.
3        13. Eye-
4            150 weeks if the accidental injury occurs on or
5        after the effective date of this amendatory Act of the
6        94th General Assembly but before February 1, 2006.
7            162 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        Where an accidental injury results in the enucleation
10    of an eye, compensation for an additional 10 weeks (if the
11    accidental injury occurs on or after the effective date of
12    this amendatory Act of the 94th General Assembly but before
13    February 1, 2006) or an additional 11 weeks (if the
14    accidental injury occurs on or after February 1, 2006)
15    shall be paid.
16        14. Loss of hearing of one ear-
17            50 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            54 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        Total and permanent loss of hearing of both ears-
23            200 weeks if the accidental injury occurs on or
24        after the effective date of this amendatory Act of the
25        94th General Assembly but before February 1, 2006.
26            215 weeks if the accidental injury occurs on or

 

 

09600SB1066ham002- 48 -LRB096 07137 WGH 44843 a

1        after February 1, 2006.
2        15. Testicle-
3            50 weeks if the accidental injury occurs on or
4        after the effective date of this amendatory Act of the
5        94th General Assembly but before February 1, 2006.
6            54 weeks if the accidental injury occurs on or
7        after February 1, 2006.
8        Both testicles-
9            150 weeks if the accidental injury occurs on or
10        after the effective date of this amendatory Act of the
11        94th General Assembly but before February 1, 2006.
12            162 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        16. For the permanent partial loss of use of a member
15    or sight of an eye, or hearing of an ear, compensation
16    during that proportion of the number of weeks in the
17    foregoing schedule provided for the loss of such member or
18    sight of an eye, or hearing of an ear, which the partial
19    loss of use thereof bears to the total loss of use of such
20    member, or sight of eye, or hearing of an ear.
21            (a) Loss of hearing for compensation purposes
22        shall be confined to the frequencies of 1,000, 2,000
23        and 3,000 cycles per second. Loss of hearing ability
24        for frequency tones above 3,000 cycles per second are
25        not to be considered as constituting disability for
26        hearing.

 

 

09600SB1066ham002- 49 -LRB096 07137 WGH 44843 a

1            (b) The percent of hearing loss, for purposes of
2        the determination of compensation claims for
3        occupational deafness, shall be calculated as the
4        average in decibels for the thresholds of hearing for
5        the frequencies of 1,000, 2,000 and 3,000 cycles per
6        second. Pure tone air conduction audiometric
7        instruments, approved by nationally recognized
8        authorities in this field, shall be used for measuring
9        hearing loss. If the losses of hearing average 30
10        decibels or less in the 3 frequencies, such losses of
11        hearing shall not then constitute any compensable
12        hearing disability. If the losses of hearing average 85
13        decibels or more in the 3 frequencies, then the same
14        shall constitute and be total or 100% compensable
15        hearing loss.
16            (c) In measuring hearing impairment, the lowest
17        measured losses in each of the 3 frequencies shall be
18        added together and divided by 3 to determine the
19        average decibel loss. For every decibel of loss
20        exceeding 30 decibels an allowance of 1.82% shall be
21        made up to the maximum of 100% which is reached at 85
22        decibels.
23            (d) If a hearing loss is established to have
24        existed on July 1, 1975 by audiometric testing the
25        employer shall not be liable for the previous loss so
26        established nor shall he be liable for any loss for

 

 

09600SB1066ham002- 50 -LRB096 07137 WGH 44843 a

1        which compensation has been paid or awarded.
2            (e) No consideration shall be given to the question
3        of whether or not the ability of an employee to
4        understand speech is improved by the use of a hearing
5        aid.
6            (f) No claim for loss of hearing due to industrial
7        noise shall be brought against an employer or allowed
8        unless the employee has been exposed for a period of
9        time sufficient to cause permanent impairment to noise
10        levels in excess of the following:
11Sound Level DBA
12Slow ResponseHours Per Day
13908
14926
15954
16973
171002
181021-1/2
191051
201101/2
211151/4
22        This subparagraph (f) shall not be applied in cases of
23    hearing loss resulting from trauma or explosion.
24        17. In computing the compensation to be paid to any
25    employee who, before the accident for which he claims
26    compensation, had before that time sustained an injury

 

 

09600SB1066ham002- 51 -LRB096 07137 WGH 44843 a

1    resulting in the loss by amputation or partial loss by
2    amputation of any member, including hand, arm, thumb or
3    fingers, leg, foot or any toes, such loss or partial loss
4    of any such member shall be deducted from any award made
5    for the subsequent injury. For the permanent loss of use or
6    the permanent partial loss of use of any such member or the
7    partial loss of sight of an eye, for which compensation has
8    been paid, then such loss shall be taken into consideration
9    and deducted from any award for the subsequent injury.
10        18. The specific case of loss of both hands, both arms,
11    or both feet, or both legs, or both eyes, or of any two
12    thereof, or the permanent and complete loss of the use
13    thereof, constitutes total and permanent disability, to be
14    compensated according to the compensation fixed by
15    paragraph (f) of this Section. These specific cases of
16    total and permanent disability do not exclude other cases.
17        Any employee who has previously suffered the loss or
18    permanent and complete loss of the use of any of such
19    members, and in a subsequent independent accident loses
20    another or suffers the permanent and complete loss of the
21    use of any one of such members the employer for whom the
22    injured employee is working at the time of the last
23    independent accident is liable to pay compensation only for
24    the loss or permanent and complete loss of the use of the
25    member occasioned by the last independent accident.
26        19. In a case of specific loss and the subsequent death

 

 

09600SB1066ham002- 52 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 53 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 54 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 55 -LRB096 07137 WGH 44843 a

1a party respondent in the application for adjustment of claim.
2The application for adjustment of claim shall state briefly and
3in general terms the approximate time and place and manner of
4the loss of the first member.
5    In its award the Commission or the Arbitrator shall
6specifically find the amount the injured employee shall be
7weekly paid, the number of weeks compensation which shall be
8paid by the employer, the date upon which payments begin out of
9the Second Injury Fund provided for in paragraph (f) of Section
107 of this Act, the length of time the weekly payments continue,
11the date upon which the pension payments commence and the
12monthly amount of the payments. The Commission shall 30 days
13after the date upon which payments out of the Second Injury
14Fund have begun as provided in the award, and every month
15thereafter, prepare and submit to the State Comptroller a
16voucher for payment for all compensation accrued to that date
17at the rate fixed by the Commission. The State Comptroller
18shall draw a warrant to the injured employee along with a
19receipt to be executed by the injured employee and returned to
20the Commission. The endorsed warrant and receipt is a full and
21complete acquittance to the Commission for the payment out of
22the Second Injury Fund. No other appropriation or warrant is
23necessary for payment out of the Second Injury Fund. The Second
24Injury Fund is appropriated for the purpose of making payments
25according to the terms of the awards.
26    As of July 1, 1980 to July 1, 1982, all claims against and

 

 

09600SB1066ham002- 56 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 57 -LRB096 07137 WGH 44843 a

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

 

 

09600SB1066ham002- 58 -LRB096 07137 WGH 44843 a

1before the effective date of this amendatory Act of the 94th
2General Assembly (Senate Bill 1283 of the 94th General
3Assembly), the annual adjustments to the compensation rate in
4awards for death benefits or permanent total disability, as
5provided in this Act, shall be paid by the employer. The
6adjustment shall be made by the employer on July 15 of the
7second year next following the date of the entry of the award
8and shall further be made on July 15 annually thereafter. If
9during the intervening period from the date of the entry of the
10award, or the last periodic adjustment, there shall have been
11an increase in the State's average weekly wage in covered
12industries under the Unemployment Insurance Act, the employer
13shall increase the weekly compensation rate proportionately by
14the same percentage as the percentage of increase in the
15State's average weekly wage in covered industries under the
16Unemployment Insurance Act. The increase in the compensation
17rate under this paragraph shall in no event bring the total
18compensation rate to an amount greater than the prevailing
19maximum rate at the time that the annual adjustment is made. In
20the event of a decrease in such average weekly wage there shall
21be no change in the then existing compensation rate. Such
22increase shall be paid by the employer in the same manner and
23at the same intervals as the payment of compensation in the
24award. This paragraph shall not apply to cases where there is
25disputed liability and in which a compromise lump sum
26settlement between the employer and the injured employee, or

 

 

09600SB1066ham002- 59 -LRB096 07137 WGH 44843 a

1his or her dependents, as the case may be, has been duly
2approved by the Illinois Workers' Compensation Commission.
3    The annual adjustments for every award of death benefits or
4permanent total disability involving accidents occurring
5before July 20, 2005 and accidents occurring on or after the
6effective date of this amendatory Act of the 94th General
7Assembly (Senate Bill 1283 of the 94th General Assembly) shall
8continue to be paid from the Rate Adjustment Fund pursuant to
9this paragraph and Section 7(f) of this Act.
10    (h) In case death occurs from any cause before the total
11compensation to which the employee would have been entitled has
12been paid, then in case the employee leaves any widow, widower,
13child, parent (or any grandchild, grandparent or other lineal
14heir or any collateral heir dependent at the time of the
15accident upon the earnings of the employee to the extent of 50%
16or more of total dependency) such compensation shall be paid to
17the beneficiaries of the deceased employee and distributed as
18provided in paragraph (g) of Section 7.
19    (h-1) In case an injured employee is under legal disability
20at the time when any right or privilege accrues to him or her
21under this Act, a guardian may be appointed pursuant to law,
22and may, on behalf of such person under legal disability, claim
23and exercise any such right or privilege with the same effect
24as if the employee himself or herself had claimed or exercised
25the right or privilege. No limitations of time provided by this
26Act run so long as the employee who is under legal disability

 

 

09600SB1066ham002- 60 -LRB096 07137 WGH 44843 a

1is without a conservator or guardian.
2    (i) In case the injured employee is under 16 years of age
3at the time of the accident and is illegally employed, the
4amount of compensation payable under paragraphs (b), (c), (d),
5(e) and (f) of this Section is increased 50%.
6    However, where an employer has on file an employment
7certificate issued pursuant to the Child Labor Law or work
8permit issued pursuant to the Federal Fair Labor Standards Act,
9as amended, or a birth certificate properly and duly issued,
10such certificate, permit or birth certificate is conclusive
11evidence as to the age of the injured minor employee for the
12purposes of this Section.
13    Nothing herein contained repeals or amends the provisions
14of the Child Labor Law relating to the employment of minors
15under the age of 16 years.
16    (j) 1. In the event the injured employee receives benefits,
17including medical, surgical or hospital benefits under any
18group plan covering non-occupational disabilities contributed
19to wholly or partially by the employer, which benefits should
20not have been payable if any rights of recovery existed under
21this Act, then such amounts so paid to the employee from any
22such group plan as shall be consistent with, and limited to,
23the provisions of paragraph 2 hereof, shall be credited to or
24against any compensation payment for temporary total
25incapacity for work or any medical, surgical or hospital
26benefits made or to be made under this Act. In such event, the

 

 

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

 

 

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1insurance carrier shall receive credit for each such payment
2only to the extent of the compensation that would have been
3payable during the period covered by such payment.
4    3. The extension of time for the filing of an Application
5for Adjustment of Claim as provided in paragraph 1 above shall
6not apply to those cases where the time for such filing had
7expired prior to the date on which payments or benefits
8enumerated herein have been initiated or resumed. Provided
9however that this paragraph 3 shall apply only to cases wherein
10the payments or benefits hereinabove enumerated shall be
11received after July 1, 1969.
12(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
1394-695, eff. 11-16-05.)
 
14    (820 ILCS 305/8.2)
15    Sec. 8.2. Fee schedule.
16    (a) Except as provided for in subsection (c), for
17procedures, treatments, or services covered under this Act and
18rendered or to be rendered on and after February 1, 2006, the
19maximum allowable payment shall be 90% of the 80th percentile
20of charges and fees as determined by the Commission utilizing
21information provided by employers' and insurers' national
22databases, with a minimum of 12,000,000 Illinois line item
23charges and fees comprised of health care provider and hospital
24charges and fees as of August 1, 2004 but not earlier than
25August 1, 2002. These charges and fees are provider billed

 

 

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1amounts and shall not include discounted charges. The 80th
2percentile is the point on an ordered data set from low to high
3such that 80% of the cases are below or equal to that point and
4at most 20% are above or equal to that point. The Commission
5shall adjust these historical charges and fees as of August 1,
62004 by the Consumer Price Index-U for the period August 1,
72004 through September 30, 2005. The Commission shall establish
8fee schedules for procedures, treatments, or services for
9hospital inpatient, hospital outpatient, emergency room and
10trauma, ambulatory surgical treatment centers, and
11professional services. These charges and fees shall be
12designated by geozip or any smaller geographic unit. The data
13shall in no way identify or tend to identify any patient,
14employer, or health care provider. As used in this Section,
15"geozip" means a three-digit zip code based on data
16similarities, geographical similarities, and frequencies. A
17geozip does not cross state boundaries. As used in this
18Section, "three-digit zip code" means a geographic area in
19which all zip codes have the same first 3 digits. If a geozip
20does not have the necessary number of charges and fees to
21calculate a valid percentile for a specific procedure,
22treatment, or service, the Commission may combine data from the
23geozip with up to 4 other geozips that are demographically and
24economically similar and exhibit similarities in data and
25frequencies until the Commission reaches 9 charges or fees for
26that specific procedure, treatment, or service. In cases where

 

 

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1the compiled data contains less than 9 charges or fees for a
2procedure, treatment, or service, reimbursement shall occur at
376% of charges and fees as determined by the Commission in a
4manner consistent with the provisions of this paragraph.
5Providers of out-of-state procedures, treatments, services,
6products, or supplies shall be reimbursed at the lesser of that
7state's fee schedule amount or the fee schedule amount that
8would apply to Cook County, Illinois. If no fee schedule exists
9in that state, the provider shall be reimbursed at the lesser
10of the actual charge or the fee schedule amount in Cook County,
11Illinois The Commission has the authority to set the maximum
12allowable payment to providers of out-of-state procedures,
13treatments, or services covered under this Act in a manner
14consistent with this Section. Not later than September 30 in
152006 and each year thereafter, the Commission shall
16automatically increase or decrease the maximum allowable
17payment for a procedure, treatment, or service established and
18in effect on January 1 of that year by the percentage change in
19the Consumer Price Index-U for the 12 month period ending
20August 31 of that year. The increase or decrease shall become
21effective on January 1 of the following year. As used in this
22Section, "Consumer Price Index-U" means the index published by
23the Bureau of Labor Statistics of the U.S. Department of Labor,
24that measures the average change in prices of all goods and
25services purchased by all urban consumers, U.S. city average,
26all items, 1982-84=100.

 

 

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1    (a-1) Notwithstanding the provisions of subsection (a),
2the following provisions shall apply to the medical fee
3schedule starting on April 1, 2011:
4        (1) The Commission shall establish and maintain fee
5    schedules for procedures, treatments, products, services,
6    or supplies for hospital inpatient, hospital outpatient,
7    emergency room, ambulatory surgical treatment centers,
8    accredited ambulatory treatment facilities, prescriptions
9    filled and dispensed outside of a licensed pharmacy, dental
10    services, and professional services. This fee schedule
11    shall be based on the fee schedule amounts already
12    established by the Commission pursuant to subsection (a) of
13    this Section. However, these fee schedule amounts shall be
14    grouped into 4 regions to be implemented as follows:
15        Region 1: Cook County.
16        Region 2: DuPage, Kane, Lake, and Will Counties.
17        Region 3: Bond, Calhoun, Clinton, Jersey, Macoupin,
18    Madison, Monroe, Montgomery, Randolph, St. Clair, and
19    Washington Counties.
20        Region 4: All counties in Illinois that are not
21    included in Regions 1, 2, or 3.
22        (2) In cases where the compiled data contains less than
23    9 charges or fees for a procedure, treatment, product,
24    supply, or service or where the fee schedule amount cannot
25    be determined by the non-discounted charge data,
26    non-Medicare relative values and conversion factors

 

 

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1    derived from established fee schedule amounts, coding
2    crosswalks, or other data as determined by the Commission,
3    reimbursement shall occur at 76% of charges and fees until
4    April 1, 2011 and 64.6% of charges and fees thereafter as
5    determined by the Commission in a manner consistent with
6    the provisions of this paragraph. If a geozip, as defined
7    in subsection (a) of this Section, overlaps into one or
8    more of the regions set forth in paragraph (1) of this
9    subsection (a-1), then the Commission shall average or
10    repeat the charges and fees in a geozip in order to
11    designate charges and fees for each region.
12        (3) To establish additional fee schedule amounts, the
13    Commission shall utilize provider non-discounted charge
14    data, non-Medicare relative values and conversion factors
15    derived from established fee schedule amounts, and coding
16    crosswalks. The Commission may establish additional fee
17    schedule amounts based on either the charge or cost of the
18    procedure, treatment, product, supply, or service.
19        (4) Implants shall be reimbursed at 25% above the net
20    manufacturer's invoice price less rebates, plus actual
21    reasonable and customary shipping charges whether or not
22    the implant charge is submitted by a provider in
23    conjunction with a bill for all other services associated
24    with the implant, submitted by a provider on a separate
25    claim form, submitted by a distributor, or submitted by the
26    manufacturer of the implant. "Implants" include the

 

 

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1    following codes or any substantially similar updated code
2    as determined by the Commission: 0274
3    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
4    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
5    (investigational devices); and 0636 (drugs requiring
6    detailed coding). Non-implantable devices or supplies
7    within these codes shall be reimbursed at 65% of actual
8    charge, which is the provider's normal rates under its
9    standard chargemaster. A standard chargemaster is the
10    provider's list of charges for procedures, treatments,
11    products, supplies, or services used to bill payers in a
12    consistent manner.
13        (5) The Commission shall automatically update all
14    codes and associated rules with the version of the codes
15    and rules valid on January 1 of that year.
16    (a-2) For procedures, treatments, services, or supplies
17covered under this Act and rendered or to be rendered on or
18after April 1, 2011, the maximum allowable payment shall be 85%
19of the fee schedule amounts and any reimbursements for charges
20and fees pursuant to paragraph (2) of subsection (a-1) in
21effect on April 1, 2011 and thereafter be adjusted yearly by
22the Consumer Price Index-U, as described in subsection (a) of
23this Section.
24    (a-3) Prescriptions filled and dispensed outside of a
25licensed pharmacy shall be subject to a fee schedule that shall
26not exceed the Average Wholesale Price (AWP) or its equivalent

 

 

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1plus a dispensing fee of $4.18. AWP or its equivalent will be
2as set forth for that drug on that date as published in
3Medispan.
4    (b) Notwithstanding the provisions of subsections
5subsection (a) and (a-1) of this Section, if the Commission
6finds that there is a significant limitation on access to
7quality health care in either a specific field of health care
8services for a specific procedure, treatment, product,
9service, or supply or for a specific geographic limitation on
10access to health care, it may adjust fee schedule amounts in a
11manner consistent with the provisions of this Act change the
12Consumer Price Index-U increase or decrease for that specific
13field or specific geographic limitation on access to health
14care to address that limitation.
15    (c) The Commission shall establish by rule a process to
16review those medical cases or outliers that involve
17extra-ordinary treatment to determine whether to make an
18additional adjustment to the maximum payment within a fee
19schedule for a procedure, treatment, or service.
20    (d) When a patient notifies a provider that the treatment,
21procedure, or service being sought is for a work-related
22illness or injury and furnishes the provider the name and
23address of the responsible employer, the provider shall bill
24the employer directly. The employer shall make payment and
25providers shall submit bills and records in accordance with the
26provisions of this Section. All payments to providers for

 

 

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1treatment provided pursuant to this Act shall be made within 60
2days of receipt of the bills as long as the claim contains
3substantially all the required data elements necessary to
4adjudicate the bills. In the case of nonpayment to a provider
5within 60 days of receipt of the bill which contained
6substantially all of the required data elements necessary to
7adjudicate the bill or nonpayment to a provider of a portion of
8such a bill up to the lesser of the actual charge or the
9payment level set by the Commission in the fee schedule
10established in this Section, the bill, or portion of the bill,
11shall incur interest at a rate of 1% per month payable to the
12provider.
13    (e) Except as provided in subsections (e-5), (e-10), and
14(e-15), a provider shall not hold an employee liable for costs
15related to a non-disputed procedure, treatment, or service
16rendered in connection with a compensable injury. The
17provisions of subsections (e-5), (e-10), (e-15), and (e-20)
18shall not apply if an employee provides information to the
19provider regarding participation in a group health plan. If the
20employee participates in a group health plan, the provider may
21submit a claim for services to the group health plan. If the
22claim for service is covered by the group health plan, the
23employee's responsibility shall be limited to applicable
24deductibles, co-payments, or co-insurance. Except as provided
25under subsections (e-5), (e-10), (e-15), and (e-20), a provider
26shall not bill or otherwise attempt to recover from the

 

 

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1employee the difference between the provider's charge and the
2amount paid by the employer or the insurer on a compensable
3injury, or for medical services or treatment determined by the
4Commission to be excessive or unnecessary.
5    (e-5) If an employer notifies a provider that the employer
6does not consider the illness or injury to be compensable under
7this Act, the provider may seek payment of the provider's
8actual charges from the employee for any procedure, treatment,
9or service rendered. Once an employee informs the provider that
10there is an application filed with the Commission to resolve a
11dispute over payment of such charges, the provider shall cease
12any and all efforts to collect payment for the services that
13are the subject of the dispute. Any statute of limitations or
14statute of repose applicable to the provider's efforts to
15collect payment from the employee shall be tolled from the date
16that the employee files the application with the Commission
17until the date that the provider is permitted to resume
18collection efforts under the provisions of this Section.
19    (e-10) If an employer notifies a provider that the employer
20will pay only a portion of a bill for any procedure, treatment,
21or service rendered in connection with a compensable illness or
22disease, the provider may seek payment from the employee for
23the remainder of the amount of the bill up to the lesser of the
24actual charge, negotiated rate, if applicable, or the payment
25level set by the Commission in the fee schedule established in
26this Section. Once an employee informs the provider that there

 

 

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

 

 

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1efforts to collect payment from the employee for the services
2rendered to the employee and the employee shall be responsible
3for payment of any outstanding bills for a procedure,
4treatment, or service rendered by a provider.
5    (e-20) Upon a final award or judgment by an Arbitrator or
6the Commission, or a settlement agreed to by the employer and
7the employee, a provider may resume any and all efforts to
8collect payment from the employee for the services rendered to
9the employee and the employee shall be responsible for payment
10of any outstanding bills for a procedure, treatment, or service
11rendered by a provider as well as the interest awarded under
12subsection (d) of this Section. In the case of a procedure,
13treatment, or service deemed compensable, the provider shall
14not require a payment rate, excluding the interest provisions
15under subsection (d), greater than the lesser of the actual
16charge or the payment level set by the Commission in the fee
17schedule established in this Section. Payment for services
18deemed not covered or not compensable under this Act is the
19responsibility of the employee unless a provider and employee
20have agreed otherwise in writing. Services not covered or not
21compensable under this Act are not subject to the fee schedule
22in this Section.
23    (f) Nothing in this Act shall prohibit an employer or
24insurer from contracting with a health care provider or group
25of health care providers for reimbursement levels for benefits
26under this Act different from those provided in this Section.

 

 

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1    (g) On or before January 1, 2010 the Commission shall
2provide to the Governor and General Assembly a report regarding
3the implementation of the medical fee schedule and the index
4used for annual adjustment to that schedule as described in
5this Section.
6(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
7    (820 ILCS 305/8.3)
8    Sec. 8.3. Workers' Compensation Medical Fee Advisory
9Board. There is created a Workers' Compensation Medical Fee
10Advisory Board consisting of 9 members appointed by the
11Governor with the advice and consent of the Senate. Three
12members of the Advisory Board shall be representative citizens
13chosen from the employee class, 3 members shall be
14representative citizens chosen from the employing class, and 3
15members shall be representative citizens chosen from the
16medical provider class. Each member shall serve a 4-year term
17and shall continue to serve until a successor is appointed. A
18vacancy on the Advisory Board shall be filled by the Governor
19for the unexpired term.
20    Members of the Advisory Board shall receive no compensation
21for their services but shall be reimbursed for expenses
22incurred in the performance of their duties by the Commission
23from appropriations made to the Commission for that purpose.
24    The Advisory Board shall advise the Commission on
25establishment of fees for medical services and accessibility of

 

 

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1medical treatment. Additionally, by April 1, 2011, the Board
2shall issue a written report, to be delivered to the Chairman
3of the Commission and the General Assembly, containing (i)
4recommendations on how to streamline the process under which
5workers' compensation insurers process and issue payments and
6health care providers receive such payments and (ii) a
7recommended set of best practices for workers' compensation
8insurers to transition from a paper-based payment system to an
9electronic-based payment system.
10(Source: P.A. 94-277, eff. 7-20-05.)
 
11    (820 ILCS 305/8.7)
12    Sec. 8.7. Utilization review programs.
13    (a) As used in this Section:
14    "Utilization review" means the evaluation of proposed or
15provided health care services to determine the appropriateness
16of both the level of health care services medically necessary
17and the quality of health care services provided to a patient,
18including evaluation of their efficiency, efficacy, and
19appropriateness of treatment, hospitalization, or office
20visits based on medically accepted standards. The evaluation
21must be accomplished by means of a system that identifies the
22utilization of health care services based on standards of care
23of or nationally recognized peer review guidelines as well as
24nationally recognized treatment guidelines and evidence-based
25medicine evidence based upon standards as provided in this Act.

 

 

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1Utilization techniques may include prospective review, second
2opinions, concurrent review, discharge planning, peer review,
3independent medical examinations, and retrospective review
4(for purposes of this sentence, retrospective review shall be
5applicable to services rendered on or after July 20, 2005).
6Nothing in this Section applies to prospective review of
7necessary first aid or emergency treatment.
8    (b) No person may conduct a utilization review program for
9workers' compensation services in this State unless once every
102 years the person registers the utilization review program
11with the Department of Insurance Financial and Professional
12Regulation and certifies compliance with the Workers'
13Compensation Utilization Management standards or Health
14Utilization Management Standards of URAC sufficient to achieve
15URAC accreditation or submits evidence of accreditation by URAC
16for its Workers' Compensation Utilization Management Standards
17or Health Utilization Management Standards. Nothing in this Act
18shall be construed to require an employer or insurer or its
19subcontractors to become URAC accredited.
20    (c) In addition, the Director Secretary of Insurance
21Financial and Professional Regulation may certify alternative
22utilization review standards of national accreditation
23organizations or entities in order for plans to comply with
24this Section. Any alternative utilization review standards
25shall meet or exceed those standards required under subsection
26(b).

 

 

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1    (d) This registration shall include submission of all of
2the following information regarding utilization review program
3activities:
4        (1) The name, address, and telephone number of the
5    utilization review programs.
6        (2) The organization and governing structure of the
7    utilization review programs.
8        (3) The number of lives for which utilization review is
9    conducted by each utilization review program.
10        (4) Hours of operation of each utilization review
11    program.
12        (5) Description of the grievance process for each
13    utilization review program.
14        (6) Number of covered lives for which utilization
15    review was conducted for the previous calendar year for
16    each utilization review program.
17        (7) Written policies and procedures for protecting
18    confidential information according to applicable State and
19    federal laws for each utilization review program.
20    (e) A utilization review program shall have written
21procedures to ensure that patient-specific information
22obtained during the process of utilization review will be:
23        (1) kept confidential in accordance with applicable
24    State and federal laws; and
25        (2) shared only with the employee, the employee's
26    designee, and the employee's health care provider, and

 

 

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1    those who are authorized by law to receive the information.
2    Summary data shall not be considered confidential if it
3    does not provide information to allow identification of
4    individual patients or health care providers.
5    Only a health care professional may make determinations
6regarding the medical necessity of health care services during
7the course of utilization review.
8    When making retrospective reviews, utilization review
9programs shall base reviews solely on the medical information
10available to the attending physician or ordering provider at
11the time the health care services were provided.
12    (f) If the Department of Insurance Financial and
13Professional Regulation finds that a utilization review
14program is not in compliance with this Section, the Department
15shall issue a corrective action plan and allow a reasonable
16amount of time for compliance with the plan. If the utilization
17review program does not come into compliance, the Department
18may issue a cease and desist order. Before issuing a cease and
19desist order under this Section, the Department shall provide
20the utilization review program with a written notice of the
21reasons for the order and allow a reasonable amount of time to
22supply additional information demonstrating compliance with
23the requirements of this Section and to request a hearing. The
24hearing notice shall be sent by certified mail, return receipt
25requested, and the hearing shall be conducted in accordance
26with the Illinois Administrative Procedure Act.

 

 

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1    (g) A utilization review program subject to a corrective
2action may continue to conduct business until a final decision
3has been issued by the Department.
4    (h) The Department of Insurance Secretary of Financial and
5Professional Regulation may by rule establish a registration
6fee for each person conducting a utilization review program.
7    (i) Upon receipt of written notice that the employer or the
8employer's agent or insurer wishes to invoke the utilization
9review process, the provider of medical, surgical or hospital
10services shall submit to the utilization review, following URAC
11procedural guidelines and appeal process. If the provider fails
12to submit to utilization review of proposed treatment or
13services, the charges for the treatment or service shall not be
14compensable or collectible against the employer, the
15employer's agent or insurer, or the employee. When an employer
16denies payment of or refuses to authorize payment of first aid,
17medical, surgical, or hospital services under Section 8(a) of
18this Act that complies with subsection (b) of this Section,
19that denial or refusal to authorize shall create a rebuttable
20presumption that the extent and scope of medical treatment is
21excessive and unnecessary. That presumption may be rebutted by
22establishing by a preponderance of the evidence that a variance
23from the standards of care or guidelines used pursuant to
24subsection (a) of this Section is reasonably required to cure
25and relieve the employee from the effects of his or her injury
26or that the utilization review did not comply with subsection

 

 

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1(b) of this Section. A utilization review will be considered by
2the Commission, along with all other evidence and in the same
3manner as all other evidence, in the determination of the
4reasonableness and necessity of the medical bills or treatment.
5Nothing in this Section shall be construed to diminish the
6rights of employees to reasonable and necessary medical
7treatment or employee choice of health care provider under
8Section 8(a) or the rights of employers to medical examinations
9under Section 12.
10    (j) When an employer denies payment of or refuses to
11authorize payment of first aid, medical, surgical, or hospital
12services under Section 8(a) of this Act, if that denial or
13refusal to authorize complies with a utilization review program
14registered under this Section and complies with all other
15requirements of this Section, then there shall be a rebuttable
16presumption that the employer shall not be responsible for
17payment of additional compensation pursuant to Section 19(k) of
18this Act and if that denial or refusal to authorize does not
19comply with a utilization review program registered under this
20Section and does not comply with all other requirements of this
21Section, then that will be considered by the Commission, along
22with all other evidence and in the same manner as all other
23evidence, in the determination of whether the employer may be
24responsible for the payment of additional compensation
25pursuant to Section 19(k) of this Act.
26(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 

 

 

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1    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)
2    Sec. 11. The compensation herein provided, together with
3the provisions of this Act, shall be the measure of the
4responsibility of any employer engaged in any of the
5enterprises or businesses enumerated in Section 3 of this Act,
6or of any employer who is not engaged in any such enterprises
7or businesses, but who has elected to provide and pay
8compensation for accidental injuries sustained by any employee
9arising out of and in the course of the employment according to
10the provisions of this Act, and whose election to continue
11under this Act, has not been nullified by any action of his
12employees as provided for in this Act.
13    Accidental injuries incurred while participating in
14voluntary recreational programs including but not limited to
15athletic events, parties and picnics do not arise out of and in
16the course of the employment even though the employer pays some
17or all of the cost thereof. This exclusion shall not apply in
18the event that the injured employee was ordered or assigned by
19his employer to participate in the program.
20    Accidental injuries incurred while participating as a
21patient in a drug or alcohol rehabilitation program do not
22arise out of and in the course of employment even though the
23employer pays some or all of the costs thereof.
24    Any injury to or disease or death of an employee arising
25from the administration of a vaccine, including without

 

 

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1limitation smallpox vaccine, to prepare for, or as a response
2to, a threatened or potential bioterrorist incident to the
3employee as part of a voluntary inoculation program in
4connection with the person's employment or in connection with
5any governmental program or recommendation for the inoculation
6of workers in the employee's occupation, geographical area, or
7other category that includes the employee is deemed to arise
8out of and in the course of the employment for all purposes
9under this Act. This paragraph added by this amendatory Act of
10the 93rd General Assembly is declarative of existing law and is
11not a new enactment.
12    No compensation shall be payable if (i) the employee's
13intoxication is the proximate cause of the employee's
14accidental injury or (ii) at the time the employee incurred
15accidental injury, the employee was so intoxicated that the
16intoxication constituted a departure from the employment.
17Admissible evidence of the concentration of (1) alcohol, (2)
18cannabis as defined in the Cannabis Control Act, (3) a
19controlled substance listed in the Illinois Controlled
20Substances Act, or (4) an intoxicating compound listed in the
21Use of Intoxicating Compounds Act in the employee's blood,
22breath, or urine at the time the employee incurred the
23accidental injury shall be considered in any hearing under this
24Act to determine whether the employee was intoxicated at the
25time the employee incurred the accidental injuries. If at the
26time of the accidental injuries, there was 0.08% or more by

 

 

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1weight of alcohol in the employee's blood, breath, or urine or
2if there is any evidence of impairment due to the unlawful or
3unauthorized use of (1) cannabis as defined in the Cannabis
4Control Act, (2) a controlled substance listed in the Illinois
5Controlled Substances Act, or (3) an intoxicating compound
6listed in the Use of Intoxicating Compounds Act or if the
7employee refuses to submit to testing of blood, breath, or
8urine, then there shall be a rebuttable presumption that the
9employee was intoxicated and that the intoxication was the
10proximate cause of the employee's injury. The employee may
11overcome the rebuttable presumption by the preponderance of the
12admissible evidence that the intoxication was not the sole
13proximate cause or proximate cause of the accidental injuries.
14Percentage by weight of alcohol in the blood shall be based on
15grams of alcohol per 100 milliliters of blood. Percentage by
16weight of alcohol in the breath shall be based upon grams of
17alcohol per 210 liters of breath. Any testing that has not been
18performed by an accredited or certified testing laboratory
19shall not be admissible in any hearing under this Act to
20determine whether the employee was intoxicated at the time the
21employee incurred the accidental injury.
22    All sample collection and testing for alcohol and drugs
23under this Section shall be performed in accordance with rules
24to be adopted by the Commission. These rules shall ensure that:
25        (1) samples are collected and tested in conformance
26    with national and State legal and regulatory standards for

 

 

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1    the privacy of the individual being tested, and in a manner
2    reasonably calculated to prevent substitutions or
3    interference with the collection or testing of reliable
4    sample;
5        (2) sample collection is documented, and the
6    documentation procedures include:
7            (A) the labeling of samples in a manner so as to
8        reasonably preclude the probability of erroneous
9        identification of test result; and
10            (B) an opportunity for the employee to provide
11        notification of any information which he or she
12        considers relevant to the test, including
13        identification of currently or recently used
14        prescription or nonprescription drugs and other
15        relevant medical information;
16        (3) sample collection, storage, and transportation to
17    the place of testing is performed in a manner so as to
18    reasonably preclude the probability of sample
19    contamination or adulteration; and
20        (4) chemical analyses of blood, urine, breath, or other
21    bodily substance are performed according to nationally
22    scientifically accepted analytical methods and procedures.
23(Source: P.A. 93-829, eff. 7-28-04.)
 
24    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
25    Sec. 14. The Commission shall appoint a secretary, an

 

 

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1assistant secretary, and arbitrators and shall employ such
2assistants and clerical help as may be necessary.
3    Each arbitrator appointed after November 22, 1977 shall be
4required to demonstrate in writing and in accordance with the
5rules and regulations of the Illinois Department of Central
6Management Services his or her knowledge of and expertise in
7the law of and judicial processes of the Workers' Compensation
8Act and the Occupational Diseases Act.
9    A formal training program for newly-hired arbitrators
10shall be implemented. The training program shall include the
11following:
12        (a) substantive and procedural aspects of the
13    arbitrator position;
14        (b) current issues in workers' compensation law and
15    practice;
16        (c) medical lectures by specialists in areas such as
17    orthopedics, ophthalmology, psychiatry, rehabilitation
18    counseling;
19        (d) orientation to each operational unit of the
20    Illinois Workers' Compensation Commission;
21        (e) observation of experienced arbitrators conducting
22    hearings of cases, combined with the opportunity to discuss
23    evidence presented and rulings made;
24        (f) the use of hypothetical cases requiring the trainee
25    to issue judgments as a means to evaluating knowledge and
26    writing ability;

 

 

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1        (g) writing skills.
2    A formal and ongoing professional development program
3including, but not limited to, the above-noted areas shall be
4implemented to keep arbitrators informed of recent
5developments and issues and to assist them in maintaining and
6enhancing their professional competence.
7    Each arbitrator shall devote full time to his or her duties
8and shall serve when assigned as an acting Commissioner when a
9Commissioner is unavailable in accordance with the provisions
10of Section 13 of this Act. Any arbitrator who is an
11attorney-at-law shall not engage in the practice of law, nor
12shall any arbitrator hold any other office or position of
13profit under the United States or this State or any municipal
14corporation or political subdivision of this State.
15Notwithstanding any other provision of this Act to the
16contrary, an arbitrator who serves as an acting Commissioner in
17accordance with the provisions of Section 13 of this Act shall
18continue to serve in the capacity of Commissioner until a
19decision is reached in every case heard by that arbitrator
20while serving as an acting Commissioner.
21    Each arbitrator appointed after the effective date of this
22amendatory Act of 1989 shall be appointed for a term of 6
23years. Each arbitrator shall be appointed for a subsequent term
24unless the Chairman makes a recommendation to the Commission,
25no later than 60 days prior to the expiration of the term, not
26to reappoint the arbitrator. Notice of such a recommendation

 

 

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1shall also be given to the arbitrator no later than 60 days
2prior to the expiration of the term. Upon such recommendation
3by the Chairman, the arbitrator shall be appointed for a
4subsequent term unless 8 of 10 members of the Commission,
5including the Chairman, vote not to reappoint the arbitrator.
6    Each arbitrator appointed to a first term on or after the
7effective date of this amendatory Act of the 96th General
8Assembly shall be required to be authorized to practice law in
9this State by the Supreme Court.
10    All arbitrators shall be subject to the provisions of the
11Personnel Code, and the performance of all arbitrators shall be
12reviewed by the Chairman on an annual basis. The Chairman shall
13allow input from the Commissioners in all such reviews.
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. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
 
18    (820 ILCS 305/16b new)
19    Sec. 16b. Signature constitutes certification. The
20signature of a petitioner or respondent or his, her, or its
21attorney or group of attorneys on any petition, motion, or
22other paper filed with the Commission constitutes a
23certification by him, her, or it that he, she, or it has read
24the petition, motion, or other paper, and, that to the best of
25his, her, or its knowledge, information, and belief formed

 

 

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1after reasonable inquiry that it is well grounded in fact and
2that it is warranted by existing law and that it is not
3interposed for any improper purpose, such as to harass or to
4cause unnecessary delay or needless increase in the cost of
5litigation. If a petition, motion, or other paper is signed in
6violation of this Section, the Commission, upon motion or upon
7its own initiative, may impose upon the petitioner or
8respondent or his, her, or its attorney or group of attorneys
9an appropriate penalty or may order him, her, or it to pay the
10other party the amount of reasonable expenses incurred because
11of the filing of the petition, motion, or other paper,
12including reasonable attorneys' fees.
 
13    (820 ILCS 305/25.5)
14    Sec. 25.5. Unlawful acts; penalties.
15    (a) It is unlawful for any person, company, corporation,
16insurance carrier, healthcare provider, or other entity to:
17        (1) Intentionally present or cause to be presented any
18    false or fraudulent claim for the payment of any workers'
19    compensation benefit.
20        (2) Intentionally make or cause to be made any false or
21    fraudulent material statement or material representation
22    for the purpose of obtaining or denying any workers'
23    compensation benefit.
24        (3) Intentionally make or cause to be made any false or
25    fraudulent statements with regard to entitlement to

 

 

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

 

 

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1    For the purposes of paragraphs (2), (3), (5), (6), and (7),
2the term "statement" includes any writing, notice, proof of
3injury, bill for services, hospital or doctor records and
4reports, or X-ray and test results.
5    (b) Any person violating subsection (a) is guilty of a
6Class 4 felony. Any person or entity convicted of any violation
7of this Section shall be ordered to pay complete restitution to
8any person or entity so defrauded in addition to any fine or
9sentence imposed as a result of the conviction.
10    (c) The Department Division of Insurance of the Department
11of Financial and Professional Regulation shall establish a
12fraud and insurance non-compliance unit responsible for
13investigating incidences of fraud and insurance non-compliance
14pursuant to this Section. The size of the staff of the unit
15shall be subject to appropriation by the General Assembly. It
16shall be the duty of the fraud and insurance non-compliance
17unit to determine the identity of insurance carriers,
18employers, employees, or other persons or entities who have
19violated the fraud and insurance non-compliance provisions of
20this Section. The fraud and insurance non-compliance unit shall
21report violations of the fraud and insurance non-compliance
22provisions of this Section to the Special Prosecutions Bureau
23of the Criminal Division of the Office of the Attorney General
24or to the State's Attorney of the county in which the offense
25allegedly occurred, either of whom has the authority to
26prosecute violations under this Section.

 

 

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

 

 

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1Adjustment of Claim and the employee must have either received
2or attempted to receive benefits under this Act that are
3related to the reported fraud or (ii) the employee must have
4made a written demand for the payment of benefits that are
5related to the reported fraud. Upon receipt of a report of
6fraud, the employee or employer shall receive immediate notice
7of the reported conduct, including the verified name and
8address of the complainant if that complainant is connected to
9the case and the nature of the reported conduct. The fraud and
10insurance non-compliance unit shall resolve all reports of
11fraud against employees or employers within 120 days of receipt
12of the report. There shall be no immunity, under this Act or
13otherwise, for any person who files a false report or who files
14a report without good and just cause. Confidentiality of
15medical information shall be strictly maintained.
16Investigations that are not referred for prosecution shall be
17immediately expunged and shall not be disclosed except that the
18employee or employer who was the subject of the report and the
19person making the report shall be notified that the
20investigation is being closed, at which time the name of any
21complainant not connected to the case shall be disclosed to the
22employee or the employer. It is unlawful for any employer,
23insurance carrier, or service adjustment company to file or
24threaten to file a report of fraud against an employee because
25of the exercise by the employee of the rights and remedies
26granted to the employee by this Act.

 

 

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1    For purposes of this subsection (e), "employer" means any
2employer, insurance carrier, third party administrator,
3self-insured, or similar entity.
4    For purposes of this subsection (e), "complainant" refers
5to the person contacting the fraud and insurance non-compliance
6unit to initiate the complaint.
7    (e-5) The fraud and insurance non-compliance unit shall
8procure and implement a system utilizing advanced analytics
9inclusive of predictive modeling, data mining, social network
10analysis, and scoring algorithms for the detection and
11prevention of fraud, waste, and abuse on or before July 1,
122011. The fraud and insurance non-compliance unit shall procure
13this system using a request for proposals process governed by
14the Illinois Procurement Code and rules adopted under that
15Code. The fraud and insurance non-compliance unit shall provide
16a report to the President of the Senate, Speaker of the House
17of Representatives, Minority Leader of the House of
18Representatives, Minority Leader of the Senate, Governor, and
19Director of Insurance on or before July 1, 2012 and annually
20thereafter detailing its activities and providing
21recommendations regarding opportunities for additional fraud
22waste and abuse detection and prevention.
23    (f) Any person convicted of fraud related to workers'
24compensation pursuant to this Section shall be subject to the
25penalties prescribed in the Criminal Code of 1961 and shall be
26ineligible to receive or retain any compensation, disability,

 

 

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1or medical benefits as defined in this Act if the compensation,
2disability, or medical benefits were owed or received as a
3result of fraud for which the recipient of the compensation,
4disability, or medical benefit was convicted. This subsection
5applies to accidental injuries or diseases that occur on or
6after the effective date of this amendatory Act of the 94th
7General Assembly.
8    (g) Civil liability. Any person convicted of fraud who
9knowingly obtains, attempts to obtain, or causes to be obtained
10any benefits under this Act by the making of a false claim or
11who knowingly misrepresents any material fact shall be civilly
12liable to the payor of benefits or the insurer or the payor's
13or insurer's subrogee or assignee in an amount equal to 3 times
14the value of the benefits or insurance coverage wrongfully
15obtained or twice the value of the benefits or insurance
16coverage attempted to be obtained, plus reasonable attorney's
17fees and expenses incurred by the payor or the payor's subrogee
18or assignee who successfully brings a claim under this
19subsection. This subsection applies to accidental injuries or
20diseases that occur on or after the effective date of this
21amendatory Act of the 94th General Assembly.
22    (h) The All proceedings under this Section shall be
23reported by the fraud and insurance non-compliance unit shall
24submit a written report on an annual basis to the Workers'
25Compensation Advisory Board, the General Assembly, the
26Governor, and the Attorney General by January 1st and July 1st

 

 

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1of each year. This report shall include, at the minimum, the
2following information:
3        (1) The number of allegations of insurance
4    non-compliance and fraud reported to the fraud and
5    insurance non-compliance unit.
6        (2) The source of the reported allegations
7    (individual, employer, or other).
8        (3) The number of allegations investigated by the fraud
9    and insurance non-compliance unit.
10        (4) The number of criminal referrals made in accordance
11    with this Section and the entity to which the referral was
12    made.
13        (5) All proceedings under this Section.
14(Source: P.A. 94-277, eff. 7-20-05.)
 
15    (820 ILCS 305/29.1 new)
16    Sec. 29.1. Recalculation of premiums. On the effective date
17of this amendatory Act of the 96th General Assembly, the
18Director of Insurance shall immediately direct in writing any
19workers' compensation rate setting advisory organization to
20recalculate workers' compensation advisory premium rates and
21assigned risk pool premium rates so that those premiums
22incorporate the provisions of this amendatory Act of the 96th
23General Assembly.
 
24    (820 ILCS 305/29.2 new)

 

 

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

 

 

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1        (4) The advisory organization premium rate for
2    workers' compensation insurance in Illinois for the
3    previous year.
4        (5) The advisory organization prescribed assigned risk
5    pool premium rate.
6        (6) The total amount of indemnity payments made by
7    workers' compensation insurers in Illinois.
8        (7) The total amount of medical payments made by
9    workers' compensation insurers in Illinois, and the
10    national rank of Illinois based on average cost of medical
11    claims per injured worker.
12        (8) The gross profitability of workers' compensation
13    insurers in Illinois, and the national rank of Illinois
14    based on profitability of workers' compensation insurers.
15        (9) The loss ratio of workers' compensation insurers in
16    Illinois and the national rank of Illinois based on the
17    loss ratio of workers' compensation insurers. For purposes
18    of this loss ratio calculation, the denominator shall
19    include all premiums and other fees collected by workers'
20    compensation insurers and the numerator shall include the
21    total amount paid by the insurer for care or compensation
22    to injured workers.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".