HB1698 EnrolledLRB097 07917 AJO 48032 b

1    AN ACT concerning civil law.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Department of Central Management Services
5Law of the Civil Administrative Code of Illinois is amended by
6changing Sections 405-105 and 405-411 as follows:
 
7    (20 ILCS 405/405-105)  (was 20 ILCS 405/64.1)
8    Sec. 405-105. Fidelity, surety, property, and casualty
9insurance. The Department shall establish and implement a
10program to coordinate the handling of all fidelity, surety,
11property, and casualty insurance exposures of the State and the
12departments, divisions, agencies, branches, and universities
13of the State. In performing this responsibility, the Department
14shall have the power and duty to do the following:
15        (1) Develop and maintain loss and exposure data on all
16    State property.
17        (2) Study the feasibility of establishing a
18    self-insurance plan for State property and prepare
19    estimates of the costs of reinsurance for risks beyond the
20    realistic limits of the self-insurance.
21        (3) Prepare a plan for centralizing the purchase of
22    property and casualty insurance on State property under a
23    master policy or policies and purchase the insurance

 

 

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1    contracted for as provided in the Illinois Purchasing Act.
2        (4) Evaluate existing provisions for fidelity bonds
3    required of State employees and recommend changes that are
4    appropriate commensurate with risk experience and the
5    determinations respecting self-insurance or reinsurance so
6    as to permit reduction of costs without loss of coverage.
7        (5) Investigate procedures for inclusion of school
8    districts, public community college districts, and other
9    units of local government in programs for the centralized
10    purchase of insurance.
11        (6) Implement recommendations of the State Property
12    Insurance Study Commission that the Department finds
13    necessary or desirable in the performance of its powers and
14    duties under this Section to achieve efficient and
15    comprehensive risk management.
16        (7) Prepare and, in the discretion of the Director,
17    implement a plan providing for the purchase of public
18    liability insurance or for self-insurance for public
19    liability or for a combination of purchased insurance and
20    self-insurance for public liability (i) covering the State
21    and drivers of motor vehicles owned, leased, or controlled
22    by the State of Illinois pursuant to the provisions and
23    limitations contained in the Illinois Vehicle Code, (ii)
24    covering other public liability exposures of the State and
25    its employees within the scope of their employment, and
26    (iii) covering drivers of motor vehicles not owned, leased,

 

 

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1    or controlled by the State but used by a State employee on
2    State business, in excess of liability covered by an
3    insurance policy obtained by the owner of the motor vehicle
4    or in excess of the dollar amounts that the Department
5    shall determine to be reasonable. Any contract of insurance
6    let under this Law shall be by bid in accordance with the
7    procedure set forth in the Illinois Purchasing Act. Any
8    provisions for self-insurance shall conform to subdivision
9    (11).
10        The term "employee" as used in this subdivision (7) and
11    in subdivision (11) means a person while in the employ of
12    the State who is a member of the staff or personnel of a
13    State agency, bureau, board, commission, committee,
14    department, university, or college or who is a State
15    officer, elected official, commissioner, member of or ex
16    officio member of a State agency, bureau, board,
17    commission, committee, department, university, or college,
18    or a member of the National Guard while on active duty
19    pursuant to orders of the Governor of the State of
20    Illinois, or any other person while using a licensed motor
21    vehicle owned, leased, or controlled by the State of
22    Illinois with the authorization of the State of Illinois,
23    provided the actual use of the motor vehicle is within the
24    scope of that authorization and within the course of State
25    service.
26        Subsequent to payment of a claim on behalf of an

 

 

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1    employee pursuant to this Section and after reasonable
2    advance written notice to the employee, the Director may
3    exclude the employee from future coverage or limit the
4    coverage under the plan if (i) the Director determines that
5    the claim resulted from an incident in which the employee
6    was grossly negligent or had engaged in willful and wanton
7    misconduct or (ii) the Director determines that the
8    employee is no longer an acceptable risk based on a review
9    of prior accidents in which the employee was at fault and
10    for which payments were made pursuant to this Section.
11        The Director is authorized to promulgate
12    administrative rules that may be necessary to establish and
13    administer the plan.
14        Appropriations from the Road Fund shall be used to pay
15    auto liability claims and related expenses involving
16    employees of the Department of Transportation, the
17    Illinois State Police, and the Secretary of State.
18        (8) Charge, collect, and receive from all other
19    agencies of the State government fees or monies equivalent
20    to the cost of purchasing the insurance.
21        (9) Establish, through the Director, charges for risk
22    management services rendered to State agencies by the
23    Department. The State agencies so charged shall reimburse
24    the Department by vouchers drawn against their respective
25    appropriations. The reimbursement shall be determined by
26    the Director as amounts sufficient to reimburse the

 

 

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1    Department for expenditures incurred in rendering the
2    service.
3        The Department shall charge the employing State agency
4    or university for workers' compensation payments for
5    temporary total disability paid to any employee after the
6    employee has received temporary total disability payments
7    for 120 days if the employee's treating physician has
8    issued a release to return to work with restrictions and
9    the employee is able to perform modified duty work but the
10    employing State agency or university does not return the
11    employee to work at modified duty. Modified duty shall be
12    duties assigned that may or may not be delineated as part
13    of the duties regularly performed by the employee. Modified
14    duties shall be assigned within the prescribed
15    restrictions established by the treating physician and the
16    physician who performed the independent medical
17    examination. The amount of all reimbursements shall be
18    deposited into the Workers' Compensation Revolving Fund
19    which is hereby created as a revolving fund in the State
20    treasury. In addition to any other purpose authorized by
21    law, moneys in the Fund shall be used, subject to
22    appropriation, to pay these or other temporary total
23    disability claims of employees of State agencies and
24    universities.
25        Beginning with fiscal year 1996, all amounts recovered
26    by the Department through subrogation in workers'

 

 

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1    compensation and workers' occupational disease cases shall
2    be deposited into the Workers' Compensation Revolving Fund
3    created under this subdivision (9).
4        (10) Establish rules, procedures, and forms to be used
5    by State agencies in the administration and payment of
6    workers' compensation claims. The Department shall
7    initially evaluate and determine the compensability of any
8    injury that is the subject of a workers' compensation claim
9    and provide for the administration and payment of such a
10    claim for all State agencies. The Director may delegate to
11    any agency with the agreement of the agency head the
12    responsibility for evaluation, administration, and payment
13    of that agency's claims.
14        (10a) If the Director determines it would be in the
15    best interests of the State and its employees, prepare and
16    implement a plan providing for: (i) the purchase of
17    workers' compensation insurance for workers' compensation
18    liability; (ii) third-party administration of
19    self-insurance, in whole or in part, for workers'
20    compensation liability; or (iii) a combination of
21    purchased insurance and self-insurance for workers'
22    compensation liability, including reinsurance or stop-loss
23    insurance. Any contract for insurance or third-party
24    administration shall be on terms consistent with State
25    policy; awarded in compliance with the Illinois
26    Procurement Code; and based on, but not limited to, the

 

 

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1    following criteria: administrative cost, service
2    capabilities of the carrier or other contractor and
3    premiums, fees, or charges. By April 1 of each year, the
4    Director must report and provide information to the State
5    Workers' Compensation Program Advisory Board concerning
6    the status of the State workers' compensation program for
7    the next fiscal year. Information includes, but is not
8    limited to, documents, reports of negotiations, bid
9    invitations, requests for proposals, specifications,
10    copies of proposed and final contracts or agreements, and
11    any other materials concerning contracts or agreements for
12    the program. By the first of each month thereafter, the
13    Director must provide updated, and any new, information to
14    the State Workers' Compensation Program Advisory Board
15    until the State workers' compensation program for the next
16    fiscal year is determined.
17        (11) Any plan for public liability self-insurance
18    implemented under this Section shall provide that (i) the
19    Department shall attempt to settle and may settle any
20    public liability claim filed against the State of Illinois
21    or any public liability claim filed against a State
22    employee on the basis of an occurrence in the course of the
23    employee's State employment; (ii) any settlement of such a
24    claim is not subject to fiscal year limitations and must be
25    approved by the Director and, in cases of settlements
26    exceeding $100,000, by the Governor; and (iii) a settlement

 

 

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1    of any public liability claim against the State or a State
2    employee shall require an unqualified release of any right
3    of action against the State and the employee for acts
4    within the scope of the employee's employment giving rise
5    to the claim.
6        Whenever and to the extent that a State employee
7    operates a motor vehicle or engages in other activity
8    covered by self-insurance under this Section, the State of
9    Illinois shall defend, indemnify, and hold harmless the
10    employee against any claim in tort filed against the
11    employee for acts or omissions within the scope of the
12    employee's employment in any proper judicial forum and not
13    settled pursuant to this subdivision (11), provided that
14    this obligation of the State of Illinois shall not exceed a
15    maximum liability of $2,000,000 for any single occurrence
16    in connection with the operation of a motor vehicle or
17    $100,000 per person per occurrence for any other single
18    occurrence, or $500,000 for any single occurrence in
19    connection with the provision of medical care by a licensed
20    physician employee.
21        Any claims against the State of Illinois under a
22    self-insurance plan that are not settled pursuant to this
23    subdivision (11) shall be heard and determined by the Court
24    of Claims and may not be filed or adjudicated in any other
25    forum. The Attorney General of the State of Illinois or the
26    Attorney General's designee shall be the attorney with

 

 

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1    respect to all public liability self-insurance claims that
2    are not settled pursuant to this subdivision (11) and
3    therefore result in litigation. The payment of any award of
4    the Court of Claims entered against the State relating to
5    any public liability self-insurance claim shall act as a
6    release against any State employee involved in the
7    occurrence.
8        (12) Administer a plan the purpose of which is to make
9    payments on final settlements or final judgments in
10    accordance with the State Employee Indemnification Act.
11    The plan shall be funded through appropriations from the
12    General Revenue Fund specifically designated for that
13    purpose, except that indemnification expenses for
14    employees of the Department of Transportation, the
15    Illinois State Police, and the Secretary of State shall be
16    paid from the Road Fund. The term "employee" as used in
17    this subdivision (12) has the same meaning as under
18    subsection (b) of Section 1 of the State Employee
19    Indemnification Act. Subject to sufficient appropriation,
20    the Director shall approve payment of any claim, without
21    regard to fiscal year limitations, presented to the
22    Director that is supported by a final settlement or final
23    judgment when the Attorney General and the chief officer of
24    the public body against whose employee the claim or cause
25    of action is asserted certify to the Director that the
26    claim is in accordance with the State Employee

 

 

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1    Indemnification Act and that they approve of the payment.
2    In no event shall an amount in excess of $150,000 be paid
3    from this plan to or for the benefit of any claimant.
4        (13) Administer a plan the purpose of which is to make
5    payments on final settlements or final judgments for
6    employee wage claims in situations where there was an
7    appropriation relevant to the wage claim, the fiscal year
8    and lapse period have expired, and sufficient funds were
9    available to pay the claim. The plan shall be funded
10    through appropriations from the General Revenue Fund
11    specifically designated for that purpose.
12        Subject to sufficient appropriation, the Director is
13    authorized to pay any wage claim presented to the Director
14    that is supported by a final settlement or final judgment
15    when the chief officer of the State agency employing the
16    claimant certifies to the Director that the claim is a
17    valid wage claim and that the fiscal year and lapse period
18    have expired. Payment for claims that are properly
19    submitted and certified as valid by the Director shall
20    include interest accrued at the rate of 7% per annum from
21    the forty-fifth day after the claims are received by the
22    Department or 45 days from the date on which the amount of
23    payment is agreed upon, whichever is later, until the date
24    the claims are submitted to the Comptroller for payment.
25    When the Attorney General has filed an appearance in any
26    proceeding concerning a wage claim settlement or judgment,

 

 

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1    the Attorney General shall certify to the Director that the
2    wage claim is valid before any payment is made. In no event
3    shall an amount in excess of $150,000 be paid from this
4    plan to or for the benefit of any claimant.
5        Nothing in Public Act 84-961 shall be construed to
6    affect in any manner the jurisdiction of the Court of
7    Claims concerning wage claims made against the State of
8    Illinois.
9        (14) Prepare and, in the discretion of the Director,
10    implement a program for self-insurance for official
11    fidelity and surety bonds for officers and employees as
12    authorized by the Official Bond Act.
13(Source: P.A. 96-928, eff. 6-15-10.)
 
14    (20 ILCS 405/405-411)
15    Sec. 405-411. Consolidation of workers' compensation
16functions.
17    (a) Notwithstanding any other law to the contrary, the
18Director of Central Management Services, working in
19cooperation with the Director of any other agency, department,
20board, or commission directly responsible to the Governor, may
21direct the consolidation, within the Department of Central
22Management Services, of those workers' compensation functions
23at that agency, department, board, or commission that are
24suitable for centralization.
25    Upon receipt of the written direction to transfer workers'

 

 

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

 

 

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

 

 

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1the Illinois Administrative Code regarding the functions
2transferred in this Section that are in force on the effective
3date of this Section. If necessary, however, the affected
4agencies shall propose, adopt, or repeal rules, rule
5amendments, and rule recodifications as appropriate to
6effectuate this Section.
7    (e) There is hereby created within the Department of
8Central Management Services an advisory body to be known as the
9State Workers' Compensation Program Advisory Board to review,
10assess, and provide recommendations to improve the State
11workers' compensation program and to ensure that the State
12manages the program in the interests of injured workers and
13taxpayers. The Governor shall appoint one person to the Board,
14who shall serve as the Chairperson. The Speaker of the House of
15Representatives, the Minority Leader of the House of
16Representatives, the President of the Senate, and the Minority
17Leader of the Senate shall each appoint one person to the
18Board. Each member initially appointed to the Board shall serve
19a term ending December 31, 2013, and each Board member
20appointed thereafter shall serve a 3-year term. A Board member
21shall continue to serve on the Board until his or her successor
22is appointed. In addition, the Director of the Department of
23Central Management Services, the Attorney General, the
24Director of the Department of Insurance, the Secretary of the
25Department of Transportation, the Director of the Department of
26Corrections, the Secretary of the Department of Human Services,

 

 

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1the Director of the Department of Revenue, and the Chairman of
2the Illinois Workers' Compensation Commission, or their
3designees, shall serve as ex officio, non-voting members of the
4Board. Members of the Board shall not receive compensation but
5shall be reimbursed from the Workers' Compensation Revolving
6Fund for reasonable expenses incurred in the necessary
7performance of their duties, and the Department of Central
8Management Services shall provide administrative support to
9the Board. The Board shall meet at least 3 times per year or
10more often if the Board deems it necessary or proper. By
11September 30, 2011, the Board shall issue a written report, to
12be delivered to the Governor, the Director of the Department of
13Central Management Services, and the General Assembly, with a
14recommended set of best practices for the State workers'
15compensation program. By July 1 of each year thereafter, the
16Board shall issue a written report, to be delivered to those
17same persons or entities, with recommendations on how to
18improve upon such practices.
19(Source: P.A. 93-839, eff. 7-30-04.)
 
20    Section 10. The Code of Civil Procedure is amended by
21changing Section 8-802 as follows:
 
22    (735 ILCS 5/8-802)  (from Ch. 110, par. 8-802)
23    Sec. 8-802. Physician and patient. No physician or surgeon
24shall be permitted to disclose any information he or she may

 

 

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1have acquired in attending any patient in a professional
2character, necessary to enable him or her professionally to
3serve the patient, except only (1) in trials for homicide when
4the disclosure relates directly to the fact or immediate
5circumstances of the homicide, (2) in actions, civil or
6criminal, against the physician for malpractice, (3) with the
7expressed consent of the patient, or in case of his or her
8death or disability, of his or her personal representative or
9other person authorized to sue for personal injury or of the
10beneficiary of an insurance policy on his or her life, health,
11or physical condition, (4) in all actions brought by or against
12the patient, his or her personal representative, a beneficiary
13under a policy of insurance, or the executor or administrator
14of his or her estate wherein the patient's physical or mental
15condition is an issue, (5) upon an issue as to the validity of
16a document as a will of the patient, (6) in any criminal action
17where the charge is either first degree murder by abortion,
18attempted abortion or abortion, (7) in actions, civil or
19criminal, arising from the filing of a report in compliance
20with the Abused and Neglected Child Reporting Act, (8) to any
21department, agency, institution or facility which has custody
22of the patient pursuant to State statute or any court order of
23commitment, (9) in prosecutions where written results of blood
24alcohol tests are admissible pursuant to Section 11-501.4 of
25the Illinois Vehicle Code, (10) in prosecutions where written
26results of blood alcohol tests are admissible under Section

 

 

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15-11a of the Boat Registration and Safety Act, (11) in criminal
2actions arising from the filing of a report of suspected
3terrorist offense in compliance with Section 29D-10(p)(7) of
4the Criminal Code of 1961, or (12) upon the issuance of a
5subpoena pursuant to Section 38 of the Medical Practice Act of
61987; the issuance of a subpoena pursuant to Section 25.1 of
7the Illinois Dental Practice Act; or the issuance of a subpoena
8pursuant to Section 22 of the Nursing Home Administrators
9Licensing and Disciplinary Act; or the issuance of a subpoena
10pursuant to Section 25.5 of the Workers' Compensation Act.
11    In the event of a conflict between the application of this
12Section and the Mental Health and Developmental Disabilities
13Confidentiality Act to a specific situation, the provisions of
14the Mental Health and Developmental Disabilities
15Confidentiality Act shall control.
16(Source: P.A. 95-478, eff. 8-27-07.)
 
17    Section 15. The Workers' Compensation Act is amended by
18changing Sections 1, 4, 8, 8.2, 8.7, 11, 13, 13.1, 14, 18, 19,
19and 25.5 and by adding Sections 1.1, 4b, 8.1a, 8.1b, 8.2a, 16b,
2018.1, 29.1, and 29.2 as follows:
 
21    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
22    Sec. 1. This Act may be cited as the Workers' Compensation
23Act.
24    (a) The term "employer" as used in this Act means:

 

 

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

 

 

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

 

 

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

 

 

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1of such other employers and who pays such employees their
2salary or wages notwithstanding that they are doing the work of
3such other employers shall be deemed a loaning employer within
4the meaning and provisions of this Section.
5    (b) The term "employee" as used in this Act means:
6    1. Every person in the service of the State, including
7members of the General Assembly, members of the Commerce
8Commission, members of the Illinois Workers' Compensation
9Commission, and all persons in the service of the University of
10Illinois, county, including deputy sheriffs and assistant
11state's attorneys, city, town, township, incorporated village
12or school district, body politic, or municipal corporation
13therein, whether by election, under appointment or contract of
14hire, express or implied, oral or written, including all
15members of the Illinois National Guard while on active duty in
16the service of the State, and all probation personnel of the
17Juvenile Court appointed pursuant to Article VI of the Juvenile
18Court Act of 1987, and including any official of the State, any
19county, city, town, township, incorporated village, school
20district, body politic or municipal corporation therein except
21any duly appointed member of a police department in any city
22whose population exceeds 200,000 according to the last Federal
23or State census, and except any member of a fire insurance
24patrol maintained by a board of underwriters in this State. A
25duly appointed member of a fire department in any city, the
26population of which exceeds 200,000 according to the last

 

 

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1federal or State census, is an employee under this Act only
2with respect to claims brought under paragraph (c) of Section
38.
4    One employed by a contractor who has contracted with the
5State, or a county, city, town, township, incorporated village,
6school district, body politic or municipal corporation
7therein, through its representatives, is not considered as an
8employee of the State, county, city, town, township,
9incorporated village, school district, body politic or
10municipal corporation which made the contract.
11    2. Every person in the service of another under any
12contract of hire, express or implied, oral or written,
13including persons whose employment is outside of the State of
14Illinois where the contract of hire is made within the State of
15Illinois, persons whose employment results in fatal or
16non-fatal injuries within the State of Illinois where the
17contract of hire is made outside of the State of Illinois, and
18persons whose employment is principally localized within the
19State of Illinois, regardless of the place of the accident or
20the place where the contract of hire was made, and including
21aliens, and minors who, for the purpose of this Act are
22considered the same and have the same power to contract,
23receive payments and give quittances therefor, as adult
24employees.
25    3. Every sole proprietor and every partner of a business
26may elect to be covered by this Act.

 

 

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1    An employee or his dependents under this Act who shall have
2a cause of action by reason of any injury, disablement or death
3arising out of and in the course of his employment may elect to
4pursue his remedy in the State where injured or disabled, or in
5the State where the contract of hire is made, or in the State
6where the employment is principally localized.
7    However, any employer may elect to provide and pay
8compensation to any employee other than those engaged in the
9usual course of the trade, business, profession or occupation
10of the employer by complying with Sections 2 and 4 of this Act.
11Employees are not included within the provisions of this Act
12when excluded by the laws of the United States relating to
13liability of employers to their employees for personal injuries
14where such laws are held to be exclusive.
15    The term "employee" does not include persons performing
16services as real estate broker, broker-salesman, or salesman
17when such persons are paid by commission only.
18    (c) "Commission" means the Industrial Commission created
19by Section 5 of "The Civil Administrative Code of Illinois",
20approved March 7, 1917, as amended, or the Illinois Workers'
21Compensation Commission created by Section 13 of this Act.
22    (d) To obtain compensation under this Act, an employee
23bears the burden of showing, by a preponderance of the
24evidence, that he or she has sustained accidental injuries
25arising out of and in the course of the employment.
26(Source: P.A. 93-721, eff. 1-1-05.)
 

 

 

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1    (820 ILCS 305/1.1 new)
2    Sec. 1.1. Standards of conduct.
3    (a) Commissioners and arbitrators shall dispose of all
4Workers' Compensation matters promptly, officially and fairly,
5without bias or prejudice. Commissioners and arbitrators shall
6be faithful to the law and maintain professional competence in
7it. They shall be unswayed by partisan interests, public
8clamor, or fear of criticism. Commissioners and arbitrators
9shall take appropriate action or initiate appropriate
10disciplinary measures against a Commissioner, arbitrator,
11lawyer, or others for unprofessional conduct of which the
12Commissioner or arbitrator may become aware.
13    (b) Except as otherwise provided in this Act, the Canons of
14the Code of Judicial Conduct as adopted by the Supreme Court of
15Illinois govern the hearing and non-hearing conduct of members
16of the Commission and arbitrators under this Act. The
17Commission may set additional rules and standards, not less
18stringent than those rules and standards established by the
19Code of Judicial Conduct, for the conduct of arbitrators.
20    (c) The following provisions of the Code of Judicial
21Conduct do not apply under this Section:
22        (1) Canon 3(B), relating to administrative
23    responsibilities of Judges.
24        (2) Canon 6(C), relating to annual filings of economic
25    interests. Instead of filing declarations of economic

 

 

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1    interests with the Clerk of the Illinois Supreme Court
2    under Illinois Supreme Court Rule 68, members of the
3    Commission and arbitrators shall make filings
4    substantially similar to those required by Rule 68 with the
5    Chairman, and such filings shall be made available for
6    examination by the public.
7    (d) An arbitrator or a Commissioner may accept an
8uncompensated appointment to a governmental committee,
9commission or other position that is concerned with issues of
10policy on matters which may come before the arbitrator or
11Commissioner if such appointment neither affects his or her
12independent professional judgment nor the conduct of his or her
13duties.
14    (e) Decisions of an arbitrator or a Commissioner shall be
15based exclusively on evidence in the record of the proceeding
16and material that has been officially noticed. Any findings of
17fact made by the arbitrator based on inquiries, investigations,
18examinations, or inspections undertaken by the arbitrator
19shall be entered into the record of the proceeding.
20    (f) Nothing in this Section shall prohibit an arbitrator
21from holding a pre-trial conference in accordance with the
22rules of the Commission.
 
23    (820 ILCS 305/4)  (from Ch. 48, par. 138.4)
24    Sec. 4. (a) Any employer, including but not limited to
25general contractors and their subcontractors, who shall come

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1Workers' Compensation Commission and by the Department of
2Insurance Financial and Professional Regulation for the
3purposes authorized in subsection (c) of Section 25.5 of this
4Act.
5    (a-2) Every Employee Leasing Company (ELC), as defined in
6Section 15 of the Employee Leasing Company Act, shall at a
7minimum provide the following information to the Commission or
8any entity designated by the Commission regarding each workers'
9compensation insurance policy issued to the ELC:
10        (1) Any client company of the ELC listed as an
11    additional named insured.
12        (2) Any informational schedule attached to the master
13    policy that identifies any individual client company's
14    name, FEIN, and job location.
15        (3) Any certificate of insurance coverage document
16    issued to a client company specifying its rights and
17    obligations under the master policy that establishes both
18    the identity and status of the client, as well as the dates
19    of inception and termination of coverage, if applicable.
20    (b) The sworn application and financial statement, or
21security, indemnity or bond, or amount of insurance, or other
22provisions, filed, furnished, carried, or made by the employer,
23as the case may be, shall be subject to the approval of the
24Commission.
25    Deposits under escrow agreements shall be cash, negotiable
26United States government bonds or negotiable general

 

 

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1obligation bonds of the State of Illinois. Such cash or bonds
2shall be deposited in escrow with any State or National Bank or
3Trust Company having trust authority in the State of Illinois.
4    Upon the approval of the sworn application and financial
5statement, security, indemnity or bond or amount of insurance,
6filed, furnished or carried, as the case may be, the Commission
7shall send to the employer written notice of its approval
8thereof. The certificate of compliance by the employer with the
9provisions of subparagraphs (2) and (3) of paragraph (a) of
10this Section shall be delivered by the insurance carrier to the
11Illinois Workers' Compensation Commission within five days
12after the effective date of the policy so certified. The
13insurance so certified shall cover all compensation liability
14occurring during the time that the insurance is in effect and
15no further certificate need be filed in case such insurance is
16renewed, extended or otherwise continued by such carrier. The
17insurance so certified shall not be cancelled or in the event
18that such insurance is not renewed, extended or otherwise
19continued, such insurance shall not be terminated until at
20least 10 days after receipt by the Illinois Workers'
21Compensation Commission of notice of the cancellation or
22termination of said insurance; provided, however, that if the
23employer has secured insurance from another insurance carrier,
24or has otherwise secured the payment of compensation in
25accordance with this Section, and such insurance or other
26security becomes effective prior to the expiration of the 10

 

 

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1days, cancellation or termination may, at the option of the
2insurance carrier indicated in such notice, be effective as of
3the effective date of such other insurance or security.
4    (c) Whenever the Commission shall find that any
5corporation, company, association, aggregation of individuals,
6reciprocal or interinsurers exchange, or other insurer
7effecting workers' compensation insurance in this State shall
8be insolvent, financially unsound, or unable to fully meet all
9payments and liabilities assumed or to be assumed for
10compensation insurance in this State, or shall practice a
11policy of delay or unfairness toward employees in the
12adjustment, settlement, or payment of benefits due such
13employees, the Commission may after reasonable notice and
14hearing order and direct that such corporation, company,
15association, aggregation of individuals, reciprocal or
16interinsurers exchange, or insurer, shall from and after a date
17fixed in such order discontinue the writing of any such
18workers' compensation insurance in this State. Subject to such
19modification of the order as the Commission may later make on
20review of the order, as herein provided, it shall thereupon be
21unlawful for any such corporation, company, association,
22aggregation of individuals, reciprocal or interinsurers
23exchange, or insurer to effect any workers' compensation
24insurance in this State. A copy of the order shall be served
25upon the Director of Insurance by registered mail. Whenever the
26Commission finds that any service or adjustment company used or

 

 

HB1698 Enrolled- 33 -LRB097 07917 AJO 48032 b

1employed by a self-insured employer or by an insurance carrier
2to process, adjust, investigate, compromise or otherwise
3handle claims under this Act, has practiced or is practicing a
4policy of delay or unfairness toward employees in the
5adjustment, settlement or payment of benefits due such
6employees, the Commission may after reasonable notice and
7hearing order and direct that such service or adjustment
8company shall from and after a date fixed in such order be
9prohibited from processing, adjusting, investigating,
10compromising or otherwise handling claims under this Act.
11    Whenever the Commission finds that any self-insured
12employer has practiced or is practicing delay or unfairness
13toward employees in the adjustment, settlement or payment of
14benefits due such employees, the Commission may, after
15reasonable notice and hearing, order and direct that after a
16date fixed in the order such self-insured employer shall be
17disqualified to operate as a self-insurer and shall be required
18to insure his entire liability to pay compensation in some
19insurance carrier authorized, licensed and permitted to do such
20insurance business in this State, as provided in subparagraph 3
21of paragraph (a) of this Section.
22    All orders made by the Commission under this Section shall
23be subject to review by the courts, said review to be taken in
24the same manner and within the same time as provided by Section
2519 of this Act for review of awards and decisions of the
26Commission, upon the party seeking the review filing with the

 

 

HB1698 Enrolled- 34 -LRB097 07917 AJO 48032 b

1clerk of the court to which said review is taken a bond in an
2amount to be fixed and approved by the court to which the
3review is taken, conditioned upon the payment of all
4compensation awarded against the person taking said review
5pending a decision thereof and further conditioned upon such
6other obligations as the court may impose. Upon the review the
7Circuit Court shall have power to review all questions of fact
8as well as of law. The penalty hereinafter provided for in this
9paragraph shall not attach and shall not begin to run until the
10final determination of the order of the Commission.
11    (d) Whenever a panel of 3 Commissioners comprised of one
12member of the employing class, one member of the employee
13class, and one member not identified with either the employing
14or employee class, with due process and after a hearing,
15determines an employer has knowingly failed to provide coverage
16as required by paragraph (a) of this Section, the failure shall
17be deemed an immediate serious danger to public health, safety,
18and welfare sufficient to justify service by the Commission of
19a work-stop order on such employer, requiring the cessation of
20all business operations of such employer at the place of
21employment or job site. Any law enforcement agency in the State
22shall, at the request of the Commission, render any assistance
23necessary to carry out the provisions of this Section,
24including, but not limited to, preventing any employee of such
25employer from remaining at a place of employment or job site
26after a work-stop order has taken effect. Any work-stop order

 

 

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1shall be lifted upon proof of insurance as required by this
2Act. Any orders under this Section are appealable under Section
319(f) to the Circuit Court.
4    Any individual employer, corporate officer or director of a
5corporate employer, partner of an employer partnership, or
6member of an employer limited liability company who knowingly
7fails to provide coverage as required by paragraph (a) of this
8Section is guilty of a Class 4 felony. This provision shall not
9apply to any corporate officer or director of any
10publicly-owned corporation. Each day's violation constitutes a
11separate offense. The State's Attorney of the county in which
12the violation occurred, or the Attorney General, shall bring
13such actions in the name of the People of the State of
14Illinois, or may, in addition to other remedies provided in
15this Section, bring an action for an injunction to restrain the
16violation or to enjoin the operation of any such employer.
17    Any individual employer, corporate officer or director of a
18corporate employer, partner of an employer partnership, or
19member of an employer limited liability company who negligently
20fails to provide coverage as required by paragraph (a) of this
21Section is guilty of a Class A misdemeanor. This provision
22shall not apply to any corporate officer or director of any
23publicly-owned corporation. Each day's violation constitutes a
24separate offense. The State's Attorney of the county in which
25the violation occurred, or the Attorney General, shall bring
26such actions in the name of the People of the State of

 

 

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1Illinois.
2    The criminal penalties in this subsection (d) shall not
3apply where there exists a good faith dispute as to the
4existence of an employment relationship. Evidence of good faith
5shall include, but not be limited to, compliance with the
6definition of employee as used by the Internal Revenue Service.
7    Employers who are subject to and who knowingly fail to
8comply with this Section shall not be entitled to the benefits
9of this Act during the period of noncompliance, but shall be
10liable in an action under any other applicable law of this
11State. In the action, such employer shall not avail himself or
12herself of the defenses of assumption of risk or negligence or
13that the injury was due to a co-employee. In the action, proof
14of the injury shall constitute prima facie evidence of
15negligence on the part of such employer and the burden shall be
16on such employer to show freedom of negligence resulting in the
17injury. The employer shall not join any other defendant in any
18such civil action. Nothing in this amendatory Act of the 94th
19General Assembly shall affect the employee's rights under
20subdivision (a)3 of Section 1 of this Act. Any employer or
21carrier who makes payments under subdivision (a)3 of Section 1
22of this Act shall have a right of reimbursement from the
23proceeds of any recovery under this Section.
24    An employee of an uninsured employer, or the employee's
25dependents in case death ensued, may, instead of proceeding
26against the employer in a civil action in court, file an

 

 

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1application for adjustment of claim with the Commission in
2accordance with the provisions of this Act and the Commission
3shall hear and determine the application for adjustment of
4claim in the manner in which other claims are heard and
5determined before the Commission.
6    All proceedings under this subsection (d) shall be reported
7on an annual basis to the Workers' Compensation Advisory Board.
8    An investigator with the Illinois Workers' Compensation
9Commission Insurance Compliance Division may issue a citation
10to any employer that is not in compliance with its obligation
11to have workers' compensation insurance under this Act. The
12amount of the fine shall be based on the period of time the
13employer was in non-compliance, but shall be no less than $500,
14and shall not exceed $2,500. An employer that has been issued a
15citation shall pay the fine to the Commission and provide to
16the Commission proof that it obtained the required workers'
17compensation insurance within 10 days after the citation was
18issued. This Section does not affect any other obligations this
19Act imposes on employers.
20    Upon a finding by the Commission, after reasonable notice
21and hearing, of the knowing and wilful failure or refusal of an
22employer to comply with any of the provisions of paragraph (a)
23of this Section, or the failure or refusal of an employer,
24service or adjustment company, or an insurance carrier to
25comply with any order of the Illinois Workers' Compensation
26Commission pursuant to paragraph (c) of this Section

 

 

HB1698 Enrolled- 38 -LRB097 07917 AJO 48032 b

1disqualifying him or her to operate as a self insurer and
2requiring him or her to insure his or her liability, or the
3knowing and willful failure of an employer to comply with a
4citation issued by an investigator with the Illinois Workers'
5Compensation Commission Insurance Compliance Division, the
6Commission may assess a civil penalty of up to $500 per day for
7each day of such failure or refusal after the effective date of
8this amendatory Act of 1989. The minimum penalty under this
9Section shall be the sum of $10,000. Each day of such failure
10or refusal shall constitute a separate offense. The Commission
11may assess the civil penalty personally and individually
12against the corporate officers and directors of a corporate
13employer, the partners of an employer partnership, and the
14members of an employer limited liability company, after a
15finding of a knowing and willful refusal or failure of each
16such named corporate officer, director, partner, or member to
17comply with this Section. The liability for the assessed
18penalty shall be against the named employer first, and if the
19named employer fails or refuses to pay the penalty to the
20Commission within 30 days after the final order of the
21Commission, then the named corporate officers, directors,
22partners, or members who have been found to have knowingly and
23willfully refused or failed to comply with this Section shall
24be liable for the unpaid penalty or any unpaid portion of the
25penalty. Upon investigation by the insurance non-compliance
26unit of the Commission, the Attorney General shall have the

 

 

HB1698 Enrolled- 39 -LRB097 07917 AJO 48032 b

1authority to prosecute all proceedings to enforce the civil and
2administrative provisions of this Section before the
3Commission. The Commission shall promulgate procedural rules
4for enforcing this Section.
5    Upon the failure or refusal of any employer, service or
6adjustment company or insurance carrier to comply with the
7provisions of this Section and with the orders of the
8Commission under this Section, or the order of the court on
9review after final adjudication, the Commission may bring a
10civil action to recover the amount of the penalty in Cook
11County or in Sangamon County in which litigation the Commission
12shall be represented by the Attorney General. The Commission
13shall send notice of its finding of non-compliance and
14assessment of the civil penalty to the Attorney General. It
15shall be the duty of the Attorney General within 30 days after
16receipt of the notice, to institute prosecutions and promptly
17prosecute all reported violations of this Section.
18    Any individual employer, corporate officer or director of a
19corporate employer, partner of an employer partnership, or
20member of an employer limited liability company who, with the
21intent to avoid payment of compensation under this Act to an
22injured employee or the employee's dependents, knowingly
23transfers, sells, encumbers, assigns, or in any manner disposes
24of, conceals, secretes, or destroys any property belonging to
25the employer, officer, director, partner, or member is guilty
26of a Class 4 felony.

 

 

HB1698 Enrolled- 40 -LRB097 07917 AJO 48032 b

1    Penalties and fines collected pursuant to this paragraph
2(d) shall be deposited upon receipt into a special fund which
3shall be designated the Injured Workers' Benefit Fund, of which
4the State Treasurer is ex-officio custodian, such special fund
5to be held and disbursed in accordance with this paragraph (d)
6for the purposes hereinafter stated in this paragraph (d), upon
7the final order of the Commission. The Injured Workers' Benefit
8Fund shall be deposited the same as are State funds and any
9interest accruing thereon shall be added thereto every 6
10months. The Injured Workers' Benefit Fund is subject to audit
11the same as State funds and accounts and is protected by the
12general bond given by the State Treasurer. The Injured Workers'
13Benefit Fund is considered always appropriated for the purposes
14of disbursements as provided in this paragraph, and shall be
15paid out and disbursed as herein provided and shall not at any
16time be appropriated or diverted to any other use or purpose.
17Moneys in the Injured Workers' Benefit Fund shall be used only
18for payment of workers' compensation benefits for injured
19employees when the employer has failed to provide coverage as
20determined under this paragraph (d) and has failed to pay the
21benefits due to the injured employee. The Commission shall have
22the right to obtain reimbursement from the employer for
23compensation obligations paid by the Injured Workers' Benefit
24Fund. Any such amounts obtained shall be deposited by the
25Commission into the Injured Workers' Benefit Fund. If an
26injured employee or his or her personal representative receives

 

 

HB1698 Enrolled- 41 -LRB097 07917 AJO 48032 b

1payment from the Injured Workers' Benefit Fund, the State of
2Illinois has the same rights under paragraph (b) of Section 5
3that the employer who failed to pay the benefits due to the
4injured employee would have had if the employer had paid those
5benefits, and any moneys recovered by the State as a result of
6the State's exercise of its rights under paragraph (b) of
7Section 5 shall be deposited into the Injured Workers' Benefit
8Fund. The custodian of the Injured Workers' Benefit Fund shall
9be joined with the employer as a party respondent in the
10application for adjustment of claim. After July 1, 2006, the
11Commission shall make disbursements from the Fund once each
12year to each eligible claimant. An eligible claimant is an
13injured worker who has within the previous fiscal year obtained
14a final award for benefits from the Commission against the
15employer and the Injured Workers' Benefit Fund and has notified
16the Commission within 90 days of receipt of such award. Within
17a reasonable time after the end of each fiscal year, the
18Commission shall make a disbursement to each eligible claimant.
19At the time of disbursement, if there are insufficient moneys
20in the Fund to pay all claims, each eligible claimant shall
21receive a pro-rata share, as determined by the Commission, of
22the available moneys in the Fund for that year. Payment from
23the Injured Workers' Benefit Fund to an eligible claimant
24pursuant to this provision shall discharge the obligations of
25the Injured Workers' Benefit Fund regarding the award entered
26by the Commission.

 

 

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1    (e) This Act shall not affect or disturb the continuance of
2any existing insurance, mutual aid, benefit, or relief
3association or department, whether maintained in whole or in
4part by the employer or whether maintained by the employees,
5the payment of benefits of such association or department being
6guaranteed by the employer or by some person, firm or
7corporation for him or her: Provided, the employer contributes
8to such association or department an amount not less than the
9full compensation herein provided, exclusive of the cost of the
10maintenance of such association or department and without any
11expense to the employee. This Act shall not prevent the
12organization and maintaining under the insurance laws of this
13State of any benefit or insurance company for the purpose of
14insuring against the compensation provided for in this Act, the
15expense of which is maintained by the employer. This Act shall
16not prevent the organization or maintaining under the insurance
17laws of this State of any voluntary mutual aid, benefit or
18relief association among employees for the payment of
19additional accident or sick benefits.
20    (f) No existing insurance, mutual aid, benefit or relief
21association or department shall, by reason of anything herein
22contained, be authorized to discontinue its operation without
23first discharging its obligations to any and all persons
24carrying insurance in the same or entitled to relief or
25benefits therein.
26    (g) Any contract, oral, written or implied, of employment

 

 

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1providing for relief benefit, or insurance or any other device
2whereby the employee is required to pay any premium or premiums
3for insurance against the compensation provided for in this Act
4shall be null and void. Any employer withholding from the wages
5of any employee any amount for the purpose of paying any such
6premium shall be guilty of a Class B misdemeanor.
7    In the event the employer does not pay the compensation for
8which he or she is liable, then an insurance company,
9association or insurer which may have insured such employer
10against such liability shall become primarily liable to pay to
11the employee, his or her personal representative or beneficiary
12the compensation required by the provisions of this Act to be
13paid by such employer. The insurance carrier may be made a
14party to the proceedings in which the employer is a party and
15an award may be entered jointly against the employer and the
16insurance carrier.
17    (h) It shall be unlawful for any employer, insurance
18company or service or adjustment company to interfere with,
19restrain or coerce an employee in any manner whatsoever in the
20exercise of the rights or remedies granted to him or her by
21this Act or to discriminate, attempt to discriminate, or
22threaten to discriminate against an employee in any way because
23of his or her exercise of the rights or remedies granted to him
24or her by this Act.
25    It shall be unlawful for any employer, individually or
26through any insurance company or service or adjustment company,

 

 

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1to discharge or to threaten to discharge, or to refuse to
2rehire or recall to active service in a suitable capacity an
3employee because of the exercise of his or her rights or
4remedies granted to him or her by this Act.
5    (i) If an employer elects to obtain a life insurance policy
6on his employees, he may also elect to apply such benefits in
7satisfaction of all or a portion of the death benefits payable
8under this Act, in which case, the employer's compensation
9premium shall be reduced accordingly.
10    (j) Within 45 days of receipt of an initial application or
11application to renew self-insurance privileges the
12Self-Insurers Advisory Board shall review and submit for
13approval by the Chairman of the Commission recommendations of
14disposition of all initial applications to self-insure and all
15applications to renew self-insurance privileges filed by
16private self-insurers pursuant to the provisions of this
17Section and Section 4a-9 of this Act. Each private self-insurer
18shall submit with its initial and renewal applications the
19application fee required by Section 4a-4 of this Act.
20    The Chairman of the Commission shall promptly act upon all
21initial applications and applications for renewal in full
22accordance with the recommendations of the Board or, should the
23Chairman disagree with any recommendation of disposition of the
24Self-Insurer's Advisory Board, he shall within 30 days of
25receipt of such recommendation provide to the Board in writing
26the reasons supporting his decision. The Chairman shall also

 

 

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1promptly notify the employer of his decision within 15 days of
2receipt of the recommendation of the Board.
3    If an employer is denied a renewal of self-insurance
4privileges pursuant to application it shall retain said
5privilege for 120 days after receipt of a notice of
6cancellation of the privilege from the Chairman of the
7Commission.
8    All orders made by the Chairman under this Section shall be
9subject to review by the courts, such review to be taken in the
10same manner and within the same time as provided by subsection
11(f) of Section 19 of this Act for review of awards and
12decisions of the Commission, upon the party seeking the review
13filing with the clerk of the court to which such review is
14taken a bond in an amount to be fixed and approved by the court
15to which the review is taken, conditioned upon the payment of
16all compensation awarded against the person taking such review
17pending a decision thereof and further conditioned upon such
18other obligations as the court may impose. Upon the review the
19Circuit Court shall have power to review all questions of fact
20as well as of law.
21(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
2294-839, eff. 6-6-06.)
 
23    (820 ILCS 305/4b new)
24    Sec. 4b. Collective bargaining pilot program.
25    (a) The Director of the Department of Labor shall adopt a

 

 

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1selection process to designate 2 international, national, or
2statewide organizations made up of affiliates who are the
3exclusive representatives of construction employer employees
4recognized or certified pursuant to the National Labor
5Relations Act to participate in the collective bargaining pilot
6program provided for in this Section.
7    (a-5) For purposes of this Section, the term "construction
8employer" means any person or legal entity or group of persons
9or legal entities engaging in or planning to engage in any
10constructing, altering, reconstructing, repairing,
11rehabilitating, refinishing, refurbishing, remodeling,
12remediating, renovating, custom fabricating, maintaining,
13landscaping, improving, wrecking, painting, decorating,
14demolishing, and adding to or subtracting from any building,
15structure, airport facility, highway, roadway, street, alley,
16bridge, sewer, drain, ditch, sewage disposal plant, water
17works, parking facility, railroad, excavation or other
18project, structure, development, real property or improvement,
19or to do any part thereof, whether or not the performance of
20the work herein described involves the addition to, or
21fabrication into, any project, structure, development, real
22property or improvement herein described, and shall also
23include any moving of construction-related materials on the job
24site or to or from the job site.
25    For purposes of this Section, "labor organization" means an
26affiliate of an international, national, or statewide

 

 

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1organization that has been selected by the Department of Labor
2to participate in the collective bargaining pilot program as
3provided for in this Section.
4    (b) Upon appropriate filing, the Commission and the courts
5of this State shall recognize as valid and binding any
6provision in a collective bargaining agreement between any
7construction employer or group of construction employers and a
8labor organization, which contains certain obligations and
9procedures relating to workers' compensation. This agreement
10must be limited to, but need not include, all of the following:
11        (1) An alternative dispute resolution ("ADR") system
12    to supplement, modify or replace the procedural or dispute
13    resolution provisions of this Act. The system may include
14    mediation, arbitration, or other dispute resolution
15    proceedings, the results of which shall be final and
16    binding upon the parties;
17        (2) An agreed list of medical treatment providers that
18    may be the exclusive source of all medical and related
19    treatment provided under this Act;
20        (3) The use of a limited list of impartial physicians
21    to conduct independent medical examinations;
22        (4) The creation of a light duty, modified job, or
23    return to work program;
24        (5) The use of a limited list of individuals and
25    companies for the establishment of vocational
26    rehabilitation or retraining programs that may be the

 

 

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1    exclusive source of rehabilitation and retraining services
2    provided under this Act; or
3        (6) The establishment of joint labor management safety
4    committees and safety procedures.
5    (c) Void agreements. Nothing in this Section shall be
6construed to authorize any provision in a collective bargaining
7agreement that diminishes or increases a construction
8employer's entitlements under this Act or an employee's
9entitlement to benefits as otherwise set forth in this Act. For
10the purposes of this Section, the procedural rights and dispute
11resolution agreements under subparagraphs (1) through (6) of
12subsection (b) of this Section are not agreements which
13diminish or increase a construction employer's entitlements
14under this Act or an employee's entitlement to benefits under
15this Act. Any agreement that diminishes or increases a
16construction employer's entitlements under this Act or an
17employee's entitlement to benefits as set forth in this Act is
18null and void. Nothing in this Section shall be construed as
19creating a mandatory subject of bargaining.
20    (d) Form of agreement. The agreement reached herein shall
21demonstrate that:
22        (1) The construction employer or group of construction
23    employers and the recognized or certified exclusive
24    bargaining representative have entered into a binding
25    collective bargaining agreement adopting the ADR plan for a
26    period of no less than 2 years;

 

 

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1        (2) Contractual agreements have been reached with the
2    construction employer's workers' compensation carrier,
3    group self-insurance fund, and any excess carriers
4    relating to the ADR plan;
5        (3) Procedures have been established by which claims
6    for benefits by employees will be lodged, administered, and
7    decided while affording procedural due process;
8        (4) The plan has designated forms upon which claims for
9    benefits shall be made;
10        (5) The system and means by which the construction
11    employer's obligation to furnish medical services and
12    vocational rehabilitation and retraining benefits shall be
13    fulfilled and provider selected;
14        (6) The method by which mediators or arbitrators are to
15    be selected.
16    (e) Filing. A copy of the agreement and a statement
17identifying the parties to the agreement shall be filed with
18the Commission. Within 21 days of receipt of an agreement, the
19Chairman shall review the agreement for compliance with this
20Section and notify the parties of its acceptance or notify the
21parties of any additional information required or any
22recommended modification that would bring the agreement into
23compliance. If no additional information or modification is
24required, the agreement shall be valid and binding from the
25time the parties receive acceptance of the agreement from the
26Chairman. Upon receipt of any requested information or

 

 

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1modification, the Chairman shall notify the parties within 21
2days whether the agreement is in compliance with this Section.
3All rejections made by the Chairman under this subsection shall
4be subject to review by the courts of this State, said review
5to be taken in the same manner and within the same time as
6provided by Section 19 of this Act for review of awards and
7decisions of the Commission. Upon the review, the Circuit Court
8shall have power to review all questions of fact as well as of
9law.
10    (f) Notice to insurance carrier. If the construction
11employer is insured under this Act, it shall provide notice to
12and obtain consent from its insurance carrier, in the manner
13provided in the insurance contract, of its intent to enter into
14an agreement as provided in this Section with its employees.
15    (g) Employees' claims for workers' compensation benefits.
16        (1) Claims for benefits shall be filed with the ADR
17    plan administrator within those periods of limitation
18    prescribed by this Act. Within 10 days of the filing of a
19    claim, the ADR plan administrator shall serve a copy of the
20    claim application upon the Commission, which shall
21    maintain records of all ADR claims and resolutions.
22        (2) Settlements of claims presented to the ADR plan
23    administrator shall be evidenced by a settlement
24    agreement. All such settlements shall be filed with the ADR
25    plan administrator, who within 10 days shall forward a copy
26    to the Commission for recording.

 

 

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1        (3) Upon assignment of claims, unless settled,
2    mediators and arbitrators shall render final orders
3    containing essential findings of fact, rulings of law and
4    referring to other matters as pertinent to the questions at
5    issue. The ADR plan administrator shall maintain a record
6    of the proceedings.
7    (h) Reporting requirements. Annually, each ADR plan
8administrator shall submit a report to the Commission
9containing the following information:
10        (1) The number of employees within the ADR program;
11        (2) The number of occurrences of work-related injuries
12    or diseases;
13        (3) The breakdown within the ADR program of injuries
14    and diseases treated;
15        (4) The total amount of disability benefits paid within
16    the ADR program;
17        (5) The total medical treatment cost paid within the
18    ADR program;
19        (6) The number of claims filed within the ADR program;
20    and
21        (7) The disposition of all claims.
 
22    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
23    Sec. 8. The amount of compensation which shall be paid to
24the employee for an accidental injury not resulting in death
25is:

 

 

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1    (a) The employer shall provide and pay the negotiated rate,
2if applicable, or the lesser of the health care provider's
3actual charges or according to a fee schedule, subject to
4Section 8.2, in effect at the time the service was rendered for
5all the necessary first aid, medical and surgical services, and
6all necessary medical, surgical and hospital services
7thereafter incurred, limited, however, to that which is
8reasonably required to cure or relieve from the effects of the
9accidental injury, even if a health care provider sells,
10transfers, or otherwise assigns an account receivable for
11procedures, treatments, or services covered under this Act. If
12the employer does not dispute payment of first aid, medical,
13surgical, and hospital services, the employer shall make such
14payment to the provider on behalf of the employee. The employer
15shall also pay for treatment, instruction and training
16necessary for the physical, mental and vocational
17rehabilitation of the employee, including all maintenance
18costs and expenses incidental thereto. If as a result of the
19injury the employee is unable to be self-sufficient the
20employer shall further pay for such maintenance or
21institutional care as shall be required.
22    The employee may at any time elect to secure his own
23physician, surgeon and hospital services at the employer's
24expense, or,
25    Upon agreement between the employer and the employees, or
26the employees' exclusive representative, and subject to the

 

 

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1approval of the Illinois Workers' Compensation Commission, the
2employer shall maintain a list of physicians, to be known as a
3Panel of Physicians, who are accessible to the employees. The
4employer shall post this list in a place or places easily
5accessible to his employees. The employee shall have the right
6to make an alternative choice of physician from such Panel if
7he is not satisfied with the physician first selected. If, due
8to the nature of the injury or its occurrence away from the
9employer's place of business, the employee is unable to make a
10selection from the Panel, the selection process from the Panel
11shall not apply. The physician selected from the Panel may
12arrange for any consultation, referral or other specialized
13medical services outside the Panel at the employer's expense.
14Provided that, in the event the Commission shall find that a
15doctor selected by the employee is rendering improper or
16inadequate care, the Commission may order the employee to
17select another doctor certified or qualified in the medical
18field for which treatment is required. If the employee refuses
19to make such change the Commission may relieve the employer of
20his obligation to pay the doctor's charges from the date of
21refusal to the date of compliance.
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
21gross net amount which he or she is earning in the modified job
22provided to the employee by the employer or in any other job
23that the employee 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 physician, surgeon or hospital initially
11    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

 

 

HB1698 Enrolled- 56 -LRB097 07917 AJO 48032 b

1    selection. At any time the employee may obtain any medical
2    treatment he desires at his own expense. This paragraph
3    shall not affect the duty to pay for rehabilitation
4    referred to above.
5        (4) The following shall apply for injuries occurring on
6    or after the effective date of this amendatory Act of the
7    97th General Assembly and only when an employer has an
8    approved preferred provider program pursuant to Section
9    8.1a on the date the employee sustained his or her
10    accidental injuries:
11            (A) The employer shall, in writing, on a form
12        promulgated by the Commission, inform the employee of
13        the preferred provider program;
14            (B) Subsequent to the report of an injury by an
15        employee, the employee may choose in writing at any
16        time to decline the preferred provider program, in
17        which case that would constitute one of the two choices
18        of medical providers to which the employee is entitled
19        under subsection (a)(2) or (a)(3); and
20            (C) Prior to the report of an injury by an
21        employee, when an employee chooses non-emergency
22        treatment from a provider not within the preferred
23        provider program, that would constitute the employee's
24        one choice of medical providers to which the employee
25        is entitled under subsection (a)(2) or (a)(3).
26    When an employer and employee so agree in writing, nothing

 

 

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1in this Act prevents an employee whose injury or disability has
2been established under this Act, from relying in good faith, on
3treatment by prayer or spiritual means alone, in accordance
4with the tenets and practice of a recognized church or
5religious denomination, by a duly accredited practitioner
6thereof, and having nursing services appropriate therewith,
7without suffering loss or diminution of the compensation
8benefits under this Act. However, the employee shall submit to
9all physical examinations required by this Act. The cost of
10such treatment and nursing care shall be paid by the employee
11unless the employer agrees to make such payment.
12    Where the accidental injury results in the amputation of an
13arm, hand, leg or foot, or the enucleation of an eye, or the
14loss of any of the natural teeth, the employer shall furnish an
15artificial of any such members lost or damaged in accidental
16injury arising out of and in the course of employment, and
17shall also furnish the necessary braces in all proper and
18necessary cases. In cases of the loss of a member or members by
19amputation, the employer shall, whenever necessary, maintain
20in good repair, refit or replace the artificial limbs during
21the lifetime of the employee. Where the accidental injury
22accompanied by physical injury results in damage to a denture,
23eye glasses or contact eye lenses, or where the accidental
24injury results in damage to an artificial member, the employer
25shall replace or repair such denture, glasses, lenses, or
26artificial member.

 

 

HB1698 Enrolled- 58 -LRB097 07917 AJO 48032 b

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

 

 

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

 

 

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1    Act, or the Illinois minimum wage under the Minimum Wage
2    Law, whichever is more, multiplied by 40 hours. This
3    percentage rate shall be increased by 10% for each spouse
4    and child, not to exceed 100% of the total minimum wage
5    calculation,
6    nor exceed the employee's average weekly wage computed in
7    accordance with the provisions of Section 10, whichever is
8    less.
9        3. As used in this Section the term "child" means a
10    child of the employee including any child legally adopted
11    before the accident or whom at the time of the accident the
12    employee was under legal obligation to support or to whom
13    the employee stood in loco parentis, and who at the time of
14    the accident was under 18 years of age and not emancipated.
15    The term "children" means the plural of "child".
16        4. All weekly compensation rates provided under
17    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
18    Section shall be subject to the following limitations:
19        The maximum weekly compensation rate from July 1, 1975,
20    except as hereinafter provided, shall be 100% of the
21    State's average weekly wage in covered industries under the
22    Unemployment Insurance Act, that being the wage that most
23    closely approximates the State's average weekly wage.
24        The maximum weekly compensation rate, for the period
25    July 1, 1984, through June 30, 1987, except as hereinafter
26    provided, shall be $293.61. Effective July 1, 1987 and on

 

 

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

 

 

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1        From July 1, 1977 and thereafter such maximum weekly
2    compensation rate in death cases under Section 7, and
3    permanent total disability cases under paragraph (f) or
4    subparagraph 18 of paragraph (3) of this Section and for
5    temporary total disability under paragraph (b) of this
6    Section and for amputation of a member or enucleation of an
7    eye under paragraph (e) of this Section shall be increased
8    to 133-1/3% of the State's average weekly wage in covered
9    industries under the Unemployment Insurance Act.
10        For injuries occurring on or after February 1, 2006,
11    the maximum weekly benefit under paragraph (d)1 of this
12    Section shall be 100% of the State's average weekly wage in
13    covered industries under the Unemployment Insurance Act.
14        4.1. Any provision herein to the contrary
15    notwithstanding, the weekly compensation rate for
16    compensation payments under subparagraph 18 of paragraph
17    (e) of this Section and under paragraph (f) of this Section
18    and under paragraph (a) of Section 7 and for amputation of
19    a member or enucleation of an eye under paragraph (e) of
20    this Section, shall in no event be less than 50% of the
21    State's average weekly wage in covered industries under the
22    Unemployment Insurance Act.
23        4.2. Any provision to the contrary notwithstanding,
24    the total compensation payable under Section 7 shall not
25    exceed the greater of $500,000 or 25 years.
26        5. For the purpose of this Section this State's average

 

 

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1    weekly wage in covered industries under the Unemployment
2    Insurance Act on July 1, 1975 is hereby fixed at $228.16
3    per week and the computation of compensation rates shall be
4    based on the aforesaid average weekly wage until modified
5    as hereinafter provided.
6        6. The Department of Employment Security of the State
7    shall on or before the first day of December, 1977, and on
8    or before the first day of June, 1978, and on the first day
9    of each December and June of each year thereafter, publish
10    the State's average weekly wage in covered industries under
11    the Unemployment Insurance Act and the Illinois Workers'
12    Compensation Commission shall on the 15th day of January,
13    1978 and on the 15th day of July, 1978 and on the 15th day
14    of each January and July of each year thereafter, post and
15    publish the State's average weekly wage in covered
16    industries under the Unemployment Insurance Act as last
17    determined and published by the Department of Employment
18    Security. The amount when so posted and published shall be
19    conclusive and shall be applicable as the basis of
20    computation of compensation rates until the next posting
21    and publication as aforesaid.
22        7. The payment of compensation by an employer or his
23    insurance carrier to an injured employee shall not
24    constitute an admission of the employer's liability to pay
25    compensation.
26    (c) For any serious and permanent disfigurement to the

 

 

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1hand, head, face, neck, arm, leg below the knee or the chest
2above the axillary line, the employee is entitled to
3compensation for such disfigurement, the amount determined by
4agreement at any time or by arbitration under this Act, at a
5hearing not less than 6 months after the date of the accidental
6injury, which amount shall not exceed 150 weeks (if the
7accidental injury occurs on or after the effective date of this
8amendatory Act of the 94th General Assembly but before February
91, 2006) or 162 weeks (if the accidental injury occurs on or
10after February 1, 2006) at the applicable rate provided in
11subparagraph 2.1 of paragraph (b) of this Section.
12    No compensation is payable under this paragraph where
13compensation is payable under paragraphs (d), (e) or (f) of
14this Section.
15    A duly appointed member of a fire department in a city, the
16population of which exceeds 200,000 according to the last
17federal or State census, is eligible for compensation under
18this paragraph only where such serious and permanent
19disfigurement results from burns.
20    (d) 1. If, after the accidental injury has been sustained,
21the employee as a result thereof becomes partially
22incapacitated from pursuing his usual and customary line of
23employment, he shall, except in cases compensated under the
24specific schedule set forth in paragraph (e) of this Section,
25receive compensation for the duration of his disability,
26subject to the limitations as to maximum amounts fixed in

 

 

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1paragraph (b) of this Section, equal to 66-2/3% of the
2difference between the average amount which he would be able to
3earn in the full performance of his duties in the occupation in
4which he was engaged at the time of the accident and the
5average amount which he is earning or is able to earn in some
6suitable employment or business after the accident. For
7accidental injuries that occur on or after September 1, 2011,
8an award for wage differential under this subsection shall be
9effective only until the employee reaches the age of 67 or 5
10years from the date the award becomes final, whichever is
11later.
12    2. If, as a result of the accident, the employee sustains
13serious and permanent injuries not covered by paragraphs (c)
14and (e) of this Section or having sustained injuries covered by
15the aforesaid paragraphs (c) and (e), he shall have sustained
16in addition thereto other injuries which injuries do not
17incapacitate him from pursuing the duties of his employment but
18which would disable him from pursuing other suitable
19occupations, or which have otherwise resulted in physical
20impairment; or if such injuries partially incapacitate him from
21pursuing the duties of his usual and customary line of
22employment but do not result in an impairment of earning
23capacity, or having resulted in an impairment of earning
24capacity, the employee elects to waive his right to recover
25under the foregoing subparagraph 1 of paragraph (d) of this
26Section then in any of the foregoing events, he shall receive

 

 

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

 

 

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1total incapacity for work resulting from such accidental
2injury, under subparagraph 1 of paragraph (b) of this Section,
3and shall receive in addition thereto compensation for a
4further period for the specific loss herein mentioned, but
5shall not receive any compensation under any other provisions
6of this Act. The following listed amounts apply to either the
7loss of or the permanent and complete loss of use of the member
8specified, such compensation for the length of time as follows:
9        1. Thumb-
10            70 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            76 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        2. First, or index finger-
16            40 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            43 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        3. Second, or middle finger-
22            35 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            38 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

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

 

 

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

 

 

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

 

 

HB1698 Enrolled- 71 -LRB097 07917 AJO 48032 b

1    shall be paid.
2        11. Foot-
3            155 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            167 weeks if the accidental injury occurs on or
7        after February 1, 2006.
8        12. Leg-
9            200 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            215 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        Where an accidental injury results in the amputation of
15    a leg below the knee, such injury shall be compensated as
16    loss of a leg. Where an accidental injury results in the
17    amputation of a leg above the knee, compensation for an
18    additional 25 weeks (if the accidental injury occurs on or
19    after the effective date of this amendatory Act of the 94th
20    General Assembly but before February 1, 2006) or an
21    additional 27 weeks (if the accidental injury occurs on or
22    after February 1, 2006) shall be paid, except where the
23    accidental injury results in the amputation of a leg at the
24    hip joint, or so close to the hip joint that an artificial
25    leg cannot be used, or results in the disarticulation of a
26    leg at the hip joint, in which case compensation for an

 

 

HB1698 Enrolled- 72 -LRB097 07917 AJO 48032 b

1    additional 75 weeks (if the accidental injury occurs on or
2    after the effective date of this amendatory Act of the 94th
3    General Assembly but before February 1, 2006) or an
4    additional 81 weeks (if the accidental injury occurs on or
5    after February 1, 2006) shall be paid.
6        13. Eye-
7            150 weeks if the accidental injury occurs on or
8        after the effective date of this amendatory Act of the
9        94th General Assembly but before February 1, 2006.
10            162 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        Where an accidental injury results in the enucleation
13    of an eye, compensation for an additional 10 weeks (if the
14    accidental injury occurs on or after the effective date of
15    this amendatory Act of the 94th General Assembly but before
16    February 1, 2006) or an additional 11 weeks (if the
17    accidental injury occurs on or after February 1, 2006)
18    shall be paid.
19        14. Loss of hearing of one ear-
20            50 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            54 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        Total and permanent loss of hearing of both ears-
26            200 weeks if the accidental injury occurs on or

 

 

HB1698 Enrolled- 73 -LRB097 07917 AJO 48032 b

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            215 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        15. Testicle-
6            50 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            54 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        Both testicles-
12            150 weeks if the accidental injury occurs on or
13        after the effective date of this amendatory Act of the
14        94th General Assembly but before February 1, 2006.
15            162 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        16. For the permanent partial loss of use of a member
18    or sight of an eye, or hearing of an ear, compensation
19    during that proportion of the number of weeks in the
20    foregoing schedule provided for the loss of such member or
21    sight of an eye, or hearing of an ear, which the partial
22    loss of use thereof bears to the total loss of use of such
23    member, or sight of eye, or hearing of an ear.
24            (a) Loss of hearing for compensation purposes
25        shall be confined to the frequencies of 1,000, 2,000
26        and 3,000 cycles per second. Loss of hearing ability

 

 

HB1698 Enrolled- 74 -LRB097 07917 AJO 48032 b

1        for frequency tones above 3,000 cycles per second are
2        not to be considered as constituting disability for
3        hearing.
4            (b) The percent of hearing loss, for purposes of
5        the determination of compensation claims for
6        occupational deafness, shall be calculated as the
7        average in decibels for the thresholds of hearing for
8        the frequencies of 1,000, 2,000 and 3,000 cycles per
9        second. Pure tone air conduction audiometric
10        instruments, approved by nationally recognized
11        authorities in this field, shall be used for measuring
12        hearing loss. If the losses of hearing average 30
13        decibels or less in the 3 frequencies, such losses of
14        hearing shall not then constitute any compensable
15        hearing disability. If the losses of hearing average 85
16        decibels or more in the 3 frequencies, then the same
17        shall constitute and be total or 100% compensable
18        hearing loss.
19            (c) In measuring hearing impairment, the lowest
20        measured losses in each of the 3 frequencies shall be
21        added together and divided by 3 to determine the
22        average decibel loss. For every decibel of loss
23        exceeding 30 decibels an allowance of 1.82% shall be
24        made up to the maximum of 100% which is reached at 85
25        decibels.
26            (d) If a hearing loss is established to have

 

 

HB1698 Enrolled- 75 -LRB097 07917 AJO 48032 b

1        existed on July 1, 1975 by audiometric testing the
2        employer shall not be liable for the previous loss so
3        established nor shall he be liable for any loss for
4        which compensation has been paid or awarded.
5            (e) No consideration shall be given to the question
6        of whether or not the ability of an employee to
7        understand speech is improved by the use of a hearing
8        aid.
9            (f) No claim for loss of hearing due to industrial
10        noise shall be brought against an employer or allowed
11        unless the employee has been exposed for a period of
12        time sufficient to cause permanent impairment to noise
13        levels in excess of the following:
14Sound Level DBA
15Slow ResponseHours Per Day
16908
17926
18954
19973
201002
211021-1/2
221051
231101/2
241151/4
25        This subparagraph (f) shall not be applied in cases of
26    hearing loss resulting from trauma or explosion.

 

 

HB1698 Enrolled- 76 -LRB097 07917 AJO 48032 b

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

 

 

HB1698 Enrolled- 77 -LRB097 07917 AJO 48032 b

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

 

 

HB1698 Enrolled- 78 -LRB097 07917 AJO 48032 b

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

 

 

HB1698 Enrolled- 79 -LRB097 07917 AJO 48032 b

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

 

 

HB1698 Enrolled- 80 -LRB097 07917 AJO 48032 b

1Section.
2    The custodian of the Second Injury Fund provided for in
3paragraph (f) of Section 7 shall be joined with the employer as
4a party respondent in the application for adjustment of claim.
5The application for adjustment of claim shall state briefly and
6in general terms the approximate time and place and manner of
7the loss of the first member.
8    In its award the Commission or the Arbitrator shall
9specifically find the amount the injured employee shall be
10weekly paid, the number of weeks compensation which shall be
11paid by the employer, the date upon which payments begin out of
12the Second Injury Fund provided for in paragraph (f) of Section
137 of this Act, the length of time the weekly payments continue,
14the date upon which the pension payments commence and the
15monthly amount of the payments. The Commission shall 30 days
16after the date upon which payments out of the Second Injury
17Fund have begun as provided in the award, and every month
18thereafter, prepare and submit to the State Comptroller a
19voucher for payment for all compensation accrued to that date
20at the rate fixed by the Commission. The State Comptroller
21shall draw a warrant to the injured employee along with a
22receipt to be executed by the injured employee and returned to
23the Commission. The endorsed warrant and receipt is a full and
24complete acquittance to the Commission for the payment out of
25the Second Injury Fund. No other appropriation or warrant is
26necessary for payment out of the Second Injury Fund. The Second

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1employee receives payments other than compensation payments,
2whether as full or partial salary, group insurance benefits,
3bonuses, annuities or any other payments, the employer or
4insurance carrier shall receive credit for each such payment
5only to the extent of the compensation that would have been
6payable during the period covered by such payment.
7    3. The extension of time for the filing of an Application
8for Adjustment of Claim as provided in paragraph 1 above shall
9not apply to those cases where the time for such filing had
10expired prior to the date on which payments or benefits
11enumerated herein have been initiated or resumed. Provided
12however that this paragraph 3 shall apply only to cases wherein
13the payments or benefits hereinabove enumerated shall be
14received after July 1, 1969.
15(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
1694-695, eff. 11-16-05.)
 
17    (820 ILCS 305/8.1a new)
18    Sec. 8.1a. Preferred provider programs. Starting on the
19effective date of this amendatory Act of the 97th General
20Assembly, to satisfy its liabilities under this Act for the
21provision of medical treatment to injured employees, an
22employer may utilize a preferred provider program approved by
23the Illinois Department of Insurance as in compliance with
24Sections 370k, 370l, 370m, and 370p of Article XX-1/2 of the
25Illinois Insurance Code. For the purposes of compliance with

 

 

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1these Sections, the employee shall be considered the
2"beneficiary" and the employer shall be considered the
3"insured". Employers and insurers contracting directly with
4providers or utilizing multiple preferred provider programs to
5implement a preferred provider program providing workers'
6compensation benefits shall be subject to the above
7requirements of Article XX-1/2 applicable to administrators
8with regard to such program, with the exception of Section 370l
9of the Illinois Insurance Code.
10    (a) In addition to the above requirements of Article XX-1/2
11of the Illinois Insurance Code, all preferred provider programs
12under this Section shall meet the following requirements:
13        (1) The provider network shall include an adequate
14    number of occupational and non-occupational providers.
15        (2) The provider network shall include an adequate
16    number and type of physicians or other providers to treat
17    common injuries experienced by injured workers in the
18    geographic area where the employees reside.
19        (3) Medical treatment for injuries shall be readily
20    available at reasonable times to all employees. To the
21    extent feasible, all medical treatment for injuries shall
22    be readily accessible to all employees.
23        (4) Physician compensation shall not be structured in
24    order to achieve the goal of inappropriately reducing,
25    delaying, or denying medical treatment or restricting
26    access to medical treatment.

 

 

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1        (5) Before entering into any agreement under this
2    Section, a program shall establish terms and conditions
3    that must be met by noninstitutional providers wishing to
4    enter into an agreement with the program. These terms and
5    conditions may not discriminate unreasonably against or
6    among noninstitutional providers. Neither difference in
7    prices among noninstitutional providers produced by a
8    process of individual negotiation nor price differences
9    among other noninstitutional providers in different
10    geographical areas or different specialties constitutes
11    unreasonable discrimination.
12    (b) The administrator of any preferred provider program
13under this Act that uses economic evaluation shall file with
14the Director of Insurance a description of any policies and
15procedures related to economic evaluation utilized by the
16program. The filing shall describe how these policies and
17procedures are used in utilization review, peer review,
18incentive and penalty programs, and in provider retention and
19termination decisions. The Director of Insurance may deny
20approval of any preferred provider program that uses any policy
21or procedure of economic evaluation to inappropriately reduce,
22delay or deny medical treatment, or to restrict access to
23medical treatment. Evaluation of providers based upon
24objective medical quality and patient outcome measurements,
25appropriate use of best clinical practices and evidence based
26medicine, and use of health information technology shall be

 

 

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1permitted. If approved, the employer shall provide a copy of
2the filing to all participating providers.
3        (1) The Director of the Department of Insurance shall
4    make each administrator's filing available to the public
5    upon request. The Director of the Department of Insurance
6    may not publicly disclose any information submitted
7    pursuant to this Section that is determined by the Director
8    of the Department of Insurance to be confidential,
9    proprietary, or trade secret information pursuant to State
10    or federal law.
11        (2) For the purposes of this subsection (b), "economic
12    evaluation" shall mean any evaluation of a particular
13    physician, provider, medical group, or individual practice
14    association based in whole or in part on the economic costs
15    or utilization of services associated with medical care
16    provided or authorized by the physician, provider, medical
17    group, or individual practice association. Economic
18    evaluation shall not include negotiated rates with a
19    provider.
20    (c) Except for the provisions of subsection (a)(4) of
21Section 8 and for injuries occurring on or after the effective
22date of this amendatory Act of the 97th General Assembly, an
23employee of an employer utilizing a preferred provider program
24shall only be allowed to select a participating network
25provider from the network. An employer shall be responsible
26for: (i) all first aid and emergency treatment; (ii) all

 

 

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1medical, surgical, and hospital services provided by the
2participating network provider initially selected by the
3employee or by any other participating network provider
4recommended by the initial participating network provider or
5any subsequent participating network provider in the chain of
6referrals from the initial participating network provider; and
7(iii) all medical, surgical, and hospital services provided by
8the participating network provider subsequently chosen by the
9employee or by any other participating network provider
10recommended by the subsequent participating network provider
11or any subsequent participating network provider in the chain
12of referrals from the second participating network provider. An
13employer shall not be liable for services determined by the
14Commission not to be compensable. An employer shall not be
15liable for medical services provided by a non-authorized
16provider when proper notice is provided to the injured worker.
17        (1) When the injured employee notifies the employer of
18    the injury or files a claim for workers' compensation with
19    the employer, the employer shall notify the employee of his
20    or her right to be treated by a physician of his or her
21    choice from the preferred provider network established
22    pursuant to this Section, and the method by which the list
23    of participating network providers may be accessed by the
24    employee, except as provided in subsection (a)(4) of
25    Section 8.
26        (2) Consistent with Article XX-1/2 of the Illinois

 

 

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1    Insurance Code, treatment by a specialist who is not a
2    member of the preferred provider network shall be permitted
3    on a case-by-case basis if the medical provider network
4    does not contain a physician who can provide the approved
5    treatment, and if the employee has complied with any
6    pre-authorization requirements of the preferred provider
7    network. Consent for the employee to visit an
8    out-of-network provider may not be unreasonably withheld.
9    When a non-network provider is authorized pursuant to this
10    subparagraph (2), the non-network provider shall not hold
11    an employee liable for costs except as provided in
12    subsection (e) of Section 8.2.
13        (3) The Director shall not approve, and may withdraw
14    prior approval of, a preferred provider program that fails
15    to provide an injured employee with sufficient access to
16    necessary treating physicians, surgeons, and specialists.
17    (d) Except as provided in subsection (a)(4) of Section 8,
18upon a finding by the Commission that the care being rendered
19by the employee's second choice of provider within the
20employer's network is improper or inadequate, the employee may
21then choose a provider outside of the network at the employer's
22expense. The Commission shall issue a decision on any petition
23filed pursuant to this Section within 5 working days.
24    (e) The Director of the Department of Insurance may
25promulgate such rules as are necessary to carry out the
26provisions of this Section relating to approval and regulation

 

 

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1of preferred provider programs.
 
2    (820 ILCS 305/8.1b new)
3    Sec. 8.1b. Determination of permanent partial disability.
4For accidental injuries that occur on or after September 1,
52011, permanent partial disability shall be established using
6the following criteria:
7    (a) A physician licensed to practice medicine in all of its
8branches preparing a permanent partial disability impairment
9report shall report the level of impairment in writing. The
10report shall include an evaluation of medically defined and
11professionally appropriate measurements of impairment that
12include, but are not limited to: loss of range of motion; loss
13of strength; measured atrophy of tissue mass consistent with
14the injury; and any other measurements that establish the
15nature and extent of the impairment. The most current edition
16of the American Medical Association's "Guides to the Evaluation
17of Permanent Impairment" shall be used by the physician in
18determining the level of impairment.
19    (b) In determining the level of permanent partial
20disability, the Commission shall base its determination on the
21following factors: (i) the reported level of impairment
22pursuant to subsection (a); (ii) the occupation of the injured
23employee; (iii) the age of the employee at the time of the
24injury; (iv) the employee's future earning capacity; and (v)
25evidence of disability corroborated by the treating medical

 

 

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1records. No single enumerated factor shall be the sole
2determinant of disability. In determining the level of
3disability, the relevance and weight of any factors used in
4addition to the level of impairment as reported by the
5physician must be explained in a written order.
 
6    (820 ILCS 305/8.2)
7    Sec. 8.2. Fee schedule.
8    (a) Except as provided for in subsection (c), for
9procedures, treatments, or services covered under this Act and
10rendered or to be rendered on and after February 1, 2006, the
11maximum allowable payment shall be 90% of the 80th percentile
12of charges and fees as determined by the Commission utilizing
13information provided by employers' and insurers' national
14databases, with a minimum of 12,000,000 Illinois line item
15charges and fees comprised of health care provider and hospital
16charges and fees as of August 1, 2004 but not earlier than
17August 1, 2002. These charges and fees are provider billed
18amounts and shall not include discounted charges. The 80th
19percentile is the point on an ordered data set from low to high
20such that 80% of the cases are below or equal to that point and
21at most 20% are above or equal to that point. The Commission
22shall adjust these historical charges and fees as of August 1,
232004 by the Consumer Price Index-U for the period August 1,
242004 through September 30, 2005. The Commission shall establish
25fee schedules for procedures, treatments, or services for

 

 

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

 

 

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1in that state, the provider shall be reimbursed at the lesser
2of the actual charge or the fee schedule amount for the region
3in which the employee resides. The Commission has the authority
4to set the maximum allowable payment to providers of
5out-of-state procedures, treatments, or services covered under
6this Act in a manner consistent with this Section. Not later
7than September 30 in 2006 and each year thereafter, the
8Commission shall automatically increase or decrease the
9maximum allowable payment for a procedure, treatment, or
10service established and in effect on January 1 of that year by
11the percentage change in the Consumer Price Index-U for the 12
12month period ending August 31 of that year. The increase or
13decrease shall become effective on January 1 of the following
14year. As used in this Section, "Consumer Price Index-U" means
15the index published by the Bureau of Labor Statistics of the
16U.S. Department of Labor, that measures the average change in
17prices of all goods and services purchased by all urban
18consumers, U.S. city average, all items, 1982-84=100.
19    (a-1) Notwithstanding the provisions of subsection (a) and
20unless otherwise indicated, the following provisions shall
21apply to the medical fee schedule starting on September 1,
222011:
23        (1) The Commission shall establish and maintain fee
24    schedules for procedures, treatments, products, services,
25    or supplies for hospital inpatient, hospital outpatient,
26    emergency room, ambulatory surgical treatment centers,

 

 

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

 

 

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

 

 

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

 

 

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1        (6) The Commission shall automatically update all
2    codes and associated rules with the version of the codes
3    and rules valid on January 1 of that year.
4    (a-2) For procedures, treatments, services, or supplies
5covered under this Act and rendered or to be rendered on or
6after September 1, 2011, the maximum allowable payment shall be
770% of the fee schedule amounts, which shall be adjusted yearly
8by the Consumer Price Index-U, as described in subsection (a)
9of this Section.
10    (a-3) Prescriptions filled and dispensed outside of a
11licensed pharmacy shall be subject to a fee schedule that shall
12not exceed the Average Wholesale Price (AWP) plus a dispensing
13fee of $4.18. AWP or its equivalent as registered by the
14National Drug Code shall be set forth for that drug on that
15date as published in Medispan.
16    (b) Notwithstanding the provisions of subsection (a), if
17the Commission finds that there is a significant limitation on
18access to quality health care in either a specific field of
19health care services or a specific geographic limitation on
20access to health care, it may change the Consumer Price Index-U
21increase or decrease for that specific field or specific
22geographic limitation on access to health care to address that
23limitation.
24    (c) The Commission shall establish by rule a process to
25review those medical cases or outliers that involve
26extra-ordinary treatment to determine whether to make an

 

 

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1additional adjustment to the maximum payment within a fee
2schedule for a procedure, treatment, or service.
3    (d) When a patient notifies a provider that the treatment,
4procedure, or service being sought is for a work-related
5illness or injury and furnishes the provider the name and
6address of the responsible employer, the provider shall bill
7the employer directly. The employer shall make payment and
8providers shall submit bills and records in accordance with the
9provisions of this Section.
10        (1) All payments to providers for treatment provided
11    pursuant to this Act shall be made within 30 60 days of
12    receipt of the bills as long as the claim contains
13    substantially all the required data elements necessary to
14    adjudicate the bills.
15        (2) If the claim does not contain substantially all the
16    required data elements necessary to adjudicate the bill, or
17    the claim is denied for any other reason, in whole or in
18    part, the employer or insurer shall provide written
19    notification, explaining the basis for the denial and
20    describing any additional necessary data elements, to the
21    provider within 30 days of receipt of the bill.
22        (3) In the case of nonpayment to a provider within 30
23    60 days of receipt of the bill which contained
24    substantially all of the required data elements necessary
25    to adjudicate the bill or nonpayment to a provider of a
26    portion of such a bill up to the lesser of the actual

 

 

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

 

 

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

 

 

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

 

 

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1collect payment from the employee for the services rendered to
2the employee and the employee shall be responsible for payment
3of any outstanding bills for a procedure, treatment, or service
4rendered by a provider as well as the interest awarded under
5subsection (d) of this Section. In the case of a procedure,
6treatment, or service deemed compensable, the provider shall
7not require a payment rate, excluding the interest provisions
8under subsection (d), greater than the lesser of the actual
9charge or the payment level set by the Commission in the fee
10schedule established in this Section. Payment for services
11deemed not covered or not compensable under this Act is the
12responsibility of the employee unless a provider and employee
13have agreed otherwise in writing. Services not covered or not
14compensable under this Act are not subject to the fee schedule
15in this Section.
16    (f) Nothing in this Act shall prohibit an employer or
17insurer from contracting with a health care provider or group
18of health care providers for reimbursement levels for benefits
19under this Act different from those provided in this Section.
20    (g) On or before January 1, 2010 the Commission shall
21provide to the Governor and General Assembly a report regarding
22the implementation of the medical fee schedule and the index
23used for annual adjustment to that schedule as described in
24this Section.
25(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 

 

 

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1    (820 ILCS 305/8.2a new)
2    Sec. 8.2a. Electronic claims.
3    (a) The Director of Insurance shall adopt rules to do all
4of the following:
5        (1) Ensure that all health care providers and
6    facilities submit medical bills for payment on
7    standardized forms.
8        (2) Require acceptance by employers and insurers of
9    electronic claims for payment of medical services.
10        (3) Ensure confidentiality of medical information
11    submitted on electronic claims for payment of medical
12    services.
13    (b) To the extent feasible, standards adopted pursuant to
14subdivision (a) shall be consistent with existing standards
15under the federal Health Insurance Portability and
16Accountability Act of 1996 and standards adopted under the
17Illinois Health Information Exchange and Technology Act.
18    (c) The rules requiring employers and insurers to accept
19electronic claims for payment of medical services shall be
20proposed on or before January 1, 2012, and shall require all
21employers and insurers to accept electronic claims for payment
22of medical services on or before June 30, 2012.
23    (d) The Director of Insurance shall by rule establish
24criteria for granting exceptions to employers, insurance
25carriers, and health care providers who are unable to submit or
26accept medical bills electronically.
 

 

 

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1    (820 ILCS 305/8.7)
2    Sec. 8.7. Utilization review programs.
3    (a) As used in this Section:
4    "Utilization review" means the evaluation of proposed or
5provided health care services to determine the appropriateness
6of both the level of health care services medically necessary
7and the quality of health care services provided to a patient,
8including evaluation of their efficiency, efficacy, and
9appropriateness of treatment, hospitalization, or office
10visits based on medically accepted standards. The evaluation
11must be accomplished by means of a system that identifies the
12utilization of health care services based on standards of care
13of or nationally recognized peer review guidelines as well as
14nationally recognized treatment guidelines and evidence-based
15medicine evidence based upon standards as provided in this Act.
16Utilization techniques may include prospective review, second
17opinions, concurrent review, discharge planning, peer review,
18independent medical examinations, and retrospective review
19(for purposes of this sentence, retrospective review shall be
20applicable to services rendered on or after July 20, 2005).
21Nothing in this Section applies to prospective review of
22necessary first aid or emergency treatment.
23    (b) No person may conduct a utilization review program for
24workers' compensation services in this State unless once every
252 years the person registers the utilization review program

 

 

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

 

 

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

 

 

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1the time the health care services were provided.
2    (f) If the Department of Insurance Financial and
3Professional Regulation finds that a utilization review
4program is not in compliance with this Section, the Department
5shall issue a corrective action plan and allow a reasonable
6amount of time for compliance with the plan. If the utilization
7review program does not come into compliance, the Department
8may issue a cease and desist order. Before issuing a cease and
9desist order under this Section, the Department shall provide
10the utilization review program with a written notice of the
11reasons for the order and allow a reasonable amount of time to
12supply additional information demonstrating compliance with
13the requirements of this Section and to request a hearing. The
14hearing notice shall be sent by certified mail, return receipt
15requested, and the hearing shall be conducted in accordance
16with the Illinois Administrative Procedure Act.
17    (g) A utilization review program subject to a corrective
18action may continue to conduct business until a final decision
19has been issued by the Department.
20    (h) The Department of Insurance Secretary of Financial and
21Professional Regulation may by rule establish a registration
22fee for each person conducting a utilization review program.
23    (i) Upon receipt of written notice that the employer or the
24employer's agent or insurer wishes to invoke the utilization
25review process, the provider of medical, surgical, or hospital
26services shall submit to the utilization review, following

 

 

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1accredited procedural guidelines.
2        (1) The provider shall make reasonable efforts to
3    provide timely and complete reports of clinical
4    information needed to support a request for treatment. If
5    the provider fails to make such reasonable efforts, the
6    charges for the treatment or service may not be compensable
7    nor collectible by the provider or claimant from the
8    employer, the employer's agent, or the employee. The
9    reporting obligations of providers shall not be
10    unreasonable or unduly burdensome.
11        (2) Written notice of utilization review decisions,
12    including the clinical rationale for certification or
13    non-certification and references to applicable standards
14    of care or evidence-based medical guidelines, shall be
15    furnished to the provider and employee.
16        (3) An employer may only deny payment of or refuse to
17    authorize payment of medical services rendered or proposed
18    to be rendered on the grounds that the extent and scope of
19    medical treatment is excessive and unnecessary in
20    compliance with an accredited utilization review program
21    under this Section.
22        (4) When a payment for medical services has been denied
23    or not authorized by an employer or when authorization for
24    medical services is denied pursuant to utilization review,
25    the employee has the burden of proof to show by a
26    preponderance of the evidence that a variance from the

 

 

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1    standards of care used by the person or entity performing
2    the utilization review pursuant to subsection (a) is
3    reasonably required to cure or relieve the effects of his
4    or her injury.
5        (5) The medical professional responsible for review in
6    the final stage of utilization review or appeal must be
7    available in this State for interview or deposition; or
8    must be available for deposition by telephone, video
9    conference, or other remote electronic means. A medical
10    professional who works or resides in this State or outside
11    of this State may comply with this requirement by making
12    himself or herself available for an interview or deposition
13    in person or by making himself or herself available by
14    telephone, video conference, or other remote electronic
15    means. The remote interview or deposition shall be
16    conducted in a fair, open, and cost-effective manner. The
17    expense of interview and the deposition method shall be
18    paid by the employer. The deponent shall be in the presence
19    of the officer administering the oath and recording the
20    deposition, unless otherwise agreed by the parties. Any
21    exhibits or other demonstrative evidence to be presented to
22    the deponent by any party at the deposition shall be
23    provided to the officer administering the oath and all
24    other parties within a reasonable period of time prior to
25    the deposition. Nothing shall prohibit any party from being
26    with the deponent during the deposition, at that party's

 

 

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1    expense; provided, however, that a party attending a
2    deposition shall give written notice of that party's
3    intention to appear at the deposition to all other parties
4    within a reasonable time prior to the deposition.
5    An admissible A utilization review shall will be considered
6by the Commission, along with all other evidence and in the
7same manner as all other evidence, and must be addressed along
8with all other evidence in the determination of the
9reasonableness and necessity of the medical bills or treatment.
10Nothing in this Section shall be construed to diminish the
11rights of employees to reasonable and necessary medical
12treatment or employee choice of health care provider under
13Section 8(a) or the rights of employers to medical examinations
14under Section 12.
15    (j) When an employer denies payment of or refuses to
16authorize payment of first aid, medical, surgical, or hospital
17services under Section 8(a) of this Act, if that denial or
18refusal to authorize complies with a utilization review program
19registered under this Section and complies with all other
20requirements of this Section, then there shall be a rebuttable
21presumption that the employer shall not be responsible for
22payment of additional compensation pursuant to Section 19(k) of
23this Act and if that denial or refusal to authorize does not
24comply with a utilization review program registered under this
25Section and does not comply with all other requirements of this
26Section, then that will be considered by the Commission, along

 

 

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1with all other evidence and in the same manner as all other
2evidence, in the determination of whether the employer may be
3responsible for the payment of additional compensation
4pursuant to Section 19(k) of this Act.
5    The changes to this Section made by this amendatory Act of
6the 97th General Assembly apply only to health care services
7provided or proposed to be provided on or after September 1,
82011.
9(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
10    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)
11    Sec. 11. The compensation herein provided, together with
12the provisions of this Act, shall be the measure of the
13responsibility of any employer engaged in any of the
14enterprises or businesses enumerated in Section 3 of this Act,
15or of any employer who is not engaged in any such enterprises
16or businesses, but who has elected to provide and pay
17compensation for accidental injuries sustained by any employee
18arising out of and in the course of the employment according to
19the provisions of this Act, and whose election to continue
20under this Act, has not been nullified by any action of his
21employees as provided for in this Act.
22    Accidental injuries incurred while participating in
23voluntary recreational programs including but not limited to
24athletic events, parties and picnics do not arise out of and in
25the course of the employment even though the employer pays some

 

 

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1or all of the cost thereof. This exclusion shall not apply in
2the event that the injured employee was ordered or assigned by
3his employer to participate in the program.
4    Accidental injuries incurred while participating as a
5patient in a drug or alcohol rehabilitation program do not
6arise out of and in the course of employment even though the
7employer pays some or all of the costs thereof.
8    Any injury to or disease or death of an employee arising
9from the administration of a vaccine, including without
10limitation smallpox vaccine, to prepare for, or as a response
11to, a threatened or potential bioterrorist incident to the
12employee as part of a voluntary inoculation program in
13connection with the person's employment or in connection with
14any governmental program or recommendation for the inoculation
15of workers in the employee's occupation, geographical area, or
16other category that includes the employee is deemed to arise
17out of and in the course of the employment for all purposes
18under this Act. This paragraph added by this amendatory Act of
19the 93rd General Assembly is declarative of existing law and is
20not a new enactment.
21    No compensation shall be payable if (i) the employee's
22intoxication is the proximate cause of the employee's
23accidental injury or (ii) at the time the employee incurred the
24accidental injury, the employee was so intoxicated that the
25intoxication constituted a departure from the employment.
26Admissible evidence of the concentration of (1) alcohol, (2)

 

 

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1cannabis as defined in the Cannabis Control Act, (3) a
2controlled substance listed in the Illinois Controlled
3Substances Act, or (4) an intoxicating compound listed in the
4Use of Intoxicating Compounds Act in the employee's blood,
5breath, or urine at the time the employee incurred the
6accidental injury shall be considered in any hearing under this
7Act to determine whether the employee was intoxicated at the
8time the employee incurred the accidental injuries. If at the
9time of the accidental injuries, there was 0.08% or more by
10weight of alcohol in the employee's blood, breath, or urine or
11if there is any evidence of impairment due to the unlawful or
12unauthorized use of (1) cannabis as defined in the Cannabis
13Control Act, (2) a controlled substance listed in the Illinois
14Controlled Substances Act, or (3) an intoxicating compound
15listed in the Use of Intoxicating Compounds Act or if the
16employee refuses to submit to testing of blood, breath, or
17urine, then there shall be a rebuttable presumption that the
18employee was intoxicated and that the intoxication was the
19proximate cause of the employee's injury. The employee may
20overcome the rebuttable presumption by the preponderance of the
21admissible evidence that the intoxication was not the sole
22proximate cause or proximate cause of the accidental injuries.
23Percentage by weight of alcohol in the blood shall be based on
24grams of alcohol per 100 milliliters of blood. Percentage by
25weight of alcohol in the breath shall be based upon grams of
26alcohol per 210 liters of breath. Any testing that has not been

 

 

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1performed by an accredited or certified testing laboratory
2shall not be admissible in any hearing under this Act to
3determine whether the employee was intoxicated at the time the
4employee incurred the accidental injury.
5    All sample collection and testing for alcohol and drugs
6under this Section shall be performed in accordance with rules
7to be adopted by the Commission. These rules shall ensure:
8        (1) compliance with the National Labor Relations Act
9    regarding collective bargaining agreements or regulations
10    promulgated by the United States Department of
11    Transportation;
12        (2) that samples are collected and tested in
13    conformance with national and State legal and regulatory
14    standards for the privacy of the individual being tested,
15    and in a manner reasonably calculated to prevent
16    substitutions or interference with the collection or
17    testing of reliable sample;
18        (3) that split testing procedures are utilized;
19        (4) that sample collection is documented, and the
20    documentation procedures include:
21            (A) the labeling of samples in a manner so as to
22        reasonably preclude the probability of erroneous
23        identification of test result; and
24            (B) an opportunity for the employee to provide
25        notification of any information which he or she
26        considers relevant to the test, including

 

 

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1        identification of currently or recently used
2        prescription or nonprescription drugs and other
3        relevant medical information;
4        (5) that sample collection, storage, and
5    transportation to the place of testing is performed in a
6    manner so as to reasonably preclude the probability of
7    sample contamination or adulteration; and
8        (6) that chemical analyses of blood, urine, breath, or
9    other bodily substance are performed according to
10    nationally scientifically accepted analytical methods and
11    procedures.
12    The changes to this Section made by this amendatory Act of
13the 97th General Assembly apply only to accidental injuries
14that occur on or after September 1, 2011.
15(Source: P.A. 93-829, eff. 7-28-04.)
 
16    (820 ILCS 305/13)  (from Ch. 48, par. 138.13)
17    Sec. 13. There is created an Illinois Workers' Compensation
18Commission consisting of 10 members to be appointed by the
19Governor, by and with the consent of the Senate, 3 of whom
20shall be representative citizens of the employing class
21operating under this Act and 3 of whom shall be representative
22citizens of the class of employees covered under this Act, and
234 of whom shall be representative citizens not identified with
24either the employing or employee classes. Not more than 6
25members of the Commission shall be of the same political party.

 

 

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1    One of the members not identified with either the employing
2or employee classes shall be designated by the Governor as
3Chairman. The Chairman shall be the chief administrative and
4executive officer of the Commission; and he or she shall have
5general supervisory authority over all personnel of the
6Commission, including arbitrators and Commissioners, and the
7final authority in all administrative matters relating to the
8Commissioners, including but not limited to the assignment and
9distribution of cases and assignment of Commissioners to the
10panels, except in the promulgation of procedural rules and
11orders under Section 16 and in the determination of cases under
12this Act.
13    Notwithstanding the general supervisory authority of the
14Chairman, each Commissioner, except those assigned to the
15temporary panel, shall have the authority to hire and supervise
162 staff attorneys each. Such staff attorneys shall report
17directly to the individual Commissioner.
18    A formal training program for newly-appointed
19Commissioners shall be implemented. The training program shall
20include the following:
21        (a) substantive and procedural aspects of the office of
22    Commissioner;
23        (b) current issues in workers' compensation law and
24    practice;
25        (c) medical lectures by specialists in areas such as
26    orthopedics, ophthalmology, psychiatry, rehabilitation

 

 

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1    counseling;
2        (d) orientation to each operational unit of the
3    Illinois Workers' Compensation Commission;
4        (e) observation of experienced arbitrators and
5    Commissioners conducting hearings of cases, combined with
6    the opportunity to discuss evidence presented and rulings
7    made;
8        (f) the use of hypothetical cases requiring the
9    newly-appointed Commissioner to issue judgments as a means
10    to evaluating knowledge and writing ability;
11        (g) writing skills; .
12        (h) professional and ethical standards pursuant to
13    Section 1.1 of this Act;
14        (i) detection of workers' compensation fraud and
15    reporting obligations of Commission employees and
16    appointees;
17        (j) standards of evidence-based medical treatment and
18    best practices for measuring and improving quality and
19    health care outcomes in the workers' compensation system,
20    including but not limited to the use of the American
21    Medical Association's "Guides to the Evaluation of
22    Permanent Impairment" and the practice of utilization
23    review; and
24        (k) substantive and procedural aspects of coal
25    workers' pneumoconiosis (black lung) cases.
26    A formal and ongoing professional development program

 

 

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1including, but not limited to, the above-noted areas shall be
2implemented to keep Commissioners informed of recent
3developments and issues and to assist them in maintaining and
4enhancing their professional competence. Each Commissioner
5shall complete 20 hours of training in the above-noted areas
6during every 2 years such Commissioner shall remain in office.
7    The Commissioner candidates, other than the Chairman, must
8meet one of the following qualifications: (a) licensed to
9practice law in the State of Illinois; or (b) served as an
10arbitrator at the Illinois Workers' Compensation Commission
11for at least 3 years; or (c) has at least 4 years of
12professional labor relations experience. The Chairman
13candidate must have public or private sector management and
14budget experience, as determined by the Governor.
15    Each Commissioner shall devote full time to his duties and
16any Commissioner who is an attorney-at-law shall not engage in
17the practice of law, nor shall any Commissioner hold any other
18office or position of profit under the United States or this
19State or any municipal corporation or political subdivision of
20this State, nor engage in any other business, employment, or
21vocation.
22    The term of office of each member of the Commission holding
23office on the effective date of this amendatory Act of 1989 is
24abolished, but the incumbents shall continue to exercise all of
25the powers and be subject to all of the duties of Commissioners
26until their respective successors are appointed and qualified.

 

 

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1    The Illinois Workers' Compensation Commission shall
2administer this Act.
3    In the promulgation of procedural rules, the determination
4of cases heard en banc, and other matters determined by the
5full Commission, the Chairman's vote shall break a tie in the
6event of a tie vote.
7    The members shall be appointed by the Governor, with the
8advice and consent of the Senate, as follows:
9        (a) After the effective date of this amendatory Act of
10    1989, 3 members, at least one of each political party, and
11    one of whom shall be a representative citizen of the
12    employing class operating under this Act, one of whom shall
13    be a representative citizen of the class of employees
14    covered under this Act, and one of whom shall be a
15    representative citizen not identified with either the
16    employing or employee classes, shall be appointed to hold
17    office until the third Monday in January of 1993, and until
18    their successors are appointed and qualified, and 4
19    members, one of whom shall be a representative citizen of
20    the employing class operating under this Act, one of whom
21    shall be a representative citizen of the class of employees
22    covered in this Act, and two of whom shall be
23    representative citizens not identified with either the
24    employing or employee classes, one of whom shall be
25    designated by the Governor as Chairman (at least one of
26    each of the two major political parties) shall be appointed

 

 

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1    to hold office until the third Monday of January in 1991,
2    and until their successors are appointed and qualified.
3        (a-5) Notwithstanding any other provision of this
4    Section, the term of each member of the Commission who was
5    appointed by the Governor and is in office on June 30, 2003
6    shall terminate at the close of business on that date or
7    when all of the successor members to be appointed pursuant
8    to this amendatory Act of the 93rd General Assembly have
9    been appointed by the Governor, whichever occurs later. As
10    soon as possible, the Governor shall appoint persons to
11    fill the vacancies created by this amendatory Act. Of the
12    initial commissioners appointed pursuant to this
13    amendatory Act of the 93rd General Assembly, 3 shall be
14    appointed for terms ending on the third Monday in January,
15    2005, and 4 shall be appointed for terms ending on the
16    third Monday in January, 2007.
17        (a-10) After the effective date of this amendatory Act
18    of the 94th General Assembly, the Commission shall be
19    increased to 10 members. As soon as possible after the
20    effective date of this amendatory Act of the 94th General
21    Assembly, the Governor shall appoint, by and with the
22    consent of the Senate, the 3 members added to the
23    Commission under this amendatory Act of the 94th General
24    Assembly, one of whom shall be a representative citizen of
25    the employing class operating under this Act, one of whom
26    shall be a representative of the class of employees covered

 

 

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1    under this Act, and one of whom shall be a representative
2    citizen not identified with either the employing or
3    employee classes. Of the members appointed under this
4    amendatory Act of the 94th General Assembly, one shall be
5    appointed for a term ending on the third Monday in January,
6    2007, and 2 shall be appointed for terms ending on the
7    third Monday in January, 2009, and until their successors
8    are appointed and qualified.
9        (b) Members shall thereafter be appointed to hold
10    office for terms of 4 years from the third Monday in
11    January of the year of their appointment, and until their
12    successors are appointed and qualified. All such
13    appointments shall be made so that the composition of the
14    Commission is in accordance with the provisions of the
15    first paragraph of this Section.
16    The Chairman shall receive an annual salary of $42,500, or
17a salary set by the Compensation Review Board, whichever is
18greater, and each other member shall receive an annual salary
19of $38,000, or a salary set by the Compensation Review Board,
20whichever is greater.
21    In case of a vacancy in the office of a Commissioner during
22the recess of the Senate, the Governor shall make a temporary
23appointment until the next meeting of the Senate, when he shall
24nominate some person to fill such office. Any person so
25nominated who is confirmed by the Senate shall hold office
26during the remainder of the term and until his successor is

 

 

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1appointed and qualified.
2    The Illinois Workers' Compensation Commission created by
3this amendatory Act of 1989 shall succeed to all the rights,
4powers, duties, obligations, records and other property and
5employees of the Industrial Commission which it replaces as
6modified by this amendatory Act of 1989 and all applications
7and reports to actions and proceedings of such prior Industrial
8Commission shall be considered as applications and reports to
9actions and proceedings of the Illinois Workers' Compensation
10Commission created by this amendatory Act of 1989.
11    Notwithstanding any other provision of this Act, in the
12event the Chairman shall make a finding that a member is or
13will be unavailable to fulfill the responsibilities of his or
14her office, the Chairman shall advise the Governor and the
15member in writing and shall designate a certified arbitrator to
16serve as acting Commissioner. The certified arbitrator shall
17act as a Commissioner until the member resumes the duties of
18his or her office or until a new member is appointed by the
19Governor, by and with the consent of the Senate, if a vacancy
20occurs in the office of the Commissioner, but in no event shall
21a certified arbitrator serve in the capacity of Commissioner
22for more than 6 months from the date of appointment by the
23Chairman. A finding by the Chairman that a member is or will be
24unavailable to fulfill the responsibilities of his or her
25office shall be based upon notice to the Chairman by a member
26that he or she will be unavailable or facts and circumstances

 

 

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1made known to the Chairman which lead him to reasonably find
2that a member is unavailable to fulfill the responsibilities of
3his or her office. The designation of a certified arbitrator to
4act as a Commissioner shall be considered representative of
5citizens not identified with either the employing or employee
6classes and the arbitrator shall serve regardless of his or her
7political affiliation. A certified arbitrator who serves as an
8acting Commissioner shall have all the rights and powers of a
9Commissioner, including salary.
10    Notwithstanding any other provision of this Act, the
11Governor shall appoint a special panel of Commissioners
12comprised of 3 members who shall be chosen by the Governor, by
13and with the consent of the Senate, from among the current
14ranks of certified arbitrators. Three members shall hold office
15until the Commission in consultation with the Governor
16determines that the caseload on review has been reduced
17sufficiently to allow cases to proceed in a timely manner or
18for a term of 18 months from the effective date of their
19appointment by the Governor, whichever shall be earlier. The 3
20members shall be considered representative of citizens not
21identified with either the employing or employee classes and
22shall serve regardless of political affiliation. Each of the 3
23members shall have only such rights and powers of a
24Commissioner necessary to dispose of those cases assigned to
25the special panel. Each of the 3 members appointed to the
26special panel shall receive the same salary as other

 

 

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1Commissioners for the duration of the panel.
2    The Commission may have an Executive Director; if so, the
3Executive Director shall be appointed by the Governor with the
4advice and consent of the Senate. The salary and duties of the
5Executive Director shall be fixed by the Commission.
6    On the effective date of this amendatory Act of the 93rd
7General Assembly, the name of the Industrial Commission is
8changed to the Illinois Workers' Compensation Commission.
9References in any law, appropriation, rule, form, or other
10document: (i) to the Industrial Commission are deemed, in
11appropriate contexts, to be references to the Illinois Workers'
12Compensation Commission for all purposes; (ii) to the
13Industrial Commission Operations Fund are deemed, in
14appropriate contexts, to be references to the Illinois Workers'
15Compensation Commission Operations Fund for all purposes;
16(iii) to the Industrial Commission Operations Fund Fee are
17deemed, in appropriate contexts, to be references to the
18Illinois Workers' Compensation Commission Operations Fund Fee
19for all purposes; and (iv) to the Industrial Commission
20Operations Fund Surcharge are deemed, in appropriate contexts,
21to be references to the Illinois Workers' Compensation
22Commission Operations Fund Surcharge for all purposes.
23(Source: P.A. 93-509, eff. 8-11-03; 93-721, eff. 1-1-05;
2494-277, eff. 7-20-05.)
 
25    (820 ILCS 305/13.1)  (from Ch. 48, par. 138.13-1)

 

 

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1    Sec. 13.1. (a) There is created a Workers' Compensation
2Advisory Board hereinafter referred to as the Advisory Board.
3After the effective date of this amendatory Act of the 94th
4General Assembly, the Advisory Board shall consist of 12
5members appointed by the Governor with the advice and consent
6of the Senate. Six members of the Advisory Board shall be
7representative citizens chosen from the employee class, and 6
8members shall be representative citizens chosen from the
9employing class. The Chairman of the Commission shall serve as
10the ex officio Chairman of the Advisory Board. After the
11effective date of this amendatory Act of the 94th General
12Assembly, each member of the Advisory Board shall serve a term
13ending on the third Monday in January 2007 and shall continue
14to serve until his or her successor is appointed and qualified.
15Members of the Advisory Board shall thereafter be appointed for
164 year terms from the third Monday in January of the year of
17their appointment, and until their successors are appointed and
18qualified. Seven members of the Advisory Board shall constitute
19a quorum to do business, but in no case shall there be less
20than one representative from each class. A vacancy on the
21Advisory Board shall be filled by the Governor for the
22unexpired term.
23    (b) Members of the Advisory Board shall receive no
24compensation for their services but shall be reimbursed for
25expenses incurred in the performance of their duties by the
26Commission from appropriations made to the Commission for such

 

 

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1purpose.
2    (c) The Advisory Board shall aid the Commission in
3formulating policies, discussing problems, setting priorities
4of expenditures, reviewing advisory rates filed by an advisory
5organization as defined in Section 463 of the Illinois
6Insurance Code, and establishing short and long range
7administrative goals. Prior to making the (1) initial set of
8arbitrator appointments pursuant to this amendatory Act of the
997th General Assembly and (2) appointment of Commissioners,
10appointments to the Commission, the Governor shall request that
11the Advisory Board make recommendations as to candidates to
12consider for appointment and the Advisory Board may then make
13such recommendations.
14    (d) The terms of all Advisory Board members serving on the
15effective date of this amendatory Act of the 97th General
16Assembly are terminated. The Governor shall appoint new members
17to the Advisory Board within 30 days after the effective date
18of the amendatory Act of the 97th General Assembly, subject to
19the advice and consent of the Senate.
20(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
21    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
22    Sec. 14. The Commission shall appoint a secretary, an
23assistant secretary, and arbitrators and shall employ such
24assistants and clerical help as may be necessary. Arbitrators
25shall be appointed pursuant to this Section, notwithstanding

 

 

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

 

 

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1        (h) professional and ethical standards pursuant to
2    Section 1.1 of this Act;
3        (i) detection of workers' compensation fraud and
4    reporting obligations of Commission employees and
5    appointees;
6        (j) standards of evidence-based medical treatment and
7    best practices for measuring and improving quality and
8    health care outcomes in the workers' compensation system,
9    including but not limited to the use of the American
10    Medical Association's "Guides to the Evaluation of
11    Permanent Impairment" and the practice of utilization
12    review; and
13        (k) substantive and procedural aspects of coal
14    workers' pneumoconiosis (black lung) cases.
15    A formal and ongoing professional development program
16including, but not limited to, the above-noted areas shall be
17implemented to keep arbitrators informed of recent
18developments and issues and to assist them in maintaining and
19enhancing their professional competence. Each arbitrator shall
20complete 20 hours of training in the above-noted areas during
21every 2 years such arbitrator shall remain in office.
22    Each arbitrator shall devote full time to his or her duties
23and shall serve when assigned as an acting Commissioner when a
24Commissioner is unavailable in accordance with the provisions
25of Section 13 of this Act. Any arbitrator who is an
26attorney-at-law shall not engage in the practice of law, nor

 

 

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1shall any arbitrator hold any other office or position of
2profit under the United States or this State or any municipal
3corporation or political subdivision of this State.
4Notwithstanding any other provision of this Act to the
5contrary, an arbitrator who serves as an acting Commissioner in
6accordance with the provisions of Section 13 of this Act shall
7continue to serve in the capacity of Commissioner until a
8decision is reached in every case heard by that arbitrator
9while serving as an acting Commissioner.
10    Notwithstanding any other provision of this Section, the
11term of all arbitrators serving on the effective date of this
12amendatory Act of the 97th General Assembly, including any
13arbitrators on administrative leave, shall terminate at the
14close of business on July 1, 2011, but the incumbents shall
15continue to exercise all of their duties until they are
16reappointed or their successors are appointed.
17    On and after the effective date of this amendatory Act of
18the 97th General Assembly, arbitrators shall be appointed to
193-year terms by the full Commission, except that initial
20appointments made on and after the effective date of this
21amendatory Act of the 97th General Assembly shall be made as
22follows:
23        (1) All appointments shall be made by the Governor with
24    the advice and consent of the Senate.
25        (2) 12 arbitrators shall be appointed to terms expiring
26    July 1, 2012; 12 arbitrators shall be appointed to terms

 

 

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1    expiring July 1, 2013; and all additional arbitrators shall
2    be appointed to terms expiring July 1, 2014.
3    Upon the expiration of a term, the Chairman shall evaluate
4the performance of the arbitrator and may recommend that he or
5she be reappointed to a second or subsequent term by the full
6Commission.
7    Each arbitrator appointed on or after the effective date of
8this amendatory Act of the 97th General Assembly and who has
9not previously served as an arbitrator for the Commission shall
10be required to be authorized to practice law in this State by
11the Supreme Court, and to maintain this authorization
12throughout his or her term of employment.
13    Each arbitrator appointed after the effective date of this
14amendatory Act of 1989 shall be appointed for a term of 6
15years. Each arbitrator shall be appointed for a subsequent term
16unless the Chairman makes a recommendation to the Commission,
17no later than 60 days prior to the expiration of the term, not
18to reappoint the arbitrator. Notice of such a recommendation
19shall also be given to the arbitrator no later than 60 days
20prior to the expiration of the term. Upon such recommendation
21by the Chairman, the arbitrator shall be appointed for a
22subsequent term unless 8 of 10 members of the Commission,
23including the Chairman, vote not to reappoint the arbitrator.
24    All arbitrators shall be subject to the provisions of the
25Personnel Code, and the performance of all arbitrators shall be
26reviewed by the Chairman on an annual basis. The changes made

 

 

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1to this Section by this amendatory Act of the 97th General
2Assembly shall prevail over any conflict with the Personnel
3Code. The Chairman shall allow input from the Commissioners in
4all such reviews.
5    The Commission shall assign no fewer than 3 arbitrators to
6each hearing site. The Commission shall establish a procedure
7to ensure that the arbitrators assigned to each hearing site
8are assigned cases on a random basis. No arbitrator shall hear
9cases in any county, other than Cook County, for more than 2
10years in each 3-year term.
11    The Secretary and each arbitrator shall receive a per annum
12salary of $4,000 less than the per annum salary of members of
13The Illinois Workers' Compensation Commission as provided in
14Section 13 of this Act, payable in equal monthly installments.
15    The members of the Commission, Arbitrators and other
16employees whose duties require them to travel, shall have
17reimbursed to them their actual traveling expenses and
18disbursements made or incurred by them in the discharge of
19their official duties while away from their place of residence
20in the performance of their duties.
21    The Commission shall provide itself with a seal for the
22authentication of its orders, awards and proceedings upon which
23shall be inscribed the name of the Commission and the words
24"Illinois--Seal".
25    The Secretary or Assistant Secretary, under the direction
26of the Commission, shall have charge and custody of the seal of

 

 

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1the Commission and also have charge and custody of all records,
2files, orders, proceedings, decisions, awards and other
3documents on file with the Commission. He shall furnish
4certified copies, under the seal of the Commission, of any such
5records, files, orders, proceedings, decisions, awards and
6other documents on file with the Commission as may be required.
7Certified copies so furnished by the Secretary or Assistant
8Secretary shall be received in evidence before the Commission
9or any Arbitrator thereof, and in all courts, provided that the
10original of such certified copy is otherwise competent and
11admissible in evidence. The Secretary or Assistant Secretary
12shall perform such other duties as may be prescribed from time
13to time by the Commission.
14(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
 
15    (820 ILCS 305/16b new)
16    Sec. 16b. Gift ban.
17    (a) An attorney appearing before the Commission shall not
18provide compensation or any gift to any person in exchange for
19the referral of a client involving a matter to be heard before
20the Commission except for a division of a fee between lawyers
21who are not in the same firm in accordance with Rule 1.5 of the
22Code of Professional Responsibility. For purposes of this
23Section, "gift" means any gratuity, discount, entertainment,
24hospitality, loan, forbearance, or any other tangible or
25intangible item having monetary value including, but not

 

 

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1limited to, cash, food and drink, and honoraria except for food
2or refreshments not exceeding $75 per person in value on a
3single calendar day, provided that the food or refreshments are
4(1) consumed on the premises from which they were purchased or
5prepared or (2) catered. "Catered" means food or refreshments
6that are purchased ready to eat and delivered by any means.
7    (b) Violation of this Section is a Class A misdemeanor.
 
8    (820 ILCS 305/18)  (from Ch. 48, par. 138.18)
9    Sec. 18. All questions arising under this Act, if not
10settled by agreement of the parties interested therein, shall,
11except as otherwise provided, be determined by the Commission.
12Claims from current and former employees of the Commission
13shall be determined in accordance with Section 18.1 of this
14Act.
15(Source: Laws 1951, p. 1060.)
 
16    (820 ILCS 305/18.1 new)
17    Sec. 18.1. Claims by former and current employees of the
18Commission. All claims by current and former employees and
19appointees of the Commission shall be assigned to a certified
20independent arbitrator not employed by the Commission
21designated by the Chairman. The Chairman shall designate an
22arbitrator from a list of approved certified arbitrators
23provided by the Commission Review Board. If the Chairman is the
24claimant, then the independent arbitrator from the approved

 

 

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1list shall be designated by the longest serving Commissioner.
2The designated independent arbitrator shall have the authority
3of arbitrators of the Commission regarding settlement and
4adjudication of the claim of the current and former employees
5and appointees of the Commission. The decision of the
6independent arbitrator shall become the decision of the
7Commission. An appeal of the independent arbitrator's decision
8shall be subject to judicial review in accordance with
9subsection (f) of Section 19.
 
10    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
11    Sec. 19. Any disputed questions of law or fact shall be
12determined as herein provided.
13    (a) It shall be the duty of the Commission upon
14notification that the parties have failed to reach an
15agreement, to designate an Arbitrator.
16        1. Whenever any claimant misconceives his remedy and
17    files an application for adjustment of claim under this Act
18    and it is subsequently discovered, at any time before final
19    disposition of such cause, that the claim for disability or
20    death which was the basis for such application should
21    properly have been made under the Workers' Occupational
22    Diseases Act, then the provisions of Section 19, paragraph
23    (a-1) of the Workers' Occupational Diseases Act having
24    reference to such application shall apply.
25        2. Whenever any claimant misconceives his remedy and

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1compensation or services as provided therein. Such petition
2shall have priority over all other petitions and shall be heard
3by the Arbitrator and Commission with all convenient speed.
4    Such petition shall contain the following information and
5shall be served on the employer at least 15 days before it is
6filed:
7        (i) the date and approximate time of accident;
8        (ii) the approximate location of the accident;
9        (iii) a description of the accident;
10        (iv) the nature of the injury incurred by the employee;
11        (v) the identity of the person, if known, to whom the
12    accident was reported and the date on which it was
13    reported;
14        (vi) the name and title of the person, if known,
15    representing the employer with whom the employee conferred
16    in any effort to obtain compensation pursuant to paragraph
17    (b) of Section 8 of this Act or medical, surgical or
18    hospital services pursuant to paragraph (a) of Section 8 of
19    this Act and the date of such conference;
20        (vii) a statement that the employer has refused to pay
21    compensation pursuant to paragraph (b) of Section 8 of this
22    Act or for medical, surgical or hospital services pursuant
23    to paragraph (a) of Section 8 of this Act;
24        (viii) the name and address, if known, of each witness
25    to the accident and of each other person upon whom the
26    employee will rely to support his allegations;

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1due under this Act. The Commission shall file in its office its
2decision thereon, and shall immediately send to each party or
3his attorney a copy of such decision and a notification of the
4time when it was filed. Decisions shall be filed within 60 days
5after the Statement of Exceptions and Supporting Brief and
6Response thereto are required to be filed or oral argument
7whichever is later.
8    In the event either party requests oral argument, such
9argument shall be had before a panel of 3 members of the
10Commission (or before all available members pursuant to the
11determination of 7 members of the Commission that such argument
12be held before all available members of the Commission)
13pursuant to the rules and regulations of the Commission. A
14panel of 3 members, which shall be comprised of not more than
15one representative citizen of the employing class and not more
16than one representative citizen of the employee class, shall
17hear the argument; provided that if all the issues in dispute
18are solely the nature and extent of the permanent partial
19disability, if any, a majority of the panel may deny the
20request for such argument and such argument shall not be held;
21and provided further that 7 members of the Commission may
22determine that the argument be held before all available
23members of the Commission. A decision of the Commission shall
24be approved by a majority of Commissioners present at such
25hearing if any; provided, if no such hearing is held, a
26decision of the Commission shall be approved by a majority of a

 

 

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1panel of 3 members of the Commission as described in this
2Section. The Commission shall give 10 days' notice to the
3parties or their attorneys of the time and place of such taking
4of testimony and of such argument.
5    In any case the Commission in its decision may find
6specially upon any question or questions of law or fact which
7shall be submitted in writing by either party whether ultimate
8or otherwise; provided that on issues other than nature and
9extent of the disability, if any, the Commission in its
10decision shall find specially upon any question or questions of
11law or fact, whether ultimate or otherwise, which are submitted
12in writing by either party; provided further that not more than
135 such questions may be submitted by either party. Any party
14may, within 20 days after receipt of notice of the Commission's
15decision, or within such further time, not exceeding 30 days,
16as the Commission may grant, file with the Commission either an
17agreed statement of the facts appearing upon the hearing, or,
18if such party shall so elect, a correct transcript of evidence
19of the additional proceedings presented before the Commission,
20in which report the party may embody a correct statement of
21such other proceedings in the case as such party may desire to
22have reviewed, such statement of facts or transcript of
23evidence to be authenticated by the signature of the parties or
24their attorneys, and in the event that they do not agree, then
25the authentication of such transcript of evidence shall be by
26the signature of any member of the Commission.

 

 

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

 

 

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1a majority of a panel, after deliberation, has arrived at its
2decision, the decision shall be filed as provided in this
3Section without unnecessary delay, and without regard to the
4fact that a member of the panel has expressed an intention to
5dissent. Any member of the panel may file a dissent. Any
6dissent shall be filed no later than 10 days after the decision
7of the majority has been filed.
8    Decisions rendered by the Commission and dissents, if any,
9shall be published together by the Commission. The conclusions
10of law set out in such decisions shall be regarded as
11precedents by arbitrators for the purpose of achieving a more
12uniform administration of this Act.
13    (f) The decision of the Commission acting within its
14powers, according to the provisions of paragraph (e) of this
15Section shall, in the absence of fraud, be conclusive unless
16reviewed as in this paragraph hereinafter provided. However,
17the Arbitrator or the Commission may on his or its own motion,
18or on the motion of either party, correct any clerical error or
19errors in computation within 15 days after the date of receipt
20of any award by such Arbitrator or any decision on review of
21the Commission and shall have the power to recall the original
22award on arbitration or decision on review, and issue in lieu
23thereof such corrected award or decision. Where such correction
24is made the time for review herein specified shall begin to run
25from the date of the receipt of the corrected award or
26decision.

 

 

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

 

 

HB1698 Enrolled- 155 -LRB097 07917 AJO 48032 b

1    known place of residence of other parties in interest or
2    their attorney or attorneys of record. The clerk of the
3    court issuing the summons shall on the day of issue mail
4    notice of the commencement of the proceedings which shall
5    be done by mailing a copy of the summons to the office of
6    the Commission, and a copy of the summons to the other
7    parties in interest or their attorney or attorneys of
8    record and the clerk of the court shall make certificate
9    that he has so sent said notices in pursuance of this
10    Section, which shall be evidence of service on the
11    Commission and other parties in interest.
12        The Commission shall not be required to certify the
13    record of their proceedings to the Circuit Court, unless
14    the party commencing the proceedings for review in the
15    Circuit Court as above provided, shall pay to the
16    Commission the sum of 80 per page of testimony taken
17    before the Commission, and 35 per page of all other
18    matters contained in such record, except as otherwise
19    provided by Section 20 of this Act. Payment for photostatic
20    copies of exhibit shall be extra. It shall be the duty of
21    the Commission upon such payment, or failure to pay as
22    permitted under Section 20 of this Act, to prepare a true
23    and correct typewritten copy of such testimony and a true
24    and correct copy of all other matters contained in such
25    record and certified to by the Secretary or Assistant
26    Secretary thereof.

 

 

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1        In its decision on review the Commission shall
2    determine in each particular case the amount of the
3    probable cost of the record to be filed as a part of the
4    summons in that case and no request for a summons may be
5    filed and no summons shall issue unless the party seeking
6    to review the decision of the Commission shall exhibit to
7    the clerk of the Circuit Court proof of payment by filing a
8    receipt showing payment or an affidavit of the attorney
9    setting forth that payment has been made of the sums so
10    determined to the Secretary or Assistant Secretary of the
11    Commission, except as otherwise provided by Section 20 of
12    this Act.
13        (2) No such summons shall issue unless the one against
14    whom the Commission shall have rendered an award for the
15    payment of money shall upon the filing of his written
16    request for such summons file with the clerk of the court a
17    bond conditioned that if he shall not successfully
18    prosecute the review, he will pay the award and the costs
19    of the proceedings in the courts. The amount of the bond
20    shall be fixed by any member of the Commission and the
21    surety or sureties of the bond shall be approved by the
22    clerk of the court. The acceptance of the bond by the clerk
23    of the court shall constitute evidence of his approval of
24    the bond.
25        Every county, city, town, township, incorporated
26    village, school district, body politic or municipal

 

 

HB1698 Enrolled- 157 -LRB097 07917 AJO 48032 b

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

 

 

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

 

 

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1agent upon whom notices may be served, immediately send a copy
2of the notice to the employer or such designated agent.
3    (h) An agreement or award under this Act providing for
4compensation in installments, may at any time within 18 months
5after such agreement or award be reviewed by the Commission at
6the request of either the employer or the employee, on the
7ground that the disability of the employee has subsequently
8recurred, increased, diminished or ended.
9    However, as to accidents occurring subsequent to July 1,
101955, which are covered by any agreement or award under this
11Act providing for compensation in installments made as a result
12of such accident, such agreement or award may at any time
13within 30 months, or 60 months in the case of an award under
14Section 8(d)1, after such agreement or award be reviewed by the
15Commission at the request of either the employer or the
16employee on the ground that the disability of the employee has
17subsequently recurred, increased, diminished or ended.
18    On such review, compensation payments may be
19re-established, increased, diminished or ended. The Commission
20shall give 15 days' notice to the parties of the hearing for
21review. Any employee, upon any petition for such review being
22filed by the employer, shall be entitled to one day's notice
23for each 100 miles necessary to be traveled by him in attending
24the hearing of the Commission upon the petition, and 3 days in
25addition thereto. Such employee shall, at the discretion of the
26Commission, also be entitled to 5 cents per mile necessarily

 

 

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

 

 

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1proceedings and such final decision, if any, shall be taken as
2final adjudication of any of the issues which are the same in
3both proceedings.
4    (k) In case where there has been any unreasonable or
5vexatious delay of payment or intentional underpayment of
6compensation, or proceedings have been instituted or carried on
7by the one liable to pay the compensation, which do not present
8a real controversy, but are merely frivolous or for delay, then
9the Commission may award compensation additional to that
10otherwise payable under this Act equal to 50% of the amount
11payable at the time of such award. Failure to pay compensation
12in accordance with the provisions of Section 8, paragraph (b)
13of this Act, shall be considered unreasonable delay.
14    When determining whether this subsection (k) shall apply,
15the Commission shall consider whether an Arbitrator has
16determined that the claim is not compensable or whether the
17employer has made payments under Section 8(j).
18    (l) If the employee has made written demand for payment of
19benefits under Section 8(a) or Section 8(b), the employer shall
20have 14 days after receipt of the demand to set forth in
21writing the reason for the delay. In the case of demand for
22payment of medical benefits under Section 8(a), the time for
23the employer to respond shall not commence until the expiration
24of the allotted 30 60 days specified under Section 8.2(d). In
25case the employer or his or her insurance carrier shall without
26good and just cause fail, neglect, refuse, or unreasonably

 

 

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1delay the payment of benefits under Section 8(a) or Section
28(b), the Arbitrator or the Commission shall allow to the
3employee additional compensation in the sum of $30 per day for
4each day that the benefits under Section 8(a) or Section 8(b)
5have been so withheld or refused, not to exceed $10,000. A
6delay in payment of 14 days or more shall create a rebuttable
7presumption of unreasonable delay.
8    (m) If the commission finds that an accidental injury was
9directly and proximately caused by the employer's wilful
10violation of a health and safety standard under the Health and
11Safety Act in force at the time of the accident, the arbitrator
12or the Commission shall allow to the injured employee or his
13dependents, as the case may be, additional compensation equal
14to 25% of the amount which otherwise would be payable under the
15provisions of this Act exclusive of this paragraph. The
16additional compensation herein provided shall be allowed by an
17appropriate increase in the applicable weekly compensation
18rate.
19    (n) After June 30, 1984, decisions of the Illinois Workers'
20Compensation Commission reviewing an award of an arbitrator of
21the Commission shall draw interest at a rate equal to the yield
22on indebtedness issued by the United States Government with a
2326-week maturity next previously auctioned on the day on which
24the decision is filed. Said rate of interest shall be set forth
25in the Arbitrator's Decision. Interest shall be drawn from the
26date of the arbitrator's award on all accrued compensation due

 

 

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1the employee through the day prior to the date of payments.
2However, when an employee appeals an award of an Arbitrator or
3the Commission, and the appeal results in no change or a
4decrease in the award, interest shall not further accrue from
5the date of such appeal.
6    The employer or his insurance carrier may tender the
7payments due under the award to stop the further accrual of
8interest on such award notwithstanding the prosecution by
9either party of review, certiorari, appeal to the Supreme Court
10or other steps to reverse, vacate or modify the award.
11    (o) By the 15th day of each month each insurer providing
12coverage for losses under this Act shall notify each insured
13employer of any compensable claim incurred during the preceding
14month and the amounts paid or reserved on the claim including a
15summary of the claim and a brief statement of the reasons for
16compensability. A cumulative report of all claims incurred
17during a calendar year or continued from the previous year
18shall be furnished to the insured employer by the insurer
19within 30 days after the end of that calendar year.
20    The insured employer may challenge, in proceeding before
21the Commission, payments made by the insurer without
22arbitration and payments made after a case is determined to be
23noncompensable. If the Commission finds that the case was not
24compensable, the insurer shall purge its records as to that
25employer of any loss or expense associated with the claim,
26reimburse the employer for attorneys' fees arising from the

 

 

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

 

 

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1arbitrator may on his own motion, or the motion of either
2party, correct any clerical errors or errors in computation
3within 15 days after the date of receipt of such award of the
4arbitrator and shall have the power to recall the original
5award on arbitration, and issue in lieu thereof such corrected
6award. The decision of the arbitrator under this subsection (p)
7shall be considered the decision of the Commission and
8proceedings for review of questions of law arising from the
9decision may be commenced by either party pursuant to
10subsection (f) of Section 19. The Advisory Board established
11under Section 13.1 shall compile a list of certified Commission
12arbitrators, each of whom shall be approved by at least 7
13members of the Advisory Board. The chairman shall select 5
14persons from such list to serve as arbitrators under this
15subsection (p). By agreement, the parties shall select one
16arbitrator from among the 5 persons selected by the chairman
17except that if the parties do not agree on an arbitrator from
18among the 5 persons, the parties may, by agreement, select an
19arbitrator of the American Arbitration Association, whose fee
20shall be paid by the State in accordance with rules promulgated
21by the Commission. Arbitration under this subsection (p) shall
22be voluntary.
23(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
 
24    (820 ILCS 305/25.5)
25    Sec. 25.5. Unlawful acts; penalties.

 

 

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

 

 

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1    security that may be required to be furnished pursuant to
2    Section 4 of this Act.
3        (7) Intentionally make or cause to be made any false or
4    fraudulent material statement to the Department Division
5    of Insurance's fraud and insurance non-compliance unit in
6    the course of an investigation of fraud or insurance
7    non-compliance.
8        (8) Intentionally assist, abet, solicit, or conspire
9    with any person, company, or other entity to commit any of
10    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
11    of this subsection (a).
12        (9) Intentionally present a bill or statement for the
13    payment for medical services that were not provided.
14    For the purposes of paragraphs (2), (3), (5), (6), and (7),
15and (9), the term "statement" includes any writing, notice,
16proof of injury, bill for services, hospital or doctor records
17and reports, or X-ray and test results.
18    (b) Sentences for violations of subsection (a) are as
19follows: Any person violating subsection (a) is guilty of a
20Class 4 felony. Any person or entity convicted of any violation
21of this Section shall be ordered to pay complete restitution to
22any person or entity so defrauded in addition to any fine or
23sentence imposed as a result of the conviction.
24        (1) A violation in which the value of the property
25    obtained or attempted to be obtained is $300 or less is a
26    Class A misdemeanor.

 

 

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1        (2) A violation in which the value of the property
2    obtained or attempted to be obtained is more than $300 but
3    not more than $10,000 is a Class 3 felony.
4        (3) A violation in which the value of the property
5    obtained or attempted to be obtained is more than $10,000
6    but not more than $100,000 is a Class 2 felony.
7        (4) A violation in which the value of the property
8    obtained or attempted to be obtained is more than $100,000
9    is a Class 1 felony.
10        (5) A person convicted under this Section shall be
11    ordered to pay monetary restitution to the insurance
12    company or self-insured entity or any other person for any
13    financial loss sustained as a result of a violation of this
14    Section, including any court costs and attorney fees. An
15    order of restitution also includes expenses incurred and
16    paid by the State of Illinois or an insurance company or
17    self-insured entity in connection with any medical
18    evaluation or treatment services.
19    For the purposes of this Section, where the exact value of
20property obtained or attempted to be obtained is either not
21alleged or is not specifically set by the terms of a policy of
22insurance, the value of the property shall be the fair market
23replacement value of the property claimed to be lost, the
24reasonable costs of reimbursing a vendor or other claimant for
25services to be rendered, or both. Notwithstanding the
26foregoing, an insurance company, self-insured entity, or any

 

 

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1other person suffering financial loss sustained as a result of
2violation of this Section may seek restitution, including court
3costs and attorney's fees in a civil action in a court of
4competent jurisdiction.
5    (c) The Department Division of Insurance of the Department
6of Financial and Professional Regulation shall establish a
7fraud and insurance non-compliance unit responsible for
8investigating incidences of fraud and insurance non-compliance
9pursuant to this Section. The size of the staff of the unit
10shall be subject to appropriation by the General Assembly. It
11shall be the duty of the fraud and insurance non-compliance
12unit to determine the identity of insurance carriers,
13employers, employees, or other persons or entities who have
14violated the fraud and insurance non-compliance provisions of
15this Section. The fraud and insurance non-compliance unit shall
16report violations of the fraud and insurance non-compliance
17provisions of this Section to the Special Prosecutions Bureau
18of the Criminal Division of the Office of the Attorney General
19or to the State's Attorney of the county in which the offense
20allegedly occurred, either of whom has the authority to
21prosecute violations under this Section.
22    With respect to the subject of any investigation being
23conducted, the fraud and insurance non-compliance unit shall
24have the general power of subpoena of the Department Division
25of Insurance, including the authority to issue a subpoena to a
26medical provider, pursuant to Section 8-802 of the Code of

 

 

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

 

 

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1or (ii) the employee must have made a written demand for the
2payment of benefits that are related to the reported fraud.
3Upon receipt of a report of fraud, the employee or employer
4shall receive immediate notice of the reported conduct,
5including the verified name and address of the complainant if
6that complainant is connected to the case and the nature of the
7reported conduct. The fraud and insurance non-compliance unit
8shall resolve all reports of fraud against employees or
9employers within 120 days of receipt of the report. There shall
10be no immunity, under this Act or otherwise, for any person who
11files a false report or who files a report without good and
12just cause. Confidentiality of medical information shall be
13strictly maintained. Investigations that are not referred for
14prosecution shall be destroyed upon the expiration of the
15statute of limitations for the acts under investigation
16immediately expunged and shall not be disclosed except that the
17employee or employer who was the subject of the report and the
18person making the report shall be notified that the
19investigation is being closed, at which time the name of any
20complainant not connected to the case shall be disclosed to the
21employee or the employer. It is unlawful for any employer,
22insurance carrier, or service adjustment company, third party
23administrator, self-insured, or similar entity 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    (e-5) The fraud and insurance non-compliance unit shall
2procure and implement a system utilizing advanced analytics
3inclusive of predictive modeling, data mining, social network
4analysis, and scoring algorithms for the detection and
5prevention of fraud, waste, and abuse on or before January 1,
62012. The fraud and insurance non-compliance unit shall procure
7this system using a request for proposals process governed by
8the Illinois Procurement Code and rules adopted under that
9Code. The fraud and insurance non-compliance unit shall provide
10a report to the President of the Senate, Speaker of the House
11of Representatives, Minority Leader of the House of
12Representatives, Minority Leader of the Senate, Governor,
13Chairman of the Commission, and Director of Insurance on or
14before July 1, 2012 and annually thereafter detailing its
15activities and providing recommendations regarding
16opportunities for additional fraud waste and abuse detection
17and prevention.
18    For purposes of this subsection (e), "employer" means any
19employer, insurance carrier, third party administrator,
20self-insured, or similar entity.
21    For purposes of this subsection (e), "complainant" refers
22to the person contacting the fraud and insurance non-compliance
23unit to initiate the complaint.
24    (f) Any person convicted of fraud related to workers'
25compensation pursuant to this Section shall be subject to the
26penalties prescribed in the Criminal Code of 1961 and shall be

 

 

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

 

 

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1General Assembly, the Governor, and the Attorney General by
2January 1 and July 1 of each year. This report shall include,
3at the minimum, the following information:
4        (1) The number of allegations of insurance
5    non-compliance and fraud reported to the fraud and
6    insurance non-compliance unit.
7        (2) The source of the reported allegations
8    (individual, employer, or other).
9        (3) The number of allegations investigated by the fraud
10    and insurance non-compliance unit.
11        (4) The number of criminal referrals made in accordance
12    with this Section and the entity to which the referral was
13    made.
14        (5) All proceedings under this Section.
15(Source: P.A. 94-277, eff. 7-20-05.)
 
16    (820 ILCS 305/29.1 new)
17    Sec. 29.1. Recalculation of premiums. On the effective date
18of this amendatory Act of the 97th General Assembly, the
19Director of Insurance shall immediately direct in writing any
20workers' compensation rate setting advisory organization to
21recalculate workers' compensation advisory premium rates and
22assigned risk pool premium rates so that those premiums
23incorporate the provisions of this amendatory Act of the 97th
24General Assembly, and to publish such rates on or before
25September 1, 2011.
 

 

 

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

 

 

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

 

 

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1    temporary total disability, scheduled and non-scheduled
2    permanent partial disability, and total disability.
3        (11) The number of injured workers receiving wage loss
4    differential awards and the average wage loss differential
5    award payout.
6        (12) Illinois' rank, relative to other states, for:
7            (i) the maximum and minimum temporary total
8        disability benefit level;
9            (ii) the maximum and minimum scheduled and
10        non-scheduled permanent partial disability benefit
11        level;
12            (iii) the maximum and minimum total disability
13        benefit level; and
14            (iv) the maximum and minimum death benefit level.
15        (13) The aggregate growth of medical benefit payout by
16    non-hospital providers and hospitals.
17        (14) The aggregate growth of medical utilization for
18    the top 10 most common injuries to specific body parts by
19    non-hospital providers and hospitals.
20        (15) The percentage of injured workers filing claims at
21    the Commission that are represented by an attorney.
22        (16) The total amount paid by injured workers for
23    attorney representation.
24    (b) The Director of Insurance shall promulgate rules
25requiring each insurer licensed to write workers' compensation
26coverage in the State to record and report the following

 

 

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1information on an aggregate basis to the Department of
2Insurance before March 1 of each year, relating to claims in
3the State opened within the prior calendar year:
4        (1) The number of claims opened.
5        (2) The number of reported medical only claims.
6        (3) The number of contested claims.
7        (4) The number of claims for which the employee has
8    attorney representation.
9        (5) The number of claims with lost time and the number
10    of claims for which temporary total disability was paid.
11        (6) The number of claim adjusters employed to adjust
12    workers' compensation claims.
13        (7) The number of claims for which temporary total
14    disability was not paid within 14 days from the first full
15    day off, regardless of reason.
16        (8) The number of medical bills paid 60 days or later
17    from date of service and the average days paid on those
18    paid after 60 days for the previous calendar year.
19        (9) The number of claims in which in-house defense
20    counsel participated, and the total amount spent on
21    in-house legal services.
22        (10) The number of claims in which outside defense
23    counsel participated, and the total amount paid to outside
24    defense counsel.
25        (11) The total amount billed to employers for bill
26    review.

 

 

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1        (12) The total amount billed to employers for fee
2    schedule savings.
3        (13) The total amount charged to employers for any and
4    all managed care fees.
5        (14) The number of claims involving in-house medical
6    nurse case management, and the total amount spent on
7    in-house medical nurse case management.
8        (15) The number of claims involving outside medical
9    nurse case management, and the total amount paid for
10    outside medical nurse case management.
11        (16) The total amount paid for Independent Medical
12    exams.
13        (17) The total amount spent on in-house Utilization
14    Review for the previous calendar year.
15        (18) The total amount paid for outside Utilization
16    Review for the previous calendar year.
17    The Department shall make the submitted information
18publicly available on the Department's Internet website or such
19other media as appropriate in a form useful for consumers.
 
20    Section 97. Severability. The provisions of this Act are
21severable under Section 1.31 of the Statute on Statutes.
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.