Sen. Kwame Raoul

Filed: 5/26/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1698

2    AMENDMENT NO. ______. Amend House Bill 1698 by replacing
3everything after the enacting clause with the following:
 
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.

 

 

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1        (2) Study the feasibility of establishing a
2    self-insurance plan for State property and prepare
3    estimates of the costs of reinsurance for risks beyond the
4    realistic limits of the self-insurance.
5        (3) Prepare a plan for centralizing the purchase of
6    property and casualty insurance on State property under a
7    master policy or policies and purchase the insurance
8    contracted for as provided in the Illinois Purchasing Act.
9        (4) Evaluate existing provisions for fidelity bonds
10    required of State employees and recommend changes that are
11    appropriate commensurate with risk experience and the
12    determinations respecting self-insurance or reinsurance so
13    as to permit reduction of costs without loss of coverage.
14        (5) Investigate procedures for inclusion of school
15    districts, public community college districts, and other
16    units of local government in programs for the centralized
17    purchase of insurance.
18        (6) Implement recommendations of the State Property
19    Insurance Study Commission that the Department finds
20    necessary or desirable in the performance of its powers and
21    duties under this Section to achieve efficient and
22    comprehensive risk management.
23        (7) Prepare and, in the discretion of the Director,
24    implement a plan providing for the purchase of public
25    liability insurance or for self-insurance for public
26    liability or for a combination of purchased insurance and

 

 

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1    self-insurance for public liability (i) covering the State
2    and drivers of motor vehicles owned, leased, or controlled
3    by the State of Illinois pursuant to the provisions and
4    limitations contained in the Illinois Vehicle Code, (ii)
5    covering other public liability exposures of the State and
6    its employees within the scope of their employment, and
7    (iii) covering drivers of motor vehicles not owned, leased,
8    or controlled by the State but used by a State employee on
9    State business, in excess of liability covered by an
10    insurance policy obtained by the owner of the motor vehicle
11    or in excess of the dollar amounts that the Department
12    shall determine to be reasonable. Any contract of insurance
13    let under this Law shall be by bid in accordance with the
14    procedure set forth in the Illinois Purchasing Act. Any
15    provisions for self-insurance shall conform to subdivision
16    (11).
17        The term "employee" as used in this subdivision (7) and
18    in subdivision (11) means a person while in the employ of
19    the State who is a member of the staff or personnel of a
20    State agency, bureau, board, commission, committee,
21    department, university, or college or who is a State
22    officer, elected official, commissioner, member of or ex
23    officio member of a State agency, bureau, board,
24    commission, committee, department, university, or college,
25    or a member of the National Guard while on active duty
26    pursuant to orders of the Governor of the State of

 

 

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1    Illinois, or any other person while using a licensed motor
2    vehicle owned, leased, or controlled by the State of
3    Illinois with the authorization of the State of Illinois,
4    provided the actual use of the motor vehicle is within the
5    scope of that authorization and within the course of State
6    service.
7        Subsequent to payment of a claim on behalf of an
8    employee pursuant to this Section and after reasonable
9    advance written notice to the employee, the Director may
10    exclude the employee from future coverage or limit the
11    coverage under the plan if (i) the Director determines that
12    the claim resulted from an incident in which the employee
13    was grossly negligent or had engaged in willful and wanton
14    misconduct or (ii) the Director determines that the
15    employee is no longer an acceptable risk based on a review
16    of prior accidents in which the employee was at fault and
17    for which payments were made pursuant to this Section.
18        The Director is authorized to promulgate
19    administrative rules that may be necessary to establish and
20    administer the plan.
21        Appropriations from the Road Fund shall be used to pay
22    auto liability claims and related expenses involving
23    employees of the Department of Transportation, the
24    Illinois State Police, and the Secretary of State.
25        (8) Charge, collect, and receive from all other
26    agencies of the State government fees or monies equivalent

 

 

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1    to the cost of purchasing the insurance.
2        (9) Establish, through the Director, charges for risk
3    management services rendered to State agencies by the
4    Department. The State agencies so charged shall reimburse
5    the Department by vouchers drawn against their respective
6    appropriations. The reimbursement shall be determined by
7    the Director as amounts sufficient to reimburse the
8    Department for expenditures incurred in rendering the
9    service.
10        The Department shall charge the employing State agency
11    or university for workers' compensation payments for
12    temporary total disability paid to any employee after the
13    employee has received temporary total disability payments
14    for 120 days if the employee's treating physician has
15    issued a release to return to work with restrictions and
16    the employee is able to perform modified duty work but the
17    employing State agency or university does not return the
18    employee to work at modified duty. Modified duty shall be
19    duties assigned that may or may not be delineated as part
20    of the duties regularly performed by the employee. Modified
21    duties shall be assigned within the prescribed
22    restrictions established by the treating physician and the
23    physician who performed the independent medical
24    examination. The amount of all reimbursements shall be
25    deposited into the Workers' Compensation Revolving Fund
26    which is hereby created as a revolving fund in the State

 

 

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1    treasury. In addition to any other purpose authorized by
2    law, moneys in the Fund shall be used, subject to
3    appropriation, to pay these or other temporary total
4    disability claims of employees of State agencies and
5    universities.
6        Beginning with fiscal year 1996, all amounts recovered
7    by the Department through subrogation in workers'
8    compensation and workers' occupational disease cases shall
9    be deposited into the Workers' Compensation Revolving Fund
10    created under this subdivision (9).
11        (10) Establish rules, procedures, and forms to be used
12    by State agencies in the administration and payment of
13    workers' compensation claims. The Department shall
14    initially evaluate and determine the compensability of any
15    injury that is the subject of a workers' compensation claim
16    and provide for the administration and payment of such a
17    claim for all State agencies. The Director may delegate to
18    any agency with the agreement of the agency head the
19    responsibility for evaluation, administration, and payment
20    of that agency's claims.
21        (10a) If the Director determines it would be in the
22    best interests of the State and its employees, prepare and
23    implement a plan providing for: (i) the purchase of
24    workers' compensation insurance for workers' compensation
25    liability; (ii) third-party administration of
26    self-insurance, in whole or in part, for workers'

 

 

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1    compensation liability; or (iii) a combination of
2    purchased insurance and self-insurance for workers'
3    compensation liability, including reinsurance or stop-loss
4    insurance. Any contract for insurance or third-party
5    administration shall be on terms consistent with State
6    policy; awarded in compliance with the Illinois
7    Procurement Code; and based on, but not limited to, the
8    following criteria: administrative cost, service
9    capabilities of the carrier or other contractor and
10    premiums, fees, or charges. By April 1 of each year, the
11    Director must report and provide information to the State
12    Workers' Compensation Program Advisory Board concerning
13    the status of the State workers' compensation program for
14    the next fiscal year. Information includes, but is not
15    limited to, documents, reports of negotiations, bid
16    invitations, requests for proposals, specifications,
17    copies of proposed and final contracts or agreements, and
18    any other materials concerning contracts or agreements for
19    the program. By the first of each month thereafter, the
20    Director must provide updated, and any new, information to
21    the State Workers' Compensation Program Advisory Board
22    until the State workers' compensation program for the next
23    fiscal year is determined.
24        (11) Any plan for public liability self-insurance
25    implemented under this Section shall provide that (i) the
26    Department shall attempt to settle and may settle any

 

 

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1    public liability claim filed against the State of Illinois
2    or any public liability claim filed against a State
3    employee on the basis of an occurrence in the course of the
4    employee's State employment; (ii) any settlement of such a
5    claim is not subject to fiscal year limitations and must be
6    approved by the Director and, in cases of settlements
7    exceeding $100,000, by the Governor; and (iii) a settlement
8    of any public liability claim against the State or a State
9    employee shall require an unqualified release of any right
10    of action against the State and the employee for acts
11    within the scope of the employee's employment giving rise
12    to the claim.
13        Whenever and to the extent that a State employee
14    operates a motor vehicle or engages in other activity
15    covered by self-insurance under this Section, the State of
16    Illinois shall defend, indemnify, and hold harmless the
17    employee against any claim in tort filed against the
18    employee for acts or omissions within the scope of the
19    employee's employment in any proper judicial forum and not
20    settled pursuant to this subdivision (11), provided that
21    this obligation of the State of Illinois shall not exceed a
22    maximum liability of $2,000,000 for any single occurrence
23    in connection with the operation of a motor vehicle or
24    $100,000 per person per occurrence for any other single
25    occurrence, or $500,000 for any single occurrence in
26    connection with the provision of medical care by a licensed

 

 

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1    physician employee.
2        Any claims against the State of Illinois under a
3    self-insurance plan that are not settled pursuant to this
4    subdivision (11) shall be heard and determined by the Court
5    of Claims and may not be filed or adjudicated in any other
6    forum. The Attorney General of the State of Illinois or the
7    Attorney General's designee shall be the attorney with
8    respect to all public liability self-insurance claims that
9    are not settled pursuant to this subdivision (11) and
10    therefore result in litigation. The payment of any award of
11    the Court of Claims entered against the State relating to
12    any public liability self-insurance claim shall act as a
13    release against any State employee involved in the
14    occurrence.
15        (12) Administer a plan the purpose of which is to make
16    payments on final settlements or final judgments in
17    accordance with the State Employee Indemnification Act.
18    The plan shall be funded through appropriations from the
19    General Revenue Fund specifically designated for that
20    purpose, except that indemnification expenses for
21    employees of the Department of Transportation, the
22    Illinois State Police, and the Secretary of State shall be
23    paid from the Road Fund. The term "employee" as used in
24    this subdivision (12) has the same meaning as under
25    subsection (b) of Section 1 of the State Employee
26    Indemnification Act. Subject to sufficient appropriation,

 

 

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1    the Director shall approve payment of any claim, without
2    regard to fiscal year limitations, presented to the
3    Director that is supported by a final settlement or final
4    judgment when the Attorney General and the chief officer of
5    the public body against whose employee the claim or cause
6    of action is asserted certify to the Director that the
7    claim is in accordance with the State Employee
8    Indemnification Act and that they approve of the payment.
9    In no event shall an amount in excess of $150,000 be paid
10    from this plan to or for the benefit of any claimant.
11        (13) Administer a plan the purpose of which is to make
12    payments on final settlements or final judgments for
13    employee wage claims in situations where there was an
14    appropriation relevant to the wage claim, the fiscal year
15    and lapse period have expired, and sufficient funds were
16    available to pay the claim. The plan shall be funded
17    through appropriations from the General Revenue Fund
18    specifically designated for that purpose.
19        Subject to sufficient appropriation, the Director is
20    authorized to pay any wage claim presented to the Director
21    that is supported by a final settlement or final judgment
22    when the chief officer of the State agency employing the
23    claimant certifies to the Director that the claim is a
24    valid wage claim and that the fiscal year and lapse period
25    have expired. Payment for claims that are properly
26    submitted and certified as valid by the Director shall

 

 

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1    include interest accrued at the rate of 7% per annum from
2    the forty-fifth day after the claims are received by the
3    Department or 45 days from the date on which the amount of
4    payment is agreed upon, whichever is later, until the date
5    the claims are submitted to the Comptroller for payment.
6    When the Attorney General has filed an appearance in any
7    proceeding concerning a wage claim settlement or judgment,
8    the Attorney General shall certify to the Director that the
9    wage claim is valid before any payment is made. In no event
10    shall an amount in excess of $150,000 be paid from this
11    plan to or for the benefit of any claimant.
12        Nothing in Public Act 84-961 shall be construed to
13    affect in any manner the jurisdiction of the Court of
14    Claims concerning wage claims made against the State of
15    Illinois.
16        (14) Prepare and, in the discretion of the Director,
17    implement a program for self-insurance for official
18    fidelity and surety bonds for officers and employees as
19    authorized by the Official Bond Act.
20(Source: P.A. 96-928, eff. 6-15-10.)
 
21    (20 ILCS 405/405-411)
22    Sec. 405-411. Consolidation of workers' compensation
23functions.
24    (a) Notwithstanding any other law to the contrary, the
25Director of Central Management Services, working in

 

 

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1cooperation with the Director of any other agency, department,
2board, or commission directly responsible to the Governor, may
3direct the consolidation, within the Department of Central
4Management Services, of those workers' compensation functions
5at that agency, department, board, or commission that are
6suitable for centralization.
7    Upon receipt of the written direction to transfer workers'
8compensation functions to the Department of Central Management
9Services, the personnel, equipment, and property (both real and
10personal) directly relating to the transferred functions shall
11be transferred to the Department of Central Management
12Services, and the relevant documents, records, and
13correspondence shall be transferred or copied, as the Director
14may prescribe.
15    (b) Upon receiving written direction from the Director of
16Central Management Services, the Comptroller and Treasurer are
17authorized to transfer the unexpended balance of any
18appropriations related to the workers' compensation functions
19transferred to the Department of Central Management Services
20and shall make the necessary fund transfers from the General
21Revenue Fund, any special fund in the State treasury, or any
22other federal or State trust fund held by the Treasurer to the
23Workers' Compensation Revolving Fund for use by the Department
24of Central Management Services in support of workers'
25compensation functions or any other related costs or expenses
26of the Department of Central Management Services.

 

 

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1    (c) The rights of employees and the State and its agencies
2under the Personnel Code and applicable collective bargaining
3agreements or under any pension, retirement, or annuity plan
4shall not be affected by any transfer under this Section.
5    (d) The functions transferred to the Department of Central
6Management Services by this Section shall be vested in and
7shall be exercised by the Department of Central Management
8Services. Each act done in the exercise of those functions
9shall have the same legal effect as if done by the agencies,
10offices, divisions, departments, bureaus, boards and
11commissions from which they were transferred.
12    Every person or other entity shall be subject to the same
13obligations and duties and any penalties, civil or criminal,
14arising therefrom, and shall have the same rights arising from
15the exercise of such rights, powers, and duties as had been
16exercised by the agencies, offices, divisions, departments,
17bureaus, boards, and commissions from which they were
18transferred.
19    Whenever reports or notices are now required to be made or
20given or papers or documents furnished or served by any person
21in regards to the functions transferred to or upon the
22agencies, offices, divisions, departments, bureaus, boards,
23and commissions from which the functions were transferred, the
24same shall be made, given, furnished or served in the same
25manner to or upon the Department of Central Management
26Services.

 

 

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1    This Section does not affect any act done, ratified, or
2cancelled or any right occurring or established or any action
3or proceeding had or commenced in an administrative, civil, or
4criminal cause regarding the functions transferred, but those
5proceedings may be continued by the Department of Central
6Management Services.
7    This Section does not affect the legality of any rules in
8the Illinois Administrative Code regarding the functions
9transferred in this Section that are in force on the effective
10date of this Section. If necessary, however, the affected
11agencies shall propose, adopt, or repeal rules, rule
12amendments, and rule recodifications as appropriate to
13effectuate this Section.
14    (e) There is hereby created within the Department of
15Central Management Services an advisory body to be known as the
16State Workers' Compensation Program Advisory Board to review,
17assess, and provide recommendations to improve the State
18workers' compensation program and to ensure that the State
19manages the program in the interests of injured workers and
20taxpayers. The Governor shall appoint one person to the Board,
21who shall serve as the Chairperson. The Speaker of the House of
22Representatives, the Minority Leader of the House of
23Representatives, the President of the Senate, and the Minority
24Leader of the Senate shall each appoint one person to the
25Board. Each member initially appointed to the Board shall serve
26a term ending December 31, 2013, and each Board member

 

 

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1appointed thereafter shall serve a 3-year term. A Board member
2shall continue to serve on the Board until his or her successor
3is appointed. In addition, the Director of the Department of
4Central Management Services, the Attorney General, the
5Director of the Department of Insurance, the Secretary of the
6Department of Transportation, the Director of the Department of
7Corrections, the Secretary of the Department of Human Services,
8the Director of the Department of Revenue, and the Chairman of
9the Illinois Workers' Compensation Commission, or their
10designees, shall serve as ex officio, non-voting members of the
11Board. Members of the Board shall not receive compensation but
12shall be reimbursed from the Workers' Compensation Revolving
13Fund for reasonable expenses incurred in the necessary
14performance of their duties, and the Department of Central
15Management Services shall provide administrative support to
16the Board. The Board shall meet at least 3 times per year or
17more often if the Board deems it necessary or proper. By
18September 30, 2011, the Board shall issue a written report, to
19be delivered to the Governor, the Director of the Department of
20Central Management Services, and the General Assembly, with a
21recommended set of best practices for the State workers'
22compensation program. By July 1 of each year thereafter, the
23Board shall issue a written report, to be delivered to those
24same persons or entities, with recommendations on how to
25improve upon such practices.
26(Source: P.A. 93-839, eff. 7-30-04.)
 

 

 

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1    Section 10. The Code of Civil Procedure is amended by
2changing Section 8-802 as follows:
 
3    (735 ILCS 5/8-802)  (from Ch. 110, par. 8-802)
4    Sec. 8-802. Physician and patient. No physician or surgeon
5shall be permitted to disclose any information he or she may
6have acquired in attending any patient in a professional
7character, necessary to enable him or her professionally to
8serve the patient, except only (1) in trials for homicide when
9the disclosure relates directly to the fact or immediate
10circumstances of the homicide, (2) in actions, civil or
11criminal, against the physician for malpractice, (3) with the
12expressed consent of the patient, or in case of his or her
13death or disability, of his or her personal representative or
14other person authorized to sue for personal injury or of the
15beneficiary of an insurance policy on his or her life, health,
16or physical condition, (4) in all actions brought by or against
17the patient, his or her personal representative, a beneficiary
18under a policy of insurance, or the executor or administrator
19of his or her estate wherein the patient's physical or mental
20condition is an issue, (5) upon an issue as to the validity of
21a document as a will of the patient, (6) in any criminal action
22where the charge is either first degree murder by abortion,
23attempted abortion or abortion, (7) in actions, civil or
24criminal, arising from the filing of a report in compliance

 

 

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1with the Abused and Neglected Child Reporting Act, (8) to any
2department, agency, institution or facility which has custody
3of the patient pursuant to State statute or any court order of
4commitment, (9) in prosecutions where written results of blood
5alcohol tests are admissible pursuant to Section 11-501.4 of
6the Illinois Vehicle Code, (10) in prosecutions where written
7results of blood alcohol tests are admissible under Section
85-11a of the Boat Registration and Safety Act, (11) in criminal
9actions arising from the filing of a report of suspected
10terrorist offense in compliance with Section 29D-10(p)(7) of
11the Criminal Code of 1961, or (12) upon the issuance of a
12subpoena pursuant to Section 38 of the Medical Practice Act of
131987; the issuance of a subpoena pursuant to Section 25.1 of
14the Illinois Dental Practice Act; or the issuance of a subpoena
15pursuant to Section 22 of the Nursing Home Administrators
16Licensing and Disciplinary Act; or the issuance of a subpoena
17pursuant to Section 25.5 of the Workers' Compensation Act.
18    In the event of a conflict between the application of this
19Section and the Mental Health and Developmental Disabilities
20Confidentiality Act to a specific situation, the provisions of
21the Mental Health and Developmental Disabilities
22Confidentiality Act shall control.
23(Source: P.A. 95-478, eff. 8-27-07.)
 
24    Section 15. The Workers' Compensation Act is amended by
25changing Sections 1, 4, 8, 8.2, 8.7, 11, 13, 13.1, 14, 18, 19,

 

 

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1and 25.5 and by adding Sections 1.1, 4b, 8.1a, 8.1b, 8.2a, 16b,
218.1, 29.1, and 29.2 as follows:
 
3    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
4    Sec. 1. This Act may be cited as the Workers' Compensation
5Act.
6    (a) The term "employer" as used in this Act means:
7    1. The State and each county, city, town, township,
8incorporated village, school district, body politic, or
9municipal corporation therein.
10    2. Every person, firm, public or private corporation,
11including hospitals, public service, eleemosynary, religious
12or charitable corporations or associations who has any person
13in service or under any contract for hire, express or implied,
14oral or written, and who is engaged in any of the enterprises
15or businesses enumerated in Section 3 of this Act, or who at or
16prior to the time of the accident to the employee for which
17compensation under this Act may be claimed, has in the manner
18provided in this Act elected to become subject to the
19provisions of this Act, and who has not, prior to such
20accident, effected a withdrawal of such election in the manner
21provided in this Act.
22    3. Any one engaging in any business or enterprise referred
23to in subsections 1 and 2 of Section 3 of this Act who
24undertakes to do any work enumerated therein, is liable to pay
25compensation to his own immediate employees in accordance with

 

 

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

 

 

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

 

 

09700HB1698sam003- 21 -LRB097 07917 AEK 56376 a

1such denial be ultimately determined not to have been bona fide
2then the provisions of Paragraph K of Section 19 of this Act
3shall apply.
4    An employer whose business or enterprise or a substantial
5part thereof consists of hiring, procuring or furnishing
6employees to or for other employers operating under and subject
7to the provisions of this Act for the performance of the work
8of such other employers and who pays such employees their
9salary or wages notwithstanding that they are doing the work of
10such other employers shall be deemed a loaning employer within
11the meaning and provisions of this Section.
12    (b) The term "employee" as used in this Act means:
13    1. Every person in the service of the State, including
14members of the General Assembly, members of the Commerce
15Commission, members of the Illinois Workers' Compensation
16Commission, and all persons in the service of the University of
17Illinois, county, including deputy sheriffs and assistant
18state's attorneys, city, town, township, incorporated village
19or school district, body politic, or municipal corporation
20therein, whether by election, under appointment or contract of
21hire, express or implied, oral or written, including all
22members of the Illinois National Guard while on active duty in
23the service of the State, and all probation personnel of the
24Juvenile Court appointed pursuant to Article VI of the Juvenile
25Court Act of 1987, and including any official of the State, any
26county, city, town, township, incorporated village, school

 

 

09700HB1698sam003- 22 -LRB097 07917 AEK 56376 a

1district, body politic or municipal corporation therein except
2any duly appointed member of a police department in any city
3whose population exceeds 200,000 according to the last Federal
4or State census, and except any member of a fire insurance
5patrol maintained by a board of underwriters in this State. A
6duly appointed member of a fire department in any city, the
7population of which exceeds 200,000 according to the last
8federal or State census, is an employee under this Act only
9with respect to claims brought under paragraph (c) of Section
108.
11    One employed by a contractor who has contracted with the
12State, or a county, city, town, township, incorporated village,
13school district, body politic or municipal corporation
14therein, through its representatives, is not considered as an
15employee of the State, county, city, town, township,
16incorporated village, school district, body politic or
17municipal corporation which made the contract.
18    2. Every person in the service of another under any
19contract of hire, express or implied, oral or written,
20including persons whose employment is outside of the State of
21Illinois where the contract of hire is made within the State of
22Illinois, persons whose employment results in fatal or
23non-fatal injuries within the State of Illinois where the
24contract of hire is made outside of the State of Illinois, and
25persons whose employment is principally localized within the
26State of Illinois, regardless of the place of the accident or

 

 

09700HB1698sam003- 23 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 24 -LRB097 07917 AEK 56376 a

1approved March 7, 1917, as amended, or the Illinois Workers'
2Compensation Commission created by Section 13 of this Act.
3    (d) To obtain compensation under this Act, an employee
4bears the burden of showing, by a preponderance of the
5evidence, that he or she has sustained accidental injuries
6arising out of and in the course of the employment.
7(Source: P.A. 93-721, eff. 1-1-05.)
 
8    (820 ILCS 305/1.1 new)
9    Sec. 1.1. Standards of conduct.
10    (a) Commissioners and arbitrators shall dispose of all
11Workers' Compensation matters promptly, officially and fairly,
12without bias or prejudice. Commissioners and arbitrators shall
13be faithful to the law and maintain professional competence in
14it. They shall be unswayed by partisan interests, public
15clamor, or fear of criticism. Commissioners and arbitrators
16shall take appropriate action or initiate appropriate
17disciplinary measures against a Commissioner, arbitrator,
18lawyer, or others for unprofessional conduct of which the
19Commissioner or arbitrator may become aware.
20    (b) Except as otherwise provided in this Act, the Canons of
21the Code of Judicial Conduct as adopted by the Supreme Court of
22Illinois govern the hearing and non-hearing conduct of members
23of the Commission and arbitrators under this Act. The
24Commission may set additional rules and standards, not less
25stringent than those rules and standards established by the

 

 

09700HB1698sam003- 25 -LRB097 07917 AEK 56376 a

1Code of Judicial Conduct, for the conduct of arbitrators.
2    (c) The following provisions of the Code of Judicial
3Conduct do not apply under this Section:
4        (1) Canon 3(B), relating to administrative
5    responsibilities of Judges.
6        (2) Canon 6(C), relating to annual filings of economic
7    interests. Instead of filing declarations of economic
8    interests with the Clerk of the Illinois Supreme Court
9    under Illinois Supreme Court Rule 68, members of the
10    Commission and arbitrators shall make filings
11    substantially similar to those required by Rule 68 with the
12    Chairman, and such filings shall be made available for
13    examination by the public.
14    (d) An arbitrator or a Commissioner may accept an
15uncompensated appointment to a governmental committee,
16commission or other position that is concerned with issues of
17policy on matters which may come before the arbitrator or
18Commissioner if such appointment neither affects his or her
19independent professional judgment nor the conduct of his or her
20duties.
21    (e) Decisions of an arbitrator or a Commissioner shall be
22based exclusively on evidence in the record of the proceeding
23and material that has been officially noticed. Any findings of
24fact made by the arbitrator based on inquiries, investigations,
25examinations, or inspections undertaken by the arbitrator
26shall be entered into the record of the proceeding.

 

 

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1    (f) Nothing in this Section shall prohibit an arbitrator
2from holding a pre-trial conference in accordance with the
3rules of the Commission.
 
4    (820 ILCS 305/4)  (from Ch. 48, par. 138.4)
5    Sec. 4. (a) Any employer, including but not limited to
6general contractors and their subcontractors, who shall come
7within the provisions of Section 3 of this Act, and any other
8employer who shall elect to provide and pay the compensation
9provided for in this Act shall:
10        (1) File with the Commission annually an application
11    for approval as a self-insurer which shall include a
12    current financial statement, and annually, thereafter, an
13    application for renewal of self-insurance, which shall
14    include a current financial statement. Said application
15    and financial statement shall be signed and sworn to by the
16    president or vice president and secretary or assistant
17    secretary of the employer if it be a corporation, or by all
18    of the partners, if it be a copartnership, or by the owner
19    if it be neither a copartnership nor a corporation. All
20    initial applications and all applications for renewal of
21    self-insurance must be submitted at least 60 days prior to
22    the requested effective date of self-insurance. An
23    employer may elect to provide and pay compensation as
24    provided for in this Act as a member of a group workers'
25    compensation pool under Article V 3/4 of the Illinois

 

 

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

 

 

09700HB1698sam003- 28 -LRB097 07917 AEK 56376 a

1    1, 2, or 4 for the remainder of his or her liability to pay
2    such compensation, subject to the following two
3    provisions:
4            Firstly, the entire compensation liability of the
5        employer to employees working at or from one location
6        shall be insured in one such insurance carrier or shall
7        be self-insured, and
8            Secondly, the employer shall submit evidence
9        satisfactorily to the Commission that his or her entire
10        liability for the compensation provided for in this Act
11        will be secured. Any provisions in any policy, or in
12        any endorsement attached thereto, attempting to limit
13        or modify in any way, the liability of the insurance
14        carriers issuing the same except as otherwise provided
15        herein shall be wholly void.
16        Nothing herein contained shall apply to policies of
17    excess liability carriage secured by employers who have
18    been approved by the Commission as self-insurers, or
19        (4) Make some other provision, satisfactory to the
20    Commission, for the securing of the payment of compensation
21    provided for in this Act, and
22        (5) Upon becoming subject to this Act and thereafter as
23    often as the Commission may in writing demand, file with
24    the Commission in form prescribed by it evidence of his or
25    her compliance with the provision of this Section.
26    (a-1) Regardless of its state of domicile or its principal

 

 

09700HB1698sam003- 29 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 30 -LRB097 07917 AEK 56376 a

1later than one year after the expiration of the applicable
2limitation period specified in subsection (d) of Section 6 of
3this Act. Penalties imposed under this subsection (a-1) shall
4be deposited into the Illinois Workers' Compensation
5Commission Operations Fund, a special fund that is created in
6the State treasury. Subject to appropriation, moneys in the
7Fund shall be used solely for the operations of the Illinois
8Workers' Compensation Commission and by the Department of
9Insurance Financial and Professional Regulation for the
10purposes authorized in subsection (c) of Section 25.5 of this
11Act.
12    (a-2) Every Employee Leasing Company (ELC), as defined in
13Section 15 of the Employee Leasing Company Act, shall at a
14minimum provide the following information to the Commission or
15any entity designated by the Commission regarding each workers'
16compensation insurance policy issued to the ELC:
17        (1) Any client company of the ELC listed as an
18    additional named insured.
19        (2) Any informational schedule attached to the master
20    policy that identifies any individual client company's
21    name, FEIN, and job location.
22        (3) Any certificate of insurance coverage document
23    issued to a client company specifying its rights and
24    obligations under the master policy that establishes both
25    the identity and status of the client, as well as the dates
26    of inception and termination of coverage, if applicable.

 

 

09700HB1698sam003- 31 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 32 -LRB097 07917 AEK 56376 a

1least 10 days after receipt by the Illinois Workers'
2Compensation Commission of notice of the cancellation or
3termination of said insurance; provided, however, that if the
4employer has secured insurance from another insurance carrier,
5or has otherwise secured the payment of compensation in
6accordance with this Section, and such insurance or other
7security becomes effective prior to the expiration of the 10
8days, cancellation or termination may, at the option of the
9insurance carrier indicated in such notice, be effective as of
10the effective date of such other insurance or security.
11    (c) Whenever the Commission shall find that any
12corporation, company, association, aggregation of individuals,
13reciprocal or interinsurers exchange, or other insurer
14effecting workers' compensation insurance in this State shall
15be insolvent, financially unsound, or unable to fully meet all
16payments and liabilities assumed or to be assumed for
17compensation insurance in this State, or shall practice a
18policy of delay or unfairness toward employees in the
19adjustment, settlement, or payment of benefits due such
20employees, the Commission may after reasonable notice and
21hearing order and direct that such corporation, company,
22association, aggregation of individuals, reciprocal or
23interinsurers exchange, or insurer, shall from and after a date
24fixed in such order discontinue the writing of any such
25workers' compensation insurance in this State. Subject to such
26modification of the order as the Commission may later make on

 

 

09700HB1698sam003- 33 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 34 -LRB097 07917 AEK 56376 a

1insurance business in this State, as provided in subparagraph 3
2of paragraph (a) of this Section.
3    All orders made by the Commission under this Section shall
4be subject to review by the courts, said review to be taken in
5the same manner and within the same time as provided by Section
619 of this Act for review of awards and decisions of the
7Commission, upon the party seeking the review filing with the
8clerk of the court to which said review is taken a bond in an
9amount to be fixed and approved by the court to which the
10review is taken, conditioned upon the payment of all
11compensation awarded against the person taking said review
12pending a decision thereof and further conditioned upon such
13other obligations as the court may impose. Upon the review the
14Circuit Court shall have power to review all questions of fact
15as well as of law. The penalty hereinafter provided for in this
16paragraph shall not attach and shall not begin to run until the
17final determination of the order of the Commission.
18    (d) Whenever a panel of 3 Commissioners comprised of one
19member of the employing class, one member of the employee
20class, and one member not identified with either the employing
21or employee class, with due process and after a hearing,
22determines an employer has knowingly failed to provide coverage
23as required by paragraph (a) of this Section, the failure shall
24be deemed an immediate serious danger to public health, safety,
25and welfare sufficient to justify service by the Commission of
26a work-stop order on such employer, requiring the cessation of

 

 

09700HB1698sam003- 35 -LRB097 07917 AEK 56376 a

1all business operations of such employer at the place of
2employment or job site. Any law enforcement agency in the State
3shall, at the request of the Commission, render any assistance
4necessary to carry out the provisions of this Section,
5including, but not limited to, preventing any employee of such
6employer from remaining at a place of employment or job site
7after a work-stop order has taken effect. Any work-stop order
8shall be lifted upon proof of insurance as required by this
9Act. Any orders under this Section are appealable under Section
1019(f) to the Circuit Court.
11    Any individual employer, corporate officer or director of a
12corporate employer, partner of an employer partnership, or
13member of an employer limited liability company who knowingly
14fails to provide coverage as required by paragraph (a) of this
15Section is guilty of a Class 4 felony. This provision shall not
16apply to any corporate officer or director of any
17publicly-owned corporation. Each day's violation constitutes a
18separate offense. The State's Attorney of the county in which
19the violation occurred, or the Attorney General, shall bring
20such actions in the name of the People of the State of
21Illinois, or may, in addition to other remedies provided in
22this Section, bring an action for an injunction to restrain the
23violation or to enjoin the operation of any such employer.
24    Any individual employer, corporate officer or director of a
25corporate employer, partner of an employer partnership, or
26member of an employer limited liability company who negligently

 

 

09700HB1698sam003- 36 -LRB097 07917 AEK 56376 a

1fails to provide coverage as required by paragraph (a) of this
2Section is guilty of a Class A misdemeanor. This provision
3shall not apply to any corporate officer or director of any
4publicly-owned corporation. Each day's violation constitutes a
5separate offense. The State's Attorney of the county in which
6the violation occurred, or the Attorney General, shall bring
7such actions in the name of the People of the State of
8Illinois.
9    The criminal penalties in this subsection (d) shall not
10apply where there exists a good faith dispute as to the
11existence of an employment relationship. Evidence of good faith
12shall include, but not be limited to, compliance with the
13definition of employee as used by the Internal Revenue Service.
14    Employers who are subject to and who knowingly fail to
15comply with this Section shall not be entitled to the benefits
16of this Act during the period of noncompliance, but shall be
17liable in an action under any other applicable law of this
18State. In the action, such employer shall not avail himself or
19herself of the defenses of assumption of risk or negligence or
20that the injury was due to a co-employee. In the action, proof
21of the injury shall constitute prima facie evidence of
22negligence on the part of such employer and the burden shall be
23on such employer to show freedom of negligence resulting in the
24injury. The employer shall not join any other defendant in any
25such civil action. Nothing in this amendatory Act of the 94th
26General Assembly shall affect the employee's rights under

 

 

09700HB1698sam003- 37 -LRB097 07917 AEK 56376 a

1subdivision (a)3 of Section 1 of this Act. Any employer or
2carrier who makes payments under subdivision (a)3 of Section 1
3of this Act shall have a right of reimbursement from the
4proceeds of any recovery under this Section.
5    An employee of an uninsured employer, or the employee's
6dependents in case death ensued, may, instead of proceeding
7against the employer in a civil action in court, file an
8application for adjustment of claim with the Commission in
9accordance with the provisions of this Act and the Commission
10shall hear and determine the application for adjustment of
11claim in the manner in which other claims are heard and
12determined before the Commission.
13    All proceedings under this subsection (d) shall be reported
14on an annual basis to the Workers' Compensation Advisory Board.
15    An investigator with the Illinois Workers' Compensation
16Commission Insurance Compliance Division may issue a citation
17to any employer that is not in compliance with its obligation
18to have workers' compensation insurance under this Act. The
19amount of the fine shall be based on the period of time the
20employer was in non-compliance, but shall be no less than $500,
21and shall not exceed $2,500. An employer that has been issued a
22citation shall pay the fine to the Commission and provide to
23the Commission proof that it obtained the required workers'
24compensation insurance within 10 days after the citation was
25issued. This Section does not affect any other obligations this
26Act imposes on employers.

 

 

09700HB1698sam003- 38 -LRB097 07917 AEK 56376 a

1    Upon a finding by the Commission, after reasonable notice
2and hearing, of the knowing and wilful failure or refusal of an
3employer to comply with any of the provisions of paragraph (a)
4of this Section, or the failure or refusal of an employer,
5service or adjustment company, or an insurance carrier to
6comply with any order of the Illinois Workers' Compensation
7Commission pursuant to paragraph (c) of this Section
8disqualifying him or her to operate as a self insurer and
9requiring him or her to insure his or her liability, or the
10knowing and willful failure of an employer to comply with a
11citation issued by an investigator with the Illinois Workers'
12Compensation Commission Insurance Compliance Division, the
13Commission may assess a civil penalty of up to $500 per day for
14each day of such failure or refusal after the effective date of
15this amendatory Act of 1989. The minimum penalty under this
16Section shall be the sum of $10,000. Each day of such failure
17or refusal shall constitute a separate offense. The Commission
18may assess the civil penalty personally and individually
19against the corporate officers and directors of a corporate
20employer, the partners of an employer partnership, and the
21members of an employer limited liability company, after a
22finding of a knowing and willful refusal or failure of each
23such named corporate officer, director, partner, or member to
24comply with this Section. The liability for the assessed
25penalty shall be against the named employer first, and if the
26named employer fails or refuses to pay the penalty to the

 

 

09700HB1698sam003- 39 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 40 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 41 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 42 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 43 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 44 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 45 -LRB097 07917 AEK 56376 a

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

 

 

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1as well as of law.
2(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
394-839, eff. 6-6-06.)
 
4    (820 ILCS 305/4b new)
5    Sec. 4b. Collective bargaining pilot program.
6    (a) The Director of the Department of Labor shall adopt a
7selection process to designate 2 labor organizations to
8participate in the collective bargaining process provided for
9in this Section.
10    (a-5) For purposes of this Section, the term "construction
11employer" means any person or legal entity or group of persons
12or legal entities engaging in or planning to engage in any
13constructing, altering, reconstructing, repairing,
14rehabilitating, refinishing, refurbishing, remodeling,
15remediating, renovating, custom fabricating, maintaining,
16landscaping, improving, wrecking, painting, decorating,
17demolishing, and adding to or subtracting from any building,
18structure, airport facility, highway, roadway, street, alley,
19bridge, sewer, drain, ditch, sewage disposal plant, water
20works, parking facility, railroad, excavation or other
21project, structure, development, real property or improvement,
22or to do any part thereof, whether or not the performance of
23the work herein described involves the addition to, or
24fabrication into, any project, structure, development, real
25property or improvement herein described, and shall also

 

 

09700HB1698sam003- 47 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 48 -LRB097 07917 AEK 56376 a

1        (5) The use of a limited list of individuals and
2    companies for the establishment of vocational
3    rehabilitation or retraining programs that may be the
4    exclusive source of rehabilitation and retraining services
5    provided under this Act; or
6        (6) The establishment of joint labor management safety
7    committees and safety procedures.
8    (c) Void agreements. Nothing in this Section shall be
9construed to authorize any provision in a collective bargaining
10agreement that diminishes or increases a construction
11employer's entitlements under this Act or an employee's
12entitlement to benefits as otherwise set forth in this Act. For
13the purposes of this Section, the procedural rights and dispute
14resolution agreements under subparagraphs (1) through (6) of
15subsection (b) of this Section are not agreements which
16diminish or increase a construction employer's entitlements
17under this Act or an employee's entitlement to benefits under
18this Act. Any agreement that diminishes or increases a
19construction employer's entitlements under this Act or an
20employee's entitlement to benefits as set forth in this Act is
21null and void. Nothing in this Section shall be construed as
22creating a mandatory subject of bargaining.
23    (d) Form of agreement. The agreement reached herein shall
24demonstrate that:
25        (1) The construction employer or group of construction
26    employers and the recognized or certified exclusive

 

 

09700HB1698sam003- 49 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 50 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 51 -LRB097 07917 AEK 56376 a

1    agreement. All such settlements shall be filed with the ADR
2    plan administrator, who within 10 days shall forward a copy
3    to the Commission for recording.
4        (3) Upon assignment of claims, unless settled,
5    mediators and arbitrators shall render final orders
6    containing essential findings of fact, rulings of law and
7    referring to other matters as pertinent to the questions at
8    issue. The ADR plan administrator shall maintain a record
9    of the proceedings.
10    (h) Reporting requirements. Annually, each ADR plan
11administrator shall submit a report to the Commission
12containing the following information:
13        (1) The number of employees within the ADR program;
14        (2) The number of occurrences of work-related injuries
15    or diseases;
16        (3) The breakdown within the ADR program of injuries
17    and diseases treated;
18        (4) The total amount of disability benefits paid within
19    the ADR program;
20        (5) The total medical treatment cost paid within the
21    ADR program;
22        (6) The number of claims filed within the ADR program;
23    and
24        (7) The disposition of all claims.
 
25    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)

 

 

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

 

 

09700HB1698sam003- 53 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 54 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 55 -LRB097 07917 AEK 56376 a

1    Every hospital, physician, surgeon or other person
2rendering treatment or services in accordance with the
3provisions of this Section shall upon written request furnish
4full and complete reports thereof to, and permit their records
5to be copied by, the employer, the employee or his dependents,
6as the case may be, or any other party to any proceeding for
7compensation before the Commission, or their attorneys.
8    Notwithstanding the foregoing, the employer's liability to
9pay for such medical services selected by an the employee of an
10employer without an approved preferred provider program
11pursuant to Section 8.1a on the date the employee sustained his
12or her accidental injuries shall be limited to:
13        (1) all first aid and emergency treatment; plus
14        (2) all medical, surgical and hospital services
15    provided by the physician, surgeon or hospital initially
16    chosen by the employee or by any other physician,
17    consultant, expert, institution or other provider of
18    services recommended by said initial service provider or
19    any subsequent provider of medical services in the chain of
20    referrals from said initial service provider; plus
21         (3) all medical, surgical and hospital services
22    provided by any second physician, surgeon or hospital
23    subsequently chosen by the employee or by any other
24    physician, consultant, expert, institution or other
25    provider of services recommended by said second service
26    provider or any subsequent provider of medical services in

 

 

09700HB1698sam003- 56 -LRB097 07917 AEK 56376 a

1    the chain of referrals from said second service provider.
2    Thereafter the employer shall select and pay for all
3    necessary medical, surgical and hospital treatment and the
4    employee may not select a provider of medical services at
5    the employer's expense unless the employer agrees to such
6    selection. At any time the employee may obtain any medical
7    treatment he desires at his own expense. This paragraph
8    shall not affect the duty to pay for rehabilitation
9    referred to above.
10        (4) The following shall apply for injuries occurring on
11    or after the effective date of this amendatory Act of the
12    97th General Assembly and only when an employer has an
13    approved preferred provider program pursuant to Section
14    8.1a on the date the employee sustained his or her
15    accidental injuries:
16            (A) The employer shall, in writing, on a form
17        promulgated by the Commission, inform the employee of
18        the preferred provider program;
19            (B) Subsequent to the report of an injury by an
20        employee, the employee may choose in writing at any
21        time to decline the preferred provider program, in
22        which case that would constitute one of the two choices
23        of medical providers to which the employee is entitled
24        under subsection (a)(2) or (a)(3); and
25            (C) Prior to the report of an injury by an
26        employee, when an employee chooses non-emergency

 

 

09700HB1698sam003- 57 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 58 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 59 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 60 -LRB097 07917 AEK 56376 a

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1provided in this paragraph shall not affect the employee's
2right to compensation payable under paragraphs (b), (c) and (e)
3of this Section for the disabilities therein covered.
4    (e) For accidental injuries in the following schedule, the
5employee shall receive compensation for the period of temporary
6total incapacity for work resulting from such accidental
7injury, under subparagraph 1 of paragraph (b) of this Section,
8and shall receive in addition thereto compensation for a
9further period for the specific loss herein mentioned, but
10shall not receive any compensation under any other provisions
11of this Act. The following listed amounts apply to either the
12loss of or the permanent and complete loss of use of the member
13specified, such compensation for the length of time as follows:
14        1. Thumb-
15            70 weeks if the accidental injury occurs on or
16        after the effective date of this amendatory Act of the
17        94th General Assembly but before February 1, 2006.
18            76 weeks if the accidental injury occurs on or
19        after February 1, 2006.
20        2. First, or index finger-
21            40 weeks if the accidental injury occurs on or
22        after the effective date of this amendatory Act of the
23        94th General Assembly but before February 1, 2006.
24            43 weeks if the accidental injury occurs on or
25        after February 1, 2006.
26        3. Second, or middle finger-

 

 

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1            35 weeks if the accidental injury occurs on or
2        after the effective date of this amendatory Act of the
3        94th General Assembly but before February 1, 2006.
4            38 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        4. Third, or ring finger-
7            25 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            27 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        5. Fourth, or little finger-
13            20 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            22 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        6. Great toe-
19            35 weeks if the accidental injury occurs on or
20        after the effective date of this amendatory Act of the
21        94th General Assembly but before February 1, 2006.
22            38 weeks if the accidental injury occurs on or
23        after February 1, 2006.
24        7. Each toe other than great toe-
25            12 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

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

 

 

09700HB1698sam003- 70 -LRB097 07917 AEK 56376 a

1        30% loss of use of the hand.
2        The loss of 2 or more digits, or one or more phalanges
3    of 2 or more digits, of a hand may be compensated on the
4    basis of partial loss of use of a hand, provided, further,
5    that the loss of 4 digits, or the loss of use of 4 digits,
6    in the same hand shall constitute the complete loss of a
7    hand.
8        10. Arm-
9            235 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            253 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        Where an accidental injury results in the amputation of
15    an arm below the elbow, such injury shall be compensated as
16    a loss of an arm. Where an accidental injury results in the
17    amputation of an arm above the elbow, compensation for an
18    additional 15 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 17 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 an arm at
24    the shoulder joint, or so close to shoulder joint that an
25    artificial arm cannot be used, or results in the
26    disarticulation of an arm at the shoulder joint, in which

 

 

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1    case compensation for an additional 65 weeks (if the
2    accidental injury occurs on or after the effective date of
3    this amendatory Act of the 94th General Assembly but before
4    February 1, 2006) or an additional 70 weeks (if the
5    accidental injury occurs on or after February 1, 2006)
6    shall be paid.
7        11. Foot-
8            155 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            167 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        12. Leg-
14            200 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            215 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        Where an accidental injury results in the amputation of
20    a leg below the knee, such injury shall be compensated as
21    loss of a leg. Where an accidental injury results in the
22    amputation of a leg above the knee, compensation for an
23    additional 25 weeks (if the accidental injury occurs on or
24    after the effective date of this amendatory Act of the 94th
25    General Assembly but before February 1, 2006) or an
26    additional 27 weeks (if the accidental injury occurs on or

 

 

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1    after February 1, 2006) shall be paid, except where the
2    accidental injury results in the amputation of a leg at the
3    hip joint, or so close to the hip joint that an artificial
4    leg cannot be used, or results in the disarticulation of a
5    leg at the hip joint, in which case compensation for an
6    additional 75 weeks (if the accidental injury occurs on or
7    after the effective date of this amendatory Act of the 94th
8    General Assembly but before February 1, 2006) or an
9    additional 81 weeks (if the accidental injury occurs on or
10    after February 1, 2006) shall be paid.
11        13. Eye-
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        Where an accidental injury results in the enucleation
18    of an eye, compensation for an additional 10 weeks (if the
19    accidental injury occurs on or after the effective date of
20    this amendatory Act of the 94th General Assembly but before
21    February 1, 2006) or an additional 11 weeks (if the
22    accidental injury occurs on or after February 1, 2006)
23    shall be paid.
24        14. Loss of hearing of one ear-
25            50 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

09700HB1698sam003- 73 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 74 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 75 -LRB097 07917 AEK 56376 a

1        average decibel loss. For every decibel of loss
2        exceeding 30 decibels an allowance of 1.82% shall be
3        made up to the maximum of 100% which is reached at 85
4        decibels.
5            (d) If a hearing loss is established to have
6        existed on July 1, 1975 by audiometric testing the
7        employer shall not be liable for the previous loss so
8        established nor shall he be liable for any loss for
9        which compensation has been paid or awarded.
10            (e) No consideration shall be given to the question
11        of whether or not the ability of an employee to
12        understand speech is improved by the use of a hearing
13        aid.
14            (f) No claim for loss of hearing due to industrial
15        noise shall be brought against an employer or allowed
16        unless the employee has been exposed for a period of
17        time sufficient to cause permanent impairment to noise
18        levels in excess of the following:
19Sound Level DBA
20Slow ResponseHours Per Day
21908
22926
23954
24973
251002
261021-1/2

 

 

09700HB1698sam003- 76 -LRB097 07917 AEK 56376 a

11051
21101/2
31151/4
4        This subparagraph (f) shall not be applied in cases of
5    hearing loss resulting from trauma or explosion.
6        17. In computing the compensation to be paid to any
7    employee who, before the accident for which he claims
8    compensation, had before that time sustained an injury
9    resulting in the loss by amputation or partial loss by
10    amputation of any member, including hand, arm, thumb or
11    fingers, leg, foot or any toes, such loss or partial loss
12    of any such member shall be deducted from any award made
13    for the subsequent injury. For the permanent loss of use or
14    the permanent partial loss of use of any such member or the
15    partial loss of sight of an eye, for which compensation has
16    been paid, then such loss shall be taken into consideration
17    and deducted from any award for the subsequent injury.
18        18. The specific case of loss of both hands, both arms,
19    or both feet, or both legs, or both eyes, or of any two
20    thereof, or the permanent and complete loss of the use
21    thereof, constitutes total and permanent disability, to be
22    compensated according to the compensation fixed by
23    paragraph (f) of this Section. These specific cases of
24    total and permanent disability do not exclude other cases.
25        Any employee who has previously suffered the loss or
26    permanent and complete loss of the use of any of such

 

 

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

 

 

09700HB1698sam003- 78 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 79 -LRB097 07917 AEK 56376 a

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

 

 

09700HB1698sam003- 80 -LRB097 07917 AEK 56376 a

1Injury Fund provided for in paragraph (f) of Section 7, which,
2together with the compensation payable from the employer in
3whose employ he was when the last accidental injury was
4incurred, will equal the amount payable for permanent and
5complete disability as provided in this paragraph of this
6Section.
7    The custodian of the Second Injury Fund provided for in
8paragraph (f) of Section 7 shall be joined with the employer as
9a party respondent in the application for adjustment of claim.
10The application for adjustment of claim shall state briefly and
11in general terms the approximate time and place and manner of
12the loss of the first member.
13    In its award the Commission or the Arbitrator shall
14specifically find the amount the injured employee shall be
15weekly paid, the number of weeks compensation which shall be
16paid by the employer, the date upon which payments begin out of
17the Second Injury Fund provided for in paragraph (f) of Section
187 of this Act, the length of time the weekly payments continue,
19the date upon which the pension payments commence and the
20monthly amount of the payments. The Commission shall 30 days
21after the date upon which payments out of the Second Injury
22Fund have begun as provided in the award, and every month
23thereafter, prepare and submit to the State Comptroller a
24voucher for payment for all compensation accrued to that date
25at the rate fixed by the Commission. The State Comptroller
26shall draw a warrant to the injured employee along with a

 

 

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1receipt to be executed by the injured employee and returned to
2the Commission. The endorsed warrant and receipt is a full and
3complete acquittance to the Commission for the payment out of
4the Second Injury Fund. No other appropriation or warrant is
5necessary for payment out of the Second Injury Fund. The Second
6Injury Fund is appropriated for the purpose of making payments
7according to the terms of the awards.
8    As of July 1, 1980 to July 1, 1982, all claims against and
9obligations of the Second Injury Fund shall become claims
10against and obligations of the Rate Adjustment Fund to the
11extent there is insufficient money in the Second Injury Fund to
12pay such claims and obligations. In that case, all references
13to "Second Injury Fund" in this Section shall also include the
14Rate Adjustment Fund.
15    (g) Every award for permanent total disability entered by
16the Commission on and after July 1, 1965 under which
17compensation payments shall become due and payable after the
18effective date of this amendatory Act, and every award for
19death benefits or permanent total disability entered by the
20Commission on and after the effective date of this amendatory
21Act shall be subject to annual adjustments as to the amount of
22the compensation rate therein provided. Such adjustments shall
23first be made on July 15, 1977, and all awards made and entered
24prior to July 1, 1975 and on July 15 of each year thereafter.
25In all other cases such adjustment shall be made on July 15 of
26the second year next following the date of the entry of the

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1credit.
2    2. Nothing contained in this Act shall be construed to give
3the employer or the insurance carrier the right to credit for
4any benefits or payments received by the employee other than
5compensation payments provided by this Act, and where the
6employee receives payments other than compensation payments,
7whether as full or partial salary, group insurance benefits,
8bonuses, annuities or any other payments, the employer or
9insurance carrier shall receive credit for each such payment
10only to the extent of the compensation that would have been
11payable during the period covered by such payment.
12    3. The extension of time for the filing of an Application
13for Adjustment of Claim as provided in paragraph 1 above shall
14not apply to those cases where the time for such filing had
15expired prior to the date on which payments or benefits
16enumerated herein have been initiated or resumed. Provided
17however that this paragraph 3 shall apply only to cases wherein
18the payments or benefits hereinabove enumerated shall be
19received after July 1, 1969.
20(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
2194-695, eff. 11-16-05.)
 
22    (820 ILCS 305/8.1a new)
23    Sec. 8.1a. Preferred provider programs. Starting on the
24effective date of this amendatory Act of the 97th General
25Assembly, to satisfy its liabilities under this Act for the

 

 

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1provision of medical treatment to injured employees, an
2employer may utilize a preferred provider program approved by
3the Illinois Department of Insurance as in compliance with
4Sections 370k, 370l, 370m, and 370p of Article XX-1/2 of the
5Illinois Insurance Code. For the purposes of compliance with
6these Sections, the employee shall be considered the
7"beneficiary" and the employer shall be considered the
8"insured". Employers and insurers contracting directly with
9providers or utilizing multiple preferred provider programs to
10implement a preferred provider program providing workers'
11compensation benefits shall be subject to the above
12requirements of Article XX-1/2 applicable to administrators
13with regard to such program, with the exception of Section 370l
14of the Illinois Insurance Code.
15    (a) In addition to the above requirements of Article XX-1/2
16of the Illinois Insurance Code, all preferred provider programs
17under this Section shall meet the following requirements:
18        (1) The provider network shall include an adequate
19    number of occupational and non-occupational providers.
20        (2) The provider network shall include an adequate
21    number and type of physicians or other providers to treat
22    common injuries experienced by injured workers in the
23    geographic area where the employees reside.
24        (3) Medical treatment for injuries shall be readily
25    available at reasonable times to all employees. To the
26    extent feasible, all medical treatment for injuries shall

 

 

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1    be readily accessible to all employees.
2        (4) Physician compensation shall not be structured in
3    order to achieve the goal of inappropriately reducing,
4    delaying, or denying medical treatment or restricting
5    access to medical treatment.
6        (5) Before entering into any agreement under this
7    Section, a program shall establish terms and conditions
8    that must be met by noninstitutional providers wishing to
9    enter into an agreement with the program. These terms and
10    conditions may not discriminate unreasonably against or
11    among noninstitutional providers. Neither difference in
12    prices among noninstitutional providers produced by a
13    process of individual negotiation nor price differences
14    among other noninstitutional providers in different
15    geographical areas or different specialties constitutes
16    unreasonable discrimination.
17    (b) The administrator of any preferred provider program
18under this Act that uses economic evaluation shall file with
19the Director of Insurance a description of any policies and
20procedures related to economic evaluation utilized by the
21program. The filing shall describe how these policies and
22procedures are used in utilization review, peer review,
23incentive and penalty programs, and in provider retention and
24termination decisions. The Director of Insurance may deny
25approval of any preferred provider program that uses any policy
26or procedure of economic evaluation to inappropriately reduce,

 

 

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1delay or deny medical treatment, or to restrict access to
2medical treatment. Evaluation of providers based upon
3objective medical quality and patient outcome measurements,
4appropriate use of best clinical practices and evidence based
5medicine, and use of health information technology shall be
6permitted. If approved, the employer shall provide a copy of
7the filing to all participating providers.
8        (1) The Director of the Department of Insurance shall
9    make each administrator's filing available to the public
10    upon request. The Director of the Department of Insurance
11    may not publicly disclose any information submitted
12    pursuant to this Section that is determined by the Director
13    of the Department of Insurance to be confidential,
14    proprietary, or trade secret information pursuant to State
15    or federal law.
16        (2) For the purposes of this subsection (b), "economic
17    evaluation" shall mean any evaluation of a particular
18    physician, provider, medical group, or individual practice
19    association based in whole or in part on the economic costs
20    or utilization of services associated with medical care
21    provided or authorized by the physician, provider, medical
22    group, or individual practice association. Economic
23    evaluation shall not include negotiated rates with a
24    provider.
25    (c) Except for the provisions of subsection (a) of Section
268 and for injuries occurring on or after the effective date of

 

 

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1this amendatory Act of the 97th General Assembly, an employee
2of an employer utilizing a preferred provider program shall
3only be allowed to select a participating network provider from
4the network. An employer shall be responsible for: (i) all
5first aid and emergency treatment; (ii) all medical, surgical,
6and hospital services provided by the participating network
7provider initially selected by the employee or by any other
8participating network provider recommended by the initial
9participating network provider or any subsequent participating
10network provider in the chain of referrals from the initial
11participating network provider; and (iii) all medical,
12surgical, and hospital services provided by the participating
13network provider subsequently chosen by the employee or by any
14other participating network provider recommended by the
15subsequent participating network provider or any subsequent
16participating network provider in the chain of referrals from
17the second participating network provider. An employer shall
18not be liable for services determined by the Commission not to
19be compensable. An employer shall not be liable for medical
20services provided by a non-authorized provider when proper
21notice is provided to the injured worker.
22        (1) When the injured employee notifies the employer of
23    the injury or files a claim for workers' compensation with
24    the employer, the employer shall notify the employee of his
25    or her right to be treated by a physician of his or her
26    choice from the preferred provider network established

 

 

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

 

 

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1expense. The Commission shall issue a decision on any petition
2filed pursuant to this Section within 5 working days.
3    (e) The Director of the Department of Insurance may
4promulgate such rules as are necessary to carry out the
5provisions of this Section relating to approval and regulation
6of preferred provider programs.
 
7    (820 ILCS 305/8.1b new)
8    Sec. 8.1b. Determination of permanent partial disability.
9For accidental injuries that occur on or after September 1,
102011, permanent partial disability shall be established using
11the following criteria:
12    (a) A physician licensed to practice medicine in all of its
13branches preparing a permanent partial disability impairment
14report shall report the level of impairment in writing. The
15report shall include an evaluation of medically defined and
16professionally appropriate measurements of impairment that
17include, but are not limited to: loss of range of motion; loss
18of strength; measured atrophy of tissue mass consistent with
19the injury; and any other measurements that establish the
20nature and extent of the impairment. The most current edition
21of the American Medical Association's "Guides to the Evaluation
22of Permanent Impairment" shall be used by the physician in
23determining the level of impairment.
24    (b) In determining the level of permanent partial
25disability, the Commission shall base its determination on the

 

 

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1following factors: (i) the reported level of impairment
2pursuant to subsection (a); (ii) the occupation of the injured
3employee; (iii) the age of the employee at the time of the
4injury; (iv) the employee's future earning capacity; and (v)
5evidence of disability corroborated by the treating medical
6records. No single enumerated factor shall be the sole
7determinant of disability. In determining the level of
8disability, the relevance and weight of any factors used in
9addition to the level of impairment as reported by the
10physician must be explained in a written order.
 
11    (820 ILCS 305/8.2)
12    Sec. 8.2. Fee schedule.
13    (a) Except as provided for in subsection (c), for
14procedures, treatments, or services covered under this Act and
15rendered or to be rendered on and after February 1, 2006, the
16maximum allowable payment shall be 90% of the 80th percentile
17of charges and fees as determined by the Commission utilizing
18information provided by employers' and insurers' national
19databases, with a minimum of 12,000,000 Illinois line item
20charges and fees comprised of health care provider and hospital
21charges and fees as of August 1, 2004 but not earlier than
22August 1, 2002. These charges and fees are provider billed
23amounts and shall not include discounted charges. The 80th
24percentile is the point on an ordered data set from low to high
25such that 80% of the cases are below or equal to that point and

 

 

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1at most 20% are above or equal to that point. The Commission
2shall adjust these historical charges and fees as of August 1,
32004 by the Consumer Price Index-U for the period August 1,
42004 through September 30, 2005. The Commission shall establish
5fee schedules for procedures, treatments, or services for
6hospital inpatient, hospital outpatient, emergency room and
7trauma, ambulatory surgical treatment centers, and
8professional services. These charges and fees shall be
9designated by geozip or any smaller geographic unit. The data
10shall in no way identify or tend to identify any patient,
11employer, or health care provider. As used in this Section,
12"geozip" means a three-digit zip code based on data
13similarities, geographical similarities, and frequencies. A
14geozip does not cross state boundaries. As used in this
15Section, "three-digit zip code" means a geographic area in
16which all zip codes have the same first 3 digits. If a geozip
17does not have the necessary number of charges and fees to
18calculate a valid percentile for a specific procedure,
19treatment, or service, the Commission may combine data from the
20geozip with up to 4 other geozips that are demographically and
21economically similar and exhibit similarities in data and
22frequencies until the Commission reaches 9 charges or fees for
23that specific procedure, treatment, or service. In cases where
24the compiled data contains less than 9 charges or fees for a
25procedure, treatment, or service, reimbursement shall occur at
2676% of charges and fees as determined by the Commission in a

 

 

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1manner consistent with the provisions of this paragraph.
2Providers of out-of-state procedures, treatments, services,
3products, or supplies shall be reimbursed at the lesser of that
4state's fee schedule amount or the fee schedule amount for the
5region in which the employee resides. If no fee schedule exists
6in that state, the provider shall be reimbursed at the lesser
7of the actual charge or the fee schedule amount for the region
8in which the employee resides. The Commission has the authority
9to set the maximum allowable payment to providers of
10out-of-state procedures, treatments, or services covered under
11this Act in a manner consistent with this Section. Not later
12than September 30 in 2006 and each year thereafter, the
13Commission shall automatically increase or decrease the
14maximum allowable payment for a procedure, treatment, or
15service established and in effect on January 1 of that year by
16the percentage change in the Consumer Price Index-U for the 12
17month period ending August 31 of that year. The increase or
18decrease shall become effective on January 1 of the following
19year. As used in this Section, "Consumer Price Index-U" means
20the index published by the Bureau of Labor Statistics of the
21U.S. Department of Labor, that measures the average change in
22prices of all goods and services purchased by all urban
23consumers, U.S. city average, all items, 1982-84=100.
24    (a-1) Notwithstanding the provisions of subsection (a) and
25unless otherwise indicated, the following provisions shall
26apply to the medical fee schedule starting on September 1,

 

 

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12011:
2        (1) The Commission shall establish and maintain fee
3    schedules for procedures, treatments, products, services,
4    or supplies for hospital inpatient, hospital outpatient,
5    emergency room, ambulatory surgical treatment centers,
6    accredited ambulatory surgical treatment facilities,
7    prescriptions filled and dispensed outside of a licensed
8    pharmacy, dental services, and professional services. This
9    fee schedule shall be based on the fee schedule amounts
10    already established by the Commission pursuant to
11    subsection (a) of this Section. However, starting on
12    January 1, 2012, these fee schedule amounts shall be
13    grouped into geographic regions in the following manner:
14            (A) Four regions for non-hospital fee schedule
15        amounts shall be utilized:
16                (i) Cook County;
17                (ii) DuPage, Kane, Lake, and Will Counties;
18                (iii) Bond, Calhoun, Clinton, Jersey,
19            Macoupin, Madison, Monroe, Montgomery, Randolph,
20            St. Clair, and Washington Counties; and
21                (iv) All other counties of the State.
22            (B) Fourteen regions for hospital fee schedule
23        amounts shall be utilized:
24                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
25            Kendall, and Grundy Counties;
26                (ii) Kankakee County;

 

 

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

 

 

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1    reimbursement shall occur at 76% of charges and fees until
2    September 1, 2011 and 53.2% of charges and fees thereafter
3    as determined by the Commission in a manner consistent with
4    the provisions of this paragraph.
5        (4) To establish additional fee schedule amounts, the
6    Commission shall utilize provider non-discounted charge
7    data, non-Medicare relative values and conversion factors
8    derived from established fee schedule amounts, and coding
9    crosswalks. The Commission may establish additional fee
10    schedule amounts based on either the charge or cost of the
11    procedure, treatment, product, supply, or service.
12        (5) Implants shall be reimbursed at 25% above the net
13    manufacturer's invoice price less rebates, plus actual
14    reasonable and customary shipping charges whether or not
15    the implant charge is submitted by a provider in
16    conjunction with a bill for all other services associated
17    with the implant, submitted by a provider on a separate
18    claim form, submitted by a distributor, or submitted by the
19    manufacturer of the implant. "Implants" include the
20    following codes or any substantially similar updated code
21    as determined by the Commission: 0274
22    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
23    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
24    (investigational devices); and 0636 (drugs requiring
25    detailed coding). Non-implantable devices or supplies
26    within these codes shall be reimbursed at 65% of actual

 

 

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1    charge, which is the provider's normal rates under its
2    standard chargemaster. A standard chargemaster is the
3    provider's list of charges for procedures, treatments,
4    products, supplies, or services used to bill payers in a
5    consistent manner.
6        (6) The Commission shall automatically update all
7    codes and associated rules with the version of the codes
8    and rules valid on January 1 of that year.
9    (a-2) For procedures, treatments, services, or supplies
10covered under this Act and rendered or to be rendered on or
11after September 1, 2011, the maximum allowable payment shall be
1270% of the fee schedule amounts, which shall be adjusted yearly
13by the Consumer Price Index-U, as described in subsection (a)
14of this Section.
15    (a-3) Prescriptions filled and dispensed outside of a
16licensed pharmacy shall be subject to a fee schedule that shall
17not exceed the Average Wholesale Price (AWP) plus a dispensing
18fee of $4.18. AWP or its equivalent as registered by the
19National Drug Code shall be set forth for that drug on that
20date as published in Medispan.
21    (b) Notwithstanding the provisions of subsection (a), if
22the Commission finds that there is a significant limitation on
23access to quality health care in either a specific field of
24health care services or a specific geographic limitation on
25access to health care, it may change the Consumer Price Index-U
26increase or decrease for that specific field or specific

 

 

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1geographic limitation on access to health care to address that
2limitation.
3    (c) The Commission shall establish by rule a process to
4review those medical cases or outliers that involve
5extra-ordinary treatment to determine whether to make an
6additional adjustment to the maximum payment within a fee
7schedule for a procedure, treatment, or service.
8    (d) When a patient notifies a provider that the treatment,
9procedure, or service being sought is for a work-related
10illness or injury and furnishes the provider the name and
11address of the responsible employer, the provider shall bill
12the employer directly. The employer shall make payment and
13providers shall submit bills and records in accordance with the
14provisions of this Section.
15        (1) All payments to providers for treatment provided
16    pursuant to this Act shall be made within 30 60 days of
17    receipt of the bills as long as the claim contains
18    substantially all the required data elements necessary to
19    adjudicate the bills.
20        (2) If the claim does not contain substantially all the
21    required data elements necessary to adjudicate the bill, or
22    the claim is denied for any other reason, in whole or in
23    part, the employer or insurer shall provide written
24    notification, explaining the basis for the denial and
25    describing any additional necessary data elements, to the
26    provider within 30 days of receipt of the bill.

 

 

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1        (3) In the case of nonpayment to a provider within 30
2    60 days of receipt of the bill which contained
3    substantially all of the required data elements necessary
4    to adjudicate the bill or nonpayment to a provider of a
5    portion of such a bill up to the lesser of the actual
6    charge or the payment level set by the Commission in the
7    fee schedule established in this Section, the bill, or
8    portion of the bill, shall incur interest at a rate of 1%
9    per month payable to the provider. Any required interest
10    payments shall be made within 30 days after payment.
11    (e) Except as provided in subsections (e-5), (e-10), and
12(e-15), a provider shall not hold an employee liable for costs
13related to a non-disputed procedure, treatment, or service
14rendered in connection with a compensable injury. The
15provisions of subsections (e-5), (e-10), (e-15), and (e-20)
16shall not apply if an employee provides information to the
17provider regarding participation in a group health plan. If the
18employee participates in a group health plan, the provider may
19submit a claim for services to the group health plan. If the
20claim for service is covered by the group health plan, the
21employee's responsibility shall be limited to applicable
22deductibles, co-payments, or co-insurance. Except as provided
23under subsections (e-5), (e-10), (e-15), and (e-20), a provider
24shall not bill or otherwise attempt to recover from the
25employee the difference between the provider's charge and the
26amount paid by the employer or the insurer on a compensable

 

 

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

 

 

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

 

 

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

 

 

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1the implementation of the medical fee schedule and the index
2used for annual adjustment to that schedule as described in
3this Section.
4(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
5    (820 ILCS 305/8.2a new)
6    Sec. 8.2a. Electronic claims.
7    (a) The Director of Insurance shall adopt rules to do all
8of the following:
9        (1) Ensure that all health care providers and
10    facilities submit medical bills for payment on
11    standardized forms.
12        (2) Require acceptance by employers and insurers of
13    electronic claims for payment of medical services.
14        (3) Ensure confidentiality of medical information
15    submitted on electronic claims for payment of medical
16    services.
17    (b) To the extent feasible, standards adopted pursuant to
18subdivision (a) shall be consistent with existing standards
19under the federal Health Insurance Portability and
20Accountability Act of 1996 and standards adopted under the
21Illinois Health Information Exchange and Technology Act.
22    (c) The rules requiring employers and insurers to accept
23electronic claims for payment of medical services shall be
24proposed on or before January 1, 2012, and shall require all
25employers and insurers to accept electronic claims for payment

 

 

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1of medical services on or before June 30, 2012.
2    (d) The Director of Insurance shall by rule establish
3criteria for granting exceptions to employers, insurance
4carriers, and health care providers who are unable to submit or
5accept medical bills electronically.
 
6    (820 ILCS 305/8.7)
7    Sec. 8.7. Utilization review programs.
8    (a) As used in this Section:
9    "Utilization review" means the evaluation of proposed or
10provided health care services to determine the appropriateness
11of both the level of health care services medically necessary
12and the quality of health care services provided to a patient,
13including evaluation of their efficiency, efficacy, and
14appropriateness of treatment, hospitalization, or office
15visits based on medically accepted standards. The evaluation
16must be accomplished by means of a system that identifies the
17utilization of health care services based on standards of care
18of or nationally recognized peer review guidelines as well as
19nationally recognized treatment guidelines and evidence-based
20medicine evidence based upon standards as provided in this Act.
21Utilization techniques may include prospective review, second
22opinions, concurrent review, discharge planning, peer review,
23independent medical examinations, and retrospective review
24(for purposes of this sentence, retrospective review shall be
25applicable to services rendered on or after July 20, 2005).

 

 

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1Nothing in this Section applies to prospective review of
2necessary first aid or emergency treatment.
3    (b) No person may conduct a utilization review program for
4workers' compensation services in this State unless once every
52 years the person registers the utilization review program
6with the Department of Insurance Financial and Professional
7Regulation and certifies compliance with the Workers'
8Compensation Utilization Management standards or Health
9Utilization Management Standards of URAC sufficient to achieve
10URAC accreditation or submits evidence of accreditation by URAC
11for its Workers' Compensation Utilization Management Standards
12or Health Utilization Management Standards. Nothing in this Act
13shall be construed to require an employer or insurer or its
14subcontractors to become URAC accredited.
15    (c) In addition, the Director Secretary of Insurance
16Financial and Professional Regulation may certify alternative
17utilization review standards of national accreditation
18organizations or entities in order for plans to comply with
19this Section. Any alternative utilization review standards
20shall meet or exceed those standards required under subsection
21(b).
22    (d) This registration shall include submission of all of
23the following information regarding utilization review program
24activities:
25        (1) The name, address, and telephone number of the
26    utilization review programs.

 

 

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

 

 

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1regarding the medical necessity of health care services during
2the course of utilization review.
3    When making retrospective reviews, utilization review
4programs shall base reviews solely on the medical information
5available to the attending physician or ordering provider at
6the time the health care services were provided.
7    (f) If the Department of Insurance Financial and
8Professional Regulation finds that a utilization review
9program is not in compliance with this Section, the Department
10shall issue a corrective action plan and allow a reasonable
11amount of time for compliance with the plan. If the utilization
12review program does not come into compliance, the Department
13may issue a cease and desist order. Before issuing a cease and
14desist order under this Section, the Department shall provide
15the utilization review program with a written notice of the
16reasons for the order and allow a reasonable amount of time to
17supply additional information demonstrating compliance with
18the requirements of this Section and to request a hearing. The
19hearing notice shall be sent by certified mail, return receipt
20requested, and the hearing shall be conducted in accordance
21with the Illinois Administrative Procedure Act.
22    (g) A utilization review program subject to a corrective
23action may continue to conduct business until a final decision
24has been issued by the Department.
25    (h) The Department of Insurance Secretary of Financial and
26Professional Regulation may by rule establish a registration

 

 

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

 

 

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1        (4) When a payment for medical services has been denied
2    or not authorized by an employer or when authorization for
3    medical services is denied pursuant to utilization review,
4    the employee has the burden of proof to show by a
5    preponderance of the evidence that a variance from the
6    standards of care used by the person or entity performing
7    the utilization review pursuant to subsection (a) is
8    reasonably required to cure or relieve the effects of his
9    or her injury.
10        (5) The medical professional responsible for review in
11    the final stage of utilization review or appeal must be
12    available in this State for interview or deposition; or
13    must be available for deposition by telephone, video
14    conference, or other remote electronic means. A medical
15    professional who works or resides in this State or outside
16    of this State may comply with this requirement by making
17    himself or herself available for an interview or deposition
18    in person or by making himself or herself available by
19    telephone, video conference, or other remote electronic
20    means. The remote interview or deposition shall be
21    conducted in a fair, open, and cost-effective manner. The
22    expense of interview and the deposition method shall be
23    paid by the employer. The deponent shall be in the presence
24    of the officer administering the oath and recording the
25    deposition, unless otherwise agreed by the parties. Any
26    exhibits or other demonstrative evidence to be presented to

 

 

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

 

 

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1payment of additional compensation pursuant to Section 19(k) of
2this Act and if that denial or refusal to authorize does not
3comply with a utilization review program registered under this
4Section and does not comply with all other requirements of this
5Section, then that will be considered by the Commission, along
6with all other evidence and in the same manner as all other
7evidence, in the determination of whether the employer may be
8responsible for the payment of additional compensation
9pursuant to Section 19(k) of this Act.
10    The changes to this Section made by this amendatory Act of
11the 97th General Assembly apply only to health care services
12provided or proposed to be provided on or after September 1,
132011.
14(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
15    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)
16    Sec. 11. The compensation herein provided, together with
17the provisions of this Act, shall be the measure of the
18responsibility of any employer engaged in any of the
19enterprises or businesses enumerated in Section 3 of this Act,
20or of any employer who is not engaged in any such enterprises
21or businesses, but who has elected to provide and pay
22compensation for accidental injuries sustained by any employee
23arising out of and in the course of the employment according to
24the provisions of this Act, and whose election to continue
25under this Act, has not been nullified by any action of his

 

 

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

 

 

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

 

 

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1proximate cause or proximate cause of the accidental injuries.
2Percentage by weight of alcohol in the blood shall be based on
3grams of alcohol per 100 milliliters of blood. Percentage by
4weight of alcohol in the breath shall be based upon grams of
5alcohol per 210 liters of breath. Any testing that has not been
6performed by an accredited or certified testing laboratory
7shall not be admissible in any hearing under this Act to
8determine whether the employee was intoxicated at the time the
9employee incurred the accidental injury.
10    All sample collection and testing for alcohol and drugs
11under this Section shall be performed in accordance with rules
12to be adopted by the Commission. These rules shall ensure:
13        (1) compliance with the National Labor Relations Act
14    regarding collective bargaining agreements or regulations
15    promulgated by the United States Department of
16    Transportation;
17        (2) that samples are collected and tested in
18    conformance with national and State legal and regulatory
19    standards for the privacy of the individual being tested,
20    and in a manner reasonably calculated to prevent
21    substitutions or interference with the collection or
22    testing of reliable sample;
23        (3) that split testing procedures are utilized;
24        (4) that sample collection is documented, and the
25    documentation procedures include:
26            (A) the labeling of samples in a manner so as to

 

 

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1        reasonably preclude the probability of erroneous
2        identification of test result; and
3            (B) an opportunity for the employee to provide
4        notification of any information which he or she
5        considers relevant to the test, including
6        identification of currently or recently used
7        prescription or nonprescription drugs and other
8        relevant medical information;
9        (5) that sample collection, storage, and
10    transportation to the place of testing is performed in a
11    manner so as to reasonably preclude the probability of
12    sample contamination or adulteration; and
13        (6) that chemical analyses of blood, urine, breath, or
14    other bodily substance are performed according to
15    nationally scientifically accepted analytical methods and
16    procedures.
17    The changes to this Section made by this amendatory Act of
18the 97th General Assembly apply only to accidental injuries
19that occur on or after September 1, 2011.
20(Source: P.A. 93-829, eff. 7-28-04.)
 
21    (820 ILCS 305/13)  (from Ch. 48, par. 138.13)
22    Sec. 13. There is created an Illinois Workers' Compensation
23Commission consisting of 10 members to be appointed by the
24Governor, by and with the consent of the Senate, 3 of whom
25shall be representative citizens of the employing class

 

 

09700HB1698sam003- 119 -LRB097 07917 AEK 56376 a

1operating under this Act and 3 of whom shall be representative
2citizens of the class of employees covered under this Act, and
34 of whom shall be representative citizens not identified with
4either the employing or employee classes. Not more than 6
5members of the Commission shall be of the same political party.
6    One of the members not identified with either the employing
7or employee classes shall be designated by the Governor as
8Chairman. The Chairman shall be the chief administrative and
9executive officer of the Commission; and he or she shall have
10general supervisory authority over all personnel of the
11Commission, including arbitrators and Commissioners, and the
12final authority in all administrative matters relating to the
13Commissioners, including but not limited to the assignment and
14distribution of cases and assignment of Commissioners to the
15panels, except in the promulgation of procedural rules and
16orders under Section 16 and in the determination of cases under
17this Act.
18    Notwithstanding the general supervisory authority of the
19Chairman, each Commissioner, except those assigned to the
20temporary panel, shall have the authority to hire and supervise
212 staff attorneys each. Such staff attorneys shall report
22directly to the individual Commissioner.
23    A formal training program for newly-appointed
24Commissioners shall be implemented. The training program shall
25include the following:
26        (a) substantive and procedural aspects of the office of

 

 

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

 

 

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1    Permanent Impairment" and the practice of utilization
2    review; and
3        (k) substantive and procedural aspects of coal
4    workers' pneumoconiosis (black lung) cases.
5    A formal and ongoing professional development program
6including, but not limited to, the above-noted areas shall be
7implemented to keep Commissioners informed of recent
8developments and issues and to assist them in maintaining and
9enhancing their professional competence. Each Commissioner
10shall complete 20 hours of training in the above-noted areas
11during every 2 years such Commissioner shall remain in office.
12    The Commissioner candidates, other than the Chairman, must
13meet one of the following qualifications: (a) licensed to
14practice law in the State of Illinois; or (b) served as an
15arbitrator at the Illinois Workers' Compensation Commission
16for at least 3 years; or (c) has at least 4 years of
17professional labor relations experience. The Chairman
18candidate must have public or private sector management and
19budget experience, as determined by the Governor.
20    Each Commissioner shall devote full time to his duties and
21any Commissioner who is an attorney-at-law shall not engage in
22the practice of law, nor shall any Commissioner hold any other
23office or position of profit under the United States or this
24State or any municipal corporation or political subdivision of
25this State, nor engage in any other business, employment, or
26vocation.

 

 

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

 

 

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1    covered in this Act, and two of whom shall be
2    representative citizens not identified with either the
3    employing or employee classes, one of whom shall be
4    designated by the Governor as Chairman (at least one of
5    each of the two major political parties) shall be appointed
6    to hold office until the third Monday of January in 1991,
7    and until their successors are appointed and qualified.
8        (a-5) Notwithstanding any other provision of this
9    Section, the term of each member of the Commission who was
10    appointed by the Governor and is in office on June 30, 2003
11    shall terminate at the close of business on that date or
12    when all of the successor members to be appointed pursuant
13    to this amendatory Act of the 93rd General Assembly have
14    been appointed by the Governor, whichever occurs later. As
15    soon as possible, the Governor shall appoint persons to
16    fill the vacancies created by this amendatory Act. Of the
17    initial commissioners appointed pursuant to this
18    amendatory Act of the 93rd General Assembly, 3 shall be
19    appointed for terms ending on the third Monday in January,
20    2005, and 4 shall be appointed for terms ending on the
21    third Monday in January, 2007.
22        (a-10) After the effective date of this amendatory Act
23    of the 94th General Assembly, the Commission shall be
24    increased to 10 members. As soon as possible after the
25    effective date of this amendatory Act of the 94th General
26    Assembly, the Governor shall appoint, by and with the

 

 

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

 

 

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1the recess of the Senate, the Governor shall make a temporary
2appointment until the next meeting of the Senate, when he shall
3nominate some person to fill such office. Any person so
4nominated who is confirmed by the Senate shall hold office
5during the remainder of the term and until his successor is
6appointed and qualified.
7    The Illinois Workers' Compensation Commission created by
8this amendatory Act of 1989 shall succeed to all the rights,
9powers, duties, obligations, records and other property and
10employees of the Industrial Commission which it replaces as
11modified by this amendatory Act of 1989 and all applications
12and reports to actions and proceedings of such prior Industrial
13Commission shall be considered as applications and reports to
14actions and proceedings of the Illinois Workers' Compensation
15Commission created by this amendatory Act of 1989.
16    Notwithstanding any other provision of this Act, in the
17event the Chairman shall make a finding that a member is or
18will be unavailable to fulfill the responsibilities of his or
19her office, the Chairman shall advise the Governor and the
20member in writing and shall designate a certified arbitrator to
21serve as acting Commissioner. The certified arbitrator shall
22act as a Commissioner until the member resumes the duties of
23his or her office or until a new member is appointed by the
24Governor, by and with the consent of the Senate, if a vacancy
25occurs in the office of the Commissioner, but in no event shall
26a certified arbitrator serve in the capacity of Commissioner

 

 

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

 

 

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1shall serve regardless of political affiliation. Each of the 3
2members shall have only such rights and powers of a
3Commissioner necessary to dispose of those cases assigned to
4the special panel. Each of the 3 members appointed to the
5special panel shall receive the same salary as other
6Commissioners for the duration of the panel.
7    The Commission may have an Executive Director; if so, the
8Executive Director shall be appointed by the Governor with the
9advice and consent of the Senate. The salary and duties of the
10Executive Director shall be fixed by the Commission.
11    On the effective date of this amendatory Act of the 93rd
12General Assembly, the name of the Industrial Commission is
13changed to the Illinois Workers' Compensation Commission.
14References in any law, appropriation, rule, form, or other
15document: (i) to the Industrial Commission are deemed, in
16appropriate contexts, to be references to the Illinois Workers'
17Compensation Commission for all purposes; (ii) to the
18Industrial Commission Operations Fund are deemed, in
19appropriate contexts, to be references to the Illinois Workers'
20Compensation Commission Operations Fund for all purposes;
21(iii) to the Industrial Commission Operations Fund Fee are
22deemed, in appropriate contexts, to be references to the
23Illinois Workers' Compensation Commission Operations Fund Fee
24for all purposes; and (iv) to the Industrial Commission
25Operations Fund Surcharge are deemed, in appropriate contexts,
26to be references to the Illinois Workers' Compensation

 

 

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1Commission Operations Fund Surcharge for all purposes.
2(Source: P.A. 93-509, eff. 8-11-03; 93-721, eff. 1-1-05;
394-277, eff. 7-20-05.)
 
4    (820 ILCS 305/13.1)  (from Ch. 48, par. 138.13-1)
5    Sec. 13.1. (a) There is created a Workers' Compensation
6Advisory Board hereinafter referred to as the Advisory Board.
7After the effective date of this amendatory Act of the 94th
8General Assembly, the Advisory Board shall consist of 12
9members appointed by the Governor with the advice and consent
10of the Senate. Six members of the Advisory Board shall be
11representative citizens chosen from the employee class, and 6
12members shall be representative citizens chosen from the
13employing class. The Chairman of the Commission shall serve as
14the ex officio Chairman of the Advisory Board. After the
15effective date of this amendatory Act of the 94th General
16Assembly, each member of the Advisory Board shall serve a term
17ending on the third Monday in January 2007 and shall continue
18to serve until his or her successor is appointed and qualified.
19Members of the Advisory Board shall thereafter be appointed for
204 year terms from the third Monday in January of the year of
21their appointment, and until their successors are appointed and
22qualified. Seven members of the Advisory Board shall constitute
23a quorum to do business, but in no case shall there be less
24than one representative from each class. A vacancy on the
25Advisory Board shall be filled by the Governor for the

 

 

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1unexpired term.
2    (b) Members of the Advisory Board shall receive no
3compensation for their services but shall be reimbursed for
4expenses incurred in the performance of their duties by the
5Commission from appropriations made to the Commission for such
6purpose.
7    (c) The Advisory Board shall aid the Commission in
8formulating policies, discussing problems, setting priorities
9of expenditures, reviewing advisory rates filed by an advisory
10organization as defined in Section 463 of the Illinois
11Insurance Code, and establishing short and long range
12administrative goals. Prior to making the (1) initial set of
13arbitrator appointments pursuant to this amendatory Act of the
1497th General Assembly and (2) appointment of Commissioners,
15appointments to the Commission, the Governor shall request that
16the Advisory Board make recommendations as to candidates to
17consider for appointment and the Advisory Board may then make
18such recommendations.
19    (d) The terms of all Advisory Board members serving on the
20effective date of this amendatory Act of the 97th General
21Assembly are terminated. The Governor shall appoint new members
22to the Advisory Board within 30 days after the effective date
23of the amendatory Act of the 97th General Assembly, subject to
24the advice and consent of the Senate.
25(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 

 

 

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1    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
2    Sec. 14. The Commission shall appoint a secretary, an
3assistant secretary, and arbitrators and shall employ such
4assistants and clerical help as may be necessary. Arbitrators
5shall be appointed pursuant to this Section, notwithstanding
6any provision of the Personnel Code.
7    Each arbitrator appointed after November 22, 1977 shall be
8required to demonstrate in writing and in accordance with the
9rules and regulations of the Illinois Department of Central
10Management Services his or her knowledge of and expertise in
11the law of and judicial processes of the Workers' Compensation
12Act and the Occupational Diseases Act.
13    A formal training program for newly-hired arbitrators
14shall be implemented. The training program shall include the
15following:
16        (a) substantive and procedural aspects of the
17    arbitrator position;
18        (b) current issues in workers' compensation law and
19    practice;
20        (c) medical lectures by specialists in areas such as
21    orthopedics, ophthalmology, psychiatry, rehabilitation
22    counseling;
23        (d) orientation to each operational unit of the
24    Illinois Workers' Compensation Commission;
25        (e) observation of experienced arbitrators conducting
26    hearings of cases, combined with the opportunity to discuss

 

 

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1    evidence presented and rulings made;
2        (f) the use of hypothetical cases requiring the trainee
3    to issue judgments as a means to evaluating knowledge and
4    writing ability;
5        (g) writing skills; .
6        (h) professional and ethical standards pursuant to
7    Section 1.1 of this Act;
8        (i) detection of workers' compensation fraud and
9    reporting obligations of Commission employees and
10    appointees;
11        (j) standards of evidence-based medical treatment and
12    best practices for measuring and improving quality and
13    health care outcomes in the workers' compensation system,
14    including but not limited to the use of the American
15    Medical Association's "Guides to the Evaluation of
16    Permanent Impairment" and the practice of utilization
17    review; and
18        (k) substantive and procedural aspects of coal
19    workers' pneumoconiosis (black lung) cases.
20    A formal and ongoing professional development program
21including, but not limited to, the above-noted areas shall be
22implemented to keep arbitrators informed of recent
23developments and issues and to assist them in maintaining and
24enhancing their professional competence. Each arbitrator shall
25complete 20 hours of training in the above-noted areas during
26every 2 years such arbitrator shall remain in office.

 

 

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1    Each arbitrator shall devote full time to his or her duties
2and shall serve when assigned as an acting Commissioner when a
3Commissioner is unavailable in accordance with the provisions
4of Section 13 of this Act. Any arbitrator who is an
5attorney-at-law shall not engage in the practice of law, nor
6shall any arbitrator hold any other office or position of
7profit under the United States or this State or any municipal
8corporation or political subdivision of this State.
9Notwithstanding any other provision of this Act to the
10contrary, an arbitrator who serves as an acting Commissioner in
11accordance with the provisions of Section 13 of this Act shall
12continue to serve in the capacity of Commissioner until a
13decision is reached in every case heard by that arbitrator
14while serving as an acting Commissioner.
15    Notwithstanding any other provision of this Section, the
16term of all arbitrators serving on the effective date of this
17amendatory Act of the 97th General Assembly, including any
18arbitrators on administrative leave, shall terminate at the
19close of business on July 1, 2011, but the incumbents shall
20continue to exercise all of their duties until they are
21reappointed or their successors are appointed.
22    On and after the effective date of this amendatory Act of
23the 97th General Assembly, arbitrators shall be appointed to
243-year terms by the full Commission, except that initial
25appointments made on and after the effective date of this
26amendatory Act of the 97th General Assembly shall be made as

 

 

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1follows:
2        (1) All appointments shall be made by the Governor with
3    the advice and consent of the Senate.
4        (2) 12 arbitrators shall be appointed to terms expiring
5    July 1, 2012; 12 arbitrators shall be appointed to terms
6    expiring July 1, 2013; and all additional arbitrators shall
7    be appointed to terms expiring July 1, 2014.
8    Upon the expiration of a term, the Chairman shall evaluate
9the performance of the arbitrator and may recommend that he or
10she be reappointed to a second or subsequent term by the full
11Commission.
12    Each arbitrator appointed on or after the effective date of
13this amendatory Act of the 97th General Assembly and who has
14not previously served as an arbitrator for the Commission shall
15be required to be authorized to practice law in this State by
16the Supreme Court, and to maintain this authorization
17throughout his or her term of employment.
18    Each arbitrator appointed after the effective date of this
19amendatory Act of 1989 shall be appointed for a term of 6
20years. Each arbitrator shall be appointed for a subsequent term
21unless the Chairman makes a recommendation to the Commission,
22no later than 60 days prior to the expiration of the term, not
23to reappoint the arbitrator. Notice of such a recommendation
24shall also be given to the arbitrator no later than 60 days
25prior to the expiration of the term. Upon such recommendation
26by the Chairman, the arbitrator shall be appointed for a

 

 

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1subsequent term unless 8 of 10 members of the Commission,
2including the Chairman, vote not to reappoint the arbitrator.
3    All arbitrators shall be subject to the provisions of the
4Personnel Code, and the performance of all arbitrators shall be
5reviewed by the Chairman on an annual basis. The changes made
6to this Section by this amendatory Act of the 97th General
7Assembly shall prevail over any conflict with the Personnel
8Code. The Chairman shall allow input from the Commissioners in
9all such reviews.
10    The Commission shall assign no fewer than 3 arbitrators to
11each hearing site. The Commission shall establish a procedure
12to ensure that the arbitrators assigned to each hearing site
13are assigned cases on a random basis. No arbitrator shall hear
14cases in any county, other than Cook County, for more than 2
15years in each 3-year term.
16    The Secretary and each arbitrator shall receive a per annum
17salary of $4,000 less than the per annum salary of members of
18The Illinois Workers' Compensation Commission as provided in
19Section 13 of this Act, payable in equal monthly installments.
20    The members of the Commission, Arbitrators and other
21employees whose duties require them to travel, shall have
22reimbursed to them their actual traveling expenses and
23disbursements made or incurred by them in the discharge of
24their official duties while away from their place of residence
25in the performance of their duties.
26    The Commission shall provide itself with a seal for the

 

 

09700HB1698sam003- 135 -LRB097 07917 AEK 56376 a

1authentication of its orders, awards and proceedings upon which
2shall be inscribed the name of the Commission and the words
3"Illinois--Seal".
4    The Secretary or Assistant Secretary, under the direction
5of the Commission, shall have charge and custody of the seal of
6the Commission and also have charge and custody of all records,
7files, orders, proceedings, decisions, awards and other
8documents on file with the Commission. He shall furnish
9certified copies, under the seal of the Commission, of any such
10records, files, orders, proceedings, decisions, awards and
11other documents on file with the Commission as may be required.
12Certified copies so furnished by the Secretary or Assistant
13Secretary shall be received in evidence before the Commission
14or any Arbitrator thereof, and in all courts, provided that the
15original of such certified copy is otherwise competent and
16admissible in evidence. The Secretary or Assistant Secretary
17shall perform such other duties as may be prescribed from time
18to time by the Commission.
19(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
 
20    (820 ILCS 305/16b new)
21    Sec. 16b. Gift ban.
22    (a) An attorney appearing before the Commission shall not
23provide compensation or any gift to any person in exchange for
24the referral of a client involving a matter to be heard before
25the Commission except for a division of a fee between lawyers

 

 

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1who are not in the same firm in accordance with Rule 1.5 of the
2Code of Professional Responsibility. For purposes of this
3Section, "gift" means any gratuity, discount, entertainment,
4hospitality, loan, forbearance, or any other tangible or
5intangible item having monetary value including, but not
6limited to, cash, food and drink, and honoraria except for food
7or refreshments not exceeding $75 per person in value on a
8single calendar day, provided that the food or refreshments are
9(1) consumed on the premises from which they were purchased or
10prepared or (2) catered. "Catered" means food or refreshments
11that are purchased ready to eat and delivered by any means.
12    (b) Violation of this Section is a Class A misdemeanor.
 
13    (820 ILCS 305/18)  (from Ch. 48, par. 138.18)
14    Sec. 18. All questions arising under this Act, if not
15settled by agreement of the parties interested therein, shall,
16except as otherwise provided, be determined by the Commission.
17Claims from current and former employees of the Commission
18shall be determined in accordance with Section 18.1 of this
19Act.
20(Source: Laws 1951, p. 1060.)
 
21    (820 ILCS 305/18.1 new)
22    Sec. 18.1. Claims by former and current employees of the
23Commission. All claims by current and former employees and
24appointees of the Commission shall be assigned to a certified

 

 

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1independent arbitrator not employed by the Commission
2designated by the Chairman. The Chairman shall designate an
3arbitrator from a list of approved certified arbitrators
4provided by the Commission Review Board. If the Chairman is the
5claimant, then the independent arbitrator from the approved
6list shall be designated by the longest serving Commissioner.
7The designated independent arbitrator shall have the authority
8of arbitrators of the Commission regarding settlement and
9adjudication of the claim of the current and former employees
10and appointees of the Commission. The decision of the
11independent arbitrator shall become the decision of the
12Commission. An appeal of the independent arbitrator's decision
13shall be subject to judicial review in accordance with
14subsection (f) of Section 19.
 
15    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
16    Sec. 19. Any disputed questions of law or fact shall be
17determined as herein provided.
18    (a) It shall be the duty of the Commission upon
19notification that the parties have failed to reach an
20agreement, to designate an Arbitrator.
21        1. Whenever any claimant misconceives his remedy and
22    files an application for adjustment of claim under this Act
23    and it is subsequently discovered, at any time before final
24    disposition of such cause, that the claim for disability or
25    death which was the basis for such application should

 

 

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

 

 

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

 

 

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1and unless such party petitioning for a review shall within 35
2days after the receipt by him of the copy of the decision, file
3with the Commission either an agreed statement of the facts
4appearing upon the hearing before the Arbitrator, or if such
5party shall so elect a correct transcript of evidence of the
6proceedings at such hearings, then the decision shall become
7the decision of the Commission and in the absence of fraud
8shall be conclusive. The Petition for Review shall contain a
9statement of the petitioning party's specific exceptions to the
10decision of the arbitrator. The jurisdiction of the Commission
11to review the decision of the arbitrator shall not be limited
12to the exceptions stated in the Petition for Review. The
13Commission, or any member thereof, may grant further time not
14exceeding 30 days, in which to file such agreed statement or
15transcript of evidence. Such agreed statement of facts or
16correct transcript of evidence, as the case may be, shall be
17authenticated by the signatures of the parties or their
18attorneys, and in the event they do not agree as to the
19correctness of the transcript of evidence it shall be
20authenticated by the signature of the Arbitrator designated by
21the Commission.
22    Whether the employee is working or not, if the employee is
23not receiving or has not received medical, surgical, or
24hospital services or other services or compensation as provided
25in paragraph (a) of Section 8, or compensation as provided in
26paragraph (b) of Section 8, the employee may at any time

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    employee cannot currently perform as a result of any
2    impairment or disability due to such injury, and the
3    prognosis for recovery;
4        (xi) complete copies of any reports, records,
5    documents and affidavits in the possession of the employee
6    on which the employee will rely to support his allegations,
7    provided that the employer shall pay the reasonable cost of
8    reproduction thereof;
9        (xii) a list of any reports, records, documents and
10    affidavits which the employee has demanded by subpoena and
11    on which he intends to rely to support his allegations;
12        (xiii) a certification signed by the employee or his
13    representative that the employer has received the petition
14    with the required information 15 days before filing.
15    Fifteen days after receipt by the employer of the petition
16with the required information the employee may file said
17petition and required information and shall serve notice of the
18filing upon the employer. The employer may file a motion
19addressed to the sufficiency of the petition. If an objection
20has been filed to the sufficiency of the petition, the
21arbitrator shall rule on the objection within 2 working days.
22If such an objection is filed, the time for filing the final
23decision of the Commission as provided in this paragraph shall
24be tolled until the arbitrator has determined that the petition
25is sufficient.
26    The employer shall, within 15 days after receipt of the

 

 

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

 

 

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1may extend the time for closing proof on the motion of a party
2for a reasonable period of time which may be more than 30 days.
3No evidence may be introduced pursuant to this paragraph as to
4permanent disability. No award may be entered for permanent
5disability pursuant to this paragraph. Either party may
6introduce into evidence the testimony taken by deposition of
7any medical practitioner.
8    The Commission shall adopt rules, regulations and
9procedures whereby the final decision of the Commission is
10filed not later than 90 days from the date the petition for
11review is filed but in no event later than 180 days from the
12date the petition for an emergency hearing is filed with the
13Illinois Workers' Compensation Commission.
14    All service required pursuant to this paragraph (b-1) must
15be by personal service or by certified mail and with evidence
16of receipt. In addition for the purposes of this paragraph, all
17service on the employer must be at the premises where the
18accident occurred if the premises are owned or operated by the
19employer. Otherwise service must be at the employee's principal
20place of employment by the employer. If service on the employer
21is not possible at either of the above, then service shall be
22at the employer's principal place of business. After initial
23service in each case, service shall be made on the employer's
24attorney or designated representative.
25    (c) (1) At a reasonable time in advance of and in
26connection with the hearing under Section 19(e) or 19(h), the

 

 

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

 

 

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1Act shall, upon request of either the employer or the employee
2or the beneficiary affected, be subject to the review and
3decision of the Commission.
4    (d) If any employee shall persist in insanitary or
5injurious practices which tend to either imperil or retard his
6recovery or shall refuse to submit to such medical, surgical,
7or hospital treatment as is reasonably essential to promote his
8recovery, the Commission may, in its discretion, reduce or
9suspend the compensation of any such injured employee. However,
10when an employer and employee so agree in writing, the
11foregoing provision shall not be construed to authorize the
12reduction or suspension of compensation of an employee who is
13relying in good faith, on treatment by prayer or spiritual
14means alone, in accordance with the tenets and practice of a
15recognized church or religious denomination, by a duly
16accredited practitioner thereof.
17    (e) This paragraph shall apply to all hearings before the
18Commission. Such hearings may be held in its office or
19elsewhere as the Commission may deem advisable. The taking of
20testimony on such hearings may be had before any member of the
21Commission. If a petition for review and agreed statement of
22facts or transcript of evidence is filed, as provided herein,
23the Commission shall promptly review the decision of the
24Arbitrator and all questions of law or fact which appear from
25the statement of facts or transcript of evidence.
26    In all cases in which the hearing before the arbitrator is

 

 

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1held after December 18, 1989, no additional evidence shall be
2introduced by the parties before the Commission on review of
3the decision of the Arbitrator. In reviewing decisions of an
4arbitrator the Commission shall award such temporary
5compensation, permanent compensation and other payments as are
6due under this Act. The Commission shall file in its office its
7decision thereon, and shall immediately send to each party or
8his attorney a copy of such decision and a notification of the
9time when it was filed. Decisions shall be filed within 60 days
10after the Statement of Exceptions and Supporting Brief and
11Response thereto are required to be filed or oral argument
12whichever is later.
13    In the event either party requests oral argument, such
14argument shall be had before a panel of 3 members of the
15Commission (or before all available members pursuant to the
16determination of 7 members of the Commission that such argument
17be held before all available members of the Commission)
18pursuant to the rules and regulations of the Commission. A
19panel of 3 members, which shall be comprised of not more than
20one representative citizen of the employing class and not more
21than one representative citizen of the employee class, shall
22hear the argument; provided that if all the issues in dispute
23are solely the nature and extent of the permanent partial
24disability, if any, a majority of the panel may deny the
25request for such argument and such argument shall not be held;
26and provided further that 7 members of the Commission may

 

 

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1determine that the argument be held before all available
2members of the Commission. A decision of the Commission shall
3be approved by a majority of Commissioners present at such
4hearing if any; provided, if no such hearing is held, a
5decision of the Commission shall be approved by a majority of a
6panel of 3 members of the Commission as described in this
7Section. The Commission shall give 10 days' notice to the
8parties or their attorneys of the time and place of such taking
9of testimony and of such argument.
10    In any case the Commission in its decision may find
11specially upon any question or questions of law or fact which
12shall be submitted in writing by either party whether ultimate
13or otherwise; provided that on issues other than nature and
14extent of the disability, if any, the Commission in its
15decision shall find specially upon any question or questions of
16law or fact, whether ultimate or otherwise, which are submitted
17in writing by either party; provided further that not more than
185 such questions may be submitted by either party. Any party
19may, within 20 days after receipt of notice of the Commission's
20decision, or within such further time, not exceeding 30 days,
21as the Commission may grant, file with the Commission either an
22agreed statement of the facts appearing upon the hearing, or,
23if such party shall so elect, a correct transcript of evidence
24of the additional proceedings presented before the Commission,
25in which report the party may embody a correct statement of
26such other proceedings in the case as such party may desire to

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1        The decision of a majority of the members of the panel
2    of the Commission, shall be considered the decision of the
3    Commission.
4    (g) Except in the case of a claim against the State of
5Illinois, either party may present a certified copy of the
6award of the Arbitrator, or a certified copy of the decision of
7the Commission when the same has become final, when no
8proceedings for review are pending, providing for the payment
9of compensation according to this Act, to the Circuit Court of
10the county in which such accident occurred or either of the
11parties are residents, whereupon the court shall enter a
12judgment in accordance therewith. In a case where the employer
13refuses to pay compensation according to such final award or
14such final decision upon which such judgment is entered the
15court shall in entering judgment thereon, tax as costs against
16him the reasonable costs and attorney fees in the arbitration
17proceedings and in the court entering the judgment for the
18person in whose favor the judgment is entered, which judgment
19and costs taxed as therein provided shall, until and unless set
20aside, have the same effect as though duly entered in an action
21duly tried and determined by the court, and shall with like
22effect, be entered and docketed. The Circuit Court shall have
23power at any time upon application to make any such judgment
24conform to any modification required by any subsequent decision
25of the Supreme Court upon appeal, or as the result of any
26subsequent proceedings for review, as provided in this Act.

 

 

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1    Judgment shall not be entered until 15 days' notice of the
2time and place of the application for the entry of judgment
3shall be served upon the employer by filing such notice with
4the Commission, which Commission shall, in case it has on file
5the address of the employer or the name and address of its
6agent upon whom notices may be served, immediately send a copy
7of the notice to the employer or such designated agent.
8    (h) An agreement or award under this Act providing for
9compensation in installments, may at any time within 18 months
10after such agreement or award be reviewed by the Commission at
11the request of either the employer or the employee, on the
12ground that the disability of the employee has subsequently
13recurred, increased, diminished or ended.
14    However, as to accidents occurring subsequent to July 1,
151955, which are covered by any agreement or award under this
16Act providing for compensation in installments made as a result
17of such accident, such agreement or award may at any time
18within 30 months, or 60 months in the case of an award under
19Section 8(d)1, after such agreement or award be reviewed by the
20Commission at the request of either the employer or the
21employee on the ground that the disability of the employee has
22subsequently recurred, increased, diminished or ended.
23    On such review, compensation payments may be
24re-established, increased, diminished or ended. The Commission
25shall give 15 days' notice to the parties of the hearing for
26review. Any employee, upon any petition for such review being

 

 

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1filed by the employer, shall be entitled to one day's notice
2for each 100 miles necessary to be traveled by him in attending
3the hearing of the Commission upon the petition, and 3 days in
4addition thereto. Such employee shall, at the discretion of the
5Commission, also be entitled to 5 cents per mile necessarily
6traveled by him within the State of Illinois in attending such
7hearing, not to exceed a distance of 300 miles, to be taxed by
8the Commission as costs and deposited with the petition of the
9employer.
10    When compensation which is payable in accordance with an
11award or settlement contract approved by the Commission, is
12ordered paid in a lump sum by the Commission, no review shall
13be had as in this paragraph mentioned.
14    (i) Each party, upon taking any proceedings or steps
15whatsoever before any Arbitrator, Commission or court, shall
16file with the Commission his address, or the name and address
17of any agent upon whom all notices to be given to such party
18shall be served, either personally or by registered mail,
19addressed to such party or agent at the last address so filed
20with the Commission. In the event such party has not filed his
21address, or the name and address of an agent as above provided,
22service of any notice may be had by filing such notice with the
23Commission.
24    (j) Whenever in any proceeding testimony has been taken or
25a final decision has been rendered and after the taking of such
26testimony or after such decision has become final, the injured

 

 

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

 

 

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1payment of medical benefits under Section 8(a), the time for
2the employer to respond shall not commence until the expiration
3of the allotted 30 60 days specified under Section 8.2(d). In
4case the employer or his or her insurance carrier shall without
5good and just cause fail, neglect, refuse, or unreasonably
6delay the payment of benefits under Section 8(a) or Section
78(b), the Arbitrator or the Commission shall allow to the
8employee additional compensation in the sum of $30 per day for
9each day that the benefits under Section 8(a) or Section 8(b)
10have been so withheld or refused, not to exceed $10,000. A
11delay in payment of 14 days or more shall create a rebuttable
12presumption of unreasonable delay.
13    (m) If the commission finds that an accidental injury was
14directly and proximately caused by the employer's wilful
15violation of a health and safety standard under the Health and
16Safety Act in force at the time of the accident, the arbitrator
17or the Commission shall allow to the injured employee or his
18dependents, as the case may be, additional compensation equal
19to 25% of the amount which otherwise would be payable under the
20provisions of this Act exclusive of this paragraph. The
21additional compensation herein provided shall be allowed by an
22appropriate increase in the applicable weekly compensation
23rate.
24    (n) After June 30, 1984, decisions of the Illinois Workers'
25Compensation Commission reviewing an award of an arbitrator of
26the Commission shall draw interest at a rate equal to the yield

 

 

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

 

 

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

 

 

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

 

 

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1be voluntary.
2(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
 
3    (820 ILCS 305/25.5)
4    Sec. 25.5. Unlawful acts; penalties.
5    (a) It is unlawful for any person, company, corporation,
6insurance carrier, healthcare provider, or other entity to:
7        (1) Intentionally present or cause to be presented any
8    false or fraudulent claim for the payment of any workers'
9    compensation benefit.
10        (2) Intentionally make or cause to be made any false or
11    fraudulent material statement or material representation
12    for the purpose of obtaining or denying any workers'
13    compensation benefit.
14        (3) Intentionally make or cause to be made any false or
15    fraudulent statements with regard to entitlement to
16    workers' compensation benefits with the intent to prevent
17    an injured worker from making a legitimate claim for any
18    workers' compensation benefits.
19        (4) Intentionally prepare or provide an invalid,
20    false, or counterfeit certificate of insurance as proof of
21    workers' compensation insurance.
22        (5) Intentionally make or cause to be made any false or
23    fraudulent material statement or material representation
24    for the purpose of obtaining workers' compensation
25    insurance at less than the proper rate for that insurance.

 

 

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

 

 

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

 

 

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1insurance, the value of the property shall be the fair market
2replacement value of the property claimed to be lost, the
3reasonable costs of reimbursing a vendor or other claimant for
4services to be rendered, or both. Notwithstanding the
5foregoing, an insurance company, self-insured entity, or any
6other person suffering financial loss sustained as a result of
7violation of this Section may seek restitution, including court
8costs and attorney's fees in a civil action in a court of
9competent jurisdiction.
10    (c) The Department Division of Insurance of the Department
11of Financial and Professional Regulation shall establish a
12fraud and insurance non-compliance unit responsible for
13investigating incidences of fraud and insurance non-compliance
14pursuant to this Section. The size of the staff of the unit
15shall be subject to appropriation by the General Assembly. It
16shall be the duty of the fraud and insurance non-compliance
17unit to determine the identity of insurance carriers,
18employers, employees, or other persons or entities who have
19violated the fraud and insurance non-compliance provisions of
20this Section. The fraud and insurance non-compliance unit shall
21report violations of the fraud and insurance non-compliance
22provisions of this Section to the Special Prosecutions Bureau
23of the Criminal Division of the Office of the Attorney General
24or to the State's Attorney of the county in which the offense
25allegedly occurred, either of whom has the authority to
26prosecute violations under this Section.

 

 

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

 

 

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

 

 

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1insurance carrier, or service adjustment company, third party
2administrator, self-insured, or similar entity to file or
3threaten to file a report of fraud against an employee because
4of the exercise by the employee of the rights and remedies
5granted to the employee by this Act.
6    (e-5) The fraud and insurance non-compliance unit shall
7procure and implement a system utilizing advanced analytics
8inclusive of predictive modeling, data mining, social network
9analysis, and scoring algorithms for the detection and
10prevention of fraud, waste, and abuse on or before January 1,
112012. The fraud and insurance non-compliance unit shall procure
12this system using a request for proposals process governed by
13the Illinois Procurement Code and rules adopted under that
14Code. The fraud and insurance non-compliance unit shall provide
15a report to the President of the Senate, Speaker of the House
16of Representatives, Minority Leader of the House of
17Representatives, Minority Leader of the Senate, Governor,
18Chairman of the Commission, and Director of Insurance on or
19before July 1, 2012 and annually thereafter detailing its
20activities and providing recommendations regarding
21opportunities for additional fraud waste and abuse detection
22and prevention.
23    For purposes of this subsection (e), "employer" means any
24employer, insurance carrier, third party administrator,
25self-insured, or similar entity.
26    For purposes of this subsection (e), "complainant" refers

 

 

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1to the person contacting the fraud and insurance non-compliance
2unit to initiate the complaint.
3    (f) Any person convicted of fraud related to workers'
4compensation pursuant to this Section shall be subject to the
5penalties prescribed in the Criminal Code of 1961 and shall be
6ineligible to receive or retain any compensation, disability,
7or medical benefits as defined in this Act if the compensation,
8disability, or medical benefits were owed or received as a
9result of fraud for which the recipient of the compensation,
10disability, or medical benefit was convicted. This subsection
11applies to accidental injuries or diseases that occur on or
12after the effective date of this amendatory Act of the 94th
13General Assembly.
14    (g) Civil liability. Any person convicted of fraud who
15knowingly obtains, attempts to obtain, or causes to be obtained
16any benefits under this Act by the making of a false claim or
17who knowingly misrepresents any material fact shall be civilly
18liable to the payor of benefits or the insurer or the payor's
19or insurer's subrogee or assignee in an amount equal to 3 times
20the value of the benefits or insurance coverage wrongfully
21obtained or twice the value of the benefits or insurance
22coverage attempted to be obtained, plus reasonable attorney's
23fees and expenses incurred by the payor or the payor's subrogee
24or assignee who successfully brings a claim under this
25subsection. This subsection applies to accidental injuries or
26diseases that occur on or after the effective date of this

 

 

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1amendatory Act of the 94th General Assembly.
2    (h) The All proceedings under this Section shall be
3reported by the fraud and insurance non-compliance unit shall
4submit a written report on an annual basis to the Chairman of
5the Commission, the Workers' Compensation Advisory Board, the
6General Assembly, the Governor, and the Attorney General by
7January 1 and July 1 of each year. This report shall include,
8at the minimum, the following information:
9        (1) The number of allegations of insurance
10    non-compliance and fraud reported to the fraud and
11    insurance non-compliance unit.
12        (2) The source of the reported allegations
13    (individual, employer, or other).
14        (3) The number of allegations investigated by the fraud
15    and insurance non-compliance unit.
16        (4) The number of criminal referrals made in accordance
17    with this Section and the entity to which the referral was
18    made.
19        (5) All proceedings under this Section.
20(Source: P.A. 94-277, eff. 7-20-05.)
 
21    (820 ILCS 305/29.1 new)
22    Sec. 29.1. Recalculation of premiums. On the effective date
23of this amendatory Act of the 97th General Assembly, the
24Director of Insurance shall immediately direct in writing any
25workers' compensation rate setting advisory organization to

 

 

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1recalculate workers' compensation advisory premium rates and
2assigned risk pool premium rates so that those premiums
3incorporate the provisions of this amendatory Act of the 97th
4General Assembly, and to publish such rates on or before
5September 1, 2011.
 
6    (820 ILCS 305/29.2 new)
7    Sec. 29.2. Insurance oversight.
8    (a) The Department of Insurance shall annually submit to
9the Governor, the Chairman of the Commission, the President of
10the Senate, the Speaker of the House of Representatives, the
11Minority Leader of the Senate, and the Minority Leader of the
12House of Representatives a written report that details the
13state of the workers' compensation insurance market in
14Illinois. The report shall be completed by April 1 of each
15year, beginning in 2012, or later if necessary data or analyses
16are only available to the Department at a later date. The
17report shall be posted on the Department of Insurance's
18Internet website. Information to be included in the report
19shall be for the preceding calendar year. The report shall
20include, at a minimum, the following:
21        (1) Gross premiums collected by workers' compensation
22    carriers in Illinois and the national rank of Illinois
23    based on premium volume.
24        (2) The number of insurance companies actively engaged
25    in Illinois in the workers' compensation insurance market,

 

 

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

 

 

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

 

 

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

 

 

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1        (10) The number of claims in which outside defense
2    counsel participated, and the total amount paid to outside
3    defense counsel.
4        (11) The total amount billed to employers for bill
5    review.
6        (12) The total amount billed to employers for fee
7    schedule savings.
8        (13) The total amount charged to employers for any and
9    all managed care fees.
10        (14) The number of claims involving in-house medical
11    nurse case management, and the total amount spent on
12    in-house medical nurse case management.
13        (15) The number of claims involving outside medical
14    nurse case management, and the total amount paid for
15    outside medical nurse case management.
16        (16) The total amount paid for Independent Medical
17    exams.
18        (17) The total amount spent on in-house Utilization
19    Review for the previous calendar year.
20        (18) The total amount paid for outside Utilization
21    Review for the previous calendar year.
22    The Department shall make the submitted information
23publicly available on the Department's Internet website or such
24other media as appropriate in a form useful for consumers.
 
25    Section 97. Severability. The provisions of this Act are

 

 

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1severable under Section 1.31 of the Statute on Statutes.
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.".