97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB2883

 

Introduced 2/22/2011, by Rep. David Reis - Dan Brady - Dwight Kay - Jim Sacia - Dave Winters

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Workers' Compensation Act. Defines "accident" and "injury." Provides that pain or other subjective complaints alone, in the absence of objective relevant medical findings, are not compensable. Deletes language allowing rebuttable presumptions for an employee employed as a firefighter, emergency medical technician (EMT), or paramedic. Deletes language allowing an employee to secure his own physician, surgeon and hospital services at the employer's expense. Provides that the employer shall choose all necessary medical, surgical and hospital services reasonably required to cure or relieve from the effects of the accidental injury at the employer's expense, except upon a finding by the Commission that the employer's choice of medical care threatens life, health, or recovery, then the employee may choose a second physician, surgeon, and hospital services at the employer's expense. Provides for a waiver of employee privacy for the employer to obtain necessary decision making information. Provides for a wage differential award and that such award shall cease when the employee reaches the full retirement age as defined by the Social Security Administration. Provides for reimbursement of out-of-state procedures, treatments, services, products or supplies. Provides for a new medical fee schedule after January 1, 2012, in accordance with the Medicare payment systems (160%). Moves the utilization review program registration and administration to the Department of Insurance. Makes numerous changes regarding employee intoxication, partial or total disability, implants, employment verification documents, and other changes.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 6, 8, 8.2, 8.7, 11, 16, and 19 as follows:
 
6    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
7    Sec. 1. This Act may be cited as the Workers' Compensation
8Act.
9    (a) The term "employer" as used in this Act means:
10    1. The State and each county, city, town, township,
11incorporated village, school district, body politic, or
12municipal corporation therein.
13    2. Every person, firm, public or private corporation,
14including hospitals, public service, eleemosynary, religious
15or charitable corporations or associations who has any person
16in service or under any contract for hire, express or implied,
17oral or written, and who is engaged in any of the enterprises
18or businesses enumerated in Section 3 of this Act, or who at or
19prior to the time of the accident to the employee for which
20compensation under this Act may be claimed, has in the manner
21provided in this Act elected to become subject to the
22provisions of this Act, and who has not, prior to such
23accident, effected a withdrawal of such election in the manner

 

 

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

 

 

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

 

 

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

 

 

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1members of the Illinois National Guard while on active duty in
2the service of the State, and all probation personnel of the
3Juvenile Court appointed pursuant to Article VI of the Juvenile
4Court Act of 1987, and including any official of the State, any
5county, city, town, township, incorporated village, school
6district, body politic or municipal corporation therein except
7any duly appointed member of a police department in any city
8whose population exceeds 200,000 according to the last Federal
9or State census, and except any member of a fire insurance
10patrol maintained by a board of underwriters in this State. A
11duly appointed member of a fire department in any city, the
12population of which exceeds 200,000 according to the last
13federal or State census, is an employee under this Act only
14with respect to claims brought under paragraph (c) of Section
158.
16    One employed by a contractor who has contracted with the
17State, or a county, city, town, township, incorporated village,
18school district, body politic or municipal corporation
19therein, through its representatives, is not considered as an
20employee of the State, county, city, town, township,
21incorporated village, school district, body politic or
22municipal corporation which made the contract.
23    2. Every person in the service of another under any
24contract of hire, express or implied, oral or written,
25including persons whose employment is outside of the State of
26Illinois where the contract of hire is made within the State of

 

 

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

 

 

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1    The term "employee" does not include persons performing
2services as real estate broker, broker-salesman, or salesman
3when such persons are paid by commission only.
4    (c) "Commission" means the Industrial Commission created
5by Section 5 of "The Civil Administrative Code of Illinois",
6approved March 7, 1917, as amended, or the Illinois Workers'
7Compensation Commission created by Section 13 of this Act.
8    (d) The term "accident" as used in this Act means an
9occurrence arising out of the employment resulting from a risk
10incidental to the employment and in the course of the
11employment at a time and place and under circumstances
12reasonably required by the employment.
13    (e) The term "injury" as used in this Act means a condition
14or impairment that arises out of and in the course of
15employment. An injury, its occupational cause, and any
16resulting manifestations or disability must be established to a
17reasonable degree of medical certainty, based on objective
18relevant medical findings, and the accidental compensable
19injury must be the major contributing cause of any resulting
20injuries. For the purposes of this Section, "major contributing
21cause" means the cause which is more than 50% responsible for
22the injury as compared to all other causes combined for which
23treatment or benefits are sought. In cases involving
24occupational disease or repetitive exposure, both causation
25and sufficient exposure to support causation must be proven by
26clear and convincing evidence. Pain or other subjective

 

 

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1complaints alone, in the absence of objective relevant medical
2findings, are not compensable. For the purposes of this
3Section, "objective relevant medical findings" are those
4objective findings that correlate to the subjective complaints
5of the injured employee and are confirmed by physical
6examination findings or diagnostic testing. Establishment of
7the causal relationship between a compensable accident and
8injuries for conditions that are not readily observable must be
9by medical evidence only, as demonstrated by physical
10examination findings or diagnostic testing. A major
11contributing cause must be demonstrated by medical evidence
12only.
13(Source: P.A. 93-721, eff. 1-1-05.)
 
14    (820 ILCS 305/6)  (from Ch. 48, par. 138.6)
15    Sec. 6. (a) Every employer within the provisions of this
16Act, shall, under the rules and regulations prescribed by the
17Commission, post printed notices in their respective places of
18employment in such number and at such places as may be
19determined by the Commission, containing such information
20relative to this Act as in the judgment of the Commission may
21be necessary to aid employees to safeguard their rights under
22this Act in event of injury.
23    In addition thereto, the employer shall post in a
24conspicuous place on the place of the employment a printed or
25typewritten notice stating whether he is insured or whether he

 

 

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1has qualified and is operating as a self-insured employer. In
2the event the employer is insured, the notice shall state the
3name and address of his insurance carrier, the number of the
4insurance policy, its effective date and the date of
5termination. In the event of the termination of the policy for
6any reason prior to the termination date stated, the posted
7notice shall promptly be corrected accordingly. In the event
8the employer is operating as a self-insured employer the notice
9shall state the name and address of the company, if any,
10servicing the compensation payments of the employer, and the
11name and address of the person in charge of making compensation
12payments.
13    (b) Every employer subject to this Act shall maintain
14accurate records of work-related deaths, injuries and illness
15other than minor injuries requiring only first aid treatment
16and which do not involve medical treatment, loss of
17consciousness, restriction of work or motion, or transfer to
18another job and file with the Commission, in writing, a report
19of all accidental deaths, injuries and illnesses arising out of
20and in the course of the employment resulting in the loss of
21more than 3 scheduled work days. In the case of death such
22report shall be made no later than 2 working days following the
23accidental death. In all other cases such report shall be made
24between the 15th and 25th of each month unless required to be
25made sooner by rule of the Commission. In case the injury
26results in permanent disability, a further report shall be made

 

 

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1as soon as it is determined that such permanent disability has
2resulted or will result from the injury. All reports shall
3state the date of the injury, including the time of day or
4night, the nature of the employer's business, the name,
5address, age, sex, conjugal condition of the injured person,
6the specific occupation of the injured person, the direct cause
7of the injury and the nature of the accident, the character of
8the injury, the length of disability, and in case of death the
9length of disability before death, the wages of the injured
10person, whether compensation has been paid to the injured
11person, or to his or her legal representative or his heirs or
12next of kin, the amount of compensation paid, the amount paid
13for physicians', surgeons' and hospital bills, and by whom
14paid, and the amount paid for funeral or burial expenses if
15known. The reports shall be made on forms and in the manner as
16prescribed by the Commission and shall contain such further
17information as the Commission shall deem necessary and require.
18The making of these reports releases the employer from making
19such reports to any other officer of the State and shall
20satisfy the reporting provisions as contained in the "Health
21and Safety Act" and "An Act in relation to safety inspections
22and education in industrial and commercial establishments and
23to repeal an Act therein named", approved July 18, 1955, as now
24or hereafter amended. The reports filed with the Commission
25pursuant to this Section shall be made available by the
26Commission to the Director of Labor or his representatives and

 

 

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1to all other departments of the State of Illinois which shall
2require such information for the proper discharge of their
3official duties. Failure to file with the Commission any of the
4reports required in this Section is a petty offense.
5    Except as provided in this paragraph, all reports filed
6hereunder shall be confidential and any person having access to
7such records filed with the Illinois Workers' Compensation
8Commission as herein required, who shall release any
9information therein contained including the names or otherwise
10identify any persons sustaining injuries or disabilities, or
11give access to such information to any unauthorized person,
12shall be subject to discipline or discharge, and in addition
13shall be guilty of a Class B misdemeanor. The Commission shall
14compile and distribute to interested persons aggregate
15statistics, taken from the reports filed hereunder. The
16aggregate statistics shall not give the names or otherwise
17identify persons sustaining injuries or disabilities or the
18employer of any injured or disabled person.
19    (c) Notice of the accident shall be given to the employer
20as soon as practicable, but not later than 45 days after the
21accident. Provided:
22    (1) In case of the legal disability of the employee or any
23dependent of a deceased employee who may be entitled to
24compensation under the provisions of this Act, the limitations
25of time by this Act provided do not begin to run against such
26person under legal disability until a guardian has been

 

 

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1appointed.
2    (2) In cases of injuries sustained by exposure to
3radiological materials or equipment, notice shall be given to
4the employer within 90 days subsequent to the time that the
5employee knows or suspects that he has received an excessive
6dose of radiation.
7    No defect or inaccuracy of such notice shall be a bar to
8the maintenance of proceedings on arbitration or otherwise by
9the employee unless the employer proves that he is unduly
10prejudiced in such proceedings by such defect or inaccuracy.
11    Notice of the accident shall give the approximate date and
12place of the accident, if known, and may be given orally or in
13writing.
14    (d) Every employer shall notify each injured employee who
15has been granted compensation under the provisions of Section 8
16of this Act of his rights to rehabilitation services and advise
17him of the locations of available public rehabilitation centers
18and any other such services of which the employer has
19knowledge.
20    In any case, other than one where the injury was caused by
21exposure to radiological materials or equipment or asbestos
22unless the application for compensation is filed with the
23Commission within 3 years after the date of the accident, where
24no compensation has been paid, or within 2 years after the date
25of the last payment of compensation, where any has been paid,
26whichever shall be later, the right to file such application

 

 

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1shall be barred.
2    In any case of injury caused by exposure to radiological
3materials or equipment or asbestos, unless application for
4compensation is filed with the Commission within 25 years after
5the last day that the employee was employed in an environment
6of hazardous radiological activity or asbestos, the right to
7file such application shall be barred.
8    If in any case except one where the injury was caused by
9exposure to radiological materials or equipment or asbestos,
10the accidental injury results in death application for
11compensation for death may be filed with the Commission within
123 years after the date of death where no compensation has been
13paid or within 2 years after the date of the last payment of
14compensation where any has been paid, whichever shall be later,
15but not thereafter.
16    If an accidental injury caused by exposure to radiological
17material or equipment or asbestos results in death within 25
18years after the last day that the employee was so exposed
19application for compensation for death may be filed with the
20Commission within 3 years after the date of death, where no
21compensation has been paid, or within 2 years after the date of
22the last payment of compensation where any has been paid,
23whichever shall be later, but not thereafter.
24    (e) Any contract or agreement made by any employer or his
25agent or attorney with any employee or any other beneficiary of
26any claim under the provisions of this Act within 7 days after

 

 

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1the injury shall be presumed to be fraudulent.
2    (f) (Blank). Any condition or impairment of health of an
3employee employed as a firefighter, emergency medical
4technician (EMT), or paramedic which results directly or
5indirectly from any bloodborne pathogen, lung or respiratory
6disease or condition, heart or vascular disease or condition,
7hypertension, tuberculosis, or cancer resulting in any
8disability (temporary, permanent, total, or partial) to the
9employee shall be rebuttably presumed to arise out of and in
10the course of the employee's firefighting, EMT, or paramedic
11employment and, further, shall be rebuttably presumed to be
12causally connected to the hazards or exposures of the
13employment. This presumption shall also apply to any hernia or
14hearing loss suffered by an employee employed as a firefighter,
15EMT, or paramedic. However, this presumption shall not apply to
16any employee who has been employed as a firefighter, EMT, or
17paramedic for less than 5 years at the time he or she files an
18Application for Adjustment of Claim concerning this condition
19or impairment with the Illinois Workers' Compensation
20Commission. The Finding and Decision of the Illinois Workers'
21Compensation Commission under only the rebuttable presumption
22provision of this subsection shall not be admissible or be
23deemed res judicata in any disability claim under the Illinois
24Pension Code arising out of the same medical condition;
25however, this sentence makes no change to the law set forth in
26Krohe v. City of Bloomington, 204 Ill.2d 392.

 

 

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1(Source: P.A. 95-316, eff. 1-1-08.)
 
2    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
3    Sec. 8. The amount of compensation which shall be paid to
4the employee for an accidental injury not resulting in death
5is:
6    (a) The employer shall provide and pay the negotiated rate,
7if applicable, or the lesser of the health care provider's
8actual charges or according to a fee schedule, subject to
9Section 8.2, in effect at the time the service was rendered for
10all the necessary first aid, medical and surgical services, and
11all necessary medical, surgical and hospital services
12thereafter incurred, limited, however, to that which is
13reasonably required to cure or relieve from the effects of the
14accidental injury. If the employer does not dispute payment of
15first aid, medical, surgical, and hospital services, the
16employer shall make such payment to the provider on behalf of
17the employee. The employer shall also pay for treatment,
18instruction and training necessary for the physical, mental and
19vocational rehabilitation of the employee, including all
20maintenance costs and expenses incidental thereto. If as a
21result of the injury the employee is unable to be
22self-sufficient the employer shall further pay for such
23maintenance or institutional care as shall be required.
24    The employer shall choose all necessary medical, surgical
25and hospital services reasonably required to cure or relieve

 

 

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1from the effects of the accidental injury, at the employer's
2expense. The employee shall cooperate with and adhere to the
3plan of care or treatment recommendations of the providers
4selected by the employer, unless the proposed care and
5treatment threatens the life, health or recovery of the injured
6employee. Upon a finding by the Commission, that the employer's
7choice of medical care threatens the life, health, or recovery
8of the injured employee, the employee may then choose a second
9physician, surgeon, and hospital services at the employer's
10expense. Initial emergency services, taking place within 45
11days of the accident, shall not constitute a choice of
12physician, surgeon, or hospital services by the employer or
13employee. employee may at any time elect to secure his own
14physician, surgeon and hospital services at the employer's
15expense, or,
16    Notwithstanding the foregoing, upon Upon agreement between
17the employer and the employees, or the employees' exclusive
18representative, and subject to the approval of the Illinois
19Workers' Compensation Commission, the employer shall maintain
20a list of physicians, to be known as a Panel of Physicians, who
21are accessible to the employees. The employer shall post this
22list in a place or places easily accessible to his employees.
23The employee shall have the right to make an alternative choice
24of physician from such Panel if he is not satisfied with the
25physician first selected. If, due to the nature of the injury
26or its occurrence away from the employer's place of business,

 

 

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

 

 

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1temporary total disability rate determined for the employee. In
2addition, maintenance shall include costs and expenses
3incidental to the vocational rehabilitation program.
4    When the employee is working light duty on a part-time
5basis or full-time basis and earns less than he or she would be
6earning if employed in the full capacity of the job or jobs,
7then the employee shall be entitled to temporary partial
8disability benefits. Temporary partial disability benefits
9shall be equal to two-thirds of the difference between the
10average amount that the employee would be able to earn in the
11full performance of his or her duties in the occupation in
12which he or she was engaged at the time of accident and the net
13amount which he or she is earning in the modified job provided
14to the employee by the employer or in any other job that the
15employee is working.
16    Every hospital, physician, surgeon or other person
17rendering treatment or services in accordance with the
18provisions of this Section shall upon written request furnish
19full and complete reports thereof to, and permit their records
20to be copied by, the employer, the employee or his dependents,
21as the case may be, or any other party to any proceeding for
22compensation before the Commission, or their attorneys.
23    When an employee makes a claim for benefits under the Act,
24he or she waives their privacy privilege with any treating
25provider to the extent solely to allow the employer to obtain
26from a treating provider the necessary information to determine

 

 

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1whether the condition of ill-being in question for which
2treatment is sought is work related, what that treatment is for
3purposes of approval of care, and whether or not, based upon
4the condition of ill-being, the employee is entitled to other
5benefits. The employer shall be entitled to contact the
6treating provider to seek information and answers from the
7treating provider regarding whether the condition of ill-being
8in question for which treatment is sought is work related, what
9that treatment or course of treatment is for purposes of
10approval of care, and the return to work options that the
11employer may have for the employee.
12    Notwithstanding the foregoing, the employer's liability to
13pay for such medical services selected by the employer or
14employee shall be limited to:
15        (1) all first aid and emergency treatment; plus
16        (2) all medical, surgical and hospital services
17    provided by the physician, surgeon or hospital initially
18    chosen by the employer employee or by any other physician,
19    consultant, expert, institution or other provider of
20    services recommended by said initial service provider or
21    any subsequent provider of medical services in the chain of
22    referrals from said initial service provider; plus
23        (3) all medical, surgical and hospital services
24    provided by any second physician, surgeon or hospital
25    subsequently chosen by the employee or by any other
26    physician, consultant, expert, institution or other

 

 

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1    provider of services recommended by said second service
2    provider or any subsequent provider of medical services in
3    the chain of referrals from said second service provider.
4    Thereafter the employer shall select and pay for all
5    necessary medical, surgical and hospital treatment and the
6    employee may not select a provider of medical services at
7    the employer's expense unless the employer agrees to such
8    selection. At any time the employee may obtain any medical
9    treatment he or she desires at his or her own expense. This
10    paragraph shall not affect the duty to pay for
11    rehabilitation referred to above.
12    When an employer and employee so agree in writing, nothing
13in this Act prevents an employee whose injury or disability has
14been established under this Act, from relying in good faith, on
15treatment by prayer or spiritual means alone, in accordance
16with the tenets and practice of a recognized church or
17religious denomination, by a duly accredited practitioner
18thereof, and having nursing services appropriate therewith,
19without suffering loss or diminution of the compensation
20benefits under this Act. However, the employee shall submit to
21all physical examinations required by this Act. The cost of
22such treatment and nursing care shall be paid by the employee
23unless the employer agrees to make such payment.
24    Where the accidental injury results in the amputation of an
25arm, hand, leg or foot, or the enucleation of an eye, or the
26loss of any of the natural teeth, the employer shall furnish an

 

 

HB2883- 21 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 22 -LRB097 10781 AEK 51211 b

1        1. The compensation rate for temporary total
2    incapacity under this paragraph (b) of this Section shall
3    be equal to 66 2/3% of the employee's average weekly wage
4    computed in accordance with Section 10, provided that it
5    shall be not less than 66 2/3% of the sum of the Federal
6    minimum wage under the Fair Labor Standards Act, or the
7    Illinois minimum wage under the Minimum Wage Law, whichever
8    is more, multiplied by 40 hours. This percentage rate shall
9    be increased by 10% for each spouse and child, not to
10    exceed 100% of the total minimum wage 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        2. The compensation rate in all cases other than for
15    temporary total disability under this paragraph (b), and
16    other than for serious and permanent disfigurement under
17    paragraph (c) and other than for permanent partial
18    disability under subparagraph (2) of paragraph (d) or under
19    paragraph (e), of this Section shall be equal to 66 2/3% of
20    the employee's average weekly wage computed in accordance
21    with the provisions of Section 10, provided that it shall
22    be not less than 66 2/3% of the sum of the Federal minimum
23    wage under the Fair Labor Standards Act, or the Illinois
24    minimum wage under the Minimum Wage Law, whichever is more,
25    multiplied by 40 hours. This percentage rate shall be
26    increased by 10% for each spouse and child, not to exceed

 

 

HB2883- 23 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 24 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 25 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 26 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 27 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 28 -LRB097 10781 AEK 51211 b

1    A duly appointed member of a fire department in a city, the
2population of which exceeds 200,000 according to the last
3federal or State census, is eligible for compensation under
4this paragraph only where such serious and permanent
5disfigurement results from burns.
6    (d) 1. If, after the accidental injury has been sustained,
7the employee as a result thereof becomes partially
8incapacitated from pursuing his usual and customary line of
9employment, he shall, except in cases compensated under the
10specific schedule set forth in paragraph (e) of this Section,
11receive compensation for the duration of his disability,
12subject to the limitations as to maximum amounts fixed in
13paragraph (b) of this Section, equal to 66-2/3% of the
14difference between the average amount which he would be able to
15earn in the full performance of his duties in the occupation in
16which he was engaged at the time of the accident and the
17average amount which he is earning or is able to earn in some
18suitable employment or business after the accident. For
19injuries sustained on or after the effective date of this
20Amendatory Act of the 97th General Assembly, awards made
21pursuant to this subparagraph shall be known as a wage
22differential award and shall cease when the employee reaches
23full retirement age as defined by the Social Security
24Administration. In addition, after a wage differential award
25becomes final, the employer shall, on no more than a quarterly
26annual basis, upon written request to the employee, be entitled

 

 

HB2883- 29 -LRB097 10781 AEK 51211 b

1to verification of an employee's current employment status and
2earnings, including the name and address of the employee's
3current employer, rate of pay or method of compensation,
4duration of such employment, and true copies of the employee's
5paychecks or other evidence of payment for the duration of such
6employment. An employer can further request the employee to
7sign an authorization to permit the employer to then obtain
8from the employee's current employer the employee's earnings
9and payroll documentation. The employer may seek to modify or
10vacate a wage differential award based on a material increase
11in the earnings of the employee during the period that the wage
12differential award is in effect. Notwithstanding and in
13addition to Section 19(h), a final wage differential award may
14at any time be reviewed by the Commission in an evidentiary
15hearing at the request of the employer on the grounds that
16there has been a subsequent material increase in the average
17weekly wage which was the basis of the wage differential award
18and the average weekly wage the employee is earning currently
19after the accident. After review, the Commission shall modify
20or vacate a final wage differential award based where there is
21a finding of a material increase in the employee's current job
22earnings from the employee's earnings from which the wage
23differential award was based upon.
24    2. If, as a result of the accident, the employee sustains
25serious and permanent injuries not covered by paragraphs (c)
26and (e) of this Section or having sustained injuries covered by

 

 

HB2883- 30 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 31 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 32 -LRB097 10781 AEK 51211 b

1        2. First, or index finger-
2            40 weeks if the accidental injury occurs on or
3        after the effective date of this amendatory Act of the
4        94th General Assembly but before February 1, 2006.
5            43 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        3. Second, or middle finger-
8            35 weeks if the accidental injury occurs on or
9        after the effective date of this amendatory Act of the
10        94th General Assembly but before February 1, 2006.
11            38 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        4. Third, or ring finger-
14            25 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            27 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        5. Fourth, or little finger-
20            20 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            22 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        6. Great toe-
26            35 weeks if the accidental injury occurs on or

 

 

HB2883- 33 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 34 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 35 -LRB097 10781 AEK 51211 b

1    this amendatory Act of the 94th General Assembly but before
2    February 1, 2006) or an additional 70 weeks (if the
3    accidental injury occurs on or after February 1, 2006)
4    shall be paid.
5        11. Foot-
6            155 weeks if the accidental injury occurs on or
7        after the effective date of this amendatory Act of the
8        94th General Assembly but before February 1, 2006.
9            167 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        12. Leg-
12            200 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            215 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        Where an accidental injury results in the amputation of
18    a leg below the knee, such injury shall be compensated as
19    loss of a leg. Where an accidental injury results in the
20    amputation of a leg above the knee, compensation for an
21    additional 25 weeks (if the accidental injury occurs on or
22    after the effective date of this amendatory Act of the 94th
23    General Assembly but before February 1, 2006) or an
24    additional 27 weeks (if the accidental injury occurs on or
25    after February 1, 2006) shall be paid, except where the
26    accidental injury results in the amputation of a leg at the

 

 

HB2883- 36 -LRB097 10781 AEK 51211 b

1    hip joint, or so close to the hip joint that an artificial
2    leg cannot be used, or results in the disarticulation of a
3    leg at the hip joint, in which case compensation for an
4    additional 75 weeks (if the accidental injury occurs on or
5    after the effective date of this amendatory Act of the 94th
6    General Assembly but before February 1, 2006) or an
7    additional 81 weeks (if the accidental injury occurs on or
8    after February 1, 2006) shall be paid.
9        13. Eye-
10            150 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            162 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        Where an accidental injury results in the enucleation
16    of an eye, compensation for an additional 10 weeks (if the
17    accidental injury occurs on or after the effective date of
18    this amendatory Act of the 94th General Assembly but before
19    February 1, 2006) or an additional 11 weeks (if the
20    accidental injury occurs on or after February 1, 2006)
21    shall be paid.
22        14. Loss of hearing of one ear-
23            50 weeks if the accidental injury occurs on or
24        after the effective date of this amendatory Act of the
25        94th General Assembly but before February 1, 2006.
26            54 weeks if the accidental injury occurs on or

 

 

HB2883- 37 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 38 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 39 -LRB097 10781 AEK 51211 b

1        made up to the maximum of 100% which is reached at 85
2        decibels.
3            (d) If a hearing loss is established to have
4        existed on July 1, 1975 by audiometric testing the
5        employer shall not be liable for the previous loss so
6        established nor shall he be liable for any loss for
7        which compensation has been paid or awarded.
8            (e) No consideration shall be given to the question
9        of whether or not the ability of an employee to
10        understand speech is improved by the use of a hearing
11        aid.
12            (f) No claim for loss of hearing due to industrial
13        noise shall be brought against an employer or allowed
14        unless the employee has been exposed for a period of
15        time sufficient to cause permanent impairment to noise
16        levels in excess of the following:
17Sound Level DBA
18Slow ResponseHours Per Day
19908
20926
21954
22973
231002
241021-1/2
251051
261101/2

 

 

HB2883- 40 -LRB097 10781 AEK 51211 b

11151/4
2        This subparagraph (f) shall not be applied in cases of
3    hearing loss resulting from trauma or explosion.
4        17. In computing the compensation to be paid to any
5    employee who, before the accident for which he claims
6    compensation, had before that time sustained an injury
7    resulting in the loss by amputation or partial loss by
8    amputation of any member, including hand, arm, thumb or
9    fingers, leg, foot or any toes, such loss or partial loss
10    of any such member shall be deducted from any award made
11    for the subsequent injury. For the permanent loss of use or
12    the permanent partial loss of use of any such member or the
13    partial loss of sight of an eye, for which compensation has
14    been paid, then such loss shall be taken into consideration
15    and deducted from any award for the subsequent injury.
16        18. The specific case of loss of both hands, both arms,
17    or both feet, or both legs, or both eyes, or of any two
18    thereof, or the permanent and complete loss of the use
19    thereof, constitutes total and permanent disability, to be
20    compensated according to the compensation fixed by
21    paragraph (f) of this Section. These specific cases of
22    total and permanent disability do not exclude other cases.
23        Any employee who has previously suffered the loss or
24    permanent and complete loss of the use of any of such
25    members, and in a subsequent independent accident loses
26    another or suffers the permanent and complete loss of the

 

 

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

 

 

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

 

 

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

 

 

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1whose employ he was when the last accidental injury was
2incurred, will equal the amount payable for permanent and
3complete disability as provided in this paragraph of this
4Section.
5    The custodian of the Second Injury Fund provided for in
6paragraph (f) of Section 7 shall be joined with the employer as
7a party respondent in the application for adjustment of claim.
8The application for adjustment of claim shall state briefly and
9in general terms the approximate time and place and manner of
10the loss of the first member.
11    In its award the Commission or the Arbitrator shall
12specifically find the amount the injured employee shall be
13weekly paid, the number of weeks compensation which shall be
14paid by the employer, the date upon which payments begin out of
15the Second Injury Fund provided for in paragraph (f) of Section
167 of this Act, the length of time the weekly payments continue,
17the date upon which the pension payments commence and the
18monthly amount of the payments. The Commission shall 30 days
19after the date upon which payments out of the Second Injury
20Fund have begun as provided in the award, and every month
21thereafter, prepare and submit to the State Comptroller a
22voucher for payment for all compensation accrued to that date
23at the rate fixed by the Commission. The State Comptroller
24shall draw a warrant to the injured employee along with a
25receipt to be executed by the injured employee and returned to
26the Commission. The endorsed warrant and receipt is a full and

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1the employer or the insurance carrier the right to credit for
2any benefits or payments received by the employee other than
3compensation payments provided by this Act, and where the
4employee receives payments other than compensation payments,
5whether as full or partial salary, group insurance benefits,
6bonuses, annuities or any other payments, the employer or
7insurance carrier shall receive credit for each such payment
8only to the extent of the compensation that would have been
9payable during the period covered by such payment.
10    3. The extension of time for the filing of an Application
11for Adjustment of Claim as provided in paragraph 1 above shall
12not apply to those cases where the time for such filing had
13expired prior to the date on which payments or benefits
14enumerated herein have been initiated or resumed. Provided
15however that this paragraph 3 shall apply only to cases wherein
16the payments or benefits hereinabove enumerated shall be
17received after July 1, 1969.
18    (k) For accidental injuries that occur on or after the
19effective date of this amendatory Act of the 97th General
20Assembly, permanent partial or total disability shall be
21certified by a physician and demonstrated by use of medically
22defined objective measurements that include, but are not
23limited to: loss of range of motion; loss of strength; and
24measured atrophy of tissue mass consistent with the injury. In
25determining the impairment, subjective complaints shall not be
26considered unless supported by and clearly related to objective

 

 

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1measurements. The most current edition of the American Medical
2Association's "Guides to the Evaluation of Permanent
3Impairment" shall be applied in determining the level of
4disability under this Act.
5(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
694-695, eff. 11-16-05.)
 
7    (820 ILCS 305/8.2)
8    Sec. 8.2. Fee schedule.
9    (a) Except as provided for in subsection (c), for
10procedures, treatments, or services covered under this Act and
11rendered or to be rendered on and after February 1, 2006 and
12until January 1, 2012, the maximum allowable payment shall be
1390% of the 80th percentile of charges and fees as determined by
14the Commission utilizing information provided by employers'
15and insurers' national databases, with a minimum of 12,000,000
16Illinois line item charges and fees comprised of health care
17provider and hospital charges and fees as of August 1, 2004 but
18not earlier than August 1, 2002. These charges and fees are
19provider billed amounts and shall not include discounted
20charges. The 80th percentile is the point on an ordered data
21set from low to high such that 80% of the cases are below or
22equal to that point and at most 20% are above or equal to that
23point. The Commission shall adjust these historical charges and
24fees as of August 1, 2004 by the Consumer Price Index-U for the
25period August 1, 2004 through September 30, 2005. The

 

 

HB2883- 53 -LRB097 10781 AEK 51211 b

1Commission shall establish fee schedules for procedures,
2treatments, or services for hospital inpatient, hospital
3outpatient, emergency room and trauma, ambulatory surgical
4treatment centers, and professional services. These charges
5and fees shall be designated by geozip or any smaller
6geographic unit. The data shall in no way identify or tend to
7identify any patient, employer, or health care provider. As
8used in this Section, "geozip" means a three-digit zip code
9based on data similarities, geographical similarities, and
10frequencies. A geozip does not cross state boundaries. As used
11in this Section, "three-digit zip code" means a geographic area
12in which all zip codes have the same first 3 digits. If a
13geozip does not have the necessary number of charges and fees
14to calculate a valid percentile for a specific procedure,
15treatment, or service, the Commission may combine data from the
16geozip with up to 4 other geozips that are demographically and
17economically similar and exhibit similarities in data and
18frequencies until the Commission reaches 9 charges or fees for
19that specific procedure, treatment, or service. In cases where
20the compiled data contains fewer less than 9 charges or fees
21for a procedure, treatment, or service, reimbursement shall
22occur at 76% of charges and fees as determined by the
23Commission in a manner consistent with the provisions of this
24paragraph. Providers of out-of-state procedures, treatments,
25services, products, or supplies shall be reimbursed at the
26lesser of that State's fee schedule amount or the fee schedule

 

 

HB2883- 54 -LRB097 10781 AEK 51211 b

1amount that would apply to the region where the employer is
2located. If no fee schedule exists in that State, the provider
3shall be reimbursed at the lesser of the actual charge or the
4fee schedule amount that would apply to the region where the
5employer is located. If out-of-state treatment is being
6undertaken and the employer is also located outside the State
7of Illinois, the provider shall be reimbursed at the lesser of
8the actual charge or the fee schedule amount that would apply
9to the location of the accident. The Commission has the
10authority to set the maximum allowable payment to providers of
11out-of-state procedures, treatments, or services covered under
12this Act in a manner consistent with this Section. Not later
13than September 30 in 2006 and each year thereafter, the
14Commission shall automatically increase or decrease the
15maximum allowable payment for a procedure, treatment, or
16service established and in effect on January 1 of that year by
17the percentage change in the Consumer Price Index-U for the 12
18month period ending August 31 of that year. The increase or
19decrease shall become effective on January 1 of the following
20year. As used in this Section, "Consumer Price Index-U" means
21the index published by the Bureau of Labor Statistics of the
22U.S. Department of Labor, that measures the average change in
23prices of all goods and services purchased by all urban
24consumers, U.S. city average, all items, 1982-84=100.
25    (a-1) Except as provided for in subparagraph (c), for
26procedures, treatments, or services covered under this Act and

 

 

HB2883- 55 -LRB097 10781 AEK 51211 b

1rendered or to be rendered on and after January 1, 2012, The
2Commission shall adopt a medical fee schedule in accordance
3with the fee-related structure and rules of the relevant
4Medicare payment systems. Maximum reasonable fees shall be 160%
5of the estimated aggregate fees prescribed in the relevant
6Medicare payment system for the same class of services.
7    To ensure a reasonable standard of access to services and
8care for injured employees, the Commission may adopt different
9conversion factors, diagnostic related group weights, and
10other factors affecting payment amounts from those used in the
11Medicare payment system, provided estimated aggregate fees do
12not exceed 160% of the estimated aggregate fees paid for the
13same class of services in the relevant Medicare payment system.
14    If the Commission determines that a medical treatment,
15facility use, product, or service is not covered by a Medicare
16payment system, the Commission shall establish maximum fees for
17that item, provided that the maximum fee paid shall not exceed
18160% of the fees paid by Medicare for services that require
19comparable resources.
20    The medical fee schedule shall be adjusted to conform to
21any relevant changes in the Medicare payment systems no later
22than 60 days after the effective date of those changes.
23    Providers of out-of-state procedures, treatments,
24services, products, or supplies shall be reimbursed at the
25lesser of that State's fee schedule amount or the fee schedule
26amount that would apply to the region where the employer is

 

 

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1located. If no fee schedule exists in that State, the provider
2shall be reimbursed at the lesser of the actual charge or the
3fee schedule amount that would apply to the region where the
4employer is located.
5    Nothing in this Section shall prohibit an employer or
6insurer from contracting with a medical provider for
7reimbursement rates different from those prescribed in the
8medical fee schedule.
9    (b) Notwithstanding the provisions of subsection (a), if
10the Commission finds that there is a significant limitation on
11access to quality health care in either a specific field of
12health care services or a specific geographic limitation on
13access to health care, it may change the Consumer Price Index-U
14increase or decrease for that specific field or specific
15geographic limitation on access to health care to address that
16limitation.
17    (c) The Commission shall establish by rule a process to
18review those medical cases or outliers that involve
19extra-ordinary treatment to determine whether to make an
20additional adjustment to the maximum payment within a fee
21schedule for a procedure, treatment, or service.
22    (c-1) For services provided on or after the effective date
23of this Amendatory Act of the 97th General Assembly until
24January 1, 2012, implants shall be reimbursed at 25% above the
25net manufacturer's invoice price less rebates, plus actual
26reasonable and customary shipping charges whether or not the

 

 

HB2883- 57 -LRB097 10781 AEK 51211 b

1implant charge is submitted by a provider in conjunction with a
2bill for all other services associated with the implant,
3submitted by a provider on a separate claim form, submitted by
4a distributor, or submitted by the manufacturer of the implant.
5"Implants" include the following codes or any substantially
6similar updated code as determined by the Commission: 0274
7(prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
8implant); 0278 (implants); 0540 and 0545 (ambulance);
90624(investigational devices); and 0636 (drugs requiring
10detailed coding). Non-implantable devices or supplies within
11these codes shall be reimbursed at 65% of actual charge, which
12is the provider's normal rates under its standard chargemaster.
13A standard chargemaster is the provider's list of charges for
14procedures, treatments, products, supplies, or services used
15to bill payers in a consistent manner.
16    (d) When a patient notifies a provider that the treatment,
17procedure, or service being sought is for a work-related
18illness or injury and furnishes the provider the name and
19address of the responsible employer, the provider shall bill
20the employer directly. The employer shall make payment and
21providers shall submit bills and records in accordance with the
22provisions of this Section. All payments to providers for
23treatment provided pursuant to this Act shall be made within 60
24days of receipt of the bills as long as the claim contains
25substantially all the required data elements necessary to
26adjudicate the bills. In the case of nonpayment to a provider

 

 

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

 

 

HB2883- 59 -LRB097 10781 AEK 51211 b

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

 

 

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

 

 

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1the Commission, or a settlement agreed to by the employer and
2the employee, a provider may resume any and all efforts to
3collect payment from the employee for the services rendered to
4the employee and the employee shall be responsible for payment
5of any outstanding bills for a procedure, treatment, or service
6rendered by a provider as well as the interest awarded under
7subsection (d) of this Section. In the case of a procedure,
8treatment, or service deemed compensable, the provider shall
9not require a payment rate, excluding the interest provisions
10under subsection (d), greater than the lesser of the actual
11charge or the payment level set by the Commission in the fee
12schedule established in this Section. Payment for services
13deemed not covered or not compensable under this Act is the
14responsibility of the employee unless a provider and employee
15have agreed otherwise in writing. Services not covered or not
16compensable under this Act are not subject to the fee schedule
17in this Section.
18    (f) Nothing in this Act shall prohibit an employer or
19insurer from contracting with a health care provider or group
20of health care providers for reimbursement levels for benefits
21under this Act different from those provided in this Section.
22    (g) On or before January 1, 2015 2010 the Commission shall
23provide to the Governor and General Assembly a report regarding
24the implementation of the medical fee schedule indicating the
25impact on medical costs for employers and access to care for
26employees and the index used for annual adjustment to that

 

 

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1schedule as described in this Section.
2(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
3    (820 ILCS 305/8.7)
4    Sec. 8.7. Utilization review programs.
5    (a) As used in this Section:
6    "Utilization review" means the evaluation of proposed or
7provided health care services to determine the appropriateness
8of both the level of health care services medically necessary
9and the quality of health care services provided to a patient,
10including evaluation of their efficiency, efficacy, and
11appropriateness of treatment, hospitalization, or office
12visits based on medically accepted standards. The evaluation
13must be accomplished by means of a system that identifies the
14utilization of health care services based on nationally
15recognized standards of care or nationally recognized peer
16review guidelines as well as nationally recognized treatment
17guidelines and evidence-based medicine evidence based upon
18standards as provided in this Act. Utilization techniques may
19include prospective review, second opinions, concurrent
20review, discharge planning, peer review, independent medical
21examinations, and retrospective review (for purposes of this
22sentence, retrospective review shall be applicable to services
23rendered on or after July 20, 2005). Nothing in this Section
24applies to prospective review of necessary first aid or
25emergency treatment.

 

 

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1    (b) No person may conduct a utilization review program for
2workers' compensation services in this State unless once every
32 years the person registers the utilization review program
4with the Department of Insurance Financial and Professional
5Regulation and certifies compliance with the Workers'
6Compensation Utilization Management standards or Health
7Utilization Management Standards of URAC sufficient to achieve
8URAC accreditation or submits evidence of accreditation by URAC
9for its Workers' Compensation Utilization Management Standards
10or Health Utilization Management Standards. Nothing in this Act
11shall be construed to require an employer or insurer or its
12subcontractors to become URAC accredited.
13    (c) In addition, the Director Secretary of Insurance
14Financial and Professional Regulation may certify alternative
15utilization review standards of national accreditation
16organizations or entities in order for plans to comply with
17this Section. Any alternative utilization review standards
18shall meet or exceed those standards required under subsection
19(b).
20    (d) This registration shall include submission of all of
21the following information regarding utilization review program
22activities:
23        (1) The name, address, and telephone number of the
24    utilization review programs.
25        (2) The organization and governing structure of the
26    utilization review programs.

 

 

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

 

 

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

 

 

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1employer's agent or insurer wishes to invoke the utilization
2review process, the provider of medical, surgical or hospital
3services shall submit to the utilization review, following URAC
4procedural guidelines and appeal process. If the provider fails
5to cooperate with the utilization review of proposed treatment
6or services, the charges for the treatment or service shall not
7be compensable or collectible against the employer, the
8employer's agent or insurer, or the employee. When an employer
9denies payment of or refuses to authorize payment of first aid,
10medical, surgical, or hospital services under Section 8(a) of
11this Act that complies with subsection (b) of this Section,
12that denial or refusal to authorize shall create a rebuttable
13presumption that the extent and scope of medical treatment is
14excessive or unnecessary. The Commission shall deny payment for
15any service which the utilization review has determined subject
16to subsection (a) of this Section to be excessive and
17unnecessary unless the presumption is rebutted by establishing
18by a preponderance of the evidence that a variance from the
19standards of care or guidelines used pursuant to subsection (a)
20of this Section is reasonably required to cure and relieve the
21employee from the effects of his or her injury or that the
22utilization review did not comply with subsection (b) of this
23Section. This subsection shall apply to medical, surgical, or
24hospital services rendered on or after the effective date of
25this Amendatory Act of the 97th General Assembly. A utilization
26review will be considered by the Commission, along with all

 

 

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1other evidence and in the same manner as all other evidence, in
2the determination of the reasonableness and necessity of the
3medical bills or treatment. Nothing in this Section shall be
4construed to diminish the rights of employees to reasonable and
5necessary medical treatment or employee choice of health care
6provider under Section 8(a) or the rights of employers to
7medical examinations under Section 12.
8    (j) When an employer denies payment of or refuses to
9authorize payment of first aid, medical, surgical, or hospital
10services under Section 8(a) of this Act, if that denial or
11refusal to authorize complies with a utilization review program
12registered under this Section and complies with all other
13requirements of this Section, then there shall be a rebuttable
14presumption that the employer shall not be responsible for
15payment of additional compensation pursuant to Section 19(k) of
16this Act and if that denial or refusal to authorize does not
17comply with a utilization review program registered under this
18Section and does not comply with all other requirements of this
19Section, then that will be considered by the Commission, along
20with all other evidence and in the same manner as all other
21evidence, in the determination of whether the employer may be
22responsible for the payment of additional compensation
23pursuant to Section 19(k) of this Act.
24(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
25    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)

 

 

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1    Sec. 11. The compensation herein provided, together with
2the provisions of this Act, shall be the measure of the
3responsibility of any employer engaged in any of the
4enterprises or businesses enumerated in Section 3 of this Act,
5or of any employer who is not engaged in any such enterprises
6or businesses, but who has elected to provide and pay
7compensation for accidental injuries sustained by any employee
8arising out of and in the course of the employment according to
9the provisions of this Act, and whose election to continue
10under this Act, has not been nullified by any action of his
11employees as provided for in this Act.
12    Accidental injuries incurred while participating in
13voluntary recreational programs including but not limited to
14athletic events, parties and picnics do not arise out of and in
15the course of the employment even though the employer pays some
16or all of the cost thereof. This exclusion shall not apply in
17the event that the injured employee was ordered or assigned by
18his employer to participate in the program.
19    Accidental injuries incurred while participating as a
20patient in a drug or alcohol rehabilitation program do not
21arise out of and in the course of employment even though the
22employer pays some or all of the costs thereof.
23    Any injury to or disease or death of an employee arising
24from the administration of a vaccine, including without
25limitation smallpox vaccine, to prepare for, or as a response
26to, a threatened or potential bioterrorist incident to the

 

 

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

 

 

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1is any evidence of impairment due to the unlawful or
2unauthorized use of (1) cannabis as defined in the Cannabis
3Control Act, (2) a controlled substance listed in the Illinois
4Controlled Substances Act, or (3) an intoxicating compound
5listed in the Use of Intoxicating Compounds Act. If the
6employee refuses to submit to testing of blood, breath, or
7urine as soon as practical after the accident, he or she shall
8be considered to have been intoxicated at the time of the
9accident. Percentage by weight of alcohol in the blood shall be
10based on grams of alcohol per 100 milliliters of blood.
11Percentage by weight of alcohol in the breath shall be based
12upon grams of alcohol per 210 liters of breath. Any testing
13that has not been performed by an accredited or certified
14testing laboratory shall not be admissible in any hearing under
15this Act to determine whether the employee was intoxicated at
16the time the employee incurred the accidental injury.
17    All sample collection and testing for alcohol and drugs
18under this Section shall be performed in accordance with rules
19to be adopted by the Commission. These rules shall ensure:
20        (1) compliance with the National Labor Relations Act
21    regarding collective bargaining agreements or regulations
22    promulgated by the United States Department of
23    Transportation;
24        (2) that samples are collected and tested in
25    conformance with national and State legal and regulatory
26    standards for the privacy of the individual being tested,

 

 

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1    and in a manner reasonably calculated to prevent
2    substitutions or interference with the collection or
3    testing of reliable sample;
4        (3) that split testing procedures are utilized;
5        (4) sample collection is documented, and the
6    documentation procedures include:
7            (A) the labeling of samples in a manner so as to
8        reasonably preclude the probability of erroneous
9        identification of test result; and
10            (B) an opportunity for the employee to provide
11        notification of any information which he or she
12        considers relevant to the test, including
13        identification of currently or recently used
14        prescription or nonprescription drugs and other
15        relevant medical information;
16        (5) that sample collection, storage, and
17    transportation to the place of testing is performed in a
18    manner so as to reasonably preclude the probability of
19    sample contamination or adulteration; and
20    (6) that chemical analyses of blood, urine, breath, or
21    other bodily substance are performed according to
22    nationally scientifically accepted analytical methods and
23    procedures.
24(Source: P.A. 93-829, eff. 7-28-04.)
 
25    (820 ILCS 305/16)  (from Ch. 48, par. 138.16)

 

 

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1    Sec. 16. The Commission shall make and publish procedural
2rules and orders for carrying out the duties imposed upon it by
3law and for determining the extent of disability sustained,
4which rules and orders shall be deemed prima facie reasonable
5and valid.
6    The process and procedure before the Commission shall be as
7simple and summary as reasonably may be.
8    The Commission upon application of either party may issue
9dedimus potestatem directed to a commissioner, notary public,
10justice of the peace or any other officer authorized by law to
11administer oaths, to take the depositions of such witness or
12witnesses as may be necessary in the judgment of such
13applicant. Such dedimus potestatem may issue to any of the
14officers aforesaid in any state or territory of the United
15States. When the deposition of any witness resident of a
16foreign country is desired to be taken, the dedimus shall be
17directed to and the deposition taken before a consul, vice
18consul or other authorized representative of the government of
19the United States of America, whose station is in the country
20where the witness whose deposition is to be taken resides. In
21countries where the government of the United States has no
22consul or other diplomatic representative, then depositions in
23such case shall be taken through the appropriate judicial
24authority of that country; or where treaties provide for other
25methods of taking depositions, then the same may be taken as in
26such treaties provided. The Commission shall have the power to

 

 

HB2883- 73 -LRB097 10781 AEK 51211 b

1adopt necessary rules to govern the issue of such dedimus
2potestatem.
3    The Commission, or any member thereof, or any Arbitrator
4designated by the Commission shall have the power to administer
5oaths, subpoena and examine witnesses; to issue subpoenas duces
6tecum, requiring the production of such books, papers, records,
7including but not limited to employment verification documents
8pursuant to subsection 8(d)1 of this Act, and documents as may
9be evidence of any matter under inquiry and to examine and
10inspect the same and such places or premises as may relate to
11the question in dispute. The Commission, or any member thereof,
12or any Arbitrator designated by the Commission, shall on
13written request of either party to the dispute, issue subpoenas
14for the attendance of such witnesses and production of such
15books, papers, records, including but not limited to employment
16verification documents pursuant to subsection 8(d)1 of this
17Act, and documents as shall be designated in the applications,
18and the parties applying for such subpoena shall advance the
19officer and witness fees provided for in civil actions pending
20in circuit courts of this State, except as otherwise provided
21by Section 20 of this Act. Service of such subpoena shall be
22made by any sheriff or other person. In case any person refuses
23to comply with an order of the Commission or subpoenas issued
24by it or by any member thereof, or any Arbitrator designated by
25the Commission or to permit an inspection of places or
26premises, or to produce any books, papers, records or

 

 

HB2883- 74 -LRB097 10781 AEK 51211 b

1documents, or any witness refuses to testify to any matters
2regarding which he or she may be lawfully interrogated, the
3Circuit Court of the county in which the hearing or matter is
4pending, on application of any member of the Commission or any
5Arbitrator designated by the Commission, shall compel
6obedience by attachment proceedings, as for contempt, as in a
7case of disobedience of the requirements of a subpoena from
8such court on a refusal to testify therein.
9    The records, reports, and bills kept by a treating
10hospital, treating physician, or other treating healthcare
11provider that renders treatment to the employee as a result of
12accidental injuries in question, certified to as true and
13correct by the hospital, physician, or other healthcare
14provider or by designated agents of the hospital, physician, or
15other healthcare provider, showing the medical and surgical
16treatment given an injured employee by such hospital,
17physician, or other healthcare provider, shall be admissible
18without any further proof as evidence of the medical and
19surgical matters stated therein, but shall not be conclusive
20proof of such matters. There shall be a rebuttable presumption
21that any such records, reports, and bills received in response
22to Commission subpoena are certified to be true and correct.
23This paragraph does not restrict, limit, or prevent the
24admissibility of records, reports, or bills that are otherwise
25admissible. This provision does not apply to reports prepared
26by treating providers for use in litigation.

 

 

HB2883- 75 -LRB097 10781 AEK 51211 b

1    The Commission at its expense shall provide an official
2court reporter to take the testimony and record of proceedings
3at the hearings before an Arbitrator or the Commission, who
4shall furnish a transcript of such testimony or proceedings to
5either party requesting it, upon payment therefor at the rate
6of $1.00 per page for the original and 35 cents per page for
7each copy of such transcript. Payment for photostatic copies of
8exhibits shall be extra. If the Commission has determined, as
9provided in Section 20 of this Act, that the employee is a poor
10person, a transcript of such testimony and proceedings,
11including photostatic copies of exhibits, shall be furnished to
12such employee at the Commission's expense.
13    The Commission shall have the power to determine the
14reasonableness and fix the amount of any fee of compensation
15charged by any person, including attorneys, physicians,
16surgeons and hospitals, for any service performed in connection
17with this Act, or for which payment is to be made under this
18Act or rendered in securing any right under this Act.
19    Whenever the Commission shall find that the employer, his
20or her agent, service company or insurance carrier has been
21guilty of delay or unfairness towards an employee in the
22adjustment, settlement or payment of benefits due such employee
23within the purview of the provisions of paragraph (c) of
24Section 4 of this Act; or has been guilty of unreasonable or
25vexatious delay, intentional under-payment of compensation
26benefits, or has engaged in frivolous defenses which do not

 

 

HB2883- 76 -LRB097 10781 AEK 51211 b

1present a real controversy, within the purview of the
2provisions of paragraph (k) of Section 19 of this Act, the
3Commission may assess all or any part of the attorney's fees
4and costs against such employer and his or her insurance
5carrier.
6(Source: P.A. 94-277, eff. 7-20-05.)
 
7    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
8    Sec. 19. Any disputed questions of law or fact shall be
9determined as herein provided.
10    (a) It shall be the duty of the Commission upon
11notification that the parties have failed to reach an
12agreement, to designate an Arbitrator.
13        1. Whenever any claimant misconceives his remedy and
14    files an application for adjustment of claim under this Act
15    and it is subsequently discovered, at any time before final
16    disposition of such cause, that the claim for disability or
17    death which was the basis for such application should
18    properly have been made under the Workers' Occupational
19    Diseases Act, then the provisions of Section 19, paragraph
20    (a-1) of the Workers' Occupational Diseases Act having
21    reference to such application shall apply.
22        2. Whenever any claimant misconceives his remedy and
23    files an application for adjustment of claim under the
24    Workers' Occupational Diseases Act and it is subsequently
25    discovered, at any time before final disposition of such

 

 

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

 

 

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

 

 

HB2883- 79 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 80 -LRB097 10781 AEK 51211 b

1compensation as provided in paragraph (b) of Section 8. When an
2employer has petitioned for an expedited hearing, the employer
3shall continue to pay compensation as provided in paragraph (b)
4of Section 8 unless the arbitrator renders a decision that the
5employee is not entitled to the benefits that are the subject
6of the expedited hearing or unless the employee's treating
7physician has released the employee to return to work at his or
8her regular job with the employer or the employee actually
9returns to work at any other job. If the arbitrator renders a
10decision that the employee is not entitled to the benefits that
11are the subject of the expedited hearing, a petition for review
12filed by the employee shall receive the same priority as if the
13employee had filed a petition for an expedited hearing by an
14Arbitrator. Neither party shall be entitled to an expedited
15hearing when the employee has returned to work and the sole
16issue in dispute amounts to less than 12 weeks of unpaid
17compensation pursuant to paragraph (b) of Section 8.
18    Expedited hearings shall have priority over all other
19petitions and shall be heard by the Arbitrator and Commission
20with all convenient speed. Any party requesting an expedited
21hearing shall give notice of a request for an expedited hearing
22under this paragraph. A copy of the Application for Adjustment
23of Claim shall be attached to the notice. The Commission shall
24adopt rules and procedures under which the final decision of
25the Commission under this paragraph is filed not later than 180
26days from the date that the Petition for Review is filed with

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1of testimony and of such argument.
2    In any case the Commission in its decision may find
3specially upon any question or questions of law or fact which
4shall be submitted in writing by either party whether ultimate
5or otherwise; provided that on issues other than nature and
6extent of the disability, if any, the Commission in its
7decision shall find specially upon any question or questions of
8law or fact, whether ultimate or otherwise, which are submitted
9in writing by either party; provided further that not more than
105 such questions may be submitted by either party. Any party
11may, within 20 days after receipt of notice of the Commission's
12decision, or within such further time, not exceeding 30 days,
13as the Commission may grant, file with the Commission either an
14agreed statement of the facts appearing upon the hearing, or,
15if such party shall so elect, a correct transcript of evidence
16of the additional proceedings presented before the Commission,
17in which report the party may embody a correct statement of
18such other proceedings in the case as such party may desire to
19have reviewed, such statement of facts or transcript of
20evidence to be authenticated by the signature of the parties or
21their attorneys, and in the event that they do not agree, then
22the authentication of such transcript of evidence shall be by
23the signature of any member of the Commission.
24    If a reporter does not for any reason furnish a transcript
25of the proceedings before the Arbitrator in any case for use on
26a hearing for review before the Commission, within the

 

 

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1limitations of time as fixed in this Section, the Commission
2may, in its discretion, order a trial de novo before the
3Commission in such case upon application of either party. The
4applications for adjustment of claim and other documents in the
5nature of pleadings filed by either party, together with the
6decisions of the Arbitrator and of the Commission and the
7statement of facts or transcript of evidence hereinbefore
8provided for in paragraphs (b) and (c) shall be the record of
9the proceedings of the Commission, and shall be subject to
10review as hereinafter provided.
11    At the request of either party or on its own motion, the
12Commission shall set forth in writing the reasons for the
13decision, including findings of fact and conclusions of law
14separately stated. The Commission shall by rule adopt a format
15for written decisions for the Commission and arbitrators. The
16written decisions shall be concise and shall succinctly state
17the facts and reasons for the decision. The Commission may
18adopt in whole or in part, the decision of the arbitrator as
19the decision of the Commission. When the Commission does so
20adopt the decision of the arbitrator, it shall do so by order.
21Whenever the Commission adopts part of the arbitrator's
22decision, but not all, it shall include in the order the
23reasons for not adopting all of the arbitrator's decision. When
24a majority of a panel, after deliberation, has arrived at its
25decision, the decision shall be filed as provided in this
26Section without unnecessary delay, and without regard to the

 

 

HB2883- 92 -LRB097 10781 AEK 51211 b

1fact that a member of the panel has expressed an intention to
2dissent. Any member of the panel may file a dissent. Any
3dissent shall be filed no later than 10 days after the decision
4of the majority has been filed.
5    Decisions rendered by the Commission and dissents, if any,
6shall be published together by the Commission. The conclusions
7of law set out in such decisions shall be regarded as
8precedents by arbitrators for the purpose of achieving a more
9uniform administration of this Act.
10    (f) The decision of the Commission acting within its
11powers, according to the provisions of paragraph (e) of this
12Section shall, in the absence of fraud, be conclusive unless
13reviewed as in this paragraph hereinafter provided. However,
14the Arbitrator or the Commission may on his or its own motion,
15or on the motion of either party, correct any clerical error or
16errors in computation within 15 days after the date of receipt
17of any award by such Arbitrator or any decision on review of
18the Commission and shall have the power to recall the original
19award on arbitration or decision on review, and issue in lieu
20thereof such corrected award or decision. Where such correction
21is made the time for review herein specified shall begin to run
22from the date of the receipt of the corrected award or
23decision.
24        (1) Except in cases of claims against the State of
25    Illinois, in which case the decision of the Commission
26    shall not be subject to judicial review, the Circuit Court

 

 

HB2883- 93 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 94 -LRB097 10781 AEK 51211 b

1    be done by mailing a copy of the summons to the office of
2    the Commission, and a copy of the summons to the other
3    parties in interest or their attorney or attorneys of
4    record and the clerk of the court shall make certificate
5    that he has so sent said notices in pursuance of this
6    Section, which shall be evidence of service on the
7    Commission and other parties in interest.
8        The Commission shall not be required to certify the
9    record of their proceedings to the Circuit Court, unless
10    the party commencing the proceedings for review in the
11    Circuit Court as above provided, shall pay to the
12    Commission the sum of 80¢ per page of testimony taken
13    before the Commission, and 35¢ per page of all other
14    matters contained in such record, except as otherwise
15    provided by Section 20 of this Act. Payment for photostatic
16    copies of exhibit shall be extra. It shall be the duty of
17    the Commission upon such payment, or failure to pay as
18    permitted under Section 20 of this Act, to prepare a true
19    and correct typewritten copy of such testimony and a true
20    and correct copy of all other matters contained in such
21    record and certified to by the Secretary or Assistant
22    Secretary thereof.
23        In its decision on review the Commission shall
24    determine in each particular case the amount of the
25    probable cost of the record to be filed as a part of the
26    summons in that case and no request for a summons may be

 

 

HB2883- 95 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 96 -LRB097 10781 AEK 51211 b

1    the court to issue such summons.
2        The court may confirm or set aside the decision of the
3    Commission. If the decision is set aside and the facts
4    found in the proceedings before the Commission are
5    sufficient, the court may enter such decision as is
6    justified by law, or may remand the cause to the Commission
7    for further proceedings and may state the questions
8    requiring further hearing, and give such other
9    instructions as may be proper. Appeals shall be taken to
10    the Appellate Court in accordance with Supreme Court Rules
11    22(g) and 303. Appeals shall be taken from the Appellate
12    Court to the Supreme Court in accordance with Supreme Court
13    Rule 315.
14        It shall be the duty of the clerk of any court
15    rendering a decision affecting or affirming an award of the
16    Commission to promptly furnish the Commission with a copy
17    of such decision, without charge.
18        The decision of a majority of the members of the panel
19    of the Commission, shall be considered the decision of the
20    Commission.
21    (g) Except in the case of a claim against the State of
22Illinois, either party may present a certified copy of the
23award of the Arbitrator, or a certified copy of the decision of
24the Commission when the same has become final, when no
25proceedings for review are pending, providing for the payment
26of compensation according to this Act, to the Circuit Court of

 

 

HB2883- 97 -LRB097 10781 AEK 51211 b

1the county in which such accident occurred or either of the
2parties are residents, whereupon the court shall enter a
3judgment in accordance therewith. In a case where the employer
4refuses to pay compensation according to such final award or
5such final decision upon which such judgment is entered the
6court shall in entering judgment thereon, tax as costs against
7him the reasonable costs and attorney fees in the arbitration
8proceedings and in the court entering the judgment for the
9person in whose favor the judgment is entered, which judgment
10and costs taxed as therein provided shall, until and unless set
11aside, have the same effect as though duly entered in an action
12duly tried and determined by the court, and shall with like
13effect, be entered and docketed. The Circuit Court shall have
14power at any time upon application to make any such judgment
15conform to any modification required by any subsequent decision
16of the Supreme Court upon appeal, or as the result of any
17subsequent proceedings for review, as provided in this Act.
18    Judgment shall not be entered until 15 days' notice of the
19time and place of the application for the entry of judgment
20shall be served upon the employer by filing such notice with
21the Commission, which Commission shall, in case it has on file
22the address of the employer or the name and address of its
23agent upon whom notices may be served, immediately send a copy
24of the notice to the employer or such designated agent.
25    (h) An agreement or award under this Act providing for
26compensation in installments, may at any time within 18 months

 

 

HB2883- 98 -LRB097 10781 AEK 51211 b

1after such agreement or award be reviewed by the Commission at
2the request of either the employer or the employee, on the
3ground that the disability of the employee has subsequently
4recurred, increased, diminished or ended.
5    However, as to accidents occurring subsequent to July 1,
61955, which are covered by any agreement or award under this
7Act providing for compensation in installments made as a result
8of such accident, such agreement or award may at any time
9within 30 months, or 60 months in the case of an award under
10Section 8(d)1, after such agreement or award be reviewed by the
11Commission at the request of either the employer or the
12employee on the ground that the disability of the employee has
13subsequently recurred, increased, diminished or ended. The
14employer at any time may seek review by the Commission of any
15final award under Section 8(d)1 of this Act where there is a
16material increase in earnings by the employee.
17    On such review, compensation payments may be
18re-established, increased, diminished or ended. The Commission
19shall give 15 days' notice to the parties of the hearing for
20review. Any employee, upon any petition for such review being
21filed by the employer, shall be entitled to one day's notice
22for each 100 miles necessary to be traveled by him in attending
23the hearing of the Commission upon the petition, and 3 days in
24addition thereto. Such employee shall, at the discretion of the
25Commission, also be entitled to 5 cents per mile necessarily
26traveled by him within the State of Illinois in attending such

 

 

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

 

 

HB2883- 100 -LRB097 10781 AEK 51211 b

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

 

 

HB2883- 101 -LRB097 10781 AEK 51211 b

1Arbitrator or the Commission shall allow to the employee
2additional compensation in the sum of $30 per day for each day
3that the benefits under Section 8(a) or Section 8(b) have been
4so withheld or refused, not to exceed $10,000. A delay in
5payment of 14 days or more shall create a rebuttable
6presumption of unreasonable delay.
7    (m) If the commission finds that an accidental injury was
8directly and proximately caused by the employer's wilful
9violation of a health and safety standard under the Health and
10Safety Act in force at the time of the accident, the arbitrator
11or the Commission shall allow to the injured employee or his
12dependents, as the case may be, additional compensation equal
13to 25% of the amount which otherwise would be payable under the
14provisions of this Act exclusive of this paragraph. The
15additional compensation herein provided shall be allowed by an
16appropriate increase in the applicable weekly compensation
17rate.
18    (n) After June 30, 1984, decisions of the Illinois Workers'
19Compensation Commission reviewing an award of an arbitrator of
20the Commission shall draw interest at a rate equal to the yield
21on indebtedness issued by the United States Government with a
2226-week maturity next previously auctioned on the day on which
23the decision is filed. Said rate of interest shall be set forth
24in the Arbitrator's Decision. Interest shall be drawn from the
25date of the arbitrator's award on all accrued compensation due
26the employee through the day prior to the date of payments.

 

 

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

 

 

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

 

 

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

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    820 ILCS 305/1from Ch. 48, par. 138.1
4    820 ILCS 305/6from Ch. 48, par. 138.6
5    820 ILCS 305/8from Ch. 48, par. 138.8
6    820 ILCS 305/8.2
7    820 ILCS 305/8.7
8    820 ILCS 305/11from Ch. 48, par. 138.11
9    820 ILCS 305/16from Ch. 48, par. 138.16
10    820 ILCS 305/19from Ch. 48, par. 138.19