97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB1676

 

Introduced 2/9/2011, by Sen. Wm. Sam McCann

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/19  from Ch. 48, par. 138.19
820 ILCS 305/25.5

    Amends the Workers' Compensation Act. Provides that the Illinois Workers' Compensation Commission may recall a decision or settlement when fraud has been determined to be committed related to the case. Provides that the Commission shall implement a rule to establish a process for recalling a decision or settlement that is subject to recall due to fraud. Provides that the fraud and insurance non-compliance unit of the Department of Insurance shall employ one or more attorneys licensed to practice law in Illinois as special prosecutors who shall initiate and prosecute any necessary criminal or civil actions in any court or tribunal of competent jurisdiction in this State. Provides that the special prosecutors may also assist State's Attorneys in prosecuting violations of this Section, without charge to the county. Provides that when the Attorney General or a State's Attorney declines to prosecute a referral from the fraud and insurance non-compliance unit of an alleged violation of this Section, the Attorney General or the State's Attorney declining prosecution shall provide in writing a response to the unit within 30 days of such decision setting forth the reasons and basis for the decision. Provides that the unit shall provide the response to the employer.


LRB097 07108 AEK 47207 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1676LRB097 07108 AEK 47207 b

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 19 and 25.5 as follows:
 
6    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
7    Sec. 19. Any disputed questions of law or fact shall be
8determined as herein provided.
9    (a) It shall be the duty of the Commission upon
10notification that the parties have failed to reach an
11agreement, to designate an Arbitrator.
12        1. Whenever any claimant misconceives his remedy and
13    files an application for adjustment of claim under this Act
14    and it is subsequently discovered, at any time before final
15    disposition of such cause, that the claim for disability or
16    death which was the basis for such application should
17    properly have been made under the Workers' Occupational
18    Diseases Act, then the provisions of Section 19, paragraph
19    (a-1) of the Workers' Occupational Diseases Act having
20    reference to such application shall apply.
21        2. Whenever any claimant misconceives his remedy and
22    files an application for adjustment of claim under the
23    Workers' Occupational Diseases Act and it is subsequently

 

 

SB1676- 2 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 3 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 4 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 5 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 6 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 7 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 8 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 9 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 10 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 11 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 12 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 13 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 14 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 15 -LRB097 07108 AEK 47207 b

1parties or their attorneys of the time and place of such taking
2of testimony and of such argument.
3    In any case the Commission in its decision may find
4specially upon any question or questions of law or fact which
5shall be submitted in writing by either party whether ultimate
6or otherwise; provided that on issues other than nature and
7extent of the disability, if any, the Commission in its
8decision shall find specially upon any question or questions of
9law or fact, whether ultimate or otherwise, which are submitted
10in writing by either party; provided further that not more than
115 such questions may be submitted by either party. Any party
12may, within 20 days after receipt of notice of the Commission's
13decision, or within such further time, not exceeding 30 days,
14as the Commission may grant, file with the Commission either an
15agreed statement of the facts appearing upon the hearing, or,
16if such party shall so elect, a correct transcript of evidence
17of the additional proceedings presented before the Commission,
18in which report the party may embody a correct statement of
19such other proceedings in the case as such party may desire to
20have reviewed, such statement of facts or transcript of
21evidence to be authenticated by the signature of the parties or
22their attorneys, and in the event that they do not agree, then
23the authentication of such transcript of evidence shall be by
24the signature of any member of the Commission.
25    If a reporter does not for any reason furnish a transcript
26of the proceedings before the Arbitrator in any case for use on

 

 

SB1676- 16 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 17 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 18 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 19 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 20 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 21 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 22 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 23 -LRB097 07108 AEK 47207 b

1the Commission, which Commission shall, in case it has on file
2the address of the employer or the name and address of its
3agent upon whom notices may be served, immediately send a copy
4of the notice to the employer or such designated agent.
5    (h) An agreement or award under this Act providing for
6compensation in installments, may at any time within 18 months
7after such agreement or award be reviewed by the Commission at
8the request of either the employer or the employee, on the
9ground that the disability of the employee has subsequently
10recurred, increased, diminished or ended.
11    However, as to accidents occurring subsequent to July 1,
121955, which are covered by any agreement or award under this
13Act providing for compensation in installments made as a result
14of such accident, such agreement or award may at any time
15within 30 months, or 60 months in the case of an award under
16Section 8(d)1, after such agreement or award be reviewed by the
17Commission at the request of either the employer or the
18employee on the ground that the disability of the employee has
19subsequently recurred, increased, diminished or ended.
20    On such review, compensation payments may be
21re-established, increased, diminished or ended. The Commission
22shall give 15 days' notice to the parties of the hearing for
23review. Any employee, upon any petition for such review being
24filed by the employer, shall be entitled to one day's notice
25for each 100 miles necessary to be traveled by him in attending
26the hearing of the Commission upon the petition, and 3 days in

 

 

SB1676- 24 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 25 -LRB097 07108 AEK 47207 b

1introduced with the same force and effect as though the witness
2having so testified were present in person in such subsequent
3proceedings and such final decision, if any, shall be taken as
4final adjudication of any of the issues which are the same in
5both proceedings.
6    (k) In case where there has been any unreasonable or
7vexatious delay of payment or intentional underpayment of
8compensation, or proceedings have been instituted or carried on
9by the one liable to pay the compensation, which do not present
10a real controversy, but are merely frivolous or for delay, then
11the Commission may award compensation additional to that
12otherwise payable under this Act equal to 50% of the amount
13payable at the time of such award. Failure to pay compensation
14in accordance with the provisions of Section 8, paragraph (b)
15of this Act, shall be considered unreasonable delay.
16    When determining whether this subsection (k) shall apply,
17the Commission shall consider whether an Arbitrator has
18determined that the claim is not compensable or whether the
19employer has made payments under Section 8(j).
20    (l) If the employee has made written demand for payment of
21benefits under Section 8(a) or Section 8(b), the employer shall
22have 14 days after receipt of the demand to set forth in
23writing the reason for the delay. In the case of demand for
24payment of medical benefits under Section 8(a), the time for
25the employer to respond shall not commence until the expiration
26of the allotted 60 days specified under Section 8.2(d). In case

 

 

SB1676- 26 -LRB097 07108 AEK 47207 b

1the employer or his or her insurance carrier shall without good
2and just cause fail, neglect, refuse, or unreasonably delay the
3payment of benefits under Section 8(a) or Section 8(b), the
4Arbitrator or the Commission shall allow to the employee
5additional compensation in the sum of $30 per day for each day
6that the benefits under Section 8(a) or Section 8(b) have been
7so withheld or refused, not to exceed $10,000. A delay in
8payment of 14 days or more shall create a rebuttable
9presumption of unreasonable delay.
10    (m) If the commission finds that an accidental injury was
11directly and proximately caused by the employer's wilful
12violation of a health and safety standard under the Health and
13Safety Act in force at the time of the accident, the arbitrator
14or the Commission shall allow to the injured employee or his
15dependents, as the case may be, additional compensation equal
16to 25% of the amount which otherwise would be payable under the
17provisions of this Act exclusive of this paragraph. The
18additional compensation herein provided shall be allowed by an
19appropriate increase in the applicable weekly compensation
20rate.
21    (n) After June 30, 1984, decisions of the Illinois Workers'
22Compensation Commission reviewing an award of an arbitrator of
23the Commission shall draw interest at a rate equal to the yield
24on indebtedness issued by the United States Government with a
2526-week maturity next previously auctioned on the day on which
26the decision is filed. Said rate of interest shall be set forth

 

 

SB1676- 27 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 28 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 29 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 30 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 31 -LRB097 07108 AEK 47207 b

1    accompanying financial statement for the purpose of
2    obtaining self-insurance status or reducing the amount of
3    security that may be required to be furnished pursuant to
4    Section 4 of this Act.
5        (7) Intentionally make or cause to be made any false or
6    fraudulent material statement to the Department Division
7    of Insurance's fraud and insurance non-compliance unit in
8    the course of an investigation of fraud or insurance
9    non-compliance.
10        (8) Intentionally assist, abet, solicit, or conspire
11    with any person, company, or other entity to commit any of
12    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
13    of this subsection (a).
14    For the purposes of paragraphs (2), (3), (5), (6), and (7),
15the term "statement" includes any writing, notice, proof of
16injury, bill for services, hospital or doctor records and
17reports, or X-ray and test results.
18    (b) Any person violating subsection (a) is guilty of a
19Class 4 felony. Any person or entity convicted of any violation
20of this Section shall be ordered to pay complete restitution to
21any person or entity so defrauded in addition to any fine or
22sentence imposed as a result of the conviction.
23    (c) The Department Division of Insurance of the Department
24of Financial and Professional Regulation shall establish a
25fraud and insurance non-compliance unit responsible for
26investigating incidences of fraud and insurance non-compliance

 

 

SB1676- 32 -LRB097 07108 AEK 47207 b

1pursuant to this Section. The size of the staff of the unit
2shall be subject to appropriation by the General Assembly. It
3shall be the duty of the fraud and insurance non-compliance
4unit to determine the identity of insurance carriers,
5employers, employees, or other persons or entities who have
6violated the fraud and insurance non-compliance provisions of
7this Section and any prosecution thereof. The fraud and
8insurance non-compliance unit shall report violations of the
9fraud and insurance non-compliance provisions of this Section
10to the Attorney General or to the State's Attorney of the
11county in which the offense allegedly occurred, either of whom
12has the authority to prosecute violations under this Section.
13    The fraud and insurance non-compliance unit shall employ
14one or more attorneys licensed to practice law in Illinois as
15special prosecutors who shall initiate and prosecute any
16necessary criminal or civil actions in any court or tribunal of
17competent jurisdiction in this State. The special prosecutors
18may also assist State's Attorneys in prosecuting violations of
19this Section, without charge to the county.
20    With respect to the subject of any investigation being
21conducted, the fraud and insurance non-compliance unit shall
22have the general power of subpoena of the Department Division
23of Insurance.
24    (d) Any person may report allegations of insurance
25non-compliance and fraud pursuant to this Section to the
26Department Division of Insurance's fraud and insurance

 

 

SB1676- 33 -LRB097 07108 AEK 47207 b

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

 

 

SB1676- 34 -LRB097 07108 AEK 47207 b

1address of the complainant if that complainant is connected to
2the case and the nature of the reported conduct. The fraud and
3insurance non-compliance unit shall resolve all reports of
4fraud against employees or employers within 120 days of receipt
5of the report. There shall be no immunity, under this Act or
6otherwise, for any person who files a false report or who files
7a report without good and just cause. Confidentiality of
8medical information shall be strictly maintained.
9Investigations that are not referred for prosecution shall be
10immediately expunged and shall not be disclosed except that the
11employee or employer who was the subject of the report and the
12person making the report shall be notified that the
13investigation is being closed, at which time the name of any
14complainant not connected to the case shall be disclosed to the
15employee or the employer. When an investigation is referred for
16prosecution the employee or employer who was the subject of the
17report and the person making the report shall immediately be
18notified that the investigation has been referred for
19prosecution. It is unlawful for any employer, insurance
20carrier, or service adjustment company to file or threaten to
21file a report of fraud against an employee because of the
22exercise by the employee of the rights and remedies granted to
23the employee by this Act.
24    When the Attorney General or a State's Attorney declines to
25prosecute a referral from the fraud and insurance
26non-compliance unit of an alleged violation of this Section,

 

 

SB1676- 35 -LRB097 07108 AEK 47207 b

1the Attorney General or the State's Attorney declining
2prosecution shall provide in writing a response to the unit
3within 30 days of such decision setting forth the reasons and
4basis for the decision. The unit shall provide the response to
5the employer.
6    For purposes of this subsection (e), "employer" means any
7employer, insurance carrier, third party administrator,
8self-insured, or similar entity.
9    For purposes of this subsection (e), "complainant" refers
10to the person contacting the fraud and insurance non-compliance
11unit to initiate the complaint.
12    (f) Any person convicted of fraud related to workers'
13compensation pursuant to this Section shall be subject to the
14penalties prescribed in the Criminal Code of 1961 and shall be
15ineligible to receive or retain any compensation, disability,
16or medical benefits as defined in this Act if the compensation,
17disability, or medical benefits were owed or received as a
18result of fraud for which the recipient of the compensation,
19disability, or medical benefit was convicted. This subsection
20applies to accidental injuries or diseases that occur on or
21after the effective date of this amendatory Act of the 94th
22General Assembly.
23    (f-1) The Department of Insurance shall post all of the
24following information on its Internet Web site for each person
25convicted of a violation of the unlawful actions provided in
26this Section:

 

 

SB1676- 36 -LRB097 07108 AEK 47207 b

1        (1) The name, case number, county or court, and other
2    identifying information with respect to the case.
3        (2) The full name of the defendant.
4        (3) The city and county of the defendant's last known
5    residence or business address.
6        (4) The date of conviction.
7        (5) A description of the offense.
8        (6) The amount of money alleged to have been defrauded.
9        (7) A description of the punishment imposed, including
10    the length of any sentence of imprisonment and the amount
11    of any fine imposed.
12    The information required to be posted under this subsection
13shall be maintained on the Department's Web site for a period
14of 5 years from the date of conviction or until the Department
15is notified in writing by the person that the conviction has
16been reversed or expunged.
17    (g) Civil liability. Any person convicted of fraud who
18knowingly obtains, attempts to obtain, or causes to be obtained
19any benefits under this Act by the making of a false claim or
20who knowingly misrepresents any material fact shall be civilly
21liable to the payor of benefits or the insurer or the payor's
22or insurer's subrogee or assignee in an amount equal to 3 times
23the value of the benefits or insurance coverage wrongfully
24obtained or twice the value of the benefits or insurance
25coverage attempted to be obtained, plus reasonable attorney's
26fees and expenses incurred by the payor or the payor's subrogee

 

 

SB1676- 37 -LRB097 07108 AEK 47207 b

1or assignee who successfully brings a claim under this
2subsection. This subsection applies to accidental injuries or
3diseases that occur on or after the effective date of this
4amendatory Act of the 94th General Assembly. This subsection
5shall not bar any plaintiff from attempting to secure civil
6remedies provided under this Section or any other law.
7    (h) All proceedings under this Section shall be reported by
8the fraud and insurance non-compliance unit on an annual basis
9to the Workers' Compensation Advisory Board.
10(Source: P.A. 94-277, eff. 7-20-05.)