97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB2521

 

Introduced 11/8/2011, by Sen. Kyle McCarter

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/1  from Ch. 48, par. 138.1
820 ILCS 305/8  from Ch. 48, par. 138.8
820 ILCS 305/8.1a
820 ILCS 305/8.1b

    Amends the Workers' Compensation Act. Defines "accident" and "injury." Provides that "injury" includes the aggravation of a pre-existing condition by an accident arising out of and in the course of the employment, but only for so long as the aggravation of the pre-existing condition continues to be the major contributing cause of the disability. Provides that an injury resulting directly or indirectly from idiopathic causes is not compensable. No longer allows an employee to choose in writing to decline their employer's preferred provider program. Makes changes concerning the determination of the level of permanent partial disability. Effective immediately.


LRB097 14633 AEK 59515 b

 

 

A BILL FOR

 

SB2521LRB097 14633 AEK 59515 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 1, 8, 8.1a, and 8.1b 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 500,000 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 500,000 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) To obtain compensation under this Act, an employee
9bears the burden of showing, by a preponderance of the
10evidence, that he or she has sustained accidental injuries
11arising out of and in the course of the employment.
12    (e) The term "accident" as used in this Act means an
13occurrence arising out of the employment, resulting from a risk
14incidental to the employment, and in the course of the
15employment at a time and place and under circumstances
16reasonably required by the employment.
17    (f) The term "injury" as used in this Act means a condition
18or impairment that arises out of and in the course of
19employment. An injury, its occupational cause, and any
20resulting manifestations or disability must be established to a
21reasonable degree of medical certainty, based on objective
22relevant medical findings, and the accidental compensable
23injury must be the major contributing cause of any resulting
24injuries. For the purposes of this Section, "major contributing
25cause" means the cause which is more than 50% responsible for
26the injury as compared to all other causes combined for which

 

 

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1treatment or benefits are sought. "Injury" includes the
2aggravation of a pre-existing condition by an accident arising
3out of and in the course of the employment, but only for so
4long as the aggravation of the pre-existing condition continues
5to be the major contributing cause of the disability.
6        (1) An injury is deemed to arise out of and in the
7    course of the employment only if:
8            (A) it is reasonably apparent, upon consideration
9        of all circumstances, that the accident is the major
10        contributing cause of the injury; and
11            (B) it does not come from a hazard or risk
12        unrelated to the employment to which employees would
13        have been equally exposed outside of the employment.
14        (2) An injury resulting directly or indirectly from
15    idiopathic causes is not compensable.
16(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; revised
179-15-11.)
 
18    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
19    Sec. 8. The amount of compensation which shall be paid to
20the employee for an accidental injury not resulting in death
21is:
22    (a) The employer shall provide and pay the negotiated rate,
23if applicable, or the lesser of the health care provider's
24actual charges or according to a fee schedule, subject to
25Section 8.2, in effect at the time the service was rendered for

 

 

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1all the necessary first aid, medical and surgical services, and
2all necessary medical, surgical and hospital services
3thereafter incurred, limited, however, to that which is
4reasonably required to cure or relieve from the effects of the
5accidental injury, even if a health care provider sells,
6transfers, or otherwise assigns an account receivable for
7procedures, treatments, or services covered under this Act. If
8the employer does not dispute payment of first aid, medical,
9surgical, and hospital services, the employer shall make such
10payment to the provider on behalf of the employee. The employer
11shall also pay for treatment, instruction and training
12necessary for the physical, mental and vocational
13rehabilitation of the employee, including all maintenance
14costs and expenses incidental thereto. If as a result of the
15injury the employee is unable to be self-sufficient the
16employer shall further pay for such maintenance or
17institutional care as shall be required.
18    The employee may at any time elect to secure his own
19physician, surgeon and hospital services at the employer's
20expense, or,
21    Upon agreement between the employer and the employees, or
22the employees' exclusive representative, and subject to the
23approval of the Illinois Workers' Compensation Commission, the
24employer shall maintain a list of physicians, to be known as a
25Panel of Physicians, who are accessible to the employees. The
26employer shall post this list in a place or places easily

 

 

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

 

 

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

 

 

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1    Notwithstanding the foregoing, the employer's liability to
2pay for such medical services selected by the employee shall be
3limited to:
4        (1) all first aid and emergency treatment; plus
5        (2) all medical, surgical and hospital services
6    provided by the physician, surgeon or hospital initially
7    chosen by the employee or by any other physician,
8    consultant, expert, institution or other provider of
9    services recommended by said initial service provider or
10    any subsequent provider of medical services in the chain of
11    referrals from said initial service provider; plus
12         (3) all medical, surgical and hospital services
13    provided by any second physician, surgeon or hospital
14    subsequently chosen by the employee or by any other
15    physician, consultant, expert, institution or other
16    provider of services recommended by said second service
17    provider or any subsequent provider of medical services in
18    the chain of referrals from said second service provider.
19    Thereafter the employer shall select and pay for all
20    necessary medical, surgical and hospital treatment and the
21    employee may not select a provider of medical services at
22    the employer's expense unless the employer agrees to such
23    selection. At any time the employee may obtain any medical
24    treatment he desires at his own expense. This paragraph
25    shall not affect the duty to pay for rehabilitation
26    referred to above.

 

 

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1        (4) The following shall apply for injuries occurring on
2    or after June 28, 2011 (the effective date of Public Act
3    97-18) this amendatory Act of the 97th General Assembly and
4    only when an employer has an approved preferred provider
5    program pursuant to Section 8.1a on the date the employee
6    sustained his or her accidental injuries:
7            (A) The employer shall, in writing, on a form
8        promulgated by the Commission, inform the employee of
9        the preferred provider program;
10            (B) Subsequent to the report of an injury by an
11        employee, the employee may choose physicians in the
12        preferred provider program as provided in subsection
13        (c) of Section 8.1a in writing at any time to decline
14        the preferred provider program, in which case that
15        would constitute one of the two choices of medical
16        providers to which the employee is entitled under
17        subsection (a)(2) or (a)(3); and
18            (C) Prior to the report of an injury by an
19        employee, when an employee chooses non-emergency
20        treatment from a provider not within the preferred
21        provider program, that would constitute the employee's
22        one choice of medical providers to which the employee
23        is entitled under subsection (c) of Section 8.1a (a)(2)
24        or (a)(3).
25    When an employer and employee so agree in writing, nothing
26in this Act prevents an employee whose injury or disability has

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    compensation rate, except as hereinafter provided, shall
2    be determined as follows: if during the preceding 12 month
3    period there shall have been an increase in the State's
4    average weekly wage in covered industries under the
5    Unemployment Insurance Act, the weekly compensation rate
6    shall be proportionately increased by the same percentage
7    as the percentage of increase in the State's average weekly
8    wage in covered industries under the Unemployment
9    Insurance Act during such period.
10        The maximum weekly compensation rate, for the period
11    January 1, 1981 through December 31, 1983, except as
12    hereinafter provided, shall be 100% of the State's average
13    weekly wage in covered industries under the Unemployment
14    Insurance Act in effect on January 1, 1981. Effective
15    January 1, 1984 and on January 1, of each year thereafter
16    the maximum weekly compensation rate, except as
17    hereinafter provided, shall be determined as follows: if
18    during the preceding 12 month period there shall have been
19    an increase in the State's average weekly wage in covered
20    industries under the Unemployment Insurance Act, the
21    weekly compensation rate shall be proportionately
22    increased by the same percentage as the percentage of
23    increase in the State's average weekly wage in covered
24    industries under the Unemployment Insurance Act during
25    such period.
26        From July 1, 1977 and thereafter such maximum weekly

 

 

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

 

 

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

 

 

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1above the axillary line, the employee is entitled to
2compensation for such disfigurement, the amount determined by
3agreement at any time or by arbitration under this Act, at a
4hearing not less than 6 months after the date of the accidental
5injury, which amount shall not exceed 150 weeks (if the
6accidental injury occurs on or after the effective date of this
7amendatory Act of the 94th General Assembly but before February
81, 2006) or 162 weeks (if the accidental injury occurs on or
9after February 1, 2006) at the applicable rate provided in
10subparagraph 2.1 of paragraph (b) of this Section.
11    No compensation is payable under this paragraph where
12compensation is payable under paragraphs (d), (e) or (f) of
13this Section.
14    A duly appointed member of a fire department in a city, the
15population of which exceeds 500,000 according to the last
16federal or State census, is eligible for compensation under
17this paragraph only where such serious and permanent
18disfigurement results from burns.
19    (d) 1. If, after the accidental injury has been sustained,
20the employee as a result thereof becomes partially
21incapacitated from pursuing his usual and customary line of
22employment, he shall, except in cases compensated under the
23specific schedule set forth in paragraph (e) of this Section,
24receive compensation for the duration of his disability,
25subject to the limitations as to maximum amounts fixed in
26paragraph (b) of this Section, equal to 66-2/3% of the

 

 

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

 

 

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

 

 

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

 

 

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1            25 weeks if the accidental injury occurs on or
2        after the effective date of this amendatory Act of the
3        94th General Assembly but before February 1, 2006.
4            27 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        5. Fourth, or little finger-
7            20 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            22 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        6. Great toe-
13            35 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            38 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        7. Each toe other than great toe-
19            12 weeks if the accidental injury occurs on or
20        after the effective date of this amendatory Act of the
21        94th General Assembly but before February 1, 2006.
22            13 weeks if the accidental injury occurs on or
23        after February 1, 2006.
24        8. The loss of the first or distal phalanx of the thumb
25    or of any finger or toe shall be considered to be equal to
26    the loss of one-half of such thumb, finger or toe and the

 

 

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1    compensation payable shall be one-half of the amount above
2    specified. The loss of more than one phalanx shall be
3    considered as the loss of the entire thumb, finger or toe.
4    In no case shall the amount received for more than one
5    finger exceed the amount provided in this schedule for the
6    loss of a hand.
7        9. Hand-
8            190 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            205 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13            190 weeks if the accidental injury occurs on or
14        after June 28, 2011 (the effective date of Public Act
15        97-18) this amendatory Act of the 97th General Assembly
16        and if the accidental injury involves carpal tunnel
17        syndrome due to repetitive or cumulative trauma, in
18        which case the permanent partial disability shall not
19        exceed 15% loss of use of the hand, except for cause
20        shown by clear and convincing evidence and in which
21        case the award shall not exceed 30% loss of use of the
22        hand.
23        The loss of 2 or more digits, or one or more phalanges
24    of 2 or more digits, of a hand may be compensated on the
25    basis of partial loss of use of a hand, provided, further,
26    that the loss of 4 digits, or the loss of use of 4 digits,

 

 

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

 

 

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1    shall be paid.
2        11. Foot-
3            155 weeks if the accidental injury occurs on or
4        after the effective date of this amendatory Act of the
5        94th General Assembly but before February 1, 2006.
6            167 weeks if the accidental injury occurs on or
7        after February 1, 2006.
8        12. Leg-
9            200 weeks if the accidental injury occurs on or
10        after the effective date of this amendatory Act of the
11        94th General Assembly but before February 1, 2006.
12            215 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        Where an accidental injury results in the amputation of
15    a leg below the knee, such injury shall be compensated as
16    loss of a leg. Where an accidental injury results in the
17    amputation of a leg above the knee, compensation for an
18    additional 25 weeks (if the accidental injury occurs on or
19    after the effective date of this amendatory Act of the 94th
20    General Assembly but before February 1, 2006) or an
21    additional 27 weeks (if the accidental injury occurs on or
22    after February 1, 2006) shall be paid, except where the
23    accidental injury results in the amputation of a leg at the
24    hip joint, or so close to the hip joint that an artificial
25    leg cannot be used, or results in the disarticulation of a
26    leg at the hip joint, in which case compensation for an

 

 

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

 

 

SB2521- 30 -LRB097 14633 AEK 59515 b

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            215 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        15. Testicle-
6            50 weeks if the accidental injury occurs on or
7        after the effective date of this amendatory Act of the
8        94th General Assembly but before February 1, 2006.
9            54 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        Both testicles-
12            150 weeks if the accidental injury occurs on or
13        after the effective date of this amendatory Act of the
14        94th General Assembly but before February 1, 2006.
15            162 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        16. For the permanent partial loss of use of a member
18    or sight of an eye, or hearing of an ear, compensation
19    during that proportion of the number of weeks in the
20    foregoing schedule provided for the loss of such member or
21    sight of an eye, or hearing of an ear, which the partial
22    loss of use thereof bears to the total loss of use of such
23    member, or sight of eye, or hearing of an ear.
24            (a) Loss of hearing for compensation purposes
25        shall be confined to the frequencies of 1,000, 2,000
26        and 3,000 cycles per second. Loss of hearing ability

 

 

SB2521- 31 -LRB097 14633 AEK 59515 b

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

 

 

SB2521- 32 -LRB097 14633 AEK 59515 b

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

 

 

SB2521- 33 -LRB097 14633 AEK 59515 b

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

 

 

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

 

 

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

 

 

SB2521- 36 -LRB097 14633 AEK 59515 b

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

 

 

SB2521- 37 -LRB097 14633 AEK 59515 b

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

 

 

SB2521- 38 -LRB097 14633 AEK 59515 b

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

 

 

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

 

 

SB2521- 40 -LRB097 14633 AEK 59515 b

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

 

 

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

 

 

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

 

 

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

 

 

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1employee receives payments other than compensation payments,
2whether as full or partial salary, group insurance benefits,
3bonuses, annuities or any other payments, the employer or
4insurance carrier shall receive credit for each such payment
5only to the extent of the compensation that would have been
6payable during the period covered by such payment.
7    3. The extension of time for the filing of an Application
8for Adjustment of Claim as provided in paragraph 1 above shall
9not apply to those cases where the time for such filing had
10expired prior to the date on which payments or benefits
11enumerated herein have been initiated or resumed. Provided
12however that this paragraph 3 shall apply only to cases wherein
13the payments or benefits hereinabove enumerated shall be
14received after July 1, 1969.
15(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; revised
169-15-11.)
 
17    (820 ILCS 305/8.1a)
18    Sec. 8.1a. Preferred provider programs. Starting on June
1928, 2011 (the effective date of Public Act 97-18), this
20amendatory Act of the 97th General Assembly, to satisfy its
21liabilities under this Act for the provision of medical
22treatment to injured employees, an employer may utilize a
23preferred provider program approved by the Illinois Department
24of Insurance as in compliance with Sections 370k, 370l, 370m,
25and 370p of Article XX-1/2 of the Illinois Insurance Code. For

 

 

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

 

 

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

 

 

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1permitted. If approved, the employer shall provide a copy of
2the filing to all participating providers.
3        (1) The Director of the Department of Insurance shall
4    make each administrator's filing available to the public
5    upon request. The Director of the Department of Insurance
6    may not publicly disclose any information submitted
7    pursuant to this Section that is determined by the Director
8    of the Department of Insurance to be confidential,
9    proprietary, or trade secret information pursuant to State
10    or federal law.
11        (2) For the purposes of this subsection (b), "economic
12    evaluation" shall mean any evaluation of a particular
13    physician, provider, medical group, or individual practice
14    association based in whole or in part on the economic costs
15    or utilization of services associated with medical care
16    provided or authorized by the physician, provider, medical
17    group, or individual practice association. Economic
18    evaluation shall not include negotiated rates with a
19    provider.
20    (c) For Except for the provisions of subsection (a)(4) of
21Section 8 and for injuries occurring on or after June 28, 2011
22the effective date of this amendatory Act of the 97th General
23Assembly, an employee of an employer utilizing a preferred
24provider program shall only be allowed to select a
25participating network provider from the network. An employer
26shall be responsible for: (i) all first aid and emergency

 

 

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

 

 

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

 

 

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1provisions of this Section relating to approval and regulation
2of preferred provider programs.
3(Source: P.A. 97-18, eff. 6-28-11.)
 
4    (820 ILCS 305/8.1b)
5    Sec. 8.1b. Determination of permanent partial disability.
6For accidental injuries that occur on or after September 1,
72011, permanent partial disability shall be established using
8the following criteria:
9    (a) A physician licensed to practice medicine in all of its
10branches preparing a permanent partial disability impairment
11report shall report the level of impairment in writing. The
12report shall include an evaluation of medically defined and
13professionally appropriate measurements of impairment that
14include, but are not limited to: loss of range of motion; loss
15of strength; measured atrophy of tissue mass consistent with
16the injury; and any other measurements that establish the
17nature and extent of the impairment. The most current edition
18of the American Medical Association's "Guides to the Evaluation
19of Permanent Impairment" shall be used by the physician in
20determining the level of impairment.
21    (b) In determining the level of permanent partial
22disability, the Commission shall base its determination on the
23following factors: (i) the reported level of impairment
24pursuant to subsection (a); (ii) the occupation of the injured
25employee; (iii) the age of the employee at the time of the

 

 

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1injury; (iv) the employee's future earning capacity; and (v)
2evidence of disability corroborated by objective findings in
3the treating medical records. No single enumerated factor shall
4be the sole determinant of disability. In determining the level
5of disability, the relevance and weight of any factors used in
6addition to the level of impairment as reported by the
7physician must be explained in a written order.
8(Source: P.A. 97-18, eff. 6-28-11.)
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.