Illinois General Assembly - Full Text of SB0162
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Full Text of SB0162  99th General Assembly

SB0162eng 99TH GENERAL ASSEMBLY



 


 
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1    AN ACT concerning civil law.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 8.1b, 8.2a, 14, and 25.5 and by adding
6Sections 14.2, 14.3, and 14.4 as follows:
 
7    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
8    Sec. 1. This Act may be cited as the Workers' Compensation
9Act.
10    (a) The term "employer" as used in this Act means:
11    1. The State and each county, city, town, township,
12incorporated village, school district, body politic, or
13municipal corporation therein.
14    2. Every person, firm, public or private corporation,
15including hospitals, public service, eleemosynary, religious
16or charitable corporations or associations who has any person
17in service or under any contract for hire, express or implied,
18oral or written, and who is engaged in any of the enterprises
19or businesses enumerated in Section 3 of this Act, or who at or
20prior to the time of the accident to the employee for which
21compensation under this Act may be claimed, has in the manner
22provided in this Act elected to become subject to the
23provisions of this Act, and who has not, prior to such

 

 

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

 

 

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

 

 

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

 

 

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1hire, express or implied, oral or written, including all
2members of the Illinois National Guard while on active duty in
3the service of the State, and all probation personnel of the
4Juvenile Court appointed pursuant to Article VI of the Juvenile
5Court Act of 1987, and including any official of the State, any
6county, city, town, township, incorporated village, school
7district, body politic or municipal corporation therein except
8any duly appointed member of a police department in any city
9whose population exceeds 500,000 according to the last Federal
10or State census, and except any member of a fire insurance
11patrol maintained by a board of underwriters in this State. A
12duly appointed member of a fire department in any city, the
13population of which exceeds 500,000 according to the last
14federal or State census, is an employee under this Act only
15with respect to claims brought under paragraph (c) of Section
168.
17    One employed by a contractor who has contracted with the
18State, or a county, city, town, township, incorporated village,
19school district, body politic or municipal corporation
20therein, through its representatives, is not considered as an
21employee of the State, county, city, town, township,
22incorporated village, school district, body politic or
23municipal corporation which made the contract.
24    2. Every person in the service of another under any
25contract of hire, express or implied, oral or written,
26including persons whose employment is outside of the State of

 

 

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

 

 

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1where such laws are held to be exclusive.
2    The term "employee" does not include persons performing
3services as real estate broker, broker-salesman, or salesman
4when such persons are paid by commission only.
5    (c) "Commission" means the Industrial Commission created
6by Section 5 of "The Civil Administrative Code of Illinois",
7approved March 7, 1917, as amended, or the Illinois Workers'
8Compensation Commission created by Section 13 of this Act.
9    (d) For the purposes of this subsection (d):
10    "In the course of employment" means the time, place, and
11circumstances surrounding the accidental injuries.
12    "Arising out of the employment" means causal connection. It
13must be shown that the injury had its origin in some risk
14connected with, or incidental to, the employment so as to
15create a causal connection between the employment and the
16accidental injuries. An injury arises out of the employment if,
17at the time of the occurrence, the employee was performing acts
18he or she was instructed to perform by his or her employer,
19acts which he or she had a common law or statutory duty to
20perform, or acts which the employee might reasonably be
21expected to perform incident to his or her assigned duties. A
22risk is incidental to the employment where it belongs to or is
23connected with what an employee has to do in fulfilling his or
24her duties.
25    To obtain compensation under this Act, an employee bears
26the burden of showing, by a preponderance of the evidence, that

 

 

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1he or she has sustained accidental injuries arising out of and
2in the course of the employment. Except as provided in
3subsection (e) of this Section, accidental injuries sustained
4while traveling to or from work do not arise out of and in the
5course of employment.
6    (e) Where an employee is required to travel away from his
7or her employer's premises in order to perform his or her job,
8the traveling employee's accidental injuries arise out of his
9or her employment, and are in the course of his or her
10employment, when the conduct in which he or she was engaged at
11the time of the injury is reasonable and when that conduct
12might have been anticipated or foreseen by the employer.
13Accidental injuries while traveling do not occur in the course
14of employment if the accident occurs during a purely personal
15deviation or personal errand unless such deviation or errand is
16insubstantial.
17    In determining whether an employee is required to travel
18away from his or her employer's premises in order to perform
19his or her job, along with all other relevant factors, the
20following factors may be considered: whether the employer had
21knowledge that the employee may be required to travel to
22perform the job; whether the employer furnished any mode of
23transportation to or from the employee; whether the employee
24received or the employer paid or agreed to pay any remuneration
25or reimbursement for costs or expenses of any form of travel;
26whether the employer in any way directed the course or method

 

 

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1of travel; whether the employer in any way assisted the
2employee in making any travel arrangements; whether the
3employer furnished lodging or in any way reimbursed the
4employee for lodging; or whether the employer received any
5benefit from the employee traveling.
6(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
7eff. 7-13-12.)
 
8    (820 ILCS 305/8.1b)
9    Sec. 8.1b. Determination of permanent partial disability.
10For accidental injuries that occur on or after September 1,
112011, permanent partial disability shall be established using
12the following criteria:
13    (a) A physician licensed to practice medicine in all of its
14branches preparing a permanent partial disability impairment
15report shall report the level of impairment in writing. The
16report shall include an evaluation of medically defined and
17professionally appropriate measurements of impairment that
18include, but are not limited to: loss of range of motion; loss
19of strength; measured atrophy of tissue mass consistent with
20the injury; and any other measurements that establish the
21nature and extent of the impairment. The most current edition
22of the American Medical Association's "Guides to the Evaluation
23of Permanent Impairment" shall be used by the physician in
24determining the level of impairment.
25    (b) In determining the level of permanent partial

 

 

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1disability, the Commission shall base its determination on the
2following factors: (i) the reported level of impairment
3pursuant to subsection (a), if such report exists; (ii) the
4occupation of the injured employee; (iii) the age of the
5employee at the time of the injury; (iv) the employee's future
6earning capacity; and (v) evidence of disability corroborated
7by the treating medical records or examination under Section 12
8of this Act. No single enumerated factor shall be the sole
9determinant of disability. In determining the level of
10disability, the relevance and weight of any factors used in
11addition to the level of impairment as reported by the
12physician must be explained in a written order.
13    (c) A report of impairment prepared pursuant to subsection
14(a) is not required for an arbitrator or the Commission to make
15an award for permanent partial disability or permanent total
16disability benefits or any award for benefits under subsection
17(c) of Section 8 or subsection (d) of Section 8 of this Act or
18to approve a Settlement Contract Lump Sum Petition.
19(Source: P.A. 97-18, eff. 6-28-11.)
 
20    (820 ILCS 305/8.2a)
21    Sec. 8.2a. Electronic claims.
22    (a) The Director of Insurance shall adopt rules to do all
23of the following:
24        (1) Ensure that all health care providers and
25    facilities submit medical bills for payment on

 

 

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1    standardized forms.
2        (2) Require acceptance by employers and insurers of
3    electronic claims for payment of medical services.
4        (3) Ensure confidentiality of medical information
5    submitted on electronic claims for payment of medical
6    services.
7        (4) Ensure that the rules establishing electronic
8    claims include a specific enforcement mechanism to ensure
9    compliance with these rules.
10        (5) Ensure that health care providers have at least 15
11    business days to comply with records requested by employers
12    and insurers for the authorization of the payment of
13    workers' compensation claims.
14        (6) Ensure that health care providers are responsible
15    for supplying only those medical records pertaining to the
16    provider's own claims that are minimally necessary under
17    the federal Health Insurance Portability and
18    Accountability Act of 1996.
19    (b) To the extent feasible, standards adopted pursuant to
20subdivision (a) shall be consistent with existing standards
21under the federal Health Insurance Portability and
22Accountability Act of 1996 and standards adopted under the
23Illinois Health Information Exchange and Technology Act.
24    (c) The rules requiring employers and insurers to accept
25electronic claims for payment of medical services shall be
26proposed on or before May 31, 2016, January 1, 2012, and shall

 

 

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1require all employers and insurers to accept electronic claims
2for payment of medical services on or before January 1, 2017
3June 30, 2012.
4    (d) The Director of Insurance shall by rule establish
5criteria for granting exceptions to employers, insurance
6carriers, and health care providers who are unable to submit or
7accept medical bills electronically.
8(Source: P.A. 97-18, eff. 6-28-11.)
 
9    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
10    Sec. 14. The Commission shall appoint a secretary, an
11assistant secretary, and arbitrators and shall employ such
12assistants and clerical help as may be necessary. Arbitrators
13shall be appointed pursuant to this Section, notwithstanding
14any provision of the Personnel Code.
15    Each arbitrator appointed after June 28, 2011 shall be
16required to demonstrate in writing his or her knowledge of and
17expertise in the law of and judicial processes of the Workers'
18Compensation Act and the Occupational Diseases Act.
19    A formal training program for newly-hired arbitrators
20shall be implemented. The training program shall include the
21following:
22        (a) substantive and procedural aspects of the
23    arbitrator position;
24        (b) current issues in workers' compensation law and
25    practice;

 

 

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

 

 

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1    A formal and ongoing professional development program
2including, but not limited to, the above-noted areas shall be
3implemented to keep arbitrators informed of recent
4developments and issues and to assist them in maintaining and
5enhancing their professional competence. Each arbitrator shall
6complete 20 hours of training in the above-noted areas during
7every 2 years such arbitrator shall remain in office.
8    Each arbitrator shall devote full time to his or her duties
9and shall serve when assigned as an acting Commissioner when a
10Commissioner is unavailable in accordance with the provisions
11of Section 13 of this Act. Any arbitrator who is an
12attorney-at-law shall not engage in the practice of law, nor
13shall any arbitrator hold any other office or position of
14profit under the United States or this State or any municipal
15corporation or political subdivision of this State.
16Notwithstanding any other provision of this Act to the
17contrary, an arbitrator who serves as an acting Commissioner in
18accordance with the provisions of Section 13 of this Act shall
19continue to serve in the capacity of Commissioner until a
20decision is reached in every case heard by that arbitrator
21while serving as an acting Commissioner.
22    Notwithstanding any other provision of this Section, the
23term of all arbitrators serving on the effective date of this
24amendatory Act of the 97th General Assembly, including any
25arbitrators on administrative leave, shall terminate at the
26close of business on July 1, 2011, but the incumbents shall

 

 

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1continue to exercise all of their duties until they are
2reappointed or their successors are appointed.
3    On and after the effective date of this amendatory Act of
4the 97th General Assembly, arbitrators shall be appointed to
53-year terms as follows:
6        (1) All appointments shall be made by the Governor with
7    the advice and consent of the Senate.
8        (2) For their initial appointments, 12 arbitrators
9    shall be appointed to terms expiring July 1, 2012; 12
10    arbitrators shall be appointed to terms expiring July 1,
11    2013; and all additional arbitrators shall be appointed to
12    terms expiring July 1, 2014. Thereafter, all arbitrators
13    shall be appointed to 3-year terms.
14    Upon the expiration of a term, the Chairman shall evaluate
15the performance of the arbitrator and may recommend to the
16Governor that he or she be reappointed to a second or
17subsequent term by the Governor with the advice and consent of
18the Senate.
19    Each arbitrator appointed on or after the effective date of
20this amendatory Act of the 97th General Assembly and who has
21not previously served as an arbitrator for the Commission shall
22be required to be authorized to practice law in this State by
23the Supreme Court, and to maintain this authorization
24throughout his or her term of employment.
25    The performance of all arbitrators shall be reviewed by the
26Chairman on an annual basis. The Chairman shall allow input

 

 

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

 

 

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1files, orders, proceedings, decisions, awards and other
2documents on file with the Commission. He shall furnish
3certified copies, under the seal of the Commission, of any such
4records, files, orders, proceedings, decisions, awards and
5other documents on file with the Commission as may be required.
6Certified copies so furnished by the Secretary or Assistant
7Secretary shall be received in evidence before the Commission
8or any Arbitrator thereof, and in all courts, provided that the
9original of such certified copy is otherwise competent and
10admissible in evidence. The Secretary or Assistant Secretary
11shall perform such other duties as may be prescribed from time
12to time by the Commission.
13(Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40,
14eff. 6-28-13.)
 
15    (820 ILCS 305/14.2 new)
16    Sec. 14.2. Ombudsman Program.
17    (a) The Commission shall establish the Workers'
18Compensation Ombudsman Program as an office within the Illinois
19Workers' Compensation Commission no later than July 1, 2016.
20The Ombudsman Program shall be composed of at least one
21full-time ombudsman who shall develop a plan to provide
22assistance to all regions of this State. One full-time
23Ombudsman shall be designated as the Chief Ombudsman and the
24Chief Ombudsman shall be an attorney licensed to practice law
25in the State of Illinois and shall have demonstrated experience

 

 

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1in Illinois workers' compensation law. The Ombudsman Program
2shall be staffed with personnel who are trained in techniques
3performed by ombudsmen and who are familiar with the provisions
4of this Act and its rules, vocational rehabilitation
5principles, the obligations of medical providers under this
6Act, the provisions of the Medical Fee Schedule, an employer's
7responsibility to maintain workers' compensation insurance,
8the duties and obligations of self-insurers, and workers'
9compensation fraud.
10    (b) The duties of the Ombudsman Program shall be as
11follows:
12        (1) assist injured employees in understanding their
13    rights and obligations under this Act, including, but not
14    limited to, filing their own claims with the Commission and
15    obtaining medical records, job descriptions, and other
16    materials pertinent to filing a claim before the
17    Commission;
18        (2) assist employers seeking information regarding
19    their rights and obligations under this Act, including
20    their obligation to maintain workers' compensation
21    insurance;
22        (3) assist medical providers with their rights and
23    obligations under this Act;
24        (4) provide information to employers, employees, and
25    medical providers with questions about workers'
26    compensation fraud;

 

 

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1        (5) assist injured employees with referral to local,
2    State, and federal financial assistance, rehabilitation,
3    and work placement programs, as well as other social
4    services that the Ombudsman Program considers appropriate;
5        (6) respond to inquiries and complaints relative to the
6    workers' compensation program;
7        (7) serve as an information source for employees,
8    employers, medical, vocational, and rehabilitation
9    personnel, insurers, third-party administrators, and
10    self-insurers; and
11        (8) perform other duties as required by the Chairman.
12    (c) The Ombudsman Program may not appear or intervene, as a
13party or otherwise, before the Commission on behalf of an
14injured employee, employer, or medical provider. This Section
15shall not be construed as requiring or allowing legal
16representation for an injured employee by the Ombudsman Program
17in any proceeding before the Commission.
18    (d) The Ombudsman Program shall prepare a report to the
19Commission, which shall also be included in the Commission's
20annual report required under Section 15 of this Act. The report
21prepared by the Ombudsman Program shall include the following
22information for the preceding fiscal year:
23        (1) the total number of persons and entities assisted
24    during the fiscal year;
25        (2) the number of injured employers assisted during the
26    fiscal year;

 

 

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1        (3) the number of employers, insurers, self-insureds,
2    and third-party administrators assisted during the fiscal
3    year;
4        (4) the total number of medical providers assisted
5    during the fiscal year;
6        (5) the number of referrals made to the Workers'
7    Compensation Fraud Unit;
8        (6) an analysis of the areas of workers' compensation
9    law requiring the most assistance for injured workers,
10    employers, and medical providers; and
11        (7) recommendations, if any, for legislation or rules
12    to be initiated by the Commission, based on the inquiries
13    received by the Ombudsman Program.
 
14    (820 ILCS 305/14.3 new)
15    Sec. 14.3. WEAR Commission.
16    (a) There is created the Workers' Compensation Edit,
17Alignment, and Reform Commission, which shall be known as the
18WEAR Commission. The purpose of the WEAR Commission is to
19develop a proposed recodification of the Workers' Compensation
20Act that meets the following goals:
21        (1) to make this Act more accessible to laypeople
22    seeking benefits under this Act and employers seeking
23    insurance coverage for their responsibilities under this
24    Act;
25        (2) to aid the Commission, attorneys, and judges in

 

 

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1    understanding and applying the provisions of this Act;
2        (3) to prevent disputes over interpretations of this
3    Act that can add additional costs to the function and
4    administration of the workers' compensation system;
5        (4) to reduce the size of each Section of this Act to
6    promote understanding, interpretation, and indexing of
7    this Act;
8        (5) to assist policymakers so that they can more easily
9    understand the implication of amendments to this Act that
10    may be proposed in the future;
11        (6) to replace outdated and obsolete language within
12    this Act;
13        (7) to limit the opportunity for lengthy and expensive
14    appeals due to confusion or contrary language within this
15    Act; and
16        (8) to meet the preceding objectives without changing
17    substantive law or disturbing established case law
18    precedent. Nothing in this Section 14.3 shall be construed
19    to allow or authorize the WEAR Commission to seek to or to
20    diminish, restrict, limit, expand, abrogate, alter, or
21    change in way the current interpretation of any substantive
22    or procedural provision of this Act by the Commission or
23    any Court.
24    (b) The members of the WEAR Commission shall be as follows:
25        (1) one Senator appointed by the President of the
26    Senate;

 

 

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1        (2) one Senator appointed by the Minority Leader of the
2    Senate;
3        (3) one Representative appointed by the Speaker of the
4    House of Representatives;
5        (4) one Representative appointed by the Minority
6    Leader of the House of Representatives;
7        (5) four attorneys representing petitioners, one each
8    appointed by the President of the Senate, Minority Leader
9    of the Senate, Speaker of the House of Representatives, and
10    Minority Leader of the House of Representatives; and
11        (6) four attorneys representing respondents, one each
12    appointed by the President of the Senate, Minority Leader
13    of the Senate, Speaker of the House of Representatives, and
14    Minority Leader of the House of Representatives.
15    The members of the WEAR Commission shall serve without
16compensation. The Chairperson of the Illinois Workers'
17Compensation Commission shall serve as the Chairperson of the
18WEAR Commission.
19    (c) The Illinois Workers' Compensation Commission, the
20Workers' Compensation Insurance Compliance Unit, and the
21Legislative Reference Bureau shall provide administrative
22support for the WEAR Commission.
23    (d) The WEAR Commission shall present a report to the
24General Assembly no later than July 1, 2017. This report shall
25include a draft of proposed legislation for the reorganization
26of the Workers' Compensation Act that accomplishes the goals

 

 

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1set forth by this Section.
2    (e) This Section is repealed on January 1, 2018.
 
3    (820 ILCS 305/14.4 new)
4    Sec. 14.4. System improvements.
5    (a) By January 1, 2017, the Commission shall procure and
6implement a computer system to replace its current outdated and
7obsolete mainframe computer system. The Commission shall use
8the funds allocated for this purpose as set forth in the
9settlement agreement for the case entitled Illinois State
10Chamber of Commerce v. Filan.
11    (b) The system procured by the Commission shall have all of
12the following capabilities:
13        (1) require the electronic filing of claims before the
14    Commission, including the Application for Adjustment of
15    Claim and all subsequent filings by a petitioner or
16    respondent; the electronic filing fields for the
17    Application of Adjustment of Claim shall include the
18    following:
19            (i) for cases involving the State of Illinois, a
20        data field for the specific agency, department,
21        constitutional officer, board, or commission;
22            (ii) a data field for the petitioner to indicate
23        that the claim involves a repetitive injury;
24            (iii) a data field for the petitioner to indicate
25        that the claim involved an injury incurred when the

 

 

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1        petitioner was traveling as part of his or her
2        employment; and
3            (iv) a data field for the petitioner to indicate
4        that he or she is pro se;
5        (2) allow for a respondent to indicate the insurance
6    carrier of the employer, or the third-party administrator
7    of the employer, if self-insured;
8        (3) allow for documents and exhibits to be uploaded
9    electronically;
10        (4) allow for the case history of each claim to be
11    viewed in a summary format arranged by the date of each
12    filing or hearing, which shall be available to the public;
13        (5) allow for the attorney of record for the
14    petitioner, if any, and the respondent to be clearly
15    indicated on any summary format, including the attorney who
16    actually tried or argued the case before an arbitrator or
17    Commissioner;
18        (6) allow for the decision of the arbitrator or the
19    Commission to be uploaded electronically;
20        (7) allow for the following data reports to be produced
21    from the electronic system:
22            (i) the total number of decisions by each
23        arbitrator within any time period;
24            (ii) the total number of awards by injury type,
25        including repetitive injuries or injuries suffered by
26        employees when traveling in the course of their

 

 

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1        employment or alleged to be suffered by employees when
2        traveling in the course of their employment;
3            (iii) the penalties assessed against employers,
4        searchable by each employer;
5            (iv) the total number of decisions by each panel of
6        Commissioners;
7            (v) the total number of claims filed by State
8        employees within any time period;
9            (vi) the total number of new claims filed in each
10        arbitration zone;
11            (vii) the total number of Settlement Contract Lump
12        Sum Petitions; and
13            (viii) the industry types of the employers against
14        whom claims are filed.
15        (7) allow for an electronic, searchable record of any
16    approved Settlement Contract Lump Sum Petitions, including
17    the amount of such Settlement Contract Lump Sum Petitions,
18    the type of injury, and the attorneys representing each
19    party, if any, for such Settlement Contract Lump Sum
20    Petitions;
21        (8) allow for the random assignment of cases by
22    arbitrator and to Commission panels, if appealed;
23        (9) allow for the electronic transmission of the record
24    of proceedings before the Commission to be transmitted to
25    the circuit court in the event of an appeal from the
26    Commission; and

 

 

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1        (10) ensure the confidentiality of all protected
2    information, including medical records.
3    (c) The Commission shall make all efforts to ensure that
4parties practicing before the Commission, including injured
5employees, are aware of the changes required by the procurement
6of the computer system required by this Section.
 
7    (820 ILCS 305/25.5)
8    Sec. 25.5. Unlawful acts; penalties.
9    (a) It is unlawful for any person, company, corporation,
10insurance carrier, healthcare provider, or other entity to:
11        (1) Intentionally present or cause to be presented any
12    false or fraudulent claim for the payment of any workers'
13    compensation benefit.
14        (2) Intentionally make or cause to be made any false or
15    fraudulent material statement or material representation
16    for the purpose of obtaining or denying any workers'
17    compensation benefit.
18        (3) Intentionally make or cause to be made any false or
19    fraudulent statements with regard to entitlement to
20    workers' compensation benefits with the intent to prevent
21    an injured worker from making a legitimate claim for any
22    workers' compensation benefits.
23        (4) Intentionally prepare or provide an invalid,
24    false, or counterfeit certificate of insurance as proof of
25    workers' compensation insurance.

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1unit to investigate a report of fraud related to an employee's
2claim, (i) the employee must have filed with the Commission an
3Application for Adjustment of Claim and the employee must have
4either received or attempted to receive benefits under this Act
5that are related to the reported fraud or (ii) the employee
6must have made a written demand for the payment of benefits
7that are related to the reported fraud. There shall be no
8immunity, under this Act or otherwise, for any person who files
9a false report or who files a report without good and just
10cause. Confidentiality of medical information shall be
11strictly maintained. Investigations that are not referred for
12prosecution shall be destroyed upon the expiration of the
13statute of limitations for the acts under investigation and
14shall not be disclosed except that the person making the report
15shall be notified that the investigation is being closed. It is
16unlawful for any employer, insurance carrier, service
17adjustment company, third party administrator, self-insured,
18or similar entity to file or threaten to file a report of fraud
19against an employee because of the exercise by the employee of
20the rights and remedies granted to the employee by this Act.
21    (e-5) The fraud and insurance non-compliance unit shall
22procure and implement a system utilizing advanced analytics
23inclusive of predictive modeling, data mining, social network
24analysis, and scoring algorithms for the detection and
25prevention of fraud, waste, and abuse on or before January 1,
262012. The fraud and insurance non-compliance unit shall procure

 

 

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1this system using a request for proposals process governed by
2the Illinois Procurement Code and rules adopted under that
3Code. The fraud and insurance non-compliance unit shall provide
4a report to the President of the Senate, Speaker of the House
5of Representatives, Minority Leader of the House of
6Representatives, Minority Leader of the Senate, Governor,
7Chairman of the Commission, and Director of Insurance on or
8before July 1, 2012 and annually thereafter detailing its
9activities and providing recommendations regarding
10opportunities for additional fraud waste and abuse detection
11and prevention.
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 2012 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    (g) Civil liability. Any person convicted of fraud who
24knowingly obtains, attempts to obtain, or causes to be obtained
25any benefits under this Act by the making of a false claim or
26who knowingly misrepresents any material fact shall be civilly

 

 

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1liable to the payor of benefits or the insurer or the payor's
2or insurer's subrogee or assignee in an amount equal to 3 times
3the value of the benefits or insurance coverage wrongfully
4obtained or twice the value of the benefits or insurance
5coverage attempted to be obtained, plus reasonable attorney's
6fees and expenses incurred by the payor or the payor's subrogee
7or assignee who successfully brings a claim under this
8subsection. This subsection applies to accidental injuries or
9diseases that occur on or after the effective date of this
10amendatory Act of the 94th General Assembly.
11    (h) The fraud and insurance non-compliance unit shall
12submit a written report on an annual basis to the Chairman of
13the Commission, the Workers' Compensation Advisory Board, the
14General Assembly, the Governor, and the Attorney General by
15January 1 and July 1 of each year. This report shall include,
16at the minimum, the following information:
17        (1) The number of allegations of insurance
18    non-compliance and fraud reported to the fraud and
19    insurance non-compliance unit.
20        (2) The source of the reported allegations
21    (individual, employer, or other).
22        (3) The number of allegations investigated by the fraud
23    and insurance non-compliance unit.
24        (4) The number of criminal referrals made in accordance
25    with this Section and the entity to which the referral was
26    made.

 

 

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1        (5) All proceedings under this Section.
2(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)