Full Text of SB0162 99th General Assembly
SB0162sam001 99TH GENERAL ASSEMBLY | Sen. Kwame Raoul Filed: 8/4/2015
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| 1 | | AMENDMENT TO SENATE BILL 162
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 162 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Workers' Compensation Act is amended by | 5 | | changing Sections 1, 8.1b, 8.2a, 14, and 25.5 and by adding | 6 | | Sections 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 | 9 | | Act.
| 10 | | (a) The term "employer" as used in this Act means:
| 11 | | 1. The State and each county, city, town, township, | 12 | | incorporated
village, school district, body politic, or | 13 | | municipal corporation
therein.
| 14 | | 2. Every person, firm, public or private corporation, | 15 | | including
hospitals, public service, eleemosynary, religious | 16 | | or charitable
corporations or associations who has any person |
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| 1 | | in service or under any
contract for hire, express or implied, | 2 | | oral or written, and who is
engaged in any of the enterprises | 3 | | or businesses enumerated in Section 3
of this Act, or who at or | 4 | | prior to the time of the accident to the
employee for which | 5 | | compensation under this Act may be claimed, has in
the manner | 6 | | provided in this Act elected to become subject to the
| 7 | | provisions of this Act, and who has not, prior to such | 8 | | accident,
effected a withdrawal of such election in the manner | 9 | | provided in this Act.
| 10 | | 3. Any one engaging in any business or enterprise referred | 11 | | to in
subsections 1 and 2 of Section 3 of this Act who | 12 | | undertakes to do any
work enumerated therein, is liable to pay | 13 | | compensation to his own
immediate employees in accordance with | 14 | | the provisions of this Act, and
in addition thereto if he | 15 | | directly or indirectly engages any contractor
whether | 16 | | principal or sub-contractor to do any such work, he is liable | 17 | | to
pay compensation to the employees of any such contractor or
| 18 | | sub-contractor unless such contractor or sub-contractor has | 19 | | insured, in
any company or association authorized under the | 20 | | laws of this State to
insure the liability to pay compensation | 21 | | under this Act, or guaranteed
his liability to pay such | 22 | | compensation. With respect to any time
limitation on the filing | 23 | | of claims provided by this Act, the timely
filing of a claim | 24 | | against a contractor or subcontractor, as the case may
be, | 25 | | shall be deemed to be a timely filing with respect to all | 26 | | persons
upon whom liability is imposed by this paragraph.
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| 1 | | In the event any such person pays compensation under this | 2 | | subsection
he may recover the amount thereof from the | 3 | | contractor or sub-contractor,
if any, and in the event the | 4 | | contractor pays compensation under this
subsection he may | 5 | | recover the amount thereof from the sub-contractor, if any.
| 6 | | This subsection does not apply in any case where the | 7 | | accident occurs
elsewhere than on, in or about the immediate | 8 | | premises on which the
principal has contracted that the work be | 9 | | done.
| 10 | | 4. Where an employer operating under and subject to the | 11 | | provisions
of this Act loans an employee to another such | 12 | | employer and such loaned
employee sustains a compensable | 13 | | accidental injury in the employment of
such borrowing employer | 14 | | and where such borrowing employer does not
provide or pay the | 15 | | benefits or payments due such injured employee, such
loaning | 16 | | employer is liable to provide or pay all benefits or payments
| 17 | | due such employee under this Act and as to such employee the | 18 | | liability
of such loaning and borrowing employers is joint and | 19 | | several, provided
that such loaning employer is in the absence | 20 | | of agreement to the
contrary entitled to receive from such | 21 | | borrowing employer full
reimbursement for all sums paid or | 22 | | incurred pursuant to this paragraph
together with reasonable | 23 | | attorneys' fees and expenses in any hearings
before the | 24 | | Illinois Workers' Compensation Commission or in any action to | 25 | | secure such
reimbursement. Where any benefit is provided or | 26 | | paid by such loaning
employer the employee has the duty of |
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| 1 | | rendering reasonable cooperation
in any hearings, trials or | 2 | | proceedings in the case, including such
proceedings for | 3 | | reimbursement.
| 4 | | Where an employee files an Application for Adjustment of | 5 | | Claim with
the Illinois Workers' Compensation
Commission | 6 | | alleging that his claim is covered by the
provisions of the | 7 | | preceding paragraph, and joining both the alleged
loaning and | 8 | | borrowing employers, they and each of them, upon written
demand | 9 | | by the employee and within 7 days after receipt of such demand,
| 10 | | shall have the duty of filing with the Illinois Workers' | 11 | | Compensation Commission a written
admission or denial of the | 12 | | allegation that the claim is covered by the
provisions of the | 13 | | preceding paragraph and in default of such filing or
if any | 14 | | such denial be ultimately determined not to have been bona fide
| 15 | | then the provisions of Paragraph K of Section 19 of this Act | 16 | | shall apply.
| 17 | | An employer whose business or enterprise or a substantial | 18 | | part
thereof consists of hiring, procuring or furnishing | 19 | | employees to or for
other employers operating under and subject | 20 | | to the provisions of this
Act for the performance of the work | 21 | | of such other employers and who pays
such employees their | 22 | | salary or wages notwithstanding that they are doing
the work of | 23 | | such other employers shall be deemed a loaning employer
within | 24 | | the meaning and provisions of this Section.
| 25 | | (b) The term "employee" as used in this Act means:
| 26 | | 1. Every person in the service of the State, including |
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| 1 | | members of
the General Assembly, members of the Commerce | 2 | | Commission, members of the
Illinois Workers' Compensation | 3 | | Commission, and all persons in the service of the University
of | 4 | | Illinois, county, including deputy sheriffs and assistant | 5 | | state's
attorneys, city, town, township, incorporated village | 6 | | or school
district, body politic, or municipal corporation | 7 | | therein, whether by
election, under appointment or contract of | 8 | | hire, express or implied,
oral or written, including all | 9 | | members of the Illinois National Guard
while on active duty in | 10 | | the service of the State, and all probation
personnel of the | 11 | | Juvenile Court appointed pursuant to Article VI
of the Juvenile | 12 | | Court Act of 1987, and including any official of the
State, any | 13 | | county, city, town, township, incorporated village, school
| 14 | | district, body politic or municipal corporation therein except | 15 | | any duly
appointed member of a police department in any city | 16 | | whose
population exceeds 500,000 according to the last Federal | 17 | | or State
census, and except any member of a fire insurance | 18 | | patrol maintained by a
board of underwriters in this State. A | 19 | | duly appointed member of a fire
department in any city, the | 20 | | population of which exceeds 500,000 according
to the last | 21 | | federal or State census, is an employee under this Act only
| 22 | | with respect to claims brought under paragraph (c) of Section | 23 | | 8.
| 24 | | One employed by a contractor who has contracted with the | 25 | | State, or a
county, city, town, township, incorporated village, | 26 | | school district,
body politic or municipal corporation |
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| 1 | | therein, through its
representatives, is not considered as an | 2 | | employee of the State, county,
city, town, township, | 3 | | incorporated village, school district, body
politic or | 4 | | municipal corporation which made the contract.
| 5 | | 2. Every person in the service of another under any | 6 | | contract of
hire, express or implied, oral or written, | 7 | | including persons whose
employment is outside of the State of | 8 | | Illinois where the contract of
hire is made within the State of | 9 | | Illinois, persons whose employment
results in fatal or | 10 | | non-fatal injuries within the State of Illinois
where the | 11 | | contract of hire is made outside of the State of Illinois, and
| 12 | | persons whose employment is principally localized within the | 13 | | State of
Illinois, regardless of the place of the accident or | 14 | | the place where the
contract of hire was made, and including | 15 | | aliens, and minors who, for the
purpose of this Act are | 16 | | considered the same and have the same power to
contract, | 17 | | receive payments and give quittances therefor, as adult | 18 | | employees.
| 19 | | 3. Every sole proprietor and every partner of a business | 20 | | may elect to
be covered by this Act.
| 21 | | An employee or his dependents under this Act who shall have | 22 | | a cause
of action by reason of any injury, disablement or death | 23 | | arising out of
and in the course of his employment may elect to | 24 | | pursue his remedy in
the State where injured or disabled, or in | 25 | | the State where the contract
of hire is made, or in the State | 26 | | where the employment is principally
localized.
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| 1 | | However, any employer may elect to provide and pay | 2 | | compensation to
any employee other than those engaged in the | 3 | | usual course of the trade,
business, profession or occupation | 4 | | of the employer by complying with
Sections 2 and 4 of this Act. | 5 | | Employees are not included within the
provisions of this Act | 6 | | when excluded by the laws of the United States
relating to | 7 | | liability of employers to their employees for personal
injuries | 8 | | where such laws are held to be exclusive.
| 9 | | The term "employee" does not include persons performing | 10 | | services as real
estate broker, broker-salesman, or salesman | 11 | | when such persons are paid by
commission only.
| 12 | | (c) "Commission" means the Industrial Commission created | 13 | | by Section
5 of "The Civil Administrative Code of Illinois", | 14 | | approved March 7,
1917, as amended, or the Illinois Workers' | 15 | | Compensation Commission created by Section 13 of
this Act.
| 16 | | (d) For the purposes of this subsection (d): | 17 | | "In the course of employment" means the time, place, and | 18 | | circumstances surrounding the accidental injuries. | 19 | | "Arising out of the employment" means causal connection. It | 20 | | must be shown that the injury had its origin in some risk | 21 | | connected with, or incidental to, the employment so as to | 22 | | create a causal connection between the employment and the | 23 | | accidental injuries. An injury arises out of the employment if, | 24 | | at the time of the occurrence, the employee was performing acts | 25 | | he or she was instructed to perform by his or her employer, | 26 | | acts which he or she had a common law or statutory duty to |
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| 1 | | perform, or acts which the employee might reasonably be | 2 | | expected to perform incident to his or her assigned duties. A | 3 | | risk is incidental to the employment where it belongs to or is | 4 | | connected with what an employee has to do in fulfilling his or | 5 | | her duties. | 6 | | To obtain compensation under this Act, an employee bears | 7 | | the burden of showing, by a preponderance of the evidence, that | 8 | | he or she has sustained accidental injuries arising out of and | 9 | | in the course of the employment. Except as provided in | 10 | | subsection (e) of this Section, accidental injuries sustained | 11 | | while traveling to or from work do not arise out of and in the | 12 | | course of employment. | 13 | | (e) Where an employee is required to travel away from his | 14 | | or her employer's premises in order to perform his or her job, | 15 | | the traveling employee's accidental injuries arise out of his | 16 | | or her employment, and are in the course of his or her | 17 | | employment, when the conduct in which he or she was engaged at | 18 | | the time of the injury is reasonable and when that conduct | 19 | | might have been anticipated or foreseen by the employer. | 20 | | Accidental injuries while traveling do not occur in the course | 21 | | of employment if the accident occurs during a purely personal | 22 | | deviation or personal errand unless such deviation or errand is | 23 | | insubstantial. | 24 | | In determining whether an employee is required to travel | 25 | | away from his or her employer's premises in order to perform | 26 | | his or her job, along with all other relevant factors, the |
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| 1 | | following factors may be considered: whether the employer had | 2 | | knowledge that the employee may be required to travel to | 3 | | perform the job; whether the employer furnished any mode of | 4 | | transportation to or from the employee; whether the employee | 5 | | received or the employer paid or agreed to pay any remuneration | 6 | | or reimbursement for costs or expenses of any form of travel; | 7 | | whether the employer in any way directed the course or method | 8 | | of travel; whether the employer in any way assisted the | 9 | | employee in making any travel arrangements; whether the | 10 | | employer furnished lodging or in any way reimbursed the | 11 | | employee for lodging; or whether the employer received any | 12 | | benefit from the employee traveling. | 13 | | (Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813, | 14 | | eff. 7-13-12.)
| 15 | | (820 ILCS 305/8.1b) | 16 | | Sec. 8.1b. Determination of permanent partial disability. | 17 | | For accidental injuries that occur on or after September 1, | 18 | | 2011, permanent partial disability shall be established using | 19 | | the following criteria: | 20 | | (a) A physician licensed to practice medicine in all of its | 21 | | branches preparing a permanent partial disability impairment | 22 | | report shall report the level of impairment in writing. The | 23 | | report shall include an evaluation of medically defined and | 24 | | professionally appropriate measurements of impairment that | 25 | | include, but are not limited to: loss of range of motion; loss |
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| 1 | | of strength; measured atrophy of tissue mass consistent with | 2 | | the injury; and any other measurements that establish the | 3 | | nature and extent of the impairment. The most current edition | 4 | | of the American Medical Association's "Guides to the Evaluation | 5 | | of Permanent Impairment" shall be used by the physician in | 6 | | determining the level of impairment. | 7 | | (b) In determining the level of permanent partial | 8 | | disability, the Commission shall base its determination on the | 9 | | following factors: (i) the reported level of impairment | 10 | | pursuant to subsection (a) , if such report exists ; (ii) the | 11 | | occupation of the injured employee; (iii) the age of the | 12 | | employee at the time of the injury; (iv) the employee's future | 13 | | earning capacity; and (v) evidence of disability corroborated | 14 | | by the treating medical records or examination under Section 12 | 15 | | of this Act . No single enumerated factor shall be the sole | 16 | | determinant of disability. In determining the level of | 17 | | disability, the relevance and weight of any factors used in | 18 | | addition to the level of impairment as reported by the | 19 | | physician must be explained in a written order. | 20 | | (c) A report of impairment prepared pursuant to subsection | 21 | | (a) is not required for an arbitrator or the Commission to make | 22 | | an award for permanent partial disability or permanent total | 23 | | disability benefits or any award for benefits under subsection | 24 | | (c) of Section 8 or subsection (d) of Section 8 of this Act or | 25 | | to approve a Settlement Contract Lump Sum Petition.
| 26 | | (Source: P.A. 97-18, eff. 6-28-11.) |
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| 1 | | (820 ILCS 305/8.2a) | 2 | | Sec. 8.2a. Electronic claims. | 3 | | (a) The Director of Insurance shall adopt rules to do all | 4 | | of the following: | 5 | | (1) Ensure that all health care providers and | 6 | | facilities submit medical bills for payment on | 7 | | standardized forms. | 8 | | (2) Require acceptance by employers and insurers of | 9 | | electronic claims for payment of medical services. | 10 | | (3) Ensure confidentiality of medical information | 11 | | submitted on electronic claims for payment of medical | 12 | | services. | 13 | | (4) Ensure that the rules establishing electronic | 14 | | claims include a specific enforcement mechanism to ensure | 15 | | compliance with these rules. | 16 | | (5) Ensure that health care providers have at least 15 | 17 | | business days to comply with records requested by employers | 18 | | and insurers for the authorization of the payment of | 19 | | workers' compensation claims. | 20 | | (6) Ensure that health care providers are responsible | 21 | | for supplying only those medical records pertaining to the | 22 | | provider's own claims that are minimally necessary under | 23 | | the federal Health Insurance Portability and | 24 | | Accountability Act of 1996. | 25 | | (b) To the extent feasible, standards adopted pursuant to |
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| 1 | | subdivision (a) shall be consistent with existing standards | 2 | | under the federal Health Insurance Portability and | 3 | | Accountability Act of 1996 and standards adopted under the | 4 | | Illinois Health Information Exchange and Technology Act. | 5 | | (c) The rules requiring employers and insurers to accept | 6 | | electronic claims for payment of medical services shall be | 7 | | proposed on or before May 31, 2016, January 1, 2012, and shall | 8 | | require all employers and insurers to accept electronic claims | 9 | | for payment of medical services on or before January 1, 2017 | 10 | | June 30, 2012 . | 11 | | (d) The Director of Insurance shall by rule establish | 12 | | criteria for granting exceptions to employers, insurance | 13 | | carriers, and health care providers who are unable to submit or | 14 | | accept medical bills electronically.
| 15 | | (Source: P.A. 97-18, eff. 6-28-11.)
| 16 | | (820 ILCS 305/14) (from Ch. 48, par. 138.14)
| 17 | | Sec. 14. The Commission shall appoint a secretary, an | 18 | | assistant
secretary, and arbitrators and shall employ such
| 19 | | assistants and clerical help as may be necessary. Arbitrators | 20 | | shall be appointed pursuant to this Section, notwithstanding | 21 | | any provision of the Personnel Code.
| 22 | | Each arbitrator appointed after June 28, 2011 shall be | 23 | | required
to demonstrate in writing his or
her knowledge of and | 24 | | expertise in the law of and judicial processes of
the Workers' | 25 | | Compensation Act and the Occupational Diseases Act.
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| 1 | | A formal training program for newly-hired arbitrators | 2 | | shall be
implemented. The training program shall include the | 3 | | following:
| 4 | | (a) substantive and procedural aspects of the | 5 | | arbitrator position;
| 6 | | (b) current issues in workers' compensation law and | 7 | | practice;
| 8 | | (c) medical lectures by specialists in areas such as | 9 | | orthopedics,
ophthalmology, psychiatry, rehabilitation | 10 | | counseling;
| 11 | | (d) orientation to each operational unit of the | 12 | | Illinois Workers' Compensation Commission;
| 13 | | (e) observation of experienced arbitrators conducting | 14 | | hearings of cases,
combined with the opportunity to discuss | 15 | | evidence presented and rulings made;
| 16 | | (f) the use of hypothetical cases requiring the trainee | 17 | | to issue
judgments as a means to evaluating knowledge and | 18 | | writing ability;
| 19 | | (g) writing skills;
| 20 | | (h) professional and ethical standards pursuant to | 21 | | Section 1.1 of this Act; | 22 | | (i) detection of workers' compensation fraud and | 23 | | reporting obligations of Commission employees and | 24 | | appointees; | 25 | | (j) standards of evidence-based medical treatment and | 26 | | best practices for measuring and improving quality and |
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| 1 | | health care outcomes in the workers' compensation system, | 2 | | including but not limited to the use of the American | 3 | | Medical Association's "Guides to the Evaluation of | 4 | | Permanent Impairment" and the practice of utilization | 5 | | review; and | 6 | | (k) substantive and procedural aspects of coal | 7 | | workers' pneumoconiosis (black lung) cases. | 8 | | A formal and ongoing professional development program | 9 | | including, but not
limited to, the above-noted areas shall be | 10 | | implemented to keep arbitrators
informed of recent | 11 | | developments and issues and to assist them in
maintaining and | 12 | | enhancing their professional competence. Each arbitrator shall | 13 | | complete 20 hours of training in the above-noted areas during | 14 | | every 2 years such arbitrator shall remain in office.
| 15 | | Each
arbitrator shall devote full time to his or her duties | 16 | | and shall serve when
assigned as
an acting Commissioner when a | 17 | | Commissioner is unavailable in accordance
with the provisions | 18 | | of Section 13 of this Act. Any
arbitrator who is an | 19 | | attorney-at-law shall not engage in the practice of
law, nor | 20 | | shall any arbitrator hold any other office or position of
| 21 | | profit under the United States or this State or any municipal
| 22 | | corporation or political subdivision of this State.
| 23 | | Notwithstanding any other provision of this Act to the | 24 | | contrary, an arbitrator
who serves as an acting Commissioner in | 25 | | accordance with the provisions of
Section 13 of this Act shall | 26 | | continue to serve in the capacity of Commissioner
until a |
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| 1 | | decision is reached in every case heard by that arbitrator | 2 | | while
serving as an acting Commissioner.
| 3 | | Notwithstanding any other provision of this Section, the | 4 | | term of all arbitrators serving on the effective date of this | 5 | | amendatory Act of the 97th General Assembly, including any | 6 | | arbitrators on administrative leave, shall terminate at the | 7 | | close of business on July 1, 2011, but the incumbents shall | 8 | | continue to exercise all of their duties until they are | 9 | | reappointed or their successors are appointed. | 10 | | On and after the effective date of this amendatory Act of | 11 | | the 97th General Assembly, arbitrators shall be appointed to | 12 | | 3-year terms as follows: | 13 | | (1) All appointments shall be made by the Governor with | 14 | | the advice and consent of the Senate. | 15 | | (2) For their initial appointments, 12 arbitrators | 16 | | shall be appointed to terms expiring July 1, 2012; 12 | 17 | | arbitrators shall be appointed to terms expiring July 1, | 18 | | 2013; and all additional arbitrators shall be appointed to | 19 | | terms expiring July 1, 2014. Thereafter, all arbitrators | 20 | | shall be appointed to 3-year terms. | 21 | | Upon the expiration of a term, the Chairman shall evaluate | 22 | | the performance of the arbitrator and may recommend to the | 23 | | Governor that he or she be reappointed to a second or | 24 | | subsequent term by the Governor with the advice and consent of | 25 | | the Senate. | 26 | | Each arbitrator appointed on or after the effective date of |
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| 1 | | this amendatory Act of the 97th General Assembly and who has | 2 | | not previously served as an arbitrator for the Commission shall | 3 | | be required to be authorized to practice law in this State by | 4 | | the Supreme Court, and to maintain this authorization | 5 | | throughout his or her term of employment.
| 6 | | The performance of all arbitrators shall be reviewed by the | 7 | | Chairman on
an annual basis. The Chairman shall allow input | 8 | | from the Commissioners in
all such reviews.
| 9 | | The Commission shall assign no fewer than 3 arbitrators to | 10 | | each hearing site. The Commission shall establish a procedure | 11 | | to ensure that the arbitrators assigned to each hearing site | 12 | | are assigned cases on a random basis. The Chairperson of the | 13 | | Commission shall have discretion to assign and reassign | 14 | | arbitrators to each hearing site as needed. No arbitrator shall | 15 | | hear cases in any county, other than Cook County, for more than | 16 | | 2 years in each 3-year term. | 17 | | The Secretary and each arbitrator shall receive a per annum | 18 | | salary of
$4,000 less than the per annum salary of members of | 19 | | The
Illinois Workers' Compensation Commission as
provided in | 20 | | Section 13 of this Act, payable in equal monthly installments.
| 21 | | The members of the Commission, Arbitrators and other | 22 | | employees whose
duties require them to travel, shall have | 23 | | reimbursed to them their
actual traveling expenses and | 24 | | disbursements made or incurred by them in
the discharge of | 25 | | their official duties while away from their place of
residence | 26 | | in the performance of their duties.
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| 1 | | The Commission shall provide itself with a seal for the
| 2 | | authentication of its orders, awards and proceedings upon which | 3 | | shall be
inscribed the name of the Commission and the words | 4 | | "Illinois--Seal".
| 5 | | The Secretary or Assistant Secretary, under the direction | 6 | | of the
Commission, shall have charge and custody of the seal of | 7 | | the Commission
and also have charge and custody of all records, | 8 | | files, orders,
proceedings, decisions, awards and other | 9 | | documents on file with the
Commission. He shall furnish | 10 | | certified copies, under the seal of the
Commission, of any such | 11 | | records, files, orders, proceedings, decisions,
awards and | 12 | | other documents on file with the Commission as may be
required. | 13 | | Certified copies so furnished by the Secretary or Assistant
| 14 | | Secretary shall be received in evidence before the Commission | 15 | | or any
Arbitrator thereof, and in all courts, provided that the | 16 | | original of
such certified copy is otherwise competent and | 17 | | admissible in evidence.
The Secretary or Assistant Secretary | 18 | | shall perform such other duties as
may be prescribed from time | 19 | | to time by the Commission.
| 20 | | (Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40, | 21 | | eff. 6-28-13.)
| 22 | | (820 ILCS 305/14.2 new) | 23 | | Sec. 14.2. Ombudsman Program. | 24 | | (a) The Commission shall establish the Workers' | 25 | | Compensation Ombudsman Program as an office within the Illinois |
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| 1 | | Workers' Compensation
Commission no later than July 1, 2016. | 2 | | The Ombudsman Program shall be composed of at least one | 3 | | full-time ombudsman who shall develop a plan to provide | 4 | | assistance to all regions of this State. One full-time | 5 | | Ombudsman shall be designated as the Chief Ombudsman and the | 6 | | Chief Ombudsman shall be an attorney licensed to practice law | 7 | | in the State of Illinois and shall have demonstrated experience | 8 | | in Illinois workers' compensation law. The Ombudsman Program | 9 | | shall be staffed with personnel who are trained in techniques | 10 | | performed by ombudsmen and who are familiar with the provisions | 11 | | of this Act and its rules, vocational rehabilitation | 12 | | principles, the obligations of medical providers under this | 13 | | Act, the provisions of the Medical Fee Schedule, an employer's | 14 | | responsibility to maintain workers' compensation insurance, | 15 | | the duties and obligations of self-insurers, and workers' | 16 | | compensation fraud. | 17 | | (b) The duties of the Ombudsman Program shall be as | 18 | | follows: | 19 | | (1) assist injured employees in understanding their | 20 | | rights and obligations under this Act, including, but not | 21 | | limited to, filing their own claims with the Commission and | 22 | | obtaining medical records, job descriptions, and other | 23 | | materials pertinent to filing a claim before the | 24 | | Commission; | 25 | | (2) assist employers seeking information regarding | 26 | | their rights and obligations under this Act, including |
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| 1 | | their obligation to maintain workers' compensation | 2 | | insurance; | 3 | | (3) assist medical providers with their rights and | 4 | | obligations under this Act; | 5 | | (4) provide information to employers, employees, and | 6 | | medical providers with questions about workers' | 7 | | compensation fraud; | 8 | | (5) assist injured employees with referral to local, | 9 | | State, and federal financial assistance, rehabilitation, | 10 | | and work placement programs, as well as other social | 11 | | services that the Ombudsman Program considers appropriate; | 12 | | (6) respond to inquiries and complaints relative to the | 13 | | workers' compensation program; | 14 | | (7) serve as an information source for employees, | 15 | | employers, medical, vocational, and rehabilitation | 16 | | personnel, insurers, third-party administrators, and | 17 | | self-insurers; and | 18 | | (8) perform other duties as required by the Chairman. | 19 | | (c) The Ombudsman Program may not appear or intervene, as a | 20 | | party or otherwise, before the Commission on behalf of an | 21 | | injured employee, employer, or medical provider. This Section | 22 | | shall not be construed as requiring or allowing legal | 23 | | representation for an injured employee by the Ombudsman Program | 24 | | in any proceeding before the Commission. | 25 | | (d) The Ombudsman Program shall prepare a report to the | 26 | | Commission, which shall also be included in the Commission's |
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| 1 | | annual report required under Section 15 of this Act. The report | 2 | | prepared by the Ombudsman Program shall include the following | 3 | | information for the preceding fiscal year: | 4 | | (1) the total number of persons and entities assisted | 5 | | during the fiscal year; | 6 | | (2) the number of injured employers assisted during the | 7 | | fiscal year; | 8 | | (3) the number of employers, insurers, self-insureds, | 9 | | and third-party administrators assisted during the fiscal | 10 | | year; | 11 | | (4) the total number of medical providers assisted | 12 | | during the fiscal year; | 13 | | (5) the number of referrals made to the Workers' | 14 | | Compensation Fraud Unit; | 15 | | (6) an analysis of the areas of workers' compensation | 16 | | law requiring the most assistance for injured workers, | 17 | | employers, and medical providers; and | 18 | | (7) recommendations, if any, for legislation or rules | 19 | | to be initiated by the Commission, based on the inquires | 20 | | received by the Ombudsman Program. | 21 | | (820 ILCS 305/14.3 new) | 22 | | Sec. 14.3. WEAR Commission. | 23 | | (a) There is created the Workers' Compensation Edit, | 24 | | Alignment, and Reform Commission, which shall be known as the | 25 | | WEAR Commission. The purpose of the WEAR Commission is to |
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| 1 | | develop a proposed recodification of the Workers' Compensation | 2 | | Act that meets the following goals: | 3 | | (1) to make this Act more accessible to laypeople | 4 | | seeking benefits under this Act and employers seeking | 5 | | insurance coverage for their responsibilities under this | 6 | | Act; | 7 | | (2) to aid the Commission, attorneys, and judges in | 8 | | understanding and applying the provisions of this Act; | 9 | | (3) to prevent disputes over interpretations of this | 10 | | Act that can add additional costs to the function and | 11 | | administration of the workers' compensation system; | 12 | | (4) to reduce the size of each Section of this Act to | 13 | | promote understanding, interpretation, and indexing of | 14 | | this Act; | 15 | | (5) to assist policymakers so that they can more easily | 16 | | understand the implication of amendments to this Act that | 17 | | may be proposed in the future; | 18 | | (6) to replace outdated and obsolete language within | 19 | | this Act; | 20 | | (7) to limit the opportunity for lengthy and expensive | 21 | | appeals due to confusion or contrary language within this | 22 | | Act; and | 23 | | (8) to meet the preceding objectives without changing | 24 | | substantive law or disturbing established case law | 25 | | precedent. Nothing in this Section 14.3 shall be construed | 26 | | to allow or authorize the WEAR Commission to seek to or to |
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| 1 | | diminish, restrict, limit, expand, abrogate, alter, or | 2 | | change in way the current interpretation of any substantive | 3 | | or procedural provision of this Act by the Commission or | 4 | | any Court. | 5 | | (b) The members of the WEAR Commission shall be as follows: | 6 | | (1) one Senator appointed by the President of the | 7 | | Senate; | 8 | | (2) one Senator appointed by the Minority Leader of the | 9 | | Senate; | 10 | | (3) one Representative appointed by the Speaker of the | 11 | | House of Representatives; | 12 | | (4) one Representative appointed by the Minority | 13 | | Leader of the House of Representatives; | 14 | | (5) four attorneys representing petitioners, one each | 15 | | appointed by the President of the Senate, Minority Leader | 16 | | of the Senate, Speaker of the House of Representatives, and | 17 | | Minority Leader of the House of Representatives; and | 18 | | (6) four attorneys representing respondents, one each | 19 | | appointed by the President of the Senate, Minority Leader | 20 | | of the Senate, Speaker of the House of Representatives, and | 21 | | Minority Leader of the House of Representatives. | 22 | | The members of the WEAR Commission shall serve without | 23 | | compensation. The Chairperson of the Illinois Workers' | 24 | | Compensation
Commission shall serve as the Chairperson of the | 25 | | WEAR Commission. | 26 | | (c) The Illinois Workers' Compensation
Commission, the |
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| 1 | | Workers' Compensation Insurance Compliance Unit, and the | 2 | | Legislative Reference Bureau shall provide administrative | 3 | | support for the WEAR Commission. | 4 | | (d) The WEAR Commission shall present a report to the | 5 | | General Assembly no later than July 1, 2017. This report shall | 6 | | include a draft of proposed legislation for the reorganization | 7 | | of the Workers' Compensation Act that accomplishes the goals | 8 | | set forth by this Section. | 9 | | (e) This Section is repealed on January 1, 2018. | 10 | | (820 ILCS 305/14.4 new) | 11 | | Sec. 14.4. System improvements. | 12 | | (a) By January 1, 2017, the Commission shall procure and | 13 | | implement a computer system to replace its current outdated and | 14 | | obsolete mainframe computer system. The Commission shall use | 15 | | the funds allocated for this purpose as set forth in the | 16 | | settlement agreement for the case entitled Illinois State | 17 | | Chamber of Commerce v. Filan. | 18 | | (b) The system procured by the Commission shall have all of | 19 | | the following capabilities: | 20 | | (1) require the electronic filing of claims before the | 21 | | Commission, including the Application for Adjustment of | 22 | | Claim and all subsequent filings by a petitioner or | 23 | | respondent; the electronic filing fields for the | 24 | | Application of Adjustment of Claim shall include the | 25 | | following: |
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| 1 | | (i) for cases involving the State of Illinois, a | 2 | | data field for the specific agency, department, | 3 | | constitutional officer, board, or commission; | 4 | | (ii) a data field for the petitioner to indicate | 5 | | that the claim involves a repetitive injury; | 6 | | (iii) a data field for the petitioner to indicate | 7 | | that the claim involved an injury incurred when the | 8 | | petitioner was traveling as part of his or her | 9 | | employment; and | 10 | | (iv) a data field for the petitioner to indicate | 11 | | that he or she is pro se; | 12 | | (2) allow for a respondent to indicate the insurance | 13 | | carrier of the employer, or the third-party administrator | 14 | | of the employer, if self-insured; | 15 | | (3) allow for documents and exhibits to be uploaded | 16 | | electronically; | 17 | | (4) allow for the case history of each claim to be | 18 | | viewed in a summary format arranged by the date of each | 19 | | filing or hearing, which shall be available to the public; | 20 | | (5) allow for the attorney of record for the | 21 | | petitioner, if any, and the respondent to be clearly | 22 | | indicated on any summary format, including the attorney who | 23 | | actually tried or argued the case before an arbitrator or | 24 | | Commissioner; | 25 | | (6) allow for the decision of the arbitrator or the | 26 | | Commission to be uploaded electronically; |
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| 1 | | (7) allow for the following data reports to be produced | 2 | | from the electronic system: | 3 | | (i) the total number of decisions by each | 4 | | arbitrator within any time period; | 5 | | (ii) the total number of awards by injury type, | 6 | | including repetitive injuries or injuries suffered by | 7 | | employees when traveling in the course of their | 8 | | employment or alleged to be suffered by employees when | 9 | | traveling in the course of their employment; | 10 | | (iii) the penalties assessed against employers, | 11 | | searchable by each employer; | 12 | | (iv) the total number of decisions by each panel of | 13 | | Commissioners; | 14 | | (v) the total number of claims filed by State | 15 | | employees within any time period; | 16 | | (vi) the total number of new claims filed in each | 17 | | arbitration zone; | 18 | | (vii) the total number of Settlement Contract Lump | 19 | | Sum Petitions; and | 20 | | (viii) the industry types of the employers against | 21 | | whom claims are filed. | 22 | | (7) allow for an electronic, searchable record of any | 23 | | approved Settlement Contract Lump Sum Petitions, including | 24 | | the amount of such Settlement Contract Lump Sum Petitions, | 25 | | the type of injury, and the attorneys representing each | 26 | | party, if any, for such Settlement Contract Lump Sum |
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| 1 | | Petitions; | 2 | | (8) allow for the random assignment of cases by | 3 | | arbitrator and to Commission panels, if appealed; | 4 | | (9) allow for the electronic transmission of the record | 5 | | of proceedings before the Commission to be transmitted to | 6 | | the circuit court in the event of an appeal from the | 7 | | Commission; and | 8 | | (10) ensure the confidentiality of all protected | 9 | | information, including medical records. | 10 | | (c) The Commission shall make all efforts to ensure that | 11 | | parties practicing before the Commission, including injured | 12 | | employees, are aware of the changes required by the procurement | 13 | | of the computer system required by this Section. | 14 | | (820 ILCS 305/25.5)
| 15 | | Sec. 25.5. Unlawful acts; penalties. | 16 | | (a) It is unlawful for any person, company, corporation, | 17 | | insurance carrier, healthcare provider, or other entity to: | 18 | | (1) Intentionally present or cause to be presented any | 19 | | false or
fraudulent claim for the payment of any workers' | 20 | | compensation
benefit.
| 21 | | (2) Intentionally make or cause to be made any false or
| 22 | | fraudulent material statement or material representation | 23 | | for the
purpose of obtaining or denying any workers' | 24 | | compensation
benefit.
| 25 | | (3) Intentionally make or cause to be made any false or
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| 1 | | fraudulent statements with regard to entitlement to | 2 | | workers'
compensation benefits with the intent to prevent | 3 | | an injured
worker from making a legitimate claim for any | 4 | | workers'
compensation benefits.
| 5 | | (4) Intentionally prepare or provide an invalid, | 6 | | false, or
counterfeit certificate of insurance as proof of | 7 | | workers'
compensation insurance.
| 8 | | (5) Intentionally make or cause to be made any false or
| 9 | | fraudulent material statement or material representation | 10 | | for the
purpose of obtaining workers' compensation | 11 | | insurance at less
than the proper rate for that insurance.
| 12 | | (6) Intentionally make or cause to be made any false or
| 13 | | fraudulent material statement or material representation | 14 | | on an
initial or renewal self-insurance application or | 15 | | accompanying
financial statement for the purpose of | 16 | | obtaining self-insurance
status or reducing the amount of | 17 | | security that may be required
to be furnished pursuant to | 18 | | Section 4 of this Act.
| 19 | | (7) Intentionally make or cause to be made any false or
| 20 | | fraudulent material statement to the Commission's | 21 | | Department of Insurance's
fraud and insurance | 22 | | non-compliance unit in the course of an
investigation of | 23 | | fraud or insurance non-compliance.
| 24 | | (8) Intentionally assist, abet, solicit, or conspire | 25 | | with any
person, company, or other entity to commit any of | 26 | | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) |
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| 1 | | of this subsection (a).
| 2 | | (9) Intentionally present a bill or statement for the | 3 | | payment for medical services that were not provided. | 4 | | For the purposes of paragraphs (2), (3), (5), (6), (7), and | 5 | | (9), the term "statement" includes any writing, notice, proof | 6 | | of injury, bill for services, hospital or doctor records and | 7 | | reports, or X-ray and test results.
| 8 | | (b) Sentences for violations of subsection (a) are as | 9 | | follows:
| 10 | | (1) A violation in which the value of the property | 11 | | obtained or attempted to be obtained is $300 or less is a | 12 | | Class A misdemeanor. | 13 | | (2) A violation in which the value of the property | 14 | | obtained or attempted to be obtained is more than $300 but | 15 | | not more than $10,000 is a Class 3 felony. | 16 | | (3) A violation in which the value of the property | 17 | | obtained or attempted to be obtained is more than $10,000 | 18 | | but not more than $100,000 is a Class 2 felony. | 19 | | (4) A violation in which the value of the property | 20 | | obtained or attempted to be obtained is more than $100,000 | 21 | | is a Class 1 felony. | 22 | | (5) A person convicted under this Section shall be | 23 | | ordered to pay monetary restitution to the insurance | 24 | | company or self-insured entity or any other person for any | 25 | | financial loss sustained as a result of a violation of this | 26 | | Section, including any court costs and attorney fees. An |
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| 1 | | order of restitution also includes expenses incurred and | 2 | | paid by the State of Illinois or an insurance company or | 3 | | self-insured entity in connection with any medical | 4 | | evaluation or treatment services. | 5 | | For the purposes of this Section, where the exact value of | 6 | | property obtained or attempted to be obtained is either not | 7 | | alleged or is not specifically set by the terms of a policy of | 8 | | insurance, the value of the property shall be the fair market | 9 | | replacement value of the property claimed to be lost, the | 10 | | reasonable costs of reimbursing a vendor or other claimant for | 11 | | services to be rendered, or both. Notwithstanding the | 12 | | foregoing, an insurance company, self-insured entity, or any | 13 | | other person suffering financial loss sustained as a result of | 14 | | violation of this Section may seek restitution, including court | 15 | | costs and attorney's fees in a civil action in a court of | 16 | | competent jurisdiction. | 17 | | (c) The Illinois Workers' Compensation
Commission | 18 | | Department of Insurance shall establish a fraud and insurance | 19 | | non-compliance unit responsible for investigating incidences | 20 | | of fraud and insurance non-compliance pursuant to this Section. | 21 | | The size of the staff of the unit shall be subject to | 22 | | appropriation by the General Assembly. It shall be the duty of | 23 | | the fraud and insurance non-compliance unit to determine the | 24 | | identity of insurance carriers, employers, employees, or other | 25 | | persons or entities who have violated the fraud and insurance | 26 | | non-compliance provisions of this Section. The fraud and |
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| 1 | | insurance non-compliance unit shall report violations of the | 2 | | fraud and insurance non-compliance provisions of this Section | 3 | | to the Special Prosecutions Bureau of the Criminal Division of | 4 | | the Office of the Attorney General or to the State's Attorney | 5 | | of the county in which the offense allegedly occurred, either | 6 | | of whom has the authority to prosecute violations under this | 7 | | Section.
| 8 | | With respect to the subject of any investigation being | 9 | | conducted, the fraud and insurance non-compliance unit shall | 10 | | have the general power of subpoena of the Department of | 11 | | Insurance , including the authority to issue a subpoena to a | 12 | | medical provider, pursuant to Section 8-802 of the Code of | 13 | | Civil Procedure.
| 14 | | (d) Any person may report allegations of insurance | 15 | | non-compliance and fraud pursuant to this Section to the | 16 | | Illinois Workers' Compensation
Commission's Department of | 17 | | Insurance's fraud and insurance non-compliance unit whose duty | 18 | | it shall be to investigate the report. The unit shall notify | 19 | | the Commission of reports of insurance non-compliance. Any | 20 | | person reporting an allegation of insurance non-compliance or | 21 | | fraud against either an employee or employer under this Section | 22 | | must identify himself. Except as provided in this subsection | 23 | | and in subsection (e), all reports shall remain confidential | 24 | | except to refer an investigation to the Attorney General or | 25 | | State's Attorney for prosecution or if the fraud and insurance | 26 | | non-compliance unit's investigation reveals that the conduct |
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| 1 | | reported may be in violation of other laws or regulations of | 2 | | the State of Illinois, the unit may report such conduct to the | 3 | | appropriate governmental agency charged with administering | 4 | | such laws and regulations. Any person who intentionally makes a | 5 | | false report under this Section to the fraud and insurance | 6 | | non-compliance unit is guilty of a Class A misdemeanor.
| 7 | | (e) In order for the fraud and insurance non-compliance | 8 | | unit to investigate a report of fraud related to an employee's | 9 | | claim, (i) the employee must have filed with the Commission an | 10 | | Application for Adjustment of Claim and the employee must have | 11 | | either received or attempted to receive benefits under this Act | 12 | | that are related to the reported fraud or (ii) the employee | 13 | | must have made a written demand for the payment of benefits | 14 | | that are related to the reported fraud. There shall be no | 15 | | immunity, under this Act or otherwise, for any person who files | 16 | | a false report or who files a report without good and just | 17 | | cause. Confidentiality of medical information shall be | 18 | | strictly maintained. Investigations that are not referred for | 19 | | prosecution shall be destroyed upon the expiration of the | 20 | | statute of limitations for the acts under investigation and | 21 | | shall not be disclosed except that the person making the report | 22 | | shall be notified that the investigation is being closed. It is | 23 | | unlawful for any employer, insurance carrier, service | 24 | | adjustment company, third party administrator, self-insured, | 25 | | or similar entity to file or threaten to file a report of fraud | 26 | | against an employee because of the exercise by the employee of |
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| 1 | | the rights and remedies granted to the employee by this Act.
| 2 | | (e-5) The fraud and insurance non-compliance unit shall | 3 | | procure and implement a system utilizing advanced analytics | 4 | | inclusive of predictive modeling, data mining, social network | 5 | | analysis, and scoring algorithms for the detection and | 6 | | prevention of fraud, waste, and abuse on or before January 1, | 7 | | 2012. The fraud and insurance non-compliance unit shall procure | 8 | | this system using a request for proposals process governed by | 9 | | the Illinois Procurement Code and rules adopted under that | 10 | | Code. The fraud and insurance non-compliance unit shall provide | 11 | | a report to the President of the Senate, Speaker of the House | 12 | | of Representatives, Minority Leader of the House of | 13 | | Representatives, Minority Leader of the Senate, Governor, | 14 | | Chairman of the Commission, and Director of Insurance on or | 15 | | before July 1, 2012 and annually thereafter detailing its | 16 | | activities and providing recommendations regarding | 17 | | opportunities for additional fraud waste and abuse detection | 18 | | and prevention. | 19 | | (f) Any person convicted of fraud related to workers' | 20 | | compensation pursuant to this Section shall be subject to the | 21 | | penalties prescribed in the Criminal Code of 2012 and shall be | 22 | | ineligible to receive or retain any compensation, disability, | 23 | | or medical benefits as defined in this Act if the compensation, | 24 | | disability, or medical benefits were owed or received as a | 25 | | result of fraud for which the recipient of the compensation, | 26 | | disability, or medical benefit was convicted. This subsection |
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| 1 | | applies to accidental injuries or diseases that occur on or | 2 | | after the effective date of this amendatory Act of the 94th | 3 | | General Assembly.
| 4 | | (g) Civil liability. Any person convicted of fraud who | 5 | | knowingly obtains, attempts to obtain, or causes to be obtained | 6 | | any benefits under this Act by the making of a false claim or | 7 | | who knowingly misrepresents any material fact shall be civilly | 8 | | liable to the payor of benefits or the insurer or the payor's | 9 | | or insurer's subrogee or assignee in an amount equal to 3 times | 10 | | the value of the benefits or insurance coverage wrongfully | 11 | | obtained or twice the value of the benefits or insurance | 12 | | coverage attempted to be obtained, plus reasonable attorney's | 13 | | fees and expenses incurred by the payor or the payor's subrogee | 14 | | or assignee who successfully brings a claim under this | 15 | | subsection. This subsection applies to accidental injuries or | 16 | | diseases that occur on or after the effective date of this | 17 | | amendatory Act of the 94th General Assembly.
| 18 | | (h) The fraud and insurance non-compliance unit shall | 19 | | submit a written report on an annual basis to the Chairman of | 20 | | the Commission, the Workers' Compensation Advisory Board, the | 21 | | General Assembly, the Governor, and the Attorney General by | 22 | | January 1 and July 1 of each year. This report shall include, | 23 | | at the minimum, the following information: | 24 | | (1) The number of allegations of insurance | 25 | | non-compliance and fraud reported to the fraud and | 26 | | insurance non-compliance unit. |
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| 1 | | (2) The source of the reported allegations | 2 | | (individual, employer, or other). | 3 | | (3) The number of allegations investigated by the fraud | 4 | | and insurance non-compliance unit. | 5 | | (4) The number of criminal referrals made in accordance | 6 | | with this Section and the entity to which the referral was | 7 | | made. | 8 | | (5) All proceedings under this Section.
| 9 | | (Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)".
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