97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5546

 

Introduced , by Rep. Dwight Kay

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/1  from Ch. 48, par. 138.1
820 ILCS 305/8  from Ch. 48, par. 138.8
820 ILCS 305/8.1a
820 ILCS 305/8.2
820 ILCS 305/11  from Ch. 48, par. 138.11

    Amends the Workers' Compensation Act. Provides that an "accident" is an occurrence that arises out of employment resulting from a risk incidental to and in the course of the employment at a time and place and under circumstances reasonably required by the employment. Provides that an "injury" is an occurrence that arises out of and in the course of employment. Provides that an injury by accident is compensable only if the accident was the primary factor in causing both the resulting medical condition and disability. Provides that certain conditions and impairments of health suffered by firefighters, paramedics, and emergency medical technicians shall be rebuttably presumed not to arise out of employment unless the accident is the primary factor in causing the resulting medical condition. Abolishes certain notice and election provisions in connection with preferred providers. Specifies that fees for certain prescriptions shall be limited to the manufacturer's Average Wholesale Price (rather than the Average Wholesale Price). Provides that an employee may overcome the rebuttable presumption that intoxication was the proximate cause of the injury by a preponderance of the evidence that the intoxication was not the sole proximate cause, rather than sole proximate cause or proximate cause, of the accidental injury.


LRB097 19514 JLS 64768 b

 

 

A BILL FOR

 

HB5546LRB097 19514 JLS 64768 b

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

 

 

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

 

 

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

 

 

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

 

 

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1members of the Illinois National Guard while on active duty in
2the service of the State, and all probation personnel of the
3Juvenile Court appointed pursuant to Article VI of the Juvenile
4Court Act of 1987, and including any official of the State, any
5county, city, town, township, incorporated village, school
6district, body politic or municipal corporation therein except
7any duly appointed member of a police department in any city
8whose population exceeds 500,000 according to the last Federal
9or State census, and except any member of a fire insurance
10patrol maintained by a board of underwriters in this State. A
11duly appointed member of a fire department in any city, the
12population of which exceeds 500,000 according to the last
13federal or State census, is an employee under this Act only
14with respect to claims brought under paragraph (c) of Section
158.
16    One employed by a contractor who has contracted with the
17State, or a county, city, town, township, incorporated village,
18school district, body politic or municipal corporation
19therein, through its representatives, is not considered as an
20employee of the State, county, city, town, township,
21incorporated village, school district, body politic or
22municipal corporation which made the contract.
23    2. Every person in the service of another under any
24contract of hire, express or implied, oral or written,
25including persons whose employment is outside of the State of
26Illinois where the contract of hire is made within the State of

 

 

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

 

 

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1    The term "employee" does not include persons performing
2services as real estate broker, broker-salesman, or salesman
3when such persons are paid by commission only.
4    (c) "Commission" means the Industrial Commission created
5by Section 5 of "The Civil Administrative Code of Illinois",
6approved March 7, 1917, as amended, or the Illinois Workers'
7Compensation Commission created by Section 13 of this Act.
8    (d) The term "accident" as used in this Act means an
9occurrence arising out of the employment resulting from a risk
10incidental to the employment and in the course of the
11employment at a time and place and under circumstances
12reasonably required by the employment. To obtain compensation
13under this Act, an employee bears the burden of showing, by a
14preponderance of the evidence, that he or she has sustained
15accidental injuries arising out of and in the course of the
16employment.
17    (e) The term "injury" as used in this Act means an injury
18that arises out of and in the course of employment. An injury
19by accident is compensable only if the accident was the primary
20factor in causing both the resulting medical condition and
21disability. The "primary factor" is defined to be the major
22contributory factor, in relation to other factors, causing both
23the resulting medical condition and disability. "Injury"
24includes the aggravation of a pre-existing condition by an
25accident arising out of and in the course of the employment,
26but only for so long as the aggravation of the pre-existing

 

 

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1condition continues to be the primary factor causing the
2disability.
3        (1) An injury is deemed to arise out of and in the
4    course of the employment only if:
5            (A) it is reasonably apparent, upon consideration
6        of all circumstances, that the accident is the primary
7        factor in causing the injury;
8            (B) it does not come from a hazard or risk
9        unrelated to the employment to which employees would
10        have been equally exposed outside of the employment.
11        (2) An injury resulting directly or indirectly from
12    idiopathic causes is not compensable.
13        (3) Any condition or impairment of health of an
14    employee employed as a suffered by a firefighter,
15    paramedic, or emergency medical technician (EMT), which
16    results directly or indirectly from any bloodborne
17    pathogen, lung or respiratory disease or condition, heart
18    or vascular disease or condition, hypertension, hernia,
19    hearing loss, tuberculosis, or cancer resulting in any
20    disability to the employee shall be rebuttably presumed not
21    to arise out of and in the course of the employment unless
22    the accident is the primary factor in causing the resulting
23    medical condition.
24(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; revised
259-15-11.)
 

 

 

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

 

 

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1physician, surgeon and hospital services at the employer's
2expense, or,
3    Upon agreement between the employer and the employees, or
4the employees' exclusive representative, and subject to the
5approval of the Illinois Workers' Compensation Commission, the
6employer shall maintain a list of physicians, to be known as a
7Panel of Physicians, who are accessible to the employees. The
8employer shall post this list in a place or places easily
9accessible to his employees. The employee shall have the right
10to make an alternative choice of physician from such Panel if
11he is not satisfied with the physician first selected. If, due
12to the nature of the injury or its occurrence away from the
13employer's place of business, the employee is unable to make a
14selection from the Panel, the selection process from the Panel
15shall not apply. The physician selected from the Panel may
16arrange for any consultation, referral or other specialized
17medical services outside the Panel at the employer's expense.
18Provided that, in the event the Commission shall find that a
19doctor selected by the employee is rendering improper or
20inadequate care, the Commission may order the employee to
21select another doctor certified or qualified in the medical
22field for which treatment is required. If the employee refuses
23to make such change the Commission may relieve the employer of
24his obligation to pay the doctor's charges from the date of
25refusal to the date of compliance.
26    Any vocational rehabilitation counselors who provide

 

 

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1service under this Act shall have appropriate certifications
2which designate the counselor as qualified to render opinions
3relating to vocational rehabilitation. Vocational
4rehabilitation may include, but is not limited to, counseling
5for job searches, supervising a job search program, and
6vocational retraining including education at an accredited
7learning institution. The employee or employer may petition to
8the Commission to decide disputes relating to vocational
9rehabilitation and the Commission shall resolve any such
10dispute, including payment of the vocational rehabilitation
11program by the employer.
12    The maintenance benefit shall not be less than the
13temporary total disability rate determined for the employee. In
14addition, maintenance shall include costs and expenses
15incidental to the vocational rehabilitation program.
16    When the employee is working light duty on a part-time
17basis or full-time basis and earns less than he or she would be
18earning if employed in the full capacity of the job or jobs,
19then the employee shall be entitled to temporary partial
20disability benefits. Temporary partial disability benefits
21shall be equal to two-thirds of the difference between the
22average amount that the employee would be able to earn in the
23full performance of his or her duties in the occupation in
24which he or she was engaged at the time of accident and the
25gross amount which he or she is earning in the modified job
26provided to the employee by the employer or in any other job

 

 

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1that the employee is working.
2    Every hospital, physician, surgeon or other person
3rendering treatment or services in accordance with the
4provisions of this Section shall upon written request furnish
5full and complete reports thereof to, and permit their records
6to be copied by, the employer, the employee or his dependents,
7as the case may be, or any other party to any proceeding for
8compensation before the Commission, or their attorneys.
9    Notwithstanding the foregoing, the employer's liability to
10pay for such medical services selected by the employee shall be
11limited to:
12        (1) all first aid and emergency treatment; plus
13        (2) all medical, surgical and hospital services
14    provided by the physician, surgeon or hospital initially
15    chosen by the employee or by any other physician,
16    consultant, expert, institution or other provider of
17    services recommended by said initial service provider or
18    any subsequent provider of medical services in the chain of
19    referrals from said initial service provider; plus
20         (3) all medical, surgical and hospital services
21    provided by any second physician, surgeon or hospital
22    subsequently chosen by the employee or by any other
23    physician, consultant, expert, institution or other
24    provider of services recommended by said second service
25    provider or any subsequent provider of medical services in
26    the chain of referrals from said second service provider.

 

 

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1    Thereafter the employer shall select and pay for all
2    necessary medical, surgical and hospital treatment and the
3    employee may not select a provider of medical services at
4    the employer's expense unless the employer agrees to such
5    selection. At any time the employee may obtain any medical
6    treatment he desires at his own expense. This paragraph
7    shall not affect the duty to pay for rehabilitation
8    referred to above.
9        (4) (Blank). The following shall apply for injuries
10    occurring on or after the effective date of this amendatory
11    Act of the 97th General Assembly and only when an employer
12    has an approved preferred provider program pursuant to
13    Section 8.1a on the date the employee sustained his or her
14    accidental injuries:
15            (A) The employer shall, in writing, on a form
16        promulgated by the Commission, inform the employee of
17        the preferred provider program;
18            (B) Subsequent to the report of an injury by an
19        employee, the employee may choose in writing at any
20        time to decline the preferred provider program, in
21        which case that would constitute one of the two choices
22        of medical providers to which the employee is entitled
23        under subsection (a)(2) or (a)(3); and
24            (C) Prior to the report of an injury by an
25        employee, when an employee chooses non-emergency
26        treatment from a provider not within the preferred

 

 

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1        provider program, that would constitute the employee's
2        one choice of medical providers to which the employee
3        is entitled under subsection (a)(2) or (a)(3).
4    When an employer and employee so agree in writing, nothing
5in this Act prevents an employee whose injury or disability has
6been established under this Act, from relying in good faith, on
7treatment by prayer or spiritual means alone, in accordance
8with the tenets and practice of a recognized church or
9religious denomination, by a duly accredited practitioner
10thereof, and having nursing services appropriate therewith,
11without suffering loss or diminution of the compensation
12benefits under this Act. However, the employee shall submit to
13all physical examinations required by this Act. The cost of
14such treatment and nursing care shall be paid by the employee
15unless the employer agrees to make such payment.
16    Where the accidental injury results in the amputation of an
17arm, hand, leg or foot, or the enucleation of an eye, or the
18loss of any of the natural teeth, the employer shall furnish an
19artificial of any such members lost or damaged in accidental
20injury arising out of and in the course of employment, and
21shall also furnish the necessary braces in all proper and
22necessary cases. In cases of the loss of a member or members by
23amputation, the employer shall, whenever necessary, maintain
24in good repair, refit or replace the artificial limbs during
25the lifetime of the employee. Where the accidental injury
26accompanied by physical injury results in damage to a denture,

 

 

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1eye glasses or contact eye lenses, or where the accidental
2injury results in damage to an artificial member, the employer
3shall replace or repair such denture, glasses, lenses, or
4artificial member.
5    The furnishing by the employer of any such services or
6appliances is not an admission of liability on the part of the
7employer to pay compensation.
8    The furnishing of any such services or appliances or the
9servicing thereof by the employer is not the payment of
10compensation.
11    (b) If the period of temporary total incapacity for work
12lasts more than 3 working days, weekly compensation as
13hereinafter provided shall be paid beginning on the 4th day of
14such temporary total incapacity and continuing as long as the
15total temporary incapacity lasts. In cases where the temporary
16total incapacity for work continues for a period of 14 days or
17more from the day of the accident compensation shall commence
18on the day after the accident.
19        1. The compensation rate for temporary total
20    incapacity under this paragraph (b) of this Section shall
21    be equal to 66 2/3% of the employee's average weekly wage
22    computed in accordance with Section 10, provided that it
23    shall be not less than 66 2/3% of the sum of the Federal
24    minimum wage under the Fair Labor Standards Act, or the
25    Illinois minimum wage under the Minimum Wage Law, whichever
26    is more, multiplied by 40 hours. This percentage rate shall

 

 

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

 

 

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1    be equal to 60% of the employee's average weekly wage
2    computed in accordance with the provisions of Section 10,
3    provided that it shall be not less than 66 2/3% of the sum
4    of the Federal minimum wage under the Fair Labor Standards
5    Act, or the Illinois minimum wage under the Minimum Wage
6    Law, whichever is more, multiplied by 40 hours. This
7    percentage rate shall be increased by 10% for each spouse
8    and child, not to exceed 100% of the total minimum wage
9    calculation,
10    nor exceed the employee's average weekly wage computed in
11    accordance with the provisions of Section 10, whichever is
12    less.
13        3. As used in this Section the term "child" means a
14    child of the employee including any child legally adopted
15    before the accident or whom at the time of the accident the
16    employee was under legal obligation to support or to whom
17    the employee stood in loco parentis, and who at the time of
18    the accident was under 18 years of age and not emancipated.
19    The term "children" means the plural of "child".
20        4. All weekly compensation rates provided under
21    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
22    Section shall be subject to the following limitations:
23        The maximum weekly compensation rate from July 1, 1975,
24    except as hereinafter provided, shall be 100% of the
25    State's average weekly wage in covered industries under the
26    Unemployment Insurance Act, that being the wage that most

 

 

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1    closely approximates the State's average weekly wage.
2        The maximum weekly compensation rate, for the period
3    July 1, 1984, through June 30, 1987, except as hereinafter
4    provided, shall be $293.61. Effective July 1, 1987 and on
5    July 1 of each year thereafter the maximum weekly
6    compensation rate, except as hereinafter provided, shall
7    be determined as follows: if during the preceding 12 month
8    period there shall have been an increase in the State's
9    average weekly wage in covered industries under the
10    Unemployment Insurance Act, the weekly compensation rate
11    shall be proportionately increased by the same percentage
12    as the percentage of increase in the State's average weekly
13    wage in covered industries under the Unemployment
14    Insurance Act during such period.
15        The maximum weekly compensation rate, for the period
16    January 1, 1981 through December 31, 1983, except as
17    hereinafter provided, shall be 100% of the State's average
18    weekly wage in covered industries under the Unemployment
19    Insurance Act in effect on January 1, 1981. Effective
20    January 1, 1984 and on January 1, of each year thereafter
21    the maximum weekly compensation rate, except as
22    hereinafter provided, shall be determined as follows: if
23    during the preceding 12 month period there shall have been
24    an increase in the State's average weekly wage in covered
25    industries under the Unemployment Insurance Act, the
26    weekly compensation rate shall be proportionately

 

 

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1    increased by the same percentage as the percentage of
2    increase in the State's average weekly wage in covered
3    industries under the Unemployment Insurance Act during
4    such period.
5        From July 1, 1977 and thereafter such maximum weekly
6    compensation rate in death cases under Section 7, and
7    permanent total disability cases under paragraph (f) or
8    subparagraph 18 of paragraph (3) of this Section and for
9    temporary total disability under paragraph (b) of this
10    Section and for amputation of a member or enucleation of an
11    eye under paragraph (e) of this Section shall be increased
12    to 133-1/3% of the State's average weekly wage in covered
13    industries under the Unemployment Insurance Act.
14        For injuries occurring on or after February 1, 2006,
15    the maximum weekly benefit under paragraph (d)1 of this
16    Section shall be 100% of the State's average weekly wage in
17    covered industries under the Unemployment Insurance Act.
18        4.1. Any provision herein to the contrary
19    notwithstanding, the weekly compensation rate for
20    compensation payments under subparagraph 18 of paragraph
21    (e) of this Section and under paragraph (f) of this Section
22    and under paragraph (a) of Section 7 and for amputation of
23    a member or enucleation of an eye under paragraph (e) of
24    this Section, shall in no event be less than 50% of the
25    State's average weekly wage in covered industries under the
26    Unemployment Insurance Act.

 

 

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1        4.2. Any provision to the contrary notwithstanding,
2    the total compensation payable under Section 7 shall not
3    exceed the greater of $500,000 or 25 years.
4        5. For the purpose of this Section this State's average
5    weekly wage in covered industries under the Unemployment
6    Insurance Act on July 1, 1975 is hereby fixed at $228.16
7    per week and the computation of compensation rates shall be
8    based on the aforesaid average weekly wage until modified
9    as hereinafter provided.
10        6. The Department of Employment Security of the State
11    shall on or before the first day of December, 1977, and on
12    or before the first day of June, 1978, and on the first day
13    of each December and June of each year thereafter, publish
14    the State's average weekly wage in covered industries under
15    the Unemployment Insurance Act and the Illinois Workers'
16    Compensation Commission shall on the 15th day of January,
17    1978 and on the 15th day of July, 1978 and on the 15th day
18    of each January and July of each year thereafter, post and
19    publish the State's average weekly wage in covered
20    industries under the Unemployment Insurance Act as last
21    determined and published by the Department of Employment
22    Security. The amount when so posted and published shall be
23    conclusive and shall be applicable as the basis of
24    computation of compensation rates until the next posting
25    and publication as aforesaid.
26        7. The payment of compensation by an employer or his

 

 

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1    insurance carrier to an injured employee shall not
2    constitute an admission of the employer's liability to pay
3    compensation.
4    (c) For any serious and permanent disfigurement to the
5hand, head, face, neck, arm, leg below the knee or the chest
6above the axillary line, the employee is entitled to
7compensation for such disfigurement, the amount determined by
8agreement at any time or by arbitration under this Act, at a
9hearing not less than 6 months after the date of the accidental
10injury, which amount shall not exceed 150 weeks (if the
11accidental injury occurs on or after the effective date of this
12amendatory Act of the 94th General Assembly but before February
131, 2006) or 162 weeks (if the accidental injury occurs on or
14after February 1, 2006) at the applicable rate provided in
15subparagraph 2.1 of paragraph (b) of this Section.
16    No compensation is payable under this paragraph where
17compensation is payable under paragraphs (d), (e) or (f) of
18this Section.
19    A duly appointed member of a fire department in a city, the
20population of which exceeds 500,000 according to the last
21federal or State census, is eligible for compensation under
22this paragraph only where such serious and permanent
23disfigurement results from burns.
24    (d) 1. If, after the accidental injury has been sustained,
25the employee as a result thereof becomes partially
26incapacitated from pursuing his usual and customary line of

 

 

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1employment, he shall, except in cases compensated under the
2specific schedule set forth in paragraph (e) of this Section,
3receive compensation for the duration of his disability,
4subject to the limitations as to maximum amounts fixed in
5paragraph (b) of this Section, equal to 66-2/3% of the
6difference between the average amount which he would be able to
7earn in the full performance of his duties in the occupation in
8which he was engaged at the time of the accident and the
9average amount which he is earning or is able to earn in some
10suitable employment or business after the accident. For
11accidental injuries that occur on or after September 1, 2011,
12an award for wage differential under this subsection shall be
13effective only until the employee reaches the age of 67 or 5
14years from the date the award becomes final, whichever is
15later.
16    2. If, as a result of the accident, the employee sustains
17serious and permanent injuries not covered by paragraphs (c)
18and (e) of this Section or having sustained injuries covered by
19the aforesaid paragraphs (c) and (e), he shall have sustained
20in addition thereto other injuries which injuries do not
21incapacitate him from pursuing the duties of his employment but
22which would disable him from pursuing other suitable
23occupations, or which have otherwise resulted in physical
24impairment; or if such injuries partially incapacitate him from
25pursuing the duties of his usual and customary line of
26employment but do not result in an impairment of earning

 

 

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

 

 

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1right to compensation payable under paragraphs (b), (c) and (e)
2of this Section for the disabilities therein covered.
3    (e) For accidental injuries in the following schedule, the
4employee shall receive compensation for the period of temporary
5total incapacity for work resulting from such accidental
6injury, under subparagraph 1 of paragraph (b) of this Section,
7and shall receive in addition thereto compensation for a
8further period for the specific loss herein mentioned, but
9shall not receive any compensation under any other provisions
10of this Act. The following listed amounts apply to either the
11loss of or the permanent and complete loss of use of the member
12specified, such compensation for the length of time as follows:
13        1. Thumb-
14            70 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            76 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        2. First, or index finger-
20            40 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            43 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        3. Second, or middle finger-
26            35 weeks if the accidental injury occurs on or

 

 

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

 

 

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1            13 weeks if the accidental injury occurs on or
2        after February 1, 2006.
3        8. The loss of the first or distal phalanx of the thumb
4    or of any finger or toe shall be considered to be equal to
5    the loss of one-half of such thumb, finger or toe and the
6    compensation payable shall be one-half of the amount above
7    specified. The loss of more than one phalanx shall be
8    considered as the loss of the entire thumb, finger or toe.
9    In no case shall the amount received for more than one
10    finger exceed the amount provided in this schedule for the
11    loss of a hand.
12        9. Hand-
13            190 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            205 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18            190 weeks if the accidental injury occurs on or
19        after June 28, 2011 (the effective date of Public Act
20        97-18) this amendatory Act of the 97th General Assembly
21        and if the accidental injury involves carpal tunnel
22        syndrome due to repetitive or cumulative trauma, in
23        which case the permanent partial disability shall not
24        exceed 15% loss of use of the hand, except for cause
25        shown by clear and convincing evidence and in which
26        case the award shall not exceed 30% loss of use of the

 

 

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

 

 

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1    case compensation for an additional 65 weeks (if the
2    accidental injury occurs on or after the effective date of
3    this amendatory Act of the 94th General Assembly but before
4    February 1, 2006) or an additional 70 weeks (if the
5    accidental injury occurs on or after February 1, 2006)
6    shall be paid.
7        11. Foot-
8            155 weeks if the accidental injury occurs on or
9        after the effective date of this amendatory Act of the
10        94th General Assembly but before February 1, 2006.
11            167 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        12. Leg-
14            200 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            215 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        Where an accidental injury results in the amputation of
20    a leg below the knee, such injury shall be compensated as
21    loss of a leg. Where an accidental injury results in the
22    amputation of a leg above the knee, compensation for an
23    additional 25 weeks (if the accidental injury occurs on or
24    after the effective date of this amendatory Act of the 94th
25    General Assembly but before February 1, 2006) or an
26    additional 27 weeks (if the accidental injury occurs on or

 

 

HB5546- 29 -LRB097 19514 JLS 64768 b

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

 

 

HB5546- 30 -LRB097 19514 JLS 64768 b

1        94th General Assembly but before February 1, 2006.
2            54 weeks if the accidental injury occurs on or
3        after February 1, 2006.
4        Total and permanent loss of hearing of both ears-
5            200 weeks if the accidental injury occurs on or
6        after the effective date of this amendatory Act of the
7        94th General Assembly but before February 1, 2006.
8            215 weeks if the accidental injury occurs on or
9        after February 1, 2006.
10        15. Testicle-
11            50 weeks if the accidental injury occurs on or
12        after the effective date of this amendatory Act of the
13        94th General Assembly but before February 1, 2006.
14            54 weeks if the accidental injury occurs on or
15        after February 1, 2006.
16        Both testicles-
17            150 weeks if the accidental injury occurs on or
18        after the effective date of this amendatory Act of the
19        94th General Assembly but before February 1, 2006.
20            162 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        16. For the permanent partial loss of use of a member
23    or sight of an eye, or hearing of an ear, compensation
24    during that proportion of the number of weeks in the
25    foregoing schedule provided for the loss of such member or
26    sight of an eye, or hearing of an ear, which the partial

 

 

HB5546- 31 -LRB097 19514 JLS 64768 b

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

 

 

HB5546- 32 -LRB097 19514 JLS 64768 b

1        average decibel loss. For every decibel of loss
2        exceeding 30 decibels an allowance of 1.82% shall be
3        made up to the maximum of 100% which is reached at 85
4        decibels.
5            (d) If a hearing loss is established to have
6        existed on July 1, 1975 by audiometric testing the
7        employer shall not be liable for the previous loss so
8        established nor shall he be liable for any loss for
9        which compensation has been paid or awarded.
10            (e) No consideration shall be given to the question
11        of whether or not the ability of an employee to
12        understand speech is improved by the use of a hearing
13        aid.
14            (f) No claim for loss of hearing due to industrial
15        noise shall be brought against an employer or allowed
16        unless the employee has been exposed for a period of
17        time sufficient to cause permanent impairment to noise
18        levels in excess of the following:
19Sound Level DBA
20Slow ResponseHours Per Day
21908
22926
23954
24973
251002
261021-1/2

 

 

HB5546- 33 -LRB097 19514 JLS 64768 b

11051
21101/2
31151/4
4        This subparagraph (f) shall not be applied in cases of
5    hearing loss resulting from trauma or explosion.
6        17. In computing the compensation to be paid to any
7    employee who, before the accident for which he claims
8    compensation, had before that time sustained an injury
9    resulting in the loss by amputation or partial loss by
10    amputation of any member, including hand, arm, thumb or
11    fingers, leg, foot or any toes, such loss or partial loss
12    of any such member shall be deducted from any award made
13    for the subsequent injury. For the permanent loss of use or
14    the permanent partial loss of use of any such member or the
15    partial loss of sight of an eye, for which compensation has
16    been paid, then such loss shall be taken into consideration
17    and deducted from any award for the subsequent injury.
18        18. The specific case of loss of both hands, both arms,
19    or both feet, or both legs, or both eyes, or of any two
20    thereof, or the permanent and complete loss of the use
21    thereof, constitutes total and permanent disability, to be
22    compensated according to the compensation fixed by
23    paragraph (f) of this Section. These specific cases of
24    total and permanent disability do not exclude other cases.
25        Any employee who has previously suffered the loss or
26    permanent and complete loss of the use of any of such

 

 

HB5546- 34 -LRB097 19514 JLS 64768 b

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

 

 

HB5546- 35 -LRB097 19514 JLS 64768 b

1reduced to $300,000, payment of the full amounts required by
2paragraph (f) of Section 7 shall be resumed, in the manner
3herein provided. The Commission shall make the changes in
4payment effective by general order, and the changes in payment
5become immediately effective for all cases coming before the
6Commission thereafter either by settlement agreement or final
7order, irrespective of the date of the accidental injury.
8    On August 1, 1996 and on February 1 and August 1 of each
9subsequent year, the Commission shall examine the special fund
10designated as the "Rate Adjustment Fund" and when, after
11deducting all advances or loans made to said fund, the amount
12therein is $4,000,000, the amount required to be paid by
13employers pursuant to paragraph (f) of Section 7 shall be
14reduced by one-half. When the Rate Adjustment Fund reaches the
15sum of $5,000,000 the payment therein shall cease entirely.
16However, when said Rate Adjustment Fund has been reduced to
17$3,000,000 the amounts required by paragraph (f) of Section 7
18shall be resumed in the manner herein provided.
19    (f) In case of complete disability, which renders the
20employee wholly and permanently incapable of work, or in the
21specific case of total and permanent disability as provided in
22subparagraph 18 of paragraph (e) of this Section, compensation
23shall be payable at the rate provided in subparagraph 2 of
24paragraph (b) of this Section for life.
25    An employee entitled to benefits under paragraph (f) of
26this Section shall also be entitled to receive from the Rate

 

 

HB5546- 36 -LRB097 19514 JLS 64768 b

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

 

 

HB5546- 37 -LRB097 19514 JLS 64768 b

1Injury Fund provided for in paragraph (f) of Section 7, which,
2together with the compensation payable from the employer in
3whose employ he was when the last accidental injury was
4incurred, will equal the amount payable for permanent and
5complete disability as provided in this paragraph of this
6Section.
7    The custodian of the Second Injury Fund provided for in
8paragraph (f) of Section 7 shall be joined with the employer as
9a party respondent in the application for adjustment of claim.
10The application for adjustment of claim shall state briefly and
11in general terms the approximate time and place and manner of
12the loss of the first member.
13    In its award the Commission or the Arbitrator shall
14specifically find the amount the injured employee shall be
15weekly paid, the number of weeks compensation which shall be
16paid by the employer, the date upon which payments begin out of
17the Second Injury Fund provided for in paragraph (f) of Section
187 of this Act, the length of time the weekly payments continue,
19the date upon which the pension payments commence and the
20monthly amount of the payments. The Commission shall 30 days
21after the date upon which payments out of the Second Injury
22Fund have begun as provided in the award, and every month
23thereafter, prepare and submit to the State Comptroller a
24voucher for payment for all compensation accrued to that date
25at the rate fixed by the Commission. The State Comptroller
26shall draw a warrant to the injured employee along with a

 

 

HB5546- 38 -LRB097 19514 JLS 64768 b

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

 

 

HB5546- 39 -LRB097 19514 JLS 64768 b

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

 

 

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

 

 

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

 

 

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1    (h-1) In case an injured employee is under legal disability
2at the time when any right or privilege accrues to him or her
3under this Act, a guardian may be appointed pursuant to law,
4and may, on behalf of such person under legal disability, claim
5and exercise any such right or privilege with the same effect
6as if the employee himself or herself had claimed or exercised
7the right or privilege. No limitations of time provided by this
8Act run so long as the employee who is under legal disability
9is without a conservator or guardian.
10    (i) In case the injured employee is under 16 years of age
11at the time of the accident and is illegally employed, the
12amount of compensation payable under paragraphs (b), (c), (d),
13(e) and (f) of this Section is increased 50%.
14    However, where an employer has on file an employment
15certificate issued pursuant to the Child Labor Law or work
16permit issued pursuant to the Federal Fair Labor Standards Act,
17as amended, or a birth certificate properly and duly issued,
18such certificate, permit or birth certificate is conclusive
19evidence as to the age of the injured minor employee for the
20purposes of this Section.
21    Nothing herein contained repeals or amends the provisions
22of the Child Labor Law relating to the employment of minors
23under the age of 16 years.
24    (j) 1. In the event the injured employee receives benefits,
25including medical, surgical or hospital benefits under any
26group plan covering non-occupational disabilities contributed

 

 

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1to wholly or partially by the employer, which benefits should
2not have been payable if any rights of recovery existed under
3this Act, then such amounts so paid to the employee from any
4such group plan as shall be consistent with, and limited to,
5the provisions of paragraph 2 hereof, shall be credited to or
6against any compensation payment for temporary total
7incapacity for work or any medical, surgical or hospital
8benefits made or to be made under this Act. In such event, the
9period of time for giving notice of accidental injury and
10filing application for adjustment of claim does not commence to
11run until the termination of such payments. This paragraph does
12not apply to payments made under any group plan which would
13have been payable irrespective of an accidental injury under
14this Act. Any employer receiving such credit shall keep such
15employee safe and harmless from any and all claims or
16liabilities that may be made against him by reason of having
17received such payments only to the extent of such credit.
18    Any excess benefits paid to or on behalf of a State
19employee by the State Employees' Retirement System under
20Article 14 of the Illinois Pension Code on a death claim or
21disputed disability claim shall be credited against any
22payments made or to be made by the State of Illinois to or on
23behalf of such employee under this Act, except for payments for
24medical expenses which have already been incurred at the time
25of the award. The State of Illinois shall directly reimburse
26the State Employees' Retirement System to the extent of such

 

 

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1credit.
2    2. Nothing contained in this Act shall be construed to give
3the employer or the insurance carrier the right to credit for
4any benefits or payments received by the employee other than
5compensation payments provided by this Act, and where the
6employee receives payments other than compensation payments,
7whether as full or partial salary, group insurance benefits,
8bonuses, annuities or any other payments, the employer or
9insurance carrier shall receive credit for each such payment
10only to the extent of the compensation that would have been
11payable during the period covered by such payment.
12    3. The extension of time for the filing of an Application
13for Adjustment of Claim as provided in paragraph 1 above shall
14not apply to those cases where the time for such filing had
15expired prior to the date on which payments or benefits
16enumerated herein have been initiated or resumed. Provided
17however that this paragraph 3 shall apply only to cases wherein
18the payments or benefits hereinabove enumerated shall be
19received after July 1, 1969.
20(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; revised
219-15-11.)
 
22    (820 ILCS 305/8.1a)
23    Sec. 8.1a. Preferred provider programs. Starting on the
24effective date of this amendatory Act of the 97th General
25Assembly, to satisfy its liabilities under this Act for the

 

 

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1provision of medical treatment to injured employees, an
2employer may utilize a preferred provider program approved by
3the Illinois Department of Insurance as in compliance with
4Sections 370k, 370l, 370m, and 370p of Article XX-1/2 of the
5Illinois Insurance Code. For the purposes of compliance with
6these Sections, the employee shall be considered the
7"beneficiary" and the employer shall be considered the
8"insured". Employers and insurers contracting directly with
9providers or utilizing multiple preferred provider programs to
10implement a preferred provider program providing workers'
11compensation benefits shall be subject to the above
12requirements of Article XX-1/2 applicable to administrators
13with regard to such program, with the exception of Section 370l
14of the Illinois Insurance Code.
15    (a) In addition to the above requirements of Article XX-1/2
16of the Illinois Insurance Code, all preferred provider programs
17under this Section shall meet the following requirements:
18        (1) The provider network shall include an adequate
19    number of occupational and non-occupational providers.
20        (2) The provider network shall include an adequate
21    number and type of physicians or other providers to treat
22    common injuries experienced by injured workers in the
23    geographic area where the employees reside.
24        (3) Medical treatment for injuries shall be readily
25    available at reasonable times to all employees. To the
26    extent feasible, all medical treatment for injuries shall

 

 

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1    be readily accessible to all employees.
2        (4) Physician compensation shall not be structured in
3    order to achieve the goal of inappropriately reducing,
4    delaying, or denying medical treatment or restricting
5    access to medical treatment.
6        (5) Before entering into any agreement under this
7    Section, a program shall establish terms and conditions
8    that must be met by noninstitutional providers wishing to
9    enter into an agreement with the program. These terms and
10    conditions may not discriminate unreasonably against or
11    among noninstitutional providers. Neither difference in
12    prices among noninstitutional providers produced by a
13    process of individual negotiation nor price differences
14    among other noninstitutional providers in different
15    geographical areas or different specialties constitutes
16    unreasonable discrimination.
17    (b) The administrator of any preferred provider program
18under this Act that uses economic evaluation shall file with
19the Director of Insurance a description of any policies and
20procedures related to economic evaluation utilized by the
21program. The filing shall describe how these policies and
22procedures are used in utilization review, peer review,
23incentive and penalty programs, and in provider retention and
24termination decisions. The Director of Insurance may deny
25approval of any preferred provider program that uses any policy
26or procedure of economic evaluation to inappropriately reduce,

 

 

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1delay or deny medical treatment, or to restrict access to
2medical treatment. Evaluation of providers based upon
3objective medical quality and patient outcome measurements,
4appropriate use of best clinical practices and evidence based
5medicine, and use of health information technology shall be
6permitted. If approved, the employer shall provide a copy of
7the filing to all participating providers.
8        (1) The Director of the Department of Insurance shall
9    make each administrator's filing available to the public
10    upon request. The Director of the Department of Insurance
11    may not publicly disclose any information submitted
12    pursuant to this Section that is determined by the Director
13    of the Department of Insurance to be confidential,
14    proprietary, or trade secret information pursuant to State
15    or federal law.
16        (2) For the purposes of this subsection (b), "economic
17    evaluation" shall mean any evaluation of a particular
18    physician, provider, medical group, or individual practice
19    association based in whole or in part on the economic costs
20    or utilization of services associated with medical care
21    provided or authorized by the physician, provider, medical
22    group, or individual practice association. Economic
23    evaluation shall not include negotiated rates with a
24    provider.
25    (c) Except for the provisions of subsection (a)(4) of
26Section 8 and for injuries occurring on or after the effective

 

 

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1date of this amendatory Act of the 97th General Assembly, an
2employee of an employer utilizing a preferred provider program
3shall only be allowed to select a participating network
4provider from the network. An employer shall be responsible
5for: (i) all first aid and emergency treatment; (ii) all
6medical care , surgical, and hospital services provided by the
7participating providers network provider initially selected by
8the employee or by any other participating network provider
9recommended by the initial participating network provider or
10any subsequent participating network provider in the chain of
11referrals from the initial participating network provider; and
12(iii) all medical, surgical, and hospital services provided by
13the participating network provider subsequently chosen by the
14employee or by any other participating network provider
15recommended by the subsequent participating network provider
16or any subsequent participating network provider in the chain
17of referrals from the second participating network provider. An
18employer shall not be liable for services determined by the
19Commission not to be compensable. An employer shall not be
20liable for medical services provided by a non-authorized
21provider when proper notice is provided to the injured worker.
22        (1) When the injured employee notifies the employer of
23    the injury or files a claim for workers' compensation with
24    the employer, the employer shall notify the employee of his
25    or her right to be treated by a physician of his or her
26    choice from the medical preferred provider network

 

 

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

 

 

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1expense. The Commission shall issue a decision on any petition
2filed pursuant to this Section within 5 working days.
3    (e) The Director of the Department of Insurance may
4promulgate such reasonable rules as are necessary and proper to
5carry out the provisions of this Section relating to approval
6and regulation of preferred provider programs.
7(Source: P.A. 97-18, eff. 6-28-11.)
 
8    (820 ILCS 305/8.2)
9    Sec. 8.2. Fee schedule.
10    (a) Except as provided for in subsection (c), for
11procedures, treatments, or services covered under this Act and
12rendered or to be rendered on and after February 1, 2006, the
13maximum allowable payment shall be 90% of the 80th percentile
14of charges and fees as determined by the Commission utilizing
15information provided by employers' and insurers' national
16databases, with a minimum of 12,000,000 Illinois line item
17charges and fees comprised of health care provider and hospital
18charges and fees as of August 1, 2004 but not earlier than
19August 1, 2002. These charges and fees are provider billed
20amounts and shall not include discounted charges. The 80th
21percentile is the point on an ordered data set from low to high
22such that 80% of the cases are below or equal to that point and
23at most 20% are above or equal to that point. The Commission
24shall adjust these historical charges and fees as of August 1,
252004 by the Consumer Price Index-U for the period August 1,

 

 

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12004 through September 30, 2005. The Commission shall establish
2fee schedules for procedures, treatments, or services for
3hospital inpatient, hospital outpatient, emergency room and
4trauma, ambulatory surgical treatment centers, and
5professional services. These charges and fees shall be
6designated by geozip or any smaller geographic unit. The data
7shall in no way identify or tend to identify any patient,
8employer, or health care provider. As used in this Section,
9"geozip" means a three-digit zip code based on data
10similarities, geographical similarities, and frequencies. A
11geozip does not cross state boundaries. As used in this
12Section, "three-digit zip code" means a geographic area in
13which all zip codes have the same first 3 digits. If a geozip
14does not have the necessary number of charges and fees to
15calculate a valid percentile for a specific procedure,
16treatment, or service, the Commission may combine data from the
17geozip with up to 4 other geozips that are demographically and
18economically similar and exhibit similarities in data and
19frequencies until the Commission reaches 9 charges or fees for
20that specific procedure, treatment, or service. In cases where
21the compiled data contains less than 9 charges or fees for a
22procedure, treatment, or service, reimbursement shall occur at
2376% of charges and fees as determined by the Commission in a
24manner consistent with the provisions of this paragraph.
25Providers of out-of-state procedures, treatments, services,
26products, or supplies shall be reimbursed at the lesser of that

 

 

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1state's fee schedule amount or the fee schedule amount for the
2region in which the employee resides. If no fee schedule exists
3in that state, the provider shall be reimbursed at the lesser
4of the actual charge or the fee schedule amount for the region
5in which the employee resides. Not later than September 30 in
62006 and each year thereafter, the Commission shall
7automatically increase or decrease the maximum allowable
8payment for a procedure, treatment, or service established and
9in effect on January 1 of that year by the percentage change in
10the Consumer Price Index-U for the 12 month period ending
11August 31 of that year. The increase or decrease shall become
12effective on January 1 of the following year. As used in this
13Section, "Consumer Price Index-U" means the index published by
14the Bureau of Labor Statistics of the U.S. Department of Labor,
15that measures the average change in prices of all goods and
16services purchased by all urban consumers, U.S. city average,
17all items, 1982-84=100.
18    (a-1) Notwithstanding the provisions of subsection (a) and
19unless otherwise indicated, the following provisions shall
20apply to the medical fee schedule starting on September 1,
212011:
22        (1) The Commission shall establish and maintain fee
23    schedules for procedures, treatments, products, services,
24    or supplies for hospital inpatient, hospital outpatient,
25    emergency room, ambulatory surgical treatment centers,
26    accredited ambulatory surgical treatment facilities,

 

 

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1    prescriptions filled and dispensed outside of a licensed
2    pharmacy, dental services, and professional services. This
3    fee schedule shall be based on the fee schedule amounts
4    already established by the Commission pursuant to
5    subsection (a) of this Section. However, starting on
6    January 1, 2012, these fee schedule amounts shall be
7    grouped into geographic regions in the following manner:
8            (A) Four regions for non-hospital fee schedule
9        amounts shall be utilized:
10                (i) Cook County;
11                (ii) DuPage, Kane, Lake, and Will Counties;
12                (iii) Bond, Calhoun, Clinton, Jersey,
13            Macoupin, Madison, Monroe, Montgomery, Randolph,
14            St. Clair, and Washington Counties; and
15                (iv) All other counties of the State.
16            (B) Fourteen regions for hospital fee schedule
17        amounts shall be utilized:
18                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
19            Kendall, and Grundy Counties;
20                (ii) Kankakee County;
21                (iii) Madison, St. Clair, Macoupin, Clinton,
22            Monroe, Jersey, Bond, and Calhoun Counties;
23                (iv) Winnebago and Boone Counties;
24                (v) Peoria, Tazewell, Woodford, Marshall, and
25            Stark Counties;
26                (vi) Champaign, Piatt, and Ford Counties;

 

 

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1                (vii) Rock Island, Henry, and Mercer Counties;
2                (viii) Sangamon and Menard Counties;
3                (ix) McLean County;
4                (x) Lake County;
5                (xi) Macon County;
6                (xii) Vermilion County;
7                (xiii) Alexander County; and
8                (xiv) All other counties of the State.
9        (2) If a geozip, as defined in subsection (a) of this
10    Section, overlaps into one or more of the regions set forth
11    in this Section, then the Commission shall average or
12    repeat the charges and fees in a geozip in order to
13    designate charges and fees for each region.
14        (3) In cases where the compiled data contains less than
15    9 charges or fees for a procedure, treatment, product,
16    supply, or service or where the fee schedule amount cannot
17    be determined by the non-discounted charge data,
18    non-Medicare relative values and conversion factors
19    derived from established fee schedule amounts, coding
20    crosswalks, or other data as determined by the Commission,
21    reimbursement shall occur at 76% of charges and fees until
22    September 1, 2011 and 53.2% of charges and fees thereafter
23    as determined by the Commission in a manner consistent with
24    the provisions of this paragraph.
25        (4) To establish additional fee schedule amounts, the
26    Commission shall utilize provider non-discounted charge

 

 

HB5546- 55 -LRB097 19514 JLS 64768 b

1    data, non-Medicare relative values and conversion factors
2    derived from established fee schedule amounts, and coding
3    crosswalks. The Commission may establish additional fee
4    schedule amounts based on either the charge or cost of the
5    procedure, treatment, product, supply, or service.
6        (5) Implants shall be reimbursed at 25% above the net
7    manufacturer's invoice price less rebates, plus actual
8    reasonable and customary shipping charges whether or not
9    the implant charge is submitted by a provider in
10    conjunction with a bill for all other services associated
11    with the implant, submitted by a provider on a separate
12    claim form, submitted by a distributor, or submitted by the
13    manufacturer of the implant. "Implants" include the
14    following codes or any substantially similar updated code
15    as determined by the Commission: 0274
16    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
17    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
18    (investigational devices); and 0636 (drugs requiring
19    detailed coding). Non-implantable devices or supplies
20    within these codes shall be reimbursed at 65% of actual
21    charge, which is the provider's normal rates under its
22    standard chargemaster. A standard chargemaster is the
23    provider's list of charges for procedures, treatments,
24    products, supplies, or services used to bill payers in a
25    consistent manner.
26        (6) The Commission shall automatically update all

 

 

HB5546- 56 -LRB097 19514 JLS 64768 b

1    codes and associated rules with the version of the codes
2    and rules valid on January 1 of that year.
3    (a-2) For procedures, treatments, services, or supplies
4covered under this Act and rendered or to be rendered on or
5after September 1, 2011, the maximum allowable payment shall be
670% of the fee schedule amounts, which shall be adjusted yearly
7by the Consumer Price Index-U, as described in subsection (a)
8of this Section.
9    (a-3) Prescriptions filled and dispensed outside of a
10licensed pharmacy shall be subject to a fee schedule that shall
11not exceed the manufacturer's Average Wholesale Price (AWP)
12plus a dispensing fee of $4.18. AWP or its equivalent as
13registered by the National Drug Code shall be set forth for
14that drug on that date as published in Medispan.
15    (b) Notwithstanding the provisions of subsection (a), if
16the Commission finds that there is a significant limitation on
17access to quality health care in either a specific field of
18health care services or a specific geographic limitation on
19access to health care, it may change the Consumer Price Index-U
20increase or decrease for that specific field or specific
21geographic limitation on access to health care to address that
22limitation.
23    (c) The Commission shall establish by rule a process to
24review those medical cases or outliers that involve
25extra-ordinary treatment to determine whether to make an
26additional adjustment to the maximum payment within a fee

 

 

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1schedule for a procedure, treatment, or service.
2    (d) When a patient notifies a provider that the treatment,
3procedure, or service being sought is for a work-related
4illness or injury and furnishes the provider the name and
5address of the responsible employer, the provider shall bill
6the employer directly. The employer shall make payment and
7providers shall submit bills and records in accordance with the
8provisions of this Section.
9        (1) All payments to providers for treatment provided
10    pursuant to this Act shall be made within 30 days of
11    receipt of the bills as long as the claim contains
12    substantially all the required data elements necessary to
13    adjudicate the bills.
14        (2) If the claim does not contain substantially all the
15    required data elements necessary to adjudicate the bill, or
16    the claim is denied for any other reason, in whole or in
17    part, the employer or insurer shall provide written
18    notification, explaining the basis for the denial and
19    describing any additional necessary data elements, to the
20    provider within 30 days of receipt of the bill.
21        (3) In the case of nonpayment to a provider within 30
22    days of receipt of the bill which contained substantially
23    all of the required data elements necessary to adjudicate
24    the bill or nonpayment to a provider of a portion of such a
25    bill up to the lesser of the actual charge or the payment
26    level set by the Commission in the fee schedule established

 

 

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1    in this Section, the bill, or portion of the bill, shall
2    incur interest at a rate of 1% per month payable to the
3    provider. Any required interest payments shall be made
4    within 30 days after payment.
5    (e) Except as provided in subsections (e-5), (e-10), and
6(e-15), a provider shall not hold an employee liable for costs
7related to a non-disputed procedure, treatment, or service
8rendered in connection with a compensable injury. The
9provisions of subsections (e-5), (e-10), (e-15), and (e-20)
10shall not apply if an employee provides information to the
11provider regarding participation in a group health plan. If the
12employee participates in a group health plan, the provider may
13submit a claim for services to the group health plan. If the
14claim for service is covered by the group health plan, the
15employee's responsibility shall be limited to applicable
16deductibles, co-payments, or co-insurance. Except as provided
17under subsections (e-5), (e-10), (e-15), and (e-20), a provider
18shall not bill or otherwise attempt to recover from the
19employee the difference between the provider's charge and the
20amount paid by the employer or the insurer on a compensable
21injury, or for medical services or treatment determined by the
22Commission to be excessive or unnecessary.
23    (e-5) If an employer notifies a provider that the employer
24does not consider the illness or injury to be compensable under
25this Act, the provider may seek payment of the provider's
26actual charges from the employee for any procedure, treatment,

 

 

HB5546- 59 -LRB097 19514 JLS 64768 b

1or service rendered. Once an employee informs the provider that
2there is an application filed with the Commission to resolve a
3dispute over payment of such charges, the provider shall cease
4any and all efforts to collect payment for the services that
5are the subject of the dispute. Any statute of limitations or
6statute of repose applicable to the provider's efforts to
7collect payment from the employee shall be tolled from the date
8that the employee files the application with the Commission
9until the date that the provider is permitted to resume
10collection efforts under the provisions of this Section.
11    (e-10) If an employer notifies a provider that the employer
12will pay only a portion of a bill for any procedure, treatment,
13or service rendered in connection with a compensable illness or
14disease, the provider may seek payment from the employee for
15the remainder of the amount of the bill up to the lesser of the
16actual charge, negotiated rate, if applicable, or the payment
17level set by the Commission in the fee schedule established in
18this Section. Once an employee informs the provider that there
19is an application filed with the Commission to resolve a
20dispute over payment of such charges, the provider shall cease
21any and all efforts to collect payment for the services that
22are the subject of the dispute. Any statute of limitations or
23statute of repose applicable to the provider's efforts to
24collect payment from the employee shall be tolled from the date
25that the employee files the application with the Commission
26until the date that the provider is permitted to resume

 

 

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

 

 

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1the employee and the employee shall be responsible for payment
2of any outstanding bills for a procedure, treatment, or service
3rendered by a provider as well as the interest awarded under
4subsection (d) of this Section. In the case of a procedure,
5treatment, or service deemed compensable, the provider shall
6not require a payment rate, excluding the interest provisions
7under subsection (d), greater than the lesser of the actual
8charge or the payment level set by the Commission in the fee
9schedule established in this Section. Payment for services
10deemed not covered or not compensable under this Act is the
11responsibility of the employee unless a provider and employee
12have agreed otherwise in writing. Services not covered or not
13compensable under this Act are not subject to the fee schedule
14in this Section.
15    (f) Nothing in this Act shall prohibit an employer or
16insurer from contracting with a health care provider or group
17of health care providers for reimbursement levels for benefits
18under this Act different from those provided in this Section.
19    (g) On or before January 1, 2010 the Commission shall
20provide to the Governor and General Assembly a report regarding
21the implementation of the medical fee schedule and the index
22used for annual adjustment to that schedule as described in
23this Section.
24(Source: P.A. 97-18, eff. 6-28-11.)
 
25    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)

 

 

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1    Sec. 11. The compensation herein provided, together with
2the provisions of this Act, shall be the measure of the
3responsibility of any employer engaged in any of the
4enterprises or businesses enumerated in Section 3 of this Act,
5or of any employer who is not engaged in any such enterprises
6or businesses, but who has elected to provide and pay
7compensation for accidental injuries sustained by any employee
8arising out of and in the course of the employment according to
9the provisions of this Act, and whose election to continue
10under this Act, has not been nullified by any action of his
11employees as provided for in this Act.
12    Accidental injuries incurred while participating in
13voluntary recreational programs including but not limited to
14athletic events, parties and picnics do not arise out of and in
15the course of the employment even though the employer pays some
16or all of the cost thereof. This exclusion shall not apply in
17the event that the injured employee was ordered or assigned by
18his employer to participate in the program.
19    Notwithstanding any other defense, accidental injuries
20incurred while the employee is engaged in the active commission
21of and as a proximate result of the active commission of (a) a
22forcible felony, (b) aggravated driving under the influence of
23alcohol, other drug or drugs, or intoxicating compound or
24compounds, or any combination thereof, or (c) reckless homicide
25and for which the employee was convicted do not arise out of
26and in the course of employment if the commission of that

 

 

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1forcible felony, aggravated driving under the influence, or
2reckless homicide caused an accident resulting in the death or
3severe injury of another person. If an employee is acquitted of
4a forcible felony, aggravated driving under the influence, or
5reckless homicide that caused an accident resulting in the
6death or severe injury of another person or if these charges
7are dismissed, there shall be no presumption that the employee
8is eligible for benefits under this Act. No employee shall be
9entitled to additional compensation under Sections 19(k) or
1019(l) of this Act or attorney's fees under Section 16 of this
11Act when the employee has been charged with a forcible felony,
12aggravated driving under the influence, or reckless homicide
13that caused an accident resulting in the death or severe injury
14of another person and the employer terminates benefits or
15refuses to pay benefits to the employee until the termination
16of any pending criminal proceedings.
17    Accidental injuries incurred while participating as a
18patient in a drug or alcohol rehabilitation program do not
19arise out of and in the course of employment even though the
20employer pays some or all of the costs thereof.
21    Any injury to or disease or death of an employee arising
22from the administration of a vaccine, including without
23limitation smallpox vaccine, to prepare for, or as a response
24to, a threatened or potential bioterrorist incident to the
25employee as part of a voluntary inoculation program in
26connection with the person's employment or in connection with

 

 

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

 

 

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1Controlled Substances Act, or (3) an intoxicating compound
2listed in the Use of Intoxicating Compounds Act or if the
3employee refuses to submit to testing of blood, breath, or
4urine, then there shall be a rebuttable presumption that the
5employee was intoxicated and that the intoxication was the
6proximate cause of the employee's injury. The employee may
7overcome the rebuttable presumption by the preponderance of the
8admissible evidence that the intoxication was not the sole
9proximate cause or proximate cause of the accidental injuries.
10Percentage by weight of alcohol in the blood shall be based on
11grams of alcohol per 100 milliliters of blood. Percentage by
12weight of alcohol in the breath shall be based upon grams of
13alcohol per 210 liters of breath. Any testing that has not been
14performed by an accredited or certified testing laboratory
15shall not be admissible in any hearing under this Act to
16determine whether the employee was intoxicated at the time the
17employee incurred the accidental injury.
18    All sample collection and testing for alcohol and drugs
19under this Section shall be performed in accordance with rules
20to be adopted by the Commission. These rules shall ensure:
21        (1) compliance with the National Labor Relations Act
22    regarding collective bargaining agreements or regulations
23    promulgated by the United States Department of
24    Transportation;
25        (2) that samples are collected and tested in
26    conformance with national and State legal and regulatory

 

 

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1    standards for the privacy of the individual being tested,
2    and in a manner reasonably calculated to prevent
3    substitutions or interference with the collection or
4    testing of reliable sample;
5        (3) that split testing procedures are utilized;
6        (4) that sample collection is documented, and the
7    documentation procedures include:
8            (A) the labeling of samples in a manner so as to
9        reasonably preclude the probability of erroneous
10        identification of test result; and
11            (B) an opportunity for the employee to provide
12        notification of any information which he or she
13        considers relevant to the test, including
14        identification of currently or recently used
15        prescription or nonprescription drugs and other
16        relevant medical information;
17        (5) that sample collection, storage, and
18    transportation to the place of testing is performed in a
19    manner so as to reasonably preclude the probability of
20    sample contamination or adulteration; and
21        (6) that chemical analyses of blood, urine, breath, or
22    other bodily substance are performed according to
23    nationally scientifically accepted analytical methods and
24    procedures.
25    The changes to this Section made by Public Act 97-18 this
26amendatory Act of the 97th General Assembly apply only to

 

 

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1accidental injuries that occur on or after September 1, 2011.
2(Source: P.A. 97-18, eff. 6-28-11; 97-276, eff. 8-8-11; revised
39-15-11.)