Illinois General Assembly - Full Text of HR0131
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Full Text of HR0131  97th General Assembly




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2    WHEREAS, The Department of Central Management Services
3(CMS) is responsible for establishing "rules, procedures, and
4forms to be used by State agencies in the administration and
5payment of workers' compensation claims" and for the initial
6evaluation, determination, administration, and payment of
7workers' compensation claims involving State agencies [20 ILCS
8405/405-105 and 405/405-411]; and
9    WHEREAS, According to the CMS website
10(, "CMS
11Workers' Compensation Adjustors and unit supervisors are
12available to ensure efficient and proper claims administration
13in the following principal areas: 1) initial claim review for
14determining compensability; 2) ongoing benefit management
15(including payment of medical charges and temporary
16disability); and 3) proper negotiation of settlements based on
17partial or total permanent disability"; and
18    WHEREAS, Also according to the CMS website, the "Office of
19the Attorney General is responsible for the defense of claims
20arising from work-related injuries or disease. The CMS Workers'
21Compensation Adjustors work closely with the Office of the
22Attorney General to bring litigated cases to a resolution if
23such resolution is advantageous to the State. Otherwise, when



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1both parties fail to reach an agreement, a disputed claim is
2heard in front of an Illinois Workers' Compensation Commission
3Arbitrator for disposition."; and
4    WHEREAS, By statute, the "hearings before the Arbitrator
5shall be held in the vicinity where the injury occurred after
610 days' notice of the time and place of such hearing shall
7have been given to each of the parties or their attorneys of
8record" [820 ILCS 305/19(b)]; and
9    WHEREAS, By rule, designation of an alternative hearing
10site "may be had upon showing to the Commission of extreme
11hardship worked upon a party or parties by the designated site,
12or by agreement of the parties" [50 Ill.Adm.Code 7020.50]; and
13    WHEREAS, According to the Illinois Workers' Compensation
14Commission's FY09 annual report, of 57,192 cases closed in FY09
15by arbitrators, 50,610 were closed through a settlement process
16in which the employer and employee enter into a Settlement
17Contract and present it for approval to the arbitrator assigned
18to the case; and
19    WHEREAS, Parties who are dissatisfied with an arbitrator's
20decision may appeal that decision to a panel of three IWCC
21commissioners, and the panel's decision is final for cases
22involving State of Illinois employees; and



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1    WHEREAS, According to the IWCC's website
2(, under a procedure in effect
3prior to March 1, 2011, over 3,500 pro se settlement contracts
4were reviewed by arbitrators before being assigned a case
5number in calendar year 2010, making it difficult for the IWCC
6to "determine if any of those contracts go astray and fail to
7get entered into the system"; and
8    WHEREAS, Recent news reports raised questions about the
9practices of two workers' compensation arbitrators, each of
10whom has since been placed on administrative leave; therefore,
11be it
14the Auditor General is directed to conduct a management audit
15of the Workers' Compensation program as it applies to State
16employees; and be it further
17    RESOLVED, That the audit include, but not be limited to,
18the following:
19        (1) the roles of the Department of Central Management
20    Services, the Attorney General's Office, and the Illinois
21    Workers' Compensation Commission in processing, reviewing,
22    determining, and paying on workers' compensation claims



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1    filed by State workers;
2        (2) the number of claims filed by State workers during
3    the last 4 years, including a classification of the types
4    of alleged injuries, employing unit, disposition, and
5    claims payments;
6        (3) a review of the settlement contract process and, in
7    particular, documentation supporting any decisions on
8    these claims;
9        (4) an analysis of any fraud identification and control
10    policies and procedures governing the workers'
11    compensation program;
12        (5) whether the processing of State employee workers'
13    compensation claims complies with applicable State law and
14    regulations;
15        (6) an analysis of arbitrator caseloads over the 4-year
16    period, including the number of cases closed, a
17    classification of the types of alleged injuries involved in
18    those cases, the employing unit involved in the claims, and
19    claim dispositions and payments;
20        (7) a review of conflict of interest policies
21    applicable to arbitrators, commissioners, and other
22    principals involved in the workers' compensation program,
23    including any procedures for handling workers'
24    compensation claims filed by arbitrators, commissioners,
25    and other principals involved in the workers' compensation
26    program; and



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1        (8) a comparison of claims history by State workers to
2    claims filed by all other workers covered under the
3    Workers' Compensation program; and be it further
4    RESOLVED, That the Department of Central Management
5Services, Attorney General's Office, Illinois Workers'
6Compensation Commission, and any other entity having
7information relevant to this audit cooperate fully and promptly
8with the Auditor General's Office in the conduct of this audit;
9and be it further
10    RESOLVED, That the Auditor General commence this audit as
11soon as possible and report his findings and recommendations
12upon completion in accordance with the provisions of Section 3-
1314 of the Illinois State Auditing Act; and be it further
14    RESOLVED, That copies of this resolution be presented to
15the Auditor General, the Director of Central Management
16Services, the Attorney General, and the Commissioners of the
17Illinois Workers' Compensation Commission.