HB1287ham007 99TH GENERAL ASSEMBLY

Rep. John E. Bradley

Filed: 6/3/2015

09900HB1287ham007 LRB099 05153 SXM 36499 a

AMENDMENT TO HOUSE BILL 1287

AMENDMENT NO. ______. Amend House Bill 1287, AS AMENDED, by inserting the following in its proper numeric sequence in the bill:

"Section 8. The Workers' Compensation Act is amended by changing Section 29.2 and by adding Section 29.3 as follows:

(820 ILCS 305/29.2)

Sec. 29.2. Insurance and self-insurance oversight.

(a) The Department of Insurance shall annually submit to the Governor, the Chairman of the Commission, the President of the Senate, the Speaker of the House of Representatives, the Minority Leader of the Senate, and the Minority Leader of the House of Representatives a written report that details the state of the workers' compensation insurance market in Illinois. The report shall be completed by April 1 of each year, beginning in 2012, or later if necessary data or analyses are only available to the Department at a later date. The report shall be posted on the Department of Insurance's Internet website. Information to be included in the report shall be for the preceding calendar year. The report shall include, at a minimum, the following:

(1) Gross premiums collected by workers' compensation carriers in Illinois and the national rank of Illinois based on premium volume.

(2) The number of insurance companies actively engaged in Illinois in the workers' compensation insurance market, including both holding companies and subsidiaries or affiliates, and the national rank of Illinois based on number of competing insurers.

(3) The total number of insured participants in the Illinois workers' compensation assigned risk insurance pool, and the size of the assigned risk pool as a proportion of the total Illinois workers' compensation insurance market.

(4) The advisory organization premium rate for workers' compensation insurance in Illinois for the previous year.

(5) The advisory organization prescribed assigned risk pool premium rate.

(6) The total amount of indemnity payments made by workers' compensation insurers in Illinois.

(7) The total amount of medical payments made by workers' compensation insurers in Illinois, and the national rank of Illinois based on average cost of medical claims per injured worker.

(8) The gross profitability of workers' compensation insurers in Illinois, and the national rank of Illinois based on profitability of workers' compensation insurers.

(9) The loss ratio of workers' compensation insurers in Illinois and the national rank of Illinois based on the loss ratio of workers' compensation insurers. For purposes of this loss ratio calculation, the denominator shall include all premiums and other fees collected by workers' compensation insurers and the numerator shall include the total amount paid by the insurer for care or compensation to injured workers.

(10) The growth of total paid indemnity benefits by temporary total disability, scheduled and non-scheduled permanent partial disability, and total disability.

(11) The number of injured workers receiving wage loss differential awards and the average wage loss differential award payout.

(12) Illinois' rank, relative to other states, for:

(i) the maximum and minimum temporary total disability benefit level;

(ii) the maximum and minimum scheduled and non-scheduled permanent partial disability benefit level;

(iii) the maximum and minimum total disability benefit level; and

(iv) the maximum and minimum death benefit level.

(13) The aggregate growth of medical benefit payout by non-hospital providers and hospitals.

(14) The aggregate growth of medical utilization for the top 10 most common injuries to specific body parts by non-hospital providers and hospitals.

(15) The percentage of injured workers filing claims at the Commission that are represented by an attorney.

(16) The total amount paid by injured workers for attorney representation.

(a-5) The Department of Insurance shall annually submit to the Governor, the Chairman of the Commission, and the General Assembly a written report that details the state of self-insurance for workers' compensation in Illinois. The report shall be completed by October 1, 2015 and April 1 of each year thereafter or later if necessary data or analyses are only available to the Department at a later date. The report shall be posted on the Department of Insurance's Internet website. Information to be included in the report shall be for the preceding calendar year. The report shall include, at a minimum, the following:

(1) The number of employers that self-insure for workers' compensation.

(2) The total number of employers belonging to a group workers' compensation pool.

(3) The total amount of indemnity payments made by self-insureds and by group workers' compensation pools in Illinois.

(4) The total amount of medical payments made by self-insureds and by group workers' compensation pools in Illinois, and the national rank of Illinois based on average cost of medical claims per injured worker.

(5) The growth of total paid indemnity benefits by temporary total disability, scheduled and non-scheduled permanent partial disability, and total disability.

(6) The number of injured workers receiving wage loss differential awards and the average wage loss differential award payout.

(7) Illinois' rank, relative to other states, for:

(i) the maximum and minimum temporary total disability benefit levels;

(ii) the maximum and minimum scheduled and non-scheduled permanent partial disability benefit levels;

(iii) the maximum and minimum total disability benefit levels; and

(iv) the maximum and minimum death benefit levels.

(8) The aggregate growth of medical benefit payouts by non-hospital providers and hospitals.

(9) The aggregate growth of medical utilization for the top 10 most common injuries to specific body parts by non-hospital providers and hospitals.

(b) The Director of Insurance shall promulgate rules requiring each insurer licensed to write workers' compensation coverage in the State self-insured employer, and group workers' compensation pool to record and report the following information on an aggregate basis to the Department of Insurance before March 1 of each year, relating to claims in the State opened within the prior calendar year:

(1) The number of claims opened.

(2) The number of reported medical only claims.

(3) The number of contested claims.

(4) The number of claims for which the employee has attorney representation.

(5) The number of claims with lost time and the number of claims for which temporary total disability was paid.

(6) The number of claim adjusters employed to adjust workers' compensation claims.

(7) The number of claims for which temporary total disability was not paid within 14 days from the first full day off, regardless of reason.

(8) The number of medical bills paid 60 days or later from date of service and the average days paid on those paid after 60 days for the previous calendar year.

(9) The number of claims in which in-house defense counsel participated, and the total amount spent on in-house legal services.

(10) The number of claims in which outside defense counsel participated, and the total amount paid to outside defense counsel.

(11) The total amount billed to employers for bill review.

(12) The total amount billed to employers for fee schedule savings.

(13) The total amount charged to employers for any and all managed care fees.

(14) The number of claims involving in-house medical nurse case management, and the total amount spent on in-house medical nurse case management.

(15) The number of claims involving outside medical nurse case management, and the total amount paid for outside medical nurse case management.

(16) The total amount paid for Independent Medical exams.

(17) The total amount spent on in-house Utilization Review for the previous calendar year.

(18) The total amount paid for outside Utilization Review for the previous calendar year.

The Department shall make the submitted information publicly available on the Department's Internet website or such other media as appropriate in a form useful for consumers.

(Source: P.A. 97-18, eff. 6-28-11.)

(820 ILCS 305/29.3 new)

Sec. 29.3. Workers' Compensation Premium Rates Task Force.

(a) There is created the Workers' Compensation Premium Rates Task Force consisting of 12 members appointed as follows: 2 legislative members appointed by the Speaker of the House of Representatives; 2 legislative members appointed by the Minority Leader of the House of Representatives; 2 legislative members appointed by the President of the Senate; 2 legislative members appointed by the Minority Leader of the Senate; and one member appointed by the Governor from each of the following organizations: (i) a statewide association representing retailers; (ii) a statewide association representing manufacturers; (ii) a statewide association representing labor interests; and (iii) a statewide association representing injured workers. The members of the Task Force shall be appointed by August 1, 2015. Two co-chairpersons, representing different political parties, shall be selected by the members of the Task Force. Members of the Task Force shall receive no compensation for their service on the Task Force.

(b) The Task Force shall study the National Council on Compensation Insurance's recommendations for workers' compensation premium rates and the extent to which Illinois employers' actual premiums reflect these recommended rates. The Department of Insurance shall provide administrative support to the Task Force.

(c) The Task Force shall report its findings and recommendations to the General Assembly no later than December 31, 2015.

(d) This Section is repealed on December 31, 2016.".