Full Text of HR0131 97th General Assembly
HR0131 97TH GENERAL ASSEMBLY |
| | HR0131 | | LRB097 10966 PJG 51588 r |
|
| 1 | | HOUSE RESOLUTION
| 2 | | WHEREAS, The Department of Central Management Services | 3 | | (CMS) is responsible for establishing "rules, procedures, and | 4 | | forms to be used by State agencies in the administration and | 5 | | payment of workers' compensation claims" and for the initial | 6 | | evaluation, determination, administration, and payment of | 7 | | workers' compensation claims involving State agencies [20 ILCS
| 8 | | 405/405-105 and 405/405-411]; and
| 9 | | WHEREAS, According to the CMS website
| 10 | | (http://www.cms.il.gov/cms/2_servicese_ben/workcomp.htm), "CMS | 11 | | Workers' Compensation
Adjustors and unit supervisors are | 12 | | available to ensure efficient and proper claims administration
| 13 | | in the following principal areas: 1) initial claim review for | 14 | | determining compensability; 2)
ongoing benefit management | 15 | | (including payment of medical charges and temporary | 16 | | disability);
and 3) proper negotiation of settlements based on | 17 | | partial or total permanent disability"; and
| 18 | | WHEREAS, Also according to the CMS website, the "Office of | 19 | | the Attorney General is responsible
for the defense of claims | 20 | | arising from work-related injuries or disease. The CMS Workers'
| 21 | | Compensation Adjustors work closely with the Office of the | 22 | | Attorney General to bring litigated cases to a resolution if | 23 | | such resolution is advantageous to the State. Otherwise, when |
| | | HR0131 | - 2 - | LRB097 10966 PJG 51588 r |
|
| 1 | | both parties
fail to reach an agreement, a disputed claim is | 2 | | heard in front of an Illinois Workers' Compensation Commission | 3 | | Arbitrator for disposition."; and
| 4 | | WHEREAS, By statute, the "hearings before the Arbitrator | 5 | | shall be held in the vicinity where the
injury occurred after | 6 | | 10 days' notice of the time and place of such hearing shall | 7 | | have been given
to each of the parties or their attorneys of | 8 | | record" [820 ILCS 305/19(b)]; and
| 9 | | WHEREAS, By rule, designation of an alternative hearing | 10 | | site "may be had upon showing to the
Commission of extreme | 11 | | hardship worked upon a party or parties by the designated site, | 12 | | or by
agreement of the parties" [50 Ill.Adm.Code 7020.50]; and
| 13 | | WHEREAS, According to the Illinois Workers' Compensation | 14 | | Commission's FY09 annual report,
of 57,192 cases closed in FY09 | 15 | | by arbitrators, 50,610 were closed through a settlement process
| 16 | | in which the employer and employee enter into a Settlement | 17 | | Contract and present it for approval
to the arbitrator assigned | 18 | | to the case; and | 19 | | WHEREAS, Parties who are dissatisfied with an arbitrator's | 20 | | decision may appeal that decision to
a panel of three IWCC | 21 | | commissioners, and the panel's decision is final for cases | 22 | | involving State
of Illinois employees; and |
| | | HR0131 | - 3 - | LRB097 10966 PJG 51588 r |
|
| 1 | | WHEREAS, According to the IWCC's website | 2 | | (http://www.iwcc.il.gov/news.htm), under a
procedure in effect | 3 | | prior to March 1, 2011, over 3,500 pro se settlement contracts | 4 | | were reviewed
by arbitrators before being assigned a case | 5 | | number in calendar year 2010, making it difficult for
the IWCC | 6 | | to "determine if any of those contracts go astray and fail to | 7 | | get entered into the
system"; and | 8 | | WHEREAS, Recent news reports raised questions about the | 9 | | practices of two workers'
compensation arbitrators, each of | 10 | | whom has since been placed on administrative leave; therefore, | 11 | | be it
| 12 | | RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE | 13 | | NINETY-SEVENTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that | 14 | | the Auditor
General is directed to conduct a management audit | 15 | | of the Workers' Compensation program as it
applies to State | 16 | | employees; and be it further
| 17 | | RESOLVED, That the audit include, but not be limited to, | 18 | | the 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 |
| | | HR0131 | - 4 - | LRB097 10966 PJG 51588 r |
|
| 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 |
| | | HR0131 | - 5 - | LRB097 10966 PJG 51588 r |
|
| 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 | 5 | | Services, Attorney General's Office,
Illinois Workers' | 6 | | Compensation Commission, and any other entity having | 7 | | information relevant to
this audit cooperate fully and promptly | 8 | | with the Auditor General's Office in the conduct of this
audit; | 9 | | and be it further | 10 | | RESOLVED, That the Auditor General commence this audit as | 11 | | soon as possible and report his
findings and recommendations | 12 | | upon completion in accordance with the provisions of Section 3-
| 13 | | 14 of the Illinois State Auditing Act; and be it further
| 14 | | RESOLVED, That copies of this resolution be presented to | 15 | | the Auditor General, the Director of Central Management | 16 | | Services, the Attorney General, and the Commissioners of the | 17 | | Illinois Workers' Compensation Commission.
|
|