100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB1309

 

Introduced 2/9/2017, by Sen. Michael Connelly

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: accidental injuries that shall not be considered to be "arising out of and in the course of the employment"; the maximum compensation rate for a period of temporary total incapacity; wage differential benefits to professional athletes; limitations on the number of chiropractic, occupational therapy, or physical therapy visits an injured worker may receive for injuries; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; additional compensation awards where there has been a vexatious delay of authorization of medical treatment; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately.


LRB100 08805 JLS 21036 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1309LRB100 08805 JLS 21036 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 1. The Freedom of Information Act is amended by
5changing Section 7.5 as follows:
 
6    (5 ILCS 140/7.5)
7    Sec. 7.5. Statutory exemptions. To the extent provided for
8by the statutes referenced below, the following shall be exempt
9from inspection and copying:
10        (a) All information determined to be confidential
11    under Section 4002 of the Technology Advancement and
12    Development Act.
13        (b) Library circulation and order records identifying
14    library users with specific materials under the Library
15    Records Confidentiality Act.
16        (c) Applications, related documents, and medical
17    records received by the Experimental Organ Transplantation
18    Procedures Board and any and all documents or other records
19    prepared by the Experimental Organ Transplantation
20    Procedures Board or its staff relating to applications it
21    has received.
22        (d) Information and records held by the Department of
23    Public Health and its authorized representatives relating

 

 

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1    to known or suspected cases of sexually transmissible
2    disease or any information the disclosure of which is
3    restricted under the Illinois Sexually Transmissible
4    Disease Control Act.
5        (e) Information the disclosure of which is exempted
6    under Section 30 of the Radon Industry Licensing Act.
7        (f) Firm performance evaluations under Section 55 of
8    the Architectural, Engineering, and Land Surveying
9    Qualifications Based Selection Act.
10        (g) Information the disclosure of which is restricted
11    and exempted under Section 50 of the Illinois Prepaid
12    Tuition Act.
13        (h) Information the disclosure of which is exempted
14    under the State Officials and Employees Ethics Act, and
15    records of any lawfully created State or local inspector
16    general's office that would be exempt if created or
17    obtained by an Executive Inspector General's office under
18    that Act.
19        (i) Information contained in a local emergency energy
20    plan submitted to a municipality in accordance with a local
21    emergency energy plan ordinance that is adopted under
22    Section 11-21.5-5 of the Illinois Municipal Code.
23        (j) Information and data concerning the distribution
24    of surcharge moneys collected and remitted by wireless
25    carriers under the Wireless Emergency Telephone Safety
26    Act.

 

 

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1        (k) Law enforcement officer identification information
2    or driver identification information compiled by a law
3    enforcement agency or the Department of Transportation
4    under Section 11-212 of the Illinois Vehicle Code.
5        (l) Records and information provided to a residential
6    health care facility resident sexual assault and death
7    review team or the Executive Council under the Abuse
8    Prevention Review Team Act.
9        (m) Information provided to the predatory lending
10    database created pursuant to Article 3 of the Residential
11    Real Property Disclosure Act, except to the extent
12    authorized under that Article.
13        (n) Defense budgets and petitions for certification of
14    compensation and expenses for court appointed trial
15    counsel as provided under Sections 10 and 15 of the Capital
16    Crimes Litigation Act. This subsection (n) shall apply
17    until the conclusion of the trial of the case, even if the
18    prosecution chooses not to pursue the death penalty prior
19    to trial or sentencing.
20        (o) Information that is prohibited from being
21    disclosed under Section 4 of the Illinois Health and
22    Hazardous Substances Registry Act.
23        (p) Security portions of system safety program plans,
24    investigation reports, surveys, schedules, lists, data, or
25    information compiled, collected, or prepared by or for the
26    Regional Transportation Authority under Section 2.11 of

 

 

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1    the Regional Transportation Authority Act or the St. Clair
2    County Transit District under the Bi-State Transit Safety
3    Act.
4        (q) Information prohibited from being disclosed by the
5    Personnel Records Review Act.
6        (r) Information prohibited from being disclosed by the
7    Illinois School Student Records Act.
8        (s) Information the disclosure of which is restricted
9    under Section 5-108 of the Public Utilities Act.
10        (t) All identified or deidentified health information
11    in the form of health data or medical records contained in,
12    stored in, submitted to, transferred by, or released from
13    the Illinois Health Information Exchange, and identified
14    or deidentified health information in the form of health
15    data and medical records of the Illinois Health Information
16    Exchange in the possession of the Illinois Health
17    Information Exchange Authority due to its administration
18    of the Illinois Health Information Exchange. The terms
19    "identified" and "deidentified" shall be given the same
20    meaning as in the Health Insurance Portability and
21    Accountability Act of 1996, Public Law 104-191, or any
22    subsequent amendments thereto, and any regulations
23    promulgated thereunder.
24        (u) Records and information provided to an independent
25    team of experts under Brian's Law.
26        (v) Names and information of people who have applied

 

 

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1    for or received Firearm Owner's Identification Cards under
2    the Firearm Owners Identification Card Act or applied for
3    or received a concealed carry license under the Firearm
4    Concealed Carry Act, unless otherwise authorized by the
5    Firearm Concealed Carry Act; and databases under the
6    Firearm Concealed Carry Act, records of the Concealed Carry
7    Licensing Review Board under the Firearm Concealed Carry
8    Act, and law enforcement agency objections under the
9    Firearm Concealed Carry Act.
10        (w) Personally identifiable information which is
11    exempted from disclosure under subsection (g) of Section
12    19.1 of the Toll Highway Act.
13        (x) Information which is exempted from disclosure
14    under Section 5-1014.3 of the Counties Code or Section
15    8-11-21 of the Illinois Municipal Code.
16        (y) Confidential information under the Adult
17    Protective Services Act and its predecessor enabling
18    statute, the Elder Abuse and Neglect Act, including
19    information about the identity and administrative finding
20    against any caregiver of a verified and substantiated
21    decision of abuse, neglect, or financial exploitation of an
22    eligible adult maintained in the Registry established
23    under Section 7.5 of the Adult Protective Services Act.
24        (z) Records and information provided to a fatality
25    review team or the Illinois Fatality Review Team Advisory
26    Council under Section 15 of the Adult Protective Services

 

 

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1    Act.
2        (aa) Information which is exempted from disclosure
3    under Section 2.37 of the Wildlife Code.
4        (bb) Information which is or was prohibited from
5    disclosure by the Juvenile Court Act of 1987.
6        (cc) Recordings made under the Law Enforcement
7    Officer-Worn Body Camera Act, except to the extent
8    authorized under that Act.
9        (dd) Information that is prohibited from being
10    disclosed under Section 45 of the Condominium and Common
11    Interest Community Ombudsperson Act.
12        (ee) (dd) Information that is exempted from disclosure
13    under Section 30.1 of the Pharmacy Practice Act.
14        (ff) Information the disclosure of which is restricted
15    and exempted under Sections 25.5 and 29.2 of the Workers'
16    Compensation Act.
17(Source: P.A. 98-49, eff. 7-1-13; 98-63, eff. 7-9-13; 98-756,
18eff. 7-16-14; 98-1039, eff. 8-25-14; 98-1045, eff. 8-25-14;
1999-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, eff. 1-1-16;
2099-642, eff. 7-28-16; 99-776, eff. 8-12-16; 99-863, eff.
218-19-16; revised 9-1-16.)
 
22    Section 3. The Criminal Code of 2012 is amended by changing
23Section 17-10.5 and by adding Section 17-10.4 as follows:
 
24    (720 ILCS 5/17-10.4 new)

 

 

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1    Sec. 17-10.4. Workers' compensation fraud.
2    (a) It is unlawful for any person, company, corporation,
3insurance carrier, health care provider, or other entity to:
4        (1) Intentionally present or cause to be presented any
5    false or fraudulent claim for the payment of any workers'
6    compensation benefit.
7        (2) Intentionally make or cause to be made any false or
8    fraudulent material statement or material representation
9    for the purpose of obtaining or denying any workers'
10    compensation benefit.
11        (3) Intentionally make or cause to be made any false or
12    fraudulent statements with regard to entitlement to
13    workers' compensation benefits with the intent to prevent
14    an injured worker from making a legitimate claim for any
15    workers' compensation benefit.
16        (4) Intentionally prepare or provide an invalid,
17    false, or counterfeit certificate of insurance as proof of
18    workers' compensation insurance.
19        (5) Intentionally make or cause to be made any false or
20    fraudulent material statement or material representation
21    for the purpose of obtaining workers' compensation
22    insurance at less than the proper amount for that
23    insurance.
24        (6) Intentionally make or cause to be made any false or
25    fraudulent material statement or material representation
26    on an initial or renewal self-insurance application or

 

 

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1    accompanying financial statement for the purpose of
2    obtaining self-insurance status or reducing the amount of
3    security that may be required to be furnished pursuant to
4    Section 4 of the Workers' Compensation Act.
5        (7) Intentionally make or cause to be made any false or
6    fraudulent material statement to the Department of
7    Insurance's fraud and insurance non-compliance unit in the
8    course of an investigation of fraud or insurance
9    non-compliance.
10        (8) Intentionally present a bill or statement for the
11    payment for medical services that were not provided.
12        (9) Intentionally assist, abet, solicit, or conspire
13    with any person, company, or other entity to commit any of
14    the acts in paragraph (1), (2), (3), (4), (5), (6), (7), or
15    (8) of this subsection (a).
16    As used in paragraphs (2), (3), (5), (6), (7), and (8),
17"statement" includes any writing, notice, proof of injury, bill
18for services, hospital or doctor records and reports, or X-ray
19and test results.
20    (b) Sentence.
21        (1) A violation of paragraph (a)(3) is a Class 4
22    felony.
23        (2) A violation of paragraph (a)(4) or (a)(7) is a
24    Class 3 felony.
25        (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
26    (a)(6), or (a)(8) in which the value of the property

 

 

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1    obtained or attempted to be obtained is $500 or less is a
2    Class A misdemeanor.
3        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
4    (a)(6), or (a)(8) in which the value of the property
5    obtained or attempted to be obtained is more than $500 but
6    not more than $10,000 is a Class 3 felony.
7        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
8    (a)(6), or (a)(8) in which the value of the property
9    obtained or attempted to be obtained is more than $10,000
10    but not more than $100,000 is a Class 2 felony.
11        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
12    (a)(6), or (a)(8) in which the value of the property
13    obtained or attempted to be obtained is more than $100,000
14    is a Class 1 felony.
15        (7) A violation of paragraph (9) of subsection (a)
16    shall be punishable as the Class of offense for which the
17    person convicted assisted, abetted, solicited, or
18    conspired to commit, as set forth in paragraphs (1) through
19    (6) of this subsection.
20        (8) A person convicted under this Section shall be
21    ordered to pay monetary restitution to the insurance
22    company or self-insured entity or any other person for any
23    financial loss sustained as a result of a violation of this
24    Section, including any court costs and attorney fees. An
25    order of restitution also includes expenses incurred and
26    paid by the State of Illinois or an insurance company or

 

 

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1    self-insured entity in connection with any medical
2    evaluation or treatment services.
3    For a violation of paragraph (a)(1) or (a)(2), the value of
4the property obtained or attempted to be obtained includes
5payments pursuant to the provisions of the Workers'
6Compensation Act as well as the amount paid for medical
7expenses. For a violation of paragraph (a)(5), the value of the
8property obtained or attempted to be obtained is the difference
9between the proper amount for the coverage sought or provided
10and the actual amount billed for workers' compensation
11insurance. For a violation of paragraph (a)(6), the value of
12the property obtained or attempted to be obtained is the
13difference between the proper amount of security required
14pursuant to Section 4 of the Workers' Compensation Act and the
15amount furnished pursuant the false or fraudulent statements or
16representations. Notwithstanding the foregoing, an insurance
17company, self-insured entity, or any other person suffering
18financial loss sustained as a result of violation of this
19Section may seek restitution, including court costs and
20attorney's fees, in a civil action in a court of competent
21jurisdiction.
 
22    (720 ILCS 5/17-10.5)
23    Sec. 17-10.5. Insurance fraud.
24    (a) Insurance fraud.
25        (1) A person commits insurance fraud when he or she

 

 

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1    knowingly obtains, attempts to obtain, or causes to be
2    obtained, by deception, control over the property of an
3    insurance company or self-insured entity by the making of a
4    false claim or by causing a false claim to be made on any
5    policy of insurance issued by an insurance company or by
6    the making of a false claim or by causing a false claim to
7    be made to a self-insured entity, intending to deprive an
8    insurance company or self-insured entity permanently of
9    the use and benefit of that property.
10        (2) A person commits health care benefits fraud against
11    a provider, other than a governmental unit or agency, when
12    he or she knowingly obtains or attempts to obtain, by
13    deception, health care benefits and that obtaining or
14    attempt to obtain health care benefits does not involve
15    control over property of the provider.
16    (b) Aggravated insurance fraud.
17        (1) A person commits aggravated insurance fraud on a
18    private entity when he or she commits insurance fraud 3 or
19    more times within an 18-month period arising out of
20    separate incidents or transactions.
21        (2) A person commits being an organizer of an
22    aggravated insurance fraud on a private entity conspiracy
23    if aggravated insurance fraud on a private entity forms the
24    basis for a charge of conspiracy under Section 8-2 of this
25    Code and the person occupies a position of organizer,
26    supervisor, financer, or other position of management

 

 

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1    within the conspiracy.
2    (c) Conspiracy to commit insurance fraud. If aggravated
3insurance fraud on a private entity forms the basis for charges
4of conspiracy under Section 8-2 of this Code, the person or
5persons with whom the accused is alleged to have agreed to
6commit the 3 or more violations of this Section need not be the
7same person or persons for each violation, as long as the
8accused was a part of the common scheme or plan to engage in
9each of the 3 or more alleged violations.
10    If aggravated insurance fraud on a private entity forms the
11basis for a charge of conspiracy under Section 8-2 of this
12Code, and the accused occupies a position of organizer,
13supervisor, financer, or other position of management within
14the conspiracy, the person or persons with whom the accused is
15alleged to have agreed to commit the 3 or more violations of
16this Section need not be the same person or persons for each
17violation as long as the accused occupied a position of
18organizer, supervisor, financer, or other position of
19management in each of the 3 or more alleged violations.
20    (d) Sentence.
21        (1) A violation of paragraph (a)(1) in which the value
22    of the property obtained, attempted to be obtained, or
23    caused to be obtained is $500 $300 or less is a Class A
24    misdemeanor.
25        (2) A violation of paragraph (a)(1) in which the value
26    of the property obtained, attempted to be obtained, or

 

 

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1    caused to be obtained is more than $500 $300 but not more
2    than $10,000 is a Class 3 felony.
3        (3) A violation of paragraph (a)(1) in which the value
4    of the property obtained, attempted to be obtained, or
5    caused to be obtained is more than $10,000 but not more
6    than $100,000 is a Class 2 felony.
7        (4) A violation of paragraph (a)(1) in which the value
8    of the property obtained, attempted to be obtained, or
9    caused to be obtained is more than $100,000 is a Class 1
10    felony.
11        (5) A violation of paragraph (a)(2) is a Class A
12    misdemeanor.
13        (6) A violation of paragraph (b)(1) is a Class 1
14    felony, regardless of the value of the property obtained,
15    attempted to be obtained, or caused to be obtained.
16        (7) A violation of paragraph (b)(2) is a Class X
17    felony.
18        (8) A person convicted of insurance fraud, vendor
19    fraud, or a federal criminal violation associated with
20    defrauding the Medicaid program shall be ordered to pay
21    monetary restitution to the insurance company or
22    self-insured entity or any other person for any financial
23    loss sustained as a result of a violation of this Section,
24    including any court costs and attorney's fees. An order of
25    restitution shall include expenses incurred and paid by the
26    State of Illinois or an insurance company or self-insured

 

 

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1    entity in connection with any medical evaluation or
2    treatment services.
3        (9) Notwithstanding Section 8-5 of this Code, a person
4    may be convicted and sentenced both for the offense of
5    conspiracy to commit insurance fraud or the offense of
6    being an organizer of an aggravated insurance fraud
7    conspiracy and for any other offense that is the object of
8    the conspiracy.
9    (e) Civil damages for insurance fraud.
10        (1) A person who knowingly obtains, attempts to obtain,
11    or causes to be obtained, by deception, control over the
12    property of any insurance company by the making of a false
13    claim or by causing a false claim to be made on a policy of
14    insurance issued by an insurance company, or by the making
15    of a false claim or by causing a false claim to be made to a
16    self-insured entity, intending to deprive an insurance
17    company or self-insured entity permanently of the use and
18    benefit of that property, shall be civilly liable to the
19    insurance company or self-insured entity that paid the
20    claim or against whom the claim was made or to the subrogee
21    of that insurance company or self-insured entity in an
22    amount equal to either 3 times the value of the property
23    wrongfully obtained or, if no property was wrongfully
24    obtained, twice the value of the property attempted to be
25    obtained, whichever amount is greater, plus reasonable
26    attorney's fees.

 

 

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1        (2) An insurance company or self-insured entity that
2    brings an action against a person under paragraph (1) of
3    this subsection in bad faith shall be liable to that person
4    for twice the value of the property claimed, plus
5    reasonable attorney's fees. In determining whether an
6    insurance company or self-insured entity acted in bad
7    faith, the court shall relax the rules of evidence to allow
8    for the introduction of any facts or other information on
9    which the insurance company or self-insured entity may have
10    relied in bringing an action under paragraph (1) of this
11    subsection.
12    (f) Determination of property value. For the purposes of
13this Section, if the exact value of the property attempted to
14be obtained is either not alleged by the claimant or not
15specifically set by the terms of a policy of insurance, the
16value of the property shall be the fair market replacement
17value of the property claimed to be lost, the reasonable costs
18of reimbursing a vendor or other claimant for services to be
19rendered, or both.
20    (g) Actions by State licensing agencies.
21        (1) All State licensing agencies, the Illinois State
22    Police, and the Department of Financial and Professional
23    Regulation shall coordinate enforcement efforts relating
24    to acts of insurance fraud.
25        (2) If a person who is licensed or registered under the
26    laws of the State of Illinois to engage in a business or

 

 

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1    profession is convicted of or pleads guilty to engaging in
2    an act of insurance fraud, the Illinois State Police must
3    forward to each State agency by which the person is
4    licensed or registered a copy of the conviction or plea and
5    all supporting evidence.
6        (3) Any agency that receives information under this
7    Section shall, not later than 6 months after the date on
8    which it receives the information, publicly report the
9    final action taken against the convicted person, including
10    but not limited to the revocation or suspension of the
11    license or any other disciplinary action taken.
12    (h) Definitions. For the purposes of this Section,
13"obtain", "obtains control", "deception", "property", and
14"permanent deprivation" have the meanings ascribed to those
15terms in Article 15 of this Code.
16(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
 
17    Section 5. The Workers' Compensation Act is amended by
18changing Sections 1, 4, 8, 8.1b, 8.2, 8.2a, 8.7, 14, 19, 25.5,
19and 29.2 as follows:
 
20    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
21    Sec. 1. This Act may be cited as the Workers' Compensation
22Act.
23    (a) The term "employer" as used in this Act means:
24    1. The State and each county, city, town, township,

 

 

SB1309- 17 -LRB100 08805 JLS 21036 b

1incorporated village, school district, body politic, or
2municipal corporation therein.
3    2. Every person, firm, public or private corporation,
4including hospitals, public service, eleemosynary, religious
5or charitable corporations or associations who has any person
6in service or under any contract for hire, express or implied,
7oral or written, and who is engaged in any of the enterprises
8or businesses enumerated in Section 3 of this Act, or who at or
9prior to the time of the accident to the employee for which
10compensation under this Act may be claimed, has in the manner
11provided in this Act elected to become subject to the
12provisions of this Act, and who has not, prior to such
13accident, effected a withdrawal of such election in the manner
14provided in this Act.
15    3. Any one engaging in any business or enterprise referred
16to in subsections 1 and 2 of Section 3 of this Act who
17undertakes to do any work enumerated therein, is liable to pay
18compensation to his own immediate employees in accordance with
19the provisions of this Act, and in addition thereto if he
20directly or indirectly engages any contractor whether
21principal or sub-contractor to do any such work, he is liable
22to pay compensation to the employees of any such contractor or
23sub-contractor unless such contractor or sub-contractor has
24insured, in any company or association authorized under the
25laws of this State to insure the liability to pay compensation
26under this Act, or guaranteed his liability to pay such

 

 

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1compensation. With respect to any time limitation on the filing
2of claims provided by this Act, the timely filing of a claim
3against a contractor or subcontractor, as the case may be,
4shall be deemed to be a timely filing with respect to all
5persons upon whom liability is imposed by this paragraph.
6    In the event any such person pays compensation under this
7subsection he may recover the amount thereof from the
8contractor or sub-contractor, if any, and in the event the
9contractor pays compensation under this subsection he may
10recover the amount thereof from the sub-contractor, if any.
11    This subsection does not apply in any case where the
12accident occurs elsewhere than on, in or about the immediate
13premises on which the principal has contracted that the work be
14done.
15    4. Where an employer operating under and subject to the
16provisions of this Act loans an employee to another such
17employer and such loaned employee sustains a compensable
18accidental injury in the employment of such borrowing employer
19and where such borrowing employer does not provide or pay the
20benefits or payments due such injured employee, such loaning
21employer is liable to provide or pay all benefits or payments
22due such employee under this Act and as to such employee the
23liability of such loaning and borrowing employers is joint and
24several, provided that such loaning employer is in the absence
25of agreement to the contrary entitled to receive from such
26borrowing employer full reimbursement for all sums paid or

 

 

SB1309- 19 -LRB100 08805 JLS 21036 b

1incurred pursuant to this paragraph together with reasonable
2attorneys' fees and expenses in any hearings before the
3Illinois Workers' Compensation Commission or in any action to
4secure such reimbursement. Where any benefit is provided or
5paid by such loaning employer the employee has the duty of
6rendering reasonable cooperation in any hearings, trials or
7proceedings in the case, including such proceedings for
8reimbursement.
9    Where an employee files an Application for Adjustment of
10Claim with the Illinois Workers' Compensation Commission
11alleging that his claim is covered by the provisions of the
12preceding paragraph, and joining both the alleged loaning and
13borrowing employers, they and each of them, upon written demand
14by the employee and within 7 days after receipt of such demand,
15shall have the duty of filing with the Illinois Workers'
16Compensation Commission a written admission or denial of the
17allegation that the claim is covered by the provisions of the
18preceding paragraph and in default of such filing or if any
19such denial be ultimately determined not to have been bona fide
20then the provisions of Paragraph K of Section 19 of this Act
21shall apply.
22    An employer whose business or enterprise or a substantial
23part thereof consists of hiring, procuring or furnishing
24employees to or for other employers operating under and subject
25to the provisions of this Act for the performance of the work
26of such other employers and who pays such employees their

 

 

SB1309- 20 -LRB100 08805 JLS 21036 b

1salary or wages notwithstanding that they are doing the work of
2such other employers shall be deemed a loaning employer within
3the meaning and provisions of this Section.
4    (b) The term "employee" as used in this Act means:
5    1. Every person in the service of the State, including
6members of the General Assembly, members of the Commerce
7Commission, members of the Illinois Workers' Compensation
8Commission, and all persons in the service of the University of
9Illinois, county, including deputy sheriffs and assistant
10state's attorneys, city, town, township, incorporated village
11or school district, body politic, or municipal corporation
12therein, whether by election, under appointment or contract of
13hire, express or implied, oral or written, including all
14members of the Illinois National Guard while on active duty in
15the service of the State, and all probation personnel of the
16Juvenile Court appointed pursuant to Article VI of the Juvenile
17Court Act of 1987, and including any official of the State, any
18county, city, town, township, incorporated village, school
19district, body politic or municipal corporation therein except
20any duly appointed member of a police department in any city
21whose population exceeds 500,000 according to the last Federal
22or State census, and except any member of a fire insurance
23patrol maintained by a board of underwriters in this State. A
24duly appointed member of a fire department in any city, the
25population of which exceeds 500,000 according to the last
26federal or State census, is an employee under this Act only

 

 

SB1309- 21 -LRB100 08805 JLS 21036 b

1with respect to claims brought under paragraph (c) of Section
28.
3    One employed by a contractor who has contracted with the
4State, or a county, city, town, township, incorporated village,
5school district, body politic or municipal corporation
6therein, through its representatives, is not considered as an
7employee of the State, county, city, town, township,
8incorporated village, school district, body politic or
9municipal corporation which made the contract.
10    2. Every person in the service of another under any
11contract of hire, express or implied, oral or written,
12including persons whose employment is outside of the State of
13Illinois where the contract of hire is made within the State of
14Illinois, persons whose employment results in fatal or
15non-fatal injuries within the State of Illinois where the
16contract of hire is made outside of the State of Illinois, and
17persons whose employment is principally localized within the
18State of Illinois, regardless of the place of the accident or
19the place where the contract of hire was made, and including
20aliens, and minors who, for the purpose of this Act are
21considered the same and have the same power to contract,
22receive payments and give quittances therefor, as adult
23employees.
24    3. Every sole proprietor and every partner of a business
25may elect to be covered by this Act.
26    An employee or his dependents under this Act who shall have

 

 

SB1309- 22 -LRB100 08805 JLS 21036 b

1a cause of action by reason of any injury, disablement or death
2arising out of and in the course of his employment may elect to
3pursue his remedy in the State where injured or disabled, or in
4the State where the contract of hire is made, or in the State
5where the employment is principally localized.
6    However, any employer may elect to provide and pay
7compensation to any employee other than those engaged in the
8usual course of the trade, business, profession or occupation
9of the employer by complying with Sections 2 and 4 of this Act.
10Employees are not included within the provisions of this Act
11when excluded by the laws of the United States relating to
12liability of employers to their employees for personal injuries
13where such laws are held to be exclusive.
14    The term "employee" does not include persons performing
15services as real estate broker, broker-salesman, or salesman
16when such persons are paid by commission only.
17    (c) "Commission" means the Industrial Commission created
18by Section 5 of "The Civil Administrative Code of Illinois",
19approved March 7, 1917, as amended, or the Illinois Workers'
20Compensation Commission created by Section 13 of this Act.
21    (d) To obtain compensation under this Act, an employee
22bears the burden of showing, by a preponderance of the
23evidence, that he or she has sustained accidental injuries
24arising out of and in the course of the employment.
25        (1) An accidental injury shall not be considered to be
26    "arising out of and in the course of employment" if,

 

 

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1    without limitation, the accidental injury or the medical
2    condition for which compensation is sought:
3            (A) resulted from a hazard or risk that was not
4        incidental to the employment or did not occur at a time
5        and place and under circumstances reasonably required
6        by the employment;
7            (B) resulted from a personal or neutral risk
8        (including, in the case of an employee who is required
9        to travel for performance of job duties, a personal or
10        neutral risk associated with travel);
11            (C) occurred (i) while the claimant was traveling
12        away from the employer's premises and the travel was
13        not required for the performance of job duties or (ii)
14        during the claimant's commute to and from the
15        employer's premises; or
16            (D) occurred while the claimant (including a
17        claimant who is required to travel for performance of
18        job duties) (i) is on a paid or unpaid break and is not
19        performing any specific tasks for the employer during
20        the break or (ii) is on a personal detour or deviation,
21        regardless of whether or not the claimant is otherwise
22        traveling for employment purposes.
23        (2) A hazard or risk is not incidental to the
24    employment if it is a risk of everyday living commonly
25    faced by members of the general public, or is associated
26    with an activity of everyday life, regardless of whether

 

 

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1    the employee was performing an activity required by the
2    employment at the time of the injury or an activity
3    connected with what the employee has to do in fulfilling
4    his duties. A risk commonly faced by members of the general
5    public or associated with an activity of everyday life is a
6    neutral risk.
7        (3) In determining whether an employee is required to
8    travel for the performance of job duties, the following
9    factors shall be considered: whether the employer had
10    knowledge that the employee may be required to travel to
11    perform the job; whether the employer furnished any mode of
12    transportation to or from the employee; whether the
13    employee received, or the employer paid or agreed to pay,
14    any remuneration or reimbursement for costs or expenses of
15    any form of travel; whether the employer in any way
16    directed the course or method of travel; whether the
17    employer in any way assisted the employee in making any
18    travel arrangements; whether the employer furnished
19    lodging or in any way reimbursed the employee for lodging;
20    and whether the employer received any benefit from the
21    employee traveling.
22        (4) Notwithstanding any provision of the Act to the
23    contrary, if an employee, who sustained an accidental
24    injury compensable under this Act which results in a
25    responsibility to pay compensation on the part of the
26    employer, subsequently sustains another injury due to his

 

 

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1    own intentional conduct or negligence that accelerates,
2    aggravates or worsens the effects or disability of the
3    first injury in any manner, regardless of whether or not he
4    has fully recovered from the effects of the first injury,
5    the employer's responsibility to pay compensation to the
6    employee or his or her dependents shall not be increased
7    due to the effects or disability resulting from the
8    subsequent injury.
9        (5) An injury, its occupational cause, and any
10    resulting manifestations or disability must be established
11    a reasonable degree of medical certainty, based on
12    objective relevant medical findings.
13(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
14eff. 7-13-12.)
 
15    (820 ILCS 305/4)  (from Ch. 48, par. 138.4)
16    Sec. 4. (a) Any employer, including but not limited to
17general contractors and their subcontractors, who shall come
18within the provisions of Section 3 of this Act, and any other
19employer who shall elect to provide and pay the compensation
20provided for in this Act shall:
21        (1) File with the Commission annually an application
22    for approval as a self-insurer which shall include a
23    current financial statement, and annually, thereafter, an
24    application for renewal of self-insurance, which shall
25    include a current financial statement. Said application

 

 

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1    and financial statement shall be signed and sworn to by the
2    president or vice president and secretary or assistant
3    secretary of the employer if it be a corporation, or by all
4    of the partners, if it be a copartnership, or by the owner
5    if it be neither a copartnership nor a corporation. All
6    initial applications and all applications for renewal of
7    self-insurance must be submitted at least 60 days prior to
8    the requested effective date of self-insurance. An
9    employer may elect to provide and pay compensation as
10    provided for in this Act as a member of a group workers'
11    compensation pool under Article V 3/4 of the Illinois
12    Insurance Code. If an employer becomes a member of a group
13    workers' compensation pool, the employer shall not be
14    relieved of any obligations imposed by this Act.
15        If the sworn application and financial statement of any
16    such employer does not satisfy the Commission of the
17    financial ability of the employer who has filed it, the
18    Commission shall require such employer to,
19        (2) Furnish security, indemnity or a bond guaranteeing
20    the payment by the employer of the compensation provided
21    for in this Act, provided that any such employer whose
22    application and financial statement shall not have
23    satisfied the commission of his or her financial ability
24    and who shall have secured his liability in part by excess
25    workers' compensation liability insurance shall be
26    required to furnish to the Commission security, indemnity

 

 

SB1309- 27 -LRB100 08805 JLS 21036 b

1    or bond guaranteeing his or her payment up to the effective
2    limits of the excess coverage, or
3        (3) Insure his entire liability to pay such
4    compensation in some workers' compensation insurance
5    carrier authorized, licensed, or permitted to do such
6    insurance business in this State. Every policy of a
7    workers' compensation an insurance carrier, insuring the
8    payment of compensation under this Act shall cover all the
9    employees and the entire compensation liability of the
10    insured: Provided, however, that any employer may insure
11    his or her compensation liability with 2 or more workers'
12    compensation insurance carriers or may insure a part and
13    qualify under subsection 1, 2, or 4 for the remainder of
14    his or her liability to pay such compensation, subject to
15    the following two provisions:
16            Firstly, the entire compensation liability of the
17        employer to employees working at or from one location
18        shall be insured in one such workers' compensation
19        insurance carrier or shall be self-insured, and
20            Secondly, the employer shall submit evidence
21        satisfactorily to the Commission that his or her entire
22        liability for the compensation provided for in this Act
23        will be secured. Any provisions in any policy, or in
24        any endorsement attached thereto, attempting to limit
25        or modify in any way, the liability of the workers'
26        compensation insurance carriers issuing the same

 

 

SB1309- 28 -LRB100 08805 JLS 21036 b

1        except as otherwise provided herein shall be wholly
2        void.
3        Nothing herein contained shall apply to policies of
4    excess liability carriage secured by employers who have
5    been approved by the Commission as self-insurers, or
6        (4) Make some other provision, satisfactory to the
7    Commission, for the securing of the payment of compensation
8    provided for in this Act, and
9        (5) Upon becoming subject to this Act and thereafter as
10    often as the Commission may in writing demand, file with
11    the Commission in form prescribed by it evidence of his or
12    her compliance with the provision of this Section.
13    (a-1) Regardless of its state of domicile or its principal
14place of business, an employer shall make payments to its
15workers' compensation insurance carrier or group
16self-insurance fund, where applicable, based upon the premium
17rates of the situs where the work or project is located in
18Illinois if:
19        (A) the employer is engaged primarily in the building
20    and construction industry; and
21        (B) subdivision (a)(3) of this Section applies to the
22    employer or the employer is a member of a group
23    self-insurance plan as defined in subsection (1) of Section
24    4a.
25    The Illinois Workers' Compensation Commission shall impose
26a penalty upon an employer for violation of this subsection

 

 

SB1309- 29 -LRB100 08805 JLS 21036 b

1(a-1) if:
2        (i) the employer is given an opportunity at a hearing
3    to present evidence of its compliance with this subsection
4    (a-1); and
5        (ii) after the hearing, the Commission finds that the
6    employer failed to make payments upon the premium rates of
7    the situs where the work or project is located in Illinois.
8    The penalty shall not exceed $1,000 for each day of work
9for which the employer failed to make payments upon the premium
10rates of the situs where the work or project is located in
11Illinois, but the total penalty shall not exceed $50,000 for
12each project or each contract under which the work was
13performed.
14    Any penalty under this subsection (a-1) must be imposed not
15later than one year after the expiration of the applicable
16limitation period specified in subsection (d) of Section 6 of
17this Act. Penalties imposed under this subsection (a-1) shall
18be deposited into the Illinois Workers' Compensation
19Commission Operations Fund, a special fund that is created in
20the State treasury. Subject to appropriation, moneys in the
21Fund shall be used solely for the operations of the Illinois
22Workers' Compensation Commission and by the Department of
23Insurance for the purposes authorized in subsection (c) of
24Section 25.5 of this Act.
25    (a-2) Every Employee Leasing Company (ELC), as defined in
26Section 15 of the Employee Leasing Company Act, shall at a

 

 

SB1309- 30 -LRB100 08805 JLS 21036 b

1minimum provide the following information to the Commission or
2any entity designated by the Commission regarding each workers'
3compensation insurance policy issued to the ELC:
4        (1) Any client company of the ELC listed as an
5    additional named insured.
6        (2) Any informational schedule attached to the master
7    policy that identifies any individual client company's
8    name, FEIN, and job location.
9        (3) Any certificate of workers' compensation insurance
10    coverage document issued to a client company specifying its
11    rights and obligations under the master policy that
12    establishes both the identity and status of the client, as
13    well as the dates of inception and termination of coverage,
14    if applicable.
15    (b) The sworn application and financial statement, or
16security, indemnity or bond, or amount of insurance, or other
17provisions, filed, furnished, carried, or made by the employer,
18as the case may be, shall be subject to the approval of the
19Commission.
20    Deposits under escrow agreements shall be cash, negotiable
21United States government bonds or negotiable general
22obligation bonds of the State of Illinois. Such cash or bonds
23shall be deposited in escrow with any State or National Bank or
24Trust Company having trust authority in the State of Illinois.
25    Upon the approval of the sworn application and financial
26statement, security, indemnity or bond or amount of insurance,

 

 

SB1309- 31 -LRB100 08805 JLS 21036 b

1filed, furnished or carried, as the case may be, the Commission
2shall send to the employer written notice of its approval
3thereof. The certificate of compliance by the employer with the
4provisions of subparagraphs (2) and (3) of paragraph (a) of
5this Section shall be delivered by the workers' compensation
6insurance carrier to the Illinois Workers' Compensation
7Commission within five days after the effective date of the
8policy so certified. The workers' compensation insurance so
9certified shall cover all compensation liability occurring
10during the time that the insurance is in effect and no further
11certificate need be filed in case such insurance is renewed,
12extended or otherwise continued by such carrier. The insurance
13so certified shall not be cancelled or in the event that such
14insurance is not renewed, extended or otherwise continued, such
15insurance shall not be terminated until at least 10 days after
16receipt by the Illinois Workers' Compensation Commission of
17notice of the cancellation or termination of said insurance;
18provided, however, that if the employer has secured insurance
19from another workers' compensation insurance carrier, or has
20otherwise secured the payment of compensation in accordance
21with this Section, and such insurance or other security becomes
22effective prior to the expiration of the 10 days, cancellation
23or termination may, at the option of the insurance carrier
24indicated in such notice, be effective as of the effective date
25of such other insurance or security.
26    (c) Whenever the Commission shall find that any

 

 

SB1309- 32 -LRB100 08805 JLS 21036 b

1corporation, company, association, aggregation of individuals,
2reciprocal or interinsurers exchange, or other insurer
3effecting workers' compensation insurance in this State shall
4be insolvent, financially unsound, or unable to fully meet all
5payments and liabilities assumed or to be assumed for workers'
6compensation insurance in this State, or shall practice a
7policy of delay or unfairness toward employees in the
8adjustment, settlement, or payment of benefits due such
9employees, the Commission may after reasonable notice and
10hearing order and direct that such corporation, company,
11association, aggregation of individuals, reciprocal or
12interinsurers exchange, or insurer, shall from and after a date
13fixed in such order discontinue the writing of any such
14workers' compensation insurance in this State. Subject to such
15modification of the order as the Commission may later make on
16review of the order, as herein provided, it shall thereupon be
17unlawful for any such corporation, company, association,
18aggregation of individuals, reciprocal or interinsurers
19exchange, or insurer to effect any workers' compensation
20insurance in this State. A copy of the order shall be served
21upon the Director of Insurance by registered mail. Whenever the
22Commission finds that any service or adjustment company used or
23employed by a self-insured employer or by an insurance carrier
24to process, adjust, investigate, compromise or otherwise
25handle claims under this Act, has practiced or is practicing a
26policy of delay or unfairness toward employees in the

 

 

SB1309- 33 -LRB100 08805 JLS 21036 b

1adjustment, settlement or payment of benefits due such
2employees, the Commission may after reasonable notice and
3hearing order and direct that such service or adjustment
4company shall from and after a date fixed in such order be
5prohibited from processing, adjusting, investigating,
6compromising or otherwise handling claims under this Act.
7    Whenever the Commission finds that any self-insured
8employer has practiced or is practicing delay or unfairness
9toward employees in the adjustment, settlement or payment of
10benefits due such employees, the Commission may, after
11reasonable notice and hearing, order and direct that after a
12date fixed in the order such self-insured employer shall be
13disqualified to operate as a self-insurer and shall be required
14to insure his entire liability to pay compensation in some
15workers' compensation insurance carrier authorized, licensed
16and permitted to do such insurance business in this State, as
17provided in subparagraph 3 of paragraph (a) of this Section.
18    All orders made by the Commission under this Section shall
19be subject to review by the courts, said review to be taken in
20the same manner and within the same time as provided by Section
2119 of this Act for review of awards and decisions of the
22Commission, upon the party seeking the review filing with the
23clerk of the court to which said review is taken a bond in an
24amount to be fixed and approved by the court to which the
25review is taken, conditioned upon the payment of all
26compensation awarded against the person taking said review

 

 

SB1309- 34 -LRB100 08805 JLS 21036 b

1pending a decision thereof and further conditioned upon such
2other obligations as the court may impose. Upon the review the
3Circuit Court shall have power to review all questions of fact
4as well as of law. The penalty hereinafter provided for in this
5paragraph shall not attach and shall not begin to run until the
6final determination of the order of the Commission.
7    (d) Whenever a panel of 3 Commissioners comprised of one
8member of the employing class, one member of the employee
9class, and one member not identified with either the employing
10or employee class, with due process and after a hearing,
11determines an employer has knowingly failed to provide coverage
12as required by paragraph (a) of this Section, the failure shall
13be deemed an immediate serious danger to public health, safety,
14and welfare sufficient to justify service by the Commission of
15a work-stop order on such employer, requiring the cessation of
16all business operations of such employer at the place of
17employment or job site. Any law enforcement agency in the State
18shall, at the request of the Commission, render any assistance
19necessary to carry out the provisions of this Section,
20including, but not limited to, preventing any employee of such
21employer from remaining at a place of employment or job site
22after a work-stop order has taken effect. Any work-stop order
23shall be lifted upon proof of workers' compensation insurance
24as required by this Act. Any orders under this Section are
25appealable under Section 19(f) to the Circuit Court.
26    Any individual employer, corporate officer or director of a

 

 

SB1309- 35 -LRB100 08805 JLS 21036 b

1corporate employer, partner of an employer partnership, or
2member of an employer limited liability company who knowingly
3fails to provide coverage as required by paragraph (a) of this
4Section is guilty of a Class 4 felony. This provision shall not
5apply to any corporate officer or director of any
6publicly-owned corporation. Each day's violation constitutes a
7separate offense. The State's Attorney of the county in which
8the violation occurred, or the Attorney General, shall bring
9such actions in the name of the People of the State of
10Illinois, or may, in addition to other remedies provided in
11this Section, bring an action for an injunction to restrain the
12violation or to enjoin the operation of any such employer.
13    Any individual employer, corporate officer or director of a
14corporate employer, partner of an employer partnership, or
15member of an employer limited liability company who negligently
16fails to provide coverage as required by paragraph (a) of this
17Section is guilty of a Class A misdemeanor. This provision
18shall not apply to any corporate officer or director of any
19publicly-owned corporation. Each day's violation constitutes a
20separate offense. The State's Attorney of the county in which
21the violation occurred, or the Attorney General, shall bring
22such actions in the name of the People of the State of
23Illinois.
24    The criminal penalties in this subsection (d) shall not
25apply where there exists a good faith dispute as to the
26existence of an employment relationship. Evidence of good faith

 

 

SB1309- 36 -LRB100 08805 JLS 21036 b

1shall include, but not be limited to, compliance with the
2definition of employee as used by the Internal Revenue Service.
3    Employers who are subject to and who knowingly fail to
4comply with this Section shall not be entitled to the benefits
5of this Act during the period of noncompliance, but shall be
6liable in an action under any other applicable law of this
7State. In the action, such employer shall not avail himself or
8herself of the defenses of assumption of risk or negligence or
9that the injury was due to a co-employee. In the action, proof
10of the injury shall constitute prima facie evidence of
11negligence on the part of such employer and the burden shall be
12on such employer to show freedom of negligence resulting in the
13injury. The employer shall not join any other defendant in any
14such civil action. Nothing in this amendatory Act of the 94th
15General Assembly shall affect the employee's rights under
16subdivision (a)3 of Section 1 of this Act. Any employer or
17carrier who makes payments under subdivision (a)3 of Section 1
18of this Act shall have a right of reimbursement from the
19proceeds of any recovery under this Section.
20    An employee of an uninsured employer, or the employee's
21dependents in case death ensued, may, instead of proceeding
22against the employer in a civil action in court, file an
23application for adjustment of claim with the Commission in
24accordance with the provisions of this Act and the Commission
25shall hear and determine the application for adjustment of
26claim in the manner in which other claims are heard and

 

 

SB1309- 37 -LRB100 08805 JLS 21036 b

1determined before the Commission.
2    All proceedings under this subsection (d) shall be reported
3on an annual basis to the Workers' Compensation Advisory Board.
4    An investigator with the Illinois Workers' Compensation
5Commission Insurance Compliance Division may issue a citation
6to any employer that is not in compliance with its obligation
7to have workers' compensation insurance under this Act. The
8amount of the fine shall be based on the period of time the
9employer was in non-compliance, but shall be no less than $500,
10and shall not exceed $2,500. An employer that has been issued a
11citation shall pay the fine to the Commission and provide to
12the Commission proof that it obtained the required workers'
13compensation insurance within 10 days after the citation was
14issued. This Section does not affect any other obligations this
15Act imposes on employers.
16    Upon a finding by the Commission, after reasonable notice
17and hearing, of the knowing and wilful failure or refusal of an
18employer to comply with any of the provisions of paragraph (a)
19of this Section, the failure or refusal of an employer, service
20or adjustment company, or an insurance carrier to comply with
21any order of the Illinois Workers' Compensation Commission
22pursuant to paragraph (c) of this Section disqualifying him or
23her to operate as a self insurer and requiring him or her to
24insure his or her liability, or the knowing and willful failure
25of an employer to comply with a citation issued by an
26investigator with the Illinois Workers' Compensation

 

 

SB1309- 38 -LRB100 08805 JLS 21036 b

1Commission Insurance Compliance Division, the Commission may
2assess a civil penalty of up to $500 per day for each day of
3such failure or refusal after the effective date of this
4amendatory Act of 1989. The minimum penalty under this Section
5shall be the sum of $10,000. Each day of such failure or
6refusal shall constitute a separate offense. The Commission may
7assess the civil penalty personally and individually against
8the corporate officers and directors of a corporate employer,
9the partners of an employer partnership, and the members of an
10employer limited liability company, after a finding of a
11knowing and willful refusal or failure of each such named
12corporate officer, director, partner, or member to comply with
13this Section. The liability for the assessed penalty shall be
14against the named employer first, and if the named employer
15fails or refuses to pay the penalty to the Commission within 30
16days after the final order of the Commission, then the named
17corporate officers, directors, partners, or members who have
18been found to have knowingly and willfully refused or failed to
19comply with this Section shall be liable for the unpaid penalty
20or any unpaid portion of the penalty. Upon investigation by the
21insurance non-compliance unit of the Commission, the Attorney
22General shall have the authority to prosecute all proceedings
23to enforce the civil and administrative provisions of this
24Section before the Commission. The Commission shall promulgate
25procedural rules for enforcing this Section.
26    Upon the failure or refusal of any employer, service or

 

 

SB1309- 39 -LRB100 08805 JLS 21036 b

1adjustment company or insurance carrier to comply with the
2provisions of this Section and with the orders of the
3Commission under this Section, or the order of the court on
4review after final adjudication, the Commission may bring a
5civil action to recover the amount of the penalty in Cook
6County or in Sangamon County in which litigation the Commission
7shall be represented by the Attorney General. The Commission
8shall send notice of its finding of non-compliance and
9assessment of the civil penalty to the Attorney General. It
10shall be the duty of the Attorney General within 30 days after
11receipt of the notice, to institute prosecutions and promptly
12prosecute all reported violations of this Section.
13    Any individual employer, corporate officer or director of a
14corporate employer, partner of an employer partnership, or
15member of an employer limited liability company who, with the
16intent to avoid payment of compensation under this Act to an
17injured employee or the employee's dependents, knowingly
18transfers, sells, encumbers, assigns, or in any manner disposes
19of, conceals, secretes, or destroys any property belonging to
20the employer, officer, director, partner, or member is guilty
21of a Class 4 felony.
22    Penalties and fines collected pursuant to this paragraph
23(d) shall be deposited upon receipt into a special fund which
24shall be designated the Injured Workers' Benefit Fund, of which
25the State Treasurer is ex-officio custodian, such special fund
26to be held and disbursed in accordance with this paragraph (d)

 

 

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1for the purposes hereinafter stated in this paragraph (d), upon
2the final order of the Commission. The Injured Workers' Benefit
3Fund shall be deposited the same as are State funds and any
4interest accruing thereon shall be added thereto every 6
5months. The Injured Workers' Benefit Fund is subject to audit
6the same as State funds and accounts and is protected by the
7general bond given by the State Treasurer. The Injured Workers'
8Benefit Fund is considered always appropriated for the purposes
9of disbursements as provided in this paragraph, and shall be
10paid out and disbursed as herein provided and shall not at any
11time be appropriated or diverted to any other use or purpose.
12Moneys in the Injured Workers' Benefit Fund shall be used only
13for payment of workers' compensation benefits for injured
14employees when the employer has failed to provide coverage as
15determined under this paragraph (d) and has failed to pay the
16benefits due to the injured employee. The Commission shall have
17the right to obtain reimbursement from the employer for
18compensation obligations paid by the Injured Workers' Benefit
19Fund. Any such amounts obtained shall be deposited by the
20Commission into the Injured Workers' Benefit Fund. If an
21injured employee or his or her personal representative receives
22payment from the Injured Workers' Benefit Fund, the State of
23Illinois has the same rights under paragraph (b) of Section 5
24that the employer who failed to pay the benefits due to the
25injured employee would have had if the employer had paid those
26benefits, and any moneys recovered by the State as a result of

 

 

SB1309- 41 -LRB100 08805 JLS 21036 b

1the State's exercise of its rights under paragraph (b) of
2Section 5 shall be deposited into the Injured Workers' Benefit
3Fund. The custodian of the Injured Workers' Benefit Fund shall
4be joined with the employer as a party respondent in the
5application for adjustment of claim. After July 1, 2006, the
6Commission shall make disbursements from the Fund once each
7year to each eligible claimant. An eligible claimant is an
8injured worker who has within the previous fiscal year obtained
9a final award for benefits from the Commission against the
10employer and the Injured Workers' Benefit Fund and has notified
11the Commission within 90 days of receipt of such award. Within
12a reasonable time after the end of each fiscal year, the
13Commission shall make a disbursement to each eligible claimant.
14At the time of disbursement, if there are insufficient moneys
15in the Fund to pay all claims, each eligible claimant shall
16receive a pro-rata share, as determined by the Commission, of
17the available moneys in the Fund for that year. Payment from
18the Injured Workers' Benefit Fund to an eligible claimant
19pursuant to this provision shall discharge the obligations of
20the Injured Workers' Benefit Fund regarding the award entered
21by the Commission.
22    (e) This Act shall not affect or disturb the continuance of
23any existing workers' compensation insurance, mutual aid,
24benefit, or relief association or department, whether
25maintained in whole or in part by the employer or whether
26maintained by the employees, the payment of benefits of such

 

 

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1association or department being guaranteed by the employer or
2by some person, firm or corporation for him or her: Provided,
3the employer contributes to such association or department an
4amount not less than the full compensation herein provided,
5exclusive of the cost of the maintenance of such association or
6department and without any expense to the employee. This Act
7shall not prevent the organization and maintaining under the
8insurance laws of this State of any benefit or insurance
9company for the purpose of insuring against the compensation
10provided for in this Act, the expense of which is maintained by
11the employer. This Act shall not prevent the organization or
12maintaining under the insurance laws of this State of any
13voluntary mutual aid, benefit or relief association among
14employees for the payment of additional accident or sick
15benefits.
16    (f) No existing workers' compensation insurance, mutual
17aid, benefit or relief association or department shall, by
18reason of anything herein contained, be authorized to
19discontinue its operation without first discharging its
20obligations to any and all persons carrying insurance in the
21same or entitled to relief or benefits therein.
22    (g) Any contract, oral, written or implied, of employment
23providing for relief benefit, or workers' compensation
24insurance or any other device whereby the employee is required
25to pay any premium or premiums for insurance against the
26compensation provided for in this Act shall be null and void.

 

 

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1Any employer withholding from the wages of any employee any
2amount for the purpose of paying any such premium shall be
3guilty of a Class B misdemeanor.
4    In the event the employer does not pay the compensation for
5which he or she is liable, then a workers' compensation an
6insurance company, association or insurer which may have
7insured such employer against such liability shall become
8primarily liable to pay to the employee, his or her personal
9representative or beneficiary the compensation required by the
10provisions of this Act to be paid by such employer. The
11insurance carrier may be made a party to the proceedings in
12which the employer is a party and an award may be entered
13jointly against the employer and the insurance carrier.
14    (h) It shall be unlawful for any employer, insurance
15company or service or adjustment company to interfere with,
16restrain or coerce an employee in any manner whatsoever in the
17exercise of the rights or remedies granted to him or her by
18this Act or to discriminate, attempt to discriminate, or
19threaten to discriminate against an employee in any way because
20of his or her exercise of the rights or remedies granted to him
21or her by this Act.
22    It shall be unlawful for any employer, individually or
23through any insurance company or service or adjustment company,
24to discharge or to threaten to discharge, or to refuse to
25rehire or recall to active service in a suitable capacity an
26employee because of the exercise of his or her rights or

 

 

SB1309- 44 -LRB100 08805 JLS 21036 b

1remedies granted to him or her by this Act.
2    (i) If an employer elects to obtain a life insurance policy
3on his employees, he may also elect to apply such benefits in
4satisfaction of all or a portion of the death benefits payable
5under this Act, in which case, the employer's compensation
6premium shall be reduced accordingly.
7    (j) Within 45 days of receipt of an initial application or
8application to renew self-insurance privileges the
9Self-Insurers Advisory Board shall review and submit for
10approval by the Chairman of the Commission recommendations of
11disposition of all initial applications to self-insure and all
12applications to renew self-insurance privileges filed by
13private self-insurers pursuant to the provisions of this
14Section and Section 4a-9 of this Act. Each private self-insurer
15shall submit with its initial and renewal applications the
16application fee required by Section 4a-4 of this Act.
17    The Chairman of the Commission shall promptly act upon all
18initial applications and applications for renewal in full
19accordance with the recommendations of the Board or, should the
20Chairman disagree with any recommendation of disposition of the
21Self-Insurer's Advisory Board, he shall within 30 days of
22receipt of such recommendation provide to the Board in writing
23the reasons supporting his decision. The Chairman shall also
24promptly notify the employer of his decision within 15 days of
25receipt of the recommendation of the Board.
26    If an employer is denied a renewal of self-insurance

 

 

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1privileges pursuant to application it shall retain said
2privilege for 120 days after receipt of a notice of
3cancellation of the privilege from the Chairman of the
4Commission.
5    All orders made by the Chairman under this Section shall be
6subject to review by the courts, such review to be taken in the
7same manner and within the same time as provided by subsection
8(f) of Section 19 of this Act for review of awards and
9decisions of the Commission, upon the party seeking the review
10filing with the clerk of the court to which such review is
11taken a bond in an amount to be fixed and approved by the court
12to which the review is taken, conditioned upon the payment of
13all compensation awarded against the person taking such review
14pending a decision thereof and further conditioned upon such
15other obligations as the court may impose. Upon the review the
16Circuit Court shall have power to review all questions of fact
17as well as of law.
18(Source: P.A. 97-18, eff. 6-28-11.)
 
19    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
20    Sec. 8. The amount of compensation which shall be paid to
21the employee for an accidental injury not resulting in death
22is:
23    (a) The employer shall provide and pay the negotiated rate,
24if applicable, or the lesser of the health care provider's
25actual charges or according to a fee schedule, subject to

 

 

SB1309- 46 -LRB100 08805 JLS 21036 b

1Section 8.2, in effect at the time the service was rendered for
2all the necessary first aid, medical and surgical services, and
3all necessary medical, surgical and hospital services
4thereafter incurred, limited, however, to that which is
5reasonably required to cure or relieve from the effects of the
6accidental injury, even if a health care provider sells,
7transfers, or otherwise assigns an account receivable for
8procedures, treatments, or services covered under this Act. If
9the employer does not dispute payment of first aid, medical,
10surgical, and hospital services, the employer shall make such
11payment to the provider on behalf of the employee. The employer
12shall also pay for treatment, instruction and training
13necessary for the physical, mental and vocational
14rehabilitation of the employee, including all maintenance
15costs and expenses incidental thereto. If as a result of the
16injury the employee is unable to be self-sufficient the
17employer shall further pay for such maintenance or
18institutional care as shall be required.
19    The employee may at any time elect to secure his own
20physician, surgeon and hospital services at the employer's
21expense, or,
22    Upon agreement between the employer and the employees, or
23the employees' exclusive representative, and subject to the
24approval of the Illinois Workers' Compensation Commission, the
25employer shall maintain a list of physicians, to be known as a
26Panel of Physicians, who are accessible to the employees. The

 

 

SB1309- 47 -LRB100 08805 JLS 21036 b

1employer shall post this list in a place or places easily
2accessible to his employees. The employee shall have the right
3to make an alternative choice of physician from such Panel if
4he is not satisfied with the physician first selected. If, due
5to the nature of the injury or its occurrence away from the
6employer's place of business, the employee is unable to make a
7selection from the Panel, the selection process from the Panel
8shall not apply. The physician selected from the Panel may
9arrange for any consultation, referral or other specialized
10medical services outside the Panel at the employer's expense.
11Provided that, in the event the Commission shall find that a
12doctor selected by the employee is rendering improper or
13inadequate care, the Commission may order the employee to
14select another doctor certified or qualified in the medical
15field for which treatment is required. If the employee refuses
16to make such change the Commission may relieve the employer of
17his obligation to pay the doctor's charges from the date of
18refusal to the date of compliance.
19    Any vocational rehabilitation counselors who provide
20service under this Act shall have appropriate certifications
21which designate the counselor as qualified to render opinions
22relating to vocational rehabilitation. Vocational
23rehabilitation may include, but is not limited to, counseling
24for job searches, supervising a job search program, and
25vocational retraining including education at an accredited
26learning institution. The employee or employer may petition to

 

 

SB1309- 48 -LRB100 08805 JLS 21036 b

1the Commission to decide disputes relating to vocational
2rehabilitation and the Commission shall resolve any such
3dispute, including payment of the vocational rehabilitation
4program by the employer.
5    The maintenance benefit shall not be less than the
6temporary total disability rate determined for the employee. In
7addition, maintenance shall include costs and expenses
8incidental to the vocational rehabilitation program.
9    When the employee is working light duty on a part-time
10basis or full-time basis and earns less than he or she would be
11earning if employed in the full capacity of the job or jobs,
12then the employee shall be entitled to temporary partial
13disability benefits. Temporary partial disability benefits
14shall be equal to two-thirds of the difference between the
15average amount that the employee would be able to earn in the
16full performance of his or her duties in the occupation in
17which he or she was engaged at the time of accident and the
18gross amount which he or she is earning in the modified job
19provided to the employee by the employer or in any other job
20that the employee is working.
21    Every hospital, physician, surgeon or other person
22rendering treatment or services in accordance with the
23provisions of this Section shall upon written request furnish
24full and complete reports thereof to, and permit their records
25to be copied by, the employer, the employee or his dependents,
26as the case may be, or any other party to any proceeding for

 

 

SB1309- 49 -LRB100 08805 JLS 21036 b

1compensation before the Commission, or their attorneys.
2    Notwithstanding the foregoing, the employer's liability to
3pay for such medical services selected by the employee shall be
4limited to:
5        (1) all first aid and emergency treatment; plus
6        (2) all medical, surgical and hospital services
7    provided by the physician, surgeon or hospital initially
8    chosen by the employee or by any other physician,
9    consultant, expert, institution or other provider of
10    services recommended by said initial service provider or
11    any subsequent provider of medical services in the chain of
12    referrals from said initial service provider; plus
13        (3) all medical, surgical and hospital services
14    provided by any second physician, surgeon or hospital
15    subsequently chosen by the employee or by any other
16    physician, consultant, expert, institution or other
17    provider of services recommended by said second service
18    provider or any subsequent provider of medical services in
19    the chain of referrals from said second service provider.
20    Thereafter the employer shall select and pay for all
21    necessary medical, surgical and hospital treatment and the
22    employee may not select a provider of medical services at
23    the employer's expense unless the employer agrees to such
24    selection. At any time the employee may obtain any medical
25    treatment he desires at his own expense. This paragraph
26    shall not affect the duty to pay for rehabilitation

 

 

SB1309- 50 -LRB100 08805 JLS 21036 b

1    referred to above.
2        (4) The following shall apply for injuries occurring on
3    or after June 28, 2011 (the effective date of Public Act
4    97-18) and only when an employer has an approved preferred
5    provider program pursuant to Section 8.1a on the date the
6    employee sustained his or her accidental injuries:
7            (A) The employer shall, in writing, on a form
8        promulgated by the Commission, inform the employee of
9        the preferred provider program;
10            (B) Subsequent to the report of an injury by an
11        employee, the employee may choose in writing at any
12        time to decline the preferred provider program, in
13        which case that would constitute one of the two choices
14        of medical providers to which the employee is entitled
15        under subsection (a)(2) or (a)(3); and
16            (C) Prior to the report of an injury by an
17        employee, when an employee chooses non-emergency
18        treatment from a provider not within the preferred
19        provider program, that would constitute the employee's
20        one choice of medical providers to which the employee
21        is entitled under subsection (a)(2) or (a)(3).
22    When an employer and employee so agree in writing, nothing
23in this Act prevents an employee whose injury or disability has
24been established under this Act, from relying in good faith, on
25treatment by prayer or spiritual means alone, in accordance
26with the tenets and practice of a recognized church or

 

 

SB1309- 51 -LRB100 08805 JLS 21036 b

1religious denomination, by a duly accredited practitioner
2thereof, and having nursing services appropriate therewith,
3without suffering loss or diminution of the compensation
4benefits under this Act. However, the employee shall submit to
5all physical examinations required by this Act. The cost of
6such treatment and nursing care shall be paid by the employee
7unless the employer agrees to make such payment.
8    Where the accidental injury results in the amputation of an
9arm, hand, leg or foot, or the enucleation of an eye, or the
10loss of any of the natural teeth, the employer shall furnish an
11artificial of any such members lost or damaged in accidental
12injury arising out of and in the course of employment, and
13shall also furnish the necessary braces in all proper and
14necessary cases. In cases of the loss of a member or members by
15amputation, the employer shall, whenever necessary, maintain
16in good repair, refit or replace the artificial limbs during
17the lifetime of the employee. Where the accidental injury
18accompanied by physical injury results in damage to a denture,
19eye glasses or contact eye lenses, or where the accidental
20injury results in damage to an artificial member, the employer
21shall replace or repair such denture, glasses, lenses, or
22artificial member.
23    The furnishing by the employer of any such services or
24appliances is not an admission of liability on the part of the
25employer to pay compensation.
26    The furnishing of any such services or appliances or the

 

 

SB1309- 52 -LRB100 08805 JLS 21036 b

1servicing thereof by the employer is not the payment of
2compensation.
3    (b) If the period of temporary total incapacity for work
4lasts more than 7 3 working days, weekly compensation as
5hereinafter provided shall be paid beginning on the 8th 4th day
6of such temporary total incapacity and continuing as long as
7the total temporary incapacity lasts. In cases where the
8temporary total incapacity for work continues for a period of
914 days or more from the day of the accident compensation shall
10commence on the day after the accident.
11        1. The compensation rate for temporary total
12    incapacity under this paragraph (b) of this Section shall
13    be equal to 66 2/3% of the employee's average weekly wage
14    computed in accordance with Section 10, provided that it
15    shall be not less than 66 2/3% of the sum of the Federal
16    minimum wage under the Fair Labor Standards Act, or the
17    Illinois minimum wage under the Minimum Wage Law, whichever
18    is more, multiplied by 40 hours. This percentage rate shall
19    be increased by 10% for each spouse and child, not to
20    exceed 100% of the total minimum wage calculation, nor
21    exceed the employee's average weekly wage computed in
22    accordance with the provisions of Section 10, whichever is
23    less.
24        2. The compensation rate in all cases other than for
25    temporary total disability under this paragraph (b), and
26    other than for serious and permanent disfigurement under

 

 

SB1309- 53 -LRB100 08805 JLS 21036 b

1    paragraph (c) and other than for permanent partial
2    disability under subparagraph (2) of paragraph (d) or under
3    paragraph (e), of this Section shall be equal to 66 2/3% of
4    the employee's average weekly wage computed in accordance
5    with the provisions of Section 10, provided that it shall
6    be not less than 66 2/3% of the sum of the Federal minimum
7    wage under the Fair Labor Standards Act, or the Illinois
8    minimum wage under the Minimum Wage Law, whichever is more,
9    multiplied by 40 hours. This percentage rate shall be
10    increased by 10% for each spouse and child, not to exceed
11    100% of the total minimum wage calculation, nor exceed the
12    employee's average weekly wage computed in accordance with
13    the provisions of Section 10, whichever is less.
14        2.1. The compensation rate in all cases of serious and
15    permanent disfigurement under paragraph (c) and of
16    permanent partial disability under subparagraph (2) of
17    paragraph (d) or under paragraph (e) of this Section shall
18    be equal to 60% of the employee's average weekly wage
19    computed in accordance with the provisions of Section 10,
20    provided that it shall be not less than 66 2/3% of the sum
21    of the Federal minimum wage under the Fair Labor Standards
22    Act, or the Illinois minimum wage under the Minimum Wage
23    Law, whichever is more, multiplied by 40 hours. This
24    percentage rate shall be increased by 10% for each spouse
25    and child, not to exceed 100% of the total minimum wage
26    calculation, nor exceed the employee's average weekly wage

 

 

SB1309- 54 -LRB100 08805 JLS 21036 b

1    computed in accordance with the provisions of Section 10,
2    whichever is less.
3        3. As used in this Section the term "child" means a
4    child of the employee including any child legally adopted
5    before the accident or whom at the time of the accident the
6    employee was under legal obligation to support or to whom
7    the employee stood in loco parentis, and who at the time of
8    the accident was under 18 years of age and not emancipated.
9    The term "children" means the plural of "child".
10        4. All weekly compensation rates provided under
11    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
12    Section shall be subject to the following limitations:
13        The maximum weekly compensation rate from July 1, 1975,
14    except as hereinafter provided, shall be 100% of the
15    State's average weekly wage in covered industries under the
16    Unemployment Insurance Act, that being the wage that most
17    closely approximates the State's average weekly wage.
18        The maximum weekly compensation rate, for the period
19    July 1, 1984, through June 30, 1987, except as hereinafter
20    provided, shall be $293.61. Effective July 1, 1987 and on
21    July 1 of each year thereafter the maximum weekly
22    compensation rate, except as hereinafter provided, shall
23    be determined as follows: if during the preceding 12 month
24    period there shall have been an increase in the State's
25    average weekly wage in covered industries under the
26    Unemployment Insurance Act, the weekly compensation rate

 

 

SB1309- 55 -LRB100 08805 JLS 21036 b

1    shall be proportionately increased by the same percentage
2    as the percentage of increase in the State's average weekly
3    wage in covered industries under the Unemployment
4    Insurance Act during such period.
5        The maximum weekly compensation rate, for the period
6    January 1, 1981 through December 31, 1983, except as
7    hereinafter provided, shall be 100% of the State's average
8    weekly wage in covered industries under the Unemployment
9    Insurance Act in effect on January 1, 1981. Effective
10    January 1, 1984 and on January 1, of each year thereafter
11    the maximum weekly compensation rate, except as
12    hereinafter provided, shall be determined as follows: if
13    during the preceding 12 month period there shall have been
14    an increase in the State's average weekly wage in covered
15    industries under the Unemployment Insurance Act, the
16    weekly compensation rate shall be proportionately
17    increased by the same percentage as the percentage of
18    increase in the State's average weekly wage in covered
19    industries under the Unemployment Insurance Act during
20    such period.
21        The maximum compensation rate for the period of June 1,
22    2017 through May 31, 2022, except as hereinafter provided,
23    shall be $775.18. Effective May 31, 2022 and on May 31 of
24    each year thereafter the maximum weekly compensation rate,
25    except as hereinafter provided, shall be determined as
26    follows: if during the preceding 12 month period there

 

 

SB1309- 56 -LRB100 08805 JLS 21036 b

1    shall have been an increase in the State's average weekly
2    wage in covered industries under the Unemployment
3    Insurance Act, the weekly compensation rate shall
4    proportionately increase by the same percentage as the
5    percentage increase in the State's average weekly wage in
6    covered industries under the Unemployment Insurance Act
7    during such period.
8        From July 1, 1977 and thereafter such maximum weekly
9    compensation rate in death cases under Section 7, and
10    permanent total disability cases under paragraph (f) or
11    subparagraph 18 of paragraph (3) of this Section and for
12    temporary total disability under paragraph (b) of this
13    Section and for amputation of a member or enucleation of an
14    eye under paragraph (e) of this Section shall be increased
15    to 133-1/3% of the State's average weekly wage in covered
16    industries under the Unemployment Insurance Act.
17        For injuries occurring on or after February 1, 2006,
18    the maximum weekly benefit under paragraph (d)1 of this
19    Section shall be 100% of the State's average weekly wage in
20    covered industries under the Unemployment Insurance Act.
21        4.1. Any provision herein to the contrary
22    notwithstanding, the weekly compensation rate for
23    compensation payments under subparagraph 18 of paragraph
24    (e) of this Section and under paragraph (f) of this Section
25    and under paragraph (a) of Section 7 and for amputation of
26    a member or enucleation of an eye under paragraph (e) of

 

 

SB1309- 57 -LRB100 08805 JLS 21036 b

1    this Section, shall in no event be less than 50% of the
2    State's average weekly wage in covered industries under the
3    Unemployment Insurance Act.
4        4.2. Any provision to the contrary notwithstanding,
5    the total compensation payable under Section 7 shall not
6    exceed the greater of $500,000 or 25 years.
7        5. For the purpose of this Section this State's average
8    weekly wage in covered industries under the Unemployment
9    Insurance Act on July 1, 1975 is hereby fixed at $228.16
10    per week and the computation of compensation rates shall be
11    based on the aforesaid average weekly wage until modified
12    as hereinafter provided.
13        6. The Department of Employment Security of the State
14    shall on or before the first day of December, 1977, and on
15    or before the first day of June, 1978, and on the first day
16    of each December and June of each year thereafter, publish
17    the State's average weekly wage in covered industries under
18    the Unemployment Insurance Act and the Illinois Workers'
19    Compensation Commission shall on the 15th day of January,
20    1978 and on the 15th day of July, 1978 and on the 15th day
21    of each January and July of each year thereafter, post and
22    publish the State's average weekly wage in covered
23    industries under the Unemployment Insurance Act as last
24    determined and published by the Department of Employment
25    Security. The amount when so posted and published shall be
26    conclusive and shall be applicable as the basis of

 

 

SB1309- 58 -LRB100 08805 JLS 21036 b

1    computation of compensation rates until the next posting
2    and publication as aforesaid.
3        7. The payment of compensation by an employer or his
4    insurance carrier to an injured employee shall not
5    constitute an admission of the employer's liability to pay
6    compensation.
7    (c) For any serious and permanent disfigurement to the
8hand, head, face, neck, arm, leg below the knee or the chest
9above the axillary line, the employee is entitled to
10compensation for such disfigurement, the amount determined by
11agreement at any time or by arbitration under this Act, at a
12hearing not less than 6 months after the date of the accidental
13injury, which amount shall not exceed 150 weeks (if the
14accidental injury occurs on or after the effective date of this
15amendatory Act of the 94th General Assembly but before February
161, 2006) or 162 weeks (if the accidental injury occurs on or
17after February 1, 2006) at the applicable rate provided in
18subparagraph 2.1 of paragraph (b) of this Section.
19    No compensation is payable under this paragraph where
20compensation is payable under paragraphs (d), (e) or (f) of
21this Section.
22    A duly appointed member of a fire department in a city, the
23population of which exceeds 500,000 according to the last
24federal or State census, is eligible for compensation under
25this paragraph only where such serious and permanent
26disfigurement results from burns.

 

 

SB1309- 59 -LRB100 08805 JLS 21036 b

1    (d) 1. If, after the accidental injury has been sustained,
2the employee as a result thereof becomes partially
3incapacitated from pursuing his usual and customary line of
4employment, he shall, except in cases compensated under the
5specific schedule set forth in paragraph (e) of this Section,
6receive compensation for the duration of his disability,
7subject to the limitations as to maximum amounts fixed in
8paragraph (b) of this Section, equal to 66-2/3% of the
9difference between the average amount which he would be able to
10earn in the full performance of his duties in the occupation in
11which he was engaged at the time of the accident and the
12average amount which he is earning or is able to earn in some
13suitable employment or business after the accident. For
14accidental injuries that occur on or after September 1, 2011,
15an award for wage differential under this subsection shall be
16effective only until the employee reaches the age of 67 or 5
17years from the date the award becomes final, whichever is
18later.
19    For accidental injuries involving professional athletes
20that occur on or after the effective date of this amendatory
21Act of the 100th General Assembly, an award for wage
22differential under this subsection shall be effective for the
23expected remaining duration of the employee's professional
24sports athletic career. As used in this paragraph (d)1,
25"professional athlete" means an individual whose employer is a
26professional athletic team that is based in Illinois and who

 

 

SB1309- 60 -LRB100 08805 JLS 21036 b

1derives the majority of his or her income from playing
2athletics for such team. The expected remaining duration of an
3employee's professional sports athletic career shall continue
4until the employee reaches the age of 35 or for a period of 5
5years from the date of the injury, whichever is later, unless
6the employer or employee is able to successfully prove, by a
7preponderance of the evidence, that the expected remaining
8duration of such employee's professional sports athletic
9career has a shorter or longer duration.
10    2. If, as a result of the accident, the employee sustains
11serious and permanent injuries not covered by paragraphs (c)
12and (e) of this Section or having sustained injuries covered by
13the aforesaid paragraphs (c) and (e), he shall have sustained
14in addition thereto other injuries which injuries do not
15incapacitate him from pursuing the duties of his employment but
16which would disable him from pursuing other suitable
17occupations, or which have otherwise resulted in physical
18impairment; or if such injuries partially incapacitate him from
19pursuing the duties of his usual and customary line of
20employment but do not result in an impairment of earning
21capacity, or having resulted in an impairment of earning
22capacity, the employee elects to waive his right to recover
23under the foregoing subparagraph 1 of paragraph (d) of this
24Section then in any of the foregoing events, he shall receive
25in addition to compensation for temporary total disability
26under paragraph (b) of this Section, compensation at the rate

 

 

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

 

 

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1and shall receive in addition thereto compensation for a
2further period for the specific loss herein mentioned, but
3shall not receive any compensation under any other provisions
4of this Act. The following listed amounts apply to either the
5loss of or the permanent and complete loss of use of the member
6specified, such compensation for the length of time as follows:
7        1. Thumb-
8            70 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            76 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        2. First, or index finger-
14            40 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            43 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        3. Second, or middle finger-
20            35 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            38 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        4. Third, or ring finger-
26            25 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            27 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        5. Fourth, or little finger-
6            20 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            22 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        6. Great toe-
12            35 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            38 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        7. Each toe other than great toe-
18            12 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            13 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        8. The loss of the first or distal phalanx of the thumb
24    or of any finger or toe shall be considered to be equal to
25    the loss of one-half of such thumb, finger or toe and the
26    compensation payable shall be one-half of the amount above

 

 

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

 

 

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1        10. Arm-
2            235 weeks if the accidental injury occurs on or
3        after the effective date of this amendatory Act of the
4        94th General Assembly but before February 1, 2006.
5            253 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        Where an accidental injury results in the amputation of
8    an arm below the elbow, such injury shall be compensated as
9    a loss of an arm. Where an accidental injury results in the
10    amputation of an arm above the elbow, compensation for an
11    additional 15 weeks (if the accidental injury occurs on or
12    after the effective date of this amendatory Act of the 94th
13    General Assembly but before February 1, 2006) or an
14    additional 17 weeks (if the accidental injury occurs on or
15    after February 1, 2006) shall be paid, except where the
16    accidental injury results in the amputation of an arm at
17    the shoulder joint, or so close to shoulder joint that an
18    artificial arm cannot be used, or results in the
19    disarticulation of an arm at the shoulder joint, in which
20    case compensation for an additional 65 weeks (if the
21    accidental injury occurs on or after the effective date of
22    this amendatory Act of the 94th General Assembly but before
23    February 1, 2006) or an additional 70 weeks (if the
24    accidental injury occurs on or after February 1, 2006)
25    shall be paid.
26        For purposes of awards under this subdivision (e),

 

 

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1    injuries to the shoulder shall be considered injuries to
2    part of the arm. The foregoing change made by this
3    amendatory Act of the 100th General Assembly to this
4    subdivision (e)10 of this Section 8 is declarative of
5    existing law and is not a new enactment.
6        11. Foot-
7            155 weeks if the accidental injury occurs on or
8        after the effective date of this amendatory Act of the
9        94th General Assembly but before February 1, 2006.
10            167 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        12. Leg-
13            200 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            215 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        Where an accidental injury results in the amputation of
19    a leg below the knee, such injury shall be compensated as
20    loss of a leg. Where an accidental injury results in the
21    amputation of a leg above the knee, compensation for an
22    additional 25 weeks (if the accidental injury occurs on or
23    after the effective date of this amendatory Act of the 94th
24    General Assembly but before February 1, 2006) or an
25    additional 27 weeks (if the accidental injury occurs on or
26    after February 1, 2006) shall be paid, except where the

 

 

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1    accidental injury results in the amputation of a leg at the
2    hip joint, or so close to the hip joint that an artificial
3    leg cannot be used, or results in the disarticulation of a
4    leg at the hip joint, in which case compensation for an
5    additional 75 weeks (if the accidental injury occurs on or
6    after the effective date of this amendatory Act of the 94th
7    General Assembly but before February 1, 2006) or an
8    additional 81 weeks (if the accidental injury occurs on or
9    after February 1, 2006) shall be paid.
10        For purposes of awards under this subdivision (e),
11    injuries to the hip shall be considered injuries to part of
12    the leg. The foregoing change made by this amendatory Act
13    of the 100th General Assembly to this subdivision (e)12 of
14    this Section 8 is declarative of existing law and is not a
15    new enactment.
16        13. Eye-
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        Where an accidental injury results in the enucleation
23    of an eye, compensation for an additional 10 weeks (if the
24    accidental injury occurs on or after the effective date of
25    this amendatory Act of the 94th General Assembly but before
26    February 1, 2006) or an additional 11 weeks (if the

 

 

SB1309- 68 -LRB100 08805 JLS 21036 b

1    accidental injury occurs on or after February 1, 2006)
2    shall be paid.
3        14. Loss of hearing of one ear-
4            50 weeks if the accidental injury occurs on or
5        after the effective date of this amendatory Act of the
6        94th General Assembly but before February 1, 2006.
7            54 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        Total and permanent loss of hearing of both ears-
10            200 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            215 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        15. Testicle-
16            50 weeks if the accidental injury occurs on or
17        after the effective date of this amendatory Act of the
18        94th General Assembly but before February 1, 2006.
19            54 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        Both testicles-
22            150 weeks if the accidental injury occurs on or
23        after the effective date of this amendatory Act of the
24        94th General Assembly but before February 1, 2006.
25            162 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

SB1309- 69 -LRB100 08805 JLS 21036 b

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

 

 

SB1309- 70 -LRB100 08805 JLS 21036 b

1        shall constitute and be total or 100% compensable
2        hearing loss.
3            (c) In measuring hearing impairment, the lowest
4        measured losses in each of the 3 frequencies shall be
5        added together and divided by 3 to determine the
6        average decibel loss. For every decibel of loss
7        exceeding 30 decibels an allowance of 1.82% shall be
8        made up to the maximum of 100% which is reached at 85
9        decibels.
10            (d) If a hearing loss is established to have
11        existed on July 1, 1975 by audiometric testing the
12        employer shall not be liable for the previous loss so
13        established nor shall he be liable for any loss for
14        which compensation has been paid or awarded.
15            (e) No consideration shall be given to the question
16        of whether or not the ability of an employee to
17        understand speech is improved by the use of a hearing
18        aid.
19            (f) No claim for loss of hearing due to industrial
20        noise shall be brought against an employer or allowed
21        unless the employee has been exposed for a period of
22        time sufficient to cause permanent impairment to noise
23        levels in excess of the following:
24Sound Level DBA
25Slow ResponseHours Per Day
26908

 

 

SB1309- 71 -LRB100 08805 JLS 21036 b

1926
2954
3973
41002
51021-1/2
61051
71101/2
81151/4
9        This subparagraph (f) shall not be applied in cases of
10    hearing loss resulting from trauma or explosion.
11        17. In computing the compensation to be paid to any
12    employee who, before the accident for which he claims
13    compensation, had before that time sustained an injury
14    resulting in the loss by amputation or partial loss by
15    amputation of any member, including hand, arm, thumb or
16    fingers, leg, foot or any toes, such loss or partial loss
17    of any such member shall be deducted from any award made
18    for the subsequent injury. For the permanent loss of use or
19    the permanent partial loss of use of any such member or the
20    partial loss of sight of an eye, for which compensation has
21    been paid, then such loss shall be taken into consideration
22    and deducted from any award for the subsequent injury. For
23    purposes of this subdivision (e)17 only, "same part of the
24    spine" means: (1) cervical spine and thoracic spine from
25    vertebra C1 through T12 and (2) lumbar and sacral spine and
26    coccyx from vertebra L1 through S5.

 

 

SB1309- 72 -LRB100 08805 JLS 21036 b

1        18. The specific case of loss of both hands, both arms,
2    or both feet, or both legs, or both eyes, or of any two
3    thereof, or the permanent and complete loss of the use
4    thereof, constitutes total and permanent disability, to be
5    compensated according to the compensation fixed by
6    paragraph (f) of this Section. These specific cases of
7    total and permanent disability do not exclude other cases.
8        Any employee who has previously suffered the loss or
9    permanent and complete loss of the use of any of such
10    members, and in a subsequent independent accident loses
11    another or suffers the permanent and complete loss of the
12    use of any one of such members the employer for whom the
13    injured employee is working at the time of the last
14    independent accident is liable to pay compensation only for
15    the loss or permanent and complete loss of the use of the
16    member occasioned by the last independent accident.
17        19. In a case of specific loss and the subsequent death
18    of such injured employee from other causes than such injury
19    leaving a widow, widower, or dependents surviving before
20    payment or payment in full for such injury, then the amount
21    due for such injury is payable to the widow or widower and,
22    if there be no widow or widower, then to such dependents,
23    in the proportion which such dependency bears to total
24    dependency.
25    Beginning July 1, 1980, and every 6 months thereafter, the
26Commission shall examine the Second Injury Fund and when, after

 

 

SB1309- 73 -LRB100 08805 JLS 21036 b

1deducting all advances or loans made to such Fund, the amount
2therein is $500,000 then the amount required to be paid by
3employers pursuant to paragraph (f) of Section 7 shall be
4reduced by one-half. When the Second Injury Fund reaches the
5sum of $600,000 then the payments shall cease entirely.
6However, when the Second Injury Fund has been reduced to
7$400,000, payment of one-half of the amounts required by
8paragraph (f) of Section 7 shall be resumed, in the manner
9herein provided, and when the Second Injury Fund has been
10reduced to $300,000, payment of the full amounts required by
11paragraph (f) of Section 7 shall be resumed, in the manner
12herein provided. The Commission shall make the changes in
13payment effective by general order, and the changes in payment
14become immediately effective for all cases coming before the
15Commission thereafter either by settlement agreement or final
16order, irrespective of the date of the accidental injury.
17    On August 1, 1996 and on February 1 and August 1 of each
18subsequent year, the Commission shall examine the special fund
19designated as the "Rate Adjustment Fund" and when, after
20deducting all advances or loans made to said fund, the amount
21therein is $4,000,000, the amount required to be paid by
22employers pursuant to paragraph (f) of Section 7 shall be
23reduced by one-half. When the Rate Adjustment Fund reaches the
24sum of $5,000,000 the payment therein shall cease entirely.
25However, when said Rate Adjustment Fund has been reduced to
26$3,000,000 the amounts required by paragraph (f) of Section 7

 

 

SB1309- 74 -LRB100 08805 JLS 21036 b

1shall be resumed in the manner herein provided.
2    (f) In case of complete disability, which renders the
3employee wholly and permanently incapable of work, or in the
4specific case of total and permanent disability as provided in
5subparagraph 18 of paragraph (e) of this Section, compensation
6shall be payable at the rate provided in subparagraph 2 of
7paragraph (b) of this Section for life.
8    An employee entitled to benefits under paragraph (f) of
9this Section shall also be entitled to receive from the Rate
10Adjustment Fund provided in paragraph (f) of Section 7 of the
11supplementary benefits provided in paragraph (g) of this
12Section 8.
13    If any employee who receives an award under this paragraph
14afterwards returns to work or is able to do so, and earns or is
15able to earn as much as before the accident, payments under
16such award shall cease. If such employee returns to work, or is
17able to do so, and earns or is able to earn part but not as much
18as before the accident, such award shall be modified so as to
19conform to an award under paragraph (d) of this Section. If
20such award is terminated or reduced under the provisions of
21this paragraph, such employees have the right at any time
22within 30 months after the date of such termination or
23reduction to file petition with the Commission for the purpose
24of determining whether any disability exists as a result of the
25original accidental injury and the extent thereof.
26    Disability as enumerated in subdivision 18, paragraph (e)

 

 

SB1309- 75 -LRB100 08805 JLS 21036 b

1of this Section is considered complete disability.
2    If an employee who had previously incurred loss or the
3permanent and complete loss of use of one member, through the
4loss or the permanent and complete loss of the use of one hand,
5one arm, one foot, one leg, or one eye, incurs permanent and
6complete disability through the loss or the permanent and
7complete loss of the use of another member, he shall receive,
8in addition to the compensation payable by the employer and
9after such payments have ceased, an amount from the Second
10Injury Fund provided for in paragraph (f) of Section 7, which,
11together with the compensation payable from the employer in
12whose employ he was when the last accidental injury was
13incurred, will equal the amount payable for permanent and
14complete disability as provided in this paragraph of this
15Section.
16    The custodian of the Second Injury Fund provided for in
17paragraph (f) of Section 7 shall be joined with the employer as
18a party respondent in the application for adjustment of claim.
19The application for adjustment of claim shall state briefly and
20in general terms the approximate time and place and manner of
21the loss of the first member.
22    In its award the Commission or the Arbitrator shall
23specifically find the amount the injured employee shall be
24weekly paid, the number of weeks compensation which shall be
25paid by the employer, the date upon which payments begin out of
26the Second Injury Fund provided for in paragraph (f) of Section

 

 

SB1309- 76 -LRB100 08805 JLS 21036 b

17 of this Act, the length of time the weekly payments continue,
2the date upon which the pension payments commence and the
3monthly amount of the payments. The Commission shall 30 days
4after the date upon which payments out of the Second Injury
5Fund have begun as provided in the award, and every month
6thereafter, prepare and submit to the State Comptroller a
7voucher for payment for all compensation accrued to that date
8at the rate fixed by the Commission. The State Comptroller
9shall draw a warrant to the injured employee along with a
10receipt to be executed by the injured employee and returned to
11the Commission. The endorsed warrant and receipt is a full and
12complete acquittance to the Commission for the payment out of
13the Second Injury Fund. No other appropriation or warrant is
14necessary for payment out of the Second Injury Fund. The Second
15Injury Fund is appropriated for the purpose of making payments
16according to the terms of the awards.
17    As of July 1, 1980 to July 1, 1982, all claims against and
18obligations of the Second Injury Fund shall become claims
19against and obligations of the Rate Adjustment Fund to the
20extent there is insufficient money in the Second Injury Fund to
21pay such claims and obligations. In that case, all references
22to "Second Injury Fund" in this Section shall also include the
23Rate Adjustment Fund.
24    (g) Every award for permanent total disability entered by
25the Commission on and after July 1, 1965 under which
26compensation payments shall become due and payable after the

 

 

SB1309- 77 -LRB100 08805 JLS 21036 b

1effective date of this amendatory Act, and every award for
2death benefits or permanent total disability entered by the
3Commission on and after the effective date of this amendatory
4Act shall be subject to annual adjustments as to the amount of
5the compensation rate therein provided. Such adjustments shall
6first be made on July 15, 1977, and all awards made and entered
7prior to July 1, 1975 and on July 15 of each year thereafter.
8In all other cases such adjustment shall be made on July 15 of
9the second year next following the date of the entry of the
10award and shall further be made on July 15 annually thereafter.
11If during the intervening period from the date of the entry of
12the award, or the last periodic adjustment, there shall have
13been an increase in the State's average weekly wage in covered
14industries under the Unemployment Insurance Act, the weekly
15compensation rate shall be proportionately increased by the
16same percentage as the percentage of increase in the State's
17average weekly wage in covered industries under the
18Unemployment Insurance Act. The increase in the compensation
19rate under this paragraph shall in no event bring the total
20compensation rate to an amount greater than the prevailing
21maximum rate at the time that the annual adjustment is made.
22Such increase shall be paid in the same manner as herein
23provided for payments under the Second Injury Fund to the
24injured employee, or his dependents, as the case may be, out of
25the Rate Adjustment Fund provided in paragraph (f) of Section 7
26of this Act. Payments shall be made at the same intervals as

 

 

SB1309- 78 -LRB100 08805 JLS 21036 b

1provided in the award or, at the option of the Commission, may
2be made in quarterly payment on the 15th day of January, April,
3July and October of each year. In the event of a decrease in
4such average weekly wage there shall be no change in the then
5existing compensation rate. The within paragraph shall not
6apply to cases where there is disputed liability and in which a
7compromise lump sum settlement between the employer and the
8injured employee, or his dependents, as the case may be, has
9been duly approved by the Illinois Workers' Compensation
10Commission.
11    Provided, that in cases of awards entered by the Commission
12for injuries occurring before July 1, 1975, the increases in
13the compensation rate adjusted under the foregoing provision of
14this paragraph (g) shall be limited to increases in the State's
15average weekly wage in covered industries under the
16Unemployment Insurance Act occurring after July 1, 1975.
17    For every accident occurring on or after July 20, 2005 but
18before the effective date of this amendatory Act of the 94th
19General Assembly (Senate Bill 1283 of the 94th General
20Assembly), the annual adjustments to the compensation rate in
21awards for death benefits or permanent total disability, as
22provided in this Act, shall be paid by the employer. The
23adjustment shall be made by the employer on July 15 of the
24second year next following the date of the entry of the award
25and shall further be made on July 15 annually thereafter. If
26during the intervening period from the date of the entry of the

 

 

SB1309- 79 -LRB100 08805 JLS 21036 b

1award, or the last periodic adjustment, there shall have been
2an increase in the State's average weekly wage in covered
3industries under the Unemployment Insurance Act, the employer
4shall increase the weekly compensation rate proportionately by
5the same percentage as the percentage of increase in the
6State's average weekly wage in covered industries under the
7Unemployment Insurance Act. The increase in the compensation
8rate under this paragraph shall in no event bring the total
9compensation rate to an amount greater than the prevailing
10maximum rate at the time that the annual adjustment is made. In
11the event of a decrease in such average weekly wage there shall
12be no change in the then existing compensation rate. Such
13increase shall be paid by the employer in the same manner and
14at the same intervals as the payment of compensation in the
15award. This paragraph shall not apply to cases where there is
16disputed liability and in which a compromise lump sum
17settlement between the employer and the injured employee, or
18his or her dependents, as the case may be, has been duly
19approved by the Illinois Workers' Compensation Commission.
20    The annual adjustments for every award of death benefits or
21permanent total disability involving accidents occurring
22before July 20, 2005 and accidents occurring on or after the
23effective date of this amendatory Act of the 94th General
24Assembly (Senate Bill 1283 of the 94th General Assembly) shall
25continue to be paid from the Rate Adjustment Fund pursuant to
26this paragraph and Section 7(f) of this Act.

 

 

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1    (h) In case death occurs from any cause before the total
2compensation to which the employee would have been entitled has
3been paid, then in case the employee leaves any widow, widower,
4child, parent (or any grandchild, grandparent or other lineal
5heir or any collateral heir dependent at the time of the
6accident upon the earnings of the employee to the extent of 50%
7or more of total dependency) such compensation shall be paid to
8the beneficiaries of the deceased employee and distributed as
9provided in paragraph (g) of Section 7.
10    (h-1) In case an injured employee is under legal disability
11at the time when any right or privilege accrues to him or her
12under this Act, a guardian may be appointed pursuant to law,
13and may, on behalf of such person under legal disability, claim
14and exercise any such right or privilege with the same effect
15as if the employee himself or herself had claimed or exercised
16the right or privilege. No limitations of time provided by this
17Act run so long as the employee who is under legal disability
18is without a conservator or guardian.
19    (i) In case the injured employee is under 16 years of age
20at the time of the accident and is illegally employed, the
21amount of compensation payable under paragraphs (b), (c), (d),
22(e) and (f) of this Section is increased 50%.
23    However, where an employer has on file an employment
24certificate issued pursuant to the Child Labor Law or work
25permit issued pursuant to the Federal Fair Labor Standards Act,
26as amended, or a birth certificate properly and duly issued,

 

 

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1such certificate, permit or birth certificate is conclusive
2evidence as to the age of the injured minor employee for the
3purposes of this Section.
4    Nothing herein contained repeals or amends the provisions
5of the Child Labor Law relating to the employment of minors
6under the age of 16 years.
7    (j) 1. In the event the injured employee receives benefits,
8including medical, surgical or hospital benefits under any
9group plan covering non-occupational disabilities contributed
10to wholly or partially by the employer, which benefits should
11not have been payable if any rights of recovery existed under
12this Act, then such amounts so paid to the employee from any
13such group plan as shall be consistent with, and limited to,
14the provisions of paragraph 2 hereof, shall be credited to or
15against any compensation payment for temporary total
16incapacity for work or any medical, surgical or hospital
17benefits made or to be made under this Act. In such event, the
18period of time for giving notice of accidental injury and
19filing application for adjustment of claim does not commence to
20run until the termination of such payments. This paragraph does
21not apply to payments made under any group plan which would
22have been payable irrespective of an accidental injury under
23this Act. Any employer receiving such credit shall keep such
24employee safe and harmless from any and all claims or
25liabilities that may be made against him by reason of having
26received such payments only to the extent of such credit.

 

 

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1    Any excess benefits paid to or on behalf of a State
2employee by the State Employees' Retirement System under
3Article 14 of the Illinois Pension Code on a death claim or
4disputed disability claim shall be credited against any
5payments made or to be made by the State of Illinois to or on
6behalf of such employee under this Act, except for payments for
7medical expenses which have already been incurred at the time
8of the award. The State of Illinois shall directly reimburse
9the State Employees' Retirement System to the extent of such
10credit.
11    2. Nothing contained in this Act shall be construed to give
12the employer or the insurance carrier the right to credit for
13any benefits or payments received by the employee other than
14compensation payments provided by this Act, and where the
15employee receives payments other than compensation payments,
16whether as full or partial salary, group insurance benefits,
17bonuses, annuities or any other payments, the employer or
18insurance carrier shall receive credit for each such payment
19only to the extent of the compensation that would have been
20payable during the period covered by such payment.
21    3. The extension of time for the filing of an Application
22for Adjustment of Claim as provided in paragraph 1 above shall
23not apply to those cases where the time for such filing had
24expired prior to the date on which payments or benefits
25enumerated herein have been initiated or resumed. Provided
26however that this paragraph 3 shall apply only to cases wherein

 

 

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1the payments or benefits hereinabove enumerated shall be
2received after July 1, 1969.
3(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
4eff. 7-13-12.)
 
5    (820 ILCS 305/8.1b)
6    Sec. 8.1b. Determination of permanent partial disability.
7For accidental injuries that occur on or after September 1,
82011, permanent partial disability shall be established using
9the following criteria:
10    (a) A physician licensed to practice medicine in all of its
11branches preparing a permanent partial disability impairment
12report shall report the level of impairment in writing. The
13report shall include an evaluation of medically defined and
14professionally appropriate measurements of impairment that
15include, but are not limited to: loss of range of motion; loss
16of strength; measured atrophy of tissue mass consistent with
17the injury; and any other measurements that establish the
18nature and extent of the impairment. The most current edition
19of the American Medical Association's "Guides to the Evaluation
20of Permanent Impairment" shall be used by the physician in
21determining the level of impairment.
22    (b) In determining the level of permanent partial
23disability, the Commission shall base its determination on the
24following factors: (i) the reported level of impairment
25pursuant to subsection (a), if such a report exists; (ii) the

 

 

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1occupation of the injured employee; (iii) the age of the
2employee at the time of the injury; (iv) the employee's future
3earning capacity; and (v) evidence of disability corroborated
4by the treating medical records or examination under Section 12
5of this Act. No single enumerated factor shall be the sole
6determinant of disability. Where an impairment report exists,
7it must be considered by the Commission in its determination.
8In determining the level of disability, the relevance and
9weight of any factors used in addition to the level of
10impairment as reported by the physician must be explained in a
11written order.
12    (c) A report of impairment prepared pursuant to subsection
13(a) is not required for an arbitrator or the Commission to
14approve a Settlement Contract Lump Sum Petition.
15(Source: P.A. 97-18, eff. 6-28-11.)
 
16    (820 ILCS 305/8.2)
17    Sec. 8.2. Fee schedule.
18    (a) Except as provided for in subsection (c), for
19procedures, treatments, or services covered under this Act and
20rendered or to be rendered on and after February 1, 2006, the
21maximum allowable payment shall be 90% of the 80th percentile
22of charges and fees as determined by the Commission utilizing
23information provided by employers' and insurers' national
24databases, with a minimum of 12,000,000 Illinois line item
25charges and fees comprised of health care provider and hospital

 

 

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1charges and fees as of August 1, 2004 but not earlier than
2August 1, 2002. These charges and fees are provider billed
3amounts and shall not include discounted charges. The 80th
4percentile is the point on an ordered data set from low to high
5such that 80% of the cases are below or equal to that point and
6at most 20% are above or equal to that point. The Commission
7shall adjust these historical charges and fees as of August 1,
82004 by the Consumer Price Index-U for the period August 1,
92004 through September 30, 2005. The Commission shall establish
10fee schedules for procedures, treatments, or services for
11hospital inpatient, hospital outpatient, emergency room and
12trauma, ambulatory surgical treatment centers, and
13professional services. These charges and fees shall be
14designated by geozip or any smaller geographic unit. The data
15shall in no way identify or tend to identify any patient,
16employer, or health care provider. As used in this Section,
17"geozip" means a three-digit zip code based on data
18similarities, geographical similarities, and frequencies. A
19geozip does not cross state boundaries. As used in this
20Section, "three-digit zip code" means a geographic area in
21which all zip codes have the same first 3 digits. If a geozip
22does not have the necessary number of charges and fees to
23calculate a valid percentile for a specific procedure,
24treatment, or service, the Commission may combine data from the
25geozip with up to 4 other geozips that are demographically and
26economically similar and exhibit similarities in data and

 

 

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1frequencies until the Commission reaches 9 charges or fees for
2that specific procedure, treatment, or service. In cases where
3the compiled data contains less than 9 charges or fees for a
4procedure, treatment, or service, reimbursement shall occur at
576% of charges and fees as determined by the Commission in a
6manner consistent with the provisions of this paragraph.
7Providers of out-of-state procedures, treatments, services,
8products, or supplies shall be reimbursed at the lesser of that
9state's fee schedule amount or the fee schedule amount for the
10region in which the employee resides. If no fee schedule exists
11in that state, the provider shall be reimbursed at the lesser
12of the actual charge or the fee schedule amount for the region
13in which the employee resides. Not later than September 30 in
142006 and each year thereafter, the Commission shall
15automatically increase or decrease the maximum allowable
16payment for a procedure, treatment, or service established and
17in effect on January 1 of that year by the percentage change in
18the Consumer Price Index-U for the 12 month period ending
19August 31 of that year. The increase or decrease shall become
20effective on January 1 of the following year. As used in this
21Section, "Consumer Price Index-U" means the index published by
22the Bureau of Labor Statistics of the U.S. Department of Labor,
23that measures the average change in prices of all goods and
24services purchased by all urban consumers, U.S. city average,
25all items, 1982-84=100.
26    The provisions of this subsection (a), other than this

 

 

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1sentence, are inoperative after December 31, 2017.
2    (a-1) Notwithstanding the provisions of subsection (a) and
3unless otherwise indicated, the following provisions shall
4apply to the medical fee schedule starting on September 1,
52011:
6        (1) The Commission shall establish and maintain fee
7    schedules for procedures, treatments, products, services,
8    or supplies for hospital inpatient, hospital outpatient,
9    emergency room, ambulatory surgical treatment centers,
10    accredited ambulatory surgical treatment facilities,
11    prescriptions filled and dispensed outside of a licensed
12    pharmacy, dental services, and professional services. This
13    fee schedule shall be based on the fee schedule amounts
14    already established by the Commission pursuant to
15    subsection (a) of this Section. However, starting on
16    January 1, 2012, these fee schedule amounts shall be
17    grouped into geographic regions in the following manner:
18            (A) Four regions for non-hospital fee schedule
19        amounts shall be utilized:
20                (i) Cook County;
21                (ii) DuPage, Kane, Lake, and Will Counties;
22                (iii) Bond, Calhoun, Clinton, Jersey,
23            Macoupin, Madison, Monroe, Montgomery, Randolph,
24            St. Clair, and Washington Counties; and
25                (iv) All other counties of the State.
26            (B) Fourteen regions for hospital fee schedule

 

 

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1        amounts shall be utilized:
2                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
3            Kendall, and Grundy Counties;
4                (ii) Kankakee County;
5                (iii) Madison, St. Clair, Macoupin, Clinton,
6            Monroe, Jersey, Bond, and Calhoun Counties;
7                (iv) Winnebago and Boone Counties;
8                (v) Peoria, Tazewell, Woodford, Marshall, and
9            Stark Counties;
10                (vi) Champaign, Piatt, and Ford Counties;
11                (vii) Rock Island, Henry, and Mercer Counties;
12                (viii) Sangamon and Menard Counties;
13                (ix) McLean County;
14                (x) Lake County;
15                (xi) Macon County;
16                (xii) Vermilion County;
17                (xiii) Alexander County; and
18                (xiv) All other counties of the State.
19        (2) If a geozip, as defined in subsection (a) of this
20    Section, overlaps into one or more of the regions set forth
21    in this Section, then the Commission shall average or
22    repeat the charges and fees in a geozip in order to
23    designate charges and fees for each region.
24        (3) In cases where the compiled data contains less than
25    9 charges or fees for a procedure, treatment, product,
26    supply, or service or where the fee schedule amount cannot

 

 

SB1309- 89 -LRB100 08805 JLS 21036 b

1    be determined by the non-discounted charge data,
2    non-Medicare relative values and conversion factors
3    derived from established fee schedule amounts, coding
4    crosswalks, or other data as determined by the Commission,
5    reimbursement shall occur at 76% of charges and fees until
6    September 1, 2011 and 53.2% of charges and fees thereafter
7    as determined by the Commission in a manner consistent with
8    the provisions of this paragraph.
9        (4) To establish additional fee schedule amounts, the
10    Commission shall utilize provider non-discounted charge
11    data, non-Medicare relative values and conversion factors
12    derived from established fee schedule amounts, and coding
13    crosswalks. The Commission may establish additional fee
14    schedule amounts based on either the charge or cost of the
15    procedure, treatment, product, supply, or service.
16        (5) Implants shall be reimbursed at 25% above the net
17    manufacturer's invoice price less rebates, plus actual
18    reasonable and customary shipping charges whether or not
19    the implant charge is submitted by a provider in
20    conjunction with a bill for all other services associated
21    with the implant, submitted by a provider on a separate
22    claim form, submitted by a distributor, or submitted by the
23    manufacturer of the implant. "Implants" include the
24    following codes or any substantially similar updated code
25    as determined by the Commission: 0274
26    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens

 

 

SB1309- 90 -LRB100 08805 JLS 21036 b

1    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
2    (investigational devices); and 0636 (drugs requiring
3    detailed coding). Non-implantable devices or supplies
4    within these codes shall be reimbursed at 65% of actual
5    charge, which is the provider's normal rates under its
6    standard chargemaster. A standard chargemaster is the
7    provider's list of charges for procedures, treatments,
8    products, supplies, or services used to bill payers in a
9    consistent manner.
10        (6) The Commission shall automatically update all
11    codes and associated rules with the version of the codes
12    and rules valid on January 1 of that year.
13    The provisions of this subsection (a-1), other than this
14sentence, are inoperative after December 31, 2017.
15    (a-1.5) The following provisions shall apply to
16procedures, treatments, services, products, and supplies
17covered under this Act and rendered or to be rendered on or
18after January 1, 2018:
19        (1) As used in this Section:
20            "CPT code" means each current procedural
21        terminology code, for each geographic region specified
22        in subsection (b) of this Section, included on the most
23        recent medical fee schedule established by the
24        Commission pursuant to this Section.
25            "DRG code" means each current diagnosis related
26        group code, for each geographic region specified in

 

 

SB1309- 91 -LRB100 08805 JLS 21036 b

1        subsection (b) of this Section, included on the most
2        recent medical fee schedule established by the
3        Commission pursuant to this Section.
4            "Geozip" means a three-digit zip code based on data
5        similarities, geographical similarities, and
6        frequencies.
7            "Health care services" means those CPT and DRG
8        codes for procedures, treatments, products, services
9        or supplies for hospital inpatient, hospital
10        outpatient, emergency room, ambulatory surgical
11        treatment centers, accredited ambulatory surgical
12        treatment facilities, and professional services. It
13        does not include codes classified as health care common
14        procedure coding systems or dental.
15            "Medicare maximum fee" means, for each CPT and DRG
16        code, the current maximum fee for that CPT or DRG code
17        allowed to be charged by the Centers for Medicare and
18        Medicaid Services for Medicare patients in that
19        geographic region.
20            "Medicare percentage amount" means, for each CPT
21        and DRG code, the workers' compensation maximum fee as
22        a percentage of the Medicare maximum fee.
23            "Workers' compensation maximum fee" means, for
24        each CPT and DRG code, the current maximum fee allowed
25        to be charged under the medical fee schedule
26        established by the Commission for that CPT or DRG code

 

 

SB1309- 92 -LRB100 08805 JLS 21036 b

1        in that geographic region.
2        (2) The Commission shall establish and maintain fee
3    schedules for procedures, treatments, products, services,
4    or supplies for hospital inpatient, hospital outpatient,
5    emergency room, ambulatory surgical treatment centers,
6    accredited ambulatory surgical treatment facilities,
7    prescriptions filled and dispensed outside of a licensed
8    pharmacy, dental services, and professional services.
9    These fee schedule amounts shall be grouped into geographic
10    regions in the following manner:
11            (A) Four regions for non-hospital fee schedule
12        amounts shall be utilized:
13                (i) Cook County;
14                (ii) DuPage, Kane, Lake, and Will Counties;
15                (iii) Bond, Calhoun, Clinton, Jersey,
16            Macoupin, Madison, Monroe, Montgomery, Randolph,
17            St. Clair, and Washington Counties; and
18                (iv) all other counties of the State.
19            (B) Fourteen regions for hospital fee schedule
20        amounts shall be utilized:
21                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
22            Kendall, and Grundy Counties;
23                (ii) Kankakee County;
24                (iii) Madison, St. Clair, Macoupin, Clinton,
25            Monroe, Jersey, Bond, and Calhoun Counties;
26                (iv) Winnebago and Boone Counties;

 

 

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1                (v) Peoria, Tazewell, Woodford, Marshall, and
2            Stark Counties;
3                (vi) Champaign, Piatt, and Ford Counties;
4                (vii) Rock Island, Henry, and Mercer Counties;
5                (viii) Sangamon and Menard Counties;
6                (ix) McLean County;
7                (x) Lake County;
8                (xi) Macon County;
9                (xii) Vermilion County;
10                (xiii) Alexander County; and
11                (xiv) all other counties of the State.
12        If a geozip overlaps into one or more of the regions
13    set forth in this Section, then the Commission shall
14    average or repeat the charges and fees in a geozip in order
15    to designate charges and fees for each region.
16        (3) The initial workers' compensation maximum fee for
17    each CPR and DRG code as of January 1, 2018 shall be
18    determined as follows:
19            (A) Within 45 days after the effective date of this
20        amendatory Act of the 100th General Assembly, the
21        Commission shall determine the Medicare percentage
22        amount for each CPT and DRG code using the most recent
23        data available.
24            CPT or DRG codes which have a value, but are not
25        covered expenses under Medicare, are still compensable
26        under the medical fee schedule according to the rate

 

 

SB1309- 94 -LRB100 08805 JLS 21036 b

1        described in subparagraph (B).
2            (B) Within 30 days after the Commission makes the
3        determinations required by subparagraph (A), the
4        Commission shall determine an adjustment to be made to
5        the then-current workers' compensation maximum fee for
6        each CPT and DRG code as follows:
7                (i) If the Medicare percentage amount for that
8            CPT or DRG code is equal to or less than 125%, then
9            the workers' compensation maximum fee for that CPT
10            or DRG code shall be adjusted so that it equals
11            125% of the most recent Medicare maximum fee for
12            that CPT or DRG code.
13                (ii) If the Medicare percentage amount for
14            that CPT or DRG code is greater than 125% but less
15            than 150%, then the workers' compensation maximum
16            fee for that CPT or DRG code shall not be adjusted.
17                (iii) If the Medicare percentage amount for
18            that CPT or DRG code is greater than 150% but less
19            than or equal to 225%, then the workers'
20            compensation maximum fee for that CPT or DRG code
21            shall be adjusted so that it equals the greater of
22            (I) 150% of the most recent Medicare maximum fee
23            for that CPT or DRG code or (II) 85% of the most
24            recent workers' compensation maximum amount for
25            that CPT or DRG code.
26                (iv) If the Medicare percentage amount for

 

 

SB1309- 95 -LRB100 08805 JLS 21036 b

1            that CPT or DRG code is greater than 225% but less
2            than or equal to 428.57%, then the workers'
3            compensation maximum fee for that CPT or DRG code
4            shall be adjusted so that it equals the greater of
5            (I) 191.25% of the most recent Medicare maximum fee
6            for that CPT or DRG code or (II) 70% of the most
7            recent workers' compensation maximum amount for
8            that CPT or DRG code.
9                (v) If the Medicare percentage amount for that
10            CPT or DRG code is greater than 428.57%, then the
11            workers' compensation maximum fee for that CPT or
12            DRG code shall be adjusted so that it equals 300%
13            of the most recent Medicare maximum fee for that
14            CPT or DRG code.
15            The Commission shall promptly publish the
16        adjustments determined pursuant to this subparagraph
17        (B) on its website.
18            (C) The initial workers' compensation maximum fee
19        for each CPT and DRG code as of January 1, 2018 shall
20        be equal to the workers' compensation maximum fee for
21        that code as determined and adjusted pursuant to
22        subparagraph (B), subject to any further adjustments
23        made pursuant to paragraph (5) of this subsection.
24        (4)_The Commission, as of January 1, 2019 and January 1
25    of each year thereafter, shall adjust the workers'
26    compensation maximum fee for each CPT or DRG code to the

 

 

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1    most recent annual increase in the Consumer Price Index-U.
2        (5) A person who believes that the workers'
3    compensation maximum fee for a CPT or DRG code, as
4    otherwise determined pursuant to this subsection, creates,
5    or would create upon implementation, a significant
6    limitation on access to quality health care in either a
7    specific field of health care services or a specific
8    geographic limitation on access to health care may petition
9    the Commission to modify the workers' compensation maximum
10    fee for that CPT or DRG code so as to not create that
11    significant limitation.
12        The petitioner bears the burden of demonstrating, by a
13    preponderance of the credible evidence, that the workers'
14    compensation maximum fee that would otherwise apply would
15    create a significant limitation on access to quality health
16    care in either a specific field of health care services or
17    a specific geographic limitation on access to health care.
18    Petitions shall be made publicly available. Such credible
19    evidence shall include empirical data demonstrating a
20    significant limitation on access to quality health care.
21    Other interested persons may file comments or responses to
22    a petition within 30 days of the filing of a petition.
23        The Commission shall take final action on each petition
24    within 180 days of filing. The Commission may, but is not
25    required to, seek the recommendation of the Workers'
26    Compensation Medical Fee Advisory Board to assist with this

 

 

SB1309- 97 -LRB100 08805 JLS 21036 b

1    determination. If the Commission grants the petition, the
2    Commission shall further increase the workers'
3    compensation maximum fee for that CPT or DRG code by the
4    amount minimally necessary to avoid creating a significant
5    limitation on access to quality health care in either a
6    specific field of health care services or a specific
7    geographic limitation on access to health care. The
8    increased workers' compensation maximum fee shall take
9    effect upon entry of the Commission's final action.
10    (a-2) For procedures, treatments, services, or supplies
11covered under this Act and rendered or to be rendered on or
12after September 1, 2011, the maximum allowable payment shall be
1370% of the fee schedule amounts, which shall be adjusted yearly
14by the Consumer Price Index-U, as described in subsection (a)
15of this Section. The provisions of this subsection (a-2), other
16than this sentence, are inoperative after December 31, 2017.
17    (a-3) Prescriptions filled and dispensed outside of a
18licensed pharmacy shall be subject to a fee schedule that shall
19not exceed the Average Wholesale Price (AWP) plus a dispensing
20fee of $4.18. AWP or its equivalent as registered by the
21National Drug Code shall be set forth for that drug on that
22date as published in Medispan.
23    (a-4) The Commission, in consultation with the Workers'
24Compensation Medical Fee Advisory Board, shall adopt, by rule,
25an evidence-based drug formulary and any rules necessary for
26its administration. Prescriptions prescribed for workers'

 

 

SB1309- 98 -LRB100 08805 JLS 21036 b

1compensation cases shall be limited to those prescription drugs
2and doses on the closed formulary.
3    A request for a prescription that is not on the closed
4formulary shall be reviewed pursuant to Section 8.7 of this
5Act.
6    (b) (Blank). Notwithstanding the provisions of subsection
7(a), if the Commission finds that there is a significant
8limitation on access to quality health care in either a
9specific field of health care services or a specific geographic
10limitation on access to health care, it may change the Consumer
11Price Index-U increase or decrease for that specific field or
12specific geographic limitation on access to health care to
13address that limitation.
14    (c) The Commission shall establish by rule a process to
15review those medical cases or outliers that involve
16extra-ordinary treatment to determine whether to make an
17additional adjustment to the maximum payment within a fee
18schedule for a procedure, treatment, or service.
19    (d) When a patient notifies a provider that the treatment,
20procedure, or service being sought is for a work-related
21illness or injury and furnishes the provider the name and
22address of the responsible employer, the provider shall bill
23the employer directly. The employer shall make payment and
24providers shall submit bills and records in accordance with the
25provisions of this Section.
26        (1) All payments to providers for treatment provided

 

 

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1    pursuant to this Act shall be made within 30 days of
2    receipt of the bills as long as the claim contains
3    substantially all the required data elements necessary to
4    adjudicate the bills.
5        (2) If the claim does not contain substantially all the
6    required data elements necessary to adjudicate the bill, or
7    the claim is denied for any other reason, in whole or in
8    part, the employer or insurer shall provide written
9    notification, explaining the basis for the denial and
10    describing any additional necessary data elements, to the
11    provider within 30 days of receipt of the bill.
12        (3) In the case of nonpayment to a provider within 30
13    days of receipt of the bill which contained substantially
14    all of the required data elements necessary to adjudicate
15    the bill or nonpayment to a provider of a portion of such a
16    bill up to the lesser of the actual charge or the payment
17    level set by the Commission in the fee schedule established
18    in this Section, the bill, or portion of the bill, shall
19    incur interest at a rate of 1% per month payable to the
20    provider. Any required interest payments shall be made
21    within 30 days after payment.
22    (e) Except as provided in subsections (e-5), (e-10), and
23(e-15), a provider shall not hold an employee liable for costs
24related to a non-disputed procedure, treatment, or service
25rendered in connection with a compensable injury. The
26provisions of subsections (e-5), (e-10), (e-15), and (e-20)

 

 

SB1309- 100 -LRB100 08805 JLS 21036 b

1shall not apply if an employee provides information to the
2provider regarding participation in a group health plan. If the
3employee participates in a group health plan, the provider may
4submit a claim for services to the group health plan. If the
5claim for service is covered by the group health plan, the
6employee's responsibility shall be limited to applicable
7deductibles, co-payments, or co-insurance. Except as provided
8under subsections (e-5), (e-10), (e-15), and (e-20), a provider
9shall not bill or otherwise attempt to recover from the
10employee the difference between the provider's charge and the
11amount paid by the employer or the insurer on a compensable
12injury, or for medical services or treatment determined by the
13Commission to be excessive or unnecessary.
14    (e-5) If an employer notifies a provider that the employer
15does not consider the illness or injury to be compensable under
16this Act, the provider may seek payment of the provider's
17actual charges from the employee for any procedure, treatment,
18or service rendered. Once an employee informs the provider that
19there is 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-10) If an employer notifies a provider that the employer
3will pay only a portion of a bill for any procedure, treatment,
4or service rendered in connection with a compensable illness or
5disease, the provider may seek payment from the employee for
6the remainder of the amount of the bill up to the lesser of the
7actual charge, negotiated rate, if applicable, or the payment
8level set by the Commission in the fee schedule established in
9this Section. Once an employee informs the provider that there
10is an application filed with the Commission to resolve a
11dispute over payment of such charges, the provider shall cease
12any and all efforts to collect payment for the services that
13are the subject of the dispute. Any statute of limitations or
14statute of repose applicable to the provider's efforts to
15collect payment from the employee shall be tolled from the date
16that the employee files the application with the Commission
17until the date that the provider is permitted to resume
18collection efforts under the provisions of this Section.
19    (e-15) When there is a dispute over the compensability of
20or amount of payment for a procedure, treatment, or service,
21and a case is pending or proceeding before an Arbitrator or the
22Commission, the provider may mail the employee reminders that
23the employee will be responsible for payment of any procedure,
24treatment or service rendered by the provider. The reminders
25must state that they are not bills, to the extent practicable
26include itemized information, and state that the employee need

 

 

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1not pay until such time as the provider is permitted to resume
2collection efforts under this Section. The reminders shall not
3be provided to any credit rating agency. The reminders may
4request that the employee furnish the provider with information
5about the proceeding under this Act, such as the file number,
6names of parties, and status of the case. If an employee fails
7to respond to such request for information or fails to furnish
8the information requested within 90 days of the date of the
9reminder, the provider is entitled to resume any and all
10efforts to collect payment from the employee for the services
11rendered to the employee and the employee shall be responsible
12for payment of any outstanding bills for a procedure,
13treatment, or service rendered by a provider.
14    (e-20) Upon a final award or judgment by an Arbitrator or
15the Commission, or a settlement agreed to by the employer and
16the employee, a provider may resume any and all efforts to
17collect payment from the employee for the services rendered to
18the employee and the employee shall be responsible for payment
19of any outstanding bills for a procedure, treatment, or service
20rendered by a provider as well as the interest awarded under
21subsection (d) of this Section. In the case of a procedure,
22treatment, or service deemed compensable, the provider shall
23not require a payment rate, excluding the interest provisions
24under subsection (d), greater than the lesser of the actual
25charge or the payment level set by the Commission in the fee
26schedule established in this Section. Payment for services

 

 

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1deemed not covered or not compensable under this Act is the
2responsibility of the employee unless a provider and employee
3have agreed otherwise in writing. Services not covered or not
4compensable under this Act are not subject to the fee schedule
5in this Section.
6    (f) Nothing in this Act shall prohibit an employer or
7insurer from contracting with a health care provider or group
8of health care providers for reimbursement levels for benefits
9under this Act different from those provided in this Section.
10    (g) On or before January 1, 2010 the Commission shall
11provide to the Governor and General Assembly a report regarding
12the implementation of the medical fee schedule and the index
13used for annual adjustment to that schedule as described in
14this Section.
15(Source: P.A. 97-18, eff. 6-28-11.)
 
16    (820 ILCS 305/8.2a)
17    Sec. 8.2a. Electronic claims.
18    (a) The Director of Insurance shall adopt rules to do all
19of the following:
20        (1) Ensure that all health care providers and
21    facilities submit medical bills for payment on
22    standardized forms.
23        (2) Require acceptance by employers and insurers of
24    electronic claims for payment of medical services.
25        (3) Ensure confidentiality of medical information

 

 

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1    submitted on electronic claims for payment of medical
2    services.
3        (4) Ensure that the rules establishing electronic
4    claims include a specific enforcement mechanism to ensure
5    compliance with these rules.
6        (5) Ensure that health care providers have at least 15
7    business days to comply with records requested by employers
8    and insurers for the authorization of the payment of
9    workers' compensation claims.
10    (b) To the extent feasible, standards adopted pursuant to
11subdivision (a) shall be consistent with existing standards
12under the federal Health Insurance Portability and
13Accountability Act of 1996 and standards adopted under the
14Illinois Health Information Exchange and Technology Act.
15    (c) The rules requiring employers and insurers to accept
16electronic claims for payment of medical services shall be
17proposed on or before April 1, 2017 January 1, 2012, and shall
18require all employers and insurers to accept electronic claims
19for payment of medical services on or before October 1, 2017
20June 30, 2012.
21    (d) The Director of Insurance shall by rule establish
22criteria for granting exceptions to employers, insurance
23carriers, and health care providers who are unable to submit or
24accept medical bills electronically.
25    (e) The Commission, with assistance from the Department of
26Insurance and the Workers' Compensation Medical Fee Advisory

 

 

SB1309- 105 -LRB100 08805 JLS 21036 b

1Board, shall publish on its Internet website a companion guide
2to assist with compliance with electronic claims rules. The
3Workers' Compensation Medical Fee Advisory Board shall
4periodically review the companion guide.
5(Source: P.A. 97-18, eff. 6-28-11.)
 
6    (820 ILCS 305/8.7)
7    Sec. 8.7. Utilization review programs.
8    (a) As used in this Section:
9    "Utilization review" means the evaluation of proposed or
10provided health care services to determine the appropriateness
11of both the level of health care services medically necessary
12and the quality of health care services provided to a patient,
13including evaluation of their efficiency, efficacy, and
14appropriateness of treatment, hospitalization, or office
15visits based on medically accepted standards. The evaluation
16must be accomplished by means of a system that identifies the
17utilization of health care services based on standards of care
18of nationally recognized peer review guidelines as well as
19nationally recognized treatment guidelines and evidence-based
20medicine based upon standards as provided in this Act.
21Utilization techniques may include prospective review, second
22opinions, concurrent review, discharge planning, peer review,
23independent medical examinations, and retrospective review
24(for purposes of this sentence, retrospective review shall be
25applicable to services rendered on or after July 20, 2005).

 

 

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1Nothing in this Section applies to prospective review of
2necessary first aid or emergency treatment.
3    (b) No person may conduct a utilization review program for
4workers' compensation services in this State unless once every
52 years the person registers the utilization review program
6with the Department of Insurance and certifies compliance with
7the Workers' Compensation Utilization Management standards or
8Health Utilization Management Standards of URAC sufficient to
9achieve URAC accreditation or submits evidence of
10accreditation by URAC for its Workers' Compensation
11Utilization Management Standards or Health Utilization
12Management Standards. Nothing in this Act shall be construed to
13require an employer or insurer or its subcontractors to become
14URAC accredited.
15    (c) In addition, the Director of Insurance may certify
16alternative utilization review standards of national
17accreditation organizations or entities in order for plans to
18comply with this Section. Any alternative utilization review
19standards shall meet or exceed those standards required under
20subsection (b).
21    (d) This registration shall include submission of all of
22the following information regarding utilization review program
23activities:
24        (1) The name, address, and telephone number of the
25    utilization review programs.
26        (2) The organization and governing structure of the

 

 

SB1309- 107 -LRB100 08805 JLS 21036 b

1    utilization review programs.
2        (3) The number of lives for which utilization review is
3    conducted by each utilization review program.
4        (4) Hours of operation of each utilization review
5    program.
6        (5) Description of the grievance process for each
7    utilization review program.
8        (6) Number of covered lives for which utilization
9    review was conducted for the previous calendar year for
10    each utilization review program.
11        (7) Written policies and procedures for protecting
12    confidential information according to applicable State and
13    federal laws for each utilization review program.
14    (e) A utilization review program shall have written
15procedures to ensure that patient-specific information
16obtained during the process of utilization review will be:
17        (1) kept confidential in accordance with applicable
18    State and federal laws; and
19        (2) shared only with the employee, the employee's
20    designee, and the employee's health care provider, and
21    those who are authorized by law to receive the information.
22    Summary data shall not be considered confidential if it
23    does not provide information to allow identification of
24    individual patients or health care providers.
25    Only a health care professional may make determinations
26regarding the medical necessity of health care services during

 

 

SB1309- 108 -LRB100 08805 JLS 21036 b

1the course of utilization review.
2    When making retrospective reviews, utilization review
3programs shall base reviews solely on the medical information
4available to the attending physician or ordering provider at
5the time the health care services were provided.
6    (f) If the Department of Insurance finds that a utilization
7review program is not in compliance with this Section, the
8Department shall issue a corrective action plan and allow a
9reasonable amount of time for compliance with the plan. If the
10utilization review program does not come into compliance, the
11Department may issue a cease and desist order. Before issuing a
12cease and desist order under this Section, the Department shall
13provide the utilization review program with a written notice of
14the reasons for the order and allow a reasonable amount of time
15to supply additional information demonstrating compliance with
16the requirements of this Section and to request a hearing. The
17hearing notice shall be sent by certified mail, return receipt
18requested, and the hearing shall be conducted in accordance
19with the Illinois Administrative Procedure Act.
20    (g) A utilization review program subject to a corrective
21action may continue to conduct business until a final decision
22has been issued by the Department.
23    (h) The Department of Insurance may by rule establish a
24registration fee for each person conducting a utilization
25review program.
26    (i) Upon receipt of written notice that the employer or the

 

 

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1employer's agent or insurer wishes to invoke the utilization
2review process, the provider of medical, surgical, or hospital
3services shall submit to the utilization review, following
4accredited procedural guidelines.
5        (1) The provider shall make reasonable efforts to
6    provide timely and complete reports of clinical
7    information needed to support a request for treatment. If
8    the provider fails to make such reasonable efforts, the
9    charges for the treatment or service may not be compensable
10    nor collectible by the provider or claimant from the
11    employer, the employer's agent, or the employee. The
12    reporting obligations of providers shall not be
13    unreasonable or unduly burdensome. The Commission shall by
14    rule establish an enforcement mechanism to ensure
15    compliance.
16        (2) Written notice of utilization review decisions,
17    including the clinical rationale for certification or
18    non-certification and references to applicable standards
19    of care or evidence-based medical guidelines, shall be
20    furnished to the provider and employee.
21        (3) An employer may only deny payment of or refuse to
22    authorize payment of medical services rendered or proposed
23    to be rendered on the grounds that the extent and scope of
24    medical treatment is excessive and unnecessary in
25    compliance with an accredited utilization review program
26    under this Section.

 

 

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1        (4) When a payment for medical services has been denied
2    or not authorized by an employer or when authorization for
3    medical services is denied pursuant to utilization review,
4    the employee has the burden of proof to show by a
5    preponderance of the evidence that a variance from the
6    standards of care used by the person or entity performing
7    the utilization review pursuant to subsection (a) is
8    reasonably required to cure or relieve the effects of his
9    or her injury.
10        (5) The medical professional responsible for review in
11    the final stage of utilization review or appeal must be
12    available in this State for interview or deposition; or
13    must be available for deposition by telephone, video
14    conference, or other remote electronic means. A medical
15    professional who works or resides in this State or outside
16    of this State may comply with this requirement by making
17    himself or herself available for an interview or deposition
18    in person or by making himself or herself available by
19    telephone, video conference, or other remote electronic
20    means. The remote interview or deposition shall be
21    conducted in a fair, open, and cost-effective manner. The
22    expense of interview and the deposition method shall be
23    paid by the employer. The deponent shall be in the presence
24    of the officer administering the oath and recording the
25    deposition, unless otherwise agreed by the parties. Any
26    exhibits or other demonstrative evidence to be presented to

 

 

SB1309- 111 -LRB100 08805 JLS 21036 b

1    the deponent by any party at the deposition shall be
2    provided to the officer administering the oath and all
3    other parties within a reasonable period of time prior to
4    the deposition. Nothing shall prohibit any party from being
5    with the deponent during the deposition, at that party's
6    expense; provided, however, that a party attending a
7    deposition shall give written notice of that party's
8    intention to appear at the deposition to all other parties
9    within a reasonable time prior to the deposition.
10    An admissible utilization review shall be considered by the
11Commission, along with all other evidence and in the same
12manner as all other evidence, and must be addressed along with
13all other evidence in the determination of the reasonableness
14and necessity of the medical bills or treatment. Nothing in
15this Section shall be construed to diminish the rights of
16employees to reasonable and necessary medical treatment or
17employee choice of health care provider under Section 8(a) or
18the rights of employers to medical examinations under Section
1912.
20    (j) When an employer denies payment of or refuses to
21authorize payment of first aid, medical, surgical, or hospital
22services under Section 8(a) of this Act, if that denial or
23refusal to authorize complies with a utilization review program
24registered under this Section and complies with all other
25requirements of this Section, then there shall be a rebuttable
26presumption that the employer shall not be responsible for

 

 

SB1309- 112 -LRB100 08805 JLS 21036 b

1payment of additional compensation pursuant to Section 19(k) of
2this Act and if that denial or refusal to authorize does not
3comply with a utilization review program registered under this
4Section and does not comply with all other requirements of this
5Section, then that will be considered by the Commission, along
6with all other evidence and in the same manner as all other
7evidence, in the determination of whether the employer may be
8responsible for the payment of additional compensation
9pursuant to Section 19(k) of this Act.
10    (k) For injuries occurring on or after March 1, 2017, an
11employee shall be entitled to no more than 24 chiropractic,
12occupational therapy, or physical therapy visits per claim.
13This limit shall not apply when an employer or insurer
14authorizes, in writing, additional visits for chiropractic,
15occupational therapy, or physical therapy services. This limit
16shall not apply to visits for post-surgical rehabilitation
17services.
18    The changes to this Section made by this amendatory Act of
19the 97th General Assembly apply only to health care services
20provided or proposed to be provided on or after September 1,
212011.
22(Source: P.A. 97-18, eff. 6-28-11.)
 
23    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
24    Sec. 14. The Commission shall appoint a secretary, an
25assistant secretary, and arbitrators and shall employ such

 

 

SB1309- 113 -LRB100 08805 JLS 21036 b

1assistants and clerical help as may be necessary. Arbitrators
2shall be appointed pursuant to this Section, notwithstanding
3any provision of the Personnel Code.
4    Each arbitrator appointed after June 28, 2011 shall be
5required to demonstrate in writing his or her knowledge of and
6expertise in the law of and judicial processes of the Workers'
7Compensation Act and the Workers' Occupational Diseases Act.
8    A formal training program for newly-hired arbitrators
9shall be implemented. The training program shall include the
10following:
11        (a) substantive and procedural aspects of the
12    arbitrator position;
13        (b) current issues in workers' compensation law and
14    practice;
15        (c) medical lectures by specialists in areas such as
16    orthopedics, ophthalmology, psychiatry, rehabilitation
17    counseling;
18        (d) orientation to each operational unit of the
19    Illinois Workers' Compensation Commission;
20        (e) observation of experienced arbitrators conducting
21    hearings of cases, combined with the opportunity to discuss
22    evidence presented and rulings made;
23        (f) the use of hypothetical cases requiring the trainee
24    to issue judgments as a means to evaluating knowledge and
25    writing ability;
26        (g) writing skills;

 

 

SB1309- 114 -LRB100 08805 JLS 21036 b

1        (h) professional and ethical standards pursuant to
2    Section 1.1 of this Act;
3        (i) detection of workers' compensation fraud and
4    reporting obligations of Commission employees and
5    appointees;
6        (j) standards of evidence-based medical treatment and
7    best practices for measuring and improving quality and
8    health care outcomes in the workers' compensation system,
9    including but not limited to the use of the American
10    Medical Association's "Guides to the Evaluation of
11    Permanent Impairment" and the practice of utilization
12    review; and
13        (k) substantive and procedural aspects of coal
14    workers' pneumoconiosis (black lung) cases.
15    A formal and ongoing professional development program
16including, but not limited to, the above-noted areas shall be
17implemented to keep arbitrators informed of recent
18developments and issues and to assist them in maintaining and
19enhancing their professional competence. Each arbitrator shall
20complete 20 hours of training in the above-noted areas during
21every 2 years such arbitrator shall remain in office.
22    Each arbitrator shall devote full time to his or her duties
23and shall serve when assigned as an acting Commissioner when a
24Commissioner is unavailable in accordance with the provisions
25of Section 13 of this Act. Any arbitrator who is an
26attorney-at-law shall not engage in the practice of law, nor

 

 

SB1309- 115 -LRB100 08805 JLS 21036 b

1shall any arbitrator hold any other office or position of
2profit under the United States or this State or any municipal
3corporation or political subdivision of this State.
4Notwithstanding any other provision of this Act to the
5contrary, an arbitrator who serves as an acting Commissioner in
6accordance with the provisions of Section 13 of this Act shall
7continue to serve in the capacity of Commissioner until a
8decision is reached in every case heard by that arbitrator
9while serving as an acting Commissioner.
10    Notwithstanding any other provision of this Section, the
11term of all arbitrators serving on June 28, 2011 (the effective
12date of Public Act 97-18), including any arbitrators on
13administrative leave, shall terminate at the close of business
14on July 1, 2011, but the incumbents shall continue to exercise
15all of their duties until they are reappointed or their
16successors are appointed.
17    On and after June 28, 2011 (the effective date of Public
18Act 97-18), arbitrators shall be appointed to 3-year terms as
19follows:
20        (1) All appointments shall be made by the Governor with
21    the advice and consent of the Senate.
22        (2) For their initial appointments, 12 arbitrators
23    shall be appointed to terms expiring July 1, 2012; 12
24    arbitrators shall be appointed to terms expiring July 1,
25    2013; and all additional arbitrators shall be appointed to
26    terms expiring July 1, 2014. Thereafter, all arbitrators

 

 

SB1309- 116 -LRB100 08805 JLS 21036 b

1    shall be appointed to 3-year terms.
2    Upon the expiration of a term, the Chairman shall evaluate
3the performance of the arbitrator and may recommend to the
4Governor that he or she be reappointed to a second or
5subsequent term by the Governor with the advice and consent of
6the Senate.
7    Each arbitrator appointed on or after June 28, 2011 (the
8effective date of Public Act 97-18) and who has not previously
9served as an arbitrator for the Commission shall be required to
10be authorized to practice law in this State by the Supreme
11Court, and to maintain this authorization throughout his or her
12term of employment.
13    The performance of all arbitrators shall be reviewed by the
14Chairman on an annual basis. The Chairman shall allow input
15from the Commissioners in all such reviews.
16    The Commission shall assign no fewer than 3 arbitrators to
17each hearing site. The Commission shall establish a procedure
18to ensure that the arbitrators assigned to each hearing site
19are assigned cases on a random basis. The Chairman of the
20Workers' Compensation Commission shall have discretion to
21assign and reassign arbitrators to each hearing site as needed.
22No arbitrator shall hear cases in any county, other than Cook
23County, for more than 2 years in each 3-year term.
24    The Secretary and each arbitrator shall receive a per annum
25salary of $4,000 less than the per annum salary of members of
26The Illinois Workers' Compensation Commission as provided in

 

 

SB1309- 117 -LRB100 08805 JLS 21036 b

1Section 13 of this Act, payable in equal monthly installments.
2    The members of the Commission, Arbitrators and other
3employees whose duties require them to travel, shall have
4reimbursed to them their actual traveling expenses and
5disbursements made or incurred by them in the discharge of
6their official duties while away from their place of residence
7in the performance of their duties.
8    The Commission shall provide itself with a seal for the
9authentication of its orders, awards and proceedings upon which
10shall be inscribed the name of the Commission and the words
11"Illinois--Seal".
12    The Secretary or Assistant Secretary, under the direction
13of the Commission, shall have charge and custody of the seal of
14the Commission and also have charge and custody of all records,
15files, orders, proceedings, decisions, awards and other
16documents on file with the Commission. He shall furnish
17certified copies, under the seal of the Commission, of any such
18records, files, orders, proceedings, decisions, awards and
19other documents on file with the Commission as may be required.
20Certified copies so furnished by the Secretary or Assistant
21Secretary shall be received in evidence before the Commission
22or any Arbitrator thereof, and in all courts, provided that the
23original of such certified copy is otherwise competent and
24admissible in evidence. The Secretary or Assistant Secretary
25shall perform such other duties as may be prescribed from time
26to time by the Commission.

 

 

SB1309- 118 -LRB100 08805 JLS 21036 b

1(Source: P.A. 98-40, eff. 6-28-13; 99-642, eff. 7-28-16.)
 
2    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
3    Sec. 19. Any disputed questions of law or fact shall be
4determined as herein provided.
5    (a) It shall be the duty of the Commission upon
6notification that the parties have failed to reach an
7agreement, to designate an Arbitrator.
8        1. Whenever any claimant misconceives his remedy and
9    files an application for adjustment of claim under this Act
10    and it is subsequently discovered, at any time before final
11    disposition of such cause, that the claim for disability or
12    death which was the basis for such application should
13    properly have been made under the Workers' Occupational
14    Diseases Act, then the provisions of Section 19, paragraph
15    (a-1) of the Workers' Occupational Diseases Act having
16    reference to such application shall apply.
17        2. Whenever any claimant misconceives his remedy and
18    files an application for adjustment of claim under the
19    Workers' Occupational Diseases Act and it is subsequently
20    discovered, at any time before final disposition of such
21    cause that the claim for injury or death which was the
22    basis for such application should properly have been made
23    under this Act, then the application so filed under the
24    Workers' Occupational Diseases Act may be amended in form,
25    substance or both to assert claim for such disability or

 

 

SB1309- 119 -LRB100 08805 JLS 21036 b

1    death under this Act and it shall be deemed to have been so
2    filed as amended on the date of the original filing
3    thereof, and such compensation may be awarded as is
4    warranted by the whole evidence pursuant to this Act. When
5    such amendment is submitted, further or additional
6    evidence may be heard by the Arbitrator or Commission when
7    deemed necessary. Nothing in this Section contained shall
8    be construed to be or permit a waiver of any provisions of
9    this Act with reference to notice but notice if given shall
10    be deemed to be a notice under the provisions of this Act
11    if given within the time required herein.
12        3. When an Arbitrator conducts a status call of cases
13    that appear on the Arbitrator's docket in accordance with
14    the rules of the Commission, parties or their attorneys may
15    appear by telephone, video conference, or other remote
16    electronic means as prescribed by the Commission.
17    (b) The Arbitrator shall make such inquiries and
18investigations as he or they shall deem necessary and may
19examine and inspect all books, papers, records, places, or
20premises relating to the questions in dispute and hear such
21proper evidence as the parties may submit.
22    The hearings before the Arbitrator shall be held in the
23vicinity where the injury occurred after 10 days' notice of the
24time and place of such hearing shall have been given to each of
25the parties or their attorneys of record.
26    The Arbitrator may find that the disabling condition is

 

 

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1temporary and has not yet reached a permanent condition and may
2order the payment of compensation up to the date of the
3hearing, which award shall be reviewable and enforceable in the
4same manner as other awards, and in no instance be a bar to a
5further hearing and determination of a further amount of
6temporary total compensation or of compensation for permanent
7disability, but shall be conclusive as to all other questions
8except the nature and extent of said disability.
9    The decision of the Arbitrator shall be filed with the
10Commission which Commission shall immediately send to each
11party or his attorney a copy of such decision, together with a
12notification of the time when it was filed. As of the effective
13date of this amendatory Act of the 94th General Assembly, all
14decisions of the Arbitrator shall set forth in writing findings
15of fact and conclusions of law, separately stated, if requested
16by either party. Unless a petition for review is filed by
17either party within 30 days after the receipt by such party of
18the copy of the decision and notification of time when filed,
19and unless such party petitioning for a review shall within 35
20days after the receipt by him of the copy of the decision, file
21with the Commission either an agreed statement of the facts
22appearing upon the hearing before the Arbitrator, or if such
23party shall so elect a correct transcript of evidence of the
24proceedings at such hearings, then the decision shall become
25the decision of the Commission and in the absence of fraud
26shall be conclusive. The Petition for Review shall contain a

 

 

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1statement of the petitioning party's specific exceptions to the
2decision of the arbitrator. The jurisdiction of the Commission
3to review the decision of the arbitrator shall not be limited
4to the exceptions stated in the Petition for Review. The
5Commission, or any member thereof, may grant further time not
6exceeding 30 days, in which to file such agreed statement or
7transcript of evidence. Such agreed statement of facts or
8correct transcript of evidence, as the case may be, shall be
9authenticated by the signatures of the parties or their
10attorneys, and in the event they do not agree as to the
11correctness of the transcript of evidence it shall be
12authenticated by the signature of the Arbitrator designated by
13the Commission.
14    Whether the employee is working or not, if the employee is
15not receiving or has not received medical, surgical, or
16hospital services or other services or compensation as provided
17in paragraph (a) of Section 8, or compensation as provided in
18paragraph (b) of Section 8, the employee may at any time
19petition for an expedited hearing by an Arbitrator on the issue
20of whether or not he or she is entitled to receive payment of
21the services or compensation. Provided the employer continues
22to pay compensation pursuant to paragraph (b) of Section 8, the
23employer may at any time petition for an expedited hearing on
24the issue of whether or not the employee is entitled to receive
25medical, surgical, or hospital services or other services or
26compensation as provided in paragraph (a) of Section 8, or

 

 

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1compensation as provided in paragraph (b) of Section 8. When an
2employer has petitioned for an expedited hearing, the employer
3shall continue to pay compensation as provided in paragraph (b)
4of Section 8 unless the arbitrator renders a decision that the
5employee is not entitled to the benefits that are the subject
6of the expedited hearing or unless the employee's treating
7physician has released the employee to return to work at his or
8her regular job with the employer or the employee actually
9returns to work at any other job. If the arbitrator renders a
10decision that the employee is not entitled to the benefits that
11are the subject of the expedited hearing, a petition for review
12filed by the employee shall receive the same priority as if the
13employee had filed a petition for an expedited hearing by an
14Arbitrator. Neither party shall be entitled to an expedited
15hearing when the employee has returned to work and the sole
16issue in dispute amounts to less than 12 weeks of unpaid
17compensation pursuant to paragraph (b) of Section 8.
18    Expedited hearings shall have priority over all other
19petitions and shall be heard by the Arbitrator and Commission
20with all convenient speed. Any party requesting an expedited
21hearing shall give notice of a request for an expedited hearing
22under this paragraph. A copy of the Application for Adjustment
23of Claim shall be attached to the notice. The Commission shall
24adopt rules and procedures under which the final decision of
25the Commission under this paragraph is filed not later than 180
26days from the date that the Petition for Review is filed with

 

 

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1the Commission.
2    Where 2 or more insurance carriers, private self-insureds,
3or a group workers' compensation pool under Article V 3/4 of
4the Illinois Insurance Code dispute coverage for the same
5injury, any such insurance carrier, private self-insured, or
6group workers' compensation pool may request an expedited
7hearing pursuant to this paragraph to determine the issue of
8coverage, provided coverage is the only issue in dispute and
9all other issues are stipulated and agreed to and further
10provided that all compensation benefits including medical
11benefits pursuant to Section 8(a) continue to be paid to or on
12behalf of petitioner. Any insurance carrier, private
13self-insured, or group workers' compensation pool that is
14determined to be liable for coverage for the injury in issue
15shall reimburse any insurance carrier, private self-insured,
16or group workers' compensation pool that has paid benefits to
17or on behalf of petitioner for the injury.
18    (b-1) If the employee is not receiving medical, surgical or
19hospital services as provided in paragraph (a) of Section 8 or
20compensation as provided in paragraph (b) of Section 8, the
21employee, in accordance with Commission Rules, may file a
22petition for an emergency hearing by an Arbitrator on the issue
23of whether or not he is entitled to receive payment of such
24compensation or services as provided therein. Such petition
25shall have priority over all other petitions and shall be heard
26by the Arbitrator and Commission with all convenient speed.

 

 

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1    Such petition shall contain the following information and
2shall be served on the employer at least 15 days before it is
3filed:
4        (i) the date and approximate time of accident;
5        (ii) the approximate location of the accident;
6        (iii) a description of the accident;
7        (iv) the nature of the injury incurred by the employee;
8        (v) the identity of the person, if known, to whom the
9    accident was reported and the date on which it was
10    reported;
11        (vi) the name and title of the person, if known,
12    representing the employer with whom the employee conferred
13    in any effort to obtain compensation pursuant to paragraph
14    (b) of Section 8 of this Act or medical, surgical or
15    hospital services pursuant to paragraph (a) of Section 8 of
16    this Act and the date of such conference;
17        (vii) a statement that the employer has refused to pay
18    compensation pursuant to paragraph (b) of Section 8 of this
19    Act or for medical, surgical or hospital services pursuant
20    to paragraph (a) of Section 8 of this Act;
21        (viii) the name and address, if known, of each witness
22    to the accident and of each other person upon whom the
23    employee will rely to support his allegations;
24        (ix) the dates of treatment related to the accident by
25    medical practitioners, and the names and addresses of such
26    practitioners, including the dates of treatment related to

 

 

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1    the accident at any hospitals and the names and addresses
2    of such hospitals, and a signed authorization permitting
3    the employer to examine all medical records of all
4    practitioners and hospitals named pursuant to this
5    paragraph;
6        (x) a copy of a signed report by a medical
7    practitioner, relating to the employee's current inability
8    to return to work because of the injuries incurred as a
9    result of the accident or such other documents or
10    affidavits which show that the employee is entitled to
11    receive compensation pursuant to paragraph (b) of Section 8
12    of this Act or medical, surgical or hospital services
13    pursuant to paragraph (a) of Section 8 of this Act. Such
14    reports, documents or affidavits shall state, if possible,
15    the history of the accident given by the employee, and
16    describe the injury and medical diagnosis, the medical
17    services for such injury which the employee has received
18    and is receiving, the physical activities which the
19    employee cannot currently perform as a result of any
20    impairment or disability due to such injury, and the
21    prognosis for recovery;
22        (xi) complete copies of any reports, records,
23    documents and affidavits in the possession of the employee
24    on which the employee will rely to support his allegations,
25    provided that the employer shall pay the reasonable cost of
26    reproduction thereof;

 

 

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1        (xii) a list of any reports, records, documents and
2    affidavits which the employee has demanded by subpoena and
3    on which he intends to rely to support his allegations;
4        (xiii) a certification signed by the employee or his
5    representative that the employer has received the petition
6    with the required information 15 days before filing.
7    Fifteen days after receipt by the employer of the petition
8with the required information the employee may file said
9petition and required information and shall serve notice of the
10filing upon the employer. The employer may file a motion
11addressed to the sufficiency of the petition. If an objection
12has been filed to the sufficiency of the petition, the
13arbitrator shall rule on the objection within 2 working days.
14If such an objection is filed, the time for filing the final
15decision of the Commission as provided in this paragraph shall
16be tolled until the arbitrator has determined that the petition
17is sufficient.
18    The employer shall, within 15 days after receipt of the
19notice that such petition is filed, file with the Commission
20and serve on the employee or his representative a written
21response to each claim set forth in the petition, including the
22legal and factual basis for each disputed allegation and the
23following information: (i) complete copies of any reports,
24records, documents and affidavits in the possession of the
25employer on which the employer intends to rely in support of
26his response, (ii) a list of any reports, records, documents

 

 

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1and affidavits which the employer has demanded by subpoena and
2on which the employer intends to rely in support of his
3response, (iii) the name and address of each witness on whom
4the employer will rely to support his response, and (iv) the
5names and addresses of any medical practitioners selected by
6the employer pursuant to Section 12 of this Act and the time
7and place of any examination scheduled to be made pursuant to
8such Section.
9    Any employer who does not timely file and serve a written
10response without good cause may not introduce any evidence to
11dispute any claim of the employee but may cross examine the
12employee or any witness brought by the employee and otherwise
13be heard.
14    No document or other evidence not previously identified by
15either party with the petition or written response, or by any
16other means before the hearing, may be introduced into evidence
17without good cause. If, at the hearing, material information is
18discovered which was not previously disclosed, the Arbitrator
19may extend the time for closing proof on the motion of a party
20for a reasonable period of time which may be more than 30 days.
21No evidence may be introduced pursuant to this paragraph as to
22permanent disability. No award may be entered for permanent
23disability pursuant to this paragraph. Either party may
24introduce into evidence the testimony taken by deposition of
25any medical practitioner.
26    The Commission shall adopt rules, regulations and

 

 

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1procedures whereby the final decision of the Commission is
2filed not later than 90 days from the date the petition for
3review is filed but in no event later than 180 days from the
4date the petition for an emergency hearing is filed with the
5Illinois Workers' Compensation Commission.
6    All service required pursuant to this paragraph (b-1) must
7be by personal service or by certified mail and with evidence
8of receipt. In addition for the purposes of this paragraph, all
9service on the employer must be at the premises where the
10accident occurred if the premises are owned or operated by the
11employer. Otherwise service must be at the employee's principal
12place of employment by the employer. If service on the employer
13is not possible at either of the above, then service shall be
14at the employer's principal place of business. After initial
15service in each case, service shall be made on the employer's
16attorney or designated representative.
17    (c)(1) At a reasonable time in advance of and in connection
18with the hearing under Section 19(e) or 19(h), the Commission
19may on its own motion order an impartial physical or mental
20examination of a petitioner whose mental or physical condition
21is in issue, when in the Commission's discretion it appears
22that such an examination will materially aid in the just
23determination of the case. The examination shall be made by a
24member or members of a panel of physicians chosen for their
25special qualifications by the Illinois State Medical Society.
26The Commission shall establish procedures by which a physician

 

 

SB1309- 129 -LRB100 08805 JLS 21036 b

1shall be selected from such list.
2    (2) Should the Commission at any time during the hearing
3find that compelling considerations make it advisable to have
4an examination and report at that time, the commission may in
5its discretion so order.
6    (3) A copy of the report of examination shall be given to
7the Commission and to the attorneys for the parties.
8    (4) Either party or the Commission may call the examining
9physician or physicians to testify. Any physician so called
10shall be subject to cross-examination.
11    (5) The examination shall be made, and the physician or
12physicians, if called, shall testify, without cost to the
13parties. The Commission shall determine the compensation and
14the pay of the physician or physicians. The compensation for
15this service shall not exceed the usual and customary amount
16for such service.
17    (6) The fees and payment thereof of all attorneys and
18physicians for services authorized by the Commission under this
19Act shall, upon request of either the employer or the employee
20or the beneficiary affected, be subject to the review and
21decision of the Commission.
22    (d) If any employee shall persist in insanitary or
23injurious practices which tend to either imperil or retard his
24recovery or shall refuse to submit to such medical, surgical,
25or hospital treatment as is reasonably essential to promote his
26recovery, the Commission may, in its discretion, reduce or

 

 

SB1309- 130 -LRB100 08805 JLS 21036 b

1suspend the compensation of any such injured employee. However,
2when an employer and employee so agree in writing, the
3foregoing provision shall not be construed to authorize the
4reduction or suspension of compensation of an employee who is
5relying in good faith, on treatment by prayer or spiritual
6means alone, in accordance with the tenets and practice of a
7recognized church or religious denomination, by a duly
8accredited practitioner thereof.
9    (e) This paragraph shall apply to all hearings before the
10Commission. Such hearings may be held in its office or
11elsewhere as the Commission may deem advisable. The taking of
12testimony on such hearings may be had before any member of the
13Commission. If a petition for review and agreed statement of
14facts or transcript of evidence is filed, as provided herein,
15the Commission shall promptly review the decision of the
16Arbitrator and all questions of law or fact which appear from
17the statement of facts or transcript of evidence.
18    In all cases in which the hearing before the arbitrator is
19held after December 18, 1989, no additional evidence shall be
20introduced by the parties before the Commission on review of
21the decision of the Arbitrator. In reviewing decisions of an
22arbitrator the Commission shall award such temporary
23compensation, permanent compensation and other payments as are
24due under this Act. The Commission shall file in its office its
25decision thereon, and shall immediately send to each party or
26his attorney a copy of such decision and a notification of the

 

 

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1time when it was filed. Decisions shall be filed within 60 days
2after the Statement of Exceptions and Supporting Brief and
3Response thereto are required to be filed or oral argument
4whichever is later.
5    In the event either party requests oral argument, such
6argument shall be had before a panel of 3 members of the
7Commission (or before all available members pursuant to the
8determination of 7 members of the Commission that such argument
9be held before all available members of the Commission)
10pursuant to the rules and regulations of the Commission. A
11panel of 3 members, which shall be comprised of not more than
12one representative citizen of the employing class and not more
13than one representative citizen of the employee class, shall
14hear the argument; provided that if all the issues in dispute
15are solely the nature and extent of the permanent partial
16disability, if any, a majority of the panel may deny the
17request for such argument and such argument shall not be held;
18and provided further that 7 members of the Commission may
19determine that the argument be held before all available
20members of the Commission. A decision of the Commission shall
21be approved by a majority of Commissioners present at such
22hearing if any; provided, if no such hearing is held, a
23decision of the Commission shall be approved by a majority of a
24panel of 3 members of the Commission as described in this
25Section. The Commission shall give 10 days' notice to the
26parties or their attorneys of the time and place of such taking

 

 

SB1309- 132 -LRB100 08805 JLS 21036 b

1of testimony and of such argument.
2    In any case the Commission in its decision may find
3specially upon any question or questions of law or fact which
4shall be submitted in writing by either party whether ultimate
5or otherwise; provided that on issues other than nature and
6extent of the disability, if any, the Commission in its
7decision shall find specially upon any question or questions of
8law or fact, whether ultimate or otherwise, which are submitted
9in writing by either party; provided further that not more than
105 such questions may be submitted by either party. Any party
11may, within 20 days after receipt of notice of the Commission's
12decision, or within such further time, not exceeding 30 days,
13as the Commission may grant, file with the Commission either an
14agreed statement of the facts appearing upon the hearing, or,
15if such party shall so elect, a correct transcript of evidence
16of the additional proceedings presented before the Commission,
17in which report the party may embody a correct statement of
18such other proceedings in the case as such party may desire to
19have reviewed, such statement of facts or transcript of
20evidence to be authenticated by the signature of the parties or
21their attorneys, and in the event that they do not agree, then
22the authentication of such transcript of evidence shall be by
23the signature of any member of the Commission.
24    If a reporter does not for any reason furnish a transcript
25of the proceedings before the Arbitrator in any case for use on
26a hearing for review before the Commission, within the

 

 

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1limitations of time as fixed in this Section, the Commission
2may, in its discretion, order a trial de novo before the
3Commission in such case upon application of either party. The
4applications for adjustment of claim and other documents in the
5nature of pleadings filed by either party, together with the
6decisions of the Arbitrator and of the Commission and the
7statement of facts or transcript of evidence hereinbefore
8provided for in paragraphs (b) and (c) shall be the record of
9the proceedings of the Commission, and shall be subject to
10review as hereinafter provided.
11    At the request of either party or on its own motion, the
12Commission shall set forth in writing the reasons for the
13decision, including findings of fact and conclusions of law
14separately stated. The Commission shall by rule adopt a format
15for written decisions for the Commission and arbitrators. The
16written decisions shall be concise and shall succinctly state
17the facts and reasons for the decision. The Commission may
18adopt in whole or in part, the decision of the arbitrator as
19the decision of the Commission. When the Commission does so
20adopt the decision of the arbitrator, it shall do so by order.
21Whenever the Commission adopts part of the arbitrator's
22decision, but not all, it shall include in the order the
23reasons for not adopting all of the arbitrator's decision. When
24a majority of a panel, after deliberation, has arrived at its
25decision, the decision shall be filed as provided in this
26Section without unnecessary delay, and without regard to the

 

 

SB1309- 134 -LRB100 08805 JLS 21036 b

1fact that a member of the panel has expressed an intention to
2dissent. Any member of the panel may file a dissent. Any
3dissent shall be filed no later than 10 days after the decision
4of the majority has been filed.
5    Decisions rendered by the Commission and dissents, if any,
6shall be published together by the Commission. The conclusions
7of law set out in such decisions shall be regarded as
8precedents by arbitrators for the purpose of achieving a more
9uniform administration of this Act.
10    (f) The decision of the Commission acting within its
11powers, according to the provisions of paragraph (e) of this
12Section shall, in the absence of fraud, be conclusive unless
13reviewed as in this paragraph hereinafter provided. However,
14the Arbitrator or the Commission may on his or its own motion,
15or on the motion of either party, correct any clerical error or
16errors in computation within 15 days after the date of receipt
17of any award by such Arbitrator or any decision on review of
18the Commission and shall have the power to recall the original
19award on arbitration or decision on review, and issue in lieu
20thereof such corrected award or decision. Where such correction
21is made the time for review herein specified shall begin to run
22from the date of the receipt of the corrected award or
23decision.
24        (1) Except in cases of claims against the State of
25    Illinois other than those claims under Section 18.1, in
26    which case the decision of the Commission shall not be

 

 

SB1309- 135 -LRB100 08805 JLS 21036 b

1    subject to judicial review, the Circuit Court of the county
2    where any of the parties defendant may be found, or if none
3    of the parties defendant can be found in this State then
4    the Circuit Court of the county where the accident
5    occurred, shall by summons to the Commission have power to
6    review all questions of law and fact presented by such
7    record.
8        A proceeding for review shall be commenced within 20
9    days of the receipt of notice of the decision of the
10    Commission. The summons shall be issued by the clerk of
11    such court upon written request returnable on a designated
12    return day, not less than 10 or more than 60 days from the
13    date of issuance thereof, and the written request shall
14    contain the last known address of other parties in interest
15    and their attorneys of record who are to be served by
16    summons. Service upon any member of the Commission or the
17    Secretary or the Assistant Secretary thereof shall be
18    service upon the Commission, and service upon other parties
19    in interest and their attorneys of record shall be by
20    summons, and such service shall be made upon the Commission
21    and other parties in interest by mailing notices of the
22    commencement of the proceedings and the return day of the
23    summons to the office of the Commission and to the last
24    known place of residence of other parties in interest or
25    their attorney or attorneys of record. The clerk of the
26    court issuing the summons shall on the day of issue mail

 

 

SB1309- 136 -LRB100 08805 JLS 21036 b

1    notice of the commencement of the proceedings which shall
2    be done by mailing a copy of the summons to the office of
3    the Commission, and a copy of the summons to the other
4    parties in interest or their attorney or attorneys of
5    record and the clerk of the court shall make certificate
6    that he has so sent said notices in pursuance of this
7    Section, which shall be evidence of service on the
8    Commission and other parties in interest.
9        The Commission shall not be required to certify the
10    record of their proceedings to the Circuit Court, unless
11    the party commencing the proceedings for review in the
12    Circuit Court as above provided, shall file with the
13    Commission notice of intent to file for review in Circuit
14    Court. It shall be the duty of the Commission upon such
15    filing of notice of intent to file for review in the
16    Circuit Court to prepare a true and correct copy of such
17    testimony and a true and correct copy of all other matters
18    contained in such record and certified to by the Secretary
19    or Assistant Secretary thereof. The changes made to this
20    subdivision (f)(1) by this amendatory Act of the 98th
21    General Assembly apply to any Commission decision entered
22    after the effective date of this amendatory Act of the 98th
23    General Assembly.
24        No request for a summons may be filed and no summons
25    shall issue unless the party seeking to review the decision
26    of the Commission shall exhibit to the clerk of the Circuit

 

 

SB1309- 137 -LRB100 08805 JLS 21036 b

1    Court proof of filing with the Commission of the notice of
2    the intent to file for review in the Circuit Court or an
3    affidavit of the attorney setting forth that notice of
4    intent to file for review in the Circuit Court has been
5    given in writing to the Secretary or Assistant Secretary of
6    the Commission.
7        (2) No such summons shall issue unless the one against
8    whom the Commission shall have rendered an award for the
9    payment of money shall upon the filing of his written
10    request for such summons file with the clerk of the court a
11    bond conditioned that if he shall not successfully
12    prosecute the review, he will pay the award and the costs
13    of the proceedings in the courts. The amount of the bond
14    shall be fixed by any member of the Commission and the
15    surety or sureties of the bond shall be approved by the
16    clerk of the court. The acceptance of the bond by the clerk
17    of the court shall constitute evidence of his approval of
18    the bond.
19        The State of Illinois, including its constitutional
20    officers, boards, commissions, agencies, public
21    institutions of higher learning, and funds administered by
22    the treasurer ex officio, and every Every county, city,
23    town, township, incorporated village, school district,
24    body politic or municipal corporation against whom the
25    Commission shall have rendered an award for the payment of
26    money shall not be required to file a bond to secure the

 

 

SB1309- 138 -LRB100 08805 JLS 21036 b

1    payment of the award and the costs of the proceedings in
2    the court to authorize the court to issue such summons.
3        The court may confirm or set aside the decision of the
4    Commission. If the decision is set aside and the facts
5    found in the proceedings before the Commission are
6    sufficient, the court may enter such decision as is
7    justified by law, or may remand the cause to the Commission
8    for further proceedings and may state the questions
9    requiring further hearing, and give such other
10    instructions as may be proper. Appeals shall be taken to
11    the Appellate Court in accordance with Supreme Court Rules
12    22(g) and 303. Appeals shall be taken from the Appellate
13    Court to the Supreme Court in accordance with Supreme Court
14    Rule 315.
15        It shall be the duty of the clerk of any court
16    rendering a decision affecting or affirming an award of the
17    Commission to promptly furnish the Commission with a copy
18    of such decision, without charge.
19        The decision of a majority of the members of the panel
20    of the Commission, shall be considered the decision of the
21    Commission.
22    (g) Except in the case of a claim against the State of
23Illinois, either party may present a certified copy of the
24award of the Arbitrator, or a certified copy of the decision of
25the Commission when the same has become final, when no
26proceedings for review are pending, providing for the payment

 

 

SB1309- 139 -LRB100 08805 JLS 21036 b

1of compensation according to this Act, to the Circuit Court of
2the county in which such accident occurred or either of the
3parties are residents, whereupon the court shall enter a
4judgment in accordance therewith. In a case where the employer
5refuses to pay compensation according to such final award or
6such final decision upon which such judgment is entered the
7court shall in entering judgment thereon, tax as costs against
8him the reasonable costs and attorney fees in the arbitration
9proceedings and in the court entering the judgment for the
10person in whose favor the judgment is entered, which judgment
11and costs taxed as therein provided shall, until and unless set
12aside, have the same effect as though duly entered in an action
13duly tried and determined by the court, and shall with like
14effect, be entered and docketed. The Circuit Court shall have
15power at any time upon application to make any such judgment
16conform to any modification required by any subsequent decision
17of the Supreme Court upon appeal, or as the result of any
18subsequent proceedings for review, as provided in this Act.
19    Judgment shall not be entered until 15 days' notice of the
20time and place of the application for the entry of judgment
21shall be served upon the employer by filing such notice with
22the Commission, which Commission shall, in case it has on file
23the address of the employer or the name and address of its
24agent upon whom notices may be served, immediately send a copy
25of the notice to the employer or such designated agent.
26    (h) An agreement or award under this Act providing for

 

 

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1compensation in installments, may at any time within 18 months
2after such agreement or award be reviewed by the Commission at
3the request of either the employer or the employee, on the
4ground that the disability of the employee has subsequently
5recurred, increased, diminished or ended.
6    However, as to accidents occurring subsequent to July 1,
71955, which are covered by any agreement or award under this
8Act providing for compensation in installments made as a result
9of such accident, such agreement or award may at any time
10within 30 months, or 60 months in the case of an award under
11Section 8(d)1, after such agreement or award be reviewed by the
12Commission at the request of either the employer or the
13employee on the ground that the disability of the employee has
14subsequently recurred, increased, diminished or ended.
15    On such review, compensation payments may be
16re-established, increased, diminished or ended. The Commission
17shall give 15 days' notice to the parties of the hearing for
18review. Any employee, upon any petition for such review being
19filed by the employer, shall be entitled to one day's notice
20for each 100 miles necessary to be traveled by him in attending
21the hearing of the Commission upon the petition, and 3 days in
22addition thereto. Such employee shall, at the discretion of the
23Commission, also be entitled to 5 cents per mile necessarily
24traveled by him within the State of Illinois in attending such
25hearing, not to exceed a distance of 300 miles, to be taxed by
26the Commission as costs and deposited with the petition of the

 

 

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1employer.
2    When compensation which is payable in accordance with an
3award or settlement contract approved by the Commission, is
4ordered paid in a lump sum by the Commission, no review shall
5be had as in this paragraph mentioned.
6    (i) Each party, upon taking any proceedings or steps
7whatsoever before any Arbitrator, Commission or court, shall
8file with the Commission his address, or the name and address
9of any agent upon whom all notices to be given to such party
10shall be served, either personally or by registered mail,
11addressed to such party or agent at the last address so filed
12with the Commission. In the event such party has not filed his
13address, or the name and address of an agent as above provided,
14service of any notice may be had by filing such notice with the
15Commission.
16    (j) Whenever in any proceeding testimony has been taken or
17a final decision has been rendered and after the taking of such
18testimony or after such decision has become final, the injured
19employee dies, then in any subsequent proceedings brought by
20the personal representative or beneficiaries of the deceased
21employee, such testimony in the former proceeding may be
22introduced with the same force and effect as though the witness
23having so testified were present in person in such subsequent
24proceedings and such final decision, if any, shall be taken as
25final adjudication of any of the issues which are the same in
26both proceedings.

 

 

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1    (k) In case where there has been any unreasonable or
2vexatious delay of payment or intentional underpayment of
3compensation, or proceedings have been instituted or carried on
4by the one liable to pay the compensation, which do not present
5a real controversy, but are merely frivolous or for delay, then
6the Commission may award compensation additional to that
7otherwise payable under this Act equal to 50% of the amount
8payable at the time of such award. Failure to pay compensation
9in accordance with the provisions of Section 8, paragraph (b)
10of this Act, shall be considered unreasonable delay.
11    When determining whether this subsection (k) shall apply,
12the Commission shall consider whether an Arbitrator has
13determined that the claim is not compensable or whether the
14employer has made payments under Section 8(j).
15    (k-1) In a case where there has been an unreasonable or
16vexatious delay of authorization of medical treatment, the
17Commission may award compensation additional to that otherwise
18payable under this Act in the sum of $30 per day for each day
19that the benefits under Section 8(a) have been so withheld or
20refused, not to exceed $10,000 or the total amount due per
21Section 8.2 for treatment to be rendered, whichever is less.
22    Unless utilization review under Section 8.7 or Section 12
23examination is, or has been, requested, a delay in
24authorization of 14 days or more from the employer's receipt of
25all appropriate records and data elements needed to allow the
26employer to make a determination whether to authorize such care

 

 

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1shall create a rebuttable presumption of unreasonable delay.
2Authorization of medical treatment does not bind the employer
3to payments if it is determined that the employee's care is not
4compensable or otherwise payable under the Act.
5    This subsection (k-1) is the only penalty provision within
6the Act applicable to delay of authorization of medical
7treatment.
8    This subsection (k-1) applies only to health care services
9provided or proposed to be provided on or after the effective
10day of this amendatory Act of the 100th General Assembly.
11    (l) If the employee has made written demand for payment of
12benefits under Section 8(a) or Section 8(b), the employer shall
13have 14 days after receipt of the demand to set forth in
14writing the reason for the delay. In the case of demand for
15payment of medical benefits under Section 8(a), the time for
16the employer to respond shall not commence until the expiration
17of the allotted 30 days specified under Section 8.2(d). In case
18the employer or his or her insurance carrier shall without good
19and just cause fail, neglect, refuse, or unreasonably delay the
20payment of benefits under Section 8(a) or Section 8(b), the
21Arbitrator or the Commission shall allow to the employee
22additional compensation in the sum of $30 per day for each day
23that the benefits under Section 8(a) or Section 8(b) have been
24so withheld or refused, not to exceed $10,000. A delay in
25payment of 14 days or more shall create a rebuttable
26presumption of unreasonable delay.

 

 

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1    (m) If the commission finds that an accidental injury was
2directly and proximately caused by the employer's wilful
3violation of a health and safety standard under the Health and
4Safety Act or the Occupational Safety and Health Act in force
5at the time of the accident, the arbitrator or the Commission
6shall allow to the injured employee or his dependents, as the
7case may be, additional compensation equal to 25% of the amount
8which otherwise would be payable under the provisions of this
9Act exclusive of this paragraph. The additional compensation
10herein provided shall be allowed by an appropriate increase in
11the applicable weekly compensation rate.
12    (n) After June 30, 1984, decisions of the Illinois Workers'
13Compensation Commission reviewing an award of an arbitrator of
14the Commission shall draw interest at a rate equal to the yield
15on indebtedness issued by the United States Government with a
1626-week maturity next previously auctioned on the day on which
17the decision is filed. Said rate of interest shall be set forth
18in the Arbitrator's Decision. Interest shall be drawn from the
19date of the arbitrator's award on all accrued compensation due
20the employee through the day prior to the date of payments.
21However, when an employee appeals an award of an Arbitrator or
22the Commission, and the appeal results in no change or a
23decrease in the award, interest shall not further accrue from
24the date of such appeal.
25    The employer or his insurance carrier may tender the
26payments due under the award to stop the further accrual of

 

 

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1interest on such award notwithstanding the prosecution by
2either party of review, certiorari, appeal to the Supreme Court
3or other steps to reverse, vacate or modify the award.
4    (o) By the 15th day of each month each insurer providing
5coverage for losses under this Act shall notify each insured
6employer of any compensable claim incurred during the preceding
7month and the amounts paid or reserved on the claim including a
8summary of the claim and a brief statement of the reasons for
9compensability. A cumulative report of all claims incurred
10during a calendar year or continued from the previous year
11shall be furnished to the insured employer by the insurer
12within 30 days after the end of that calendar year.
13    The insured employer may challenge, in proceeding before
14the Commission, payments made by the insurer without
15arbitration and payments made after a case is determined to be
16noncompensable. If the Commission finds that the case was not
17compensable, the insurer shall purge its records as to that
18employer of any loss or expense associated with the claim,
19reimburse the employer for attorneys' fees arising from the
20challenge and for any payment required of the employer to the
21Rate Adjustment Fund or the Second Injury Fund, and may not
22reflect the loss or expense for rate making purposes. The
23employee shall not be required to refund the challenged
24payment. The decision of the Commission may be reviewed in the
25same manner as in arbitrated cases. No challenge may be
26initiated under this paragraph more than 3 years after the

 

 

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1payment is made. An employer may waive the right of challenge
2under this paragraph on a case by case basis.
3    (p) After filing an application for adjustment of claim but
4prior to the hearing on arbitration the parties may voluntarily
5agree to submit such application for adjustment of claim for
6decision by an arbitrator under this subsection (p) where such
7application for adjustment of claim raises only a dispute over
8temporary total disability, permanent partial disability or
9medical expenses. Such agreement shall be in writing in such
10form as provided by the Commission. Applications for adjustment
11of claim submitted for decision by an arbitrator under this
12subsection (p) shall proceed according to rule as established
13by the Commission. The Commission shall promulgate rules
14including, but not limited to, rules to ensure that the parties
15are adequately informed of their rights under this subsection
16(p) and of the voluntary nature of proceedings under this
17subsection (p). The findings of fact made by an arbitrator
18acting within his or her powers under this subsection (p) in
19the absence of fraud shall be conclusive. However, the
20arbitrator may on his own motion, or the motion of either
21party, correct any clerical errors or errors in computation
22within 15 days after the date of receipt of such award of the
23arbitrator and shall have the power to recall the original
24award on arbitration, and issue in lieu thereof such corrected
25award. The decision of the arbitrator under this subsection (p)
26shall be considered the decision of the Commission and

 

 

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1proceedings for review of questions of law arising from the
2decision may be commenced by either party pursuant to
3subsection (f) of Section 19. The Advisory Board established
4under Section 13.1 shall compile a list of certified Commission
5arbitrators, each of whom shall be approved by at least 7
6members of the Advisory Board. The chairman shall select 5
7persons from such list to serve as arbitrators under this
8subsection (p). By agreement, the parties shall select one
9arbitrator from among the 5 persons selected by the chairman
10except that if the parties do not agree on an arbitrator from
11among the 5 persons, the parties may, by agreement, select an
12arbitrator of the American Arbitration Association, whose fee
13shall be paid by the State in accordance with rules promulgated
14by the Commission. Arbitration under this subsection (p) shall
15be voluntary.
16(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
17eff. 1-1-15.)
 
18    (820 ILCS 305/25.5)
19    Sec. 25.5. Unlawful acts; penalties.
20    (a) It is unlawful for any person, company, corporation,
21insurance carrier, healthcare provider, or other entity to:
22        (1) Intentionally present or cause to be presented any
23    false or fraudulent claim for the payment of any workers'
24    compensation benefit.
25        (2) Intentionally make or cause to be made any false or

 

 

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1    fraudulent material statement or material representation
2    for the purpose of obtaining or denying any workers'
3    compensation benefit.
4        (3) Intentionally make or cause to be made any false or
5    fraudulent statements with regard to entitlement to
6    workers' compensation benefits with the intent to prevent
7    an injured worker from making a legitimate claim for any
8    workers' compensation benefits.
9        (4) Intentionally prepare or provide an invalid,
10    false, or counterfeit certificate of insurance as proof of
11    workers' compensation insurance.
12        (5) Intentionally make or cause to be made any false or
13    fraudulent material statement or material representation
14    for the purpose of obtaining workers' compensation
15    insurance at less than the proper amount rate for that
16    insurance.
17        (6) Intentionally make or cause to be made any false or
18    fraudulent material statement or material representation
19    on an initial or renewal self-insurance application or
20    accompanying financial statement for the purpose of
21    obtaining self-insurance status or reducing the amount of
22    security that may be required to be furnished pursuant to
23    Section 4 of this Act.
24        (7) Intentionally make or cause to be made any false or
25    fraudulent material statement to the Department of
26    Insurance's fraud and insurance non-compliance unit in the

 

 

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1    course of an investigation of fraud or insurance
2    non-compliance.
3        (8) Intentionally assist, abet, solicit, or conspire
4    with any person, company, or other entity to commit any of
5    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
6    of this subsection (a).
7        (9) Intentionally present a bill or statement for the
8    payment for medical services that were not provided.
9    For the purposes of paragraphs (2), (3), (5), (6), (7), and
10(9), the term "statement" includes any writing, notice, proof
11of injury, bill for services, hospital or doctor records and
12reports, or X-ray and test results.
13    (b) Sentence. Sentences for violations of subsection (a)
14are as follows:
15        (1) A violation of paragraph (a)(3) is a Class 4
16    felony.
17        (2) A violation of paragraph (a)(4) or (a)(7) is a
18    Class 3 felony.
19        (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
20    (a)(6), or (a)(9) in which the value of the property
21    obtained or attempted to be obtained is $500 or less is a
22    Class A misdemeanor.
23        (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
24    (a)(6), or (a)(9) in which the value of the property
25    obtained or attempted to be obtained is more than $500 but
26    not more than $10,000 is a Class 3 felony.

 

 

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1        (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
2    (a)(6), or (a)(9) in which the value of the property
3    obtained or attempted to be obtained is more than $10,000
4    but not more than $100,000 is a Class 2 felony.
5        (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
6    (a)(6), or (a)(9) in which the value of the property
7    obtained or attempted to be obtained is more than $100,000
8    is a Class 1 felony.
9        (7) A violation of paragraph (8) of subsection (a)
10    shall be punishable as the class of offense for which the
11    person convicted assisted, abetted, solicited, or
12    conspired to commit, as set forth in paragraphs (1) through
13    (6) of this subsection.
14        (1) A violation in which the value of the property
15    obtained or attempted to be obtained is $300 or less is a
16    Class A misdemeanor.
17        (2) A violation in which the value of the property
18    obtained or attempted to be obtained is more than $300 but
19    not more than $10,000 is a Class 3 felony.
20        (3) A violation in which the value of the property
21    obtained or attempted to be obtained is more than $10,000
22    but not more than $100,000 is a Class 2 felony.
23        (4) A violation in which the value of the property
24    obtained or attempted to be obtained is more than $100,000
25    is a Class 1 felony.
26        (8) (5) A person convicted under this Section shall be

 

 

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1    ordered to pay monetary restitution to the insurance
2    company or self-insured entity or any other person for any
3    financial loss sustained as a result of a violation of this
4    Section, including any court costs and attorney fees. An
5    order of restitution also includes expenses incurred and
6    paid by the State of Illinois or an insurance company or
7    self-insured entity in connection with any medical
8    evaluation or treatment services.
9    For a violation of paragraph (a)(1) or (a)(2), the value of
10the property obtained or attempted to be obtained shall include
11payments pursuant to the provisions of this Act as well as the
12amount paid for medical expenses. For a violation of paragraph
13(a)(5), the value of the property obtained or attempted to be
14obtained shall be the difference between the proper amount for
15the coverage sought or provided and the actual amount billed
16for workers' compensation insurance. For a violation of
17paragraph (a)(6), the value of the property obtained or
18attempted to be obtained shall be the difference between the
19proper amount of security required pursuant to Section 4 of
20this Act and the amount furnished pursuant the false or
21fraudulent statements or representations. For the purposes of
22this Section, where the exact value of property obtained or
23attempted to be obtained is either not alleged or is not
24specifically set by the terms of a policy of insurance, the
25value of the property shall be the fair market replacement
26value of the property claimed to be lost, the reasonable costs

 

 

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1of reimbursing a vendor or other claimant for services to be
2rendered, or both. Notwithstanding the foregoing, an insurance
3company, self-insured entity, or any other person suffering
4financial loss sustained as a result of violation of this
5Section may seek restitution, including court costs and
6attorney's fees in a civil action in a court of competent
7jurisdiction.
8    (c) The Department of Insurance shall establish a fraud and
9insurance non-compliance unit responsible for investigating
10incidences of fraud and insurance non-compliance pursuant to
11this Section. The size of the staff of the unit shall be
12subject to appropriation by the General Assembly. It shall be
13the duty of the fraud and insurance non-compliance unit to
14determine the identity of insurance carriers, employers,
15employees, or other persons or entities who have violated the
16fraud and insurance non-compliance provisions of this Section.
17The fraud and insurance non-compliance unit shall report
18violations of the fraud and insurance non-compliance
19provisions of this Section to the Special Prosecutions Bureau
20of the Criminal Division of the Office of the Attorney General
21or to the State's Attorney of the county in which the offense
22allegedly occurred, either of whom has the authority to
23prosecute violations under this Section.
24    With respect to the subject of any investigation being
25conducted, the fraud and insurance non-compliance unit shall
26have the general power of subpoena of the Department of

 

 

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1Insurance, including the authority to issue a subpoena to a
2medical provider, pursuant to Section 8-802 of the Code of
3Civil Procedure.
4    (d) Any person may report allegations of insurance
5non-compliance and fraud pursuant to this Section to the
6Department of Insurance's fraud and insurance non-compliance
7unit whose duty it shall be to investigate the report. The unit
8shall notify the Commission of reports of insurance
9non-compliance. Any person reporting an allegation of
10insurance non-compliance or fraud against either an employee or
11employer under this Section must identify himself. Except as
12provided in this subsection and in subsection (e), all reports
13shall remain confidential except to refer an investigation to
14the Attorney General or State's Attorney for prosecution or if
15the fraud and insurance non-compliance unit's investigation
16reveals that the conduct reported may be in violation of other
17laws or regulations of the State of Illinois, the unit may
18report such conduct to the appropriate governmental agency
19charged with administering such laws and regulations. Any
20person who intentionally makes a false report under this
21Section to the fraud and insurance non-compliance unit is
22guilty of a Class A misdemeanor.
23    (e) In order for the fraud and insurance non-compliance
24unit to investigate a report of fraud related to an employee's
25claim, (i) the employee must have filed with the Commission an
26Application for Adjustment of Claim and the employee must have

 

 

SB1309- 154 -LRB100 08805 JLS 21036 b

1either received or attempted to receive benefits under this Act
2that are related to the reported fraud or (ii) the employee
3must have made a written demand for the payment of benefits
4that are related to the reported fraud. There shall be no
5immunity, under this Act or otherwise, for any person who files
6a false report or who files a report without good and just
7cause. Confidentiality of medical information shall be
8strictly maintained. Investigations that are not referred for
9prosecution shall be destroyed upon the expiration of the
10statute of limitations for the acts under investigation and
11shall not be disclosed except that the person making the report
12shall be notified that the investigation is being closed. It is
13unlawful for any employer, insurance carrier, service
14adjustment company, third party administrator, self-insured,
15or similar entity to file or threaten to file a report of fraud
16against an employee because of the exercise by the employee of
17the rights and remedies granted to the employee by this Act.
18    The Department of Insurance's papers, documents, reports,
19or evidence relevant to the subject of an investigation under
20this Section shall be confidential and not subject to subpoena,
21public inspection, or to disclosure under the Freedom of
22Information Act for so long as the Director deems reasonably
23necessary to complete the investigation, to protect the person
24investigated from unwarranted injury, or to be in the public
25interest. No officer, agent, or employee of the Department is
26subject to subpoena in any civil or administrative action to

 

 

SB1309- 155 -LRB100 08805 JLS 21036 b

1testify concerning a matter of which they have knowledge under
2a pending fraud or insurance non-compliance investigation by
3the Department.
4    No cause of action exists and no liability may be imposed,
5either civil or criminal, against the State, the Director of
6Insurance, any officer, agent, or employee of the Department of
7Insurance, or individuals employed or retained by the Director
8of Insurance, for an act or omission by them in the performance
9of a power or duty authorized by this Section, unless the act
10or omission was performed in bad faith and with intent to
11injure a particular person.
12    (e-5) The fraud and insurance non-compliance unit shall
13procure and implement a system utilizing advanced analytics
14inclusive of predictive modeling, data mining, social network
15analysis, and scoring algorithms for the detection and
16prevention of fraud, waste, and abuse on or before January 1,
172012. The fraud and insurance non-compliance unit shall procure
18this system using a request for proposals process governed by
19the Illinois Procurement Code and rules adopted under that
20Code. The fraud and insurance non-compliance unit shall provide
21a report to the President of the Senate, Speaker of the House
22of Representatives, Minority Leader of the House of
23Representatives, Minority Leader of the Senate, Governor,
24Chairman of the Commission, and Director of Insurance on or
25before July 1, 2012 and annually thereafter detailing its
26activities and providing recommendations regarding

 

 

SB1309- 156 -LRB100 08805 JLS 21036 b

1opportunities for additional fraud waste and abuse detection
2and prevention.
3    (f) Any person convicted of fraud related to workers'
4compensation pursuant to this Section shall be subject to the
5penalties prescribed in the Criminal Code of 2012 and shall be
6ineligible to receive or retain any compensation, disability,
7or medical benefits as defined in this Act if the compensation,
8disability, or medical benefits were owed or received as a
9result of fraud for which the recipient of the compensation,
10disability, or medical benefit was convicted. This subsection
11applies to accidental injuries or diseases that occur on or
12after the effective date of this amendatory Act of the 94th
13General Assembly.
14    (g) Civil liability. Any person convicted of fraud who
15knowingly obtains, attempts to obtain, or causes to be obtained
16any benefits under this Act by the making of a false claim or
17who knowingly misrepresents any material fact shall be civilly
18liable to the payor of benefits or the insurer or the payor's
19or insurer's subrogee or assignee in an amount equal to 3 times
20the value of the benefits or insurance coverage wrongfully
21obtained or twice the value of the benefits or insurance
22coverage attempted to be obtained, plus reasonable attorney's
23fees and expenses incurred by the payor or the payor's subrogee
24or assignee who successfully brings a claim under this
25subsection. This subsection applies to accidental injuries or
26diseases that occur on or after the effective date of this

 

 

SB1309- 157 -LRB100 08805 JLS 21036 b

1amendatory Act of the 94th General Assembly.
2    (h) The fraud and insurance non-compliance unit shall
3submit a written report on an annual basis to the Chairman of
4the Commission, the Workers' Compensation Advisory Board, the
5General Assembly, the Governor, and the Attorney General by
6January 1 and July 1 of each year. This report shall include,
7at the minimum, the following information:
8        (1) The number of allegations of insurance
9    non-compliance and fraud reported to the fraud and
10    insurance non-compliance unit.
11        (2) The source of the reported allegations
12    (individual, employer, or other).
13        (3) The number of allegations investigated by the fraud
14    and insurance non-compliance unit.
15        (4) The number of criminal referrals made in accordance
16    with this Section and the entity to which the referral was
17    made.
18        (5) All proceedings under this Section.
19(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
 
20    (820 ILCS 305/29.2)
21    Sec. 29.2. Insurance and self-insurance oversight.
22    (a) The Department of Insurance shall annually submit to
23the Governor, the Chairman of the Commission, the President of
24the Senate, the Speaker of the House of Representatives, the
25Minority Leader of the Senate, and the Minority Leader of the

 

 

SB1309- 158 -LRB100 08805 JLS 21036 b

1House of Representatives a written report that details the
2state of the workers' compensation insurance market in
3Illinois. The report shall be completed by April 1 of each
4year, beginning in 2012, or later if necessary data or analyses
5are only available to the Department at a later date. The
6report shall be posted on the Department of Insurance's
7Internet website. Information to be included in the report
8shall be for the preceding calendar year. The report shall
9include, at a minimum, the following:
10        (1) Gross premiums collected by workers' compensation
11    carriers in Illinois and the national rank of Illinois
12    based on premium volume.
13        (2) The number of insurance companies actively engaged
14    in Illinois in the workers' compensation insurance market,
15    including both holding companies and subsidiaries or
16    affiliates, and the national rank of Illinois based on
17    number of competing insurers.
18        (3) The total number of insured participants in the
19    Illinois workers' compensation assigned risk insurance
20    pool, and the size of the assigned risk pool as a
21    proportion of the total Illinois workers' compensation
22    insurance market.
23        (4) The advisory organization premium rate for
24    workers' compensation insurance in Illinois for the
25    previous year.
26        (5) The advisory organization prescribed assigned risk

 

 

SB1309- 159 -LRB100 08805 JLS 21036 b

1    pool premium rate.
2        (6) The total amount of indemnity payments made by
3    workers' compensation insurers in Illinois.
4        (7) The total amount of medical payments made by
5    workers' compensation insurers in Illinois, and the
6    national rank of Illinois based on average cost of medical
7    claims per injured worker.
8        (8) The gross profitability of workers' compensation
9    insurers in Illinois, and the national rank of Illinois
10    based on profitability of workers' compensation insurers.
11        (9) The loss ratio of workers' compensation insurers in
12    Illinois and the national rank of Illinois based on the
13    loss ratio of workers' compensation insurers. For purposes
14    of this loss ratio calculation, the denominator shall
15    include all premiums and other fees collected by workers'
16    compensation insurers and the numerator shall include the
17    total amount paid by the insurer for care or compensation
18    to injured workers.
19        (10) The growth of total paid indemnity benefits by
20    temporary total disability, scheduled and non-scheduled
21    permanent partial disability, and total disability.
22        (11) The number of injured workers receiving wage loss
23    differential awards and the average wage loss differential
24    award payout.
25        (12) Illinois' rank, relative to other states, for:
26            (i) the maximum and minimum temporary total

 

 

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1        disability benefit level;
2            (ii) the maximum and minimum scheduled and
3        non-scheduled permanent partial disability benefit
4        level;
5            (iii) the maximum and minimum total disability
6        benefit level; and
7            (iv) the maximum and minimum death benefit level.
8        (13) The aggregate growth of medical benefit payout by
9    non-hospital providers and hospitals.
10        (14) The aggregate growth of medical utilization for
11    the top 10 most common injuries to specific body parts by
12    non-hospital providers and hospitals.
13        (15) The percentage of injured workers filing claims at
14    the Commission that are represented by an attorney.
15        (16) The total amount paid by injured workers for
16    attorney representation.
17    (a-5) The Commission shall annually submit to the Governor
18and the General Assembly a written report that details the
19state of self-insurance for workers' compensation in Illinois.
20The report shall be based on information currently collected by
21the Commission or the Department of Insurance from
22self-insurers, as of the effective date of this amendatory Act
23of the 100th General Assembly. The report shall be completed by
24December 1, 2017. The report shall be posted on the
25Commission's Internet website. Information to be included in
26the report shall be for the preceding calendar year. The report

 

 

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1shall include, at a minimum, the following in the aggregate:
2        (1) The number of employers that self-insure for
3    workers' compensation.
4        (2) The total number of employees covered by
5    self-insurance.
6        (3) The total amount of indemnity payments made by
7    self-insureds.
8        (4) The total amount of medical payments made by
9    self-insureds.
10        (5) Illinois' rank, relative to other states, for:
11            (i) the maximum and minimum temporary total
12        disability benefit levels;
13            (ii) the maximum and minimum scheduled and
14        non-scheduled permanent partial disability benefit
15        levels;
16            (iii) the maximum and minimum total disability
17        benefit levels; and
18            (iv) the maximum and minimum death benefit levels.
19        (6) The aggregate growth of medical benefit payouts by
20    non-hospital providers and hospitals.
21    Any information collected by the Commission from
22self-insureds shall be exempt from public inspection and
23disclosure under the Freedom of Information Act.
24    (b) The Director of Insurance shall promulgate rules
25requiring each insurer licensed to write workers' compensation
26coverage in the State to record and report the following

 

 

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1information on an aggregate basis to the Department of
2Insurance before March 1 of each year, relating to claims in
3the State opened within the prior calendar year:
4        (1) The number of claims opened.
5        (2) The number of reported medical only claims.
6        (3) The number of contested claims.
7        (4) The number of claims for which the employee has
8    attorney representation.
9        (5) The number of claims with lost time and the number
10    of claims for which temporary total disability was paid.
11        (6) The number of claim adjusters employed to adjust
12    workers' compensation claims.
13        (7) The number of claims for which temporary total
14    disability was not paid within 14 days from the first full
15    day off, regardless of reason.
16        (8) The number of medical bills paid 60 days or later
17    from date of service and the average days paid on those
18    paid after 60 days for the previous calendar year.
19        (9) The number of claims in which in-house defense
20    counsel participated, and the total amount spent on
21    in-house legal services.
22        (10) The number of claims in which outside defense
23    counsel participated, and the total amount paid to outside
24    defense counsel.
25        (11) The total amount billed to employers for bill
26    review.

 

 

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1        (12) The total amount billed to employers for fee
2    schedule savings.
3        (13) The total amount charged to employers for any and
4    all managed care fees.
5        (14) The number of claims involving in-house medical
6    nurse case management, and the total amount spent on
7    in-house medical nurse case management.
8        (15) The number of claims involving outside medical
9    nurse case management, and the total amount paid for
10    outside medical nurse case management.
11        (16) The total amount paid for Independent Medical
12    exams.
13        (17) The total amount spent on in-house Utilization
14    Review for the previous calendar year.
15        (18) The total amount paid for outside Utilization
16    Review for the previous calendar year.
17    The Department shall make the submitted information
18publicly available on the Department's Internet website or such
19other media as appropriate in a form useful for consumers.
20(Source: P.A. 97-18, eff. 6-28-11.)
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 140/7.5
4    720 ILCS 5/17-10.4 new
5    720 ILCS 5/17-10.5
6    820 ILCS 305/1from Ch. 48, par. 138.1
7    820 ILCS 305/4from Ch. 48, par. 138.4
8    820 ILCS 305/8from Ch. 48, par. 138.8
9    820 ILCS 305/8.1b
10    820 ILCS 305/8.2
11    820 ILCS 305/8.2a
12    820 ILCS 305/8.7
13    820 ILCS 305/14from Ch. 48, par. 138.14
14    820 ILCS 305/19from Ch. 48, par. 138.19
15    820 ILCS 305/25.5
16    820 ILCS 305/29.2