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1 | | Sec. 8.6. State Police Training and Academy Fund; Law |
2 | | Enforcement Training Fund. Before April 1 of each year, each |
3 | | insurer engaged in writing private passenger motor vehicle |
4 | | insurance coverage that is included in Class 2 and Class 3 of |
5 | | Section 4 of the Illinois Insurance Code, as a condition of its |
6 | | authority to transact business in this State, may collect and |
7 | | shall pay shall collect and remit to the Department of |
8 | | Insurance an amount equal to $4, or a lesser amount determined |
9 | | by the Illinois Law Enforcement Training Board by rule, |
10 | | multiplied by the insurer's total earned car years of private |
11 | | passenger motor vehicle insurance policies providing physical |
12 | | damage insurance coverage written in this State during the |
13 | | preceding calendar year. Of the amounts collected under this |
14 | | Section, the Department of Insurance shall deposit 10% into |
15 | | the State Police Training and Academy Fund and 90% into the Law |
16 | | Enforcement Training Fund.
|
17 | | (Source: P.A. 102-16, eff. 6-17-21.) |
18 | | Section 10. The Illinois Insurance Code is amended by |
19 | | changing Sections 35B-30, 143, 143a, 229.4a, 353a, 355a, 408, |
20 | | 412, and 416 and by adding Section 355c as follows: |
21 | | (215 ILCS 5/35B-30) |
22 | | Sec. 35B-30. Certificate of division. |
23 | | (a) After a plan of division has been adopted and |
24 | | approved, an officer or duly authorized representative of the |
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1 | | dividing company shall sign a certificate of division. |
2 | | (b) The certificate of division shall set forth: |
3 | | (1) the name of the dividing company; |
4 | | (2) a statement disclosing whether the dividing |
5 | | company will survive the division; |
6 | | (3) the name of each new company that will be created |
7 | | by the division; |
8 | | (4) the kinds of insurance business enumerated in |
9 | | Section 4 that the new company will be authorized to |
10 | | conduct; |
11 | | (5) the date that the division is to be effective, |
12 | | which shall not be more than 90 days after the dividing |
13 | | company has filed the certificate of division with the |
14 | | recorder, with a concurrent copy to the Director; |
15 | | (6) a statement that the division was approved by the |
16 | | Director in accordance with Section 35B-25; |
17 | | (7) (6) a statement that the dividing company |
18 | | provided, no later than 10 business days after the |
19 | | dividing company filed the plan of division with the |
20 | | Director, reasonable notice to each reinsurer that is |
21 | | party to a reinsurance contract that is applicable to the |
22 | | policies included in the plan of division; |
23 | | (8) (7) if the dividing company will survive the |
24 | | division, an amendment to its articles of incorporation or |
25 | | bylaws approved as part of the plan of division; |
26 | | (9) (8) for each new company created by the division, |
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1 | | its articles of incorporation and bylaws, provided that |
2 | | the articles of incorporation and bylaws need not state |
3 | | the name or address of an incorporator; and |
4 | | (10) (9) a reasonable description of the capital, |
5 | | surplus, other assets and liabilities, including policy |
6 | | liabilities, of the dividing company that are to be |
7 | | allocated to each resulting company. |
8 | | (c) The articles of incorporation and bylaws of each new |
9 | | company must satisfy the requirements of the laws of this |
10 | | State, provided that the documents need not be signed or |
11 | | include a provision that need not be included in a restatement |
12 | | of the document. |
13 | | (d) A certificate of division is effective when filed with |
14 | | the recorder, with a concurrent copy to the Director, as |
15 | | provided in this Section or on another date specified in the |
16 | | plan of division, whichever is later, provided that a |
17 | | certificate of division shall become effective not more than |
18 | | 90 days after it is filed with the recorder. A division is |
19 | | effective when the relevant certificate of division is |
20 | | effective.
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21 | | (Source: P.A. 100-1118, eff. 11-27-18.)
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22 | | (215 ILCS 5/143) (from Ch. 73, par. 755)
|
23 | | Sec. 143. Policy forms.
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24 | | (1) Life, accident and health. No company
transacting the |
25 | | kind or kinds of business enumerated in Classes 1 (a), 1
(b) |
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1 | | and 2 (a) of Section 4 shall issue or deliver in this State a |
2 | | policy
or certificate of insurance or evidence of coverage, |
3 | | attach an
endorsement or rider thereto,
incorporate by |
4 | | reference bylaws or other matter therein or use an
application |
5 | | blank in this State until the form and content of such
policy, |
6 | | certificate, evidence of coverage, endorsement, rider, bylaw |
7 | | or
other matter
incorporated by reference or application blank |
8 | | has been filed electronically
with the Director, either |
9 | | through the System for Electronic Rate and Form Filing (SERFF) |
10 | | or as otherwise prescribed by the Director, and
approved by |
11 | | the Director. Any such endorsement or rider
that unilaterally |
12 | | reduces benefits and is to be attached to a
policy subsequent |
13 | | to the date the policy is
issued must be filed with, reviewed, |
14 | | and formally approved by the
Director prior to the date it is |
15 | | attached to a policy issued or
delivered in this State. It |
16 | | shall be the duty of the Director to disapprove or withdraw
|
17 | | withhold approval of any such policy, certificate, |
18 | | endorsement, rider,
bylaw or other matter incorporated by |
19 | | reference or application blank
filed with him if it contains |
20 | | deficiencies, provisions which encourage
misrepresentation or |
21 | | are unjust, unfair, inequitable, ambiguous,
misleading, |
22 | | inconsistent, deceptive, contrary to law or to the public
|
23 | | policy of this State, or contains exceptions and conditions |
24 | | that
unreasonably or deceptively affect the risk purported to |
25 | | be assumed in
the general coverage of the policy. In all cases |
26 | | the Director shall
approve , withdraw, or disapprove any such |
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1 | | form within 60 days after submission
unless the Director |
2 | | extends by not more than an additional 30 days the
period |
3 | | within which the he shall approve or disapprove any such form |
4 | | shall be approved, withdrawn, or disapproved by
giving written |
5 | | notice to the insurer of such extension before expiration
of |
6 | | the initial 60 days period. The Director shall withdraw his |
7 | | approval
of a policy, certificate, evidence of coverage, |
8 | | endorsement, rider,
bylaw, or other matter incorporated
by |
9 | | reference or application blank if it is subsequently |
10 | | determined he subsequently determines that such
policy, |
11 | | certificate, evidence of coverage, endorsement, rider, bylaw,
|
12 | | other matter, or application
blank is misrepresentative, |
13 | | unjust, unfair, inequitable, ambiguous, misleading,
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14 | | inconsistent, deceptive, contrary to law or public policy of |
15 | | this State,
or contains exceptions or conditions which |
16 | | unreasonably or deceptively affect
the risk purported to be |
17 | | assumed in the general coverage of the policy or
evidence of |
18 | | coverage.
|
19 | | If a previously approved policy, certificate, evidence of
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20 | | coverage, endorsement, rider, bylaw
or other matter |
21 | | incorporated by reference or application blank is withdrawn
|
22 | | for use, the Director shall serve upon the company an order of |
23 | | withdrawal
of use, either personally or by mail, and if by |
24 | | mail, such service shall
be completed if such notice be |
25 | | deposited in the post office, postage prepaid,
addressed to |
26 | | the company's last known address specified in the records
of |
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1 | | the Department of Insurance. The order of withdrawal of use |
2 | | shall take
effect 30 days from the date of mailing but shall be |
3 | | stayed if within the
30-day period a written request for |
4 | | hearing is filed with the Director.
Such hearing shall be held |
5 | | at such time and place as designated in the order
given by the |
6 | | Director. The hearing may be held either in the City of |
7 | | Springfield,
the City of Chicago or in the county where the |
8 | | principal business address
of the company is located.
The |
9 | | action of the Director in
disapproving or withdrawing such |
10 | | form shall be subject to judicial review under
the
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11 | | Administrative Review Law.
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12 | | This subsection shall not apply to riders or endorsements |
13 | | issued or
made at the request of the individual policyholder |
14 | | relating to the
manner of distribution of benefits or to the |
15 | | reservation of rights and
benefits under his life insurance |
16 | | policy.
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17 | | (2) Casualty, fire, and marine. The Director shall require |
18 | | the
filing of all policy forms issued or delivered by any |
19 | | company transacting
the kind or
kinds of business enumerated |
20 | | in Classes 2 (except Class 2 (a)) and 3 of
Section 4 in an |
21 | | electronic format either through the System for Electronic |
22 | | Rate and Form Filing (SERFF) or as otherwise prescribed and |
23 | | approved by the Director. In addition, he may require the |
24 | | filing of any
generally used riders, endorsements, |
25 | | certificates, application blanks, and
other matter
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26 | | incorporated by reference in any such policy or contract of |
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1 | | insurance.
Companies that are members of an organization, |
2 | | bureau, or association may
have the same filed for them by the |
3 | | organization, bureau, or association. If
the Director shall |
4 | | find from an examination of any such policy form,
rider, |
5 | | endorsement, certificate, application blank, or other matter
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6 | | incorporated by
reference in any such policy so filed that it |
7 | | (i) violates any provision of
this Code, (ii) contains |
8 | | inconsistent, ambiguous, or misleading clauses, or
(iii) |
9 | | contains exceptions and conditions that will unreasonably or |
10 | | deceptively
affect the risks that are purported to be assumed |
11 | | by the policy, he
shall order the company or companies issuing |
12 | | these forms to discontinue
their use. Nothing in this |
13 | | subsection shall require a company
transacting the kind or |
14 | | kinds of business enumerated in Classes 2
(except Class 2 (a)) |
15 | | and 3 of Section 4 to obtain approval of these forms
before |
16 | | they are issued nor in any way affect the legality of any
|
17 | | policy that has been issued and found to be in conflict with |
18 | | this
subsection, but such policies shall be subject to the |
19 | | provisions of
Section 442.
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20 | | (3) This Section shall not apply (i) to surety contracts |
21 | | or fidelity
bonds, (ii) to policies issued to an industrial |
22 | | insured as defined in Section
121-2.08 except for workers' |
23 | | compensation policies, nor (iii) to riders
or
endorsements |
24 | | prepared to meet special, unusual,
peculiar, or extraordinary |
25 | | conditions applying to an individual risk.
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26 | | (Source: P.A. 97-486, eff. 1-1-12; 98-226, eff. 1-1-14.)
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1 | | (215 ILCS 5/143a) (from Ch. 73, par. 755a)
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2 | | Sec. 143a. Uninsured and hit and run motor vehicle |
3 | | coverage.
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4 | | (1) No policy insuring against
loss resulting from |
5 | | liability imposed by law for bodily injury or death
suffered |
6 | | by any person arising out of the ownership, maintenance or use
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7 | | of a motor vehicle that is designed for use on public highways |
8 | | and that
is either required to be registered in this State or |
9 | | is principally garaged
in this State shall be renewed, |
10 | | delivered, or issued for delivery
in this State unless |
11 | | coverage is provided therein or
supplemental thereto, in |
12 | | limits for bodily injury or death set forth in
Section 7-203 of |
13 | | the Illinois Vehicle Code for the
protection of persons |
14 | | insured thereunder who are legally entitled to
recover damages |
15 | | from owners or operators of uninsured motor vehicles and
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16 | | hit-and-run motor vehicles because of bodily injury, sickness |
17 | | or
disease, including death, resulting therefrom. Uninsured |
18 | | motor vehicle
coverage does not apply to bodily injury, |
19 | | sickness, disease, or death resulting
therefrom, of an insured |
20 | | while occupying a motor vehicle owned by, or furnished
or |
21 | | available for the regular use of the insured, a resident |
22 | | spouse or resident
relative, if that motor vehicle is not |
23 | | described in the policy under which a
claim is made or is not a |
24 | | newly acquired or replacement motor vehicle covered
under the |
25 | | terms of the policy. The limits for any coverage for any |
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1 | | vehicle
under the policy may not be aggregated with the limits |
2 | | for any similar
coverage, whether provided by the same insurer |
3 | | or another insurer, applying to
other motor vehicles, for |
4 | | purposes of determining the total limit of insurance
coverage |
5 | | available for bodily injury or death suffered by a person in |
6 | | any one
accident. No
policy shall be renewed, delivered, or |
7 | | issued for delivery in this
State unless it is provided |
8 | | therein that any dispute
with respect to the coverage and the |
9 | | amount of damages shall be submitted
for arbitration to the
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10 | | American Arbitration Association and be subject to its rules |
11 | | for the conduct
of arbitration hearings
as to all matters |
12 | | except medical opinions. As to medical opinions, if the
amount |
13 | | of damages being sought is equal to or less than the amount |
14 | | provided for
in Section 7-203 of the Illinois Vehicle Code, |
15 | | then the current American
Arbitration Association Rules shall |
16 | | apply. If the amount being sought in an
American Arbitration |
17 | | Association case exceeds that amount as set forth in
Section |
18 | | 7-203 of the Illinois Vehicle Code, then the Rules of Evidence |
19 | | that
apply in the circuit court for placing medical opinions |
20 | | into evidence shall
govern. Alternatively, disputes with |
21 | | respect to damages and the coverage shall
be
determined in the
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22 | | following
manner: Upon the insured requesting arbitration, |
23 | | each party to the
dispute shall select an arbitrator and the 2 |
24 | | arbitrators so named
shall select a third arbitrator. If such |
25 | | arbitrators are not selected
within 45 days from such request, |
26 | | either party may request that the
arbitration be submitted to |
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1 | | the American Arbitration Association.
Any decision made by the |
2 | | arbitrators shall be binding for the amount of
damages not |
3 | | exceeding $75,000 for bodily injury to or
death of any one |
4 | | person, $150,000 for bodily injury to or death of 2 or more
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5 | | persons in any one motor vehicle accident,
or the |
6 | | corresponding policy limits for bodily injury or death, |
7 | | whichever is
less.
All 3-person arbitration cases proceeding |
8 | | in accordance with any uninsured
motorist
coverage conducted |
9 | | in this State in
which the claimant is only seeking monetary |
10 | | damages up to the limits
set forth in Section 7-203 of the |
11 | | Illinois Vehicle Code
shall be subject to the following rules:
|
12 | | (A) If at least 60 days' written
notice of the |
13 | | intention to offer the following documents in evidence is |
14 | | given
to every other party, accompanied by a copy of the |
15 | | document, a party may offer
in evidence, without |
16 | | foundation or other proof:
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17 | | (1) bills, records, and reports of hospitals, |
18 | | doctors, dentists,
registered nurses, licensed |
19 | | practical nurses, physical therapists, and other
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20 | | healthcare providers;
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21 | | (2) bills for drugs, medical appliances, and |
22 | | prostheses;
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23 | | (3) property repair bills or estimates, when |
24 | | identified and itemized
setting forth the charges for |
25 | | labor and material used or proposed for use in
the |
26 | | repair of the property;
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1 | | (4) a report of the rate of earnings and time lost |
2 | | from work or lost
compensation prepared by an |
3 | | employer;
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4 | | (5) the written opinion of an opinion witness, the |
5 | | deposition of a
witness, and the statement of a |
6 | | witness that the witness would be allowed to
express |
7 | | if testifying in person, if the opinion or statement |
8 | | is made by
affidavit or by
certification as provided |
9 | | in Section 1-109 of the Code of Civil Procedure;
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10 | | (6) any other document not specifically covered by |
11 | | any of the foregoing
provisions that is otherwise |
12 | | admissible under the rules of evidence.
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13 | | Any party receiving a notice under this paragraph (A) |
14 | | may apply to the
arbitrator or panel of arbitrators, as |
15 | | the case may be, for the issuance of a
subpoena directed to |
16 | | the author or maker or custodian of the document that is
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17 | | the subject of the notice, requiring the person subpoenaed |
18 | | to produce copies of
any additional documents as may be |
19 | | related to the subject matter of the
document that is the |
20 | | subject of the notice. Any such subpoena shall be issued
|
21 | | in substantially similar form and served by notice as |
22 | | provided by Illinois
Supreme Court Rule 204(a)(4). Any |
23 | | such subpoena shall be returnable not
less than 5 days |
24 | | before the arbitration hearing.
|
25 | | (B) Notwithstanding the provisions of Supreme Court |
26 | | Rule 213(g), a party
who proposes to use a written opinion |
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1 | | of an expert or opinion witness or the
testimony of
an |
2 | | expert or opinion witness at the hearing may do so |
3 | | provided a written notice
of that
intention is given to |
4 | | every other party not less than 60 days prior to the date
|
5 | | of hearing, accompanied by a statement containing the |
6 | | identity of the
witness, his or her qualifications, the |
7 | | subject matter, the basis of the
witness's conclusions,
|
8 | | and his or her opinion.
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9 | | (C) Any other party may subpoena the author or maker |
10 | | of a document
admissible under this subsection, at that |
11 | | party's expense, and examine the
author
or maker as if |
12 | | under cross-examination. The provisions of Section 2-1101 |
13 | | of
the
Code of Civil Procedure shall be applicable to |
14 | | arbitration hearings, and it
shall be the duty of a party |
15 | | requesting the subpoena to modify the form to show
that |
16 | | the appearance is set before an arbitration panel and to |
17 | | give the time and
place set for the hearing.
|
18 | | (D) The provisions of Section 2-1102 of the Code of |
19 | | Civil Procedure shall
be
applicable to arbitration |
20 | | hearings under this subsection.
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21 | | (2) No policy insuring
against loss resulting from |
22 | | liability imposed by law for property damage
arising out of |
23 | | the ownership, maintenance, or use of a motor vehicle shall
be |
24 | | renewed, delivered, or issued for delivery in this State with |
25 | | respect
to any private passenger or recreational motor vehicle |
26 | | that is
designed for use on public highways and that is either |
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1 | | required to be
registered in this State or is principally |
2 | | garaged in this State and
is not covered by collision |
3 | | insurance under the provisions of such
policy , unless coverage |
4 | | is made available in the amount of the actual
cash value of the |
5 | | motor vehicle described in the policy or the corresponding |
6 | | policy limit for uninsured motor vehicle property damage |
7 | | coverage, $15,000
whichever is less, subject to a maximum $250 |
8 | | deductible, for the protection of
persons insured thereunder |
9 | | who are legally entitled to recover damages from
owners or |
10 | | operators of uninsured motor vehicles and hit-and-run motor
|
11 | | vehicles because of property damage to the motor vehicle |
12 | | described in the
policy.
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13 | | There shall be no liability imposed under the uninsured |
14 | | motorist
property damage coverage required by this subsection |
15 | | if the owner or
operator of the at-fault uninsured motor |
16 | | vehicle or hit-and-run motor
vehicle cannot be identified. |
17 | | This subsection shall not apply to any
policy which does not |
18 | | provide primary motor vehicle liability insurance for
|
19 | | liabilities arising from the maintenance, operation, or use of |
20 | | a
specifically insured motor vehicle.
|
21 | | Each insurance company providing motor vehicle property |
22 | | damage liability
insurance shall advise applicants of the |
23 | | availability of uninsured motor
vehicle property damage |
24 | | coverage, the premium therefor, and provide a brief
|
25 | | description of the coverage. That information
need be given |
26 | | only once and shall not be required in any subsequent renewal,
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1 | | reinstatement or reissuance, substitute, amended, replacement |
2 | | or
supplementary policy. No written rejection shall be |
3 | | required, and
the absence of a premium payment for uninsured |
4 | | motor vehicle property damage
shall constitute conclusive |
5 | | proof that the applicant or policyholder has
elected not to |
6 | | accept uninsured motorist property damage coverage.
|
7 | | An insurance company issuing uninsured motor vehicle
|
8 | | property damage coverage may provide that:
|
9 | | (i) Property damage losses recoverable thereunder |
10 | | shall be limited to
damages caused by the actual physical |
11 | | contact of an uninsured motor vehicle
with the insured |
12 | | motor vehicle.
|
13 | | (ii) There shall be no coverage for loss of use of the |
14 | | insured motor
vehicle and no coverage for loss or damage |
15 | | to personal property located in
the insured motor vehicle.
|
16 | | (iii) Any claim submitted shall include the name and |
17 | | address of the
owner of the at-fault uninsured motor |
18 | | vehicle, or a registration number and
description of the |
19 | | vehicle, or any other available information to
establish |
20 | | that there is no applicable motor vehicle property damage |
21 | | liability
insurance.
|
22 | | Any dispute with respect to the coverage and the amount of
|
23 | | damages shall be submitted for
arbitration to the American |
24 | | Arbitration Association and be subject to its
rules for the |
25 | | conduct of arbitration hearings or for determination in
the |
26 | | following manner: Upon the insured requesting arbitration, |
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1 | | each party
to the dispute shall select an arbitrator and the 2 |
2 | | arbitrators so named
shall select a third arbitrator. If such |
3 | | arbitrators are not selected
within 45 days from such request, |
4 | | either party may request that the
arbitration be submitted to |
5 | | the American Arbitration Association.
Any arbitration |
6 | | proceeding under this subsection seeking recovery for
property |
7 | | damages shall be
subject to the following rules:
|
8 | | (A) If at least 60 days' written
notice of the |
9 | | intention to offer the following documents in evidence is |
10 | | given
to every other party, accompanied by a copy of the |
11 | | document, a party may offer
in evidence, without |
12 | | foundation or other proof:
|
13 | | (1) property repair bills or estimates, when |
14 | | identified and itemized
setting forth the charges for |
15 | | labor and material used or proposed for use in
the |
16 | | repair of the property;
|
17 | | (2) the written opinion of an opinion witness, the |
18 | | deposition of a
witness, and the statement of a |
19 | | witness that the witness would be allowed to
express |
20 | | if testifying in person, if the opinion or statement |
21 | | is made by
affidavit or by
certification as provided |
22 | | in Section 1-109 of the Code of Civil Procedure;
|
23 | | (3) any other document not specifically covered by |
24 | | any of the foregoing
provisions that is otherwise |
25 | | admissible under the rules of evidence.
|
26 | | Any party receiving a notice under this paragraph (A) |
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1 | | may apply to the
arbitrator or panel of arbitrators, as |
2 | | the case may be, for the issuance of a
subpoena directed to |
3 | | the author or maker or custodian of the document that is
|
4 | | the subject of the notice, requiring the person subpoenaed |
5 | | to produce copies of
any additional documents as may be |
6 | | related to the subject matter of the
document that is the |
7 | | subject of the notice. Any such subpoena shall be issued
|
8 | | in substantially similar form and served by notice as |
9 | | provided by Illinois
Supreme Court Rule 204(a)(4). Any |
10 | | such subpoena shall be returnable not
less than 5 days |
11 | | before the arbitration hearing.
|
12 | | (B) Notwithstanding the provisions of Supreme Court |
13 | | Rule 213(g), a party
who proposes to use a written opinion |
14 | | of an expert or opinion witness or the
testimony of
an |
15 | | expert or opinion witness at the hearing may do so |
16 | | provided a written notice
of that
intention is given to |
17 | | every other party not less than 60 days prior to the date
|
18 | | of hearing, accompanied by a statement containing the |
19 | | identity of the
witness, his or her qualifications, the |
20 | | subject matter, the basis of the
witness's conclusions,
|
21 | | and his or her opinion.
|
22 | | (C) Any other party may subpoena the author or maker |
23 | | of a document
admissible under this subsection, at that |
24 | | party's expense, and examine the
author
or maker as if |
25 | | under cross-examination. The provisions of Section 2-1101 |
26 | | of
the
Code of Civil Procedure shall be applicable to |
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1 | | arbitration hearings, and it
shall be the duty of a party |
2 | | requesting the subpoena to modify the form to show
that |
3 | | the appearance is set before an arbitration panel and to |
4 | | give the time and
place set for the hearing.
|
5 | | (D) The provisions of Section 2-1102 of the Code of |
6 | | Civil Procedure shall
be
applicable to arbitration |
7 | | hearings under this subsection.
|
8 | | (3) For the purpose of the coverage, the term "uninsured |
9 | | motor
vehicle" includes, subject to the terms and conditions |
10 | | of the coverage,
a motor vehicle where on, before or after the |
11 | | accident date the
liability insurer thereof is unable to make |
12 | | payment with respect to the
legal liability of its insured |
13 | | within the limits specified in the policy
because of the entry |
14 | | by a court of competent jurisdiction of an order of
|
15 | | rehabilitation or liquidation by reason of insolvency on or |
16 | | after the
accident date. An insurer's extension of coverage, |
17 | | as provided in this
subsection, shall be applicable to all |
18 | | accidents occurring after July
1, 1967 during a policy period |
19 | | in which its insured's uninsured motor
vehicle coverage is in |
20 | | effect. Nothing in this Section may be construed
to prevent |
21 | | any insurer from extending coverage under terms and
conditions |
22 | | more favorable to its insureds than is required by this |
23 | | Section.
|
24 | | (4) In the event of payment to any person under the |
25 | | coverage
required by this Section and subject to the terms and |
26 | | conditions of the
coverage, the insurer making the payment |
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1 | | shall, to the extent thereof,
be entitled to the proceeds of |
2 | | any settlement or judgment resulting from
the exercise of any |
3 | | rights of recovery of the person against any person
or |
4 | | organization legally responsible for the property damage, |
5 | | bodily
injury or death for which the payment is made, |
6 | | including the proceeds
recoverable from the assets of the |
7 | | insolvent insurer. With respect to
payments made by reason of |
8 | | the coverage described in subsection (3), the
insurer making |
9 | | such payment shall not be entitled to any right of recovery
|
10 | | against the tortfeasor in excess of the proceeds recovered |
11 | | from the assets
of the insolvent insurer of the tortfeasor.
|
12 | | (5) This amendatory Act of 1967 (Laws of Illinois 1967, |
13 | | page 875) shall not be construed to terminate
or reduce any |
14 | | insurance coverage or any right of any party under this
Code in |
15 | | effect before July 1, 1967. Public Act 86-1155 shall not
be |
16 | | construed to terminate or reduce any insurance coverage or any |
17 | | right of
any party under this Code in effect before its |
18 | | effective date.
|
19 | | (6) Failure of the motorist from whom the claimant is |
20 | | legally
entitled to recover damages to file the appropriate |
21 | | forms with the
Safety Responsibility Section of the Department |
22 | | of Transportation within
120 days of the accident date shall |
23 | | create a rebuttable presumption that
the motorist was |
24 | | uninsured at the time of the injurious occurrence.
|
25 | | (7) An insurance carrier may upon good cause require the
|
26 | | insured to commence a legal action against the owner or |
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1 | | operator of an
uninsured motor vehicle before good faith |
2 | | negotiation with the carrier. If
the action is commenced at |
3 | | the request of the insurance carrier, the
carrier shall pay to |
4 | | the insured, before the action is commenced, all court
costs, |
5 | | jury fees and sheriff's fees arising from the action.
|
6 | | The changes made by Public Act 90-451 apply to all |
7 | | policies of
insurance amended, delivered, issued, or renewed |
8 | | on and after January 1, 1998 (the effective
date of Public Act |
9 | | 90-451).
|
10 | | (8) The changes made by Public Act 98-927 apply to all |
11 | | policies of
insurance amended, delivered, issued, or renewed |
12 | | on and after January 1, 2015 (the effective
date of Public Act |
13 | | 98-927). |
14 | | (Source: P.A. 98-242, eff. 1-1-14; 98-927, eff. 1-1-15; |
15 | | 99-642, eff. 7-28-16.)
|
16 | | (215 ILCS 5/229.4a)
|
17 | | Sec. 229.4a. Standard Non-forfeiture Law for Individual |
18 | | Deferred
Annuities. |
19 | | (1)
Title.
This Section shall be known as the Standard |
20 | | Nonforfeiture Law for Individual Deferred Annuities. |
21 | | (2) Applicability.
This Section shall not apply to any |
22 | | reinsurance, group annuity purchased under a retirement plan |
23 | | or plan of deferred compensation established or maintained by |
24 | | an employer (including a partnership or sole proprietorship) |
25 | | or by an employee organization, or by both, other than a plan |
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1 | | providing individual retirement accounts or individual |
2 | | retirement annuities under Section 408 of the Internal Revenue |
3 | | Code, as now or hereafter amended, premium deposit fund, |
4 | | variable annuity, investment annuity, immediate annuity, any |
5 | | deferred annuity contract after annuity payments have |
6 | | commenced, or reversionary annuity, nor to any contract which |
7 | | shall be delivered outside this State through an agent or |
8 | | other representative of the company issuing the contract. |
9 | | (3) Nonforfeiture Requirements. |
10 | | (A) In the case of contracts issued on or after the |
11 | | operative date of this Section
as defined in subsection |
12 | | (13), no contract of annuity, except as stated in |
13 | | subsection (2), shall be delivered or issued for delivery |
14 | | in this State unless it contains in substance the |
15 | | following provisions, or corresponding provisions which in |
16 | | the opinion of the Director of Insurance are at least as |
17 | | favorable to the contract holder, upon cessation of |
18 | | payment of considerations under the contract: |
19 | | (i) That upon cessation of payment of |
20 | | considerations under a contract, or upon the written |
21 | | request of the contract owner, the company shall grant |
22 | | a paid-up annuity benefit on a plan stipulated in the |
23 | | contract of such value as is specified in subsections |
24 | | (5), (6), (7), (8) and (10); |
25 | | (ii)
If a contract provides for a lump sum |
26 | | settlement at maturity, or at any other time, that |
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1 | | upon surrender of the contract at or prior to the |
2 | | commencement of any annuity payments, the company |
3 | | shall pay in lieu of a paid-up annuity benefit a cash |
4 | | surrender benefit of such amount as is
specified in |
5 | | subsections (5), (6), (8) and (10). The company may |
6 | | reserve the right to
defer the payment of the cash |
7 | | surrender benefit for a period not to exceed 6 months |
8 | | after demand therefor with surrender of the contract |
9 | | after making written request and receiving written |
10 | | approval of the Director. The request shall address |
11 | | the necessity and equitability to all policyholders of |
12 | | the deferral; |
13 | | (iii) A statement of the mortality table, if any, |
14 | | and interest rates used calculating any minimum |
15 | | paid-up annuity, cash surrender, or death benefits |
16 | | that are guaranteed under the contract, together with |
17 | | sufficient information to determine the amounts of the |
18 | | benefits; and |
19 | | (iv)
A statement that any paid-up annuity, cash |
20 | | surrender or death benefits that may be available |
21 | | under the contract are not less than the minimum |
22 | | benefits required by any statute of the state in which |
23 | | the contract is delivered and an explanation of the |
24 | | manner in which the benefits are altered by the |
25 | | existence of any additional amounts credited by the |
26 | | company to the contract, any indebtedness to the |
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1 | | company on the contract or any prior withdrawals from |
2 | | or partial surrenders of the contract. |
3 | | (B) Notwithstanding the requirements of this Section, |
4 | | a deferred annuity contract may provide that if no |
5 | | considerations have been received under a contract for a |
6 | | period of 2 full years and the portion of the paid-up |
7 | | annuity benefit at maturity on the plan stipulated in the |
8 | | contract arising from prior considerations paid would be |
9 | | less than $20 monthly, the company may at its option |
10 | | terminate the contract by payment in cash of the then |
11 | | present value of the portion of the paid-up annuity |
12 | | benefit, calculated on the basis on the mortality table, |
13 | | if any, and interest rate specified in the contract for |
14 | | determining the paid-up annuity benefit, and by this |
15 | | payment shall be relieved of any further obligation under |
16 | | the contract. |
17 | | (4) Minimum values. The minimum values as specified in |
18 | | subsections (5), (6), (7), (8) and (10) of any paid-up |
19 | | annuity, cash surrender or death benefits available under an |
20 | | annuity contract shall be based upon minimum nonforfeiture |
21 | | amounts as defined in this subsection.
|
22 | | (A)(i) The minimum nonforfeiture amount at any time at |
23 | | or prior to the commencement of any annuity payments shall |
24 | | be equal to an accumulation up to such time at rates of |
25 | | interest as indicated in subdivision (4)(B) of the net |
26 | | considerations (as hereinafter defined) paid prior to such |
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1 | | time, decreased by the sum of paragraphs (a) through (d) |
2 | | below: |
3 | | (a) Any prior withdrawals from or partial |
4 | | surrenders of the contract accumulated at rates of |
5 | | interest as indicated in subdivision (4)(B);
|
6 | | (b) An annual contract charge of $50, accumulated |
7 | | at rates of interest as indicated in subdivision |
8 | | (4)(B);
|
9 | | (c) Any premium tax paid by the company for the |
10 | | contract, accumulated at rates of interest as |
11 | | indicated in subdivision (4)(B); and
|
12 | | (d) The amount of any indebtedness to the company |
13 | | on the contract, including
interest due and accrued. |
14 | | (ii) The net considerations for a given contract year |
15 | | used to define the minimum nonforfeiture amount shall be |
16 | | an amount
equal to 87.5% of the gross considerations,
|
17 | | credited to the contract during that contract year. |
18 | | (B) The interest rate used in determining minimum |
19 | | nonforfeiture amounts shall be an
annual rate of interest |
20 | | determined as the lesser of 3% per annum
and the |
21 | | following, which shall be specified in the contract if the |
22 | | interest rate will be reset: |
23 | | (i) The five-year Constant Maturity Treasury Rate |
24 | | reported by the Federal Reserve as of a date, or |
25 | | average over a period, rounded to the nearest 1/20th |
26 | | of one percent, specified in the contract no longer |
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1 | | than 15 months prior to the contract issue date or |
2 | | redetermination date under subdivision (4)(B)(iv); |
3 | | (ii) Reduced by 125 basis points; |
4 | | (iii) Where the resulting interest rate is not |
5 | | less than 0.15% 1% ; and |
6 | | (iv) The interest rate shall apply for an initial |
7 | | period and may be redetermined for additional periods. |
8 | | The redetermination date, basis and period, if any, |
9 | | shall be stated in the contract. The basis is the date |
10 | | or average over a specified period that produces the |
11 | | value of the 5-year Constant Maturity Treasury Rate to |
12 | | be used at each redetermination date. |
13 | | (C) During the period or term that a contract provides |
14 | | substantive participation in an equity indexed benefit, it |
15 | | may increase the reduction described in subdivision |
16 | | (4)(B)(ii)
above by up to an additional 100 basis points |
17 | | to reflect the value of the equity
index benefit. The |
18 | | present value at the contract issue date, and at each
|
19 | | redetermination date thereafter, of the additional |
20 | | reduction shall not exceed market value of the benefit. |
21 | | The Director may require a demonstration that the present |
22 | | value of the additional reduction does not exceed the |
23 | | market value of the benefit. Lacking such a demonstration |
24 | | that is acceptable to the Director, the Director may |
25 | | disallow or limit the additional reduction. |
26 | | (D) The Director may adopt rules to implement the |
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1 | | provisions of subdivision (4)(C) and to provide for |
2 | | further adjustments to the calculation of minimum |
3 | | nonforfeiture amounts for contracts that provide |
4 | | substantive participation in an equity index benefit and |
5 | | for other contracts that the Director determines |
6 | | adjustments are justified. |
7 | | (5) Computation of Present Value.
Any paid-up annuity |
8 | | benefit available under a contract shall be such that its |
9 | | present value on the date annuity payments are to commence is |
10 | | at least equal to the minimum nonforfeiture amount on that |
11 | | date. Present value shall be computed using the mortality |
12 | | table, if any, and the interest rates specified in the |
13 | | contract for determining the minimum paid-up annuity benefits |
14 | | guaranteed in the contract. |
15 | | (6) Calculation of Cash Surrender Value.
For contracts |
16 | | that provide cash surrender benefits, the cash surrender |
17 | | benefits available prior to maturity shall not be less than |
18 | | the present value as of the date of surrender of that portion |
19 | | of the maturity value of the paid-up annuity benefit that |
20 | | would be provided under the contract at maturity arising from |
21 | | considerations paid prior to the time of cash surrender |
22 | | reduced by the amount appropriate to reflect any prior |
23 | | withdrawals from or partial surrenders of the contract, such |
24 | | present value being calculated on the basis of an interest |
25 | | rate not more than 1% higher than the interest rate specified |
26 | | in the contract for accumulating the net considerations to |
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1 | | determine maturity value, decreased by the amount of any |
2 | | indebtedness to the company on the contract, including |
3 | | interest due and accrued, and increased by any existing |
4 | | additional amounts credited by the company to the contract. In |
5 | | no event shall any cash surrender benefit be less than the |
6 | | minimum nonforfeiture amount at that time. The death benefit |
7 | | under such contracts shall be at least equal to the cash |
8 | | surrender benefit. |
9 | | (7) Calculation of Paid-up Annuity Benefits.
For contracts |
10 | | that do not provide cash surrender benefits, the present value |
11 | | of any paid-up annuity benefit available as a nonforfeiture |
12 | | option at any time prior to maturity shall not be less than the |
13 | | present value of that portion of the maturity value of the |
14 | | paid-up annuity benefit provided under the contract arising |
15 | | from considerations paid prior to the time the contract is
|
16 | | surrendered in exchange for, or changed to, a deferred paid-up |
17 | | annuity, such present value being calculated for the period |
18 | | prior to the maturity date on the basis of the interest rate |
19 | | specified in the contract for accumulating the net |
20 | | considerations to determine maturity value, and increased by |
21 | | any additional amounts credited by the company to the |
22 | | contract. For contracts that do not provide any death benefits |
23 | | prior to the commencement of any annuity payments, present |
24 | | values shall be calculated on the basis of such interest rate |
25 | | and the mortality table specified in the contract for |
26 | | determining the maturity value of the paid-up annuity benefit. |
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1 | | However, in no event shall the present value of a paid-up |
2 | | annuity benefit be less than the minimum nonforfeiture amount |
3 | | at that time. |
4 | | (8) Maturity Date.
For the purpose of determining the |
5 | | benefits calculated under subsections (6) and (7), in the case |
6 | | of annuity contracts under which an election may be made to |
7 | | have annuity payments commence at optional maturity dates, the |
8 | | maturity date shall be deemed to be the latest date for which |
9 | | election shall be permitted by the contract, but shall not be |
10 | | deemed to be later than the anniversary of the contract next |
11 | | following the annuitant's seventieth birthday or the tenth |
12 | | anniversary of the contract, whichever is later. |
13 | | (9) Disclosure of Limited Death Benefits.
A contract that |
14 | | does not provide cash surrender benefits or does not provide |
15 | | death benefits at least equal to the minimum nonforfeiture |
16 | | amount prior to the commencement of any annuity payments shall |
17 | | include a statement in a prominent place in the contract that |
18 | | such benefits are not
provided. |
19 | | (10) Inclusion of Lapse of Time Considerations.
Any |
20 | | paid-up annuity, cash surrender or death benefits available at |
21 | | any time, other than on the contract anniversary under any |
22 | | contract with fixed scheduled considerations, shall be |
23 | | calculated with allowance for the lapse of time and the |
24 | | payment of any scheduled considerations beyond the beginning |
25 | | of the contract year in which cessation of payment of |
26 | | considerations under the contract occurs. |
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1 | | (11) Proration of Values; Additional Benefits.
For a |
2 | | contract which provides, within the same contract by rider or |
3 | | supplemental contract provision, both annuity benefits and |
4 | | life insurance benefits that are in excess of the greater of |
5 | | cash surrender benefits or a return of the gross |
6 | | considerations with interest, the minimum nonforfeiture |
7 | | benefits shall be equal to the sum of the minimum |
8 | | nonforfeiture benefits for the annuity portion and the minimum |
9 | | nonforfeiture benefits, if any, for the life insurance portion |
10 | | computed as if each portion were a separate contract. |
11 | | Notwithstanding the provisions of subsections (5), (6), (7), |
12 | | (8) and (10), additional benefits payable in the event of |
13 | | total and permanent disability, as reversionary annuity or |
14 | | deferred reversionary annuity benefits, or as other policy |
15 | | benefits additional to life insurance, endowment and annuity |
16 | | benefits, and considerations for all such additional benefits, |
17 | | shall be disregarded in ascertaining the minimum nonforfeiture |
18 | | amounts,
paid-up annuity, cash surrender and death benefits |
19 | | that may be required under this Section. The inclusion of such |
20 | | benefits shall not be required in any paid-up benefits, unless |
21 | | the additional benefits separately would require minimum |
22 | | nonforfeiture amounts, paid-up annuity, cash surrender and |
23 | | death benefits. |
24 | | (12) Rules. The Director may adopt rules to implement the |
25 | | provisions of this Section. |
26 | | (13) Effective Date. After the effective date of this |
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1 | | amendatory Act of the 93rd General Assembly, a company may |
2 | | elect to apply its provisions to annuity
contracts on a |
3 | | contract form-by-contract form basis before July 1, 2006. In |
4 | | all other instances, this Section shall become operative with |
5 | | respect to annuity contracts issued by the company on or after |
6 | | July 1, 2006.
|
7 | | (14) (Blank).
|
8 | | (Source: P.A. 93-873, eff. 8-6-04; 94-1076, eff. 12-29-06 .)
|
9 | | (215 ILCS 5/353a) (from Ch. 73, par. 965a)
|
10 | | Sec. 353a.
Accident
and health reserves.
|
11 | | The reserves for all accident and health policies issued |
12 | | after the
operative date of this section shall be computed and |
13 | | maintained on a basis
which shall place an actuarially sound |
14 | | value on the liabilities under such
policies. To provide a |
15 | | basis for the determination of such actuarially
sound value, |
16 | | the Director from time to time shall adopt rules requiring the
|
17 | | use of appropriate tables of morbidity, mortality, interest |
18 | | rates and
valuation methods for such reserves for policies |
19 | | issued before January 1, 2017. For policies issued on or after |
20 | | January 1, 2017, Section 223 shall govern the basis for |
21 | | determining such actuarially sound value . In no event shall |
22 | | such reserves be
less than the pro rata gross unearned premium |
23 | | reserve for such policies.
|
24 | | The company shall give the notice required in section 234 |
25 | | on all
non-cancellable accident and health policies.
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1 | | After this section becomes effective, any company may file |
2 | | with the
Director written notice of its election to comply |
3 | | with the provisions of
this section after a specified date |
4 | | before January 1, 1967. After the
filing of such notice, then |
5 | | upon such specified date (which shall be the
operative date of |
6 | | this section for such company), this section shall become
|
7 | | operative with respect to the accident and health policies |
8 | | thereafter
issued by such company. If a company makes no such |
9 | | election, the operative
date of this section for such company |
10 | | shall be January 1, 1967.
|
11 | | After this section becomes effective, any company may file |
12 | | with the
Director written notice of its election to establish |
13 | | and maintain reserves
upon its accident and health policies |
14 | | issued prior to the operative date of
this section in |
15 | | accordance with the standards for reserves established by
this |
16 | | section, and thereafter the reserve standards prescribed |
17 | | pursuant to
this section shall be effective with respect to |
18 | | said accident and health
policies issued prior to the |
19 | | operative date of this section.
|
20 | | (Source: Laws 1965, p. 740.)
|
21 | | (215 ILCS 5/355a) (from Ch. 73, par. 967a)
|
22 | | Sec. 355a. Standardization of terms and coverage.
|
23 | | (1) The purposes of this Section shall be (a) to provide
|
24 | | reasonable standardization and simplification of terms and |
25 | | coverages of
individual accident and health insurance policies |
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1 | | to facilitate public
understanding and comparisons; (b) to |
2 | | eliminate provisions contained in
individual accident and |
3 | | health insurance policies which may be
misleading or |
4 | | unreasonably confusing in connection either with the
purchase |
5 | | of such coverages or with the settlement of claims; and (c) to
|
6 | | provide for reasonable disclosure in the sale of accident and |
7 | | health
coverages.
|
8 | | (2) Definitions applicable to this Section are as follows:
|
9 | | (a) "Policy" means all or any part of the forms |
10 | | constituting the
contract between the insurer and the |
11 | | insured, including the policy,
certificate, subscriber |
12 | | contract, riders, endorsements, and the
application if |
13 | | attached, which are subject to filing with and approval
by |
14 | | the Director.
|
15 | | (b) "Service corporations" means
voluntary health and |
16 | | dental
corporations organized and operating respectively |
17 | | under
the Voluntary Health Services Plans Act and
the |
18 | | Dental Service Plan Act.
|
19 | | (c) "Accident and health insurance" means insurance |
20 | | written under
Article XX of this Code, other than credit |
21 | | accident and health
insurance, and coverages provided in |
22 | | subscriber contracts issued by
service corporations. For |
23 | | purposes of this Section such service
corporations shall |
24 | | be deemed to be insurers engaged in the business of
|
25 | | insurance.
|
26 | | (3) The Director shall issue such rules as he shall deem |
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1 | | necessary
or desirable to establish specific standards, |
2 | | including standards of
full and fair disclosure that set forth |
3 | | the form and content and
required disclosure for sale, of |
4 | | individual policies of accident and
health insurance, which |
5 | | rules and regulations shall be in addition to
and in |
6 | | accordance with the applicable laws of this State, and which |
7 | | may
cover but shall not be limited to: (a) terms of |
8 | | renewability; (b)
initial and subsequent conditions of |
9 | | eligibility; (c) non-duplication of
coverage provisions; (d) |
10 | | coverage of dependents; (e) pre-existing
conditions; (f) |
11 | | termination of insurance; (g) probationary periods; (h)
|
12 | | limitation, exceptions, and reductions; (i) elimination |
13 | | periods; (j)
requirements regarding replacements; (k) |
14 | | recurrent conditions; and (l)
the definition of terms, |
15 | | including, but not limited to, the following:
hospital, |
16 | | accident, sickness, injury, physician, accidental means, total
|
17 | | disability, partial disability, nervous disorder, guaranteed |
18 | | renewable,
and non-cancellable.
|
19 | | The Director may issue rules that specify prohibited |
20 | | policy
provisions not otherwise specifically authorized by |
21 | | statute which in the
opinion of the Director are unjust, |
22 | | unfair or unfairly discriminatory to
the policyholder, any |
23 | | person insured under the policy, or beneficiary.
|
24 | | (4) The Director shall issue such rules as he shall deem |
25 | | necessary
or desirable to establish minimum standards for |
26 | | benefits under each
category of coverage in individual |
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1 | | accident and health policies, other
than conversion policies |
2 | | issued pursuant to a contractual conversion
privilege under a |
3 | | group policy, including but not limited to the
following |
4 | | categories: (a) basic hospital expense coverage; (b) basic
|
5 | | medical-surgical expense coverage; (c) hospital confinement |
6 | | indemnity
coverage; (d) major medical expense coverage; (e) |
7 | | disability income
protection coverage; (f) accident only |
8 | | coverage; and (g) specified
disease or specified accident |
9 | | coverage.
|
10 | | Nothing in this subsection (4) shall preclude the issuance |
11 | | of any
policy which combines two or more of the categories of |
12 | | coverage
enumerated in subparagraphs (a) through (f) of this |
13 | | subsection.
|
14 | | No policy shall be delivered or issued for delivery in |
15 | | this State
which does not meet the prescribed minimum |
16 | | standards for the categories
of coverage listed in this |
17 | | subsection unless the Director finds that
such policy is |
18 | | necessary to meet specific needs of individuals or groups
and |
19 | | such individuals or groups will be adequately informed that |
20 | | such
policy does not meet the prescribed minimum standards, |
21 | | and such policy
meets the requirement that the benefits |
22 | | provided therein are reasonable
in relation to the premium |
23 | | charged. The standards and criteria to be
used by the Director |
24 | | in approving such policies shall be included in the
rules |
25 | | required under this Section with as much specificity as
|
26 | | practicable.
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| | HB4493 Enrolled | - 35 - | LRB102 22845 BMS 31996 b |
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1 | | The Director shall prescribe by rule the method of |
2 | | identification of
policies based upon coverages provided.
|
3 | | (5) (a) In order to provide for full and fair disclosure in |
4 | | the
sale of individual accident and health insurance policies, |
5 | | no such
policy shall be delivered or issued for delivery in |
6 | | this State unless
the outline of coverage described in |
7 | | paragraph (b) of this subsection
either accompanies the |
8 | | policy, or is delivered to the applicant at the
time the |
9 | | application is made, and an acknowledgment signed by the
|
10 | | insured, of receipt of delivery of such outline, is provided |
11 | | to the
insurer. In the event the policy is issued on a basis |
12 | | other than that
applied for, the outline of coverage properly |
13 | | describing the policy must
accompany the policy when it is |
14 | | delivered and such outline shall clearly
state that the policy |
15 | | differs, and to what extent, from that for which
application |
16 | | was originally made. All policies, except single premium
|
17 | | nonrenewal policies, shall have a notice prominently printed |
18 | | on the
first page of the policy or attached thereto stating in |
19 | | substance, that
the policyholder shall have the right to |
20 | | return the policy within 10 days of its delivery and to have |
21 | | the premium refunded if after
examination of the policy the |
22 | | policyholder is not satisfied for any
reason.
|
23 | | (b) The Director shall issue such rules as he shall deem |
24 | | necessary
or desirable to prescribe the format and content of |
25 | | the outline of
coverage required by paragraph (a) of this |
26 | | subsection. "Format" means
style, arrangement, and overall |
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| | HB4493 Enrolled | - 36 - | LRB102 22845 BMS 31996 b |
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1 | | appearance, including such items as the
size, color, and |
2 | | prominence of type and the arrangement of text and
captions. |
3 | | "Content" shall include without limitation thereto,
statements |
4 | | relating to the particular policy as to the applicable
|
5 | | category of coverage prescribed under subsection (4); |
6 | | principal benefits;
exceptions, reductions and limitations; |
7 | | and renewal provisions,
including any reservation by the |
8 | | insurer of a right to change premiums.
Such outline of |
9 | | coverage shall clearly state that it constitutes a
summary of |
10 | | the policy issued or applied for and that the policy should
be |
11 | | consulted to determine governing contractual provisions.
|
12 | | (c) (Blank). Without limiting the generality of paragraph |
13 | | (b) of this subsection (5), no qualified health plans shall be |
14 | | offered for sale directly to consumers through the health |
15 | | insurance marketplace operating in the State in accordance |
16 | | with Sections 1311 and
1321 of the federal Patient Protection |
17 | | and Affordable Care Act of 2010 (Public Law 111-148), as |
18 | | amended by the federal Health Care and Education |
19 | | Reconciliation Act of 2010 (Public Law 111-152), and any |
20 | | amendments thereto, or regulations or guidance issued |
21 | | thereunder (collectively, "the Federal Act"), unless the |
22 | | following information is made available to the consumer at the |
23 | | time he or she is comparing policies and their premiums: |
24 | | (i) With respect to prescription drug benefits, the |
25 | | most recently published formulary where a consumer can |
26 | | view in one location covered prescription drugs; |
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| | HB4493 Enrolled | - 37 - | LRB102 22845 BMS 31996 b |
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1 | | information on tiering and the cost-sharing structure for |
2 | | each tier; and information about how a consumer can obtain |
3 | | specific copayment amounts or coinsurance percentages for |
4 | | a specific qualified health plan before enrolling in that |
5 | | plan. This information shall clearly identify the |
6 | | qualified health plan to which it applies. |
7 | | (ii) The most recently published provider directory |
8 | | where a consumer can view the provider network that |
9 | | applies to each qualified health plan and information |
10 | | about each provider, including location, contact |
11 | | information, specialty, medical group, if any, any |
12 | | institutional affiliation, and whether the provider is |
13 | | accepting new patients at each of the specific locations |
14 | | listing the provider. Dental providers shall notify |
15 | | qualified health plans electronically or in writing of any |
16 | | changes to their information as listed in the provider |
17 | | directory. Qualified health plans shall update their |
18 | | directories in a manner consistent with the information |
19 | | provided by the provider or dental management service |
20 | | organization within 10 business days after being notified |
21 | | of the change by the provider. Nothing in this paragraph |
22 | | (ii) shall void any contractual relationship between the |
23 | | provider and the plan. The information shall clearly |
24 | | identify the qualified health plan to which it applies. |
25 | | (d) (Blank). Each company that offers qualified health |
26 | | plans for sale directly to consumers through the health |
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| | HB4493 Enrolled | - 38 - | LRB102 22845 BMS 31996 b |
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1 | | insurance marketplace operating in the State shall make the |
2 | | information in paragraph (c) of this subsection (5), for each |
3 | | qualified health plan that it offers, available and accessible |
4 | | to the general public on the company's Internet website and |
5 | | through other means for individuals without access to the |
6 | | Internet. |
7 | | (e) (Blank). The Department shall ensure that |
8 | | State-operated Internet websites, in addition to the Internet |
9 | | website for the health insurance marketplace established in |
10 | | this State in accordance with the Federal Act, prominently |
11 | | provide links to Internet-based materials and tools to help |
12 | | consumers be informed purchasers of health insurance. |
13 | | (f) (Blank). Nothing in this Section shall be interpreted |
14 | | or implemented in a manner not consistent with the Federal |
15 | | Act. This Section shall apply to all qualified health plans |
16 | | offered for sale directly to consumers through the health |
17 | | insurance marketplace operating in this State for any coverage |
18 | | year beginning on or after January 1, 2015. |
19 | | (6) Prior to the issuance of rules pursuant to this |
20 | | Section, the
Director shall afford the public, including the |
21 | | companies affected
thereby, reasonable opportunity for |
22 | | comment. Such rulemaking is subject
to the provisions of the |
23 | | Illinois Administrative Procedure Act.
|
24 | | (7) When a rule has been adopted, pursuant to this |
25 | | Section, all
policies of insurance or subscriber contracts |
26 | | which are not in
compliance with such rule shall, when so |
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| | HB4493 Enrolled | - 39 - | LRB102 22845 BMS 31996 b |
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1 | | provided in such rule, be
deemed to be disapproved as of a date |
2 | | specified in such rule not less
than 120 days following its |
3 | | effective date, without any further or
additional notice other |
4 | | than the adoption of the rule.
|
5 | | (8) When a rule adopted pursuant to this Section so |
6 | | provides, a
policy of insurance or subscriber contract which |
7 | | does not comply with
the rule shall, not less than 120 days |
8 | | from the effective date of such
rule, be construed, and the |
9 | | insurer or service corporation shall be
liable, as if the |
10 | | policy or contract did comply with the rule.
|
11 | | (9) Violation of any rule adopted pursuant to this Section |
12 | | shall be
a violation of the insurance law for purposes of |
13 | | Sections 370 and 446 of this
Code.
|
14 | | (Source: P.A. 99-329, eff. 1-1-16; 100-201, eff. 8-18-17.)
|
15 | | (215 ILCS 5/355c new) |
16 | | Sec. 355c. Availability of information on qualified health |
17 | | plans. |
18 | | (a) Without limiting the generality of paragraph (b) of |
19 | | subsection (5) of Section 355a, no qualified health plans |
20 | | shall be offered for sale directly to consumers through the |
21 | | health insurance marketplace operating in this State in |
22 | | accordance with Sections 1311 and 1321 of the federal Patient |
23 | | Protection and Affordable Care Act of 2010 (Public Law |
24 | | 111-148), as amended by the federal Health Care and Education |
25 | | Reconciliation Act of 2010 (Public Law 111-152), and any |
|
| | HB4493 Enrolled | - 40 - | LRB102 22845 BMS 31996 b |
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|
1 | | amendments thereto, or regulations or guidance issued |
2 | | thereunder (collectively, "the Federal Act"), unless the |
3 | | following information is made available to the consumer at the |
4 | | time he or she is comparing policies and their premiums: |
5 | | (1) With respect to prescription drug benefits, the |
6 | | most recently published formulary where a consumer can |
7 | | view in one location covered prescription drugs; |
8 | | information on tiering and the cost-sharing structure for |
9 | | each tier; and information about how a consumer can obtain |
10 | | specific copayment amounts or coinsurance percentages for |
11 | | a specific qualified health plan before enrolling in that |
12 | | plan. This information shall clearly identify the |
13 | | qualified health plan to which it applies. |
14 | | (2) The most recently published provider directory |
15 | | where a consumer can view the provider network that |
16 | | applies to each qualified health plan and information |
17 | | about each provider, including location, contact |
18 | | information, specialty, medical group, if any, any |
19 | | institutional affiliation, and whether the provider is |
20 | | accepting new patients at each of the specific locations |
21 | | listing the provider. Dental providers shall notify |
22 | | qualified health plans electronically or in writing of any |
23 | | changes to their information as listed in the provider |
24 | | directory. Qualified health plans shall update their |
25 | | directories in a manner consistent with the information |
26 | | provided by the provider or dental management service |
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| | HB4493 Enrolled | - 41 - | LRB102 22845 BMS 31996 b |
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1 | | organization within 10 business days after being notified |
2 | | of the change by the provider. Nothing in this paragraph |
3 | | (2) shall void any contractual relationship between the |
4 | | provider and the plan. The information shall clearly |
5 | | identify the qualified health plan to which it applies. |
6 | | (b) Each company that offers qualified health plans for |
7 | | sale directly to consumers through the health insurance |
8 | | marketplace operating in this State shall make the information |
9 | | in subsection (a), for each qualified health plan that it |
10 | | offers, available and accessible to the general public on the |
11 | | company's website and through other means for individuals |
12 | | without access to the Internet. |
13 | | (c) The Department shall ensure that State-operated |
14 | | websites, in addition to the website for the health insurance |
15 | | marketplace established in this State in accordance with the |
16 | | Federal Act, prominently provide links to Internet-based |
17 | | materials and tools to help consumers be informed purchasers |
18 | | of health insurance. |
19 | | (d) Nothing in this Section shall be interpreted or |
20 | | implemented in a manner not consistent with the Federal Act. |
21 | | This Section shall apply to all qualified health plans offered |
22 | | for sale directly to consumers through the health insurance |
23 | | marketplace operating in this State for any coverage year |
24 | | beginning on or after January 1, 2015.
|
25 | | (215 ILCS 5/408) (from Ch. 73, par. 1020)
|
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| | HB4493 Enrolled | - 42 - | LRB102 22845 BMS 31996 b |
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1 | | Sec. 408. Fees and charges.
|
2 | | (1) The Director shall charge, collect and
give proper |
3 | | acquittances for the payment of the following fees and |
4 | | charges:
|
5 | | (a) For filing all documents submitted for the |
6 | | incorporation or
organization or certification of a |
7 | | domestic company, except for a fraternal
benefit society, |
8 | | $2,000.
|
9 | | (b) For filing all documents submitted for the |
10 | | incorporation or
organization of a fraternal benefit |
11 | | society, $500.
|
12 | | (c) For filing amendments to articles of incorporation |
13 | | and amendments to
declaration of organization, except for |
14 | | a fraternal benefit society, a
mutual benefit association, |
15 | | a burial society or a farm mutual, $200.
|
16 | | (d) For filing amendments to articles of incorporation |
17 | | of a fraternal
benefit society, a mutual benefit |
18 | | association or a burial society, $100.
|
19 | | (e) For filing amendments to articles of incorporation |
20 | | of a farm mutual,
$50.
|
21 | | (f) For filing bylaws or amendments thereto, $50.
|
22 | | (g) For filing agreement of merger or consolidation:
|
23 | | (i) for a domestic company, except
for a fraternal |
24 | | benefit society, a
mutual benefit association, a |
25 | | burial society,
or a farm mutual, $2,000.
|
26 | | (ii) for a foreign or
alien company, except for a |
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| | HB4493 Enrolled | - 43 - | LRB102 22845 BMS 31996 b |
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1 | | fraternal
benefit society, $600.
|
2 | | (iii) for a fraternal benefit society,
a mutual |
3 | | benefit association, a burial society,
or a farm |
4 | | mutual, $200.
|
5 | | (h) For filing agreements of reinsurance by a domestic |
6 | | company, $200.
|
7 | | (i) For filing all documents submitted by a foreign or |
8 | | alien
company to be admitted to transact business or |
9 | | accredited as a
reinsurer in this State, except for a
|
10 | | fraternal benefit society, $5,000.
|
11 | | (j) For filing all documents submitted by a foreign or |
12 | | alien
fraternal benefit society to be admitted to transact |
13 | | business
in this State, $500.
|
14 | | (k) For filing declaration of withdrawal of a foreign |
15 | | or
alien company, $50.
|
16 | | (l) For filing annual statement by a domestic company, |
17 | | except a fraternal benefit
society, a mutual benefit |
18 | | association, a burial society, or
a farm mutual, $200.
|
19 | | (m) For filing annual statement by a domestic |
20 | | fraternal benefit
society, $100.
|
21 | | (n) For filing annual statement by a farm mutual, a |
22 | | mutual benefit
association, or a burial society, $50.
|
23 | | (o) For issuing a certificate of authority or
renewal |
24 | | thereof except to a foreign fraternal benefit society, |
25 | | $400.
|
26 | | (p) For issuing a certificate of authority or renewal |
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| | HB4493 Enrolled | - 44 - | LRB102 22845 BMS 31996 b |
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1 | | thereof to a foreign
fraternal benefit society, $200.
|
2 | | (q) For issuing an amended certificate of authority, |
3 | | $50.
|
4 | | (r) For each certified copy of certificate of |
5 | | authority, $20.
|
6 | | (s) For each certificate of deposit, or valuation, or |
7 | | compliance
or surety certificate, $20.
|
8 | | (t) For copies of papers or records per page, $1.
|
9 | | (u) For each certification to copies
of papers or |
10 | | records, $10.
|
11 | | (v) For multiple copies of documents or certificates |
12 | | listed in
subparagraphs (r), (s), and (u) of paragraph (1) |
13 | | of this Section, $10 for
the first copy of a certificate of |
14 | | any type and $5 for each additional copy
of the same |
15 | | certificate requested at the same time, unless, pursuant |
16 | | to
paragraph (2) of this Section, the Director finds these |
17 | | additional fees
excessive.
|
18 | | (w) For issuing a permit to sell shares or increase |
19 | | paid-up
capital:
|
20 | | (i) in connection with a public stock offering, |
21 | | $300;
|
22 | | (ii) in any other case, $100.
|
23 | | (x) For issuing any other certificate required or |
24 | | permissible
under the law, $50.
|
25 | | (y) For filing a plan of exchange of the stock of a |
26 | | domestic
stock insurance company, a plan of |
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1 | | demutualization of a domestic
mutual company, or a plan of |
2 | | reorganization under Article XII, $2,000.
|
3 | | (z) For filing a statement of acquisition of a
|
4 | | domestic company as defined in Section 131.4 of this Code, |
5 | | $2,000.
|
6 | | (aa) For filing an agreement to purchase the business |
7 | | of an
organization authorized under the Dental Service |
8 | | Plan Act
or the Voluntary Health Services Plans Act or
of a |
9 | | health maintenance
organization or a limited health |
10 | | service organization, $2,000.
|
11 | | (bb) For filing a statement of acquisition of a |
12 | | foreign or alien
insurance company as defined in Section |
13 | | 131.12a of this Code, $1,000.
|
14 | | (cc) For filing a registration statement as required |
15 | | in Sections 131.13
and 131.14, the notification as |
16 | | required by Sections 131.16,
131.20a, or 141.4, or an
|
17 | | agreement or transaction required by Sections 124.2(2), |
18 | | 141, 141a, or
141.1, $200.
|
19 | | (dd) For filing an application for licensing of:
|
20 | | (i) a religious or charitable risk pooling trust |
21 | | or a workers'
compensation pool, $1,000;
|
22 | | (ii) a workers' compensation service company, |
23 | | $500;
|
24 | | (iii) a self-insured automobile fleet, $200; or
|
25 | | (iv) a renewal of or amendment of any license |
26 | | issued pursuant to (i),
(ii), or (iii) above, $100.
|
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| | HB4493 Enrolled | - 46 - | LRB102 22845 BMS 31996 b |
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1 | | (ee) For filing articles of incorporation for a |
2 | | syndicate to engage in
the business of insurance through |
3 | | the Illinois Insurance Exchange, $2,000.
|
4 | | (ff) For filing amended articles of incorporation for |
5 | | a syndicate engaged
in the business of insurance through |
6 | | the Illinois Insurance Exchange, $100.
|
7 | | (gg) For filing articles of incorporation for a |
8 | | limited syndicate to
join with other subscribers or |
9 | | limited syndicates to do business through
the Illinois |
10 | | Insurance Exchange, $1,000.
|
11 | | (hh) For filing amended articles of incorporation for |
12 | | a limited
syndicate to do business through the Illinois |
13 | | Insurance Exchange, $100.
|
14 | | (ii) For a permit to solicit subscriptions to a |
15 | | syndicate
or limited syndicate, $100.
|
16 | | (jj) For the filing of each form as required in |
17 | | Section 143 of this
Code, $50 per form. Informational and |
18 | | advertising filings shall be $25 per filing. The fee for |
19 | | advisory and rating
organizations shall be $200 per form.
|
20 | | (i) For the purposes of the form filing fee, |
21 | | filings made on insert page
basis will be considered |
22 | | one form at the time of its original submission.
|
23 | | Changes made to a form subsequent to its approval |
24 | | shall be considered a
new filing.
|
25 | | (ii) Only one fee shall be charged for a form, |
26 | | regardless of the number
of other forms or policies |
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1 | | with which it will be used.
|
2 | | (iii) Fees charged for a policy filed as it will be |
3 | | issued regardless of the number of forms comprising |
4 | | that policy shall not exceed $1,500. For advisory or |
5 | | rating organizations, fees charged for a policy filed |
6 | | as it will be issued regardless of the number of forms |
7 | | comprising that policy shall not exceed $2,500.
|
8 | | (iv) The Director may by rule exempt forms from |
9 | | such fees.
|
10 | | (kk) For filing an application for licensing of a |
11 | | reinsurance
intermediary, $500.
|
12 | | (ll) For filing an application for renewal of a |
13 | | license of a reinsurance
intermediary, $200.
|
14 | | (mm) For filing a plan of division of a domestic stock |
15 | | company under Article IIB, $10,000. |
16 | | (nn) For filing all documents submitted by a foreign |
17 | | or alien company to be a certified reinsurer in this |
18 | | State, except for a fraternal benefit society, $1,000. |
19 | | (oo) For filing a renewal by a foreign or alien
|
20 | | company to be a certified reinsurer in this State, except
|
21 | | for a fraternal benefit society, $400. |
22 | | (pp) For filing all documents submitted by a reinsurer |
23 | | domiciled in a reciprocal jurisdiction, $1,000. |
24 | | (qq) For filing a renewal by a reinsurer domiciled in |
25 | | a reciprocal jurisdiction, $400. |
26 | | (rr) For registering a captive management company or |
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| | HB4493 Enrolled | - 48 - | LRB102 22845 BMS 31996 b |
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1 | | renewal thereof, $50. |
2 | | (2) When printed copies or numerous copies of the same |
3 | | paper or records
are furnished or certified, the Director may |
4 | | reduce such fees for copies
if he finds them excessive. He may, |
5 | | when he considers it in the public
interest, furnish without |
6 | | charge to state insurance departments and persons
other than |
7 | | companies, copies or certified copies of reports of |
8 | | examinations
and of other papers and records.
|
9 | | (3) The expenses incurred in any performance
examination |
10 | | authorized by law shall be paid by the company or person being
|
11 | | examined. The charge shall be reasonably related to the cost |
12 | | of the
examination including but not limited to compensation |
13 | | of examiners,
electronic data processing costs, supervision |
14 | | and preparation of an
examination report and lodging and |
15 | | travel expenses.
All lodging and travel expenses shall be in |
16 | | accord
with the applicable travel regulations as published by |
17 | | the Department of
Central Management Services and approved by |
18 | | the Governor's Travel Control
Board, except that out-of-state |
19 | | lodging and travel expenses related to
examinations authorized |
20 | | under Section 132 shall be in accordance with
travel rates |
21 | | prescribed under paragraph 301-7.2 of the Federal Travel
|
22 | | Regulations, 41 C.F.R. 301-7.2, for reimbursement of |
23 | | subsistence expenses
incurred during official travel. All |
24 | | lodging and travel expenses may be reimbursed directly upon |
25 | | authorization of the
Director. With the exception of the
|
26 | | direct reimbursements authorized by the
Director, all |
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| | HB4493 Enrolled | - 49 - | LRB102 22845 BMS 31996 b |
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1 | | performance examination charges collected by the
Department |
2 | | shall be paid
to the Insurance Producer Administration Fund,
|
3 | | however, the electronic data processing costs
incurred by the |
4 | | Department in the performance of any examination shall be
|
5 | | billed directly to the company being examined for payment to |
6 | | the Technology Management
Revolving Fund.
|
7 | | (4) At the time of any service of process on the Director
|
8 | | as attorney for such service, the Director shall charge and |
9 | | collect the
sum of $40 $20 , which may be recovered as taxable |
10 | | costs by
the party to the suit or action causing such service |
11 | | to be made if he prevails
in such suit or action.
|
12 | | (5) (a) The costs incurred by the Department of Insurance
|
13 | | in conducting any hearing authorized by law shall be assessed |
14 | | against the
parties to the hearing in such proportion as the |
15 | | Director of Insurance may
determine upon consideration of all |
16 | | relevant circumstances including: (1)
the nature of the |
17 | | hearing; (2) whether the hearing was instigated by, or
for the |
18 | | benefit of a particular party or parties; (3) whether there is |
19 | | a
successful party on the merits of the proceeding; and (4) the |
20 | | relative levels
of participation by the parties.
|
21 | | (b) For purposes of this subsection (5) costs incurred |
22 | | shall
mean the hearing officer fees, court reporter fees, and |
23 | | travel expenses
of Department of Insurance officers and |
24 | | employees; provided however, that
costs incurred shall not |
25 | | include hearing officer fees or court reporter
fees unless the |
26 | | Department has retained the services of independent
|
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| | HB4493 Enrolled | - 50 - | LRB102 22845 BMS 31996 b |
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1 | | contractors or outside experts to perform such functions.
|
2 | | (c) The Director shall make the assessment of costs |
3 | | incurred as part of
the final order or decision arising out of |
4 | | the proceeding; provided, however,
that such order or decision |
5 | | shall include findings and conclusions in support
of the |
6 | | assessment of costs. This subsection (5) shall not be |
7 | | construed as
permitting the payment of travel expenses unless |
8 | | calculated in accordance
with the applicable travel |
9 | | regulations of the Department
of Central Management Services, |
10 | | as approved by the Governor's Travel Control
Board. The |
11 | | Director as part of such order or decision shall require all
|
12 | | assessments for hearing officer fees and court reporter fees, |
13 | | if any, to
be paid directly to the hearing officer or court |
14 | | reporter by the party(s)
assessed for such costs. The |
15 | | assessments for travel expenses of Department
officers and |
16 | | employees shall be reimbursable to the
Director of Insurance |
17 | | for
deposit to the fund out of which those expenses had been |
18 | | paid.
|
19 | | (d) The provisions of this subsection (5) shall apply in |
20 | | the case of any
hearing conducted by the Director of Insurance |
21 | | not otherwise specifically
provided for by law.
|
22 | | (6) The Director shall charge and collect an annual |
23 | | financial
regulation fee from every domestic company for |
24 | | examination and analysis of
its financial condition and to |
25 | | fund the internal costs and expenses of the
Interstate |
26 | | Insurance Receivership Commission as may be allocated to the |
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| | HB4493 Enrolled | - 51 - | LRB102 22845 BMS 31996 b |
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1 | | State
of Illinois and companies doing an insurance business in |
2 | | this State pursuant to
Article X of the Interstate Insurance |
3 | | Receivership Compact. The fee shall be
the greater fixed |
4 | | amount based upon
the combination of nationwide direct premium |
5 | | income and
nationwide reinsurance
assumed premium
income or |
6 | | upon admitted assets calculated under this subsection as |
7 | | follows:
|
8 | | (a) Combination of nationwide direct premium income |
9 | | and
nationwide reinsurance assumed premium.
|
10 | | (i) $150, if the premium is less than $500,000 and |
11 | | there is
no
reinsurance assumed premium;
|
12 | | (ii) $750, if the premium is $500,000 or more, but |
13 | | less
than $5,000,000
and there is no reinsurance |
14 | | assumed premium; or if the premium is less than
|
15 | | $5,000,000 and the reinsurance assumed premium is less |
16 | | than $10,000,000;
|
17 | | (iii) $3,750, if the premium is less than |
18 | | $5,000,000 and
the reinsurance
assumed premium is |
19 | | $10,000,000 or more;
|
20 | | (iv) $7,500, if the premium is $5,000,000 or more, |
21 | | but
less than
$10,000,000;
|
22 | | (v) $18,000, if the premium is $10,000,000 or |
23 | | more, but
less than $25,000,000;
|
24 | | (vi) $22,500, if the premium is $25,000,000 or |
25 | | more, but
less
than $50,000,000;
|
26 | | (vii) $30,000, if the premium is $50,000,000 or |
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1 | | more,
but less than $100,000,000;
|
2 | | (viii) $37,500, if the premium is $100,000,000 or |
3 | | more.
|
4 | | (b) Admitted assets.
|
5 | | (i) $150, if admitted assets are less than |
6 | | $1,000,000;
|
7 | | (ii) $750, if admitted assets are $1,000,000 or |
8 | | more, but
less than
$5,000,000;
|
9 | | (iii) $3,750, if admitted assets are $5,000,000 or |
10 | | more,
but less than
$25,000,000;
|
11 | | (iv) $7,500, if admitted assets are $25,000,000 or |
12 | | more,
but less than
$50,000,000;
|
13 | | (v) $18,000, if admitted assets are $50,000,000 or |
14 | | more,
but less than
$100,000,000;
|
15 | | (vi) $22,500, if admitted assets are $100,000,000 |
16 | | or
more, but less
than $500,000,000;
|
17 | | (vii) $30,000, if admitted assets are $500,000,000 |
18 | | or
more, but less
than $1,000,000,000;
|
19 | | (viii) $37,500, if admitted assets are |
20 | | $1,000,000,000
or more.
|
21 | | (c) The sum of financial regulation fees charged to |
22 | | the domestic
companies of the same affiliated group shall |
23 | | not exceed $250,000
in the aggregate in any single year |
24 | | and shall be billed by the Director to
the member company |
25 | | designated by the
group.
|
26 | | (7) The Director shall charge and collect an annual |
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1 | | financial regulation
fee from every foreign or alien company, |
2 | | except fraternal benefit
societies, for the
examination and |
3 | | analysis of its financial condition and to fund the internal
|
4 | | costs and expenses of the Interstate Insurance Receivership |
5 | | Commission as may
be allocated to the State of Illinois and |
6 | | companies doing an insurance business
in this State pursuant |
7 | | to Article X of the Interstate Insurance Receivership
Compact.
|
8 | | The fee shall be a fixed amount based upon Illinois direct |
9 | | premium income
and nationwide reinsurance assumed premium |
10 | | income in accordance with the
following schedule:
|
11 | | (a) $150, if the premium is less than $500,000 and |
12 | | there is
no
reinsurance assumed premium;
|
13 | | (b) $750, if the premium is $500,000 or more, but less |
14 | | than
$5,000,000
and there is no reinsurance assumed |
15 | | premium;
or if the premium is less than $5,000,000 and the |
16 | | reinsurance assumed
premium is less than $10,000,000;
|
17 | | (c) $3,750, if the premium is less than $5,000,000 and |
18 | | the
reinsurance
assumed premium is $10,000,000 or more;
|
19 | | (d) $7,500, if the premium is $5,000,000 or more, but |
20 | | less
than
$10,000,000;
|
21 | | (e) $18,000, if the premium is $10,000,000 or more, |
22 | | but
less than
$25,000,000;
|
23 | | (f) $22,500, if the premium is $25,000,000 or more, |
24 | | but
less than
$50,000,000;
|
25 | | (g) $30,000, if the premium is $50,000,000 or more, |
26 | | but
less than
$100,000,000;
|
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1 | | (h) $37,500, if the premium is $100,000,000 or more.
|
2 | | The sum of financial regulation fees under this subsection |
3 | | (7)
charged to the foreign or alien companies within the same |
4 | | affiliated group
shall not exceed $250,000 in the aggregate in |
5 | | any single year
and shall be
billed by the Director to the |
6 | | member company designated by the group.
|
7 | | (8) Beginning January 1, 1992, the financial regulation |
8 | | fees imposed
under subsections (6) and (7)
of this Section |
9 | | shall be paid by each company or domestic affiliated group
|
10 | | annually. After January
1, 1994, the fee shall be billed by |
11 | | Department invoice
based upon the company's
premium income or |
12 | | admitted assets as shown in its annual statement for the
|
13 | | preceding calendar year. The invoice is due upon
receipt and |
14 | | must be paid no later than June 30 of each calendar year. All
|
15 | | financial
regulation fees collected by the Department shall be |
16 | | paid to the Insurance
Financial Regulation Fund. The |
17 | | Department may not collect financial
examiner per diem charges |
18 | | from companies subject to subsections (6) and (7)
of this |
19 | | Section undergoing financial examination
after June 30, 1992.
|
20 | | (9) In addition to the financial regulation fee required |
21 | | by this
Section, a company undergoing any financial |
22 | | examination authorized by law
shall pay the following costs |
23 | | and expenses incurred by the Department:
electronic data |
24 | | processing costs, the expenses authorized under Section 131.21
|
25 | | and
subsection (d) of Section 132.4 of this Code, and lodging |
26 | | and travel expenses.
|
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1 | | Electronic data processing costs incurred by the |
2 | | Department in the
performance of any examination shall be |
3 | | billed directly to the company
undergoing examination for |
4 | | payment to the Technology Management Revolving
Fund. Except |
5 | | for direct reimbursements authorized by the Director or
direct |
6 | | payments made under Section 131.21 or subsection (d) of |
7 | | Section
132.4 of this Code, all financial regulation fees and |
8 | | all financial
examination charges collected by the Department |
9 | | shall be paid to the
Insurance Financial Regulation Fund.
|
10 | | All lodging and travel expenses shall be in accordance |
11 | | with applicable
travel regulations published by the Department |
12 | | of Central Management
Services and approved by the Governor's |
13 | | Travel Control Board, except that
out-of-state lodging and |
14 | | travel expenses related to examinations authorized
under |
15 | | Sections 132.1 through 132.7 shall be in accordance
with |
16 | | travel rates prescribed
under paragraph 301-7.2 of the Federal |
17 | | Travel Regulations, 41 C.F.R. 301-7.2,
for reimbursement of |
18 | | subsistence expenses incurred during official travel.
All |
19 | | lodging and travel expenses may be
reimbursed directly upon |
20 | | the authorization of the Director.
|
21 | | In the case of an organization or person not subject to the |
22 | | financial
regulation fee, the expenses incurred in any |
23 | | financial examination authorized
by law shall be paid by the |
24 | | organization or person being examined. The charge
shall be |
25 | | reasonably related to the cost of the examination including, |
26 | | but not
limited to, compensation of examiners and other costs |
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1 | | described in this
subsection.
|
2 | | (10) Any company, person, or entity failing to make any |
3 | | payment of $150
or more as required under this Section shall be |
4 | | subject to the penalty and
interest provisions provided for in |
5 | | subsections (4) and (7)
of Section 412.
|
6 | | (11) Unless otherwise specified, all of the fees collected |
7 | | under this
Section shall be paid into the Insurance Financial |
8 | | Regulation Fund.
|
9 | | (12) For purposes of this Section:
|
10 | | (a) "Domestic company" means a company as defined in |
11 | | Section 2 of this
Code which is incorporated or organized |
12 | | under the laws of this State, and in
addition includes a |
13 | | not-for-profit corporation authorized under the Dental
|
14 | | Service Plan Act or the Voluntary Health
Services Plans |
15 | | Act, a health maintenance organization, and a
limited
|
16 | | health service organization.
|
17 | | (b) "Foreign company" means a company as defined in |
18 | | Section 2 of this
Code which is incorporated or organized |
19 | | under the laws of any state of the
United States other than |
20 | | this State and in addition includes a health
maintenance |
21 | | organization and a limited health service organization |
22 | | which is
incorporated or organized under the laws
of any |
23 | | state of the United States other than this State.
|
24 | | (c) "Alien company" means a company as defined in |
25 | | Section 2 of this Code
which is incorporated or organized |
26 | | under the laws of any country other than
the United |
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1 | | States.
|
2 | | (d) "Fraternal benefit society" means a corporation, |
3 | | society, order,
lodge or voluntary association as defined |
4 | | in Section 282.1 of this
Code.
|
5 | | (e) "Mutual benefit association" means a company, |
6 | | association or
corporation authorized by the Director to |
7 | | do business in this State under
the provisions of Article |
8 | | XVIII of this Code.
|
9 | | (f) "Burial society" means a person, firm, |
10 | | corporation, society or
association of individuals |
11 | | authorized by the Director to do business in
this State |
12 | | under the provisions of Article XIX of this Code.
|
13 | | (g) "Farm mutual" means a district, county and |
14 | | township mutual insurance
company authorized by the |
15 | | Director to do business in this State under the
provisions |
16 | | of the Farm Mutual Insurance Company Act of 1986.
|
17 | | (Source: P.A. 100-23, eff. 7-6-17.)
|
18 | | (215 ILCS 5/412) (from Ch. 73, par. 1024)
|
19 | | Sec. 412. Refunds; penalties; collection.
|
20 | | (1)(a) Whenever it appears to
the satisfaction of the |
21 | | Director that because of some mistake of fact,
error in |
22 | | calculation, or erroneous interpretation of a statute of this
|
23 | | or any other state, any authorized company, surplus line |
24 | | producer, or industrial insured has paid to him, pursuant to
|
25 | | any provision of law, taxes, fees, or other charges
in excess |
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1 | | of the
amount legally chargeable against it, during the 6 year |
2 | | period
immediately preceding the discovery of such |
3 | | overpayment, he shall have
power to refund to such company, |
4 | | surplus line producer, or industrial insured the amount of the |
5 | | excess or excesses by
applying the amount or amounts thereof |
6 | | toward
the payment of taxes, fees, or other charges already |
7 | | due, or which may
thereafter become due from that company |
8 | | until such excess or excesses have been
fully
refunded, or |
9 | | upon a written request from the authorized company, surplus |
10 | | line producer, or industrial insured, the
Director shall |
11 | | provide a cash refund within
120 days after receipt of the |
12 | | written request if all necessary information has
been filed |
13 | | with the Department in order for it to perform an audit of the
|
14 | | tax report for the transaction or period or annual return for |
15 | | the year in which the overpayment occurred or within 120 days
|
16 | | after the date the Department receives all the necessary |
17 | | information to perform
such audit. The Director shall not |
18 | | provide a cash refund if there are
insufficient funds in the |
19 | | Insurance Premium Tax Refund Fund to provide a cash
refund, if |
20 | | the amount of the overpayment is less than $100, or if the |
21 | | amount of
the overpayment can be fully offset against the |
22 | | taxpayer's estimated liability
for the year following the year |
23 | | of the cash refund request. Any cash refund
shall be paid from |
24 | | the Insurance Premium Tax Refund Fund, a special fund hereby
|
25 | | created in the
State treasury.
|
26 | | (b) As determined by the Director pursuant to paragraph |
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1 | | (a) of this subsection Beginning January 1, 2000 and |
2 | | thereafter , the Department shall deposit an amount of cash |
3 | | refunds approved by the Director for payment as a result of |
4 | | overpayment of tax liability
a percentage of the amounts |
5 | | collected under Sections 121-2.08, 409, 444, and 444.1 , and |
6 | | 445 of
this
Code into the Insurance Premium Tax Refund Fund. |
7 | | The percentage deposited into
the Insurance Premium Tax Refund |
8 | | Fund shall be the annual percentage. The
annual
percentage |
9 | | shall be calculated as a fraction, the numerator of which |
10 | | shall be
the amount of cash refunds approved by the Director |
11 | | for payment and paid during
the preceding calendar year as a |
12 | | result of overpayment of tax liability under
Sections |
13 | | 121-2.08, 409, 444, 444.1, and 445 of this Code and the |
14 | | denominator of which shall
be the amounts collected pursuant |
15 | | to Sections 121-2.08, 409, 444, 444.1, and 445 of this Code
|
16 | | during the preceding calendar year. However, if there were no |
17 | | cash refunds
paid in a preceding calendar year, the Department |
18 | | shall deposit 5% of the
amount collected in that preceding |
19 | | calendar year pursuant to Sections 121-2.08, 409, 444,
444.1, |
20 | | and 445 of this Code into the Insurance Premium Tax Refund Fund |
21 | | instead of an
amount calculated by using the annual |
22 | | percentage.
|
23 | | (c) Beginning July 1, 1999, moneys in the Insurance |
24 | | Premium Tax Refund
Fund
shall be expended exclusively for the |
25 | | purpose of paying cash refunds resulting
from overpayment of |
26 | | tax liability under Sections 121-2.08, 409, 444, 444.1, and |
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1 | | 445 of this
Code
as
determined by the Director pursuant to |
2 | | subsection 1(a) of this Section. Cash
refunds made in |
3 | | accordance with this Section may be made from the Insurance
|
4 | | Premium Tax Refund Fund only to the extent that amounts have |
5 | | been deposited and
retained in the Insurance Premium Tax |
6 | | Refund Fund.
|
7 | | (d) This Section shall constitute an irrevocable and |
8 | | continuing
appropriation from the Insurance Premium Tax Refund |
9 | | Fund for the purpose of
paying cash refunds pursuant to the |
10 | | provisions of this Section.
|
11 | | (2)(a) When any insurance company fails to
file any tax |
12 | | return required under Sections 408.1, 409, 444, and 444.1 of
|
13 | | this Code or Section 12 of the Fire Investigation Act on the |
14 | | date
prescribed, including any extensions, there shall be |
15 | | added as a penalty
$400 or 10% of the amount of such tax, |
16 | | whichever is
greater, for each month
or part of a month of |
17 | | failure to file, the entire penalty not to exceed
$2,000 or 50% |
18 | | of the tax due, whichever is greater.
|
19 | | (b) When any industrial insured or surplus line producer |
20 | | fails to file any tax return or report required under Sections |
21 | | 121-2.08 and 445 of this Code or Section 12 of the Fire |
22 | | Investigation Act on the date prescribed, including any |
23 | | extensions, there shall be added: |
24 | | (i) as a late fee, if the return or report is received |
25 | | at least one day but not more than 7 days after the |
26 | | prescribed due date, $400 or 10% of the tax due, whichever |
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1 | | is greater, the entire fee not to exceed $1,000; |
2 | | (ii) as a late fee, if the return or report is received |
3 | | at least 8 days but not more than 14 days after the |
4 | | prescribed due date, $400 or 10% of the tax due, whichever |
5 | | is greater, the entire fee not to exceed $1,500; |
6 | | (iii) as a late fee, if the return or report is |
7 | | received at least 15 days but not more than 21 days after |
8 | | the prescribed due date, $400 or 10% of the tax due, |
9 | | whichever is greater, the entire fee not to exceed $2,000; |
10 | | or |
11 | | (iv) as a penalty, if the return or report is received |
12 | | more than 21 days after the prescribed due date, $400 or |
13 | | 10% of the tax due, whichever is greater, for each month or |
14 | | part of a month of failure to file, the entire penalty not |
15 | | to exceed $2,000 or 50% of the tax due, whichever is |
16 | | greater. |
17 | | A tax return or report shall be deemed received as of the |
18 | | date mailed as evidenced by a postmark, proof of mailing on a |
19 | | recognized United States Postal Service form or a form |
20 | | acceptable to the United States Postal Service or other |
21 | | commercial mail delivery service, or other evidence acceptable |
22 | | to the Director.
|
23 | | (3)(a) When any insurance company
fails to pay the full |
24 | | amount due under the provisions of this Section,
Sections |
25 | | 408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
|
26 | | Fire Investigation Act, there shall be added to the amount due |
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1 | | as a penalty
an amount equal to 10% of the deficiency.
|
2 | | (a-5) When any industrial insured or surplus line producer |
3 | | fails to pay the full amount due under the provisions of this |
4 | | Section, Sections 121-2.08 or 445 of this Code, or Section 12 |
5 | | of the Fire Investigation Act on the date prescribed, there |
6 | | shall be added: |
7 | | (i) as a late fee, if the payment is received at least |
8 | | one day but not more than 7 days after the prescribed due |
9 | | date, 10% of the tax due, the entire fee not to exceed |
10 | | $1,000; |
11 | | (ii) as a late fee, if the payment is received at least |
12 | | 8 days but not more than 14 days after the prescribed due |
13 | | date, 10% of the tax due, the entire fee not to exceed |
14 | | $1,500; |
15 | | (iii) as a late fee, if the payment is received at |
16 | | least 15 days but not more than 21 days after the |
17 | | prescribed due date, 10% of the tax due, the entire fee not |
18 | | to exceed $2,000; or |
19 | | (iv) as a penalty, if the return or report is received |
20 | | more than 21 days after the prescribed due date, 10% of the |
21 | | tax due. |
22 | | A tax payment shall be deemed received as of the date |
23 | | mailed as evidenced by a postmark, proof of mailing on a |
24 | | recognized United States Postal Service form or a form |
25 | | acceptable to the United States Postal Service or other |
26 | | commercial mail delivery service, or other evidence acceptable |
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1 | | to the Director.
|
2 | | (b) If such failure to pay is determined by the Director to |
3 | | be wilful,
after a hearing under Sections 402 and 403, there |
4 | | shall be added to the tax
as a penalty an amount equal to the |
5 | | greater of 50% of the
deficiency or 10%
of the amount due and |
6 | | unpaid for each month or part of a month that the
deficiency |
7 | | remains unpaid commencing with the date that the amount |
8 | | becomes
due. Such amount shall be in lieu of any determined |
9 | | under paragraph (a) or (a-5).
|
10 | | (4) Any insurance company, industrial insured, or surplus |
11 | | line producer that
fails to pay the full amount due under this |
12 | | Section or Sections 121-2.08, 408.1, 409,
444, 444.1, or 445 |
13 | | of this Code, or Section 12 of the Fire Investigation
Act is |
14 | | liable, in addition to the tax and any late fees and penalties, |
15 | | for interest
on such deficiency at the rate of 12% per annum, |
16 | | or at such higher adjusted
rates as are or may be established |
17 | | under subsection (b) of Section 6621
of the Internal Revenue |
18 | | Code, from the date that payment of any such tax
was due, |
19 | | determined without regard to any extensions, to the date of |
20 | | payment
of such amount.
|
21 | | (5) The Director, through the Attorney
General, may |
22 | | institute an action in the name of the People of the State
of |
23 | | Illinois, in any court of competent jurisdiction, for the |
24 | | recovery of
the amount of such taxes, fees, and penalties due, |
25 | | and prosecute the same to
final judgment, and take such steps |
26 | | as are necessary to collect the same.
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1 | | (6) In the event that the certificate of authority of a |
2 | | foreign or
alien company is revoked for any cause or the |
3 | | company withdraws from
this State prior to the renewal date of |
4 | | the certificate of authority as
provided in Section 114, the |
5 | | company may recover the amount of any such
tax paid in advance. |
6 | | Except as provided in this subsection, no
revocation or |
7 | | withdrawal excuses payment of or constitutes grounds for
the |
8 | | recovery of any taxes or penalties imposed by this Code.
|
9 | | (7) When an insurance company or domestic affiliated group |
10 | | fails to pay
the full amount of any fee of $200 or more due |
11 | | under
Section 408 of this Code, there shall be added to the |
12 | | amount due as
a penalty the greater of $100 or an amount equal |
13 | | to 10%
of the deficiency for
each month or part of
a month that |
14 | | the deficiency remains unpaid.
|
15 | | (8) The Department shall have a lien for the taxes, fees, |
16 | | charges, fines, penalties, interest, other charges, or any |
17 | | portion thereof, imposed or assessed pursuant to this Code, |
18 | | upon all the real and personal property of any company or |
19 | | person to whom the assessment or final order has been issued or |
20 | | whenever a tax return is filed without payment of the tax or |
21 | | penalty shown therein to be due, including all such property |
22 | | of the company or person acquired after receipt of the |
23 | | assessment, issuance of the order, or filing of the return. |
24 | | The company or person is liable for the filing fee incurred by |
25 | | the Department for filing the lien and the filing fee incurred |
26 | | by the Department to file the release of that lien. The filing |
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1 | | fees shall be paid to the Department in addition to payment of |
2 | | the tax, fee, charge, fine, penalty, interest, other charges, |
3 | | or any portion thereof, included in the amount of the lien. |
4 | | However, where the lien arises because of the issuance of a |
5 | | final order of the Director or tax assessment by the |
6 | | Department, the lien shall not attach and the notice referred |
7 | | to in this Section shall not be filed until all administrative |
8 | | proceedings or proceedings in court for review of the final |
9 | | order or assessment have terminated or the time for the taking |
10 | | thereof has expired without such proceedings being instituted. |
11 | | Upon the granting of Department review after a lien has |
12 | | attached, the lien shall remain in full force except to the |
13 | | extent to which the final assessment may be reduced by a |
14 | | revised final assessment following the rehearing or review. |
15 | | The lien created by the issuance of a final assessment shall |
16 | | terminate, unless a notice of lien is filed, within 3 years |
17 | | after the date all proceedings in court for the review of the |
18 | | final assessment have terminated or the time for the taking |
19 | | thereof has expired without such proceedings being instituted, |
20 | | or (in the case of a revised final assessment issued pursuant |
21 | | to a rehearing or review by the Department) within 3 years |
22 | | after the date all proceedings in court for the review of such |
23 | | revised final assessment have terminated or the time for the |
24 | | taking thereof has expired without such proceedings being |
25 | | instituted. Where the lien results from the filing of a tax |
26 | | return without payment of the tax or penalty shown therein to |
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1 | | be due, the lien shall terminate, unless a notice of lien is |
2 | | filed, within 3 years after the date when the return is filed |
3 | | with the Department. |
4 | | The time limitation period on the Department's right to |
5 | | file a notice of lien shall not run during any period of time |
6 | | in which the order of any court has the effect of enjoining or |
7 | | restraining the Department from filing such notice of lien. If |
8 | | the Department finds that a company or person is about to |
9 | | depart from the State, to conceal himself or his property, or |
10 | | to do any other act tending to prejudice or to render wholly or |
11 | | partly ineffectual proceedings to collect the amount due and |
12 | | owing to the Department unless such proceedings are brought |
13 | | without delay, or if the Department finds that the collection |
14 | | of the amount due from any company or person will be |
15 | | jeopardized by delay, the Department shall give the company or |
16 | | person notice of such findings and shall make demand for |
17 | | immediate return and payment of the amount, whereupon the |
18 | | amount shall become immediately due and payable. If the |
19 | | company or person, within 5 days after the notice (or within |
20 | | such extension of time as the Department may grant), does not |
21 | | comply with the notice or show to the Department that the |
22 | | findings in the notice are erroneous, the Department may file |
23 | | a notice of jeopardy assessment lien in the office of the |
24 | | recorder of the county in which any property of the company or |
25 | | person may be located and shall notify the company or person of |
26 | | the filing. The jeopardy assessment lien shall have the same |
|
| | HB4493 Enrolled | - 67 - | LRB102 22845 BMS 31996 b |
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1 | | scope and effect as the statutory lien provided for in this |
2 | | Section. If the company or person believes that the company or |
3 | | person does not owe some or all of the tax for which the |
4 | | jeopardy assessment lien against the company or person has |
5 | | been filed, or that no jeopardy to the revenue in fact exists, |
6 | | the company or person may protest within 20 days after being |
7 | | notified by the Department of the filing of the jeopardy |
8 | | assessment lien and request a hearing, whereupon the |
9 | | Department shall hold a hearing in conformity with the |
10 | | provisions of this Code and, pursuant thereto, shall notify |
11 | | the company or person of its findings as to whether or not the |
12 | | jeopardy assessment lien will be released. If not, and if the |
13 | | company or person is aggrieved by this decision, the company |
14 | | or person may file an action for judicial review of the final |
15 | | determination of the Department in accordance with the |
16 | | Administrative Review Law. If, pursuant to such hearing (or |
17 | | after an independent determination of the facts by the |
18 | | Department without a hearing), the Department determines that |
19 | | some or all of the amount due covered by the jeopardy |
20 | | assessment lien is not owed by the company or person, or that |
21 | | no jeopardy to the revenue exists, or if on judicial review the |
22 | | final judgment of the court is that the company or person does |
23 | | not owe some or all of the amount due covered by the jeopardy |
24 | | assessment lien against them, or that no jeopardy to the |
25 | | revenue exists, the Department shall release its jeopardy |
26 | | assessment lien to the extent of such finding of nonliability |
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1 | | for the amount, or to the extent of such finding of no jeopardy |
2 | | to the revenue. The Department shall also release its jeopardy |
3 | | assessment lien against the company or person whenever the |
4 | | amount due and owing covered by the lien, plus any interest |
5 | | which may be due, are paid and the company or person has paid |
6 | | the Department in cash or by guaranteed remittance an amount |
7 | | representing the filing fee for the lien and the filing fee for |
8 | | the release of that lien. The Department shall file that |
9 | | release of lien with the recorder of the county where that lien |
10 | | was filed. |
11 | | Nothing in this Section shall be construed to give the |
12 | | Department a preference over the rights of any bona fide |
13 | | purchaser, holder of a security interest, mechanics |
14 | | lienholder, mortgagee, or judgment lien creditor arising prior |
15 | | to the filing of a regular notice of lien or a notice of |
16 | | jeopardy assessment lien in the office of the recorder in the |
17 | | county in which the property subject to the lien is located. |
18 | | For purposes of this Section, "bona fide" shall not include |
19 | | any mortgage of real or personal property or any other credit |
20 | | transaction that results in the mortgagee or the holder of the |
21 | | security acting as trustee for unsecured creditors of the |
22 | | company or person mentioned in the notice of lien who executed |
23 | | such chattel or real property mortgage or the document |
24 | | evidencing such credit transaction. The lien shall be inferior |
25 | | to the lien of general taxes, special assessments, and special |
26 | | taxes levied by any political subdivision of this State. In |
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1 | | case title to land to be affected by the notice of lien or |
2 | | notice of jeopardy assessment lien is registered under the |
3 | | provisions of the Registered Titles (Torrens) Act, such notice |
4 | | shall be filed in the office of the Registrar of Titles of the |
5 | | county within which the property subject to the lien is |
6 | | situated and shall be entered upon the register of titles as a |
7 | | memorial or charge upon each folium of the register of titles |
8 | | affected by such notice, and the Department shall not have a |
9 | | preference over the rights of any bona fide purchaser, |
10 | | mortgagee, judgment creditor, or other lienholder arising |
11 | | prior to the registration of such notice. The regular lien or |
12 | | jeopardy assessment lien shall not be effective against any |
13 | | purchaser with respect to any item in a retailer's stock in |
14 | | trade purchased from the retailer in the usual course of the |
15 | | retailer's business. |
16 | | (Source: P.A. 98-158, eff. 8-2-13; 98-978, eff. 1-1-15 .)
|
17 | | (215 ILCS 5/416)
|
18 | | Sec. 416. Illinois Workers' Compensation
Commission |
19 | | Operations Fund Surcharge.
|
20 | | (a) As of July 30, 2004 (the effective date of Public Act |
21 | | 93-840), every company licensed or
authorized by the Illinois |
22 | | Department of Insurance and insuring employers'
liabilities |
23 | | arising under the Workers' Compensation Act or the Workers'
|
24 | | Occupational Diseases Act shall remit to the Director a |
25 | | surcharge based upon
the annual direct written premium, as |
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| | HB4493 Enrolled | - 70 - | LRB102 22845 BMS 31996 b |
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1 | | reported under Section 136 of this Act,
of the company in the |
2 | | manner provided in this
Section. Such
proceeds shall
be |
3 | | deposited into the Illinois Workers' Compensation
Commission |
4 | | Operations Fund as
established in
the Workers' Compensation |
5 | | Act. If a company
survives or
was formed by a merger, |
6 | | consolidation, reorganization, or reincorporation, the
direct
|
7 | | written premiums of all companies party to the merger, |
8 | | consolidation,
reorganization, or
reincorporation shall, for |
9 | | purposes of determining the amount of the fee
imposed by this
|
10 | | Section, be regarded as those of the surviving or new company.
|
11 | | (b)(1) Except as provided in subsection (b)(2) of this |
12 | | Section, beginning on
July 30, 2004 (the effective date of |
13 | | Public Act 93-840) and on July 1 of each year thereafter,
the
|
14 | | Director shall
charge an annual Illinois Workers' Compensation |
15 | | Commission Operations Fund Surcharge from every
company |
16 | | subject to subsection (a) of this Section equal to 1.01% of its |
17 | | direct
written
premium for insuring employers' liabilities |
18 | | arising under the Workers'
Compensation Act or Workers' |
19 | | Occupational Diseases Act as reported in each
company's
annual
|
20 | | statement filed for the previous year as required by Section |
21 | | 136. The
Illinois Workers' Compensation Commission Operations |
22 | | Fund Surcharge shall be collected by companies
subject to |
23 | | subsection (a) of this Section as a separately stated |
24 | | surcharge on
insured employers at the rate of 1.01% of direct |
25 | | written premium. The
Illinois Workers' Compensation Commission |
26 | | Operations Fund Surcharge shall not be collected by companies
|
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| | HB4493 Enrolled | - 71 - | LRB102 22845 BMS 31996 b |
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1 | | subject to subsection (a) of this Section from any employer |
2 | | that self-insures its liabilities arising under the Workers' |
3 | | Compensation Act or Workers' Occupational Diseases Act, |
4 | | provided that the employer has paid the Illinois Workers' |
5 | | Compensation Commission Operations Fund Fee pursuant to |
6 | | Section 4d of the Workers' Compensation Act. All sums
|
7 | | collected by
the Department of Insurance under the provisions |
8 | | of this Section shall be paid
promptly
after the receipt of the |
9 | | same, accompanied by a detailed statement thereof,
into the
|
10 | | Illinois Workers' Compensation Commission Operations Fund in |
11 | | the State treasury.
|
12 | | (b)(2) The surcharge due pursuant to Public Act 93-840 |
13 | | shall be collected instead of the surcharge due on July 1, 2004 |
14 | | under Public Act 93-32. Payment of the surcharge due under |
15 | | Public Act 93-840 shall discharge the employer's obligations |
16 | | due on July 1, 2004.
|
17 | | (c) In addition to the authority specifically granted |
18 | | under Article XXV of
this
Code, the Director shall have such |
19 | | authority to adopt rules or establish forms
as may be
|
20 | | reasonably necessary for purposes of enforcing this Section. |
21 | | The Director shall
also have
authority to defer, waive, or |
22 | | abate the surcharge or any penalties imposed by
this
Section |
23 | | if in
the Director's opinion the company's solvency and |
24 | | ability to meet its insured
obligations
would be immediately |
25 | | threatened by payment of the surcharge due.
|
26 | | (d) When a company fails to pay the full amount of any |
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| | HB4493 Enrolled | - 72 - | LRB102 22845 BMS 31996 b |
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1 | | annual
Illinois Workers' Compensation
Commission Operations |
2 | | Fund Surcharge of $100 or more due under this Section,
there
|
3 | | shall be
added to the amount due as a penalty the greater of |
4 | | $1,000 or an amount equal
to 10% 5% of
the deficiency for each |
5 | | month or part of a month that the deficiency remains
unpaid.
|
6 | | (e) The Department of Insurance may enforce the collection |
7 | | of any delinquent
payment, penalty, or portion thereof by |
8 | | legal action or in any other manner by
which the
collection of |
9 | | debts due the State of Illinois may be enforced under the laws |
10 | | of
this State.
|
11 | | (f) Whenever it appears to the satisfaction of the |
12 | | Director that a company
has
paid
pursuant to this Act an |
13 | | Illinois Workers' Compensation Commission Operations Fund |
14 | | Surcharge in
an amount
in excess of the amount legally |
15 | | collectable from the company, the Director
shall issue a
|
16 | | credit memorandum for an amount equal to the amount of such |
17 | | overpayment. A
credit
memorandum may be applied for the 2-year |
18 | | period from the date of issuance,
against the
payment of any |
19 | | amount due during that period under the surcharge imposed by
|
20 | | this
Section or,
subject to reasonable rule of the Department |
21 | | of Insurance including requirement
of
notification, may be |
22 | | assigned to any other company subject to regulation under
this |
23 | | Act.
Any application of credit memoranda after the period |
24 | | provided for in this
Section is void.
|
25 | | (g) Annually, the Governor may direct a transfer of up to |
26 | | 2% of all moneys
collected under this Section to the Insurance |
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1 | | Financial Regulation Fund.
|
2 | | (Source: P.A. 95-331, eff. 8-21-07.)
|
3 | | (215 ILCS 5/356z.27 rep.) |
4 | | Section 15. The Illinois Insurance Code is amended by |
5 | | repealing Section 356z.27. |
6 | | Section 20. The Illinois Health Insurance Portability and |
7 | | Accountability Act is amended by changing Section 20 as |
8 | | follows:
|
9 | | (215 ILCS 97/20)
|
10 | | Sec. 20.
Increased portability through prohibition of |
11 | | limitation on preexisting
condition exclusions.
|
12 | | (A) No health insurance coverage issued, amended, |
13 | | delivered, or renewed on or after the effective date of this |
14 | | amendatory Act of the 102nd General Assembly may impose any |
15 | | preexisting condition exclusion with respect to the plan or |
16 | | coverage. This provision does not apply to the provision of |
17 | | excepted benefits as described in paragraph (2) of subsection |
18 | | (C). Limitation of preexisting condition exclusion period;
|
19 | | crediting for periods of previous coverage. Subject
to |
20 | | subsection (D), a group health plan, and a health
insurance |
21 | | issuer offering group health insurance
coverage, may, with |
22 | | respect to a participant or
beneficiary, impose a preexisting |
23 | | condition exclusion
only if:
|
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1 | | (1) the exclusion relates to a condition (whether
|
2 | | physical or mental), regardless of the cause of
the |
3 | | condition, for which medical advice,
diagnosis, care, or |
4 | | treatment was recommended or
received
within the 6-month |
5 | | period ending on the enrollment
date;
|
6 | | (2) the exclusion extends for a period of not more
|
7 | | than 12 months (or 18 months in the case of a late
|
8 | | enrollee) after the enrollment date; and
|
9 | | (3) the period of any such preexisting condition
|
10 | | exclusion is reduced by the aggregate of the periods
of |
11 | | creditable coverage (if any, as defined in
subsection |
12 | | (C)(1)) applicable to the participant or
beneficiary as of |
13 | | the enrollment date.
|
14 | | (B) (Blank). Preexisting condition exclusion. A group
|
15 | | health plan, and health insurance issuer offering
group health |
16 | | insurance coverage, may not impose
any preexisting condition |
17 | | exclusion relating to
pregnancy as a preexisting condition.
|
18 | | Genetic information shall not be treated as a condition
|
19 | | described in subsection (A)(1) in the absence of a
diagnosis |
20 | | of the condition related to such
information.
|
21 | | (C) Rules relating to crediting previous coverage.
|
22 | | (1) Creditable coverage defined. For purposes of this
|
23 | | Act, the term "creditable coverage" means, with
respect to |
24 | | an individual, coverage of the individual
under any of the |
25 | | following:
|
26 | | (a) A group health plan.
|
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| | HB4493 Enrolled | - 75 - | LRB102 22845 BMS 31996 b |
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1 | | (b) Health insurance coverage.
|
2 | | (c) Part A or part B of title XVIII of the Social |
3 | | Security
Act.
|
4 | | (d) Title XIX of the Social Security Act, other |
5 | | than coverage
consisting solely of benefits under |
6 | | Section 1928.
|
7 | | (e) Chapter 55 of title 10, United States Code.
|
8 | | (f) A medical care program of the Indian Health |
9 | | Service or of
a tribal organization.
|
10 | | (g) A State health benefits risk pool.
|
11 | | (h) A health plan offered under chapter 89 of |
12 | | title 5, United
States Code.
|
13 | | (i) A public health plan (as defined in |
14 | | regulations).
|
15 | | (j) A health benefit plan under Section 5(e) of |
16 | | the Peace
Corps Act (22 U.S.C. 2504(e)).
|
17 | | (k) Title XXI of the federal Social Security Act, |
18 | | State Children's
Health Insurance Program.
|
19 | | Such term does not include coverage consisting solely |
20 | | of
coverage of excepted benefits.
|
21 | | (2) Excepted benefits. For purposes of this Act, the |
22 | | term "excepted
benefits" means benefits under one or more |
23 | | of the following:
|
24 | | (a) Benefits not subject to requirements:
|
25 | | (i) Coverage only for accident, or disability |
26 | | income
insurance, or any combination thereof.
|
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| | HB4493 Enrolled | - 76 - | LRB102 22845 BMS 31996 b |
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1 | | (ii) Coverage issued as a supplement to |
2 | | liability insurance.
|
3 | | (iii) Liability insurance, including general |
4 | | liability
insurance and automobile liability |
5 | | insurance.
|
6 | | (iv) Workers' compensation or similar |
7 | | insurance.
|
8 | | (v) Automobile medical payment insurance.
|
9 | | (vi) Credit-only insurance.
|
10 | | (vii) Coverage for on-site medical clinics.
|
11 | | (viii) Other similar insurance coverage, |
12 | | specified
in regulations, under which benefits for |
13 | | medical
care are secondary or incidental to other |
14 | | insurance
benefits.
|
15 | | (b) Benefits not subject to requirements if |
16 | | offered separately:
|
17 | | (i) Limited scope dental or vision benefits.
|
18 | | (ii) Benefits for long-term care, nursing home |
19 | | care, home
health care, community-based care, or |
20 | | any combination
thereof.
|
21 | | (iii) Such other similar, limited benefits as |
22 | | are
specified in rules.
|
23 | | (c) Benefits not subject to requirements if |
24 | | offered, as
independent, noncoordinated benefits:
|
25 | | (i) Coverage only for a specified disease or
|
26 | | illness.
|
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| | HB4493 Enrolled | - 77 - | LRB102 22845 BMS 31996 b |
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1 | | (ii) Hospital indemnity or other fixed |
2 | | indemnity
insurance.
|
3 | | (d) Benefits not subject to requirements if |
4 | | offered as
separate insurance policy. Medicare |
5 | | supplemental health
insurance (as defined under |
6 | | Section 1882(g)(1) of the
Social Security Act), |
7 | | coverage supplemental to the
coverage provided under |
8 | | chapter 55 of title 10, United
States Code, and |
9 | | similar supplemental coverage provided to
coverage |
10 | | under a group health plan.
|
11 | | (3) Not counting periods before significant breaks in |
12 | | coverage.
|
13 | | (a) In general. A period of creditable coverage |
14 | | shall not
be counted, with respect to enrollment of an
|
15 | | individual under a group health plan, if, after such
|
16 | | period and before the enrollment date, there was a |
17 | | 63-day period during all of
which the individual was |
18 | | not
covered under any creditable coverage.
|
19 | | (b) Waiting period not treated as a break in
|
20 | | coverage. For purposes of subparagraph (a) and
|
21 | | subsection (D)(3), any period that an individual is in
|
22 | | a waiting period for any coverage under a group health
|
23 | | plan (or for group health insurance coverage) or is in
|
24 | | an affiliation period (as defined in subsection
|
25 | | (G)(2)) shall not be taken into account in determining
|
26 | | the continuous period under subparagraph (a).
|
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1 | | (4) (Blank). Method of crediting coverage.
|
2 | | (a) Standard method. Except as otherwise provided |
3 | | under
subparagraph (b), for purposes of applying |
4 | | subsection
(A)(3), a group health plan, and a health |
5 | | insurance
issuer offering group health insurance |
6 | | coverage, shall
count a period of creditable coverage |
7 | | without regard
to the specific benefits covered during |
8 | | the period.
|
9 | | (b) Election of alternative method. A group health |
10 | | plan,
or a health insurance issuer offering group |
11 | | health
insurance, may elect to apply subsection (A)(3) |
12 | | based
on coverage of benefits within each of several |
13 | | classes
or categories of benefits specified in |
14 | | regulations
rather than as provided under subparagraph |
15 | | (a). Such
election shall be made on a uniform basis for |
16 | | all
participants and beneficiaries. Under such |
17 | | election a
group health plan or issuer shall count a |
18 | | period of
creditable coverage with respect to any |
19 | | class or
category of benefits if any level of benefits |
20 | | is
covered within such class or category.
|
21 | | (c) Plan notice. In the case of an election with |
22 | | respect
to a group health plan under subparagraph (b) |
23 | | (whether
or not health insurance coverage is provided |
24 | | in
connection with such plan), the plan shall:
|
25 | | (i) prominently state in any disclosure |
26 | | statements
concerning the plan, and state to each |
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| | HB4493 Enrolled | - 79 - | LRB102 22845 BMS 31996 b |
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|
1 | | enrollee at
the time of enrollment under the plan, |
2 | | that the
plan has made such election; and
|
3 | | (ii) include in such statements a description |
4 | | of
the effect of this election.
|
5 | | (d) Issuer notice. In the case of an election
|
6 | | under subparagraph (b) with respect to health
|
7 | | insurance coverage offered by an issuer in the small
|
8 | | or large group market, the issuer:
|
9 | | (i) shall prominently state in any disclosure
|
10 | | statements concerning the coverage, and to each
|
11 | | employer at the time of the offer or sale of the
|
12 | | coverage, that the issuer has made such election;
|
13 | | and
|
14 | | (ii) shall include in such statements a
|
15 | | description of the effect of such election.
|
16 | | (5) Establishment of period. Periods of creditable |
17 | | coverage
with respect to an individual shall be |
18 | | established through
presentation or certifications |
19 | | described in subsection (E)
or in such other manner as may |
20 | | be specified in
regulations.
|
21 | | (D) (Blank). Exceptions:
|
22 | | (1) Exclusion not applicable to certain newborns.
|
23 | | Subject to paragraph (3), a group health plan, and
a |
24 | | health insurance issuer offering group health
insurance |
25 | | coverage, may not impose any preexisting
condition |
26 | | exclusion in the case of an
individual who, as of the last |
|
| | HB4493 Enrolled | - 80 - | LRB102 22845 BMS 31996 b |
|
|
1 | | day of the 30-day
period beginning with the date of birth, |
2 | | is
covered under creditable coverage.
|
3 | | (2) Exclusion not applicable to certain adopted
|
4 | | children. Subject to paragraph (3), a group
health plan, |
5 | | and a health insurance issuer
offering group health |
6 | | insurance coverage, may not
impose any preexisting |
7 | | condition exclusion in the
case of a child who is adopted |
8 | | or placed for
adoption before attaining 18 years of age |
9 | | and who,
as of the last day of the 30-day period beginning
|
10 | | on the date of the adoption or placement for
adoption, is |
11 | | covered under creditable coverage.
|
12 | | The previous sentence
shall not apply to coverage |
13 | | before the date of
such adoption or placement for |
14 | | adoption.
|
15 | | (3) Loss if break in coverage. Paragraphs (1) and
(2) |
16 | | shall no longer apply to an individual
after the end of the |
17 | | first 63-day period
during all of which the individual was |
18 | | not
covered under any creditable coverage.
|
19 | | (E) Certifications and disclosure of coverage.
|
20 | | (1) Requirement for Certification of Period of |
21 | | Creditable
Coverage.
|
22 | | (a) A group health plan, and a
health insurance |
23 | | issuer offering group health
insurance coverage, shall |
24 | | provide the certification described in subparagraph
|
25 | | (b):
|
26 | | (i) at the time an individual ceases to be |
|
| | HB4493 Enrolled | - 81 - | LRB102 22845 BMS 31996 b |
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|
1 | | covered
under the plan or otherwise becomes |
2 | | covered
under a COBRA continuation provision;
|
3 | | (ii) in the case of an individual becoming |
4 | | covered
under such a provision, at the time the
|
5 | | individual ceases to be covered under such
|
6 | | provision; and
|
7 | | (iii) on the request on behalf of an |
8 | | individual
made not later than 24 months after the |
9 | | date
of cessation of the coverage described in
|
10 | | clause (i) or (ii), whichever is later.
|
11 | | The certification under clause (i) may be provided, to
|
12 | | the extent practicable, at a time consistent with
|
13 | | notices required under any applicable COBRA
|
14 | | continuation provision.
|
15 | | (b) The certification described in
this |
16 | | subparagraph is a written certification of:
|
17 | | (i) the period of creditable coverage of the
|
18 | | individual under such plan and the coverage (if
|
19 | | any) under such COBRA continuation provision; and
|
20 | | (ii) the waiting period (if any) (and
|
21 | | affiliation period, if applicable) imposed with
|
22 | | respect to the individual for any coverage under
|
23 | | such plan.
|
24 | | (c) To the extent that medical care
under a group |
25 | | health plan consists of group health
insurance |
26 | | coverage, the plan is deemed to have
satisfied the |
|
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|
1 | | certification requirement under this
paragraph if the |
2 | | health insurance issuer offering the
coverage provides |
3 | | for such certification in accordance
with this |
4 | | paragraph.
|
5 | | (2) (Blank). Disclosure of information on previous |
6 | | benefits. In the
case of an election described in |
7 | | subsection (C)(4)(b) by a
group health plan or health |
8 | | insurance issuer, if the plan
or issuer enrolls an |
9 | | individual for coverage under the
plan and the individual |
10 | | provides a certification of
coverage of the individual |
11 | | under paragraph (1):
|
12 | | (a) upon request of such plan or issuer, the |
13 | | entity which
issued the certification provided by the |
14 | | individual
shall promptly disclose to such requesting |
15 | | plan or
issuer information on coverage of classes and
|
16 | | categories of health benefits available under such
|
17 | | entity's plan or coverage; and
|
18 | | (b) such entity may charge the requesting plan or |
19 | | issuer
for the reasonable cost of disclosing such
|
20 | | information.
|
21 | | (3) Rules. The Department shall establish rules to
|
22 | | prevent an entity's failure to provide information under
|
23 | | paragraph (1) or (2) with respect to previous coverage of
|
24 | | an individual from adversely affecting any subsequent
|
25 | | coverage of the individual under another group health plan
|
26 | | or health insurance coverage.
|
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|
1 | | (4) Treatment of certain plans as group health plan |
2 | | for
notice provision. A program under which creditable
|
3 | | coverage described in subparagraph (c), (d), (e), or
(f) |
4 | | of Section 20(C)(1) is provided shall be treated
as a |
5 | | group health plan for purposes of this Section.
|
6 | | (F) Special enrollment periods.
|
7 | | (1) Individuals losing other coverage. A group health
|
8 | | plan, and a health insurance issuer offering group
health |
9 | | insurance coverage in connection with a group health
plan, |
10 | | shall permit an employee who is eligible, but not
|
11 | | enrolled, for coverage under the terms of the plan (or a
|
12 | | dependent of such an employee if the dependent is |
13 | | eligible,
but not enrolled, for coverage under such terms) |
14 | | to enroll for
coverage under the terms of the plan if each |
15 | | of the following
conditions is met:
|
16 | | (a) The employee or dependent was covered under a
|
17 | | group health plan or had health insurance coverage
at |
18 | | the time coverage was previously offered to the
|
19 | | employee or dependent.
|
20 | | (b) The employee stated in writing at such time
|
21 | | that coverage under a group health plan or health
|
22 | | insurance coverage was the reason for declining
|
23 | | enrollment, but only if the plan sponsor or issuer
(if |
24 | | applicable) required such a statement at such
time and |
25 | | provided the employee with notice of such
requirement |
26 | | (and the consequences of such
requirement) at such |
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1 | | time.
|
2 | | (c) The employee's or dependent's coverage
|
3 | | described in subparagraph (a):
|
4 | | (i) was under a COBRA continuation provision |
5 | | and the
coverage under such provision was |
6 | | exhausted; or
|
7 | | (ii) was not under such a provision and either |
8 | | the
coverage was terminated as a result of loss of
|
9 | | eligibility for the coverage (including as a
|
10 | | result of legal separation, divorce, death,
|
11 | | termination of employment, or reduction in the
|
12 | | number of hours of
employment) or employer |
13 | | contributions towards such
coverage were |
14 | | terminated.
|
15 | | (d) Under the terms of the plan, the employee
|
16 | | requests such enrollment not later than 30 days after
|
17 | | the date of exhaustion of coverage described in
|
18 | | subparagraph (c)(i) or termination of coverage or
|
19 | | employer contributions described in subparagraph
|
20 | | (c)(ii).
|
21 | | (2) For dependent beneficiaries.
|
22 | | (a) In general. If:
|
23 | | (i) a group health plan makes coverage
|
24 | | available with respect to a dependent of an
|
25 | | individual,
|
26 | | (ii) the individual is a participant under the |
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1 | | plan (or
has met any waiting period applicable to |
2 | | becoming a
participant under the plan and is |
3 | | eligible to be
enrolled under the plan but for a |
4 | | failure to enroll
during a previous enrollment |
5 | | period), and
|
6 | | (iii) a person becomes such a dependent of the |
7 | | individual
through marriage, birth, or adoption or |
8 | | placement
for adoption,
|
9 | | then the group health plan shall provide
for a |
10 | | dependent special enrollment period described
in |
11 | | subparagraph (b) during which the person (or, if
not |
12 | | otherwise enrolled, the individual) may be
enrolled |
13 | | under the plan as a dependent of the
individual, and in |
14 | | the case of the birth or
adoption of a child, the |
15 | | spouse of the individual
may be enrolled as a |
16 | | dependent of the individual if
such spouse is |
17 | | otherwise eligible for coverage.
|
18 | | (b) Dependent special enrollment period. A
|
19 | | dependent special enrollment period under this
|
20 | | subparagraph shall be a period of not less than 30 days
|
21 | | and shall begin on the later of:
|
22 | | (i) the date dependent coverage is made
|
23 | | available; or
|
24 | | (ii) the date of the marriage, birth, or |
25 | | adoption or
placement for adoption (as the case |
26 | | may be)
described in subparagraph (a)(iii).
|
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1 | | (c) No waiting period. If an individual seeks to |
2 | | enroll
a dependent during the first 30 days of such a
|
3 | | dependent special enrollment period, the coverage of
|
4 | | the dependent shall become effective:
|
5 | | (i) in the case of marriage, not later than |
6 | | the
first day of the first month beginning after |
7 | | the
date the completed request for enrollment is
|
8 | | received;
|
9 | | (ii) in the case of a dependent's birth, as of |
10 | | the
date of such birth; or
|
11 | | (iii) in the case of a dependent's adoption or
|
12 | | placement for adoption, the date of such
adoption |
13 | | or placement for adoption.
|
14 | | (G) Use of affiliation period by HMOs as alternative to |
15 | | preexisting
condition exclusion.
|
16 | | (1) In general. A health maintenance organization
|
17 | | which offers health insurance coverage in connection
with |
18 | | a group health plan and which does not impose any
|
19 | | pre-existing condition exclusion allowed under
subsection |
20 | | (A) with respect to any particular coverage
option may |
21 | | impose an affiliation period for such
coverage option, but |
22 | | only if:
|
23 | | (a) such period is applied uniformly without |
24 | | regard to
any health status-related factors; and
|
25 | | (b) such period does not exceed 2 months (or 3 |
26 | | months in
the case of a late enrollee).
|
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1 | | (2) Affiliation period.
|
2 | | (a) Defined. For purposes of this Act, the term
|
3 | | "affiliation period" means a period which, under the
|
4 | | terms of the health insurance coverage offered by the
|
5 | | health maintenance organization, must expire before |
6 | | the
health insurance coverage becomes
effective. The |
7 | | organization is not required to
provide health care |
8 | | services or benefits during such
period and no premium |
9 | | shall be charged to the
participant or beneficiary for |
10 | | any coverage during
the period.
|
11 | | (b) Beginning. Such period shall begin on the
|
12 | | enrollment date.
|
13 | | (c) Runs concurrently with waiting periods. An
|
14 | | affiliation period under a plan shall run concurrently |
15 | | with any waiting period
under the plan.
|
16 | | (3) Alternative methods. A health maintenance |
17 | | organization
described in paragraph (1) may use |
18 | | alternative methods,
from those described in such |
19 | | paragraph, to address
adverse selection as approved by the |
20 | | Department.
|
21 | | (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
|
22 | | Section 25. The Health Maintenance Organization Act is |
23 | | amended by changing Section 5-3 as follows:
|
24 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
|
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1 | | Sec. 5-3. Insurance Code provisions.
|
2 | | (a) Health Maintenance Organizations
shall be subject to |
3 | | the provisions of Sections 133, 134, 136, 137, 139, 140, |
4 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, |
5 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, |
6 | | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, |
7 | | 356y,
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, |
8 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, |
9 | | 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, |
10 | | 356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, |
11 | | 356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50, |
12 | | 356z.51, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, |
13 | | 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
|
14 | | 408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of |
15 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
|
16 | | XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
17 | | Illinois Insurance Code.
|
18 | | (b) For purposes of the Illinois Insurance Code, except |
19 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, |
20 | | Health Maintenance Organizations in
the following categories |
21 | | are deemed to be "domestic companies":
|
22 | | (1) a corporation authorized under the
Dental Service |
23 | | Plan Act or the Voluntary Health Services Plans Act;
|
24 | | (2) a corporation organized under the laws of this |
25 | | State; or
|
26 | | (3) a corporation organized under the laws of another |
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1 | | state, 30% or more
of the enrollees of which are residents |
2 | | of this State, except a
corporation subject to |
3 | | substantially the same requirements in its state of
|
4 | | organization as is a "domestic company" under Article VIII |
5 | | 1/2 of the
Illinois Insurance Code.
|
6 | | (c) In considering the merger, consolidation, or other |
7 | | acquisition of
control of a Health Maintenance Organization |
8 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
9 | | (1) the Director shall give primary consideration to |
10 | | the continuation of
benefits to enrollees and the |
11 | | financial conditions of the acquired Health
Maintenance |
12 | | Organization after the merger, consolidation, or other
|
13 | | acquisition of control takes effect;
|
14 | | (2)(i) the criteria specified in subsection (1)(b) of |
15 | | Section 131.8 of
the Illinois Insurance Code shall not |
16 | | apply and (ii) the Director, in making
his determination |
17 | | with respect to the merger, consolidation, or other
|
18 | | acquisition of control, need not take into account the |
19 | | effect on
competition of the merger, consolidation, or |
20 | | other acquisition of control;
|
21 | | (3) the Director shall have the power to require the |
22 | | following
information:
|
23 | | (A) certification by an independent actuary of the |
24 | | adequacy
of the reserves of the Health Maintenance |
25 | | Organization sought to be acquired;
|
26 | | (B) pro forma financial statements reflecting the |
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1 | | combined balance
sheets of the acquiring company and |
2 | | the Health Maintenance Organization sought
to be |
3 | | acquired as of the end of the preceding year and as of |
4 | | a date 90 days
prior to the acquisition, as well as pro |
5 | | forma financial statements
reflecting projected |
6 | | combined operation for a period of 2 years;
|
7 | | (C) a pro forma business plan detailing an |
8 | | acquiring party's plans with
respect to the operation |
9 | | of the Health Maintenance Organization sought to
be |
10 | | acquired for a period of not less than 3 years; and
|
11 | | (D) such other information as the Director shall |
12 | | require.
|
13 | | (d) The provisions of Article VIII 1/2 of the Illinois |
14 | | Insurance Code
and this Section 5-3 shall apply to the sale by |
15 | | any health maintenance
organization of greater than 10% of its
|
16 | | enrollee population (including without limitation the health |
17 | | maintenance
organization's right, title, and interest in and |
18 | | to its health care
certificates).
|
19 | | (e) In considering any management contract or service |
20 | | agreement subject
to Section 141.1 of the Illinois Insurance |
21 | | Code, the Director (i) shall, in
addition to the criteria |
22 | | specified in Section 141.2 of the Illinois
Insurance Code, |
23 | | take into account the effect of the management contract or
|
24 | | service agreement on the continuation of benefits to enrollees |
25 | | and the
financial condition of the health maintenance |
26 | | organization to be managed or
serviced, and (ii) need not take |
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1 | | into account the effect of the management
contract or service |
2 | | agreement on competition.
|
3 | | (f) Except for small employer groups as defined in the |
4 | | Small Employer
Rating, Renewability and Portability Health |
5 | | Insurance Act and except for
medicare supplement policies as |
6 | | defined in Section 363 of the Illinois
Insurance Code, a |
7 | | Health Maintenance Organization may by contract agree with a
|
8 | | group or other enrollment unit to effect refunds or charge |
9 | | additional premiums
under the following terms and conditions:
|
10 | | (i) the amount of, and other terms and conditions with |
11 | | respect to, the
refund or additional premium are set forth |
12 | | in the group or enrollment unit
contract agreed in advance |
13 | | of the period for which a refund is to be paid or
|
14 | | additional premium is to be charged (which period shall |
15 | | not be less than one
year); and
|
16 | | (ii) the amount of the refund or additional premium |
17 | | shall not exceed 20%
of the Health Maintenance |
18 | | Organization's profitable or unprofitable experience
with |
19 | | respect to the group or other enrollment unit for the |
20 | | period (and, for
purposes of a refund or additional |
21 | | premium, the profitable or unprofitable
experience shall |
22 | | be calculated taking into account a pro rata share of the
|
23 | | Health Maintenance Organization's administrative and |
24 | | marketing expenses, but
shall not include any refund to be |
25 | | made or additional premium to be paid
pursuant to this |
26 | | subsection (f)). The Health Maintenance Organization and |
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1 | | the
group or enrollment unit may agree that the profitable |
2 | | or unprofitable
experience may be calculated taking into |
3 | | account the refund period and the
immediately preceding 2 |
4 | | plan years.
|
5 | | The Health Maintenance Organization shall include a |
6 | | statement in the
evidence of coverage issued to each enrollee |
7 | | describing the possibility of a
refund or additional premium, |
8 | | and upon request of any group or enrollment unit,
provide to |
9 | | the group or enrollment unit a description of the method used |
10 | | to
calculate (1) the Health Maintenance Organization's |
11 | | profitable experience with
respect to the group or enrollment |
12 | | unit and the resulting refund to the group
or enrollment unit |
13 | | or (2) the Health Maintenance Organization's unprofitable
|
14 | | experience with respect to the group or enrollment unit and |
15 | | the resulting
additional premium to be paid by the group or |
16 | | enrollment unit.
|
17 | | In no event shall the Illinois Health Maintenance |
18 | | Organization
Guaranty Association be liable to pay any |
19 | | contractual obligation of an
insolvent organization to pay any |
20 | | refund authorized under this Section.
|
21 | | (g) Rulemaking authority to implement Public Act 95-1045, |
22 | | if any, is conditioned on the rules being adopted in |
23 | | accordance with all provisions of the Illinois Administrative |
24 | | Procedure Act and all rules and procedures of the Joint |
25 | | Committee on Administrative Rules; any purported rule not so |
26 | | adopted, for whatever reason, is unauthorized. |
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1 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
2 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. |
3 | | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, |
4 | | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
5 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
6 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
7 | | eff. 10-8-21; revised 10-27-21.) |
8 | | Section 30. The Limited Health Service Organization Act is |
9 | | amended by changing Section 4003 as follows:
|
10 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
|
11 | | Sec. 4003. Illinois Insurance Code provisions. Limited |
12 | | health service
organizations shall be subject to the |
13 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, |
14 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
15 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, |
16 | | 355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, |
17 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46, |
18 | | 356z.47, 356z.51, 364.3, 356z.43, 368a, 401, 401.1,
402,
403, |
19 | | 403A, 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, |
20 | | VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the |
21 | | Illinois Insurance Code. For purposes of the
Illinois |
22 | | Insurance Code, except for Sections 444 and 444.1 and Articles |
23 | | XIII
and XIII 1/2, limited health service organizations in the |
24 | | following categories
are deemed to be domestic companies:
|
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1 | | (1) a corporation under the laws of this State; or
|
2 | | (2) a corporation organized under the laws of another |
3 | | state, 30% or more
of the enrollees of which are residents |
4 | | of this State, except a corporation
subject to |
5 | | substantially the same requirements in its state of |
6 | | organization as
is a domestic company under Article VIII |
7 | | 1/2 of the Illinois Insurance Code.
|
8 | | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
9 | | 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. |
10 | | 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, |
11 | | eff. 1-1-22; revised 10-27-21.)
|
12 | | Section 35. The Voluntary Health Services Plans Act is |
13 | | amended by changing Section 10 as follows:
|
14 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
|
15 | | Sec. 10. Application of Insurance Code provisions. Health |
16 | | services
plan corporations and all persons interested therein |
17 | | or dealing therewith
shall be subject to the provisions of |
18 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, |
19 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
20 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, |
21 | | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, |
22 | | 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, |
23 | | 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, |
24 | | 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40, |
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1 | | 356z.41, 356z.46, 356z.47, 356z.51, 356z.43, 364.01, 364.3, |
2 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
3 | | and paragraphs (7) and (15) of Section 367 of the Illinois
|
4 | | Insurance Code.
|
5 | | Rulemaking authority to implement Public Act 95-1045, if |
6 | | any, is conditioned on the rules being adopted in accordance |
7 | | with all provisions of the Illinois Administrative Procedure |
8 | | Act and all rules and procedures of the Joint Committee on |
9 | | Administrative Rules; any purported rule not so adopted, for |
10 | | whatever reason, is unauthorized. |
11 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
12 | | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. |
13 | | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, |
14 | | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; |
15 | | revised 10-27-21.) |
16 | | Section 40. The Workers' Compensation Act is amended by
|
17 | | changing Section 19 as follows:
|
18 | | (820 ILCS 305/19) (from Ch. 48, par. 138.19)
|
19 | | Sec. 19. Any disputed questions of law or fact shall be |
20 | | determined
as herein provided.
|
21 | | (a) It shall be the duty of the Commission upon |
22 | | notification that
the parties have failed to reach an |
23 | | agreement, to designate an Arbitrator.
|
24 | | 1. Whenever any claimant misconceives his remedy and |
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1 | | files an
application for adjustment of claim under this |
2 | | Act and it is
subsequently discovered, at any time before |
3 | | final disposition of such
cause, that the claim for |
4 | | disability or death which was the basis for
such |
5 | | application should properly have been made under the |
6 | | Workers'
Occupational Diseases Act, then the provisions of |
7 | | Section 19, paragraph
(a-1) of the Workers' Occupational |
8 | | Diseases Act having reference to such
application shall |
9 | | apply.
|
10 | | 2. Whenever any claimant misconceives his remedy and |
11 | | files an
application for adjustment of claim under the |
12 | | Workers' Occupational
Diseases Act and it is subsequently |
13 | | discovered, at any time before final
disposition of such |
14 | | cause that the claim for injury or death which was
the |
15 | | basis for such application should properly have been made |
16 | | under this
Act, then the application so filed under the |
17 | | Workers' Occupational
Diseases Act may be amended in form, |
18 | | substance or both to assert claim
for such disability or |
19 | | death under this Act and it shall be deemed to
have been so |
20 | | filed as amended on the date of the original filing
|
21 | | thereof, and such compensation may be awarded as is |
22 | | warranted by the
whole evidence pursuant to this Act. When |
23 | | such amendment is submitted,
further or additional |
24 | | evidence may be heard by the Arbitrator or
Commission when |
25 | | deemed necessary. Nothing in this Section contained
shall |
26 | | be construed to be or permit a waiver of any provisions of |
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1 | | this
Act with reference to notice but notice if given |
2 | | shall be deemed to be a
notice under the provisions of this |
3 | | Act if given within the time
required herein.
|
4 | | (b) The Arbitrator shall make such inquiries and |
5 | | investigations as he or
they shall deem necessary and may |
6 | | examine and inspect all books, papers,
records, places, or |
7 | | premises relating to the questions in dispute and hear
such |
8 | | proper evidence as the parties may submit.
|
9 | | The hearings before the Arbitrator shall be held in the |
10 | | vicinity where
the injury occurred after 10 days' notice of |
11 | | the time and place of such
hearing shall have been given to |
12 | | each of the parties or their attorneys
of record.
|
13 | | The Arbitrator may find that the disabling condition is |
14 | | temporary and has
not yet reached a permanent condition and |
15 | | may order the payment of
compensation up to the date of the |
16 | | hearing, which award shall be reviewable
and enforceable in |
17 | | the same manner as other awards, and in no instance be a
bar to |
18 | | a further hearing and determination of a further amount of |
19 | | temporary
total compensation or of compensation for permanent |
20 | | disability, but shall
be conclusive as to all other questions |
21 | | except the nature and extent of said
disability.
|
22 | | The decision of the Arbitrator shall be filed with the |
23 | | Commission which
Commission shall immediately send to each |
24 | | party or his attorney a copy of
such decision, together with a |
25 | | notification of the time when it was filed.
As of the effective |
26 | | date of this amendatory Act of the 94th General Assembly, all |
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1 | | decisions of the Arbitrator shall set forth
in writing |
2 | | findings of fact and conclusions of law, separately stated, if |
3 | | requested by either party.
Unless a petition for review is |
4 | | filed by either party within 30 days after
the receipt by such |
5 | | party of the copy of the decision and notification of
time when |
6 | | filed, and unless such party petitioning for a review shall
|
7 | | within 35 days after the receipt by him of the copy of the |
8 | | decision, file
with the Commission either an agreed statement |
9 | | of the facts appearing upon
the hearing before the Arbitrator, |
10 | | or if such
party shall so elect a correct transcript of |
11 | | evidence of the proceedings
at such hearings, then the |
12 | | decision shall become the decision of the
Commission and in |
13 | | the absence of fraud shall be conclusive.
The Petition for |
14 | | Review shall contain a statement of the petitioning party's
|
15 | | specific exceptions to the decision of the arbitrator. The |
16 | | jurisdiction
of the Commission to review the decision of the |
17 | | arbitrator shall not be
limited to the exceptions stated in |
18 | | the Petition for Review.
The Commission, or any member |
19 | | thereof, may grant further time not exceeding
30 days, in |
20 | | which to file such agreed statement or transcript of
evidence. |
21 | | Such agreed statement of facts or correct transcript of
|
22 | | evidence, as the case may be, shall be authenticated by the |
23 | | signatures
of the parties or their attorneys, and in the event |
24 | | they do not agree as
to the correctness of the transcript of |
25 | | evidence it shall be authenticated
by the signature of the |
26 | | Arbitrator designated by the Commission.
|
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1 | | Whether the employee is working or not, if the employee is |
2 | | not receiving or has not received medical, surgical, or |
3 | | hospital services or other services or compensation as |
4 | | provided in paragraph (a) of Section 8, or compensation as |
5 | | provided in paragraph (b) of Section 8, the employee may at any |
6 | | time petition for an expedited hearing by an Arbitrator on the |
7 | | issue of whether or not he or she is entitled to receive |
8 | | payment of the services or compensation. Provided the employer |
9 | | continues to pay compensation pursuant to paragraph (b) of |
10 | | Section 8, the employer may at any time petition for an |
11 | | expedited hearing on the issue of whether or not the employee |
12 | | is entitled to receive medical, surgical, or hospital services |
13 | | or other services or compensation as provided in paragraph (a) |
14 | | of Section 8, or compensation as provided in paragraph (b) of |
15 | | Section 8. When an employer has petitioned for an expedited |
16 | | hearing, the employer shall continue to pay compensation as |
17 | | provided in paragraph (b) of Section 8 unless the arbitrator |
18 | | renders a decision that the employee is not entitled to the |
19 | | benefits that are the subject of the expedited hearing or |
20 | | unless the employee's treating physician has released the |
21 | | employee to return to work at his or her regular job with the |
22 | | employer or the employee actually returns to work at any other |
23 | | job. If the arbitrator renders a decision that the employee is |
24 | | not entitled to the benefits that are the subject of the |
25 | | expedited hearing, a petition for review filed by the employee |
26 | | shall receive the same priority as if the employee had filed a |
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1 | | petition for an expedited hearing by an Arbitrator. Neither |
2 | | party shall be entitled to an expedited hearing when the |
3 | | employee has returned to work and the sole issue in dispute |
4 | | amounts to less than 12 weeks of unpaid compensation pursuant |
5 | | to paragraph (b) of Section 8. |
6 | | Expedited hearings shall have priority over all other |
7 | | petitions and shall be heard by the Arbitrator and Commission |
8 | | with all convenient speed. Any party requesting an expedited |
9 | | hearing shall give notice of a request for an expedited |
10 | | hearing under this paragraph. A copy of the Application for |
11 | | Adjustment of Claim shall be attached to the notice. The |
12 | | Commission shall adopt rules and procedures under which the |
13 | | final decision of the Commission under this paragraph is filed |
14 | | not later than 180 days from the date that the Petition for |
15 | | Review is filed with the Commission. |
16 | | Where 2 or more insurance carriers, private self-insureds, |
17 | | or a group workers' compensation pool under Article V 3/4 of |
18 | | the Illinois Insurance Code dispute coverage for the same |
19 | | injury, any such insurance carrier, private self-insured, or |
20 | | group workers' compensation pool may request an expedited |
21 | | hearing pursuant to this paragraph to determine the issue of |
22 | | coverage, provided coverage is the only issue in dispute and |
23 | | all other issues are stipulated and agreed to and further |
24 | | provided that all compensation benefits including medical |
25 | | benefits pursuant to Section 8(a) continue to be paid to or on |
26 | | behalf of petitioner. Any insurance carrier, private |
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1 | | self-insured, or group workers' compensation pool that is |
2 | | determined to be liable for coverage for the injury in issue |
3 | | shall reimburse any insurance carrier, private self-insured, |
4 | | or group workers' compensation pool that has paid benefits to |
5 | | or on behalf of petitioner for the injury.
|
6 | | (b-1) If the employee is not receiving medical, surgical |
7 | | or hospital
services as provided in paragraph (a) of Section 8 |
8 | | or compensation as
provided in paragraph (b) of Section 8, the |
9 | | employee, in accordance with
Commission Rules, may file a |
10 | | petition for an emergency hearing by an
Arbitrator on the |
11 | | issue of whether or not he is entitled to receive payment
of |
12 | | such compensation or services as provided therein. Such |
13 | | petition shall
have priority over all other petitions and |
14 | | shall be heard by the Arbitrator
and Commission with all |
15 | | convenient speed.
|
16 | | Such petition shall contain the following information and |
17 | | shall be served
on the employer at least 15 days before it is |
18 | | filed:
|
19 | | (i) the date and approximate time of accident;
|
20 | | (ii) the approximate location of the accident;
|
21 | | (iii) a description of the accident;
|
22 | | (iv) the nature of the injury incurred by the |
23 | | employee;
|
24 | | (v) the identity of the person, if known, to whom the |
25 | | accident was
reported and the date on which it was |
26 | | reported;
|
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1 | | (vi) the name and title of the person, if known, |
2 | | representing the
employer with whom the employee conferred |
3 | | in any effort to obtain
compensation pursuant to paragraph |
4 | | (b) of Section 8 of this Act or medical,
surgical or |
5 | | hospital services pursuant to paragraph (a) of Section 8 |
6 | | of
this Act and the date of such conference;
|
7 | | (vii) a statement that the employer has refused to pay |
8 | | compensation
pursuant to paragraph (b) of Section 8 of |
9 | | this Act or for medical, surgical
or hospital services |
10 | | pursuant to paragraph (a) of Section 8 of this Act;
|
11 | | (viii) the name and address, if known, of each witness |
12 | | to the accident
and of each other person upon whom the |
13 | | employee will rely to support his
allegations;
|
14 | | (ix) the dates of treatment related to the accident by |
15 | | medical
practitioners, and the names and addresses of such |
16 | | practitioners, including
the dates of treatment related to |
17 | | the accident at any hospitals and the
names and addresses |
18 | | of such hospitals, and a signed authorization
permitting |
19 | | the employer to examine all medical records of all |
20 | | practitioners
and hospitals named pursuant to this |
21 | | paragraph;
|
22 | | (x) a copy of a signed report by a medical |
23 | | practitioner, relating to the
employee's current inability |
24 | | to return to work because of the injuries
incurred as a |
25 | | result of the accident or such other documents or |
26 | | affidavits
which show that the employee is entitled to |
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1 | | receive compensation pursuant
to paragraph (b) of Section |
2 | | 8 of this Act or medical, surgical or hospital
services |
3 | | pursuant to paragraph (a) of Section 8 of this Act. Such |
4 | | reports,
documents or affidavits shall state, if possible, |
5 | | the history of the
accident given by the employee, and |
6 | | describe the injury and medical
diagnosis, the medical |
7 | | services for such injury which the employee has
received |
8 | | and is receiving, the physical activities which the |
9 | | employee
cannot currently perform as a result of any |
10 | | impairment or disability due to
such injury, and the |
11 | | prognosis for recovery;
|
12 | | (xi) complete copies of any reports, records, |
13 | | documents and affidavits
in the possession of the employee |
14 | | on which the employee will rely to
support his |
15 | | allegations, provided that the employer shall pay the
|
16 | | reasonable cost of reproduction thereof;
|
17 | | (xii) a list of any reports, records, documents and |
18 | | affidavits which
the employee has demanded by subpoena and |
19 | | on which he intends to
rely to support his allegations;
|
20 | | (xiii) a certification signed by the employee or his |
21 | | representative that
the employer has received the petition |
22 | | with the required information 15
days before filing.
|
23 | | Fifteen days after receipt by the employer of the petition |
24 | | with the
required information the employee may file said |
25 | | petition and required
information and shall serve notice of |
26 | | the filing upon the employer. The
employer may file a motion |
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1 | | addressed to the sufficiency of the petition.
If an objection |
2 | | has been filed to the sufficiency of the petition, the
|
3 | | arbitrator shall rule on the objection within 2 working days. |
4 | | If such an
objection is filed, the time for filing the final |
5 | | decision of the
Commission as provided in this paragraph shall |
6 | | be tolled until the
arbitrator has determined that the |
7 | | petition is sufficient.
|
8 | | The employer shall, within 15 days after receipt of the |
9 | | notice that such
petition is filed, file with the Commission |
10 | | and serve on the employee or
his representative a written |
11 | | response to each claim set forth in the
petition, including |
12 | | the legal and factual basis for each disputed
allegation and |
13 | | the following information: (i) complete copies of any
reports, |
14 | | records, documents and affidavits in the possession of the
|
15 | | employer on which the employer intends to rely in support of |
16 | | his response,
(ii) a list of any reports, records, documents |
17 | | and affidavits which the
employer has demanded by subpoena and |
18 | | on which the employer intends to rely
in support of his |
19 | | response, (iii) the name and address of each witness on
whom |
20 | | the employer will rely to support his response, and (iv) the |
21 | | names and
addresses of any medical practitioners selected by |
22 | | the employer pursuant to
Section 12 of this Act and the time |
23 | | and place of any examination scheduled
to be made pursuant to |
24 | | such Section.
|
25 | | Any employer who does not timely file and serve a written |
26 | | response
without good cause may not introduce any evidence to |
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1 | | dispute any claim of
the employee but may cross examine the |
2 | | employee or any witness brought by
the employee and otherwise |
3 | | be heard.
|
4 | | No document or other evidence not previously identified by |
5 | | either party
with the petition or written response, or by any |
6 | | other means before the
hearing, may be introduced into |
7 | | evidence without good cause.
If, at the hearing, material |
8 | | information is discovered which was
not previously disclosed, |
9 | | the Arbitrator may extend the time for closing
proof on the |
10 | | motion of a party for a reasonable period of time which may
be |
11 | | more than 30 days. No evidence may be introduced pursuant
to |
12 | | this paragraph as to permanent disability. No award may be |
13 | | entered for
permanent disability pursuant to this paragraph. |
14 | | Either party may introduce
into evidence the testimony taken |
15 | | by deposition of any medical practitioner.
|
16 | | The Commission shall adopt rules, regulations and |
17 | | procedures whereby the
final decision of the Commission is |
18 | | filed not later than 90 days from the
date the petition for |
19 | | review is filed but in no event later than 180 days from
the |
20 | | date the petition for an emergency hearing is filed with the |
21 | | Illinois Workers' Compensation
Commission.
|
22 | | All service required pursuant to this paragraph (b-1) must |
23 | | be by personal
service or by certified mail and with evidence |
24 | | of receipt. In addition for
the purposes of this paragraph, |
25 | | all service on the employer must be at the
premises where the |
26 | | accident occurred if the premises are owned or operated
by the |
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1 | | employer. Otherwise service must be at the employee's |
2 | | principal
place of employment by the employer. If service on |
3 | | the employer is not
possible at either of the above, then |
4 | | service shall be at the employer's
principal place of |
5 | | business. After initial service in each case, service
shall be |
6 | | made on the employer's attorney or designated representative.
|
7 | | (c)(1) At a reasonable time in advance of and in |
8 | | connection with the
hearing under Section 19(e) or 19(h), the |
9 | | Commission may on its own motion
order an impartial physical |
10 | | or mental examination of a petitioner whose
mental or physical |
11 | | condition is in issue, when in the Commission's
discretion it |
12 | | appears that such an examination will materially aid in the
|
13 | | just determination of the case. The examination shall be made |
14 | | by a member
or members of a panel of physicians chosen for |
15 | | their special qualifications
by the Illinois State Medical |
16 | | Society. The Commission shall establish
procedures by which a |
17 | | physician shall be selected from such list.
|
18 | | (2) Should the Commission at any time during the hearing |
19 | | find that
compelling considerations make it advisable to have |
20 | | an examination and
report at that time, the commission may in |
21 | | its discretion so order.
|
22 | | (3) A copy of the report of examination shall be given to |
23 | | the Commission
and to the attorneys for the parties.
|
24 | | (4) Either party or the Commission may call the examining |
25 | | physician or
physicians to testify. Any physician so called |
26 | | shall be subject to
cross-examination.
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1 | | (5) The examination shall be made, and the physician or |
2 | | physicians, if
called, shall testify, without cost to the |
3 | | parties. The Commission shall
determine the compensation and |
4 | | the pay of the physician or physicians. The
compensation for |
5 | | this service shall not exceed the usual and customary amount
|
6 | | for such service.
|
7 | | (6) The fees and payment thereof of all attorneys and |
8 | | physicians for
services authorized by the Commission under |
9 | | this Act shall, upon request
of either the employer or the |
10 | | employee or the beneficiary affected, be
subject to the review |
11 | | and decision of the Commission.
|
12 | | (d) If any employee shall persist in insanitary or |
13 | | injurious
practices which tend to either imperil or retard his |
14 | | recovery or shall
refuse to submit to such medical, surgical, |
15 | | or hospital treatment as is
reasonably essential to promote |
16 | | his recovery, the Commission may, in its
discretion, reduce or |
17 | | suspend the compensation of any such injured
employee. |
18 | | However, when an employer and employee so agree in writing,
|
19 | | the foregoing provision shall not be construed to authorize |
20 | | the
reduction or suspension of compensation of an employee who |
21 | | is relying in
good faith, on treatment by prayer or spiritual |
22 | | means alone, in
accordance with the tenets and practice of a |
23 | | recognized church or
religious denomination, by a duly |
24 | | accredited practitioner thereof.
|
25 | | (e) This paragraph shall apply to all hearings before the |
26 | | Commission.
Such hearings may be held in its office or |
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1 | | elsewhere as the Commission
may deem advisable. The taking of |
2 | | testimony on such hearings may be had
before any member of the |
3 | | Commission. If a petition for review and agreed
statement of |
4 | | facts or transcript of evidence is filed, as provided herein,
|
5 | | the Commission shall promptly review the decision of the |
6 | | Arbitrator and all
questions of law or fact which appear from |
7 | | the statement of facts or
transcript of evidence.
|
8 | | In all cases in which the hearing before the arbitrator is |
9 | | held after
December 18, 1989, no additional evidence shall be |
10 | | introduced by the
parties before the Commission on review of |
11 | | the decision of the Arbitrator.
In reviewing decisions of an |
12 | | arbitrator the Commission shall award such
temporary |
13 | | compensation, permanent compensation and other payments as are
|
14 | | due under this Act. The Commission shall file in its office its |
15 | | decision
thereon, and shall immediately send to each party or |
16 | | his attorney a copy of
such decision and a notification of the |
17 | | time when it was filed. Decisions
shall be filed within 60 days |
18 | | after the Statement of Exceptions and
Supporting Brief and |
19 | | Response thereto are required to be filed or oral
argument |
20 | | whichever is later.
|
21 | | In the event either party requests oral argument, such |
22 | | argument shall be
had before a panel of 3 members of the |
23 | | Commission (or before all available
members pursuant to the |
24 | | determination of 7 members of the Commission that
such |
25 | | argument be held before all available members of the |
26 | | Commission)
pursuant to the rules and regulations of the |
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1 | | Commission. A panel of 3
members, which shall be comprised of |
2 | | not more than one representative
citizen of the employing |
3 | | class and not more than one representative from a labor |
4 | | organization recognized under the National Labor Relations Act |
5 | | or an attorney who has represented labor organizations or has |
6 | | represented employees in workers' compensation cases, shall |
7 | | hear the argument; provided that if all the
issues in dispute |
8 | | are solely the nature and extent of the permanent partial
|
9 | | disability, if any, a majority of the panel may deny the |
10 | | request for such
argument and such argument shall not be held; |
11 | | and provided further that 7
members of the Commission may |
12 | | determine that the argument be held before
all available |
13 | | members of the Commission. A decision of the Commission
shall |
14 | | be approved by a majority of Commissioners present at such |
15 | | hearing if
any; provided, if no such hearing is held, a |
16 | | decision of the Commission
shall be approved by a majority of a |
17 | | panel of 3 members of the Commission
as described in this |
18 | | Section. The Commission shall give 10 days' notice to
the |
19 | | parties or their attorneys of the time and place of such taking |
20 | | of
testimony and of such argument.
|
21 | | In any case the Commission in its decision may find |
22 | | specially
upon any question or questions of law or fact which |
23 | | shall be submitted
in writing by either party whether ultimate |
24 | | or otherwise;
provided that on issues other than nature and |
25 | | extent of the disability,
if any, the Commission in its |
26 | | decision shall find specially upon any
question or questions |
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1 | | of law or fact, whether ultimate or otherwise,
which are |
2 | | submitted in writing by either party; provided further that
|
3 | | not more than 5 such questions may be submitted by either |
4 | | party. Any
party may, within 20 days after receipt of notice of |
5 | | the Commission's
decision, or within such further time, not |
6 | | exceeding 30 days, as the
Commission may grant, file with the |
7 | | Commission either an agreed
statement of the facts appearing |
8 | | upon the hearing, or, if such party
shall so elect, a correct |
9 | | transcript of evidence of the additional
proceedings presented |
10 | | before the Commission, in which report the party
may embody a |
11 | | correct statement of such other proceedings in the case as
|
12 | | such party may desire to have reviewed, such statement of |
13 | | facts or
transcript of evidence to be authenticated by the |
14 | | signature of the
parties or their attorneys, and in the event |
15 | | that they do not agree,
then the authentication of such |
16 | | transcript of evidence shall be by the
signature of any member |
17 | | of the Commission.
|
18 | | If a reporter does not for any reason furnish a transcript |
19 | | of the
proceedings before the Arbitrator in any case for use on |
20 | | a hearing for
review before the Commission, within the |
21 | | limitations of time as fixed in
this Section, the Commission |
22 | | may, in its discretion, order a trial de
novo before the |
23 | | Commission in such case upon application of either
party. The |
24 | | applications for adjustment of claim and other documents in
|
25 | | the nature of pleadings filed by either party, together with |
26 | | the
decisions of the Arbitrator and of the Commission and the |
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1 | | statement of
facts or transcript of evidence hereinbefore |
2 | | provided for in paragraphs
(b) and (c) shall be the record of |
3 | | the proceedings of the Commission,
and shall be subject to |
4 | | review as hereinafter provided.
|
5 | | At the request of either party or on its own motion, the |
6 | | Commission shall
set forth in writing the reasons for the |
7 | | decision, including findings of
fact and conclusions of law |
8 | | separately stated. The Commission shall by rule
adopt a format |
9 | | for written decisions for the Commission and arbitrators.
The |
10 | | written decisions shall be concise and shall succinctly state |
11 | | the facts
and reasons for the decision. The Commission may |
12 | | adopt in whole or in part,
the decision of the arbitrator as |
13 | | the decision of the Commission. When the
Commission does so |
14 | | adopt the decision of the arbitrator, it shall do so by
order. |
15 | | Whenever the Commission adopts part of the arbitrator's |
16 | | decision,
but not all, it shall include in the order the |
17 | | reasons for not adopting all
of the arbitrator's decision. |
18 | | When a majority of a panel, after
deliberation, has arrived at |
19 | | its decision, the decision shall be filed as
provided in this |
20 | | Section without unnecessary delay, and without regard to
the |
21 | | fact that a member of the panel has expressed an intention to |
22 | | dissent.
Any member of the panel may file a dissent. Any |
23 | | dissent shall be filed no
later than 10 days after the decision |
24 | | of the majority has been filed.
|
25 | | Decisions rendered by the Commission and dissents, if any, |
26 | | shall be
published together by the Commission. The conclusions |
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1 | | of law set out in
such decisions shall be regarded as |
2 | | precedents by arbitrators for the purpose
of achieving a more |
3 | | uniform administration of this Act.
|
4 | | (f) The decision of the Commission acting within its |
5 | | powers,
according to the provisions of paragraph (e) of this |
6 | | Section shall, in
the absence of fraud, be conclusive unless |
7 | | reviewed as in this paragraph
hereinafter provided. However, |
8 | | the Arbitrator or the Commission may on
his or its own motion, |
9 | | or on the motion of either party, correct any
clerical error or |
10 | | errors in computation within 15 days after the date of
receipt |
11 | | of any award by such Arbitrator or any decision on review of |
12 | | the
Commission and shall have the power to recall the original |
13 | | award on
arbitration or decision on review, and issue in lieu |
14 | | thereof such
corrected award or decision. Where such |
15 | | correction is made the time for
review herein specified shall |
16 | | begin to run from the date of
the receipt of the corrected |
17 | | award or decision.
|
18 | | (1) Except in cases of claims against the State of |
19 | | Illinois other than those claims under Section 18.1, in
|
20 | | which case the decision of the Commission shall not be |
21 | | subject to
judicial review, the Circuit Court of the |
22 | | county where any of the
parties defendant may be found, or |
23 | | if none of the parties defendant can
be found in this State |
24 | | then the Circuit Court of the county where the
accident |
25 | | occurred, shall by summons to the Commission have
power to |
26 | | review all questions of law and fact presented by such |
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1 | | record.
|
2 | | A proceeding for review shall be commenced within 20 |
3 | | days of
the receipt of notice of the decision of the |
4 | | Commission. The summons shall
be issued by the clerk of |
5 | | such court upon written request returnable on a
designated |
6 | | return day, not less than 10 or more than 60 days from the |
7 | | date
of issuance thereof, and the written request shall |
8 | | contain the last known
address of other parties in |
9 | | interest and their attorneys of record who are
to be |
10 | | served by summons. Service upon any member of the |
11 | | Commission or the
Secretary or the Assistant Secretary |
12 | | thereof shall be service upon the
Commission, and service |
13 | | upon other parties in interest and their attorneys
of |
14 | | record shall be by summons, and such service shall be made |
15 | | upon the
Commission and other parties in interest by |
16 | | mailing notices of the
commencement of the proceedings and |
17 | | the return day of the summons to the
office of the |
18 | | Commission and to the last known place of residence of |
19 | | other
parties in interest or their attorney or attorneys |
20 | | of record. The clerk of
the court issuing the summons |
21 | | shall on the day of issue mail notice of the
commencement |
22 | | of the proceedings which shall be done by mailing a copy of
|
23 | | the summons to the office of the Commission, and a copy of |
24 | | the summons to
the other parties in interest or their |
25 | | attorney or attorneys of record and
the clerk of the court |
26 | | shall make certificate that he has so sent said
notices in |
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1 | | pursuance of this Section, which shall be evidence of |
2 | | service on
the Commission and other parties in interest.
|
3 | | The Commission shall not be required to certify the |
4 | | record of their
proceedings to the Circuit Court, unless |
5 | | the party commencing the
proceedings for review in the |
6 | | Circuit Court as above provided, shall file with the |
7 | | Commission notice of intent to file for review in Circuit |
8 | | Court. It shall be the duty
of the Commission upon such |
9 | | filing of notice of intent to file for review in the |
10 | | Circuit Court to prepare a true and correct
copy of such |
11 | | testimony and a true and correct copy of all other matters
|
12 | | contained in such record and certified to by the Secretary |
13 | | or Assistant
Secretary thereof. The changes made to this |
14 | | subdivision (f)(1) by this amendatory Act of the 98th |
15 | | General Assembly apply to any Commission decision entered |
16 | | after the effective date of this amendatory Act of the |
17 | | 98th General Assembly.
|
18 | | No request for a summons
may be filed and no summons |
19 | | shall issue unless the party seeking to review
the |
20 | | decision of the Commission shall exhibit to the clerk of |
21 | | the Circuit
Court proof of filing with the Commission of |
22 | | the notice of the intent to file for review in the Circuit |
23 | | Court or an affidavit
of the attorney setting forth that |
24 | | notice of intent to file for review in the Circuit Court |
25 | | has been given in writing to the Secretary or Assistant |
26 | | Secretary of the Commission.
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1 | | (2) No such summons shall issue unless the one against |
2 | | whom the
Commission shall have rendered an award for the |
3 | | payment of money shall upon
the filing of his written |
4 | | request for such summons file with the clerk of
the court a |
5 | | bond conditioned that if he shall not successfully
|
6 | | prosecute the review, he will pay the award and the costs |
7 | | of the
proceedings in the courts. The amount of the bond |
8 | | shall be fixed by any
member of the Commission and the |
9 | | surety or sureties of the bond shall be
approved by the |
10 | | clerk of the court. The acceptance of the bond by the
clerk |
11 | | of the court shall constitute evidence of his approval of |
12 | | the bond.
|
13 | | The following Every county, city, town, township, |
14 | | incorporated village, school
district, body politic or |
15 | | municipal corporation against whom the
Commission shall |
16 | | have rendered an award for the payment of money shall
not |
17 | | be required to file a bond to secure the payment of the |
18 | | award and
the costs of the proceedings in the court to |
19 | | authorize the court to
issue such summons : .
|
20 | | (1) the State Treasurer, for a fund administered |
21 | | by the State Treasurer ex officio against whom the |
22 | | Commission shall have rendered an award for the |
23 | | payment of money; and |
24 | | (2) a county, city, town, township, incorporated |
25 | | village, school district, body politic, or municipal |
26 | | corporation against whom the Commission shall have |
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1 | | rendered an award for the payment of money. |
2 | | The court may confirm or set aside the decision of the |
3 | | Commission. If
the decision is set aside and the facts |
4 | | found in the proceedings before
the Commission are |
5 | | sufficient, the court may enter such decision as is
|
6 | | justified by law, or may remand the cause to the |
7 | | Commission for further
proceedings and may state the |
8 | | questions requiring further hearing, and
give such other |
9 | | instructions as may be proper. Appeals shall be taken
to |
10 | | the Appellate Court in accordance
with Supreme Court Rules |
11 | | 22(g) and 303. Appeals
shall be taken from the Appellate
|
12 | | Court to the Supreme Court in accordance with Supreme |
13 | | Court Rule 315.
|
14 | | It shall be the duty of the clerk of any court |
15 | | rendering a decision
affecting or affirming an award of |
16 | | the Commission to promptly furnish
the Commission with a |
17 | | copy of such decision, without charge.
|
18 | | The decision of a majority of the members of the panel |
19 | | of the Commission,
shall be considered the decision of the |
20 | | Commission.
|
21 | | (g) Except in the case of a claim against the State of |
22 | | Illinois,
either party may present a certified copy of the |
23 | | award of the
Arbitrator, or a certified copy of the decision of |
24 | | the Commission when
the same has become final, when no |
25 | | proceedings for review are pending,
providing for the payment |
26 | | of compensation according to this Act, to the
Circuit Court of |
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1 | | the county in which such accident occurred or either of
the |
2 | | parties are residents, whereupon the court shall enter a |
3 | | judgment
in accordance therewith. In a case where the employer |
4 | | refuses to pay
compensation according to such final award or |
5 | | such final decision upon
which such judgment is entered the |
6 | | court shall in entering judgment
thereon, tax as costs against |
7 | | him the reasonable costs and attorney fees
in the arbitration |
8 | | proceedings and in the court entering the judgment
for the |
9 | | person in whose favor the judgment is entered, which judgment
|
10 | | and costs taxed as therein provided shall, until and unless |
11 | | set aside,
have the same effect as though duly entered in an |
12 | | action duly tried and
determined by the court, and shall with |
13 | | like effect, be entered and
docketed. The Circuit Court shall |
14 | | have power at any time upon
application to make any such |
15 | | judgment conform to any modification
required by any |
16 | | subsequent decision of the Supreme Court upon appeal, or
as |
17 | | the result of any subsequent proceedings for review, as |
18 | | provided in
this Act.
|
19 | | Judgment shall not be entered until 15 days' notice of the |
20 | | time and
place of the application for the entry of judgment |
21 | | shall be served upon
the employer by filing such notice with |
22 | | the Commission, which Commission
shall, in case it has on file |
23 | | the address of the employer or the name
and address of its |
24 | | agent upon whom notices may be served, immediately
send a copy |
25 | | of the notice to the employer or such designated agent.
|
26 | | (h) An agreement or award under this Act providing for |
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1 | | compensation
in installments, may at any time within 18 months |
2 | | after such agreement
or award be reviewed by the Commission at |
3 | | the request of either the
employer or the employee, on the |
4 | | ground that the disability of the
employee has subsequently |
5 | | recurred, increased, diminished or ended.
|
6 | | However, as to accidents occurring subsequent to July 1, |
7 | | 1955, which
are covered by any agreement or award under this |
8 | | Act providing for
compensation in installments made as a |
9 | | result of such accident, such
agreement or award may at any |
10 | | time within 30 months, or 60 months in the case of an award |
11 | | under Section 8(d)1, after such agreement
or award be reviewed |
12 | | by the Commission at the request of either the
employer or the |
13 | | employee on the ground that the disability of the
employee has |
14 | | subsequently recurred, increased, diminished or ended.
|
15 | | On such review, compensation payments may be |
16 | | re-established,
increased, diminished or ended. The Commission |
17 | | shall give 15 days'
notice to the parties of the hearing for |
18 | | review. Any employee, upon any
petition for such review being |
19 | | filed by the employer, shall be entitled
to one day's notice |
20 | | for each 100 miles necessary to be traveled by him in
attending |
21 | | the hearing of the Commission upon the petition, and 3 days in
|
22 | | addition thereto. Such employee shall, at the discretion of |
23 | | the
Commission, also be entitled to 5 cents per mile |
24 | | necessarily traveled by
him within the State of Illinois in |
25 | | attending such hearing, not to
exceed a distance of 300 miles, |
26 | | to be taxed by the Commission as costs
and deposited with the |
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1 | | petition of the employer.
|
2 | | When compensation which is payable in accordance with an |
3 | | award or
settlement contract approved by the Commission, is |
4 | | ordered paid in a
lump sum by the Commission, no review shall |
5 | | be had as in this paragraph
mentioned.
|
6 | | (i) Each party, upon taking any proceedings or steps |
7 | | whatsoever
before any Arbitrator, Commission or court, shall |
8 | | file with the Commission
his address, or the name and address |
9 | | of any agent upon whom all notices to
be given to such party |
10 | | shall be served, either personally or by registered
mail, |
11 | | addressed to such party or agent at the last address so filed |
12 | | with
the Commission. In the event such party has not filed his |
13 | | address, or the
name and address of an agent as above provided, |
14 | | service of any notice may
be had by filing such notice with the |
15 | | Commission.
|
16 | | (j) Whenever in any proceeding testimony has been taken or |
17 | | a final
decision has been rendered and after the taking of such |
18 | | testimony or
after such decision has become final, the injured |
19 | | employee dies, then in
any subsequent proceedings brought by |
20 | | the personal representative or
beneficiaries of the deceased |
21 | | employee, such testimony in the former
proceeding may be |
22 | | introduced with the same force and effect as though
the |
23 | | witness having so testified were present in person in such
|
24 | | subsequent proceedings and such final decision, if any, shall |
25 | | be taken
as final adjudication of any of the issues which are |
26 | | the same in both
proceedings.
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1 | | (k) In case where there has been any unreasonable or |
2 | | vexatious delay
of payment or intentional underpayment of |
3 | | compensation, or proceedings
have been instituted or carried |
4 | | on by the one liable to pay the
compensation, which do not |
5 | | present a real controversy, but are merely
frivolous or for |
6 | | delay, then the Commission may award compensation
additional |
7 | | to that otherwise payable under this Act equal to 50% of the
|
8 | | amount payable at the time of such award. Failure to pay |
9 | | compensation
in accordance with the provisions of Section 8, |
10 | | paragraph (b) of this
Act, shall be considered unreasonable |
11 | | delay.
|
12 | | When determining whether this subsection (k) shall apply, |
13 | | the
Commission shall consider whether an Arbitrator has |
14 | | determined
that the claim is not compensable or whether the |
15 | | employer has
made payments under Section 8(j). |
16 | | (l) If the employee has made written demand for payment of
|
17 | | benefits under Section 8(a) or Section 8(b), the employer |
18 | | shall
have 14 days after receipt of the demand to set forth in
|
19 | | writing the reason for the delay. In the case of demand for
|
20 | | payment of medical benefits under Section 8(a), the time for
|
21 | | the employer to respond shall not commence until the |
22 | | expiration
of the allotted 30 days specified under Section |
23 | | 8.2(d). In case
the employer or his or her insurance carrier |
24 | | shall without good and
just cause fail, neglect, refuse, or |
25 | | unreasonably delay the
payment of benefits under Section 8(a) |
26 | | or Section 8(b), the
Arbitrator or the Commission shall allow |
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1 | | to the employee
additional compensation in the sum of $30 per |
2 | | day for each day
that the benefits under Section 8(a) or |
3 | | Section 8(b) have been
so withheld or refused, not to exceed |
4 | | $10,000.
A delay in payment of 14 days or more
shall create a |
5 | | rebuttable presumption of unreasonable delay.
|
6 | | (m) If the commission finds that an accidental injury was |
7 | | directly
and proximately caused by the employer's wilful |
8 | | violation of a health
and safety standard under the Health and |
9 | | Safety Act or the Occupational Safety and Health Act in force |
10 | | at the time of the
accident, the arbitrator or the Commission |
11 | | shall allow to the injured
employee or his dependents, as the |
12 | | case may be, additional compensation
equal to 25% of the |
13 | | amount which otherwise would be payable under the
provisions |
14 | | of this Act exclusive of this paragraph. The additional
|
15 | | compensation herein provided shall be allowed by an |
16 | | appropriate increase
in the applicable weekly compensation |
17 | | rate.
|
18 | | (n) After June 30, 1984, decisions of the Illinois |
19 | | Workers' Compensation Commission
reviewing an award of an |
20 | | arbitrator of the Commission shall draw interest
at a rate |
21 | | equal to the yield on indebtedness issued by the United States
|
22 | | Government with a 26-week maturity next previously auctioned |
23 | | on the day on
which the decision is filed. Said rate of |
24 | | interest shall be set forth in
the Arbitrator's Decision. |
25 | | Interest shall be drawn from the date of the
arbitrator's |
26 | | award on all accrued compensation due the employee through the
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1 | | day prior to the date of payments. However, when an employee |
2 | | appeals an
award of an Arbitrator or the Commission, and the |
3 | | appeal results in no
change or a decrease in the award, |
4 | | interest shall not further accrue from
the date of such |
5 | | appeal.
|
6 | | The employer or his insurance carrier may tender the |
7 | | payments due under
the award to stop the further accrual of |
8 | | interest on such award
notwithstanding the prosecution by |
9 | | either party of review, certiorari,
appeal to the Supreme |
10 | | Court or other steps to reverse, vacate or modify
the award.
|
11 | | (o) By the 15th day of each month each insurer providing |
12 | | coverage for
losses under this Act shall notify each insured |
13 | | employer of any compensable
claim incurred during the |
14 | | preceding month and the amounts paid or reserved
on the claim |
15 | | including a summary of the claim and a brief statement of the
|
16 | | reasons for compensability. A cumulative report of all claims |
17 | | incurred
during a calendar year or continued from the previous |
18 | | year shall be
furnished to the insured employer by the insurer |
19 | | within 30 days after the
end of that calendar year.
|
20 | | The insured employer may challenge, in proceeding before |
21 | | the Commission,
payments made by the insurer without |
22 | | arbitration and payments
made after a case is determined to be |
23 | | noncompensable. If the Commission
finds that the case was not |
24 | | compensable, the insurer shall purge its records
as to that |
25 | | employer of any loss or expense associated with the claim, |
26 | | reimburse
the employer for attorneys' fees arising from the |
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1 | | challenge and for any
payment required of the employer to the |
2 | | Rate Adjustment Fund or the
Second Injury Fund, and may not |
3 | | reflect the loss or expense for rate making
purposes. The |
4 | | employee shall not be required to refund the challenged
|
5 | | payment. The decision of the Commission may be reviewed in the |
6 | | same manner
as in arbitrated cases. No challenge may be |
7 | | initiated under this paragraph
more than 3 years after the |
8 | | payment is made. An employer may waive the
right of challenge |
9 | | under this paragraph on a case by case basis.
|
10 | | (p) After filing an application for adjustment of claim |
11 | | but prior to
the hearing on arbitration the parties may |
12 | | voluntarily agree to submit such
application for adjustment of |
13 | | claim for decision by an arbitrator under
this subsection (p) |
14 | | where such application for adjustment of claim raises
only a |
15 | | dispute over temporary total disability, permanent partial
|
16 | | disability or medical expenses. Such agreement shall be in |
17 | | writing in such
form as provided by the Commission. |
18 | | Applications for adjustment of claim
submitted for decision by |
19 | | an arbitrator under this subsection (p) shall
proceed |
20 | | according to rule as established by the Commission. The |
21 | | Commission
shall promulgate rules including, but not limited |
22 | | to, rules to ensure that
the parties are adequately informed |
23 | | of their rights under this subsection
(p) and of the voluntary |
24 | | nature of proceedings under this subsection (p).
The findings |
25 | | of fact made by an arbitrator acting within his or her powers
|
26 | | under this subsection (p) in the absence of fraud shall be |
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1 | | conclusive.
However, the arbitrator may on his own motion, or |
2 | | the motion of either
party, correct any clerical errors or |
3 | | errors in computation within 15 days
after the date of receipt |
4 | | of such award of the arbitrator
and shall have the power to |
5 | | recall the original award on arbitration, and
issue in lieu |
6 | | thereof such corrected award.
The decision of the arbitrator |
7 | | under this subsection (p) shall be
considered the decision of |
8 | | the Commission and proceedings for review of
questions of law |
9 | | arising from the decision may be commenced by either party
|
10 | | pursuant to subsection (f) of Section 19. The Advisory Board |
11 | | established
under Section 13.1 shall compile a list of |
12 | | certified Commission
arbitrators, each of whom shall be |
13 | | approved by at least 7 members of the
Advisory Board. The |
14 | | chairman shall select 5 persons from such list to
serve as |
15 | | arbitrators under this subsection (p). By agreement, the |
16 | | parties
shall select one arbitrator from among the 5 persons |
17 | | selected by the
chairman except that if the parties do not |
18 | | agree on an arbitrator from
among the 5 persons, the parties |
19 | | may, by agreement, select an arbitrator of
the American |
20 | | Arbitration Association, whose fee shall be paid by the State
|
21 | | in accordance with rules promulgated by the Commission. |
22 | | Arbitration under
this subsection (p) shall be voluntary.
|
23 | | (Source: P.A. 101-384, eff. 1-1-20 .)
|
24 | | Section 45. The Workers' Occupational Diseases Act is |
25 | | amended by changing Section 19 as follows:
|
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1 | | (820 ILCS 310/19) (from Ch. 48, par. 172.54)
|
2 | | Sec. 19. Any disputed questions of law or fact shall be |
3 | | determined as
herein provided.
|
4 | | (a) It shall be the duty of the Commission upon |
5 | | notification that
the parties have failed to reach an |
6 | | agreement to designate an
Arbitrator.
|
7 | | (1) The application for adjustment of claim filed with |
8 | | the
Commission shall state:
|
9 | | A. The approximate date of the last day of the last |
10 | | exposure and the
approximate date of the disablement.
|
11 | | B. The general nature and character of the illness |
12 | | or disease
claimed.
|
13 | | C. The name and address of the employer by whom |
14 | | employed on the last
day of the last exposure and if |
15 | | employed by any other employer after
such last |
16 | | exposure and before disablement the name and address |
17 | | of such
other employer or employers.
|
18 | | D. In case of death, the date and place of death.
|
19 | | (2) Amendments to applications for adjustment of claim |
20 | | which relate
to the same disablement or disablement |
21 | | resulting in death originally
claimed upon may be allowed |
22 | | by the Commissioner or an Arbitrator
thereof, in their |
23 | | discretion, and in the exercise of such discretion,
they |
24 | | may in proper cases order a trial de novo; such amendment |
25 | | shall
relate back to the date of the filing of the original |
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1 | | application so
amended.
|
2 | | (3) Whenever any claimant misconceives his remedy and |
3 | | files an
application for adjustment of claim under this |
4 | | Act and it is
subsequently discovered, at any time before |
5 | | final disposition of such
cause, that the claim for |
6 | | disability or death which was the basis for
such |
7 | | application should properly have been made under the |
8 | | Workers'
Compensation Act, then the provisions of Section |
9 | | 19 paragraph (a-1) of
the Workers' Compensation Act having |
10 | | reference to such application shall
apply.
|
11 | | Whenever any claimant misconceives his remedy and |
12 | | files an
application for adjustment of claim under the |
13 | | Workers' Compensation Act
and it is subsequently |
14 | | discovered, at any time before final disposition
of such |
15 | | cause that the claim for injury or death which was the |
16 | | basis for
such application should properly have been made |
17 | | under this Act, then the
application so filed under the |
18 | | Workers' Compensation Act may be amended
in form, |
19 | | substance or both to assert claim for such disability or |
20 | | death
under this Act and it shall be deemed to have been so |
21 | | filed as amended
on the date of the original filing |
22 | | thereof, and such compensation may be
awarded as is |
23 | | warranted by the whole evidence pursuant to the provisions
|
24 | | of this Act. When such amendment is submitted, further or |
25 | | additional
evidence may be heard by the Arbitrator or |
26 | | Commission when deemed
necessary; provided, that nothing |
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1 | | in this Section contained shall be
construed to be or |
2 | | permit a waiver of any provisions of this Act with
|
3 | | reference to notice, but notice if given shall be deemed |
4 | | to be a notice
under the provisions of this Act if given |
5 | | within the time required
herein.
|
6 | | (b) The Arbitrator shall make such inquiries and |
7 | | investigations as he
shall deem necessary and may examine and |
8 | | inspect all books, papers,
records, places, or premises |
9 | | relating to the questions in dispute and hear
such proper |
10 | | evidence as the parties may submit.
|
11 | | The hearings before the Arbitrator shall be held in the |
12 | | vicinity where
the last exposure occurred, after 10 days' |
13 | | notice of the time and place of
such hearing shall have been |
14 | | given to each of the parties or their attorneys of record.
|
15 | | The Arbitrator may find that the disabling condition is |
16 | | temporary and has
not yet reached a permanent condition and |
17 | | may order the payment of
compensation up to the date of the |
18 | | hearing, which award shall be reviewable
and enforceable in |
19 | | the same manner as other awards, and in no instance be a
bar to |
20 | | a further hearing and determination of a further amount of |
21 | | temporary
total compensation or of compensation for permanent |
22 | | disability, but shall
be conclusive as to all other questions |
23 | | except the nature and extent of such
disability.
|
24 | | The decision of the Arbitrator shall be filed with the |
25 | | Commission which
Commission shall immediately send to each |
26 | | party or his attorney a copy of
such decision, together with a |
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1 | | notification of the time when it was filed.
As of the effective |
2 | | date of this amendatory Act of the 94th General Assembly, all |
3 | | decisions of the Arbitrator shall set forth
in writing |
4 | | findings of fact and conclusions of law, separately stated, if |
5 | | requested by either party.
Unless a petition for review is |
6 | | filed by either party within 30 days after
the receipt by such |
7 | | party of the copy of the decision and notification of
time when |
8 | | filed, and unless such party petitioning for a review shall
|
9 | | within 35 days after the receipt by him of the copy of the |
10 | | decision, file
with the Commission either an agreed statement |
11 | | of the facts appearing upon
the hearing before the Arbitrator, |
12 | | or if such party shall so elect a
correct transcript of |
13 | | evidence of the proceedings at such hearings, then
the |
14 | | decision shall become the decision of the Commission and in |
15 | | the absence
of fraud shall be conclusive. The Petition for |
16 | | Review shall contain a
statement of the petitioning party's |
17 | | specific exceptions to the decision of
the arbitrator. The |
18 | | jurisdiction of the Commission to review the decision
of the |
19 | | arbitrator shall not be limited to the exceptions stated in |
20 | | the
Petition for Review. The Commission, or any member |
21 | | thereof, may grant
further time not exceeding 30 days, in |
22 | | which to file such agreed statement
or transcript of evidence. |
23 | | Such agreed statement of facts or correct
transcript of |
24 | | evidence, as the case may be, shall be authenticated by the
|
25 | | signatures of the parties or their attorneys, and in the event |
26 | | they do not
agree as to the correctness of the transcript of |
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1 | | evidence it shall be
authenticated by the signature of the |
2 | | Arbitrator designated by the Commission.
|
3 | | Whether the employee is working or not, if the employee is |
4 | | not receiving or has not received medical, surgical, or |
5 | | hospital services or other services or compensation as |
6 | | provided in paragraph (a) of Section 8 of the Workers' |
7 | | Compensation
Act, or compensation as provided in paragraph (b) |
8 | | of Section 8 of the Workers' Compensation
Act, the employee |
9 | | may at any time petition for an expedited hearing by an |
10 | | Arbitrator on the issue of whether or not he or she is entitled |
11 | | to receive payment of the services or compensation. Provided |
12 | | the employer continues to pay compensation pursuant to |
13 | | paragraph (b) of Section 8 of the Workers' Compensation
Act, |
14 | | the employer may at any time petition for an expedited hearing |
15 | | on the issue of whether or not the employee is entitled to |
16 | | receive medical, surgical, or hospital services or other |
17 | | services or compensation as provided in paragraph (a) of |
18 | | Section 8 of the Workers' Compensation
Act, or compensation as |
19 | | provided in paragraph (b) of Section 8 of the Workers' |
20 | | Compensation
Act. When an employer has petitioned for an |
21 | | expedited hearing, the employer shall continue to pay |
22 | | compensation as provided in paragraph (b) of Section 8 of the |
23 | | Workers' Compensation
Act unless the arbitrator renders a |
24 | | decision that the employee is not entitled to the benefits |
25 | | that are the subject of the expedited hearing or unless the |
26 | | employee's treating physician has released the employee to |
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1 | | return to work at his or her regular job with the employer or |
2 | | the employee actually returns to work at any other job. If the |
3 | | arbitrator renders a decision that the employee is not |
4 | | entitled to the benefits that are the subject of the expedited |
5 | | hearing, a petition for review filed by the employee shall |
6 | | receive the same priority as if the employee had filed a |
7 | | petition for an expedited hearing by an arbitrator. Neither |
8 | | party shall be entitled to an expedited hearing when the |
9 | | employee has returned to work and the sole issue in dispute |
10 | | amounts to less than 12 weeks of unpaid compensation pursuant |
11 | | to paragraph (b) of Section 8 of the Workers' Compensation
|
12 | | Act. |
13 | | Expedited hearings shall have priority over all other |
14 | | petitions and shall be heard by the Arbitrator and Commission |
15 | | with all convenient speed. Any party requesting an expedited |
16 | | hearing shall give notice of a request for an expedited |
17 | | hearing under this paragraph. A copy of the Application for |
18 | | Adjustment of Claim shall be attached to the notice. The |
19 | | Commission shall adopt rules and procedures under which the |
20 | | final decision of the Commission under this paragraph is filed |
21 | | not later than 180 days from the date that the Petition for |
22 | | Review is filed with the Commission. |
23 | | Where 2 or more insurance carriers, private self-insureds, |
24 | | or a group workers' compensation pool under Article V 3/4 of |
25 | | the Illinois Insurance Code dispute coverage for the same |
26 | | disease, any such insurance carrier, private self-insured, or |
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1 | | group workers' compensation pool may request an expedited |
2 | | hearing pursuant to this paragraph to determine the issue of |
3 | | coverage, provided coverage is the only issue in dispute and |
4 | | all other issues are stipulated and agreed to and further |
5 | | provided that all compensation benefits including medical |
6 | | benefits pursuant to Section 8(a) of the Workers' Compensation
|
7 | | Act continue to be paid to or on behalf of petitioner. Any |
8 | | insurance carrier, private self-insured, or group workers' |
9 | | compensation pool that is determined to be liable for coverage |
10 | | for the disease in issue shall reimburse any insurance |
11 | | carrier, private self-insured, or group workers' compensation |
12 | | pool that has paid benefits to or on behalf of petitioner for |
13 | | the disease.
|
14 | | (b-1) If the employee is not receiving, pursuant to |
15 | | Section 7, medical,
surgical or hospital services of the type |
16 | | provided for in paragraph (a) of
Section 8 of the Workers' |
17 | | Compensation Act or compensation of the type
provided for in |
18 | | paragraph (b) of Section 8 of the Workers' Compensation
Act, |
19 | | the employee, in accordance with Commission Rules, may file a |
20 | | petition
for an emergency hearing by an Arbitrator on the |
21 | | issue of whether or not he
is entitled to receive payment of |
22 | | such compensation or services as provided
therein. Such |
23 | | petition shall have priority over all other petitions and
|
24 | | shall be heard by the Arbitrator and Commission with all |
25 | | convenient speed.
|
26 | | Such petition shall contain the following information and |
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1 | | shall be served
on the employer at least 15 days before it is |
2 | | filed:
|
3 | | (i) the date and approximate time of the last |
4 | | exposure;
|
5 | | (ii) the approximate location of the last exposure;
|
6 | | (iii) a description of the last exposure;
|
7 | | (iv) the nature of the disability incurred by the |
8 | | employee;
|
9 | | (v) the identity of the person, if known, to whom the |
10 | | disability was
reported and the date on which it was |
11 | | reported;
|
12 | | (vi) the name and title of the person, if known, |
13 | | representing the
employer with whom the employee conferred |
14 | | in any effort to obtain pursuant
to Section 7 compensation |
15 | | of the type provided for in paragraph (b) of
Section 8 of |
16 | | the Workers' Compensation Act or medical, surgical or |
17 | | hospital
services of the type provided for in paragraph |
18 | | (a) of Section 8 of the
Workers' Compensation Act and the |
19 | | date of such conference;
|
20 | | (vii) a statement that the employer has refused to pay |
21 | | compensation
pursuant to Section 7 of the type provided |
22 | | for in paragraph (b) of Section
8 of the Workers' |
23 | | Compensation Act or for medical, surgical
or hospital |
24 | | services pursuant to Section 7 of the type provided for in
|
25 | | paragraph (a) of Section 8 of the Workers' Compensation |
26 | | Act;
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1 | | (viii) the name and address, if known, of each witness |
2 | | to the last
exposure and of each other person upon whom the |
3 | | employee will rely to
support his allegations;
|
4 | | (ix) the dates of treatment related to the disability |
5 | | by medical
practitioners, and the names and addresses of |
6 | | such practitioners, including
the dates of treatment |
7 | | related to the disability at any hospitals and the
names |
8 | | and addresses of such hospitals, and a signed |
9 | | authorization
permitting the employer to examine all |
10 | | medical records of all practitioners
and hospitals named |
11 | | pursuant to this paragraph;
|
12 | | (x) a copy of a signed report by a medical |
13 | | practitioner, relating to the
employee's current inability |
14 | | to return to work because of the disability
incurred as a |
15 | | result of the exposure or such other documents or |
16 | | affidavits
which show that the employee is entitled to |
17 | | receive pursuant to Section 7
compensation of the type |
18 | | provided for in paragraph (b) of Section 8 of the
Workers' |
19 | | Compensation Act or medical, surgical or hospital services |
20 | | of the
type provided for in paragraph (a) of Section 8 of |
21 | | the Workers'
Compensation Act. Such reports, documents or |
22 | | affidavits shall state, if
possible, the history of the |
23 | | exposure given by the employee, and describe
the |
24 | | disability and medical diagnosis, the medical services for |
25 | | such
disability which the employee has received and is |
26 | | receiving, the physical
activities which the employee |
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1 | | cannot currently perform as a result of such
disability, |
2 | | and the prognosis for recovery;
|
3 | | (xi) complete copies of any reports, records, |
4 | | documents and affidavits
in the possession of the employee |
5 | | on which the employee will rely to
support his |
6 | | allegations, provided that the employer shall pay the
|
7 | | reasonable cost of reproduction thereof;
|
8 | | (xii) a list of any reports, records, documents and |
9 | | affidavits which
the employee has demanded by subpoena and |
10 | | on which he intends to
rely to support his allegations;
|
11 | | (xiii) a certification signed by the employee or his |
12 | | representative that
the employer has received the petition |
13 | | with the required information 15
days before filing.
|
14 | | Fifteen days after receipt by the employer of the petition |
15 | | with the
required information the employee may file said |
16 | | petition and required
information and shall serve notice of |
17 | | the filing upon the employer. The
employer may file a motion |
18 | | addressed to the sufficiency of the petition.
If an objection |
19 | | has been filed to the sufficiency of the petition, the
|
20 | | arbitrator shall rule on the objection within 2 working days. |
21 | | If such an
objection is filed, the time for filing the final |
22 | | decision of the Commission
as provided in this paragraph shall |
23 | | be tolled until the arbitrator has
determined that the |
24 | | petition is sufficient.
|
25 | | The employer shall, within 15 days after receipt of the |
26 | | notice that such
petition is filed, file with the Commission |
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1 | | and serve on the employee or
his representative a written |
2 | | response to each claim set
forth in the petition, including |
3 | | the legal and factual basis for each
disputed allegation and |
4 | | the following information: (i)
complete copies of any reports, |
5 | | records, documents and affidavits
in the possession of the |
6 | | employer on which the employer intends to rely in
support of |
7 | | his response, (ii) a list of any reports, records, documents |
8 | | and
affidavits which the employer has demanded by subpoena and |
9 | | on which the
employer intends to rely in support of his |
10 | | response, (iii) the name and address
of each witness on whom |
11 | | the employer will rely to support his response,
and (iv) the |
12 | | names and addresses of any medical practitioners
selected by |
13 | | the employer pursuant to Section 12 of this Act and the time
|
14 | | and place of any examination scheduled to be made pursuant to |
15 | | such Section.
|
16 | | Any employer who does not timely file and serve a written |
17 | | response
without good cause may not introduce any evidence to |
18 | | dispute any claim of
the employee but may cross examine the |
19 | | employee or any witness brought by
the employee and otherwise |
20 | | be heard.
|
21 | | No document or other evidence not previously identified by |
22 | | either party
with the petition or written response, or by any |
23 | | other means before the
hearing, may be introduced into |
24 | | evidence without good cause. If, at the
hearing, material |
25 | | information is discovered which was not previously
disclosed, |
26 | | the Arbitrator may extend the time for closing proof on the
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1 | | motion of a party for a reasonable period of time which may be |
2 | | more than 30
days. No evidence may be introduced pursuant to |
3 | | this paragraph as to
permanent disability. No award may be |
4 | | entered for permanent disability
pursuant to this paragraph. |
5 | | Either party may introduce into evidence the
testimony taken |
6 | | by deposition of any medical practitioner.
|
7 | | The Commission shall adopt rules, regulations and |
8 | | procedures whereby
the final decision of the Commission is |
9 | | filed not later than 90 days from
the date the petition for |
10 | | review is filed but in no event later than 180
days from the |
11 | | date the petition for an emergency hearing is filed with the
|
12 | | Illinois Workers' Compensation Commission.
|
13 | | All service required pursuant to this paragraph (b-1) must |
14 | | be by personal
service or by certified mail and with evidence |
15 | | of receipt. In addition,
for the purposes of this paragraph, |
16 | | all service on the employer must be at
the premises where the |
17 | | accident occurred if the premises are owned or
operated by the |
18 | | employer. Otherwise service must be at the employee's
|
19 | | principal place of employment by the employer. If service on |
20 | | the employer
is not possible at either of the above, then |
21 | | service shall be at the
employer's principal place of |
22 | | business. After initial service in each case,
service shall be |
23 | | made on the employer's attorney or designated representative.
|
24 | | (c)(1) At a reasonable time in advance of and in |
25 | | connection with the
hearing under Section 19(e) or 19(h), the |
26 | | Commission may on its own motion
order an impartial physical |
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1 | | or mental examination of a petitioner whose
mental or physical |
2 | | condition is in issue, when in the Commission's
discretion it |
3 | | appears that such an examination will materially aid in the
|
4 | | just determination of the case. The examination shall be made |
5 | | by a member
or members of a panel of physicians chosen for |
6 | | their special qualifications
by the Illinois State Medical |
7 | | Society. The Commission shall establish
procedures by which a |
8 | | physician shall be selected from such list.
|
9 | | (2) Should the Commission at any time during the hearing |
10 | | find that
compelling considerations make it advisable to have |
11 | | an examination and
report at that time, the Commission may in |
12 | | its discretion so order.
|
13 | | (3) A copy of the report of examination shall be given to |
14 | | the Commission
and to the attorneys for the parties.
|
15 | | (4) Either party or the Commission may call the examining |
16 | | physician
or physicians to testify. Any physician so called |
17 | | shall be subject to
cross-examination.
|
18 | | (5) The examination shall be made, and the physician or |
19 | | physicians,
if called, shall testify, without cost to the |
20 | | parties. The Commission shall
determine the compensation and |
21 | | the pay of the physician or physicians. The
compensation for |
22 | | this service shall not exceed the usual and customary amount
|
23 | | for such service.
|
24 | | The fees and payment thereof of all attorneys and |
25 | | physicians for
services authorized by the Commission under |
26 | | this Act shall, upon request
of either the employer or the |
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1 | | employee or the beneficiary affected, be
subject to the review |
2 | | and decision of the Commission.
|
3 | | (d) If any employee shall persist in insanitary or |
4 | | injurious
practices which tend to either imperil or retard his |
5 | | recovery or shall
refuse to submit to such medical, surgical, |
6 | | or hospital treatment as is
reasonably essential to promote |
7 | | his recovery, the Commission may, in its
discretion, reduce or |
8 | | suspend the compensation of any such employee;
provided, that |
9 | | when an employer and employee so agree in writing, the
|
10 | | foregoing provision shall not be construed to authorize the |
11 | | reduction or
suspension of compensation of an employee who is |
12 | | relying in good faith,
on treatment by prayer or spiritual |
13 | | means alone, in accordance with the
tenets and practice of a |
14 | | recognized church or religious denomination, by
a duly |
15 | | accredited practitioner thereof.
|
16 | | (e) This paragraph shall apply to all hearings before the |
17 | | Commission.
Such hearings may be held in its office or |
18 | | elsewhere as the Commission may
deem advisable. The taking of |
19 | | testimony on such hearings may be had before
any member of the |
20 | | Commission. If a petition for review and agreed statement
of |
21 | | facts or transcript of evidence is filed, as provided herein, |
22 | | the
Commission shall promptly review the decision of the |
23 | | Arbitrator and all
questions of law or fact which appear from |
24 | | the statement of facts or
transcripts of evidence. In all |
25 | | cases in which the hearing before the
arbitrator is held after |
26 | | the effective date of this amendatory Act of 1989,
no |
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1 | | additional evidence shall be introduced by the parties before |
2 | | the
Commission on review of the decision of the Arbitrator. |
3 | | The Commission
shall file in its office its decision thereon, |
4 | | and shall immediately send
to each party or his attorney a copy |
5 | | of such decision and a notification of
the time when it was |
6 | | filed. Decisions shall be filed within 60 days after
the |
7 | | Statement of Exceptions and Supporting Brief and Response |
8 | | thereto are
required to be filed or oral argument whichever is |
9 | | later.
|
10 | | In the event either party requests oral argument, such |
11 | | argument shall be
had before a panel of 3 members of the |
12 | | Commission (or before all available
members pursuant to the |
13 | | determination of 7 members of the Commission that
such |
14 | | argument be held before all available members of the |
15 | | Commission)
pursuant to the rules and regulations of the |
16 | | Commission. A panel of 3
members, which shall be comprised of |
17 | | not more than one representative
citizen of the employing |
18 | | class and not more than one representative from a labor |
19 | | organization recognized under the National Labor Relations Act |
20 | | or an attorney who has represented labor organizations or has |
21 | | represented employees in workers' compensation cases, shall |
22 | | hear the argument; provided that if all the
issues in dispute |
23 | | are solely the nature and extent of the permanent partial
|
24 | | disability, if any, a majority of the panel may deny the |
25 | | request for such
argument and such argument shall not be held; |
26 | | and provided further that 7
members of the Commission may |
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1 | | determine that the argument be held before
all available |
2 | | members of the Commission. A decision of the Commission shall
|
3 | | be approved by a majority of Commissioners present at such |
4 | | hearing if any;
provided, if no such hearing is held, a |
5 | | decision of the Commission shall be
approved by a majority of a |
6 | | panel of 3 members of the Commission as
described in this |
7 | | Section. The Commission shall give 10 days' notice to the
|
8 | | parties or their attorneys of the time and place of such taking |
9 | | of
testimony and of such argument.
|
10 | | In any case the Commission in its decision may in its |
11 | | discretion find
specially upon any question or questions of |
12 | | law or facts which shall be
submitted in writing by either |
13 | | party whether ultimate or otherwise;
provided that on issues |
14 | | other than nature and extent of the disablement,
if any, the |
15 | | Commission in its decision shall find specially upon any
|
16 | | question or questions of law or fact, whether ultimate or |
17 | | otherwise,
which are submitted in writing by either party; |
18 | | provided further that
not more than 5 such questions may be |
19 | | submitted by either party. Any
party may, within 20 days after |
20 | | receipt of notice of the Commission's
decision, or within such |
21 | | further time, not exceeding 30 days, as the
Commission may |
22 | | grant, file with the Commission either an agreed
statement of |
23 | | the facts appearing upon the hearing, or, if such party
shall |
24 | | so elect, a correct transcript of evidence of the additional
|
25 | | proceedings presented before the Commission in which report |
26 | | the party
may embody a correct statement of such other |
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1 | | proceedings in the case as
such party may desire to have |
2 | | reviewed, such statement of facts or
transcript of evidence to |
3 | | be authenticated by the signature of the
parties or their |
4 | | attorneys, and in the event that they do not agree,
then the |
5 | | authentication of such transcript of evidence shall be by the
|
6 | | signature of any member of the Commission.
|
7 | | If a reporter does not for any reason furnish a transcript |
8 | | of the
proceedings before the Arbitrator in any case for use on |
9 | | a hearing for
review before the Commission, within the |
10 | | limitations of time as fixed in
this Section, the Commission |
11 | | may, in its discretion, order a trial de
novo before the |
12 | | Commission in such case upon application of either
party. The |
13 | | applications for adjustment of claim and other documents in
|
14 | | the nature of pleadings filed by either party, together with |
15 | | the
decisions of the Arbitrator and of the Commission and the |
16 | | statement of
facts or transcript of evidence hereinbefore |
17 | | provided for in paragraphs
(b) and (c) shall be the record of |
18 | | the proceedings of the Commission,
and shall be subject to |
19 | | review as hereinafter provided.
|
20 | | At the request of either party or on its own motion, the |
21 | | Commission shall
set forth in writing the reasons for the |
22 | | decision, including findings of
fact and conclusions of law, |
23 | | separately stated. The Commission shall by
rule adopt a format |
24 | | for written decisions for the Commission and
arbitrators. The |
25 | | written decisions shall be concise and shall succinctly
state |
26 | | the facts and reasons for the decision. The Commission may |
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1 | | adopt in
whole or in part, the decision of the arbitrator as |
2 | | the decision of the
Commission. When the Commission does so |
3 | | adopt the decision of the
arbitrator, it shall do so by order. |
4 | | Whenever the Commission adopts part of
the arbitrator's |
5 | | decision, but not all, it shall include in the order the
|
6 | | reasons for not adopting all of the arbitrator's decision. |
7 | | When a majority
of a panel, after deliberation, has arrived at |
8 | | its decision, the decision
shall be filed as provided in this |
9 | | Section without unnecessary delay, and
without regard to the |
10 | | fact that a member of the panel has expressed an
intention to |
11 | | dissent. Any member of the panel may file a dissent. Any
|
12 | | dissent shall be filed no later than 10 days after the decision |
13 | | of the
majority has been filed.
|
14 | | Decisions rendered by the Commission after the effective |
15 | | date of this
amendatory Act of 1980 and dissents, if any, shall |
16 | | be published
together by the Commission. The conclusions
of |
17 | | law set out in such decisions shall be regarded as precedents
|
18 | | by arbitrators, for the purpose of achieving
a more uniform |
19 | | administration of this Act.
|
20 | | (f) The decision of the Commission acting within its |
21 | | powers,
according to the provisions of paragraph (e) of this |
22 | | Section shall, in
the absence of fraud, be conclusive unless |
23 | | reviewed as in this paragraph
hereinafter provided. However, |
24 | | the Arbitrator or the Commission may on
his or its own motion, |
25 | | or on the motion of either party, correct any
clerical error or |
26 | | errors in computation within 15 days after the date of
receipt |
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1 | | of any award by such Arbitrator or any decision on review of |
2 | | the
Commission, and shall have the power to recall the |
3 | | original award on
arbitration or decision on review, and issue |
4 | | in lieu thereof such
corrected award or decision. Where such |
5 | | correction is made the time for
review herein specified shall |
6 | | begin to run from the date of
the receipt of the corrected |
7 | | award or decision.
|
8 | | (1) Except in cases of claims against the State of |
9 | | Illinois, in
which case the decision of the Commission |
10 | | shall not be subject to
judicial review, the Circuit Court |
11 | | of the county where any of the
parties defendant may be |
12 | | found, or if none of the parties defendant be
found in this |
13 | | State then the Circuit Court of the county where any of
the |
14 | | exposure occurred, shall by summons to the Commission
have |
15 | | power to review all questions of law and fact presented by |
16 | | such
record.
|
17 | | A proceeding for review shall be commenced within 20 |
18 | | days of the
receipt of notice of the decision of the |
19 | | Commission. The summons shall be
issued by the clerk of |
20 | | such court upon written request returnable on a
designated |
21 | | return day, not less than 10 or more than 60 days from the |
22 | | date
of issuance thereof, and the written request shall |
23 | | contain the last known
address of other parties in |
24 | | interest and their attorneys of record who are
to be |
25 | | served by summons. Service upon any member of the |
26 | | Commission or the
Secretary or the Assistant Secretary |
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1 | | thereof shall be service upon the
Commission, and service |
2 | | upon other parties in interest and their attorneys
of |
3 | | record shall be by summons, and such service shall be made |
4 | | upon the
Commission and other parties in interest by |
5 | | mailing notices of the
commencement of the proceedings and |
6 | | the return day of the summons to the
office of the |
7 | | Commission and to the last known place of residence of
|
8 | | other parties in interest or their attorney or attorneys |
9 | | of record. The
clerk of the court issuing the summons |
10 | | shall on the day of issue mail notice
of the commencement |
11 | | of the proceedings which shall be done by mailing a
copy of |
12 | | the summons to the office of the Commission, and a copy of |
13 | | the
summons to the other parties in interest or their |
14 | | attorney or
attorneys of record and the clerk of the court |
15 | | shall make certificate
that he has so sent such notices in |
16 | | pursuance of this Section, which
shall be evidence of |
17 | | service on the Commission and other parties in
interest.
|
18 | | The Commission shall not be required to certify the |
19 | | record of their
proceedings in the Circuit Court unless |
20 | | the party commencing the
proceedings for review in the |
21 | | Circuit Court as above provided, shall file with the |
22 | | Commission notice of intent to file for review in Circuit |
23 | | Court. It shall be
the duty of the Commission upon such |
24 | | filing of notice of intent to file for review in Circuit |
25 | | Court to prepare a true and correct
copy of such testimony |
26 | | and a true and correct copy of all
other matters contained |
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1 | | in such record and certified to by the Secretary
or |
2 | | Assistant Secretary thereof. The changes made to this |
3 | | subdivision (f)(1) by this amendatory Act of the 98th |
4 | | General Assembly apply to any Commission decision entered |
5 | | after the effective date of this amendatory Act of the |
6 | | 98th General Assembly.
|
7 | | No request
for a summons may be filed and no summons |
8 | | shall
issue unless the party seeking to review the |
9 | | decision of the Commission
shall exhibit to the clerk of |
10 | | the Circuit Court proof of
filing with the Commission of |
11 | | the notice of the intent to file for review in the Circuit |
12 | | Court or an affidavit of the attorney setting
forth that |
13 | | notice of intent to file for review in Circuit Court has |
14 | | been given in writing to the Secretary
or Assistant |
15 | | Secretary of the Commission.
|
16 | | (2) No such summons shall issue unless the one against
|
17 | | whom the Commission shall have rendered an award for the |
18 | | payment of money
shall upon the filing of his written |
19 | | request for such summons file with the
clerk of the court a |
20 | | bond conditioned that if he shall not successfully
|
21 | | prosecute the review, he will pay the award and the costs |
22 | | of the
proceedings in the court. The amount of the bond |
23 | | shall be fixed by any
member of the Commission and the |
24 | | surety or sureties of the bond shall be
approved by the |
25 | | clerk of the court. The acceptance of the bond by the
clerk |
26 | | of the court shall constitute evidence of his approval of |
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1 | | the
bond.
|
2 | | The following Every county, city, town, township, |
3 | | incorporated village, school
district, body politic or |
4 | | municipal corporation having a population of
500,000 or |
5 | | more against whom the Commission shall have rendered an |
6 | | award
for the payment of money shall not be required to |
7 | | file a bond to secure
the payment of the award and the |
8 | | costs of the proceedings in the court
to authorize the |
9 | | court to issue such summons : .
|
10 | | (1) the State Treasurer, for a fund administered |
11 | | by the State Treasurer ex officio against whom the |
12 | | Commission shall have rendered an award for the |
13 | | payment of money; and |
14 | | (2) a county, city, town, township, incorporated |
15 | | village, school district, body politic, or municipal |
16 | | corporation having a population of 500,000 or more |
17 | | against whom the Commission shall have rendered an |
18 | | award for the payment of money. |
19 | | The court may confirm or set aside the decision of the |
20 | | Commission. If
the decision is set aside and the facts |
21 | | found in the proceedings before
the Commission are |
22 | | sufficient, the court may enter such decision as is
|
23 | | justified by law, or may remand the cause to the |
24 | | Commission for further
proceedings and may state the |
25 | | questions requiring further hearing, and
give such other |
26 | | instructions as may be proper. Appeals shall be taken
to |
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1 | | the Appellate Court in accordance
with Supreme Court Rules |
2 | | 22(g) and 303. Appeals shall be taken from the
Appellate |
3 | | Court to the Supreme Court
in accordance with Supreme |
4 | | Court Rule 315.
|
5 | | It shall be the duty of the clerk of any court |
6 | | rendering a decision
affecting or affirming an award of |
7 | | the Commission to promptly furnish
the Commission with a |
8 | | copy of such decision, without charge.
|
9 | | The decision of a majority of the members of the panel |
10 | | of the Commission,
shall be considered the decision of the |
11 | | Commission.
|
12 | | (g) Except in the case of a claim against the State of |
13 | | Illinois,
either party may present a certified copy of the |
14 | | award of the
Arbitrator, or a certified copy of the decision of |
15 | | the Commission when
the same has become final, when no |
16 | | proceedings for review are pending,
providing for the payment |
17 | | of compensation according to this Act, to the
Circuit Court of |
18 | | the county in which such exposure occurred or either of
the |
19 | | parties are residents, whereupon the court shall enter a |
20 | | judgment
in accordance therewith. In case where the employer |
21 | | refuses to pay
compensation according to such final award or |
22 | | such final decision upon
which such judgment is entered, the |
23 | | court shall in entering judgment
thereon, tax as costs against |
24 | | him the reasonable costs and attorney fees
in the arbitration |
25 | | proceedings and in the court entering the judgment
for the |
26 | | person in whose favor the judgment is entered, which judgment
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1 | | and costs taxed as herein provided shall, until and unless set |
2 | | aside,
have the same effect as though duly entered in an action |
3 | | duly tried and
determined by the court, and shall with like |
4 | | effect, be entered and
docketed. The Circuit Court shall have |
5 | | power at any time upon
application to make any such judgment |
6 | | conform to any modification
required by any subsequent |
7 | | decision of the Supreme Court upon appeal, or
as the result of |
8 | | any subsequent proceedings for review, as provided in
this |
9 | | Act.
|
10 | | Judgment shall not be entered until 15 days' notice of the |
11 | | time and
place of the application for the entry of judgment |
12 | | shall be served upon
the employer by filing such notice with |
13 | | the Commission, which Commission
shall, in case it has on file |
14 | | the address of the employer or the name
and address of its |
15 | | agent upon whom notices may be served, immediately
send a copy |
16 | | of the notice to the employer or such designated agent.
|
17 | | (h) An agreement or award under this Act providing for |
18 | | compensation
in installments, may at any time within 18 months |
19 | | after such agreement
or award be reviewed by the Commission at |
20 | | the request of either the
employer or the employee on the |
21 | | ground that the disability of the
employee has subsequently |
22 | | recurred, increased, diminished or ended.
|
23 | | However, as to disablements occurring subsequently to July |
24 | | 1, 1955,
which are covered by any agreement or award under this |
25 | | Act providing for
compensation in installments made as a |
26 | | result of such disablement, such
agreement or award may at any |
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1 | | time within 30 months after such agreement
or award be |
2 | | reviewed by the Commission at the request of either the
|
3 | | employer or the employee on the ground that the disability of |
4 | | the
employee has subsequently recurred, increased, diminished |
5 | | or ended.
|
6 | | On such review compensation payments may be |
7 | | re-established,
increased, diminished or ended. The Commission |
8 | | shall give 15 days'
notice to the parties of the hearing for |
9 | | review. Any employee, upon any
petition for such review being |
10 | | filed by the employer, shall be entitled
to one day's notice |
11 | | for each 100 miles necessary to be traveled by him in
attending |
12 | | the hearing of the Commission upon the petition, and 3 days in
|
13 | | addition thereto. Such employee shall, at the discretion of |
14 | | the
Commission, also be entitled to 5 cents per mile |
15 | | necessarily traveled by
him within the State of Illinois in |
16 | | attending such hearing, not to
exceed a distance of 300 miles, |
17 | | to be taxed by the Commission as costs
and deposited with the |
18 | | petition of the employer.
|
19 | | When compensation which is payable in accordance with an |
20 | | award or
settlement contract approved by the Commission, is |
21 | | ordered paid in a
lump sum by the Commission, no review shall |
22 | | be had as in this paragraph
mentioned.
|
23 | | (i) Each party, upon taking any proceedings or steps |
24 | | whatsoever
before any Arbitrator, Commission or court,
shall |
25 | | file with the Commission his address, or the name and address |
26 | | of
any agent upon whom all notices to be given to such party |
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1 | | shall be
served, either personally or by registered mail, |
2 | | addressed to such party
or agent at the last address so filed |
3 | | with the Commission. In the event
such party has not filed his |
4 | | address, or the name and address of an
agent as above provided, |
5 | | service of any notice may be had by filing such
notice with the |
6 | | Commission.
|
7 | | (j) Whenever in any proceeding testimony has been taken or |
8 | | a final
decision has been rendered, and after the taking of |
9 | | such testimony or
after such decision has become final, the |
10 | | employee dies, then in any
subsequent proceeding brought by |
11 | | the personal representative or
beneficiaries of the deceased |
12 | | employee, such testimony in the former
proceeding may be |
13 | | introduced with the same force and effect as though
the |
14 | | witness having so testified were present in person in such
|
15 | | subsequent proceedings and such final decision, if any, shall |
16 | | be taken
as final adjudication of any of the issues which are |
17 | | the same in both
proceedings.
|
18 | | (k) In any case where there has been any unreasonable or |
19 | | vexatious
delay of payment or intentional underpayment of |
20 | | compensation, or
proceedings have been instituted or carried |
21 | | on by one liable to pay the
compensation, which do not present |
22 | | a real controversy, but are merely
frivolous or for delay, |
23 | | then the Commission may award compensation
additional to that |
24 | | otherwise payable under this Act equal to 50% of the
amount |
25 | | payable at the time of such award. Failure to pay compensation |
26 | | in
accordance with the provisions of Section 8, paragraph (b) |
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1 | | of this Act,
shall be considered unreasonable delay.
|
2 | | When determining whether this subsection (k) shall apply, |
3 | | the
Commission shall consider whether an arbitrator has |
4 | | determined
that the claim is not compensable or whether the |
5 | | employer has
made payments under Section 8(j) of the Workers' |
6 | | Compensation Act. |
7 | | (k-1) If the employee has made written demand for payment |
8 | | of
benefits under Section 8(a) or Section 8(b) of the Workers' |
9 | | Compensation Act, the employer shall
have 14 days after |
10 | | receipt of the demand to set forth in
writing the reason for |
11 | | the delay. In the case of demand for
payment of medical |
12 | | benefits under Section 8(a) of the Workers' Compensation Act, |
13 | | the time for
the employer to respond shall not commence until |
14 | | the expiration
of the allotted 60 days specified under Section |
15 | | 8.2(d) of the Workers' Compensation Act. In case
the employer |
16 | | or his or her insurance carrier shall without good and
just |
17 | | cause fail, neglect, refuse, or unreasonably delay the
payment |
18 | | of benefits under Section 8(a) or Section 8(b) of the Workers' |
19 | | Compensation Act, the
Arbitrator or the Commission shall allow |
20 | | to the employee
additional compensation in the sum of $30 per |
21 | | day for each day
that the benefits under Section 8(a) or |
22 | | Section 8(b) of the Workers' Compensation Act have been
so |
23 | | withheld or refused, not to exceed $10,000.
A delay in payment |
24 | | of 14 days or more
shall create a rebuttable presumption of |
25 | | unreasonable delay.
|
26 | | (l) By the 15th day of each month each insurer providing |
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1 | | coverage for
losses under this Act shall notify each insured |
2 | | employer of any compensable
claim incurred during the |
3 | | preceding month and the amounts paid or reserved
on the claim |
4 | | including a summary of the claim and a brief statement of the
|
5 | | reasons for compensability. A cumulative report of all claims |
6 | | incurred
during a calendar year or continued
from the previous |
7 | | year shall be furnished to the insured employer by the
insurer |
8 | | within 30 days after the end of that calendar year.
|
9 | | The insured employer may challenge, in proceeding before |
10 | | the Commission,
payments made by the insurer without |
11 | | arbitration and payments made after
a case is determined to be |
12 | | noncompensable. If the Commission finds that
the case was not |
13 | | compensable, the insurer shall purge its records as to
that |
14 | | employer of any loss or expense associated with the claim, |
15 | | reimburse
the employer for attorneys fee arising from the |
16 | | challenge and for any payment
required of the employer to the |
17 | | Rate Adjustment Fund or the Second Injury
Fund, and may not |
18 | | effect the loss or expense for rate making purposes. The
|
19 | | employee shall not be required to refund the challenged |
20 | | payment. The
decision of the Commission may be reviewed in the |
21 | | same
manner as in arbitrated cases. No challenge may be |
22 | | initiated under this
paragraph more than 3 years after the |
23 | | payment is made. An employer may
waive the right of challenge |
24 | | under this paragraph on a case by case basis.
|
25 | | (m) After filing an application for adjustment of claim |
26 | | but prior to
the hearing on arbitration the parties may |
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1 | | voluntarily agree to submit such
application for adjustment of |
2 | | claim for decision by an arbitrator under
this subsection (m) |
3 | | where such application for adjustment
of claim raises only a |
4 | | dispute over temporary total disability, permanent
partial |
5 | | disability or medical expenses. Such agreement shall be in |
6 | | writing
in such form as provided by the Commission. |
7 | | Applications for adjustment of
claim submitted for decision by |
8 | | an arbitrator under
this subsection (m) shall proceed |
9 | | according
to rule as established by the Commission. The |
10 | | Commission shall promulgate
rules including, but not limited |
11 | | to, rules to ensure that the parties are
adequately informed |
12 | | of their rights under this subsection (m) and of the
voluntary |
13 | | nature of proceedings under this subsection
(m). The findings |
14 | | of fact made by an arbitrator acting within his or her
powers |
15 | | under this subsection (m) in the absence of fraud shall be
|
16 | | conclusive. However, the arbitrator may on his own motion, or |
17 | | the motion
of either party, correct any clerical errors or |
18 | | errors in computation
within 15 days after the date of receipt |
19 | | of such award of the arbitrator
and shall have the power to |
20 | | recall the original award on arbitration, and
issue in lieu |
21 | | thereof such corrected award.
The decision of the arbitrator |
22 | | under this subsection (m) shall be
considered the decision of |
23 | | the Commission and proceedings for review of
questions of law |
24 | | arising from the decision may be commenced by either party
|
25 | | pursuant to subsection (f) of Section 19. The Advisory Board |
26 | | established
under Section 13.1 of the Workers' Compensation |
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1 | | Act shall compile a list of
certified Commission arbitrators, |
2 | | each of whom shall be approved by at least
7 members of the |
3 | | Advisory Board. The chairman shall select 5 persons
from such |
4 | | list to serve as arbitrators under this subsection (m). By
|
5 | | agreement, the parties shall select one arbitrator from among |
6 | | the 5 persons
selected by the chairman except, that if the |
7 | | parties do not agree on an
arbitrator from among the 5 persons, |
8 | | the parties may, by agreement,
select an arbitrator of the |
9 | | American Arbitration Association, whose fee
shall be paid by |
10 | | the State in accordance with rules promulgated by the
|
11 | | Commission. Arbitration under this subsection (m) shall be |
12 | | voluntary.
|
13 | | (Source: P.A. 101-384, eff. 1-1-20 .)
|
14 | | Section 50. The Unemployment Insurance Act is amended by
|
15 | | changing Section 1900 as follows:
|
16 | | (820 ILCS 405/1900) (from Ch. 48, par. 640)
|
17 | | Sec. 1900. Disclosure of information.
|
18 | | A. Except as provided in this Section, information |
19 | | obtained from any
individual or employing unit during the |
20 | | administration of this Act shall:
|
21 | | 1. be confidential,
|
22 | | 2. not be published or open to public inspection,
|
23 | | 3. not be used in any court in any pending action or |
24 | | proceeding,
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1 | | 4. not be admissible in evidence in any action or |
2 | | proceeding other than
one arising out of this Act.
|
3 | | B. No finding, determination, decision, ruling , or order |
4 | | (including
any finding of fact, statement or conclusion made |
5 | | therein) issued pursuant
to this Act shall be admissible or |
6 | | used in evidence in any action other than
one arising out of |
7 | | this Act, nor shall it be binding or conclusive except
as |
8 | | provided in this Act, nor shall it constitute res judicata, |
9 | | regardless
of whether the actions were between the same or |
10 | | related parties or involved
the same facts.
|
11 | | C. Any officer or employee of this State, any officer or |
12 | | employee of any
entity authorized to obtain information |
13 | | pursuant to this Section, and any
agent of this State or of |
14 | | such entity
who, except with authority of
the Director under |
15 | | this Section or as authorized pursuant to subsection P-1, |
16 | | shall disclose information shall be guilty
of a Class B |
17 | | misdemeanor and shall be disqualified from holding any
|
18 | | appointment or employment by the State.
|
19 | | D. An individual or his duly authorized agent may be |
20 | | supplied with
information from records only to the extent |
21 | | necessary for the proper
presentation of his claim for |
22 | | benefits or with his existing or prospective
rights to |
23 | | benefits. Discretion to disclose this information belongs
|
24 | | solely to the Director and is not subject to a release or |
25 | | waiver by the
individual.
Notwithstanding any other provision |
26 | | to the contrary, an individual or his or
her duly authorized |
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1 | | agent may be supplied with a statement of the amount of
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2 | | benefits paid to the individual during the 18 months preceding |
3 | | the date of his
or her request.
|
4 | | E. An employing unit may be furnished with information, |
5 | | only if deemed by
the Director as necessary to enable it to |
6 | | fully discharge its obligations or
safeguard its rights under |
7 | | the Act. Discretion to disclose this information
belongs |
8 | | solely to the Director and is not subject to a release or |
9 | | waiver by the
employing unit.
|
10 | | F. The Director may furnish any information that he may |
11 | | deem proper to
any public officer or public agency of this or |
12 | | any other State or of the
federal government dealing with:
|
13 | | 1. the administration of relief,
|
14 | | 2. public assistance,
|
15 | | 3. unemployment compensation,
|
16 | | 4. a system of public employment offices,
|
17 | | 5. wages and hours of employment, or
|
18 | | 6. a public works program.
|
19 | | The Director may make available to the Illinois Workers' |
20 | | Compensation Commission or the Department of Insurance
|
21 | | information regarding employers for the purpose of verifying |
22 | | the insurance
coverage required under the Workers' |
23 | | Compensation Act and Workers'
Occupational Diseases Act.
|
24 | | G. The Director may disclose information submitted by the |
25 | | State or any
of its political subdivisions, municipal |
26 | | corporations, instrumentalities,
or school or community |
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1 | | college districts, except for information which
specifically |
2 | | identifies an individual claimant.
|
3 | | H. The Director shall disclose only that information |
4 | | required to be
disclosed under Section 303 of the Social |
5 | | Security Act, as amended, including:
|
6 | | 1. any information required to be given the United |
7 | | States Department of
Labor under Section 303(a)(6); and
|
8 | | 2. the making available upon request to any agency of |
9 | | the United States
charged with the administration of |
10 | | public works or assistance through
public employment, the |
11 | | name, address, ordinary occupation , and employment
status |
12 | | of each recipient of unemployment compensation, and a |
13 | | statement of
such recipient's right to further |
14 | | compensation under such law as required
by Section |
15 | | 303(a)(7); and
|
16 | | 3. records to make available to the Railroad |
17 | | Retirement Board as
required by Section 303(c)(1); and
|
18 | | 4. information that will assure reasonable cooperation |
19 | | with every agency
of the United States charged with the |
20 | | administration of any unemployment
compensation law as |
21 | | required by Section 303(c)(2); and
|
22 | | 5. information upon request and on a reimbursable |
23 | | basis to the United
States Department of Agriculture and |
24 | | to any State food stamp agency
concerning any information |
25 | | required to be furnished by Section 303(d); and
|
26 | | 6. any wage information upon request and on a |
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1 | | reimbursable basis
to any State or local child support |
2 | | enforcement agency required by
Section 303(e); and
|
3 | | 7. any information required under the income |
4 | | eligibility and
verification system as required by Section |
5 | | 303(f); and
|
6 | | 8. information that might be useful in locating an |
7 | | absent parent or that
parent's employer, establishing |
8 | | paternity or establishing, modifying, or
enforcing child |
9 | | support orders
for the purpose of a child support |
10 | | enforcement program
under Title IV of the Social Security |
11 | | Act upon the request of
and on a reimbursable basis to
the |
12 | | public
agency administering the Federal Parent Locator |
13 | | Service as required by
Section 303(h); and
|
14 | | 9. information, upon request, to representatives of |
15 | | any federal, State ,
or local governmental public housing |
16 | | agency with respect to individuals who
have signed the |
17 | | appropriate consent form approved by the Secretary of |
18 | | Housing
and Urban Development and who are applying for or |
19 | | participating in any housing
assistance program |
20 | | administered by the United States Department of Housing |
21 | | and
Urban Development as required by Section 303(i).
|
22 | | I. The Director, upon the request of a public agency of |
23 | | Illinois, of the
federal government , or of any other state |
24 | | charged with the investigation or
enforcement of Section 10-5 |
25 | | of the Criminal Code of 2012 (or a similar
federal law or |
26 | | similar law of another State), may furnish the public agency
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1 | | information regarding the individual specified in the request |
2 | | as to:
|
3 | | 1. the current or most recent home address of the |
4 | | individual, and
|
5 | | 2. the names and addresses of the individual's |
6 | | employers.
|
7 | | J. Nothing in this Section shall be deemed to interfere |
8 | | with the
disclosure of certain records as provided for in |
9 | | Section 1706 or with the
right to make available to the |
10 | | Internal Revenue Service of the United
States Department of |
11 | | the Treasury, or the Department of Revenue of the
State of |
12 | | Illinois, information obtained under this Act. With respect to |
13 | | each benefit claim that appears to have been filed other than |
14 | | by the individual in whose name the claim was filed or by the |
15 | | individual's authorized agent and with respect to which |
16 | | benefits were paid during the prior calendar year, the |
17 | | Director shall annually report to the Department of Revenue |
18 | | information that is in the Director's possession and may |
19 | | assist in avoiding negative income tax consequences for the |
20 | | individual in whose name the claim was filed.
|
21 | | K. The Department shall make available to the Illinois |
22 | | Student Assistance
Commission, upon request, information in |
23 | | the possession of the Department that
may be necessary or |
24 | | useful to the
Commission in the collection of defaulted or |
25 | | delinquent student loans which
the Commission administers.
|
26 | | L. The Department shall make available to the State |
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1 | | Employees'
Retirement System, the State Universities |
2 | | Retirement System, the
Teachers' Retirement System of the |
3 | | State of Illinois, and the Department of Central Management |
4 | | Services, Risk Management Division, upon request,
information |
5 | | in the possession of the Department that may be necessary or |
6 | | useful
to the System or the Risk Management Division for the |
7 | | purpose of determining whether any recipient of a
disability |
8 | | benefit from the System or a workers' compensation benefit |
9 | | from the Risk Management Division is gainfully employed.
|
10 | | M. This Section shall be applicable to the information |
11 | | obtained in the
administration of the State employment |
12 | | service, except that the Director
may publish or release |
13 | | general labor market information and may furnish
information |
14 | | that he may deem proper to an individual, public officer , or
|
15 | | public agency of this or any other State or the federal |
16 | | government (in
addition to those public officers or public |
17 | | agencies specified in this
Section) as he prescribes by Rule.
|
18 | | N. The Director may require such safeguards as he deems |
19 | | proper to insure
that information disclosed pursuant to this |
20 | | Section is used only for the
purposes set forth in this |
21 | | Section.
|
22 | | O. Nothing in this Section prohibits communication with an |
23 | | individual or entity through unencrypted e-mail or other |
24 | | unencrypted electronic means as long as the communication does |
25 | | not contain the individual's or entity's name in combination |
26 | | with any one or more of the individual's or entity's entire or |
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1 | | partial social security number; driver's license or State |
2 | | identification number; credit or debit card number; or any |
3 | | required security code, access code, or password that would |
4 | | permit access to further information pertaining to the |
5 | | individual or entity.
|
6 | | P. (Blank). |
7 | | P-1. With the express written consent of a claimant or
|
8 | | employing unit and an agreement not to publicly disclose, the |
9 | | Director shall provide requested information related to a |
10 | | claim
to an elected official performing constituent services |
11 | | or his or her agent.
|
12 | | Q. The Director shall make available to an elected federal
|
13 | | official the name and address of an individual or entity that |
14 | | is located within
the jurisdiction from which the official was |
15 | | elected and that, for the most
recently completed calendar |
16 | | year, has reported to the Department as paying
wages to |
17 | | workers, where the information will be used in connection with |
18 | | the
official duties of the official and the official requests |
19 | | the information in
writing, specifying the purposes for which |
20 | | it will be used.
For purposes of this subsection, the use of |
21 | | information in connection with the
official duties of an |
22 | | official does not include use of the information in
connection |
23 | | with the solicitation of contributions or expenditures, in |
24 | | money or
in kind, to or on behalf of a candidate for public or |
25 | | political office or a
political party or with respect to a |
26 | | public question, as defined in Section 1-3
of the Election |
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1 | | Code, or in connection with any commercial solicitation. Any
|
2 | | elected federal official who, in submitting a request for |
3 | | information
covered by this subsection, knowingly makes a |
4 | | false statement or fails to
disclose a material fact, with the |
5 | | intent to obtain the information for a
purpose not authorized |
6 | | by this subsection, shall be guilty of a Class B
misdemeanor.
|
7 | | R. The Director may provide to any State or local child |
8 | | support
agency, upon request and on a reimbursable basis, |
9 | | information that might be
useful in locating an absent parent |
10 | | or that parent's employer, establishing
paternity, or |
11 | | establishing, modifying, or enforcing child support orders.
|
12 | | S. The Department shall make available to a State's |
13 | | Attorney of this
State or a State's Attorney's investigator,
|
14 | | upon request, the current address or, if the current address |
15 | | is
unavailable, current employer information, if available, of |
16 | | a victim of
a felony or a
witness to a felony or a person |
17 | | against whom an arrest warrant is
outstanding.
|
18 | | T. The Director shall make available to the Illinois State |
19 | | Police, a county sheriff's office, or a municipal police |
20 | | department, upon request, any information concerning the |
21 | | current address and place of employment or former places of |
22 | | employment of a person who is required to register as a sex |
23 | | offender under the Sex Offender Registration Act that may be |
24 | | useful in enforcing the registration provisions of that Act. |
25 | | U. The Director shall make information available to the |
26 | | Department of Healthcare and Family Services and the |
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1 | | Department of Human Services for the purpose of determining |
2 | | eligibility for public benefit programs authorized under the |
3 | | Illinois Public Aid Code and related statutes administered by |
4 | | those departments, for verifying sources and amounts of |
5 | | income, and for other purposes directly connected with the |
6 | | administration of those programs. |
7 | | V. The Director shall make information available to the |
8 | | State Board of Elections as may be required by an agreement the |
9 | | State Board of Elections has entered into with a multi-state |
10 | | voter registration list maintenance system. |
11 | | W. The Director shall make information available to the |
12 | | State Treasurer's office and the Department of Revenue for the |
13 | | purpose of facilitating compliance with the Illinois Secure |
14 | | Choice Savings Program Act, including employer contact |
15 | | information for employers with 25 or more employees and any |
16 | | other information the Director deems appropriate that is |
17 | | directly related to the administration of this program. |
18 | | X. The Director shall make information available, upon |
19 | | request, to the Illinois Student Assistance Commission for the |
20 | | purpose of determining eligibility for the adult vocational |
21 | | community college scholarship program under Section 65.105 of |
22 | | the Higher Education Student Assistance Act. |
23 | | Y. Except as required under State or federal law, or |
24 | | unless otherwise provided for in this Section, the Department |
25 | | shall not disclose an individual's entire social security |
26 | | number in any correspondence physically mailed to an |