State of Illinois
2017 and 2018


Introduced 5/30/2018, by Sen. Kyle McCarter


820 ILCS 305/8.2
820 ILCS 305/8.2a
820 ILCS 305/8.7
820 ILCS 305/19  from Ch. 48, par. 138.19

    Amends the Workers' Compensation Act. Makes numerous additions and changes concerning: employers giving medical providers addresses to which medical bills should be sent; payments by employers to medical providers; explanations of benefits; interest payments by employers to medical providers under specified circumstances; petitions by medical providers if interest has not been paid; duties of the Director of Insurance regarding compliance by health care providers with requests for records by employers and insurers for the authorization of the payment of workers' compensation claims and imposition of administrative fines if an employer or insurer has intentionally failed to comply or demonstrates a repeated pattern of failing to comply with the electronic claims acceptance and response process; utilization review; entry of judgments based on final awards or decisions; and other matters. Effective immediately.

LRB100 22282 KTG 41004 b





SB3617LRB100 22282 KTG 41004 b

1    AN ACT concerning employment.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 8.2, 8.2a, 8.7, and 19 as follows:
6    (820 ILCS 305/8.2)
7    Sec. 8.2. Fee schedule.
8    (a) Except as provided for in subsection (c), for
9procedures, treatments, or services covered under this Act and
10rendered or to be rendered on and after February 1, 2006, the
11maximum allowable payment shall be 90% of the 80th percentile
12of charges and fees as determined by the Commission utilizing
13information provided by employers' and insurers' national
14databases, with a minimum of 12,000,000 Illinois line item
15charges and fees comprised of health care provider and hospital
16charges and fees as of August 1, 2004 but not earlier than
17August 1, 2002. These charges and fees are provider billed
18amounts and shall not include discounted charges. The 80th
19percentile is the point on an ordered data set from low to high
20such that 80% of the cases are below or equal to that point and
21at most 20% are above or equal to that point. The Commission
22shall adjust these historical charges and fees as of August 1,
232004 by the Consumer Price Index-U for the period August 1,



SB3617- 2 -LRB100 22282 KTG 41004 b

12004 through September 30, 2005. The Commission shall establish
2fee schedules for procedures, treatments, or services for
3hospital inpatient, hospital outpatient, emergency room and
4trauma, ambulatory surgical treatment centers, and
5professional services. These charges and fees shall be
6designated by geozip or any smaller geographic unit. The data
7shall in no way identify or tend to identify any patient,
8employer, or health care provider. As used in this Section,
9"geozip" means a three-digit zip code based on data
10similarities, geographical similarities, and frequencies. A
11geozip does not cross state boundaries. As used in this
12Section, "three-digit zip code" means a geographic area in
13which all zip codes have the same first 3 digits. If a geozip
14does not have the necessary number of charges and fees to
15calculate a valid percentile for a specific procedure,
16treatment, or service, the Commission may combine data from the
17geozip with up to 4 other geozips that are demographically and
18economically similar and exhibit similarities in data and
19frequencies until the Commission reaches 9 charges or fees for
20that specific procedure, treatment, or service. In cases where
21the compiled data contains less than 9 charges or fees for a
22procedure, treatment, or service, reimbursement shall occur at
2376% of charges and fees as determined by the Commission in a
24manner consistent with the provisions of this paragraph.
25Providers of out-of-state procedures, treatments, services,
26products, or supplies shall be reimbursed at the lesser of that



SB3617- 3 -LRB100 22282 KTG 41004 b

1state's fee schedule amount or the fee schedule amount for the
2region in which the employee resides. If no fee schedule exists
3in that state, the provider shall be reimbursed at the lesser
4of the actual charge or the fee schedule amount for the region
5in which the employee resides. Not later than September 30 in
62006 and each year thereafter, the Commission shall
7automatically increase or decrease the maximum allowable
8payment for a procedure, treatment, or service established and
9in effect on January 1 of that year by the percentage change in
10the Consumer Price Index-U for the 12 month period ending
11August 31 of that year. The increase or decrease shall become
12effective on January 1 of the following year. As used in this
13Section, "Consumer Price Index-U" means the index published by
14the Bureau of Labor Statistics of the U.S. Department of Labor,
15that measures the average change in prices of all goods and
16services purchased by all urban consumers, U.S. city average,
17all items, 1982-84=100.
18    (a-1) Notwithstanding the provisions of subsection (a) and
19unless otherwise indicated, the following provisions shall
20apply to the medical fee schedule starting on September 1,
22        (1) The Commission shall establish and maintain fee
23    schedules for procedures, treatments, products, services,
24    or supplies for hospital inpatient, hospital outpatient,
25    emergency room, ambulatory surgical treatment centers,
26    accredited ambulatory surgical treatment facilities,



SB3617- 4 -LRB100 22282 KTG 41004 b

1    prescriptions filled and dispensed outside of a licensed
2    pharmacy, dental services, and professional services. This
3    fee schedule shall be based on the fee schedule amounts
4    already established by the Commission pursuant to
5    subsection (a) of this Section. However, starting on
6    January 1, 2012, these fee schedule amounts shall be
7    grouped into geographic regions in the following manner:
8            (A) Four regions for non-hospital fee schedule
9        amounts shall be utilized:
10                (i) Cook County;
11                (ii) DuPage, Kane, Lake, and Will Counties;
12                (iii) Bond, Calhoun, Clinton, Jersey,
13            Macoupin, Madison, Monroe, Montgomery, Randolph,
14            St. Clair, and Washington Counties; and
15                (iv) All other counties of the State.
16            (B) Fourteen regions for hospital fee schedule
17        amounts shall be utilized:
18                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
19            Kendall, and Grundy Counties;
20                (ii) Kankakee County;
21                (iii) Madison, St. Clair, Macoupin, Clinton,
22            Monroe, Jersey, Bond, and Calhoun Counties;
23                (iv) Winnebago and Boone Counties;
24                (v) Peoria, Tazewell, Woodford, Marshall, and
25            Stark Counties;
26                (vi) Champaign, Piatt, and Ford Counties;



SB3617- 5 -LRB100 22282 KTG 41004 b

1                (vii) Rock Island, Henry, and Mercer Counties;
2                (viii) Sangamon and Menard Counties;
3                (ix) McLean County;
4                (x) Lake County;
5                (xi) Macon County;
6                (xii) Vermilion County;
7                (xiii) Alexander County; and
8                (xiv) All other counties of the State.
9        (2) If a geozip, as defined in subsection (a) of this
10    Section, overlaps into one or more of the regions set forth
11    in this Section, then the Commission shall average or
12    repeat the charges and fees in a geozip in order to
13    designate charges and fees for each region.
14        (3) In cases where the compiled data contains less than
15    9 charges or fees for a procedure, treatment, product,
16    supply, or service or where the fee schedule amount cannot
17    be determined by the non-discounted charge data,
18    non-Medicare relative values and conversion factors
19    derived from established fee schedule amounts, coding
20    crosswalks, or other data as determined by the Commission,
21    reimbursement shall occur at 76% of charges and fees until
22    September 1, 2011 and 53.2% of charges and fees thereafter
23    as determined by the Commission in a manner consistent with
24    the provisions of this paragraph.
25        (4) To establish additional fee schedule amounts, the
26    Commission shall utilize provider non-discounted charge



SB3617- 6 -LRB100 22282 KTG 41004 b

1    data, non-Medicare relative values and conversion factors
2    derived from established fee schedule amounts, and coding
3    crosswalks. The Commission may establish additional fee
4    schedule amounts based on either the charge or cost of the
5    procedure, treatment, product, supply, or service.
6        (5) Implants shall be reimbursed at 25% above the net
7    manufacturer's invoice price less rebates, plus actual
8    reasonable and customary shipping charges whether or not
9    the implant charge is submitted by a provider in
10    conjunction with a bill for all other services associated
11    with the implant, submitted by a provider on a separate
12    claim form, submitted by a distributor, or submitted by the
13    manufacturer of the implant. "Implants" include the
14    following codes or any substantially similar updated code
15    as determined by the Commission: 0274
16    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
17    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
18    (investigational devices); and 0636 (drugs requiring
19    detailed coding). Non-implantable devices or supplies
20    within these codes shall be reimbursed at 65% of actual
21    charge, which is the provider's normal rates under its
22    standard chargemaster. A standard chargemaster is the
23    provider's list of charges for procedures, treatments,
24    products, supplies, or services used to bill payers in a
25    consistent manner.
26        (6) The Commission shall automatically update all



SB3617- 7 -LRB100 22282 KTG 41004 b

1    codes and associated rules with the version of the codes
2    and rules valid on January 1 of that year.
3    (a-2) For procedures, treatments, services, or supplies
4covered under this Act and rendered or to be rendered on or
5after September 1, 2011, the maximum allowable payment shall be
670% of the fee schedule amounts, which shall be adjusted yearly
7by the Consumer Price Index-U, as described in subsection (a)
8of this Section.
9    (a-3) Prescriptions filled and dispensed outside of a
10licensed pharmacy shall be subject to a fee schedule that shall
11not exceed the Average Wholesale Price (AWP) plus a dispensing
12fee of $4.18. AWP or its equivalent as registered by the
13National Drug Code shall be set forth for that drug on that
14date as published in Medispan.
15    (b) Notwithstanding the provisions of subsection (a), if
16the Commission finds that there is a significant limitation on
17access to quality health care in either a specific field of
18health care services or a specific geographic limitation on
19access to health care, it may change the Consumer Price Index-U
20increase or decrease for that specific field or specific
21geographic limitation on access to health care to address that
23    (c) The Commission shall establish by rule a process to
24review those medical cases or outliers that involve
25extra-ordinary treatment to determine whether to make an
26additional adjustment to the maximum payment within a fee



SB3617- 8 -LRB100 22282 KTG 41004 b

1schedule for a procedure, treatment, or service.
2    (d) Upon receipt of notice of injury, an employer or its
3designee shall provide to an injured worker or an injured
4worker's medical provider a mailing address and an electronic
5mail address to which medical bills should be sent.
6    A medical provider shall submit its bill to the employer or
7insurer within 90 days of providing services to the injured
9    When a patient notifies a provider that the treatment,
10procedure, or service being sought is for a work-related
11illness or injury and furnishes the provider the name and
12address of the responsible employer, the provider shall bill
13the employer or its designee directly. The employer or its
14designee shall make payment for treatment in accordance with
15the provisions of this Section directly to the provider, except
16payment shall be made directly to the billing entity if a
17provider has designated a third-party billing entity to bill on
18its behalf. Providers and providers shall submit bills and
19records in accordance with the provisions of this Section.
20        (1) All payments to providers for treatment provided
21    pursuant to this Act shall be made within 30 days of
22    receipt of the bill bills as long as the claim contains
23    substantially all the required data elements necessary to
24    adjudicate the bill bills.
25        (2) If the claim does not contain substantially all the
26    required data elements necessary to adjudicate the bill, or



SB3617- 9 -LRB100 22282 KTG 41004 b

1    the claim is denied for any other reason, in whole or in
2    part, the employer or insurer shall send provide written
3    notification to the provider in the form of an explanation
4    of benefits , explaining the basis for the denial and
5    describing any additional necessary data elements, to the
6    provider within 30 days of receipt of the bill. The
7    Commission shall adopt rules detailing the requirements
8    for the explanation of benefits required under this
9    subsection.
10        (3) In the case of: (i) nonpayment to a provider within
11    30 days of receipt of an electronic bill for which the
12    employer is liable and that contained substantially all of
13    the required data elements necessary to adjudicate the
14    bill, (ii) nonpayment to a provider of a portion of such a
15    bill as noted in item (i), or (iii) nonissuance to the
16    provider of an explanation of benefits for such a bill, the
17    bill, or the unpaid portion of the bill up to the lesser of
18    the actual charge, the contracted amount, or the payment
19    level set by the Commission in the fee scheduled
20    established in this Section, shall incur interest: (A) from
21    the date of determination of liability where there exists a
22    reasonable dispute as to liability for the expense, at a
23    rate of 1% per month, or (B) after 30 days of receipt of
24    the claim, where there is no dispute as to liability or
25    there is an unreasonable or vexatious dispute as to
26    liability for the expense, at a rate of 1% per month



SB3617- 10 -LRB100 22282 KTG 41004 b

1    payable by the employer, where self-insured, or its insurer
2    to the provider.
3        (4) In the case of: (i) nonpayment to a provider within
4    60 days of receipt of a nonelectronic bill for which the
5    employer is liable and that contained substantially all of
6    the required data elements necessary to adjudicate the
7    bill, (ii) nonpayment to a provider of a portion of such a
8    bill as noted in item (i), or (iii) nonissuance to the
9    provider of an explanation of benefits for a such a bill
10    the unpaid portion of the bill up to the lesser of the
11    actual charge, the contracted amount or the payment level
12    set by the Commission in the fee scheduled established in
13    this Section, shall incur interest, from the date of
14    determination of liability where there exists a dispute as
15    to liability for the expense, at a rate of 1% per month
16    payable by the employer, where self-insured, or its insurer
17    to the provider. Any required interest payments shall be
18    made by the employer or its insurer to the provider not
19    later than 30 days after payment of the bill.
20        (5) A medical provider may file a petition with the
21    Commission if interest has not been paid on undisputed
22    medical bills. Within 30 days of receipt of the petition,
23    the employer or its designee may file a response to the
24    petition. The Commission within 180 days shall determine if
25    interest is owed on the bills and if interest is owed, the
26    Commission will order the interest paid to the provider as



SB3617- 11 -LRB100 22282 KTG 41004 b

1    part of its decision.
2    The changes made to this subsection (d) by this amendatory
3Act of the 100th General Assembly apply to procedures,
4treatments, and services rendered on and after the effective
5date of this amendatory Act of the 100th General Assembly. In
6the case of nonpayment to a provider within 30 days of receipt
7of the bill which contained substantially all of the required
8data elements necessary to adjudicate the bill or nonpayment to
9a provider of a portion of such a bill up to the lesser of the
10actual charge or the payment level set by the Commission in the
11fee schedule established in this Section, the bill, or portion
12of the bill, shall incur interest at a rate of 1% per month
13payable to the provider. Any required interest payments shall
14be made within 30 days after payment.
15    (e) Except as provided in subsections (e-5), (e-10), and
16(e-15), a provider shall not hold an employee liable for costs
17related to a non-disputed procedure, treatment, or service
18rendered in connection with a compensable injury. The
19provisions of subsections (e-5), (e-10), (e-15), and (e-20)
20shall not apply if an employee provides information to the
21provider regarding participation in a group health plan. If the
22employee participates in a group health plan, the provider may
23submit a claim for services to the group health plan. If the
24claim for service is covered by the group health plan, the
25employee's responsibility shall be limited to applicable
26deductibles, co-payments, or co-insurance. Except as provided



SB3617- 12 -LRB100 22282 KTG 41004 b

1under subsections (e-5), (e-10), (e-15), and (e-20), a provider
2shall not bill or otherwise attempt to recover from the
3employee the difference between the provider's charge and the
4amount paid by the employer or the insurer on a compensable
5injury, or for medical services or treatment determined by the
6Commission to be excessive or unnecessary.
7    (e-5) If an employer notifies a provider that the employer
8does not consider the illness or injury to be compensable under
9this Act, the provider may seek payment of the provider's
10actual charges from the employee for any procedure, treatment,
11or service rendered. Once an employee informs the provider that
12there is an application filed with the Commission to resolve a
13dispute over payment of such charges, the provider shall cease
14any and all efforts to collect payment for the services that
15are the subject of the dispute. Any statute of limitations or
16statute of repose applicable to the provider's efforts to
17collect payment from the employee shall be tolled from the date
18that the employee files the application with the Commission
19until the date that the provider is permitted to resume
20collection efforts under the provisions of this Section.
21    (e-10) If an employer notifies a provider that the employer
22will pay only a portion of a bill for any procedure, treatment,
23or service rendered in connection with a compensable illness or
24disease, the provider may seek payment from the employee for
25the remainder of the amount of the bill up to the lesser of the
26actual charge, negotiated rate, if applicable, or the payment



SB3617- 13 -LRB100 22282 KTG 41004 b

1level set by the Commission in the fee schedule established in
2this Section. Once an employee informs the provider that there
3is an application filed with the Commission to resolve a
4dispute over payment of such charges, the provider shall cease
5any and all efforts to collect payment for the services that
6are the subject of the dispute. Any statute of limitations or
7statute of repose applicable to the provider's efforts to
8collect payment from the employee shall be tolled from the date
9that the employee files the application with the Commission
10until the date that the provider is permitted to resume
11collection efforts under the provisions of this Section.
12    (e-15) When there is a dispute over the compensability of
13or amount of payment for a procedure, treatment, or service,
14and a case is pending or proceeding before an Arbitrator or the
15Commission, the provider may mail the employee reminders that
16the employee will be responsible for payment of any procedure,
17treatment or service rendered by the provider. The reminders
18must state that they are not bills, to the extent practicable
19include itemized information, and state that the employee need
20not pay until such time as the provider is permitted to resume
21collection efforts under this Section. The reminders shall not
22be provided to any credit rating agency. The reminders may
23request that the employee furnish the provider with information
24about the proceeding under this Act, such as the file number,
25names of parties, and status of the case. If an employee fails
26to respond to such request for information or fails to furnish



SB3617- 14 -LRB100 22282 KTG 41004 b

1the information requested within 90 days of the date of the
2reminder, the provider is entitled to resume any and all
3efforts to collect payment from the employee for the services
4rendered to the employee and the employee shall be responsible
5for payment of any outstanding bills for a procedure,
6treatment, or service rendered by a provider.
7    (e-20) Upon a final award or judgment by an Arbitrator or
8the Commission, or a settlement agreed to by the employer and
9the employee, a provider may resume any and all efforts to
10collect payment from the employee for the services rendered to
11the employee and the employee shall be responsible for payment
12of any outstanding bills for a procedure, treatment, or service
13rendered by a provider as well as the interest awarded under
14subsection (d) of this Section. In the case of a procedure,
15treatment, or service deemed compensable, the provider shall
16not require a payment rate, excluding the interest provisions
17under subsection (d), greater than the lesser of the actual
18charge or the payment level set by the Commission in the fee
19schedule established in this Section. Payment for services
20deemed not covered or not compensable under this Act is the
21responsibility of the employee unless a provider and employee
22have agreed otherwise in writing. Services not covered or not
23compensable under this Act are not subject to the fee schedule
24in this Section.
25    (f) Nothing in this Act shall prohibit an employer or
26insurer from contracting with a health care provider or group



SB3617- 15 -LRB100 22282 KTG 41004 b

1of health care providers for reimbursement levels for benefits
2under this Act different from those provided in this Section.
3    (g) On or before January 1, 2010 the Commission shall
4provide to the Governor and General Assembly a report regarding
5the implementation of the medical fee schedule and the index
6used for annual adjustment to that schedule as described in
7this Section.
8(Source: P.A. 97-18, eff. 6-28-11.)
9    (820 ILCS 305/8.2a)
10    Sec. 8.2a. Electronic claims.
11    (a) The Director of Insurance shall adopt rules to do all
12of the following:
13        (1) Ensure that all health care providers and
14    facilities submit medical bills for payment on
15    standardized forms.
16        (2) Require acceptance by employers and insurers of
17    electronic claims for payment of medical services.
18        (3) Ensure confidentiality of medical information
19    submitted on electronic claims for payment of medical
20    services.
21        (4) Ensure that health care providers have an
22    opportunity to comply with requests for records by
23    employers and insurers for the authorization of the payment
24    of workers' compensation claims.
25        (5) Provide that the Department of Insurance shall



SB3617- 16 -LRB100 22282 KTG 41004 b

1    impose an administrative fine if it determines that an
2    employer or insurer has intentionally failed to comply or
3    demonstrates a repeated pattern of failing to comply with
4    the electronic claims acceptance and response process. The
5    amount of the administrative fine shall be no greater than
6    $500 per violation but shall not exceed $10,000 for
7    violations found or determined during a calendar year.
8    (b) To the extent feasible, standards adopted pursuant to
9subdivision (a) shall be consistent with existing standards
10under the federal Health Insurance Portability and
11Accountability Act of 1996 and standards adopted under the
12Illinois Health Information Exchange and Technology Act.
13    (c) The rules requiring employers and insurers to accept
14electronic claims for payment of medical services shall be
15proposed on or before January 1, 2012, and shall require all
16employers and insurers to accept electronic claims for payment
17of medical services on or before June 30, 2012. The Director of
18Insurance shall adopt rules by January 1, 2019 to implement the
19changes to this Section made by this amendatory Act of this
20100th General Assembly. The Commission, with assistance from
21the Department, shall publish on its Internet website a
22companion guide to assist with compliance with electronic
23claims rules. The Medical Fee Advisory Board shall periodically
24review the companion guide.
25    (d) The Director of Insurance shall by rule establish
26criteria for granting exceptions to employers, insurance



SB3617- 17 -LRB100 22282 KTG 41004 b

1carriers, and health care providers who are unable to submit or
2accept medical bills electronically.
3(Source: P.A. 97-18, eff. 6-28-11.)
4    (820 ILCS 305/8.7)
5    Sec. 8.7. Utilization review programs.
6    (a) As used in this Section:
7    "Utilization review" means the evaluation of proposed or
8provided health care services to determine the appropriateness
9of both the level of health care services medically necessary
10and the quality of health care services provided to a patient,
11including evaluation of their efficiency, efficacy, and
12appropriateness of treatment, hospitalization, or office
13visits based on medically accepted standards. The evaluation
14must be accomplished by means of a system that identifies the
15utilization of health care services based on standards of care
16of nationally recognized peer review guidelines as well as
17nationally recognized treatment guidelines and evidence-based
18medicine based upon standards as provided in this Act.
19Utilization techniques may include prospective review, second
20opinions, concurrent review, discharge planning, peer review,
21independent medical examinations, and retrospective review
22(for purposes of this sentence, retrospective review shall be
23applicable to services rendered on or after July 20, 2005).
24Nothing in this Section applies to prospective review of
25necessary first aid or emergency treatment.



SB3617- 18 -LRB100 22282 KTG 41004 b

1    (b) No person may conduct a utilization review program for
2workers' compensation services in this State unless once every
32 years the person registers the utilization review program
4with the Department of Insurance and certifies compliance with
5the Workers' Compensation Utilization Management standards or
6Health Utilization Management Standards of URAC sufficient to
7achieve URAC accreditation or submits evidence of
8accreditation by URAC for its Workers' Compensation
9Utilization Management Standards or Health Utilization
10Management Standards. Nothing in this Act shall be construed to
11require an employer or insurer or its subcontractors to become
12URAC accredited.
13    (c) In addition, the Director of Insurance may certify
14alternative utilization review standards of national
15accreditation organizations or entities in order for plans to
16comply with this Section. Any alternative utilization review
17standards shall meet or exceed those standards required under
18subsection (b).
19    (d) This registration shall include submission of all of
20the following information regarding utilization review program
22        (1) The name, address, and telephone number of the
23    utilization review programs.
24        (2) The organization and governing structure of the
25    utilization review programs.
26        (3) The number of lives for which utilization review is



SB3617- 19 -LRB100 22282 KTG 41004 b

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



SB3617- 20 -LRB100 22282 KTG 41004 b

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



SB3617- 21 -LRB100 22282 KTG 41004 b

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



SB3617- 22 -LRB100 22282 KTG 41004 b

1    preponderance of the evidence that a variance from the
2    standards of care used by the person or entity performing
3    the utilization review pursuant to subsection (a) is
4    reasonably required to cure or relieve the effects of his
5    or her injury.
6        (5) The medical professional responsible for review in
7    the final stage of utilization review or appeal must be
8    available in this State for interview or deposition; or
9    must be available for deposition by telephone, video
10    conference, or other remote electronic means. A medical
11    professional who works or resides in this State or outside
12    of this State may comply with this requirement by making
13    himself or herself available for an interview or deposition
14    in person or by making himself or herself available by
15    telephone, video conference, or other remote electronic
16    means. The remote interview or deposition shall be
17    conducted in a fair, open, and cost-effective manner. The
18    expense of interview and the deposition method shall be
19    paid by the employer. The deponent shall be in the presence
20    of the officer administering the oath and recording the
21    deposition, unless otherwise agreed by the parties. Any
22    exhibits or other demonstrative evidence to be presented to
23    the deponent by any party at the deposition shall be
24    provided to the officer administering the oath and all
25    other parties within a reasonable period of time prior to
26    the deposition. Nothing shall prohibit any party from being



SB3617- 23 -LRB100 22282 KTG 41004 b

1    with the deponent during the deposition, at that party's
2    expense; provided, however, that a party attending a
3    deposition shall give written notice of that party's
4    intention to appear at the deposition to all other parties
5    within a reasonable time prior to the deposition.
6    An admissible utilization review shall be considered by the
7Commission, along with all other evidence and in the same
8manner as all other evidence, and must be addressed along with
9all other evidence in the determination of the reasonableness
10and necessity of the medical bills or treatment. Nothing in
11this Section shall be construed to diminish the rights of
12employees to reasonable and necessary medical treatment or
13employee choice of health care provider under Section 8(a) or
14the rights of employers to medical examinations under Section
16    (j) When an employer denies payment of or refuses to
17authorize payment of first aid, medical, surgical, or hospital
18services under Section 8(a) of this Act, if that denial or
19refusal to authorize complies with a utilization review program
20registered under this Section and complies with all other
21requirements of this Section, then there shall be a rebuttable
22presumption that the employer shall not be responsible for
23payment of additional compensation pursuant to Section 19(k) of
24this Act or interest penalties provided in Section 8.2 of this
25Act and if that denial or refusal to authorize does not comply
26with a utilization review program registered under this Section



SB3617- 24 -LRB100 22282 KTG 41004 b

1and does not comply with all other requirements of this
2Section, then that will be considered by the Commission, along
3with all other evidence and in the same manner as all other
4evidence, in the determination of whether the employer may be
5responsible for the payment of additional compensation
6pursuant to Section 19(k) of this Act or interest penalties
7provided in Section 8.2 of this Act.
8    The changes to this Section made by this amendatory Act of
9the 97th General Assembly apply only to health care services
10provided or proposed to be provided on or after September 1,
12(Source: P.A. 97-18, eff. 6-28-11.)
13    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
14    Sec. 19. Any disputed questions of law or fact shall be
15determined as herein provided.
16    (a) It shall be the duty of the Commission upon
17notification that the parties have failed to reach an
18agreement, to designate an Arbitrator.
19        1. Whenever any claimant misconceives his remedy and
20    files an application for adjustment of claim under this Act
21    and it is subsequently discovered, at any time before final
22    disposition of such cause, that the claim for disability or
23    death which was the basis for such application should
24    properly have been made under the Workers' Occupational
25    Diseases Act, then the provisions of Section 19, paragraph



SB3617- 25 -LRB100 22282 KTG 41004 b

1    (a-1) of the Workers' Occupational Diseases Act having
2    reference to such application shall apply.
3        2. Whenever any claimant misconceives his remedy and
4    files an application for adjustment of claim under the
5    Workers' Occupational Diseases Act and it is subsequently
6    discovered, at any time before final disposition of such
7    cause that the claim for injury or death which was the
8    basis for such application should properly have been made
9    under this Act, then the application so filed under the
10    Workers' Occupational Diseases Act may be amended in form,
11    substance or both to assert claim for such disability or
12    death under this Act and it shall be deemed to have been so
13    filed as amended on the date of the original filing
14    thereof, and such compensation may be awarded as is
15    warranted by the whole evidence pursuant to this Act. When
16    such amendment is submitted, further or additional
17    evidence may be heard by the Arbitrator or Commission when
18    deemed necessary. Nothing in this Section contained shall
19    be construed to be or permit a waiver of any provisions of
20    this Act with reference to notice but notice if given shall
21    be deemed to be a notice under the provisions of this Act
22    if given within the time required herein.
23    (b) The Arbitrator shall make such inquiries and
24investigations as he or they shall deem necessary and may
25examine and inspect all books, papers, records, places, or
26premises relating to the questions in dispute and hear such



SB3617- 26 -LRB100 22282 KTG 41004 b

1proper evidence as the parties may submit.
2    The hearings before the Arbitrator shall be held in the
3vicinity where the injury occurred after 10 days' notice of the
4time and place of such hearing shall have been given to each of
5the parties or their attorneys of record.
6    The Arbitrator may find that the disabling condition is
7temporary and has not yet reached a permanent condition and may
8order the payment of compensation up to the date of the
9hearing, which award shall be reviewable and enforceable in the
10same manner as other awards, and in no instance be a bar to a
11further hearing and determination of a further amount of
12temporary total compensation or of compensation for permanent
13disability, but shall be conclusive as to all other questions
14except the nature and extent of said disability.
15    The decision of the Arbitrator shall be filed with the
16Commission which Commission shall immediately send to each
17party or his attorney a copy of such decision, together with a
18notification of the time when it was filed. As of the effective
19date of this amendatory Act of the 94th General Assembly, all
20decisions of the Arbitrator shall set forth in writing findings
21of fact and conclusions of law, separately stated, if requested
22by either party. Unless a petition for review is filed by
23either party within 30 days after the receipt by such party of
24the copy of the decision and notification of time when filed,
25and unless such party petitioning for a review shall within 35
26days after the receipt by him of the copy of the decision, file



SB3617- 27 -LRB100 22282 KTG 41004 b

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



SB3617- 28 -LRB100 22282 KTG 41004 b

1the services or compensation. Provided the employer continues
2to pay compensation pursuant to paragraph (b) of Section 8, the
3employer may at any time petition for an expedited hearing on
4the issue of whether or not the employee is entitled to receive
5medical, surgical, or hospital services or other services or
6compensation as provided in paragraph (a) of Section 8, or
7compensation as provided in paragraph (b) of Section 8. When an
8employer has petitioned for an expedited hearing, the employer
9shall continue to pay compensation as provided in paragraph (b)
10of Section 8 unless the arbitrator renders a decision that the
11employee is not entitled to the benefits that are the subject
12of the expedited hearing or unless the employee's treating
13physician has released the employee to return to work at his or
14her regular job with the employer or the employee actually
15returns to work at any other job. If the arbitrator renders a
16decision that the employee is not entitled to the benefits that
17are the subject of the expedited hearing, a petition for review
18filed by the employee shall receive the same priority as if the
19employee had filed a petition for an expedited hearing by an
20Arbitrator. Neither party shall be entitled to an expedited
21hearing when the employee has returned to work and the sole
22issue in dispute amounts to less than 12 weeks of unpaid
23compensation pursuant to paragraph (b) of Section 8.
24    Expedited hearings shall have priority over all other
25petitions and shall be heard by the Arbitrator and Commission
26with all convenient speed. Any party requesting an expedited



SB3617- 29 -LRB100 22282 KTG 41004 b

1hearing shall give notice of a request for an expedited hearing
2under this paragraph. A copy of the Application for Adjustment
3of Claim shall be attached to the notice. The Commission shall
4adopt rules and procedures under which the final decision of
5the Commission under this paragraph is filed not later than 180
6days from the date that the Petition for Review is filed with
7the Commission.
8    Where 2 or more insurance carriers, private self-insureds,
9or a group workers' compensation pool under Article V 3/4 of
10the Illinois Insurance Code dispute coverage for the same
11injury, any such insurance carrier, private self-insured, or
12group workers' compensation pool may request an expedited
13hearing pursuant to this paragraph to determine the issue of
14coverage, provided coverage is the only issue in dispute and
15all other issues are stipulated and agreed to and further
16provided that all compensation benefits including medical
17benefits pursuant to Section 8(a) continue to be paid to or on
18behalf of petitioner. Any insurance carrier, private
19self-insured, or group workers' compensation pool that is
20determined to be liable for coverage for the injury in issue
21shall reimburse any insurance carrier, private self-insured,
22or group workers' compensation pool that has paid benefits to
23or on behalf of petitioner for the injury.
24    (b-1) If the employee is not receiving medical, surgical or
25hospital services as provided in paragraph (a) of Section 8 or
26compensation as provided in paragraph (b) of Section 8, the



SB3617- 30 -LRB100 22282 KTG 41004 b

1employee, in accordance with Commission Rules, may file a
2petition for an emergency hearing by an Arbitrator on the issue
3of whether or not he is entitled to receive payment of such
4compensation or services as provided therein. Such petition
5shall have priority over all other petitions and shall be heard
6by the Arbitrator and Commission with all convenient speed.
7    Such petition shall contain the following information and
8shall be served on the employer at least 15 days before it is
10        (i) the date and approximate time of accident;
11        (ii) the approximate location of the accident;
12        (iii) a description of the accident;
13        (iv) the nature of the injury incurred by the employee;
14        (v) the identity of the person, if known, to whom the
15    accident was reported and the date on which it was
16    reported;
17        (vi) the name and title of the person, if known,
18    representing the employer with whom the employee conferred
19    in any effort to obtain compensation pursuant to paragraph
20    (b) of Section 8 of this Act or medical, surgical or
21    hospital services pursuant to paragraph (a) of Section 8 of
22    this Act and the date of such conference;
23        (vii) a statement that the employer has refused to pay
24    compensation pursuant to paragraph (b) of Section 8 of this
25    Act or for medical, surgical or hospital services pursuant
26    to paragraph (a) of Section 8 of this Act;



SB3617- 31 -LRB100 22282 KTG 41004 b

1        (viii) the name and address, if known, of each witness
2    to the accident 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 accident by
5    medical practitioners, and the names and addresses of such
6    practitioners, including the dates of treatment related to
7    the accident at any hospitals and the names and addresses
8    of such hospitals, and a signed authorization permitting
9    the employer to examine all medical records of all
10    practitioners and hospitals named pursuant to this
11    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 injuries incurred as a
15    result of the accident or such other documents or
16    affidavits which show that the employee is entitled to
17    receive compensation pursuant to paragraph (b) of Section 8
18    of this Act or medical, surgical or hospital services
19    pursuant to paragraph (a) of Section 8 of this Act. Such
20    reports, documents or affidavits shall state, if possible,
21    the history of the accident given by the employee, and
22    describe the injury and medical diagnosis, the medical
23    services for such injury which the employee has received
24    and is receiving, the physical activities which the
25    employee cannot currently perform as a result of any
26    impairment or disability due to such injury, and the



SB3617- 32 -LRB100 22282 KTG 41004 b

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



SB3617- 33 -LRB100 22282 KTG 41004 b

1response to each claim set forth in the petition, including the
2legal and factual basis for each disputed allegation and the
3following information: (i) complete copies of any reports,
4records, documents and affidavits in the possession of the
5employer on which the employer intends to rely in support of
6his response, (ii) a list of any reports, records, documents
7and affidavits which the employer has demanded by subpoena and
8on which the employer intends to rely in support of his
9response, (iii) the name and address of each witness on whom
10the employer will rely to support his response, and (iv) the
11names and addresses of any medical practitioners selected by
12the employer pursuant to Section 12 of this Act and the time
13and place of any examination scheduled to be made pursuant to
14such Section.
15    Any employer who does not timely file and serve a written
16response without good cause may not introduce any evidence to
17dispute any claim of the employee but may cross examine the
18employee or any witness brought by the employee and otherwise
19be heard.
20    No document or other evidence not previously identified by
21either party with the petition or written response, or by any
22other means before the hearing, may be introduced into evidence
23without good cause. If, at the hearing, material information is
24discovered which was not previously disclosed, the Arbitrator
25may extend the time for closing proof on the motion of a party
26for a reasonable period of time which may be more than 30 days.



SB3617- 34 -LRB100 22282 KTG 41004 b

1No evidence may be introduced pursuant to this paragraph as to
2permanent disability. No award may be entered for permanent
3disability pursuant to this paragraph. Either party may
4introduce into evidence the testimony taken by deposition of
5any medical practitioner.
6    The Commission shall adopt rules, regulations and
7procedures whereby the final decision of the Commission is
8filed not later than 90 days from the date the petition for
9review is filed but in no event later than 180 days from the
10date the petition for an emergency hearing is filed with the
11Illinois Workers' Compensation Commission.
12    All service required pursuant to this paragraph (b-1) must
13be by personal service or by certified mail and with evidence
14of receipt. In addition for the purposes of this paragraph, all
15service on the employer must be at the premises where the
16accident occurred if the premises are owned or operated by the
17employer. Otherwise service must be at the employee's principal
18place of employment by the employer. If service on the employer
19is not possible at either of the above, then service shall be
20at the employer's principal place of business. After initial
21service in each case, service shall be made on the employer's
22attorney or designated representative.
23    (c)(1) At a reasonable time in advance of and in connection
24with the hearing under Section 19(e) or 19(h), the Commission
25may on its own motion order an impartial physical or mental
26examination of a petitioner whose mental or physical condition



SB3617- 35 -LRB100 22282 KTG 41004 b

1is in issue, when in the Commission's discretion it appears
2that such an examination will materially aid in the just
3determination of the case. The examination shall be made by a
4member or members of a panel of physicians chosen for their
5special qualifications by the Illinois State Medical Society.
6The Commission shall establish procedures by which a physician
7shall be selected from such list.
8    (2) Should the Commission at any time during the hearing
9find that compelling considerations make it advisable to have
10an examination and report at that time, the commission may in
11its discretion so order.
12    (3) A copy of the report of examination shall be given to
13the Commission and to the attorneys for the parties.
14    (4) Either party or the Commission may call the examining
15physician or physicians to testify. Any physician so called
16shall be subject to cross-examination.
17    (5) The examination shall be made, and the physician or
18physicians, if called, shall testify, without cost to the
19parties. The Commission shall determine the compensation and
20the pay of the physician or physicians. The compensation for
21this service shall not exceed the usual and customary amount
22for such service.
23    (6) The fees and payment thereof of all attorneys and
24physicians for services authorized by the Commission under this
25Act shall, upon request of either the employer or the employee
26or the beneficiary affected, be subject to the review and



SB3617- 36 -LRB100 22282 KTG 41004 b

1decision of the Commission.
2    (d) If any employee shall persist in insanitary or
3injurious practices which tend to either imperil or retard his
4recovery or shall refuse to submit to such medical, surgical,
5or hospital treatment as is reasonably essential to promote his
6recovery, the Commission may, in its discretion, reduce or
7suspend the compensation of any such injured employee. However,
8when an employer and employee so agree in writing, the
9foregoing provision shall not be construed to authorize the
10reduction or suspension of compensation of an employee who is
11relying in good faith, on treatment by prayer or spiritual
12means alone, in accordance with the tenets and practice of a
13recognized church or religious denomination, by a duly
14accredited practitioner thereof.
15    (e) This paragraph shall apply to all hearings before the
16Commission. Such hearings may be held in its office or
17elsewhere as the Commission may deem advisable. The taking of
18testimony on such hearings may be had before any member of the
19Commission. If a petition for review and agreed statement of
20facts or transcript of evidence is filed, as provided herein,
21the Commission shall promptly review the decision of the
22Arbitrator and all questions of law or fact which appear from
23the statement of facts or transcript of evidence.
24    In all cases in which the hearing before the arbitrator is
25held after December 18, 1989, no additional evidence shall be
26introduced by the parties before the Commission on review of



SB3617- 37 -LRB100 22282 KTG 41004 b

1the decision of the Arbitrator. In reviewing decisions of an
2arbitrator the Commission shall award such temporary
3compensation, permanent compensation and other payments as are
4due under this Act. The Commission shall file in its office its
5decision thereon, and shall immediately send to each party or
6his attorney a copy of such decision and a notification of the
7time when it was filed. Decisions shall be filed within 60 days
8after the Statement of Exceptions and Supporting Brief and
9Response thereto are required to be filed or oral argument
10whichever is later.
11    In the event either party requests oral argument, such
12argument shall be had before a panel of 3 members of the
13Commission (or before all available members pursuant to the
14determination of 7 members of the Commission that such argument
15be held before all available members of the Commission)
16pursuant to the rules and regulations of the Commission. A
17panel of 3 members, which shall be comprised of not more than
18one representative citizen of the employing class and not more
19than one representative citizen of the employee class, shall
20hear the argument; provided that if all the issues in dispute
21are solely the nature and extent of the permanent partial
22disability, if any, a majority of the panel may deny the
23request for such argument and such argument shall not be held;
24and provided further that 7 members of the Commission may
25determine that the argument be held before all available
26members of the Commission. A decision of the Commission shall



SB3617- 38 -LRB100 22282 KTG 41004 b

1be approved by a majority of Commissioners present at such
2hearing if any; provided, if no such hearing is held, a
3decision of the Commission shall be approved by a majority of a
4panel of 3 members of the Commission as described in this
5Section. The Commission shall give 10 days' notice to the
6parties or their attorneys of the time and place of such taking
7of testimony and of such argument.
8    In any case the Commission in its decision may find
9specially upon any question or questions of law or fact which
10shall be submitted in writing by either party whether ultimate
11or otherwise; provided that on issues other than nature and
12extent of the disability, if any, the Commission in its
13decision shall find specially upon any question or questions of
14law or fact, whether ultimate or otherwise, which are submitted
15in writing by either party; provided further that not more than
165 such questions may be submitted by either party. Any party
17may, within 20 days after receipt of notice of the Commission's
18decision, or within such further time, not exceeding 30 days,
19as the Commission may grant, file with the Commission either an
20agreed statement of the facts appearing upon the hearing, or,
21if such party shall so elect, a correct transcript of evidence
22of the additional proceedings presented before the Commission,
23in which report the party may embody a correct statement of
24such other proceedings in the case as such party may desire to
25have reviewed, such statement of facts or transcript of
26evidence to be authenticated by the signature of the parties or



SB3617- 39 -LRB100 22282 KTG 41004 b

1their attorneys, and in the event that they do not agree, then
2the authentication of such transcript of evidence shall be by
3the signature of any member of the Commission.
4    If a reporter does not for any reason furnish a transcript
5of the proceedings before the Arbitrator in any case for use on
6a hearing for review before the Commission, within the
7limitations of time as fixed in this Section, the Commission
8may, in its discretion, order a trial de novo before the
9Commission in such case upon application of either party. The
10applications for adjustment of claim and other documents in the
11nature of pleadings filed by either party, together with the
12decisions of the Arbitrator and of the Commission and the
13statement of facts or transcript of evidence hereinbefore
14provided for in paragraphs (b) and (c) shall be the record of
15the proceedings of the Commission, and shall be subject to
16review as hereinafter provided.
17    At the request of either party or on its own motion, the
18Commission shall set forth in writing the reasons for the
19decision, including findings of fact and conclusions of law
20separately stated. The Commission shall by rule adopt a format
21for written decisions for the Commission and arbitrators. The
22written decisions shall be concise and shall succinctly state
23the facts and reasons for the decision. The Commission may
24adopt in whole or in part, the decision of the arbitrator as
25the decision of the Commission. When the Commission does so
26adopt the decision of the arbitrator, it shall do so by order.



SB3617- 40 -LRB100 22282 KTG 41004 b

1Whenever the Commission adopts part of the arbitrator's
2decision, but not all, it shall include in the order the
3reasons for not adopting all of the arbitrator's decision. When
4a majority of a panel, after deliberation, has arrived at its
5decision, the decision shall be filed as provided in this
6Section without unnecessary delay, and without regard to the
7fact that a member of the panel has expressed an intention to
8dissent. Any member of the panel may file a dissent. Any
9dissent shall be filed no later than 10 days after the decision
10of the majority has been filed.
11    Decisions rendered by the Commission and dissents, if any,
12shall be published together by the Commission. The conclusions
13of law set out in such decisions shall be regarded as
14precedents by arbitrators for the purpose of achieving a more
15uniform administration of this Act.
16    (f) The decision of the Commission acting within its
17powers, according to the provisions of paragraph (e) of this
18Section shall, in the absence of fraud, be conclusive unless
19reviewed as in this paragraph hereinafter provided. However,
20the Arbitrator or the Commission may on his or its own motion,
21or on the motion of either party, correct any clerical error or
22errors in computation within 15 days after the date of receipt
23of any award by such Arbitrator or any decision on review of
24the Commission and shall have the power to recall the original
25award on arbitration or decision on review, and issue in lieu
26thereof such corrected award or decision. Where such correction



SB3617- 41 -LRB100 22282 KTG 41004 b

1is made the time for review herein specified shall begin to run
2from the date of the receipt of the corrected award or
4        (1) Except in cases of claims against the State of
5    Illinois other than those claims under Section 18.1, in
6    which case the decision of the Commission shall not be
7    subject to judicial review, the Circuit Court of the county
8    where any of the parties defendant may be found, or if none
9    of the parties defendant can be found in this State then
10    the Circuit Court of the county where the accident
11    occurred, shall by summons to the Commission have power to
12    review all questions of law and fact presented by such
13    record.
14        A proceeding for review shall be commenced within 20
15    days of the receipt of notice of the decision of the
16    Commission. The summons shall be issued by the clerk of
17    such court upon written request returnable on a designated
18    return day, not less than 10 or more than 60 days from the
19    date of issuance thereof, and the written request shall
20    contain the last known address of other parties in interest
21    and their attorneys of record who are to be served by
22    summons. Service upon any member of the Commission or the
23    Secretary or the Assistant Secretary thereof shall be
24    service upon the Commission, and service upon other parties
25    in interest and their attorneys of record shall be by
26    summons, and such service shall be made upon the Commission



SB3617- 42 -LRB100 22282 KTG 41004 b

1    and other parties in interest by mailing notices of the
2    commencement of the proceedings and the return day of the
3    summons to the office of the Commission and to the last
4    known place of residence of other parties in interest or
5    their attorney or attorneys of record. The clerk of the
6    court issuing the summons shall on the day of issue mail
7    notice of the commencement of the proceedings which shall
8    be done by mailing a copy of the summons to the office of
9    the Commission, and a copy of the summons to the other
10    parties in interest or their attorney or attorneys of
11    record and the clerk of the court shall make certificate
12    that he has so sent said notices in pursuance of this
13    Section, which shall be evidence of service on the
14    Commission and other parties in interest.
15        The Commission shall not be required to certify the
16    record of their proceedings to the Circuit Court, unless
17    the party commencing the proceedings for review in the
18    Circuit Court as above provided, shall file with the
19    Commission notice of intent to file for review in Circuit
20    Court. It shall be the duty of the Commission upon such
21    filing of notice of intent to file for review in the
22    Circuit Court to prepare a true and correct copy of such
23    testimony and a true and correct copy of all other matters
24    contained in such record and certified to by the Secretary
25    or Assistant Secretary thereof. The changes made to this
26    subdivision (f)(1) by this amendatory Act of the 98th



SB3617- 43 -LRB100 22282 KTG 41004 b

1    General Assembly apply to any Commission decision entered
2    after the effective date of this amendatory Act of the 98th
3    General Assembly.
4        No request for a summons may be filed and no summons
5    shall issue unless the party seeking to review the decision
6    of the Commission shall exhibit to the clerk of the Circuit
7    Court proof of filing with the Commission of the notice of
8    the intent to file for review in the Circuit Court or an
9    affidavit of the attorney setting forth that notice of
10    intent to file for review in the Circuit Court has been
11    given in writing to the Secretary or Assistant Secretary of
12    the Commission.
13        (2) No such summons shall issue unless the one against
14    whom the Commission shall have rendered an award for the
15    payment of money shall upon the filing of his written
16    request for such summons file with the clerk of the court a
17    bond conditioned that if he shall not successfully
18    prosecute the review, he will pay the award and the costs
19    of the proceedings in the courts. The amount of the bond
20    shall be fixed by any member of the Commission and the
21    surety or sureties of the bond shall be approved by the
22    clerk of the court. The acceptance of the bond by the clerk
23    of the court shall constitute evidence of his approval of
24    the bond.
25        Every county, city, town, township, incorporated
26    village, school district, body politic or municipal



SB3617- 44 -LRB100 22282 KTG 41004 b

1    corporation against whom the Commission shall have
2    rendered an award for the payment of money shall not be
3    required to file a bond to secure the payment of the award
4    and the costs of the proceedings in the court to authorize
5    the court to issue such summons.
6        The court may confirm or set aside the decision of the
7    Commission. If the decision is set aside and the facts
8    found in the proceedings before the Commission are
9    sufficient, the court may enter such decision as is
10    justified by law, or may remand the cause to the Commission
11    for further proceedings and may state the questions
12    requiring further hearing, and give such other
13    instructions as may be proper. Appeals shall be taken to
14    the Appellate Court in accordance with Supreme Court Rules
15    22(g) and 303. Appeals shall be taken from the Appellate
16    Court to the Supreme Court in accordance with Supreme Court
17    Rule 315.
18        It shall be the duty of the clerk of any court
19    rendering a decision affecting or affirming an award of the
20    Commission to promptly furnish the Commission with a copy
21    of such decision, without charge.
22        The decision of a majority of the members of the panel
23    of the Commission, shall be considered the decision of the
24    Commission.
25    (g) Except in the case of a claim against the State of
26Illinois, or a medical provider receiving an award of interest



SB3617- 45 -LRB100 22282 KTG 41004 b

1under Section 8.2, either party may present a certified copy of
2the award of the Arbitrator, or a certified copy of the
3decision of the Commission when the same has become final, when
4no proceedings for review are pending, providing for the
5payment of compensation according to this Act, to the Circuit
6Court of the county in which such accident occurred or either
7of the parties are residents, whereupon the court shall enter a
8judgment in accordance therewith. In a case where the employer
9refuses to pay compensation according to such final award or
10such final decision upon which such judgment is entered the
11court shall in entering judgment thereon, tax as costs against
12him the reasonable costs and attorney fees in the arbitration
13proceedings and in the court entering the judgment for the
14person in whose favor the judgment is entered, which judgment
15and costs taxed as therein provided shall, until and unless set
16aside, have the same effect as though duly entered in an action
17duly tried and determined by the court, and shall with like
18effect, be entered and docketed. The Circuit Court shall have
19power at any time upon application to make any such judgment
20conform to any modification required by any subsequent decision
21of the Supreme Court upon appeal, or as the result of any
22subsequent proceedings for review, as provided in this Act.
23    Judgment shall not be entered until 15 days' notice of the
24time and place of the application for the entry of judgment
25shall be served upon the employer by filing such notice with
26the Commission, which Commission shall, in case it has on file



SB3617- 46 -LRB100 22282 KTG 41004 b

1the address of the employer or the name and address of its
2agent upon whom notices may be served, immediately send a copy
3of the notice to the employer or such designated agent.
4    (h) An agreement or award under this Act providing for
5compensation in installments, may at any time within 18 months
6after such agreement or award be reviewed by the Commission at
7the request of either the employer or the employee, on the
8ground that the disability of the employee has subsequently
9recurred, increased, diminished or ended.
10    However, as to accidents occurring subsequent to July 1,
111955, which are covered by any agreement or award under this
12Act providing for compensation in installments made as a result
13of such accident, such agreement or award may at any time
14within 30 months, or 60 months in the case of an award under
15Section 8(d)1, after such agreement or award be reviewed by the
16Commission at the request of either the employer or the
17employee on the ground that the disability of the employee has
18subsequently recurred, increased, diminished or ended.
19    On such review, compensation payments may be
20re-established, increased, diminished or ended. The Commission
21shall give 15 days' notice to the parties of the hearing for
22review. Any employee, upon any petition for such review being
23filed by the employer, shall be entitled to one day's notice
24for each 100 miles necessary to be traveled by him in attending
25the hearing of the Commission upon the petition, and 3 days in
26addition thereto. Such employee shall, at the discretion of the



SB3617- 47 -LRB100 22282 KTG 41004 b

1Commission, also be entitled to 5 cents per mile necessarily
2traveled by him within the State of Illinois in attending such
3hearing, not to exceed a distance of 300 miles, to be taxed by
4the Commission as costs and deposited with the petition of the
6    When compensation which is payable in accordance with an
7award or settlement contract approved by the Commission, is
8ordered paid in a lump sum by the Commission, no review shall
9be had as in this paragraph mentioned.
10    (i) Each party, upon taking any proceedings or steps
11whatsoever before any Arbitrator, Commission or court, shall
12file with the Commission his address, or the name and address
13of any agent upon whom all notices to be given to such party
14shall be served, either personally or by registered mail,
15addressed to such party or agent at the last address so filed
16with the Commission. In the event such party has not filed his
17address, or the name and address of an agent as above provided,
18service of any notice may be had by filing such notice with the
20    (j) Whenever in any proceeding testimony has been taken or
21a final decision has been rendered and after the taking of such
22testimony or after such decision has become final, the injured
23employee dies, then in any subsequent proceedings brought by
24the personal representative or beneficiaries of the deceased
25employee, such testimony in the former proceeding may be
26introduced with the same force and effect as though the witness



SB3617- 48 -LRB100 22282 KTG 41004 b

1having so testified were present in person in such subsequent
2proceedings and such final decision, if any, shall be taken as
3final adjudication of any of the issues which are the same in
4both proceedings.
5    (k) In case where there has been any unreasonable or
6vexatious delay of payment or intentional underpayment of
7compensation, or proceedings have been instituted or carried on
8by the one liable to pay the compensation, which do not present
9a real controversy, but are merely frivolous or for delay, then
10the Commission may award compensation additional to that
11otherwise payable under this Act equal to 50% of the amount
12payable at the time of such award. Failure to pay compensation
13in accordance with the provisions of Section 8, paragraph (b)
14of this Act, shall be considered unreasonable delay.
15    When determining whether this subsection (k) shall apply,
16the Commission shall consider whether an Arbitrator has
17determined that the claim is not compensable or whether the
18employer has made payments under Section 8(j).
19    (l) If the employee has made written demand for payment of
20benefits under Section 8(a) or Section 8(b), the employer shall
21have 14 days after receipt of the demand to set forth in
22writing the reason for the delay. In the case of demand for
23payment of medical benefits under Section 8(a), the time for
24the employer to respond shall not commence until the expiration
25of the allotted 30 days specified under Section 8.2(d). In case
26the employer or his or her insurance carrier shall without good



SB3617- 49 -LRB100 22282 KTG 41004 b

1and just cause fail, neglect, refuse, or unreasonably delay the
2payment of benefits under Section 8(a) or Section 8(b), the
3Arbitrator or the Commission shall allow to the employee
4additional compensation in the sum of $30 per day for each day
5that the benefits under Section 8(a) or Section 8(b) have been
6so withheld or refused, not to exceed $10,000. A delay in
7payment of 14 days or more shall create a rebuttable
8presumption of unreasonable delay.
9    (m) If the commission finds that an accidental injury was
10directly and proximately caused by the employer's wilful
11violation of a health and safety standard under the Health and
12Safety Act or the Occupational Safety and Health Act in force
13at the time of the accident, the arbitrator or the Commission
14shall allow to the injured employee or his dependents, as the
15case may be, additional compensation equal to 25% of the amount
16which otherwise would be payable under the provisions of this
17Act exclusive of this paragraph. The additional compensation
18herein provided shall be allowed by an appropriate increase in
19the applicable weekly compensation rate.
20    (n) After June 30, 1984, decisions of the Illinois Workers'
21Compensation Commission reviewing an award of an arbitrator of
22the Commission shall draw interest at a rate equal to the yield
23on indebtedness issued by the United States Government with a
2426-week maturity next previously auctioned on the day on which
25the decision is filed. Said rate of interest shall be set forth
26in the Arbitrator's Decision. Interest shall be drawn from the



SB3617- 50 -LRB100 22282 KTG 41004 b

1date of the arbitrator's award on all accrued compensation due
2the employee through the day prior to the date of payments.
3However, when an employee appeals an award of an Arbitrator or
4the Commission, and the appeal results in no change or a
5decrease in the award, interest shall not further accrue from
6the date of such appeal.
7    The employer or his insurance carrier may tender the
8payments due under the award to stop the further accrual of
9interest on such award notwithstanding the prosecution by
10either party of review, certiorari, appeal to the Supreme Court
11or other steps to reverse, vacate or modify the award.
12    (o) By the 15th day of each month each insurer providing
13coverage for losses under this Act shall notify each insured
14employer of any compensable claim incurred during the preceding
15month and the amounts paid or reserved on the claim including a
16summary of the claim and a brief statement of the reasons for
17compensability. A cumulative report of all claims incurred
18during a calendar year or continued from the previous year
19shall be furnished to the insured employer by the insurer
20within 30 days after the end of that calendar year.
21    The insured employer may challenge, in proceeding before
22the Commission, payments made by the insurer without
23arbitration and payments made after a case is determined to be
24noncompensable. If the Commission finds that the case was not
25compensable, the insurer shall purge its records as to that
26employer of any loss or expense associated with the claim,



SB3617- 51 -LRB100 22282 KTG 41004 b

1reimburse the employer for attorneys' fees arising from the
2challenge and for any payment required of the employer to the
3Rate Adjustment Fund or the Second Injury Fund, and may not
4reflect the loss or expense for rate making purposes. The
5employee shall not be required to refund the challenged
6payment. The decision of the Commission may be reviewed in the
7same manner as in arbitrated cases. No challenge may be
8initiated under this paragraph more than 3 years after the
9payment is made. An employer may waive the right of challenge
10under this paragraph on a case by case basis.
11    (p) After filing an application for adjustment of claim but
12prior to the hearing on arbitration the parties may voluntarily
13agree to submit such application for adjustment of claim for
14decision by an arbitrator under this subsection (p) where such
15application for adjustment of claim raises only a dispute over
16temporary total disability, permanent partial disability or
17medical expenses. Such agreement shall be in writing in such
18form as provided by the Commission. Applications for adjustment
19of claim submitted for decision by an arbitrator under this
20subsection (p) shall proceed according to rule as established
21by the Commission. The Commission shall promulgate rules
22including, but not limited to, rules to ensure that the parties
23are adequately informed of their rights under this subsection
24(p) and of the voluntary nature of proceedings under this
25subsection (p). The findings of fact made by an arbitrator
26acting within his or her powers under this subsection (p) in



SB3617- 52 -LRB100 22282 KTG 41004 b

1the absence of fraud shall be conclusive. However, the
2arbitrator may on his own motion, or the motion of either
3party, correct any clerical errors or errors in computation
4within 15 days after the date of receipt of such award of the
5arbitrator and shall have the power to recall the original
6award on arbitration, and issue in lieu thereof such corrected
7award. The decision of the arbitrator under this subsection (p)
8shall be considered the decision of the Commission and
9proceedings for review of questions of law arising from the
10decision may be commenced by either party pursuant to
11subsection (f) of Section 19. The Advisory Board established
12under Section 13.1 shall compile a list of certified Commission
13arbitrators, each of whom shall be approved by at least 7
14members of the Advisory Board. The chairman shall select 5
15persons from such list to serve as arbitrators under this
16subsection (p). By agreement, the parties shall select one
17arbitrator from among the 5 persons selected by the chairman
18except that if the parties do not agree on an arbitrator from
19among the 5 persons, the parties may, by agreement, select an
20arbitrator of the American Arbitration Association, whose fee
21shall be paid by the State in accordance with rules promulgated
22by the Commission. Arbitration under this subsection (p) shall
23be voluntary.
24(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
25eff. 1-1-15.)
26    Section 99. Effective date. This Act takes effect upon



SB3617- 53 -LRB100 22282 KTG 41004 b

1becoming law.