093_SB0621 LRB093 03315 AMC 03333 b 1 AN ACT concerning patient billing. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Health Maintenance Organization Act is 5 amended by changing Section 2-8 as follows: 6 (215 ILCS 125/2-8) (from Ch. 111 1/2, par. 1407.01) 7 Sec. 2-8. Provider agreements and stipulations. 8 (a) All provider contracts currently in existence between 9 any organization and any provider
hospitalwhich are renewed 10 on or after 180 days following the effective date of this 11 amendatory Act of 1987, and all contracts between any 12 organization and any provider hospitalexecuted on or after 13 180 days after such effective date, shall contain the 14 following "hold-harmless" clause: "The provider agrees that 15 in no event, including but not limited to nonpayment by the 16 organization of amounts due the hospitalprovider under this 17 contract, insolvency of the organization or any breach of 18 this contract by the organization, shall the hospital19 provider or its assignees or subcontractors have a right to 20 seek any type of payment from, bill, charge, collect a 21 deposit from, or have any recourse against, the enrollee, 22 persons acting on the enrollee's behalf (other than the 23 organization), the employer or group contract holder for 24 services provided pursuant to this contract except for the 25 payment of applicable co-payments or deductibles for services 26 covered by the organization or fees for services not covered 27 by the organization. The requirements of this clause shall 28 survive any termination of this contract for services 29 rendered prior to such termination, regardless of the cause 30 of such termination. The organization's enrollees, the 31 persons acting on the enrollee's behalf (other than the -2- LRB093 03315 AMC 03333 b 1 organization) and the employer or group contract holder shall 2 be third party beneficiaries of this clause. This clause 3 supersedes any oral or written agreement now existing or 4 hereafter entered into between the provider and the enrollee, 5 persons acting on the enrollee's behalf (other than the 6 organization) and the employer or group contract holder." To 7 the extent that any hospitalprovider contract, which is 8 renewed or entered into on or after 180 days following the 9 effective date of this amendatory Act of 1987, fails to 10 incorporate such provisions, such provisions shall be deemed 11 incorporated into such contracts by operation of law as of 12 the date of such renewal or execution. 13 (b) Providers and their assignees or subcontractors may 14 not seek any type of payment from, bill, charge, collect a 15 deposit from, or have any recourse against an enrollee, 16 persons acting on an enrollee's behalf (other than the 17 organization), the employer, or group contract holder for 18 services provided pursuant to a contract, except for the 19 payment of applicable copayments or deductibles for services 20 covered by the organization or fees for services not covered 21 by the organization. 22 When a provider sends the enrollee a statement for 23 services billed to the organization, such statement shall 24 contain the following language conspicuously displayed on the 25 front of such statement in at least fourteen-point boldface 26 capital letters: "NOTICE: THIS IS NOT A BILL. DO NOT PAY.". 27 Nothing in this subsection shall prevent a provider from 28 seeking to bill, charge, or collect from an enrollee any 29 amount that is the legal liability of the enrollee. 30 (c) Any collection or attempt to collect moneys or 31 maintain action against any subscriber or enrollee as 32 prohibited in subsection (b) may be reported as a complaint 33 to the Director by any person. A person making such a 34 complaint shall be immune from liability for doing so. -3- LRB093 03315 AMC 03333 b 1 (d) Within 14 days after of the Director's receipt of a 2 complaint under this subsection, the Director must provide a 3 written notice of the complaint to the reported provider's 4 licensing or disciplinary board or committee. 5 (e) The Director must maintain a record of all notices 6 of complaint provided to licensing or disciplinary boards or 7 committees under this Section. This record must be provided 8 to any person within 14 days after the Director's receipt of 9 a written request for the record. 10 (f) The Department shall investigate complaints received 11 by the Director regarding violations of subsection (b). 12 (g) The Department must utilize the most efficient and 13 effective methods to investigate each complaint. This may 14 include requirements of the production of documents or review 15 of records. 16 (h) When the Department determines through its 17 investigation that a violation of subsection (b) has 18 occurred, the Director shall require that the provider 19 reimburse, with interest at the rate of 9% per year, the 20 subscriber or enrollee for any prohibited collection of 21 moneys described in subsection (b). 22 (i) When the Department determines through its 23 investigation that a violation subsection (b) has occurred, a 24 notice of violation shall be served upon the provider. 25 (j) A notice of violation must be in writing and must 26 include all of the following: 27 (1) A description of the nature of the violation. 28 (2) A citation of the statutory provision alleged 29 to have been violated. 30 (3) A description of any action the Department may 31 take under this Section and any penalties that may be 32 assessed under the Medical Patient Rights Act. 33 (4) A description of the manner in which the 34 provider may contest the notice of violation and the -4- LRB093 03315 AMC 03333 b 1 right to a hearing to contest the notice. 2 (k) The Director shall establish by rulemaking a formal 3 hearing process for subsection (b) of this Section. 4 (l) When the Department has determined a violation of 5 subsection (b) has occurred and (1) any appeal hearing has 6 taken place resulting in a decision upholding the 7 Department's determination or (2) the provider has waived the 8 appeal hearing, the Director shall carry out the sanctions 9 described in the notice of violation as outlined in item (3) 10 of subsection (j). 11 (m) The Director must provide a copy of the written 12 notice of violation imposed by the Department upon a provider 13 to the provider's licensing or disciplinary board or 14 committee. 15 (n) The Director must provide a copy of the written 16 notice of violation imposed by the Department upon a provider 17 to the State's Attorney's office in the county where the 18 violation occurred. 19 (o) The Director must maintain a record of all notices 20 of violation provided to licensing or disciplinary boards or 21 committees under this Section. This record must be provided 22 to any person within 14 days after the Director's receipt of 23 a written request for the record. 24 (p) The Department, an enrollee, or a health maintenance 25 organization may pursue injunctive relief to ensure 26 compliance with this Section. 27 (q) (b)All provider and subcontractor contracts must 28 contain provisions whereby the provider or subcontractor 29 shall provide, arrange for, or participate in the quality 30 assurance programs mandated by this Act, unless the Illinois 31 Department of Public Health certifies that such programs will 32 be fully implemented without any participation or actions 33 from such contracting provider. 34 (r) (c)The Director may promulgate rules requiring that -5- LRB093 03315 AMC 03333 b 1 provider contracts contain provisions concerning reasonable 2 notices to be given between the parties and for the 3 organization to provide reasonable notice to its enrollees 4 and to the Director. Notice shall be given for such events 5 as, but not limited to, termination of insurance protection, 6 quality assurance or availability of medical care. 7 (Source: P.A. 86-620.) 8 Section 10. The Medical Patient Rights Act is amended by 9 changing Section 4 and adding Section 3.3 as follows: 10 (410 ILCS 50/3.3 new) 11 Sec. 3.3. Prohibited billing practices. 12 (a) Health care providers, physicians, and their 13 assignees or subcontractors may not seek any type of payment 14 from, bill, charge, collect a deposit from, or have any 15 recourse against an insured patient, persons acting on the 16 insured patient's behalf (other than the insurer), the 17 employer, or group contract holder for services provided 18 pursuant to a contract in which an insurance company or 19 health services corporation has contractually agreed with a 20 health care provider or physician that the health care 21 provider or physician does not have such a right or rights, 22 except for the payment of applicable copayments or 23 deductibles for services covered by the insurance company or 24 health services corporation or fees for services not covered 25 by the insurance company or health services corporation. 26 (b) The Department of Insurance shall enforce the 27 provisions of this Section: 28 (1) Any collection or attempt to collect moneys or 29 maintain action against any insured patient as prohibited 30 in subsection (a) may be reported as a complaint to the 31 Director of the Department of Insurance by any person. 32 (2) A person making such a complaint shall be -6- LRB093 03315 AMC 03333 b 1 immune from liability for doing so. Within 14 days after 2 the Director's receipt of a complaint under this Section, 3 the Director must provide a written notice of the 4 complaint to the reported health care provider's or 5 physician's licensing or disciplinary board or committee. 6 (3) The Director must maintain a record of all 7 notices of complaint provided to licensing or 8 disciplinary boards or committees under this Section. 9 This record must be provided to any person within 14 days 10 after the Director's receipt of a written request for the 11 record. 12 (4) The Department shall investigate complaints 13 received by the Director regarding violations of 14 subsection (a). 15 (5) The Department must utilize the most efficient 16 and effective methods to investigate each complaint. 17 This may include requirements of the production of 18 documents or review of records. 19 (6) When the Department determines through its 20 investigation that a violation of subsection (a) has 21 occurred, the Director shall require that the provider 22 reimburse, with interest at the rate of 9% per year, the 23 subscriber or enrollee for any prohibited collection of 24 moneys described in subsection (a). 25 (7) When the Department determines through its 26 investigation that a violation subsection (a) has 27 occurred, a notice of violation shall be served upon the 28 provider. 29 (8) A notice of violation must be in writing and 30 must include all of the following: 31 (A) A description of the nature of the 32 violation. 33 (B) A citation of the statutory provision 34 alleged to have been violated. -7- LRB093 03315 AMC 03333 b 1 (C) A description of any action the Department 2 may take under this Section and any additional 3 penalties that may be assessed under this Act. 4 (D) A description of the manner in which the 5 provider may contest the notice of violation and the 6 right to a hearing to contest the notice. 7 (9) The Director shall establish by rulemaking a 8 formal hearing process for subsection (a) of this 9 Section. 10 (10) When the Department has determined a violation 11 of subsection (a) has occurred and (i) any appeal hearing 12 has taken place resulting in a decision upholding the 13 Department's determination or (ii) the provider has 14 waived the appeal hearing, the Director shall carry out 15 the sanctions described in the notice of violation as 16 outlined in item (8)(C) of this subsection. 17 (11) The Director must provide a copy of the 18 written notice of violation imposed by the Department 19 upon a provider to the provider's licensing or 20 disciplinary board or committee. 21 (12) The Director shall provide a copy of the 22 written notice of violation imposed by the Department 23 upon a provider to the State's Attorney's office in the 24 county where the violation occurred. 25 (13) The Director must maintain a record of all 26 notices of violation provided to licensing or 27 disciplinary boards or committees under this Section. 28 This record must be provided to any person within 14 days 29 after the Director's receipt of a written request for the 30 record. 31 (14) The Department, an insured patient, an 32 insurance company, or a health services corporation may 33 pursue injunctive relief to ensure compliance with this 34 Section in addition to the penalties provided for under -8- LRB093 03315 AMC 03333 b 1 this Act. 2 (410 ILCS 50/4) (from Ch. 111 1/2, par. 5404) 3 Sec. 4. Violations. Any physician or health care 4 provider that violates a patient's rights as set forth in 5 subparagraph (b) of Section 3 or Section 3.3 is guilty of a 6 petty offense and shall be fined $500 per incident. Any 7 insurance company or health service corporation that violates 8 a patient's rights as set forth in subparagraph (c) of 9 Section 3 is guilty of a petty offense and shall be fined 10 $1,000. Any physician, health care provider, health services 11 corporation or insurance company that violates a patient's 12 rights as set forth in subsection (d) of Section 3 is guilty 13 of a petty offense and shall be fined $1,000. 14 (Source: P.A. 92-651, eff. 7-11-02.) 15 Section 10. The Workers' Compensation Act is amended by 16 changing Section 8 as follows: 17 (820 ILCS 305/8) (from Ch. 48, par. 138.8) 18 Sec. 8. The amount of compensation which shall be paid 19 to the employee for an accidental injury not resulting in 20 death is: 21 (a) The employer shall provide and pay for all the 22 necessary first aid, medical and surgical services, and all 23 necessary medical, surgical and hospital services thereafter 24 incurred, limited, however, to that which is reasonably 25 required to cure or relieve from the effects of the 26 accidental injury. The employer shall also pay for treatment, 27 instruction and training necessary for the physical, mental 28 and vocational rehabilitation of the employee, including all 29 maintenance costs and expenses incidental thereto. If as a 30 result of the injury the employee is unable to be 31 self-sufficient the employer shall further pay for such -9- LRB093 03315 AMC 03333 b 1 maintenance or institutional care as shall be required. 2 The employee may at any time elect to secure his own 3 physician, surgeon and hospital services at the employer's 4 expense, or, 5 Upon agreement between the employer and the employees, or 6 the employees' exclusive representative, and subject to the 7 approval of the Industrial Commission, the employer shall 8 maintain a list of physicians, to be known as a Panel of 9 Physicians, who are accessible to the employees. The employer 10 shall post this list in a place or places easily accessible 11 to his employees. The employee shall have the right to make 12 an alternative choice of physician from such Panel if he is 13 not satisfied with the physician first selected. If, due to 14 the nature of the injury or its occurrence away from the 15 employer's place of business, the employee is unable to make 16 a selection from the Panel, the selection process from the 17 Panel shall not apply. The physician selected from the Panel 18 may arrange for any consultation, referral or other 19 specialized medical services outside the Panel at the 20 employer's expense. Provided that, in the event the 21 Commission shall find that a doctor selected by the employee 22 is rendering improper or inadequate care, the Commission may 23 order the employee to select another doctor certified or 24 qualified in the medical field for which treatment is 25 required. If the employee refuses to make such change the 26 Commission may relieve the employer of his obligation to pay 27 the doctor's charges from the date of refusal to the date of 28 compliance. 29 Every hospital, physician, surgeon or other person 30 rendering treatment or services in accordance with the 31 provisions of this Section shall upon written request furnish 32 full and complete reports thereof to, and permit their 33 records to be copied by, the employer, the employee or his 34 dependents, as the case may be, or any other party to any -10- LRB093 03315 AMC 03333 b 1 proceeding for compensation before the Commission, or their 2 attorneys. 3 Notwithstanding the foregoing, the employer's liability 4 to pay for such medical services selected by the employee 5 shall be limited to: 6 (1) all first aid and emergency treatment; plus 7 (2) all medical, surgical and hospital services 8 provided by the physician, surgeon or hospital initially 9 chosen by the employee or by any other physician, 10 consultant, expert, institution or other provider of 11 services recommended by said initial service provider or 12 any subsequent provider of medical services in the chain 13 of referrals from said initial service provider; plus 14 (3) all medical, surgical and hospital services 15 provided by any second physician, surgeon or hospital 16 subsequently chosen by the employee or by any other 17 physician, consultant, expert, institution or other 18 provider of services recommended by said second service 19 provider or any subsequent provider of medical services 20 in the chain of referrals from said second service 21 provider. Thereafter the employer shall select and pay 22 for all necessary medical, surgical and hospital 23 treatment and the employee may not select a provider of 24 medical services at the employer's expense unless the 25 employer agrees to such selection. At any time the 26 employee may obtain any medical treatment he desires at 27 his own expense. This paragraph shall not affect the duty 28 to pay for rehabilitation referred to above. 29 When an employer and employee so agree in writing, 30 nothing in this Act prevents an employee whose injury or 31 disability has been established under this Act, from relying 32 in good faith, on treatment by prayer or spiritual means 33 alone, in accordance with the tenets and practice of a 34 recognized church or religious denomination, by a duly -11- LRB093 03315 AMC 03333 b 1 accredited practitioner thereof, and having nursing services 2 appropriate therewith, without suffering loss or diminution 3 of the compensation benefits under this Act. However, the 4 employee shall submit to all physical examinations required 5 by this Act. The cost of such treatment and nursing care 6 shall be paid by the employee unless the employer agrees to 7 make such payment. 8 Where the accidental injury results in the amputation of 9 an arm, hand, leg or foot, or the enucleation of an eye, or 10 the loss of any of the natural teeth, the employer shall 11 furnish an artificial of any such members lost or damaged in 12 accidental injury arising out of and in the course of 13 employment, and shall also furnish the necessary braces in 14 all proper and necessary cases. In cases of the loss of a 15 member or members by amputation, the employer shall, whenever 16 necessary, maintain in good repair, refit or replace the 17 artificial limbs during the lifetime of the employee. Where 18 the accidental injury accompanied by physical injury results 19 in damage to a denture, eye glasses or contact eye lenses, or 20 where the accidental injury results in damage to an 21 artificial member, the employer shall replace or repair such 22 denture, glasses, lenses, or artificial member. 23 The furnishing by the employer of any such services or 24 appliances is not an admission of liability on the part of 25 the employer to pay compensation. 26 The furnishing of any such services or appliances or the 27 servicing thereof by the employer is not the payment of 28 compensation. 29 The provider of any services, treatment, care, 30 instruction, training, or appliances or other tangible things 31 for which an employer is responsible for payment under this 32 subsection (a) agrees to be bound by charges or payment 33 levels allowed by the Industrial Commission, and any dispute 34 regarding the reasonableness of a fee, charge, or payment -12- LRB093 03315 AMC 03333 b 1 level shall be resolved in accordance with Section 16 of this 2 Act or Section 16 of the Workers' Occupational Diseases Act. 3 Neither the provider nor an employer or insurance carrier may 4 seek payment from the employee if the employer is responsible 5 for payment under this subsection (a). 6 (b) If the period of temporary total incapacity for work 7 lasts more than 3 working days, weekly compensation as 8 hereinafter provided shall be paid beginning on the 4th day 9 of such temporary total incapacity and continuing as long as 10 the total temporary incapacity lasts. In cases where the 11 temporary total incapacity for work continues for a period of 12 14 days or more from the day of the accident compensation 13 shall commence on the day after the accident. 14 1. The compensation rate for temporary total 15 incapacity under this paragraph (b) of this Section shall 16 be equal to 66 2/3% of the employee's average weekly wage 17 computed in accordance with Section 10, provided that it 18 shall be not less than the following amounts in the 19 following cases: 20 $100.90 in case of a single person; 21 $105.50 in case of a married person with no 22 children; 23 $108.30 in case of one child; 24 $113.40 in case of 2 children; 25 $117.40 in case of 3 children; 26 $124.30 in case of 4 or more children; 27 nor exceed the employee's average weekly wage computed in 28 accordance with the provisions of Section 10, whichever 29 is less. 30 2. The compensation rate in all cases other than 31 for temporary total disability under this paragraph (b), 32 and other than for serious and permanent disfigurement 33 under paragraph (c) and other than for permanent partial 34 disability under subparagraph (2) of paragraph (d) or -13- LRB093 03315 AMC 03333 b 1 under paragraph (e), of this Section shall be equal to 66 2 2/3% of the employee's average weekly wage computed in 3 accordance with the provisions of Section 10, provided 4 that it shall be not less than the following amounts in 5 the following cases: 6 $80.90 in case of a single person; 7 $83.20 in case of a married person with no 8 children; 9 $86.10 in case of one child; 10 $88.90 in case of 2 children; 11 $91.80 in case of 3 children; 12 $96.90 in case of 4 or more children; 13 nor exceed the employee's average weekly wage computed in 14 accordance with the provisions of Section 10, whichever 15 is less. 16 2.1. The compensation rate in all cases of serious 17 and permanent disfigurement under paragraph (c) and of 18 permanent partial disability under subparagraph (2) of 19 paragraph (d) or under paragraph (e) of this Section 20 shall be equal to 60% of the employee's average weekly 21 wage computed in accordance with the provisions of 22 Section 10, provided that it shall be not less than the 23 following amounts in the following cases: 24 $80.90 in case of a single person; 25 $83.20 in case of a married person with no 26 children; 27 $86.10 in case of one child; 28 $88.90 in case of 2 children; 29 $91.80 in case of 3 children; 30 $96.90 in case of 4 or more children; 31 nor exceed the employee's average weekly wage computed in 32 accordance with the provisions of Section 10, whichever 33 is less. 34 3. As used in this Section the term "child" means a -14- LRB093 03315 AMC 03333 b 1 child of the employee including any child legally adopted 2 before the accident or whom at the time of the accident 3 the employee was under legal obligation to support or to 4 whom the employee stood in loco parentis, and who at the 5 time of the accident was under 18 years of age and not 6 emancipated. The term "children" means the plural of 7 "child". 8 4. All weekly compensation rates provided under 9 subparagraphs 1, 2 and 2.1 of this paragraph (b) of this 10 Section shall be subject to the following limitations: 11 The maximum weekly compensation rate from July 1, 12 1975, except as hereinafter provided, shall be 100% of 13 the State's average weekly wage in covered industries 14 under the Unemployment Insurance Act, that being the wage 15 that most closely approximates the State's average weekly 16 wage. 17 The maximum weekly compensation rate, for the period 18 July 1, 1984, through June 30, 1987, except as 19 hereinafter provided, shall be $293.61. Effective July 1, 20 1987 and on July 1 of each year thereafter the maximum 21 weekly compensation rate, except as hereinafter provided, 22 shall be determined as follows: if during the preceding 23 12 month period there shall have been an increase in the 24 State's average weekly wage in covered industries under 25 the Unemployment Insurance Act, the weekly compensation 26 rate shall be proportionately increased by the same 27 percentage as the percentage of increase in the State's 28 average weekly wage in covered industries under the 29 Unemployment Insurance Act during such period. 30 The maximum weekly compensation rate, for the period 31 January 1, 1981 through December 31, 1983, except as 32 hereinafter provided, shall be 100% of the State's 33 average weekly wage in covered industries under the 34 Unemployment Insurance Act in effect on January 1, 1981. -15- LRB093 03315 AMC 03333 b 1 Effective January 1, 1984 and on January 1, of each year 2 thereafter the maximum weekly compensation rate, except 3 as hereinafter provided, shall be determined as follows: 4 if during the preceding 12 month period there shall have 5 been an increase in the State's average weekly wage in 6 covered industries under the Unemployment Insurance Act, 7 the weekly compensation rate shall be proportionately 8 increased by the same percentage as the percentage of 9 increase in the State's average weekly wage in covered 10 industries under the Unemployment Insurance Act during 11 such period. 12 From July 1, 1977 and thereafter such maximum weekly 13 compensation rate in death cases under Section 7, and 14 permanent total disability cases under paragraph (f) or 15 subparagraph 18 of paragraph (3) of this Section and for 16 temporary total disability under paragraph (b) of this 17 Section and for amputation of a member or enucleation of 18 an eye under paragraph (e) of this Section shall be 19 increased to 133-1/3% of the State's average weekly wage 20 in covered industries under the Unemployment Insurance 21 Act. 22 4.1. Any provision herein to the contrary 23 notwithstanding, the weekly compensation rate for 24 compensation payments under subparagraph 18 of paragraph 25 (e) of this Section and under paragraph (f) of this 26 Section and under paragraph (a) of Section 7, shall in no 27 event be less than 50% of the State's average weekly wage 28 in covered industries under the Unemployment Insurance 29 Act. 30 4.2. Any provision to the contrary notwithstanding, 31 the total compensation payable under Section 7 shall not 32 exceed the greater of $250,000 or 20 years. 33 5. For the purpose of this Section this State's 34 average weekly wage in covered industries under the -16- LRB093 03315 AMC 03333 b 1 Unemployment Insurance Act on July 1, 1975 is hereby 2 fixed at $228.16 per week and the computation of 3 compensation rates shall be based on the aforesaid 4 average weekly wage until modified as hereinafter 5 provided. 6 6. The Department of Employment Security of the 7 State shall on or before the first day of December, 1977, 8 and on or before the first day of June, 1978, and on the 9 first day of each December and June of each year 10 thereafter, publish the State's average weekly wage in 11 covered industries under the Unemployment Insurance Act 12 and the Industrial Commission shall on the 15th day of 13 January, 1978 and on the 15th day of July, 1978 and on 14 the 15th day of each January and July of each year 15 thereafter, post and publish the State's average weekly 16 wage in covered industries under the Unemployment 17 Insurance Act as last determined and published by the 18 Department of Employment Security. The amount when so 19 posted and published shall be conclusive and shall be 20 applicable as the basis of computation of compensation 21 rates until the next posting and publication as 22 aforesaid. 23 7. The payment of compensation by an employer or 24 his insurance carrier to an injured employee shall not 25 constitute an admission of the employer's liability to 26 pay compensation. 27 (c) For any serious and permanent disfigurement to the 28 hand, head, face, neck, arm, leg below the knee or the chest 29 above the axillary line, the employee is entitled to 30 compensation for such disfigurement, the amount determined by 31 agreement at any time or by arbitration under this Act, at a 32 hearing not less than 6 months after the date of the 33 accidental injury, which amount shall not exceed 150 weeks at 34 the applicable rate provided in subparagraph 2.1 of paragraph -17- LRB093 03315 AMC 03333 b 1 (b) of this Section. 2 No compensation is payable under this paragraph where 3 compensation is payable under paragraphs (d), (e) or (f) of 4 this Section. 5 A duly appointed member of a fire department in a city, 6 the population of which exceeds 200,000 according to the last 7 federal or State census, is eligible for compensation under 8 this paragraph only where such serious and permanent 9 disfigurement results from burns. 10 (d) 1. If, after the accidental injury has been 11 sustained, the employee as a result thereof becomes partially 12 incapacitated from pursuing his usual and customary line of 13 employment, he shall, except in cases compensated under the 14 specific schedule set forth in paragraph (e) of this Section, 15 receive compensation for the duration of his disability, 16 subject to the limitations as to maximum amounts fixed in 17 paragraph (b) of this Section, equal to 66-2/3% of the 18 difference between the average amount which he would be able 19 to earn in the full performance of his duties in the 20 occupation in which he was engaged at the time of the 21 accident and the average amount which he is earning or is 22 able to earn in some suitable employment or business after 23 the accident. 24 2. If, as a result of the accident, the employee 25 sustains serious and permanent injuries not covered by 26 paragraphs (c) and (e) of this Section or having sustained 27 injuries covered by the aforesaid paragraphs (c) and (e), he 28 shall have sustained in addition thereto other injuries which 29 injuries do not incapacitate him from pursuing the duties of 30 his employment but which would disable him from pursuing 31 other suitable occupations, or which have otherwise resulted 32 in physical impairment; or if such injuries partially 33 incapacitate him from pursuing the duties of his usual and 34 customary line of employment but do not result in an -18- LRB093 03315 AMC 03333 b 1 impairment of earning capacity, or having resulted in an 2 impairment of earning capacity, the employee elects to waive 3 his right to recover under the foregoing subparagraph 1 of 4 paragraph (d) of this Section then in any of the foregoing 5 events, he shall receive in addition to compensation for 6 temporary total disability under paragraph (b) of this 7 Section, compensation at the rate provided in subparagraph 8 2.1 of paragraph (b) of this Section for that percentage of 9 500 weeks that the partial disability resulting from the 10 injuries covered by this paragraph bears to total disability. 11 If the employee shall have sustained a fracture of one or 12 more vertebra or fracture of the skull, the amount of 13 compensation allowed under this Section shall be not less 14 than 6 weeks for a fractured skull and 6 weeks for each 15 fractured vertebra, and in the event the employee shall have 16 sustained a fracture of any of the following facial bones: 17 nasal, lachrymal, vomer, zygoma, maxilla, palatine or 18 mandible, the amount of compensation allowed under this 19 Section shall be not less than 2 weeks for each such 20 fractured bone, and for a fracture of each transverse process 21 not less than 3 weeks. In the event such injuries shall 22 result in the loss of a kidney, spleen or lung, the amount of 23 compensation allowed under this Section shall be not less 24 than 10 weeks for each such organ. Compensation awarded 25 under this subparagraph 2 shall not take into consideration 26 injuries covered under paragraphs (c) and (e) of this Section 27 and the compensation provided in this paragraph shall not 28 affect the employee's right to compensation payable under 29 paragraphs (b), (c) and (e) of this Section for the 30 disabilities therein covered. 31 (e) For accidental injuries in the following schedule, 32 the employee shall receive compensation for the period of 33 temporary total incapacity for work resulting from such 34 accidental injury, under subparagraph 1 of paragraph (b) of -19- LRB093 03315 AMC 03333 b 1 this Section, and shall receive in addition thereto 2 compensation for a further period for the specific loss 3 herein mentioned, but shall not receive any compensation 4 under any other provisions of this Act. The following 5 listed amounts apply to either the loss of or the permanent 6 and complete loss of use of the member specified, such 7 compensation for the length of time as follows: 8 1. Thumb-70 weeks. 9 2. First, or index finger-40 weeks. 10 3. Second, or middle finger-35 weeks. 11 4. Third, or ring finger-25 weeks. 12 5. Fourth, or little finger-20 weeks. 13 6. Great toe-35 weeks. 14 7. Each toe other than great toe-12 weeks. 15 8. The loss of the first or distal phalanx of the 16 thumb or of any finger or toe shall be considered to be 17 equal to the loss of one-half of such thumb, finger or 18 toe and the compensation payable shall be one-half of the 19 amount above specified. The loss of more than one 20 phalanx shall be considered as the loss of the entire 21 thumb, finger or toe. In no case shall the amount 22 received for more than one finger exceed the amount 23 provided in this schedule for the loss of a hand. 24 9. Hand-190 weeks. The loss of 2 or more digits, 25 or one or more phalanges of 2 or more digits, of a hand 26 may be compensated on the basis of partial loss of use of 27 a hand, provided, further, that the loss of 4 digits, or 28 the loss of use of 4 digits, in the same hand shall 29 constitute the complete loss of a hand. 30 10. Arm-235 weeks. Where an accidental injury 31 results in the amputation of an arm below the elbow, such 32 injury shall be compensated as a loss of an arm. Where 33 an accidental injury results in the amputation of an arm 34 above the elbow, compensation for an additional 15 weeks -20- LRB093 03315 AMC 03333 b 1 shall be paid, except where the accidental injury results 2 in the amputation of an arm at the shoulder joint, or so 3 close to shoulder joint that an artificial arm cannot be 4 used, or results in the disarticulation of an arm at the 5 shoulder joint, in which case compensation for an 6 additional 65 weeks shall be paid. 7 11. Foot-155 weeks. 8 12. Leg-200 weeks. Where an accidental injury 9 results in the amputation of a leg below the knee, such 10 injury shall be compensated as loss of a leg. Where an 11 accidental injury results in the amputation of a leg 12 above the knee, compensation for an additional 25 weeks 13 shall be paid, except where the accidental injury results 14 in the amputation of a leg at the hip joint, or so close 15 to the hip joint that an artificial leg cannot be used, 16 or results in the disarticulation of a leg at the hip 17 joint, in which case compensation for an additional 75 18 weeks shall be paid. 19 13. Eye-150 weeks. Where an accidental injury 20 results in the enucleation of an eye, compensation for an 21 additional 10 weeks shall be paid. 22 14. Loss of hearing of one ear-50 weeks; total and 23 permanent loss of hearing of both ears-200 weeks. 24 15. Testicle-50 weeks; both testicles-150 weeks. 25 16. For the permanent partial loss of use of a 26 member or sight of an eye, or hearing of an ear, 27 compensation during that proportion of the number of 28 weeks in the foregoing schedule provided for the loss of 29 such member or sight of an eye, or hearing of an ear, 30 which the partial loss of use thereof bears to the total 31 loss of use of such member, or sight of eye, or hearing 32 of an ear. 33 (a) Loss of hearing for compensation purposes 34 shall be confined to the frequencies of 1,000, 2,000 -21- LRB093 03315 AMC 03333 b 1 and 3,000 cycles per second. Loss of hearing ability 2 for frequency tones above 3,000 cycles per second 3 are not to be considered as constituting disability 4 for hearing. 5 (b) The percent of hearing loss, for purposes 6 of the determination of compensation claims for 7 occupational deafness, shall be calculated as the 8 average in decibels for the thresholds of hearing 9 for the frequencies of 1,000, 2,000 and 3,000 cycles 10 per second. Pure tone air conduction audiometric 11 instruments, approved by nationally recognized 12 authorities in this field, shall be used for 13 measuring hearing loss. If the losses of hearing 14 average 30 decibels or less in the 3 frequencies, 15 such losses of hearing shall not then constitute any 16 compensable hearing disability. If the losses of 17 hearing average 85 decibels or more in the 3 18 frequencies, then the same shall constitute and be 19 total or 100% compensable hearing loss. 20 (c) In measuring hearing impairment, the 21 lowest measured losses in each of the 3 frequencies 22 shall be added together and divided by 3 to 23 determine the average decibel loss. For every 24 decibel of loss exceeding 30 decibels an allowance 25 of 1.82% shall be made up to the maximum of 100% 26 which is reached at 85 decibels. 27 (d) If a hearing loss is established to have 28 existed on July 1, 1975 by audiometric testing the 29 employer shall not be liable for the previous loss 30 so established nor shall he be liable for any loss 31 for which compensation has been paid or awarded. 32 (e) No consideration shall be given to the 33 question of whether or not the ability of an 34 employee to understand speech is improved by the use -22- LRB093 03315 AMC 03333 b 1 of a hearing aid. 2 (f) No claim for loss of hearing due to 3 industrial noise shall be brought against an 4 employer or allowed unless the employee has been 5 exposed for a period of time sufficient to cause 6 permanent impairment to noise levels in excess of 7 the following: 8 Sound Level DBA 9 Slow Response Hours Per Day 10 90 8 11 92 6 12 95 4 13 97 3 14 100 2 15 102 1-1/2 16 105 1 17 110 1/2 18 115 1/4 19 This subparagraph (f) shall not be applied in cases 20 of hearing loss resulting from trauma or explosion. 21 17. In computing the compensation to be paid to any 22 employee who, before the accident for which he claims 23 compensation, had before that time sustained an injury 24 resulting in the loss by amputation or partial loss by 25 amputation of any member, including hand, arm, thumb or 26 fingers, leg, foot or any toes, such loss or partial loss 27 of any such member shall be deducted from any award made 28 for the subsequent injury. For the permanent loss of use 29 or the permanent partial loss of use of any such member 30 or the partial loss of sight of an eye, for which 31 compensation has been paid, then such loss shall be taken 32 into consideration and deducted from any award for the 33 subsequent injury. 34 18. The specific case of loss of both hands, both -23- LRB093 03315 AMC 03333 b 1 arms, or both feet, or both legs, or both eyes, or of any 2 two thereof, or the permanent and complete loss of the 3 use thereof, constitutes total and permanent disability, 4 to be compensated according to the compensation fixed by 5 paragraph (f) of this Section. These specific cases of 6 total and permanent disability do not exclude other 7 cases. 8 Any employee who has previously suffered the loss or 9 permanent and complete loss of the use of any of such 10 members, and in a subsequent independent accident loses 11 another or suffers the permanent and complete loss of the 12 use of any one of such members the employer for whom the 13 injured employee is working at the time of the last 14 independent accident is liable to pay compensation only 15 for the loss or permanent and complete loss of the use of 16 the member occasioned by the last independent accident. 17 19. In a case of specific loss and the subsequent 18 death of such injured employee from other causes than 19 such injury leaving a widow, widower, or dependents 20 surviving before payment or payment in full for such 21 injury, then the amount due for such injury is payable to 22 the widow or widower and, if there be no widow or 23 widower, then to such dependents, in the proportion which 24 such dependency bears to total dependency. 25 Beginning July 1, 1980, and every 6 months thereafter, 26 the Commission shall examine the Second Injury Fund and when, 27 after deducting all advances or loans made to such Fund, the 28 amount therein is $500,000 then the amount required to be 29 paid by employers pursuant to paragraph (f) of Section 7 30 shall be reduced by one-half. When the Second Injury Fund 31 reaches the sum of $600,000 then the payments shall cease 32 entirely. However, when the Second Injury Fund has been 33 reduced to $400,000, payment of one-half of the amounts 34 required by paragraph (f) of Section 7 shall be resumed, in -24- LRB093 03315 AMC 03333 b 1 the manner herein provided, and when the Second Injury Fund 2 has been reduced to $300,000, payment of the full amounts 3 required by paragraph (f) of Section 7 shall be resumed, in 4 the manner herein provided. The Commission shall make the 5 changes in payment effective by general order, and the 6 changes in payment become immediately effective for all cases 7 coming before the Commission thereafter either by settlement 8 agreement or final order, irrespective of the date of the 9 accidental injury. 10 On August 1, 1996 and on February 1 and August 1 of each 11 subsequent year, the Commission shall examine the special 12 fund designated as the "Rate Adjustment Fund" and when, after 13 deducting all advances or loans made to said fund, the amount 14 therein is $4,000,000, the amount required to be paid by 15 employers pursuant to paragraph (f) of Section 7 shall be 16 reduced by one-half. When the Rate Adjustment Fund reaches 17 the sum of $5,000,000 the payment therein shall cease 18 entirely. However, when said Rate Adjustment Fund has been 19 reduced to $3,000,000 the amounts required by paragraph (f) 20 of Section 7 shall be resumed in the manner herein provided. 21 (f) In case of complete disability, which renders the 22 employee wholly and permanently incapable of work, or in the 23 specific case of total and permanent disability as provided 24 in subparagraph 18 of paragraph (e) of this Section, 25 compensation shall be payable at the rate provided in 26 subparagraph 2 of paragraph (b) of this Section for life. 27 An employee entitled to benefits under paragraph (f) of 28 this Section shall also be entitled to receive from the Rate 29 Adjustment Fund provided in paragraph (f) of Section 7 of the 30 supplementary benefits provided in paragraph (g) of this 31 Section 8. 32 If any employee who receives an award under this 33 paragraph afterwards returns to work or is able to do so, and 34 earns or is able to earn as much as before the accident, -25- LRB093 03315 AMC 03333 b 1 payments under such award shall cease. If such employee 2 returns to work, or is able to do so, and earns or is able to 3 earn part but not as much as before the accident, such award 4 shall be modified so as to conform to an award under 5 paragraph (d) of this Section. If such award is terminated 6 or reduced under the provisions of this paragraph, such 7 employees have the right at any time within 30 months after 8 the date of such termination or reduction to file petition 9 with the Commission for the purpose of determining whether 10 any disability exists as a result of the original accidental 11 injury and the extent thereof. 12 Disability as enumerated in subdivision 18, paragraph (e) 13 of this Section is considered complete disability. 14 If an employee who had previously incurred loss or the 15 permanent and complete loss of use of one member, through the 16 loss or the permanent and complete loss of the use of one 17 hand, one arm, one foot, one leg, or one eye, incurs 18 permanent and complete disability through the loss or the 19 permanent and complete loss of the use of another member, he 20 shall receive, in addition to the compensation payable by the 21 employer and after such payments have ceased, an amount from 22 the Second Injury Fund provided for in paragraph (f) of 23 Section 7, which, together with the compensation payable from 24 the employer in whose employ he was when the last accidental 25 injury was incurred, will equal the amount payable for 26 permanent and complete disability as provided in this 27 paragraph of this Section. 28 The custodian of the Second Injury Fund provided for in 29 paragraph (f) of Section 7 shall be joined with the employer 30 as a party respondent in the application for adjustment of 31 claim. The application for adjustment of claim shall state 32 briefly and in general terms the approximate time and place 33 and manner of the loss of the first member. 34 In its award the Commission or the Arbitrator shall -26- LRB093 03315 AMC 03333 b 1 specifically find the amount the injured employee shall be 2 weekly paid, the number of weeks compensation which shall be 3 paid by the employer, the date upon which payments begin out 4 of the Second Injury Fund provided for in paragraph (f) of 5 Section 7 of this Act, the length of time the weekly payments 6 continue, the date upon which the pension payments commence 7 and the monthly amount of the payments. The Commission shall 8 30 days after the date upon which payments out of the Second 9 Injury Fund have begun as provided in the award, and every 10 month thereafter, prepare and submit to the State Comptroller 11 a voucher for payment for all compensation accrued to that 12 date at the rate fixed by the Commission. The State 13 Comptroller shall draw a warrant to the injured employee 14 along with a receipt to be executed by the injured employee 15 and returned to the Commission. The endorsed warrant and 16 receipt is a full and complete acquittance to the Commission 17 for the payment out of the Second Injury Fund. No other 18 appropriation or warrant is necessary for payment out of the 19 Second Injury Fund. The Second Injury Fund is appropriated 20 for the purpose of making payments according to the terms of 21 the awards. 22 As of July 1, 1980 to July 1, 1982, all claims against 23 and obligations of the Second Injury Fund shall become claims 24 against and obligations of the Rate Adjustment Fund to the 25 extent there is insufficient money in the Second Injury Fund 26 to pay such claims and obligations. In that case, all 27 references to "Second Injury Fund" in this Section shall also 28 include the Rate Adjustment Fund. 29 (g) Every award for permanent total disability entered 30 by the Commission on and after July 1, 1965 under which 31 compensation payments shall become due and payable after the 32 effective date of this amendatory Act, and every award for 33 death benefits or permanent total disability entered by the 34 Commission on and after the effective date of this amendatory -27- LRB093 03315 AMC 03333 b 1 Act shall be subject to annual adjustments as to the amount 2 of the compensation rate therein provided. Such adjustments 3 shall first be made on July 15, 1977, and all awards made and 4 entered prior to July 1, 1975 and on July 15 of each year 5 thereafter. In all other cases such adjustment shall be made 6 on July 15 of the second year next following the date of the 7 entry of the award and shall further be made on July 15 8 annually thereafter. If during the intervening period from 9 the date of the entry of the award, or the last periodic 10 adjustment, there shall have been an increase in the State's 11 average weekly wage in covered industries under the 12 Unemployment Insurance Act, the weekly compensation rate 13 shall be proportionately increased by the same percentage as 14 the percentage of increase in the State's average weekly wage 15 in covered industries under the Unemployment Insurance Act. 16 The increase in the compensation rate under this paragraph 17 shall in no event bring the total compensation rate to an 18 amount greater than the prevailing maximum rate. Such 19 increase shall be paid in the same manner as herein provided 20 for payments under the Second Injury Fund to the injured 21 employee, or his dependents, as the case may be, out of the 22 Rate Adjustment Fund provided in paragraph (f) of Section 7 23 of this Act. Payments shall be made at the same intervals as 24 provided in the award or, at the option of the Commission, 25 may be made in quarterly payment on the 15th day of January, 26 April, July and October of each year. In the event of a 27 decrease in such average weekly wage there shall be no change 28 in the then existing compensation rate. The within paragraph 29 shall not apply to cases where there is disputed liability 30 and in which a compromise lump sum settlement between the 31 employer and the injured employee, or his dependents, as the 32 case may be, has been duly approved by the Industrial 33 Commission. 34 Provided, that in cases of awards entered by the -28- LRB093 03315 AMC 03333 b 1 Commission for injuries occurring before July 1, 1975, the 2 increases in the compensation rate adjusted under the 3 foregoing provision of this paragraph (g) shall be limited to 4 increases in the State's average weekly wage in covered 5 industries under the Unemployment Insurance Act occurring 6 after July 1, 1975. 7 (h) In case death occurs from any cause before the total 8 compensation to which the employee would have been entitled 9 has been paid, then in case the employee leaves any widow, 10 widower, child, parent (or any grandchild, grandparent or 11 other lineal heir or any collateral heir dependent at the 12 time of the accident upon the earnings of the employee to the 13 extent of 50% or more of total dependency) such compensation 14 shall be paid to the beneficiaries of the deceased employee 15 and distributed as provided in paragraph (g) of Section 7. 16 (h-1) In case an injured employee is under legal 17 disability at the time when any right or privilege accrues to 18 him or her under this Act, a guardian may be appointed 19 pursuant to law, and may, on behalf of such person under 20 legal disability, claim and exercise any such right or 21 privilege with the same effect as if the employee himself or 22 herself had claimed or exercised the right or privilege. No 23 limitations of time provided by this Act run so long as the 24 employee who is under legal disability is without a 25 conservator or guardian. 26 (i) In case the injured employee is under 16 years of 27 age at the time of the accident and is illegally employed, 28 the amount of compensation payable under paragraphs (b), (c), 29 (d), (e) and (f) of this Section is increased 50%. 30 However, where an employer has on file an employment 31 certificate issued pursuant to the Child Labor Law or work 32 permit issued pursuant to the Federal Fair Labor Standards 33 Act, as amended, or a birth certificate properly and duly 34 issued, such certificate, permit or birth certificate is -29- LRB093 03315 AMC 03333 b 1 conclusive evidence as to the age of the injured minor 2 employee for the purposes of this Section. 3 Nothing herein contained repeals or amends the provisions 4 of the Child Labor Law relating to the employment of minors 5 under the age of 16 years. 6 (j) 1. In the event the injured employee receives 7 benefits, including medical, surgical or hospital benefits 8 under any group plan covering non-occupational disabilities 9 contributed to wholly or partially by the employer, which 10 benefits should not have been payable if any rights of 11 recovery existed under this Act, then such amounts so paid to 12 the employee from any such group plan as shall be consistent 13 with, and limited to, the provisions of paragraph 2 hereof, 14 shall be credited to or against any compensation payment for 15 temporary total incapacity for work or any medical, surgical 16 or hospital benefits made or to be made under this Act. In 17 such event, the period of time for giving notice of 18 accidental injury and filing application for adjustment of 19 claim does not commence to run until the termination of such 20 payments. This paragraph does not apply to payments made 21 under any group plan which would have been payable 22 irrespective of an accidental injury under this Act. Any 23 employer receiving such credit shall keep such employee safe 24 and harmless from any and all claims or liabilities that may 25 be made against him by reason of having received such 26 payments only to the extent of such credit. 27 Any excess benefits paid to or on behalf of a State 28 employee by the State Employees' Retirement System under 29 Article 14 of the Illinois Pension Code on a death claim or 30 disputed disability claim shall be credited against any 31 payments made or to be made by the State of Illinois to or on 32 behalf of such employee under this Act, except for payments 33 for medical expenses which have already been incurred at the 34 time of the award. The State of Illinois shall directly -30- LRB093 03315 AMC 03333 b 1 reimburse the State Employees' Retirement System to the 2 extent of such credit. 3 2. Nothing contained in this Act shall be construed to 4 give the employer or the insurance carrier the right to 5 credit for any benefits or payments received by the employee 6 other than compensation payments provided by this Act, and 7 where the employee receives payments other than compensation 8 payments, whether as full or partial salary, group insurance 9 benefits, bonuses, annuities or any other payments, the 10 employer or insurance carrier shall receive credit for each 11 such payment only to the extent of the compensation that 12 would have been payable during the period covered by such 13 payment. 14 3. The extension of time for the filing of an 15 Application for Adjustment of Claim as provided in paragraph 16 1 above shall not apply to those cases where the time for 17 such filing had expired prior to the date on which payments 18 or benefits enumerated herein have been initiated or resumed. 19 Provided however that this paragraph 3 shall apply only to 20 cases wherein the payments or benefits hereinabove enumerated 21 shall be received after July 1, 1969. 22 (Source: P.A. 89-470, eff. 6-13-96.) 23 Section 99. Effective date. This Act takes effect upon 24 becoming law.