Rep. John E. Bradley
Filed: 1/7/2011
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1 | AMENDMENT TO SENATE BILL 1066
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2 | AMENDMENT NO. ______. Amend Senate Bill 1066, AS AMENDED, | ||||||
3 | by replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | Section 5. The Department of Central Management Services | ||||||
6 | Law of the
Civil Administrative Code of Illinois is amended by | ||||||
7 | changing Section 405-411 as follows: | ||||||
8 | (20 ILCS 405/405-411) | ||||||
9 | Sec. 405-411. Consolidation of workers' compensation | ||||||
10 | functions. | ||||||
11 | (a) Notwithstanding any other law to the contrary, the | ||||||
12 | Director of Central Management Services, working in | ||||||
13 | cooperation with the Director of any other agency, department, | ||||||
14 | board, or commission directly responsible to the Governor, may | ||||||
15 | direct the consolidation, within the Department of Central | ||||||
16 | Management Services, of those workers' compensation functions |
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1 | at that agency, department, board, or commission that are | ||||||
2 | suitable for centralization. | ||||||
3 | Upon receipt of the written direction to transfer workers' | ||||||
4 | compensation functions to the Department of Central Management | ||||||
5 | Services, the personnel, equipment, and property (both real and | ||||||
6 | personal) directly relating to the transferred functions shall | ||||||
7 | be transferred to the Department of Central Management | ||||||
8 | Services, and the relevant documents, records, and | ||||||
9 | correspondence shall be transferred or copied, as the Director | ||||||
10 | may prescribe. | ||||||
11 | (b) Upon receiving written direction from the Director of | ||||||
12 | Central Management Services, the Comptroller and Treasurer are | ||||||
13 | authorized to transfer the unexpended balance of any | ||||||
14 | appropriations related to the workers' compensation functions | ||||||
15 | transferred to the Department of Central Management Services | ||||||
16 | and shall make the necessary fund transfers from the General | ||||||
17 | Revenue Fund, any special fund in the State treasury, or any | ||||||
18 | other federal or State trust fund held by the Treasurer to the | ||||||
19 | Workers' Compensation Revolving Fund for use by the Department | ||||||
20 | of Central Management Services in support of workers' | ||||||
21 | compensation functions or any other related costs or expenses | ||||||
22 | of the Department of Central Management Services. | ||||||
23 | (c) The rights of employees and the State and its agencies | ||||||
24 | under the Personnel Code and applicable collective bargaining | ||||||
25 | agreements or under any pension, retirement, or annuity plan | ||||||
26 | shall not be affected by any transfer under this Section. |
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1 | (d) The functions transferred to the Department of Central | ||||||
2 | Management Services by this Section shall be vested in and | ||||||
3 | shall be exercised by the Department of Central Management | ||||||
4 | Services. Each act done in the exercise of those functions | ||||||
5 | shall have the same legal effect as if done by the agencies, | ||||||
6 | offices, divisions, departments, bureaus, boards and | ||||||
7 | commissions from which they were transferred. | ||||||
8 | Every person or other entity shall be subject to the same | ||||||
9 | obligations and duties and any penalties, civil or criminal, | ||||||
10 | arising therefrom, and shall have the same rights arising from | ||||||
11 | the exercise of such rights, powers, and duties as had been | ||||||
12 | exercised by the agencies, offices, divisions, departments, | ||||||
13 | bureaus, boards, and commissions from which they were | ||||||
14 | transferred. | ||||||
15 | Whenever reports or notices are now required to be made or | ||||||
16 | given or papers or documents furnished or served by any person | ||||||
17 | in regards to the functions transferred to or upon the | ||||||
18 | agencies, offices, divisions, departments, bureaus, boards, | ||||||
19 | and commissions from which the functions were transferred, the | ||||||
20 | same shall be made, given, furnished or served in the same | ||||||
21 | manner to or upon the Department of Central Management | ||||||
22 | Services. | ||||||
23 | This Section does not affect any act done, ratified, or | ||||||
24 | cancelled or any right occurring or established or any action | ||||||
25 | or proceeding had or commenced in an administrative, civil, or | ||||||
26 | criminal cause regarding the functions transferred, but those |
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1 | proceedings may be continued by the Department of Central | ||||||
2 | Management Services. | ||||||
3 | This Section does not affect the legality of any rules in | ||||||
4 | the Illinois Administrative Code regarding the functions | ||||||
5 | transferred in this Section that are in force on the effective | ||||||
6 | date of this Section. If necessary, however, the affected | ||||||
7 | agencies shall propose, adopt, or repeal rules, rule | ||||||
8 | amendments, and rule recodifications as appropriate to | ||||||
9 | effectuate this Section.
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10 | (e) There is hereby created within the Department of | ||||||
11 | Central Management Services an advisory body to be known as the | ||||||
12 | Workers' Compensation Advisory Board to review, assess, and | ||||||
13 | provide recommendations to improve the State workers' | ||||||
14 | compensation program and to ensure that the State manages the | ||||||
15 | program in the interests of injured workers and taxpayers. The | ||||||
16 | Governor, the Speaker of the House of Representatives, the | ||||||
17 | Minority Leader of the House of Representatives, the President | ||||||
18 | of the Senate, and the Minority Leader of the Senate shall each | ||||||
19 | appoint one person to the Board. Each Board member initially | ||||||
20 | appointed to the Board shall serve a term ending December 31, | ||||||
21 | 2013. Each Board member appointed thereafter shall serve a | ||||||
22 | 3-year term, and a Board member shall continue to serve on the | ||||||
23 | Board until his or her successor is appointed. In addition, the | ||||||
24 | Director of the Department of Central Management Services, the | ||||||
25 | Attorney General, the Director of the Department of Insurance, | ||||||
26 | the Director of the Department of Corrections, the Secretary of |
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1 | the Department of Transportation, the Secretary of the | ||||||
2 | Department of Human Services, and the Commissioner of the | ||||||
3 | Illinois Workers' Compensation Commission, or their designees, | ||||||
4 | shall serve on the Board. The Board shall select one of its | ||||||
5 | members to serve as Chairperson. Members of the Board shall not | ||||||
6 | receive compensation but shall be reimbursed from the Workers' | ||||||
7 | Compensation Revolving Fund for reasonable expenses incurred | ||||||
8 | in the necessary performance of their duties, and the | ||||||
9 | Department of Central Management Services shall provide | ||||||
10 | administrative support to the Board. The Board shall meet at | ||||||
11 | least 3 times per year, or more often if the Board deems it | ||||||
12 | necessary or proper. By July 1, 2011, the Board shall issue a | ||||||
13 | written report, to be delivered to the Governor, the Director | ||||||
14 | of the Department of Central Management Services, and the | ||||||
15 | General Assembly, with a recommended set of best practices for | ||||||
16 | the State workers' compensation program. By July 1st of each | ||||||
17 | year thereafter, the Board shall issue a written report, to be | ||||||
18 | delivered to those same persons or entities, with | ||||||
19 | recommendations on how to improve upon such practices. | ||||||
20 | (Source: P.A. 93-839, eff. 7-30-04.) | ||||||
21 | Section 10. The Workers' Compensation Act is amended by | ||||||
22 | changing Sections 4, 8, 8.2, 8.3, 8.7, 11, 14, and 25.5 and | ||||||
23 | adding Sections 16b, 29.1, and 29.2 as follows:
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24 | (820 ILCS 305/4) (from Ch. 48, par. 138.4)
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1 | Sec. 4. (a) Any employer, including but not limited to | ||||||
2 | general contractors
and their subcontractors, who shall come | ||||||
3 | within the provisions of
Section 3 of this Act, and any other | ||||||
4 | employer who shall elect to provide
and pay the compensation | ||||||
5 | provided for in this Act shall:
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6 | (1) File with the Commission annually an application | ||||||
7 | for approval as a
self-insurer which shall include a | ||||||
8 | current financial statement, and
annually, thereafter, an | ||||||
9 | application for renewal of self-insurance, which
shall | ||||||
10 | include a current financial statement. Said
application | ||||||
11 | and financial statement shall be signed and sworn to by the
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12 | president or vice president and secretary or assistant | ||||||
13 | secretary of the
employer if it be a corporation, or by all | ||||||
14 | of the partners, if it be a
copartnership, or by the owner | ||||||
15 | if it be neither a copartnership nor a
corporation. All | ||||||
16 | initial applications and all applications for renewal of
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17 | self-insurance must be submitted at least 60 days prior to | ||||||
18 | the requested
effective date of self-insurance. An | ||||||
19 | employer may elect to provide and pay
compensation as | ||||||
20 | provided
for in this Act as a member of a group workers' | ||||||
21 | compensation pool under Article
V 3/4 of the Illinois | ||||||
22 | Insurance Code. If an employer becomes a member of a
group | ||||||
23 | workers' compensation pool, the employer shall not be | ||||||
24 | relieved of any
obligations imposed by this Act.
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25 | If the sworn application and financial statement of any | ||||||
26 | such employer
does not satisfy the Commission of the |
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1 | financial ability of the employer
who has filed it, the | ||||||
2 | Commission shall require such employer to,
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3 | (2) Furnish security, indemnity or a bond guaranteeing | ||||||
4 | the payment
by the employer of the compensation provided | ||||||
5 | for in this Act, provided
that any such employer whose | ||||||
6 | application and financial statement shall
not have | ||||||
7 | satisfied the commission of his or her financial ability | ||||||
8 | and
who shall have secured his liability in part by excess | ||||||
9 | liability insurance
shall be required to furnish to the | ||||||
10 | Commission security, indemnity or bond
guaranteeing his or | ||||||
11 | her payment up to the effective limits of the excess
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12 | coverage, or
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13 | (3) Insure his entire liability to pay such | ||||||
14 | compensation in some
insurance carrier authorized, | ||||||
15 | licensed, or permitted to do such
insurance business in | ||||||
16 | this State. Every policy of an insurance carrier,
insuring | ||||||
17 | the payment of compensation under this Act shall cover all | ||||||
18 | the
employees and the entire compensation liability of the | ||||||
19 | insured:
Provided, however, that any employer may insure | ||||||
20 | his or her compensation
liability with 2 or more insurance | ||||||
21 | carriers or may insure a part and
qualify under subsection | ||||||
22 | 1, 2, or 4 for the remainder of his or her
liability to pay | ||||||
23 | such compensation, subject to the following two | ||||||
24 | provisions:
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25 | Firstly, the entire compensation liability of the | ||||||
26 | employer to
employees working at or from one location |
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1 | shall be insured in one such
insurance carrier or shall | ||||||
2 | be self-insured, and
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3 | Secondly, the employer shall submit evidence | ||||||
4 | satisfactorily to the
Commission that his or her entire | ||||||
5 | liability for the compensation provided
for in this Act | ||||||
6 | will be secured. Any provisions in any policy, or in | ||||||
7 | any
endorsement attached thereto, attempting to limit | ||||||
8 | or modify in any way,
the liability of the insurance | ||||||
9 | carriers issuing the same except as
otherwise provided | ||||||
10 | herein shall be wholly void.
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11 | Nothing herein contained shall apply to policies of | ||||||
12 | excess liability
carriage secured by employers who have | ||||||
13 | been approved by the Commission
as self-insurers, or
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14 | (4) Make some other provision, satisfactory to the | ||||||
15 | Commission, for
the securing of the payment of compensation | ||||||
16 | provided for in this Act,
and
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17 | (5) Upon becoming subject to this Act and thereafter as | ||||||
18 | often as the
Commission may in writing demand, file with | ||||||
19 | the Commission in form prescribed
by it evidence of his or | ||||||
20 | her compliance with the provision of this Section.
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21 | (a-1) Regardless of its state of domicile or its principal | ||||||
22 | place of
business, an employer shall make payments to its | ||||||
23 | insurance carrier or group
self-insurance fund, where | ||||||
24 | applicable, based upon the premium rates of the
situs where the | ||||||
25 | work or project is located in Illinois if:
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26 | (A) the employer is engaged primarily in the building |
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1 | and
construction industry; and
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2 | (B) subdivision (a)(3) of this Section applies to the | ||||||
3 | employer or
the employer is a member of a group | ||||||
4 | self-insurance plan as defined in
subsection (1) of Section | ||||||
5 | 4a.
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6 | The Illinois Workers' Compensation Commission shall impose | ||||||
7 | a penalty upon an employer
for violation of this subsection | ||||||
8 | (a-1) if:
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9 | (i) the employer is given an opportunity at a hearing | ||||||
10 | to present
evidence of its compliance with this subsection | ||||||
11 | (a-1); and
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12 | (ii) after the hearing, the Commission finds that the | ||||||
13 | employer
failed to make payments upon the premium rates of | ||||||
14 | the situs where the work or
project is located in Illinois.
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15 | The penalty shall not exceed $1,000 for each day of work | ||||||
16 | for which
the employer failed to make payments upon the premium | ||||||
17 | rates of the situs where
the
work or project is located in | ||||||
18 | Illinois, but the total penalty shall not exceed
$50,000 for | ||||||
19 | each project or each contract under which the work was
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20 | performed.
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21 | Any penalty under this subsection (a-1) must be imposed not | ||||||
22 | later
than one year after the expiration of the applicable | ||||||
23 | limitation period
specified in subsection (d) of Section 6 of | ||||||
24 | this Act. Penalties imposed under
this subsection (a-1) shall | ||||||
25 | be deposited into the Illinois Workers' Compensation | ||||||
26 | Commission
Operations Fund, a special fund that is created in |
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1 | the State treasury. Subject
to appropriation, moneys in the | ||||||
2 | Fund shall be used solely for the operations
of the Illinois | ||||||
3 | Workers' Compensation Commission and by the Department of | ||||||
4 | Financial and Professional Regulation for the purposes | ||||||
5 | authorized in subsection (c) of Section 25.5 of this Act.
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6 | (a-2) For purposes of this subsection, "Professional | ||||||
7 | Employer Organization" or "PEO" means an entity or group of | ||||||
8 | entities that provides the services of its workers to its | ||||||
9 | client or clients through an arrangement for a fee pursuant to | ||||||
10 | an agreement, written or otherwise. "Professional Employer | ||||||
11 | Organization" or "PEO" also includes an employee leasing | ||||||
12 | company or other similarly administered arrangement. Any | ||||||
13 | workers' compensation insurance policy issued to a PEO shall at | ||||||
14 | a minimum provide the following information to the Commission | ||||||
15 | or any entity designated by the Commission regarding each | ||||||
16 | policy issued to the PEO: | ||||||
17 | (1) Each client company of the PEO listed as an | ||||||
18 | additional named insured. | ||||||
19 | (2) Information schedules attached to the master | ||||||
20 | policy to identify each individual company's name, FEIN, | ||||||
21 | and job location. | ||||||
22 | (3) A certificate of insurance coverage document | ||||||
23 | issued to each client company specifying its rights and | ||||||
24 | obligations under the master policy that clearly | ||||||
25 | establishes both the identity and status of the client, as | ||||||
26 | well as the dates of inception and termination of coverage, |
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1 | if applicable. | ||||||
2 | (b) The sworn application and financial statement, or | ||||||
3 | security,
indemnity or bond, or amount of insurance, or other | ||||||
4 | provisions, filed,
furnished, carried, or made by the employer, | ||||||
5 | as the case may be, shall
be subject to the approval of the | ||||||
6 | Commission.
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7 | Deposits under escrow agreements shall be cash, negotiable | ||||||
8 | United
States government bonds or negotiable general | ||||||
9 | obligation bonds of the
State of Illinois. Such cash or bonds | ||||||
10 | shall be deposited in
escrow with any State or National Bank or | ||||||
11 | Trust Company having trust
authority in the State of Illinois.
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12 | Upon the approval of the sworn application and financial | ||||||
13 | statement,
security, indemnity or bond or amount of insurance, | ||||||
14 | filed, furnished or
carried, as the case may be, the Commission | ||||||
15 | shall send to the employer
written notice of its approval | ||||||
16 | thereof. The certificate of compliance
by the employer with the | ||||||
17 | provisions of subparagraphs (2) and (3) of
paragraph (a) of | ||||||
18 | this Section shall be delivered by the insurance
carrier to the | ||||||
19 | Illinois Workers' Compensation Commission within five days | ||||||
20 | after the
effective date of the policy so certified. The | ||||||
21 | insurance so certified
shall cover all compensation liability | ||||||
22 | occurring during the time that
the insurance is in effect and | ||||||
23 | no further certificate need be filed in case
such insurance is | ||||||
24 | renewed, extended or otherwise continued by such
carrier. The | ||||||
25 | insurance so certified shall not be cancelled or in the
event | ||||||
26 | that such insurance is not renewed, extended or otherwise
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1 | continued, such insurance shall not be terminated until at | ||||||
2 | least 10
days after receipt by the Illinois Workers' | ||||||
3 | Compensation Commission of notice of the
cancellation or | ||||||
4 | termination of said insurance; provided, however, that
if the | ||||||
5 | employer has secured insurance from another insurance carrier, | ||||||
6 | or
has otherwise secured the payment of compensation in | ||||||
7 | accordance with
this Section, and such insurance or other | ||||||
8 | security becomes effective
prior to the expiration of the 10 | ||||||
9 | days, cancellation or termination may, at
the option of the | ||||||
10 | insurance carrier indicated in such notice, be effective
as of | ||||||
11 | the effective date of such other insurance or security.
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12 | (c) Whenever the Commission shall find that any | ||||||
13 | corporation,
company, association, aggregation of individuals, | ||||||
14 | reciprocal or
interinsurers exchange, or other insurer | ||||||
15 | effecting workers' compensation
insurance in this State shall | ||||||
16 | be insolvent, financially unsound, or
unable to fully meet all | ||||||
17 | payments and liabilities assumed or to be
assumed for | ||||||
18 | compensation insurance in this State, or shall practice a
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19 | policy of delay or unfairness toward employees in the | ||||||
20 | adjustment,
settlement, or payment of benefits due such | ||||||
21 | employees, the Commission
may after reasonable notice and | ||||||
22 | hearing order and direct that such
corporation, company, | ||||||
23 | association, aggregation of individuals,
reciprocal or | ||||||
24 | interinsurers exchange, or insurer, shall from and after a
date | ||||||
25 | fixed in such order discontinue the writing of any such | ||||||
26 | workers'
compensation insurance in this State. Subject to such |
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1 | modification of
the order as the Commission may later make on | ||||||
2 | review of the order,
as herein provided, it shall thereupon be | ||||||
3 | unlawful for any such
corporation, company, association, | ||||||
4 | aggregation of individuals,
reciprocal or interinsurers | ||||||
5 | exchange, or insurer to effect any workers'
compensation | ||||||
6 | insurance in this State. A copy of the order shall be served
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7 | upon the Director of Insurance by registered mail. Whenever the | ||||||
8 | Commission
finds that any service or adjustment company used or | ||||||
9 | employed
by a self-insured employer or by an insurance carrier | ||||||
10 | to process,
adjust, investigate, compromise or otherwise | ||||||
11 | handle claims under this
Act, has practiced or is practicing a | ||||||
12 | policy of delay or unfairness
toward employees in the | ||||||
13 | adjustment, settlement or payment of benefits
due such | ||||||
14 | employees, the Commission may after reasonable notice and
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15 | hearing order and direct that such service or adjustment | ||||||
16 | company shall
from and after a date fixed in such order be | ||||||
17 | prohibited from processing,
adjusting, investigating, | ||||||
18 | compromising or otherwise handling claims
under this Act.
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19 | Whenever the Commission finds that any self-insured | ||||||
20 | employer has
practiced or is practicing delay or unfairness | ||||||
21 | toward employees in the
adjustment, settlement or payment of | ||||||
22 | benefits due such employees, the
Commission may, after | ||||||
23 | reasonable notice and hearing, order and direct
that after a | ||||||
24 | date fixed in the order such self-insured employer shall be
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25 | disqualified to operate as a self-insurer and shall be required | ||||||
26 | to
insure his entire liability to pay compensation in some |
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1 | insurance
carrier authorized, licensed and permitted to do such | ||||||
2 | insurance business
in this State, as provided in subparagraph 3 | ||||||
3 | of paragraph (a) of this
Section.
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4 | All orders made by the Commission under this Section shall | ||||||
5 | be subject
to review by the courts, said review to be taken in | ||||||
6 | the same manner and
within the same time as provided by Section | ||||||
7 | 19 of this Act for review of
awards and decisions of the | ||||||
8 | Commission, upon the party seeking the
review filing with the | ||||||
9 | clerk of the court to which said review is taken
a bond in an | ||||||
10 | amount to be fixed and approved by the court to which the
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11 | review is taken, conditioned upon the payment of all | ||||||
12 | compensation awarded
against the person taking said review | ||||||
13 | pending a decision thereof and
further conditioned upon such | ||||||
14 | other obligations as the court may impose.
Upon the review the | ||||||
15 | Circuit Court shall have power to review all questions
of fact | ||||||
16 | as well as of law. The penalty hereinafter provided for in this
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17 | paragraph shall not attach and shall not begin to run until the | ||||||
18 | final
determination of the order of the Commission.
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19 | (d) Whenever a Commissioner panel of 3 Commissioners | ||||||
20 | comprised of one member of the employing class, one member of | ||||||
21 | the employee class, and one member not identified with either | ||||||
22 | the employing or employee class , with due process and after a | ||||||
23 | hearing, determines : (1) an employer has knowingly failed to | ||||||
24 | provide coverage as required by paragraph (a) of this Section, | ||||||
25 | and (2) the failure is shall be deemed an immediate serious | ||||||
26 | danger to public health, safety, and welfare sufficient to |
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1 | justify service by the Commission of a work-stop order on such | ||||||
2 | employer, then a Commissioner may enter a work-stop order | ||||||
3 | requiring the cessation of all business operations of such | ||||||
4 | employer at the place of employment or job site. Any law | ||||||
5 | enforcement agency in the State shall, at the request of the | ||||||
6 | Commission, render any assistance necessary to carry out the | ||||||
7 | provisions of this Section, including, but not limited to, | ||||||
8 | preventing any employee of such employer from remaining at a | ||||||
9 | place of employment or job site after a work-stop order has | ||||||
10 | taken effect. Any work-stop order shall be lifted immediately | ||||||
11 | upon proof of insurance as required by this Act and payment of | ||||||
12 | any applicable fines or penalties . Any orders under this | ||||||
13 | Section are appealable under Section 19(f) to the Circuit | ||||||
14 | Court.
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15 | Any individual employer, corporate officer or director of a | ||||||
16 | corporate employer, partner of an employer partnership, or | ||||||
17 | member of an employer limited liability company who knowingly | ||||||
18 | fails to provide coverage as required by paragraph (a) of this | ||||||
19 | Section is guilty of a Class 4 felony. This provision shall not | ||||||
20 | apply to any corporate officer or director of any | ||||||
21 | publicly-owned corporation. Each day's violation constitutes a | ||||||
22 | separate offense. The State's Attorney of the county in which | ||||||
23 | the violation occurred, or the Attorney General, shall bring | ||||||
24 | such actions in the name of the People of the State of | ||||||
25 | Illinois, or may, in addition to other remedies provided in | ||||||
26 | this Section, bring an action for an injunction to restrain the |
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1 | violation or to enjoin the operation of any such employer.
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2 | Any individual employer, corporate officer or director of a | ||||||
3 | corporate employer, partner of an employer partnership, or | ||||||
4 | member of an employer limited liability company who negligently | ||||||
5 | fails to provide coverage as required by paragraph (a) of this | ||||||
6 | Section is guilty of a Class A misdemeanor. This provision | ||||||
7 | shall not apply to any corporate officer or director of any | ||||||
8 | publicly-owned corporation. Each day's violation constitutes a | ||||||
9 | separate offense. The State's Attorney of the county in which | ||||||
10 | the violation occurred, or the Attorney General, shall bring | ||||||
11 | such actions in the name of the People of the State of | ||||||
12 | Illinois.
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13 | The criminal penalties in this subsection (d) shall not | ||||||
14 | apply where
there exists a good faith dispute as to the | ||||||
15 | existence of an
employment relationship. Evidence of good faith | ||||||
16 | shall
include, but not be limited to, compliance with the | ||||||
17 | definition
of employee as used by the Internal Revenue Service.
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18 | Employers who are subject to and who knowingly fail to | ||||||
19 | comply with this Section shall not be entitled to the benefits | ||||||
20 | of this Act during the period of noncompliance, but shall be | ||||||
21 | liable in an action under any other applicable law of this | ||||||
22 | State. In the action, such employer shall not avail himself or | ||||||
23 | herself of the defenses of assumption of risk or negligence or | ||||||
24 | that the injury was due to a co-employee. In the action, proof | ||||||
25 | of the injury shall constitute prima facie evidence of | ||||||
26 | negligence on the part of such employer and the burden shall be |
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1 | on such employer to show freedom of negligence resulting in the | ||||||
2 | injury. The employer shall not join any other defendant in any | ||||||
3 | such civil action. Nothing in this amendatory Act of the 94th | ||||||
4 | General Assembly shall affect the employee's rights under | ||||||
5 | subdivision (a)3 of Section 1 of this Act. Any employer or | ||||||
6 | carrier who makes payments under subdivision (a)3 of Section 1 | ||||||
7 | of this Act shall have a right of reimbursement from the | ||||||
8 | proceeds of any recovery under this Section.
| ||||||
9 | An employee of an uninsured employer, or the employee's | ||||||
10 | dependents in case death ensued, may, instead of proceeding | ||||||
11 | against the employer in a civil action in court, file an | ||||||
12 | application for adjustment of claim with the Commission in | ||||||
13 | accordance with the provisions of this Act and the Commission | ||||||
14 | shall hear and determine the application for adjustment of | ||||||
15 | claim in the manner in which other claims are heard and | ||||||
16 | determined before the Commission.
| ||||||
17 | All proceedings under this subsection (d) shall be reported | ||||||
18 | on an annual basis to the Workers' Compensation Advisory Board.
| ||||||
19 | An investigator with the Illinois Workers' Compensation | ||||||
20 | Commission Insurance Compliance Division may issue a citation | ||||||
21 | to any employer that is not in compliance with its obligation | ||||||
22 | to have workers' compensation insurance under this Act. The | ||||||
23 | amount of the fine shall be based on the period of time the | ||||||
24 | employer was in non-compliance, but shall be no less than $500, | ||||||
25 | and shall not exceed $2,500. An employer that has been issued a | ||||||
26 | citation shall pay the fine to the Commission and provide to |
| |||||||
| |||||||
1 | the Commission proof that it obtained the required workers' | ||||||
2 | compensation insurance within 10 days after the citation was | ||||||
3 | issued. This Section does not affect any other obligations this | ||||||
4 | Act imposes on employers. | ||||||
5 | Upon a finding by the Commission, after reasonable notice | ||||||
6 | and
hearing, of the knowing and wilful failure or refusal of an | ||||||
7 | employer to
comply with
any of the provisions of paragraph (a) | ||||||
8 | of this Section , or the failure or
refusal of an employer, | ||||||
9 | service or adjustment company, or an insurance
carrier to | ||||||
10 | comply with any order of the Illinois Workers' Compensation | ||||||
11 | Commission pursuant to
paragraph (c) of this Section | ||||||
12 | disqualifying him or her to operate as a self
insurer and | ||||||
13 | requiring him or her to insure his or her liability, or the | ||||||
14 | knowing and willful failure of an employer to comply with a | ||||||
15 | citation issued by an investigator with the Illinois Workers' | ||||||
16 | Compensation Commission Insurance Compliance Division, the
| ||||||
17 | Commission may assess a civil penalty of up to $500 per day for | ||||||
18 | each day of
such failure or refusal after the effective date of | ||||||
19 | this amendatory Act of
1989. The minimum penalty under this | ||||||
20 | Section shall be the sum of $10,000.
Each day of such failure | ||||||
21 | or refusal shall constitute a separate offense.
The Commission | ||||||
22 | may assess the civil penalty personally and individually
| ||||||
23 | against the corporate officers and directors of a corporate | ||||||
24 | employer, the
partners of an employer partnership, and the | ||||||
25 | members of an employer limited
liability company, after a | ||||||
26 | finding of a knowing and willful refusal or failure
of each |
| |||||||
| |||||||
1 | such named corporate officer, director, partner, or member to | ||||||
2 | comply
with this Section. The liability for the assessed | ||||||
3 | penalty shall be
against the named employer first, and
if the | ||||||
4 | named employer fails or refuses to pay the penalty to the
| ||||||
5 | Commission within 30 days after the final order of the | ||||||
6 | Commission, then the
named
corporate officers, directors, | ||||||
7 | partners, or members who have been found to have
knowingly and | ||||||
8 | willfully refused or failed to comply with this Section shall | ||||||
9 | be
liable for the unpaid penalty or any unpaid portion of the | ||||||
10 | penalty. Upon investigation by the insurance non-compliance | ||||||
11 | unit of the Commission, the Attorney General shall have the | ||||||
12 | authority to prosecute all proceedings to enforce the civil and | ||||||
13 | administrative provisions of this Section before the | ||||||
14 | Commission. The Commission shall promulgate procedural rules | ||||||
15 | for enforcing this Section.
| ||||||
16 | Upon the failure or refusal of any employer, service or | ||||||
17 | adjustment
company or insurance carrier to comply with the | ||||||
18 | provisions of this Section
and with the orders of the | ||||||
19 | Commission under this Section, or the order of
the court on | ||||||
20 | review after final adjudication, the Commission may bring a
| ||||||
21 | civil action to recover the amount of the penalty in Cook | ||||||
22 | County or in
Sangamon County in which litigation the Commission | ||||||
23 | shall be represented by
the Attorney General. The Commission | ||||||
24 | shall send notice of its finding of
non-compliance and | ||||||
25 | assessment of the civil penalty to the Attorney General.
It | ||||||
26 | shall be the duty of the Attorney General within 30 days after |
| |||||||
| |||||||
1 | receipt
of the notice, to institute prosecutions and promptly | ||||||
2 | prosecute all
reported violations of this Section.
| ||||||
3 | Any individual employer, corporate officer or director of a | ||||||
4 | corporate employer, partner of an employer partnership, or | ||||||
5 | member of an employer limited liability company who, with the | ||||||
6 | intent to avoid payment of compensation under this Act to an | ||||||
7 | injured employee or the employee's dependents, knowingly | ||||||
8 | transfers, sells, encumbers, assigns, or in any manner disposes | ||||||
9 | of, conceals, secretes, or destroys any property belonging to | ||||||
10 | the employer, officer, director, partner, or member is guilty | ||||||
11 | of a Class 4 felony.
| ||||||
12 | Penalties and fines collected pursuant to this paragraph | ||||||
13 | (d) shall be deposited upon receipt into a special fund which | ||||||
14 | shall be designated the Injured Workers' Benefit Fund, of which | ||||||
15 | the State Treasurer is ex-officio custodian, such special fund | ||||||
16 | to be held and disbursed in accordance with this paragraph (d) | ||||||
17 | for the purposes hereinafter stated in this paragraph (d), upon | ||||||
18 | the final order of the Commission. The Injured Workers' Benefit | ||||||
19 | Fund shall be deposited the same as are State funds and any | ||||||
20 | interest accruing thereon shall be added thereto every 6 | ||||||
21 | months. The Injured Workers' Benefit Fund is subject to audit | ||||||
22 | the same as State funds and accounts and is protected by the | ||||||
23 | general bond given by the State Treasurer. The Injured Workers' | ||||||
24 | Benefit Fund is considered always appropriated for the purposes | ||||||
25 | of disbursements as provided in this paragraph, and shall be | ||||||
26 | paid out and disbursed as herein provided and shall not at any |
| |||||||
| |||||||
1 | time be appropriated or diverted to any other use or purpose. | ||||||
2 | Moneys in the Injured Workers' Benefit Fund shall be used only | ||||||
3 | for payment of workers' compensation benefits for injured | ||||||
4 | employees when the employer has failed to provide coverage as | ||||||
5 | determined under this paragraph (d) and has failed to pay the | ||||||
6 | benefits due to the injured employee. The Commission shall have | ||||||
7 | the right to obtain reimbursement from the employer for | ||||||
8 | compensation obligations paid by the Injured Workers' Benefit | ||||||
9 | Fund. Any such amounts obtained shall be deposited by the | ||||||
10 | Commission into the Injured Workers' Benefit Fund. If an | ||||||
11 | injured employee or his or her personal representative receives | ||||||
12 | payment from the Injured Workers' Benefit Fund, the State of | ||||||
13 | Illinois has the same rights under paragraph (b) of Section 5 | ||||||
14 | that the employer who failed to pay the benefits due to the | ||||||
15 | injured employee would have had if the employer had paid those | ||||||
16 | benefits, and any moneys recovered by the State as a result of | ||||||
17 | the State's exercise of its rights under paragraph (b) of | ||||||
18 | Section 5 shall be deposited into the Injured Workers' Benefit | ||||||
19 | Fund. The custodian of the Injured Workers' Benefit Fund shall | ||||||
20 | be joined with the employer as a party respondent in the | ||||||
21 | application for adjustment of claim. After July 1, 2006, the | ||||||
22 | Commission shall make disbursements from the Fund once each | ||||||
23 | year to each eligible claimant. An eligible claimant is an | ||||||
24 | injured worker who has within the previous fiscal year obtained | ||||||
25 | a final award for benefits from the Commission against the | ||||||
26 | employer and the Injured Workers' Benefit Fund and has notified |
| |||||||
| |||||||
1 | the Commission within 90 days of receipt of such award. Within | ||||||
2 | a reasonable time after the end of each fiscal year, the | ||||||
3 | Commission shall make a disbursement to each eligible claimant. | ||||||
4 | At the time of disbursement, if there are insufficient moneys | ||||||
5 | in the Fund to pay all claims, each eligible claimant shall | ||||||
6 | receive a pro-rata share, as determined by the Commission, of | ||||||
7 | the available moneys in the Fund for that year. Payment from | ||||||
8 | the Injured Workers' Benefit Fund to an eligible claimant | ||||||
9 | pursuant to this provision shall discharge the obligations of | ||||||
10 | the Injured Workers' Benefit Fund regarding the award entered | ||||||
11 | by the Commission.
| ||||||
12 | (e) This Act shall not affect or disturb the continuance of | ||||||
13 | any
existing insurance, mutual aid, benefit, or relief | ||||||
14 | association or
department, whether maintained in whole or in | ||||||
15 | part by the employer or
whether maintained by the employees, | ||||||
16 | the payment of benefits of such
association or department being | ||||||
17 | guaranteed by the employer or by some
person, firm or | ||||||
18 | corporation for him or her: Provided, the employer contributes
| ||||||
19 | to such association or department an amount not less than the | ||||||
20 | full
compensation herein provided, exclusive of the cost of the | ||||||
21 | maintenance
of such association or department and without any | ||||||
22 | expense to the
employee. This Act shall not prevent the | ||||||
23 | organization and maintaining
under the insurance laws of this | ||||||
24 | State of any benefit or insurance
company for the purpose of | ||||||
25 | insuring against the compensation provided
for in this Act, the | ||||||
26 | expense of which is maintained by the employer.
This Act shall |
| |||||||
| |||||||
1 | not prevent the organization or maintaining under the
insurance | ||||||
2 | laws of this State of any voluntary mutual aid, benefit or
| ||||||
3 | relief association among employees for the payment of | ||||||
4 | additional
accident or sick benefits.
| ||||||
5 | (f) No existing insurance, mutual aid, benefit or relief | ||||||
6 | association
or department shall, by reason of anything herein | ||||||
7 | contained, be
authorized to discontinue its operation without | ||||||
8 | first discharging its
obligations to any and all persons | ||||||
9 | carrying insurance in the same or
entitled to relief or | ||||||
10 | benefits therein.
| ||||||
11 | (g) Any contract, oral, written or implied, of employment | ||||||
12 | providing
for relief benefit, or insurance or any other device | ||||||
13 | whereby the
employee is required to pay any premium or premiums | ||||||
14 | for insurance
against the compensation provided for in this Act | ||||||
15 | shall be null and
void. Any employer withholding from the wages | ||||||
16 | of any employee any
amount for the purpose of paying any such | ||||||
17 | premium shall be guilty of a
Class B misdemeanor.
| ||||||
18 | In the event the employer does not pay the compensation for | ||||||
19 | which he or
she is liable, then an insurance company, | ||||||
20 | association or insurer which may
have insured such employer | ||||||
21 | against such liability shall become primarily
liable to pay to | ||||||
22 | the employee, his or her personal representative or
beneficiary | ||||||
23 | the compensation required by the provisions of this Act to
be | ||||||
24 | paid by such employer. The insurance carrier may be made a | ||||||
25 | party to
the proceedings in which the employer is a party and | ||||||
26 | an award may be
entered jointly against the employer and the |
| |||||||
| |||||||
1 | insurance carrier.
| ||||||
2 | (h) It shall be unlawful for any employer, insurance | ||||||
3 | company or
service or adjustment company to interfere with, | ||||||
4 | restrain or coerce an
employee in any manner whatsoever in the | ||||||
5 | exercise of the rights or
remedies granted to him or her by | ||||||
6 | this Act or to discriminate, attempt to
discriminate, or | ||||||
7 | threaten to discriminate against an employee in any way
because | ||||||
8 | of his or her exercise of the rights or remedies granted to
him | ||||||
9 | or her by this Act.
| ||||||
10 | It shall be unlawful for any employer, individually or | ||||||
11 | through any
insurance company or service or adjustment company, | ||||||
12 | to discharge or to
threaten to discharge, or to refuse to | ||||||
13 | rehire or recall to active
service in a suitable capacity an | ||||||
14 | employee because of the exercise of
his or her rights or | ||||||
15 | remedies granted to him or her by this Act.
| ||||||
16 | (i) If an employer elects to obtain a life insurance policy | ||||||
17 | on his
employees, he may also elect to apply such benefits in | ||||||
18 | satisfaction of all
or a portion of the death benefits payable | ||||||
19 | under this Act, in which case,
the employer's compensation | ||||||
20 | premium shall be reduced accordingly.
| ||||||
21 | (j) Within 45 days of receipt of an initial application or | ||||||
22 | application
to renew self-insurance privileges the | ||||||
23 | Self-Insurers Advisory Board shall
review and submit for | ||||||
24 | approval by the Chairman of the Commission
recommendations of | ||||||
25 | disposition of all initial applications to self-insure
and all | ||||||
26 | applications to renew self-insurance privileges filed by |
| |||||||
| |||||||
1 | private
self-insurers pursuant to the provisions of this | ||||||
2 | Section and Section 4a-9
of this Act. Each private self-insurer | ||||||
3 | shall submit with its initial and
renewal applications the | ||||||
4 | application fee required by Section 4a-4 of this Act.
| ||||||
5 | The Chairman of the Commission shall promptly act upon all | ||||||
6 | initial
applications and applications for renewal in full | ||||||
7 | accordance with the
recommendations of the Board or, should the | ||||||
8 | Chairman disagree with any
recommendation of disposition of the | ||||||
9 | Self-Insurer's Advisory Board, he
shall within 30 days of | ||||||
10 | receipt of such recommendation provide to the Board
in writing | ||||||
11 | the reasons supporting his decision. The Chairman shall also
| ||||||
12 | promptly notify the employer of his decision within 15 days of | ||||||
13 | receipt of
the recommendation of the Board.
| ||||||
14 | If an employer is denied a renewal of self-insurance | ||||||
15 | privileges pursuant
to application it shall retain said | ||||||
16 | privilege for 120 days after receipt of
a notice of | ||||||
17 | cancellation of the privilege from the Chairman of the | ||||||
18 | Commission.
| ||||||
19 | All orders made by the Chairman under this Section shall be | ||||||
20 | subject to
review by the courts, such review to be taken in the | ||||||
21 | same manner and within
the same time as provided by subsection | ||||||
22 | (f) of Section 19 of this Act for
review of awards and | ||||||
23 | decisions of the Commission, upon the party seeking
the review | ||||||
24 | filing with the clerk of the court to which such review is | ||||||
25 | taken
a bond in an amount to be fixed and approved by the court | ||||||
26 | to which the
review is taken, conditioned upon the payment of |
| |||||||
| |||||||
1 | all compensation awarded
against the person taking such review | ||||||
2 | pending a decision thereof and
further conditioned upon such | ||||||
3 | other obligations as the court may impose.
Upon the review the | ||||||
4 | Circuit Court shall have power to review all questions
of fact | ||||||
5 | as well as of law.
| ||||||
6 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||||||
7 | 94-839, eff. 6-6-06.)
| ||||||
8 | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
| ||||||
9 | Sec. 8. The amount of compensation which shall be paid to | ||||||
10 | the
employee for an accidental injury not resulting in death | ||||||
11 | is:
| ||||||
12 | (a) The employer shall provide and pay the negotiated rate, | ||||||
13 | if applicable, or the lesser of the health care provider's | ||||||
14 | actual charges or according to a fee schedule, subject to | ||||||
15 | Section 8.2, in effect at the time the service was rendered for | ||||||
16 | all the necessary first
aid, medical and surgical services, and | ||||||
17 | all necessary medical, surgical
and hospital services | ||||||
18 | thereafter incurred, limited, however, to that
which is | ||||||
19 | reasonably required to cure or relieve from the effects of the
| ||||||
20 | accidental injury , even if a health care provider sells, | ||||||
21 | transfers, or otherwise assigns an account receivable for | ||||||
22 | procedures, treatments, or services covered under this Act . If | ||||||
23 | the employer does not dispute payment of first aid, medical, | ||||||
24 | surgical,
and hospital services, the employer shall make such | ||||||
25 | payment to the provider on behalf of the employee. The employer |
| |||||||
| |||||||
1 | shall also pay for treatment,
instruction and training | ||||||
2 | necessary for the physical, mental and
vocational | ||||||
3 | rehabilitation of the employee, including all maintenance
| ||||||
4 | costs and expenses incidental thereto. If as a result of the | ||||||
5 | injury the
employee is unable to be self-sufficient the | ||||||
6 | employer shall further pay
for such maintenance or | ||||||
7 | institutional care as shall be required.
| ||||||
8 | The employer shall select the employee's first physician, | ||||||
9 | surgeon, or provider of hospital services at the employer's | ||||||
10 | expense. However, in the event the employer fails to exercise | ||||||
11 | his, her, or its right to select the first physician, surgeon, | ||||||
12 | or provider of hospital services or where it is impracticable | ||||||
13 | for the employer to exercise this right, the selection shall be | ||||||
14 | made by the employee at the employer's expense. In the event | ||||||
15 | the employee is dissatisfied with the first physician, surgeon, | ||||||
16 | or provider of hospital services, the employee has an absolute | ||||||
17 | right to select a second physician, surgeon, or provider of | ||||||
18 | hospital services at the employer's expense. Emergency | ||||||
19 | services and "chains-of-referral" shall not constitute a | ||||||
20 | choice of physician, surgeon, or provider of hospital services | ||||||
21 | by the employer or employee. The employee may at any time elect | ||||||
22 | to secure his own physician,
surgeon and hospital services at | ||||||
23 | the employer's expense , or,
| ||||||
24 | Notwithstanding the foregoing, upon Upon agreement between | ||||||
25 | the employer and the employees, or the employees'
exclusive | ||||||
26 | representative, and subject to the approval of the Illinois |
| |||||||
| |||||||
1 | Workers' Compensation
Commission, the employer shall maintain | ||||||
2 | a list of physicians, to be
known as a Panel of Physicians, who | ||||||
3 | are accessible to the employees.
The employer shall post this | ||||||
4 | list in a place or places easily accessible
to his employees. | ||||||
5 | The employee shall have the right to make an
alternative choice | ||||||
6 | of physician from such Panel if he is not satisfied
with the | ||||||
7 | physician first selected. If, due to the nature of the injury
| ||||||
8 | or its occurrence away from the employer's place of business, | ||||||
9 | the
employee is unable to make a selection from the Panel, the | ||||||
10 | selection
process from the Panel shall not apply. The physician | ||||||
11 | selected from the
Panel may arrange for any consultation, | ||||||
12 | referral or other specialized
medical services outside the | ||||||
13 | Panel at the employer's expense. Provided
that, in the event | ||||||
14 | the Commission shall find that a doctor selected by
the | ||||||
15 | employee is rendering improper or inadequate care, the | ||||||
16 | Commission
may order the employee to select another doctor | ||||||
17 | certified or qualified
in the medical field for which treatment | ||||||
18 | is required. If the employee
refuses to make such change the | ||||||
19 | Commission may relieve the employer of
his obligation to pay | ||||||
20 | the doctor's charges from the date of refusal to
the date of | ||||||
21 | compliance.
| ||||||
22 | Any vocational rehabilitation counselors who provide | ||||||
23 | service under this Act shall have
appropriate certifications | ||||||
24 | which designate the counselor as qualified to render
opinions | ||||||
25 | relating to vocational rehabilitation. Vocational | ||||||
26 | rehabilitation
may include, but is not limited to, counseling |
| |||||||
| |||||||
1 | for job searches, supervising
a job search program, and | ||||||
2 | vocational retraining including education at an
accredited | ||||||
3 | learning institution. The employee or employer may petition to | ||||||
4 | the Commission to decide disputes relating to vocational | ||||||
5 | rehabilitation and the Commission shall resolve any such | ||||||
6 | dispute, including payment of the vocational rehabilitation | ||||||
7 | program by the employer. | ||||||
8 | The maintenance benefit shall not be less than the | ||||||
9 | temporary total disability
rate determined for the employee. In | ||||||
10 | addition, maintenance shall include costs
and expenses | ||||||
11 | incidental to the vocational rehabilitation program. | ||||||
12 | When the employee is working light duty on a part-time | ||||||
13 | basis or full-time
basis
and earns less than he or she would be | ||||||
14 | earning if employed in the full capacity
of the job or jobs, | ||||||
15 | then the employee shall be entitled to temporary partial | ||||||
16 | disability benefits. Temporary partial disability benefits | ||||||
17 | shall be
equal to two-thirds of
the difference between the | ||||||
18 | average amount that the employee would be able to
earn in the | ||||||
19 | full performance of his or her duties in the occupation in | ||||||
20 | which he
or she was engaged at the time of accident and the net | ||||||
21 | amount which he or she
is
earning in the modified job provided | ||||||
22 | to the employee by the employer or in any other job that the | ||||||
23 | employee is working. | ||||||
24 | Every hospital, physician, surgeon or other person | ||||||
25 | rendering
treatment or services in accordance with the | ||||||
26 | provisions of this Section
shall upon written request furnish |
| |||||||
| |||||||
1 | full and complete reports thereof to,
and permit their records | ||||||
2 | to be copied by, the employer, the employee or
his dependents, | ||||||
3 | as the case may be, or any other party to any proceeding
for | ||||||
4 | compensation before the Commission, or their attorneys.
| ||||||
5 | Notwithstanding the foregoing, the employer's liability to | ||||||
6 | pay for such
medical services selected by the employee shall be | ||||||
7 | limited to:
| ||||||
8 | (1) all first aid and emergency treatment; plus
| ||||||
9 | (2) all medical, surgical and hospital services | ||||||
10 | provided by the
first physician, surgeon or hospital | ||||||
11 | initially chosen by the employee or by any
other physician, | ||||||
12 | consultant, expert, institution or other provider of
| ||||||
13 | services recommended by said initial service provider or | ||||||
14 | any subsequent
provider of medical services in the chain of | ||||||
15 | referrals from said
initial service provider; plus
| ||||||
16 | (3) all medical, surgical and hospital services | ||||||
17 | provided by any second
physician, surgeon or hospital | ||||||
18 | subsequently chosen by the employee or by
any other | ||||||
19 | physician, consultant, expert, institution or other | ||||||
20 | provider of
services recommended by said second service | ||||||
21 | provider or any subsequent provider
of medical services in | ||||||
22 | the chain of referrals
from said second service provider. | ||||||
23 | Thereafter the employer shall select
and pay for all | ||||||
24 | necessary medical, surgical and hospital treatment and the
| ||||||
25 | employee may not select a provider of medical services at | ||||||
26 | the employer's
expense unless the employer agrees to such |
| |||||||
| |||||||
1 | selection. | ||||||
2 | At any time the employee
may obtain any medical treatment | ||||||
3 | he desires at his own expense. This paragraph
shall not affect | ||||||
4 | the duty to pay for rehabilitation referred to above.
| ||||||
5 | When an employer and employee so agree in writing, nothing | ||||||
6 | in this
Act prevents an employee whose injury or disability has | ||||||
7 | been established
under this Act, from relying in good faith, on | ||||||
8 | treatment by prayer or
spiritual means alone, in accordance | ||||||
9 | with the tenets and practice of a
recognized church or | ||||||
10 | religious denomination, by a duly accredited
practitioner | ||||||
11 | thereof, and having nursing services appropriate therewith,
| ||||||
12 | without suffering loss or diminution of the compensation | ||||||
13 | benefits under
this Act. However, the employee shall submit to | ||||||
14 | all physical
examinations required by this Act. The cost of | ||||||
15 | such treatment and
nursing care shall be paid by the employee | ||||||
16 | unless the employer agrees to
make such payment.
| ||||||
17 | Where the accidental injury results in the amputation of an | ||||||
18 | arm,
hand, leg or foot, or the enucleation of an eye, or the | ||||||
19 | loss of any of
the natural teeth, the employer shall furnish an | ||||||
20 | artificial of any such
members lost or damaged in accidental | ||||||
21 | injury arising out of and in the
course of employment, and | ||||||
22 | shall also furnish the necessary braces in all
proper and | ||||||
23 | necessary cases. In cases of the loss of a member or members
by | ||||||
24 | amputation, the employer shall, whenever necessary, maintain | ||||||
25 | in good
repair, refit or replace the artificial limbs during | ||||||
26 | the lifetime of the
employee. Where the accidental injury |
| |||||||
| |||||||
1 | accompanied by physical injury
results in damage to a denture, | ||||||
2 | eye glasses or contact eye lenses, or
where the accidental | ||||||
3 | injury results in damage to an artificial member,
the employer | ||||||
4 | shall replace or repair such denture, glasses, lenses, or
| ||||||
5 | artificial member.
| ||||||
6 | The furnishing by the employer of any such services or | ||||||
7 | appliances is
not an admission of liability on the part of the | ||||||
8 | employer to pay
compensation.
| ||||||
9 | The furnishing of any such services or appliances or the | ||||||
10 | servicing
thereof by the employer is not the payment of | ||||||
11 | compensation.
| ||||||
12 | (b) If the period of temporary total incapacity for work | ||||||
13 | lasts more
than 3 working days, weekly compensation as | ||||||
14 | hereinafter provided shall
be paid beginning on the 4th day of | ||||||
15 | such temporary total incapacity and
continuing as long as the | ||||||
16 | total temporary incapacity lasts. In cases
where the temporary | ||||||
17 | total incapacity for work continues for a period of
14 days or | ||||||
18 | more from the day of the accident compensation shall commence
| ||||||
19 | on the day after the accident.
| ||||||
20 | 1. The compensation rate for temporary total | ||||||
21 | incapacity under this
paragraph (b) of this Section shall | ||||||
22 | be equal to 66 2/3% of the
employee's average weekly wage | ||||||
23 | computed in accordance with Section 10,
provided that it | ||||||
24 | shall be not less than 66 2/3% of the sum of the Federal | ||||||
25 | minimum wage under the Fair Labor
Standards Act, or the | ||||||
26 | Illinois minimum wage under the Minimum Wage Law,
whichever |
| |||||||
| |||||||
1 | is more, multiplied by 40 hours. This percentage rate shall | ||||||
2 | be
increased by 10% for each spouse and child, not to | ||||||
3 | exceed 100% of the total
minimum wage calculation,
| ||||||
4 | nor exceed the employee's average weekly wage computed in | ||||||
5 | accordance
with the provisions of Section 10, whichever is | ||||||
6 | less.
| ||||||
7 | 2. The compensation rate in all cases other than for | ||||||
8 | temporary total
disability under this paragraph (b), and | ||||||
9 | other than for serious and
permanent disfigurement under | ||||||
10 | paragraph (c) and other than for permanent
partial | ||||||
11 | disability under subparagraph (2) of paragraph (d) or under
| ||||||
12 | paragraph (e), of this Section shall be equal to 66
2/3% of | ||||||
13 | the employee's average weekly wage computed in accordance | ||||||
14 | with
the provisions of Section 10, provided that it shall | ||||||
15 | be not less than
66 2/3% of the sum of the Federal minimum | ||||||
16 | wage under the Fair Labor Standards Act, or the Illinois | ||||||
17 | minimum wage under the Minimum Wage Law, whichever is more, | ||||||
18 | multiplied by 40 hours. This percentage rate shall be | ||||||
19 | increased by 10% for each spouse and child, not to exceed | ||||||
20 | 100% of the total minimum wage calculation,
| ||||||
21 | nor exceed the employee's average weekly wage computed in | ||||||
22 | accordance
with the provisions of Section 10, whichever is | ||||||
23 | less.
| ||||||
24 | 2.1. The compensation rate in all cases of serious and | ||||||
25 | permanent
disfigurement under paragraph (c) and of | ||||||
26 | permanent partial disability
under subparagraph (2) of |
| |||||||
| |||||||
1 | paragraph (d) or under paragraph (e) of this
Section shall | ||||||
2 | be equal to
60% of the employee's average
weekly wage | ||||||
3 | computed in accordance with
the provisions of Section 10, | ||||||
4 | provided that it shall be not less than
66 2/3% of the sum | ||||||
5 | of the Federal minimum wage under the Fair Labor Standards | ||||||
6 | Act, or the Illinois minimum wage under the Minimum Wage | ||||||
7 | Law, whichever is more, multiplied by 40 hours. This | ||||||
8 | percentage rate shall be increased by 10% for each spouse | ||||||
9 | and child, not to exceed 100% of the total minimum wage | ||||||
10 | calculation,
| ||||||
11 | nor exceed the employee's average weekly wage computed in | ||||||
12 | accordance
with the provisions of Section 10, whichever is | ||||||
13 | less.
| ||||||
14 | 3. As used in this Section the term "child" means a | ||||||
15 | child of the
employee including any child legally adopted | ||||||
16 | before the accident or whom
at the time of the accident the | ||||||
17 | employee was under legal obligation to
support or to whom | ||||||
18 | the employee stood in loco parentis, and who at the
time of | ||||||
19 | the accident was under 18 years of age and not emancipated. | ||||||
20 | The
term "children" means the plural of "child".
| ||||||
21 | 4. All weekly compensation rates provided under | ||||||
22 | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||||||
23 | Section shall be subject to the
following limitations:
| ||||||
24 | The maximum weekly compensation rate from July 1, 1975, | ||||||
25 | except as
hereinafter provided, shall be 100% of the | ||||||
26 | State's average weekly wage in
covered industries under the |
| |||||||
| |||||||
1 | Unemployment Insurance Act, that being the
wage that most | ||||||
2 | closely approximates the State's average weekly wage.
| ||||||
3 | The maximum weekly compensation rate, for the period | ||||||
4 | July 1, 1984,
through June 30, 1987, except as hereinafter | ||||||
5 | provided, shall be $293.61.
Effective July 1, 1987 and on | ||||||
6 | July 1 of each year thereafter the maximum
weekly | ||||||
7 | compensation rate, except as hereinafter provided, shall | ||||||
8 | be
determined as follows: if during the preceding 12 month | ||||||
9 | period there shall
have been an increase in the State's | ||||||
10 | average weekly wage in covered
industries under the | ||||||
11 | Unemployment Insurance Act, the weekly compensation
rate | ||||||
12 | shall be proportionately increased by the same percentage | ||||||
13 | as the
percentage of increase in the State's average weekly | ||||||
14 | wage in covered
industries under the Unemployment | ||||||
15 | Insurance Act during such period.
| ||||||
16 | The maximum weekly compensation rate, for the period | ||||||
17 | January 1, 1981
through December 31, 1983, except as | ||||||
18 | hereinafter provided, shall be 100% of
the State's average | ||||||
19 | weekly wage in covered industries under the
Unemployment | ||||||
20 | Insurance Act in effect on January 1, 1981. Effective | ||||||
21 | January
1, 1984 and on January 1, of each year thereafter | ||||||
22 | the maximum weekly
compensation rate, except as | ||||||
23 | hereinafter provided, shall be determined as
follows: if | ||||||
24 | during the preceding 12 month period there shall have been | ||||||
25 | an
increase in the State's average weekly wage in covered | ||||||
26 | industries under the
Unemployment Insurance Act, the |
| |||||||
| |||||||
1 | weekly compensation rate shall be
proportionately | ||||||
2 | increased by the same percentage as the percentage of
| ||||||
3 | increase in the State's average weekly wage in covered | ||||||
4 | industries under the
Unemployment Insurance Act during | ||||||
5 | such period.
| ||||||
6 | From July 1, 1977 and thereafter such maximum weekly | ||||||
7 | compensation
rate in death cases under Section 7, and | ||||||
8 | permanent total disability
cases under paragraph (f) or | ||||||
9 | subparagraph 18 of paragraph (3) of this
Section and for | ||||||
10 | temporary total disability under paragraph (b) of this
| ||||||
11 | Section and for amputation of a member or enucleation of an | ||||||
12 | eye under
paragraph (e) of this Section shall be increased | ||||||
13 | to 133-1/3% of the
State's average weekly wage in covered | ||||||
14 | industries under the
Unemployment Insurance Act.
| ||||||
15 | For injuries occurring on or after February 1, 2006, | ||||||
16 | the maximum weekly benefit under paragraph (d)1 of this | ||||||
17 | Section shall be 100% of the State's average weekly wage in | ||||||
18 | covered industries under the Unemployment Insurance Act.
| ||||||
19 | 4.1. Any provision herein to the contrary | ||||||
20 | notwithstanding, the
weekly compensation rate for | ||||||
21 | compensation payments under subparagraph 18
of paragraph | ||||||
22 | (e) of this Section and under paragraph (f) of this
Section | ||||||
23 | and under paragraph (a) of Section 7 and for amputation of | ||||||
24 | a member or enucleation of an eye under paragraph (e) of | ||||||
25 | this Section, shall in no event be less
than 50% of the | ||||||
26 | State's average weekly wage in covered industries under
the |
| |||||||
| |||||||
1 | Unemployment Insurance Act.
| ||||||
2 | 4.2. Any provision to the contrary notwithstanding, | ||||||
3 | the total
compensation payable under Section 7 shall not | ||||||
4 | exceed the greater of $500,000
or 25
years.
| ||||||
5 | 5. For the purpose of this Section this State's average | ||||||
6 | weekly wage
in covered industries under the Unemployment | ||||||
7 | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | ||||||
8 | per
week and the computation of compensation rates shall be | ||||||
9 | based on the
aforesaid average weekly wage until modified | ||||||
10 | as hereinafter provided.
| ||||||
11 | 6. The Department of Employment Security of the State | ||||||
12 | shall
on or before the first day of December, 1977, and on | ||||||
13 | or before the first
day of June, 1978, and on the first day | ||||||
14 | of each December and June of each
year thereafter, publish | ||||||
15 | the State's average weekly wage in covered
industries under | ||||||
16 | the Unemployment Insurance Act and the Illinois Workers' | ||||||
17 | Compensation
Commission shall on the 15th day of January, | ||||||
18 | 1978 and on the 15th day of
July, 1978 and on the 15th day | ||||||
19 | of each January and July of each year
thereafter, post and | ||||||
20 | publish the State's average weekly wage in covered
| ||||||
21 | industries under the Unemployment Insurance Act as last | ||||||
22 | determined and
published by the Department of Employment | ||||||
23 | Security. The amount when so
posted and published shall be | ||||||
24 | conclusive and shall be applicable as the
basis of | ||||||
25 | computation of compensation rates until the next posting | ||||||
26 | and
publication as aforesaid.
|
| |||||||
| |||||||
1 | 7. The payment of compensation by an employer or his | ||||||
2 | insurance
carrier to an injured employee shall not | ||||||
3 | constitute an admission of the
employer's liability to pay | ||||||
4 | compensation.
| ||||||
5 | (c) For any serious and permanent disfigurement to the | ||||||
6 | hand, head,
face, neck, arm, leg below the knee or the chest | ||||||
7 | above the axillary
line, the employee is entitled to | ||||||
8 | compensation for such disfigurement,
the amount determined by | ||||||
9 | agreement at any time or by arbitration under
this Act, at a | ||||||
10 | hearing not less than 6 months after the date of the
accidental | ||||||
11 | injury, which amount shall not exceed 150 weeks (if the | ||||||
12 | accidental injury occurs on or after the effective date of this | ||||||
13 | amendatory Act of the 94th General Assembly
but before February
| ||||||
14 | 1, 2006) or 162
weeks (if the accidental injury occurs on or | ||||||
15 | after February
1, 2006) at the
applicable rate provided in | ||||||
16 | subparagraph 2.1 of paragraph (b) of this Section.
| ||||||
17 | No compensation is payable under this paragraph where | ||||||
18 | compensation is
payable under paragraphs (d), (e) or (f) of | ||||||
19 | this Section.
| ||||||
20 | A duly appointed member of a fire department in a city, the | ||||||
21 | population of
which exceeds 200,000 according to the last | ||||||
22 | federal or State census, is
eligible for compensation under | ||||||
23 | this paragraph only where such serious and
permanent | ||||||
24 | disfigurement results from burns.
| ||||||
25 | (d) 1. If, after the accidental injury has been sustained, | ||||||
26 | the
employee as a result thereof becomes partially |
| |||||||
| |||||||
1 | incapacitated from
pursuing his usual and customary line of | ||||||
2 | employment, he shall, except in
cases compensated under the | ||||||
3 | specific schedule set forth in paragraph (e)
of this Section, | ||||||
4 | receive compensation for the duration of his
disability, | ||||||
5 | subject to the limitations as to maximum amounts fixed in
| ||||||
6 | paragraph (b) of this Section, equal to 66-2/3% of the | ||||||
7 | difference
between the average amount which he would be able to | ||||||
8 | earn in the full
performance of his duties in the occupation in | ||||||
9 | which he was engaged at
the time of the accident and the | ||||||
10 | average amount which he is earning or
is able to earn in some | ||||||
11 | suitable employment or business after the accident. An award | ||||||
12 | for wage differential under this subsection shall be effective | ||||||
13 | only until the employee reaches the age of 67 or 5 years from | ||||||
14 | the date the award becomes final, whichever is later. In | ||||||
15 | addition, after a wage differential award under this paragraph | ||||||
16 | (d)1 becomes final, the employer shall, on no more than a | ||||||
17 | quarter annual basis, upon written request to the employee, be | ||||||
18 | entitled to verification of an employee's current employment | ||||||
19 | status and earnings, including the name and address of the | ||||||
20 | employee's current employer, rate of pay or method of | ||||||
21 | compensation, duration of such employment, and true copies of | ||||||
22 | the employee's paychecks or other evidence of payment for the | ||||||
23 | duration of such employment. An employer may also request that | ||||||
24 | the employee sign an authorization to permit the employer to | ||||||
25 | then obtain from the employee's current employer the employee's | ||||||
26 | earnings and payroll documentation. Notwithstanding and in |
| |||||||
| |||||||
1 | addition to Section 19(h), a final award for wage differential | ||||||
2 | under this paragraph (d)1 may at any time be reviewed by the | ||||||
3 | Commission in an evidentiary hearing at the request of the | ||||||
4 | employer or employee on the grounds that there has been a | ||||||
5 | subsequent material change in the difference between the | ||||||
6 | average amount the employee would be able to earn currently in | ||||||
7 | the full performance of his or her duties in the occupation in | ||||||
8 | which the employee was engaged at the time of the accident and | ||||||
9 | the average amount the employee is earning currently in some | ||||||
10 | suitable employment or business after the accident. After | ||||||
11 | review under this paragraph (d)1, the Commission may modify or | ||||||
12 | vacate a final wage differential award. Such modification or | ||||||
13 | vacation shall be based on a material change in the employee's | ||||||
14 | current job earnings or a material change in the job earnings | ||||||
15 | the employee would be receiving currently in the full | ||||||
16 | performance of his or her duties in the occupation in which the | ||||||
17 | employee was engaged at the time of the accident.
| ||||||
18 | 2. If, as a result of the accident, the employee sustains | ||||||
19 | serious
and permanent injuries not covered by paragraphs (c) | ||||||
20 | and (e) of this
Section or having sustained injuries covered by | ||||||
21 | the aforesaid
paragraphs (c) and (e), he shall have sustained | ||||||
22 | in addition thereto
other injuries which injuries do not | ||||||
23 | incapacitate him from pursuing the
duties of his employment but | ||||||
24 | which would disable him from pursuing other
suitable | ||||||
25 | occupations, or which have otherwise resulted in physical
| ||||||
26 | impairment; or if such injuries partially incapacitate him from |
| |||||||
| |||||||
1 | pursuing
the duties of his usual and customary line of | ||||||
2 | employment but do not
result in an impairment of earning | ||||||
3 | capacity, or having resulted in an
impairment of earning | ||||||
4 | capacity, the employee elects to waive his right
to recover | ||||||
5 | under the foregoing subparagraph 1 of paragraph (d) of this
| ||||||
6 | Section then in any of the foregoing events, he shall receive | ||||||
7 | in
addition to compensation for temporary total disability | ||||||
8 | under paragraph
(b) of this Section, compensation at the rate | ||||||
9 | provided in subparagraph 2.1
of paragraph (b) of this Section | ||||||
10 | for that percentage of 500 weeks that
the partial disability | ||||||
11 | resulting from the injuries covered by this
paragraph bears to | ||||||
12 | total disability. If the employee shall have
sustained a | ||||||
13 | fracture of one or more vertebra or fracture of the skull,
the | ||||||
14 | amount of compensation allowed under this Section shall be not | ||||||
15 | less
than 6 weeks for a fractured skull and 6 weeks for each | ||||||
16 | fractured
vertebra, and in the event the employee shall have | ||||||
17 | sustained a fracture
of any of the following facial bones: | ||||||
18 | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||||||
19 | mandible, the amount of compensation allowed under
this Section | ||||||
20 | shall be not less than 2 weeks for each such fractured
bone, | ||||||
21 | and for a fracture of each transverse process not less than 3
| ||||||
22 | weeks. In the event such injuries shall result in the loss of a | ||||||
23 | kidney,
spleen or lung, the amount of compensation allowed | ||||||
24 | under this Section
shall be not less than 10 weeks for each | ||||||
25 | such organ. Compensation
awarded under this subparagraph 2 | ||||||
26 | shall not take into consideration
injuries covered under |
| |||||||
| |||||||
1 | paragraphs (c) and (e) of this Section and the
compensation | ||||||
2 | provided in this paragraph shall not affect the employee's
| ||||||
3 | right to compensation payable under paragraphs (b), (c) and (e) | ||||||
4 | of this
Section for the disabilities therein covered.
| ||||||
5 | (e) For accidental injuries in the following schedule, the | ||||||
6 | employee
shall receive compensation for the period of temporary | ||||||
7 | total incapacity
for work resulting from such accidental | ||||||
8 | injury, under subparagraph 1 of
paragraph (b) of this Section, | ||||||
9 | and shall receive in addition thereto
compensation for a | ||||||
10 | further period for the specific loss herein
mentioned, but | ||||||
11 | shall not receive any compensation under any other
provisions | ||||||
12 | of this Act. The following listed amounts apply to either
the | ||||||
13 | loss of or the permanent and complete loss of use of the member
| ||||||
14 | specified, such compensation for the length of time as follows:
| ||||||
15 | 1. Thumb- | ||||||
16 | 70 weeks if the accidental injury occurs on or | ||||||
17 | after the effective date of this amendatory Act of the | ||||||
18 | 94th General Assembly
but before February
1, 2006.
| ||||||
19 | 76
weeks if the accidental injury occurs on or | ||||||
20 | after February
1, 2006.
| ||||||
21 | 2. First, or index finger- | ||||||
22 | 40 weeks if the accidental injury occurs on or | ||||||
23 | after the effective date of this amendatory Act of the | ||||||
24 | 94th General Assembly
but before February
1, 2006.
| ||||||
25 | 43
weeks if the accidental injury occurs on or | ||||||
26 | after February
1, 2006.
|
| |||||||
| |||||||
1 | 3. Second, or middle finger- | ||||||
2 | 35 weeks if the accidental injury occurs on or | ||||||
3 | after the effective date of this amendatory Act of the | ||||||
4 | 94th General Assembly
but before February
1, 2006.
| ||||||
5 | 38
weeks if the accidental injury occurs on or | ||||||
6 | after February
1, 2006.
| ||||||
7 | 4. Third, or ring finger- | ||||||
8 | 25 weeks if the accidental injury occurs on or | ||||||
9 | after the effective date of this amendatory Act of the | ||||||
10 | 94th General Assembly
but before February
1, 2006.
| ||||||
11 | 27
weeks if the accidental injury occurs on or | ||||||
12 | after February
1, 2006.
| ||||||
13 | 5. Fourth, or little finger- | ||||||
14 | 20 weeks if the accidental injury occurs on or | ||||||
15 | after the effective date of this amendatory Act of the | ||||||
16 | 94th General Assembly
but before February
1, 2006.
| ||||||
17 | 22
weeks if the accidental injury occurs on or | ||||||
18 | after February
1, 2006.
| ||||||
19 | 6. Great toe- | ||||||
20 | 35 weeks if the accidental injury occurs on or | ||||||
21 | after the effective date of this amendatory Act of the | ||||||
22 | 94th General Assembly
but before February
1, 2006.
| ||||||
23 | 38
weeks if the accidental injury occurs on or | ||||||
24 | after February
1, 2006.
| ||||||
25 | 7. Each toe other than great toe- | ||||||
26 | 12 weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after the effective date of this amendatory Act of the | ||||||
2 | 94th General Assembly
but before February
1, 2006.
| ||||||
3 | 13
weeks if the accidental injury occurs on or | ||||||
4 | after February
1, 2006.
| ||||||
5 | 8. The loss of the first or distal phalanx of the thumb | ||||||
6 | or of any
finger or toe shall be considered to be equal to | ||||||
7 | the loss of one-half of
such thumb, finger or toe and the | ||||||
8 | compensation payable shall be one-half
of the amount above | ||||||
9 | specified. The loss of more than one phalanx shall
be | ||||||
10 | considered as the loss of the entire thumb, finger or toe. | ||||||
11 | In no
case shall the amount received for more than one | ||||||
12 | finger exceed the
amount provided in this schedule for the | ||||||
13 | loss of a hand.
| ||||||
14 | 9. Hand- | ||||||
15 | 190 weeks if the accidental injury occurs on or | ||||||
16 | after the effective date of this amendatory Act of the | ||||||
17 | 94th General Assembly
but before February
1, 2006.
| ||||||
18 | 205
weeks if the accidental injury occurs on or | ||||||
19 | after February
1, 2006. | ||||||
20 | The loss of 2 or more digits, or one or more
phalanges | ||||||
21 | of 2 or more digits, of a hand may be compensated on the | ||||||
22 | basis
of partial loss of use of a hand, provided, further, | ||||||
23 | that the loss of 4
digits, or the loss of use of 4 digits, | ||||||
24 | in the same hand shall
constitute the complete loss of a | ||||||
25 | hand.
| ||||||
26 | 10. Arm- |
| |||||||
| |||||||
1 | 235 weeks if the accidental injury occurs on or | ||||||
2 | after the effective date of this amendatory Act of the | ||||||
3 | 94th General Assembly
but before February
1, 2006.
| ||||||
4 | 253
weeks if the accidental injury occurs on or | ||||||
5 | after February
1, 2006. | ||||||
6 | Where an accidental injury results in the
amputation of | ||||||
7 | an arm below the elbow, such injury shall be compensated
as | ||||||
8 | a loss of an arm. Where an accidental injury results in the
| ||||||
9 | amputation of an arm above the elbow, compensation for an | ||||||
10 | additional 15 weeks (if the accidental injury occurs on or | ||||||
11 | after the effective date of this amendatory Act of the 94th | ||||||
12 | General Assembly
but before February
1, 2006) or an | ||||||
13 | additional 17
weeks (if the accidental injury occurs on or | ||||||
14 | after February
1, 2006) shall be paid, except where the | ||||||
15 | accidental injury results in the
amputation of an arm at | ||||||
16 | the shoulder joint, or so close to shoulder
joint that an | ||||||
17 | artificial arm cannot be used, or results in the
| ||||||
18 | disarticulation of an arm at the shoulder joint, in which | ||||||
19 | case
compensation for an additional 65 weeks (if the | ||||||
20 | accidental injury occurs on or after the effective date of | ||||||
21 | this amendatory Act of the 94th General Assembly
but before | ||||||
22 | February
1, 2006) or an additional 70
weeks (if the | ||||||
23 | accidental injury occurs on or after February
1, 2006)
| ||||||
24 | shall be paid.
| ||||||
25 | 11. Foot- | ||||||
26 | 155 weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after the effective date of this amendatory Act of the | ||||||
2 | 94th General Assembly
but before February
1, 2006.
| ||||||
3 | 167
weeks if the accidental injury occurs on or | ||||||
4 | after February
1, 2006.
| ||||||
5 | 12. Leg- | ||||||
6 | 200 weeks if the accidental injury occurs on or | ||||||
7 | after the effective date of this amendatory Act of the | ||||||
8 | 94th General Assembly
but before February
1, 2006.
| ||||||
9 | 215
weeks if the accidental injury occurs on or | ||||||
10 | after February
1, 2006. | ||||||
11 | Where an accidental injury results in the
amputation of | ||||||
12 | a leg below the knee, such injury shall be compensated as
| ||||||
13 | loss of a leg. Where an accidental injury results in the | ||||||
14 | amputation of a
leg above the knee, compensation for an | ||||||
15 | additional 25 weeks (if the accidental injury occurs on or | ||||||
16 | after the effective date of this amendatory Act of the 94th | ||||||
17 | General Assembly
but before February
1, 2006) or an | ||||||
18 | additional 27
weeks (if the accidental injury occurs on or | ||||||
19 | after February
1, 2006) shall be
paid, except where the | ||||||
20 | accidental injury results in the amputation of a
leg at the | ||||||
21 | hip joint, or so close to the hip joint that an artificial
| ||||||
22 | leg cannot be used, or results in the disarticulation of a | ||||||
23 | leg at the
hip joint, in which case compensation for an | ||||||
24 | additional 75 weeks (if the accidental injury occurs on or | ||||||
25 | after the effective date of this amendatory Act of the 94th | ||||||
26 | General Assembly
but before February
1, 2006) or an |
| |||||||
| |||||||
1 | additional 81
weeks (if the accidental injury occurs on or | ||||||
2 | after February
1, 2006) shall
be paid.
| ||||||
3 | 13. Eye- | ||||||
4 | 150 weeks if the accidental injury occurs on or | ||||||
5 | after the effective date of this amendatory Act of the | ||||||
6 | 94th General Assembly
but before February
1, 2006.
| ||||||
7 | 162
weeks if the accidental injury occurs on or | ||||||
8 | after February
1, 2006. | ||||||
9 | Where an accidental injury results in the
enucleation | ||||||
10 | of an eye, compensation for an additional 10 weeks (if the | ||||||
11 | accidental injury occurs on or after the effective date of | ||||||
12 | this amendatory Act of the 94th General Assembly
but before | ||||||
13 | February
1, 2006) or an additional 11
weeks (if the | ||||||
14 | accidental injury occurs on or after February
1, 2006)
| ||||||
15 | shall be
paid.
| ||||||
16 | 14. Loss of hearing of one ear- | ||||||
17 | 50 weeks if the accidental injury occurs on or | ||||||
18 | after the effective date of this amendatory Act of the | ||||||
19 | 94th General Assembly
but before February
1, 2006.
| ||||||
20 | 54
weeks if the accidental injury occurs on or | ||||||
21 | after February
1, 2006.
| ||||||
22 | Total and permanent loss of
hearing of both ears- | ||||||
23 | 200 weeks if the accidental injury occurs on or | ||||||
24 | after the effective date of this amendatory Act of the | ||||||
25 | 94th General Assembly
but before February
1, 2006. | ||||||
26 | 215
weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after February
1, 2006.
| ||||||
2 | 15. Testicle- | ||||||
3 | 50 weeks if the accidental injury occurs on or | ||||||
4 | after the effective date of this amendatory Act of the | ||||||
5 | 94th General Assembly
but before February
1, 2006.
| ||||||
6 | 54
weeks if the accidental injury occurs on or | ||||||
7 | after February
1, 2006.
| ||||||
8 | Both testicles- | ||||||
9 | 150 weeks if the accidental injury occurs on or | ||||||
10 | after the effective date of this amendatory Act of the | ||||||
11 | 94th General Assembly
but before February
1, 2006.
| ||||||
12 | 162
weeks if the accidental injury occurs on or | ||||||
13 | after February
1, 2006.
| ||||||
14 | 16. For the permanent partial loss of use of a member | ||||||
15 | or sight of an
eye, or hearing of an ear, compensation | ||||||
16 | during that proportion of the
number of weeks in the | ||||||
17 | foregoing schedule provided for the loss of such
member or | ||||||
18 | sight of an eye, or hearing of an ear, which the partial | ||||||
19 | loss
of use thereof bears to the total loss of use of such | ||||||
20 | member, or sight
of eye, or hearing of an ear.
| ||||||
21 | (a) Loss of hearing for compensation purposes | ||||||
22 | shall be
confined to the frequencies of 1,000, 2,000 | ||||||
23 | and 3,000 cycles per second.
Loss of hearing ability | ||||||
24 | for frequency tones above 3,000 cycles per second
are | ||||||
25 | not to be considered as constituting disability for | ||||||
26 | hearing.
|
| |||||||
| |||||||
1 | (b) The percent of hearing loss, for purposes of | ||||||
2 | the
determination of compensation claims for | ||||||
3 | occupational deafness,
shall be calculated as the | ||||||
4 | average in decibels for the thresholds
of hearing for | ||||||
5 | the frequencies of 1,000, 2,000 and 3,000 cycles per | ||||||
6 | second.
Pure tone air conduction audiometric | ||||||
7 | instruments, approved by
nationally recognized | ||||||
8 | authorities in this field, shall be used for measuring
| ||||||
9 | hearing loss. If the losses of hearing average 30 | ||||||
10 | decibels or less in the
3 frequencies, such losses of | ||||||
11 | hearing shall not then constitute any
compensable | ||||||
12 | hearing disability. If the losses of hearing average 85
| ||||||
13 | decibels or more in the 3 frequencies, then the same | ||||||
14 | shall constitute and
be total or 100% compensable | ||||||
15 | hearing loss.
| ||||||
16 | (c) In measuring hearing impairment, the lowest | ||||||
17 | measured
losses in each of the 3 frequencies shall be | ||||||
18 | added together and
divided by 3 to determine the | ||||||
19 | average decibel loss. For every decibel
of loss | ||||||
20 | exceeding 30 decibels an allowance of 1.82% shall be | ||||||
21 | made up to
the maximum of 100% which is reached at 85 | ||||||
22 | decibels.
| ||||||
23 | (d) If a hearing loss is established to have | ||||||
24 | existed on July 1, 1975 by
audiometric testing the | ||||||
25 | employer shall not be liable for the previous loss
so | ||||||
26 | established nor shall he be liable for any loss for |
| ||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||
1 | which compensation
has been paid or awarded.
| |||||||||||||||||||||||||||||||||||||||||||||
2 | (e) No consideration shall be given to the question | |||||||||||||||||||||||||||||||||||||||||||||
3 | of
whether or not the ability of an employee to | |||||||||||||||||||||||||||||||||||||||||||||
4 | understand speech
is improved by the use of a hearing | |||||||||||||||||||||||||||||||||||||||||||||
5 | aid.
| |||||||||||||||||||||||||||||||||||||||||||||
6 | (f) No claim for loss of hearing due to industrial | |||||||||||||||||||||||||||||||||||||||||||||
7 | noise
shall be brought against an employer or allowed | |||||||||||||||||||||||||||||||||||||||||||||
8 | unless the employee has
been exposed for a period of | |||||||||||||||||||||||||||||||||||||||||||||
9 | time sufficient to cause permanent impairment
to noise | |||||||||||||||||||||||||||||||||||||||||||||
10 | levels in excess of the following:
| |||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||
22 | This subparagraph (f) shall not be applied in cases of | |||||||||||||||||||||||||||||||||||||||||||||
23 | hearing loss
resulting from trauma or explosion.
| |||||||||||||||||||||||||||||||||||||||||||||
24 | 17. In computing the compensation to be paid to any | |||||||||||||||||||||||||||||||||||||||||||||
25 | employee who,
before the accident for which he claims | |||||||||||||||||||||||||||||||||||||||||||||
26 | compensation, had before that
time sustained an injury |
| |||||||
| |||||||
1 | resulting in the loss by amputation or partial
loss by | ||||||
2 | amputation of any member, including hand, arm, thumb or | ||||||
3 | fingers,
leg, foot or any toes, such loss or partial loss | ||||||
4 | of any such member
shall be deducted from any award made | ||||||
5 | for the subsequent injury. For
the permanent loss of use or | ||||||
6 | the permanent partial loss of use of any
such member or the | ||||||
7 | partial loss of sight of an eye, for which
compensation has | ||||||
8 | been paid, then such loss shall be taken into
consideration | ||||||
9 | and deducted from any award for the subsequent injury.
| ||||||
10 | 18. The specific case of loss of both hands, both arms, | ||||||
11 | or both
feet, or both legs, or both eyes, or of any two | ||||||
12 | thereof, or the
permanent and complete loss of the use | ||||||
13 | thereof, constitutes total and
permanent disability, to be | ||||||
14 | compensated according to the compensation
fixed by | ||||||
15 | paragraph (f) of this Section. These specific cases of | ||||||
16 | total
and permanent disability do not exclude other cases.
| ||||||
17 | Any employee who has previously suffered the loss or | ||||||
18 | permanent and
complete loss of the use of any of such | ||||||
19 | members, and in a subsequent
independent accident loses | ||||||
20 | another or suffers the permanent and complete
loss of the | ||||||
21 | use of any one of such members the employer for whom the
| ||||||
22 | injured employee is working at the time of the last | ||||||
23 | independent accident
is liable to pay compensation only for | ||||||
24 | the loss or permanent and
complete loss of the use of the | ||||||
25 | member occasioned by the last
independent accident.
| ||||||
26 | 19. In a case of specific loss and the subsequent death |
| |||||||
| |||||||
1 | of such
injured employee from other causes than such injury | ||||||
2 | leaving a widow,
widower, or dependents surviving before | ||||||
3 | payment or payment in full for
such injury, then the amount | ||||||
4 | due for such injury is payable to the widow
or widower and, | ||||||
5 | if there be no widow or widower, then to such
dependents, | ||||||
6 | in the proportion which such dependency bears to total
| ||||||
7 | dependency.
| ||||||
8 | Beginning July 1, 1980, and every 6 months thereafter, the | ||||||
9 | Commission
shall examine the Second Injury Fund and when, after | ||||||
10 | deducting all
advances or loans made to such Fund, the amount | ||||||
11 | therein is $500,000
then the amount required to be paid by | ||||||
12 | employers pursuant to paragraph
(f) of Section 7 shall be | ||||||
13 | reduced by one-half. When the Second Injury Fund
reaches the | ||||||
14 | sum of $600,000 then the payments shall cease entirely.
| ||||||
15 | However, when the Second Injury Fund has been reduced to | ||||||
16 | $400,000, payment
of one-half of the amounts required by | ||||||
17 | paragraph (f) of Section 7
shall be resumed, in the manner | ||||||
18 | herein provided, and when the Second Injury
Fund has been | ||||||
19 | reduced to $300,000, payment of the full amounts required by
| ||||||
20 | paragraph (f) of Section 7 shall be resumed, in the manner | ||||||
21 | herein provided.
The Commission shall make the changes in | ||||||
22 | payment effective by
general order, and the changes in payment | ||||||
23 | become immediately effective
for all cases coming before the | ||||||
24 | Commission thereafter either by
settlement agreement or final | ||||||
25 | order, irrespective of the date of the
accidental injury.
| ||||||
26 | On August 1, 1996 and on February 1 and August 1 of each |
| |||||||
| |||||||
1 | subsequent year, the Commission
shall examine the special fund | ||||||
2 | designated as the "Rate
Adjustment Fund" and when, after | ||||||
3 | deducting all advances or loans made to
said fund, the amount | ||||||
4 | therein is $4,000,000, the amount required to be
paid by | ||||||
5 | employers pursuant to paragraph (f) of Section 7 shall be
| ||||||
6 | reduced by one-half. When the Rate Adjustment Fund reaches the | ||||||
7 | sum of
$5,000,000 the payment therein shall cease entirely. | ||||||
8 | However, when said
Rate Adjustment Fund has been reduced to | ||||||
9 | $3,000,000 the amounts required by
paragraph (f) of Section 7 | ||||||
10 | shall be resumed in the manner herein provided.
| ||||||
11 | (f) In case of complete disability, which renders the | ||||||
12 | employee
wholly and permanently incapable of work, or in the | ||||||
13 | specific case of
total and permanent disability as provided in | ||||||
14 | subparagraph 18 of
paragraph (e) of this Section, compensation | ||||||
15 | shall be payable at the rate
provided in subparagraph 2 of | ||||||
16 | paragraph (b) of this Section for life.
| ||||||
17 | An employee entitled to benefits under paragraph (f) of | ||||||
18 | this Section
shall also be entitled to receive from the Rate | ||||||
19 | Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||||||
20 | supplementary benefits
provided in paragraph (g) of this | ||||||
21 | Section 8.
| ||||||
22 | If any employee who receives an award under this paragraph | ||||||
23 | afterwards
returns to work or is able to do so, and earns or is | ||||||
24 | able to earn as
much as before the accident, payments under | ||||||
25 | such award shall cease. If
such employee returns to work, or is | ||||||
26 | able to do so, and earns or is able
to earn part but not as much |
| |||||||
| |||||||
1 | as before the accident, such award shall be
modified so as to | ||||||
2 | conform to an award under paragraph (d) of this
Section. If | ||||||
3 | such award is terminated or reduced under the provisions of
| ||||||
4 | this paragraph, such employees have the right at any time | ||||||
5 | within 30
months after the date of such termination or | ||||||
6 | reduction to file petition
with the Commission for the purpose | ||||||
7 | of determining whether any
disability exists as a result of the | ||||||
8 | original accidental injury and the
extent thereof.
| ||||||
9 | Disability as enumerated in subdivision 18, paragraph (e) | ||||||
10 | of this
Section is considered complete disability.
| ||||||
11 | If an employee who had previously incurred loss or the | ||||||
12 | permanent and
complete loss of use of one member, through the | ||||||
13 | loss or the permanent
and complete loss of the use of one hand, | ||||||
14 | one arm, one foot, one leg, or
one eye, incurs permanent and | ||||||
15 | complete disability through the loss or
the permanent and | ||||||
16 | complete loss of the use of another member, he shall
receive, | ||||||
17 | in addition to the compensation payable by the employer and
| ||||||
18 | after such payments have ceased, an amount from the Second | ||||||
19 | Injury Fund
provided for in paragraph (f) of Section 7, which, | ||||||
20 | together with the
compensation payable from the employer in | ||||||
21 | whose employ he was when the
last accidental injury was | ||||||
22 | incurred, will equal the amount payable for
permanent and | ||||||
23 | complete disability as provided in this paragraph of this
| ||||||
24 | Section.
| ||||||
25 | The custodian of the Second Injury Fund provided for in | ||||||
26 | paragraph (f)
of Section 7 shall be joined with the employer as |
| |||||||
| |||||||
1 | a party respondent in
the application for adjustment of claim. | ||||||
2 | The application for adjustment
of claim shall state briefly and | ||||||
3 | in general terms the approximate time
and place and manner of | ||||||
4 | the loss of the first member.
| ||||||
5 | In its award the Commission or the Arbitrator shall | ||||||
6 | specifically find
the amount the injured employee shall be | ||||||
7 | weekly paid, the number of
weeks compensation which shall be | ||||||
8 | paid by the employer, the date upon
which payments begin out of | ||||||
9 | the Second Injury Fund provided for in
paragraph (f) of Section | ||||||
10 | 7 of this Act, the length of time the weekly
payments continue, | ||||||
11 | the date upon which the pension payments commence and
the | ||||||
12 | monthly amount of the payments. The Commission shall 30 days | ||||||
13 | after
the date upon which payments out of the Second Injury | ||||||
14 | Fund have begun as
provided in the award, and every month | ||||||
15 | thereafter, prepare and submit to
the State Comptroller a | ||||||
16 | voucher for payment for all compensation accrued
to that date | ||||||
17 | at the rate fixed by the Commission. The State Comptroller
| ||||||
18 | shall draw a warrant to the injured employee along with a | ||||||
19 | receipt to be
executed by the injured employee and returned to | ||||||
20 | the Commission. The
endorsed warrant and receipt is a full and | ||||||
21 | complete acquittance to the
Commission for the payment out of | ||||||
22 | the Second Injury Fund. No other
appropriation or warrant is | ||||||
23 | necessary for payment out of the Second
Injury Fund. The Second | ||||||
24 | Injury Fund is appropriated for the purpose of
making payments | ||||||
25 | according to the terms of the awards.
| ||||||
26 | As of July 1, 1980 to July 1, 1982, all claims against and |
| |||||||
| |||||||
1 | obligations
of the Second Injury Fund shall become claims | ||||||
2 | against and obligations of
the Rate Adjustment Fund to the | ||||||
3 | extent there is insufficient money in the
Second Injury Fund to | ||||||
4 | pay such claims and obligations. In that case, all
references | ||||||
5 | to "Second Injury Fund" in this Section shall also include the
| ||||||
6 | Rate Adjustment Fund.
| ||||||
7 | (g) Every award for permanent total disability entered by | ||||||
8 | the
Commission on and after July 1, 1965 under which | ||||||
9 | compensation payments
shall become due and payable after the | ||||||
10 | effective date of this amendatory
Act, and every award for | ||||||
11 | death benefits or permanent total disability
entered by the | ||||||
12 | Commission on and after the effective date of this
amendatory | ||||||
13 | Act shall be subject to annual adjustments as to the amount
of | ||||||
14 | the compensation rate therein provided. Such adjustments shall | ||||||
15 | first
be made on July 15, 1977, and all awards made and entered | ||||||
16 | prior to July
1, 1975 and on July 15 of each year
thereafter. | ||||||
17 | In all other cases such adjustment shall be made on July 15
of | ||||||
18 | the second year next following the date of the entry of the | ||||||
19 | award and
shall further be made on July 15 annually thereafter. | ||||||
20 | If during the
intervening period from the date of the entry of | ||||||
21 | the award, or the last
periodic adjustment, there shall have | ||||||
22 | been an increase in the State's
average weekly wage in covered | ||||||
23 | industries under the Unemployment
Insurance Act, the weekly | ||||||
24 | compensation rate shall be proportionately
increased by the | ||||||
25 | same percentage as the percentage of increase in the
State's | ||||||
26 | average weekly wage in covered industries under the
|
| |||||||
| |||||||
1 | Unemployment Insurance Act. The increase in the compensation | ||||||
2 | rate
under this paragraph shall in no event bring the total | ||||||
3 | compensation rate
to an amount greater than the prevailing | ||||||
4 | maximum rate at the time that the annual adjustment is made. | ||||||
5 | Such increase
shall be paid in the same manner as herein | ||||||
6 | provided for payments under
the Second Injury Fund to the | ||||||
7 | injured employee, or his dependents, as
the case may be, out of | ||||||
8 | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||||||
9 | of this Act. Payments shall be made at
the same intervals as | ||||||
10 | provided in the award or, at the option of the
Commission, may | ||||||
11 | be made in quarterly payment on the 15th day of January,
April, | ||||||
12 | July and October of each year. In the event of a decrease in
| ||||||
13 | such average weekly wage there shall be no change in the then | ||||||
14 | existing
compensation rate. The within paragraph shall not | ||||||
15 | apply to cases where
there is disputed liability and in which a | ||||||
16 | compromise lump sum settlement
between the employer and the | ||||||
17 | injured employee, or his dependents, as the
case may be, has | ||||||
18 | been duly approved by the Illinois Workers' Compensation
| ||||||
19 | Commission.
| ||||||
20 | Provided, that in cases of awards entered by the Commission | ||||||
21 | for
injuries occurring before July 1, 1975, the increases in | ||||||
22 | the
compensation rate adjusted under the foregoing provision of | ||||||
23 | this
paragraph (g) shall be limited to increases in the State's | ||||||
24 | average
weekly wage in covered industries under the | ||||||
25 | Unemployment Insurance Act
occurring after July 1, 1975.
| ||||||
26 | For every accident occurring on or after July 20, 2005 but |
| |||||||
| |||||||
1 | before the effective date of this amendatory Act of the 94th | ||||||
2 | General Assembly (Senate Bill 1283 of the 94th General | ||||||
3 | Assembly), the annual adjustments to the compensation rate in | ||||||
4 | awards for death benefits or permanent total disability, as | ||||||
5 | provided in this Act, shall be paid by the employer. The | ||||||
6 | adjustment shall be made by the employer on July 15 of the | ||||||
7 | second year next following the date of the entry of the award | ||||||
8 | and shall further be made on July 15 annually thereafter. If | ||||||
9 | during the intervening period from the date of the entry of the | ||||||
10 | award, or the last periodic adjustment, there shall have been | ||||||
11 | an increase in the State's average weekly wage in covered | ||||||
12 | industries under the Unemployment Insurance Act, the employer | ||||||
13 | shall increase the weekly compensation rate proportionately by | ||||||
14 | the same percentage as the percentage of increase in the | ||||||
15 | State's average weekly wage in covered industries under the | ||||||
16 | Unemployment Insurance Act. The increase in the compensation | ||||||
17 | rate under this paragraph shall in no event bring the total | ||||||
18 | compensation rate to an amount greater than the prevailing | ||||||
19 | maximum rate at the time that the annual adjustment is made. In | ||||||
20 | the event of a decrease in such average weekly wage there shall | ||||||
21 | be no change in the then existing compensation rate. Such | ||||||
22 | increase shall be paid by the employer in the same manner and | ||||||
23 | at the same intervals as the payment of compensation in the | ||||||
24 | award. This paragraph shall not apply to cases where there is | ||||||
25 | disputed liability and in which a compromise lump sum | ||||||
26 | settlement between the employer and the injured employee, or |
| |||||||
| |||||||
1 | his or her dependents, as the case may be, has been duly | ||||||
2 | approved by the Illinois Workers' Compensation Commission. | ||||||
3 | The annual adjustments for every award of death benefits or | ||||||
4 | permanent total disability involving accidents occurring | ||||||
5 | before July 20, 2005 and accidents occurring on or after the | ||||||
6 | effective date of this amendatory Act of the 94th General | ||||||
7 | Assembly (Senate Bill 1283 of the 94th General Assembly) shall | ||||||
8 | continue to be paid from the Rate Adjustment Fund pursuant to | ||||||
9 | this paragraph and Section 7(f) of this Act.
| ||||||
10 | (h) In case death occurs from any cause before the total
| ||||||
11 | compensation to which the employee would have been entitled has | ||||||
12 | been
paid, then in case the employee leaves any widow, widower, | ||||||
13 | child, parent
(or any grandchild, grandparent or other lineal | ||||||
14 | heir or any collateral
heir dependent at the time of the | ||||||
15 | accident upon the earnings of the
employee to the extent of 50% | ||||||
16 | or more of total dependency) such
compensation shall be paid to | ||||||
17 | the beneficiaries of the deceased employee
and distributed as | ||||||
18 | provided in paragraph (g) of Section 7.
| ||||||
19 | (h-1) In case an injured employee is under legal disability
| ||||||
20 | at the time when any right or privilege accrues to him or her | ||||||
21 | under this
Act, a guardian may be appointed pursuant to law, | ||||||
22 | and may, on behalf
of such person under legal disability, claim | ||||||
23 | and exercise any
such right or privilege with the same effect | ||||||
24 | as if the employee himself
or herself had claimed or exercised | ||||||
25 | the right or privilege. No limitations
of time provided by this | ||||||
26 | Act run so long as the employee who is under legal
disability |
| |||||||
| |||||||
1 | is without a conservator or guardian.
| ||||||
2 | (i) In case the injured employee is under 16 years of age | ||||||
3 | at the
time of the accident and is illegally employed, the | ||||||
4 | amount of
compensation payable under paragraphs (b), (c), (d), | ||||||
5 | (e) and (f) of this
Section is increased 50%.
| ||||||
6 | However, where an employer has on file an employment | ||||||
7 | certificate
issued pursuant to the Child Labor Law or work | ||||||
8 | permit issued pursuant
to the Federal Fair Labor Standards Act, | ||||||
9 | as amended, or a birth
certificate properly and duly issued, | ||||||
10 | such certificate, permit or birth
certificate is conclusive | ||||||
11 | evidence as to the age of the injured minor
employee for the | ||||||
12 | purposes of this Section.
| ||||||
13 | Nothing herein contained repeals or amends the provisions | ||||||
14 | of the
Child Labor Law relating to the employment of minors | ||||||
15 | under the age of 16 years.
| ||||||
16 | (j) 1. In the event the injured employee receives benefits,
| ||||||
17 | including medical, surgical or hospital benefits under any | ||||||
18 | group plan
covering non-occupational disabilities contributed | ||||||
19 | to wholly or
partially by the employer, which benefits should | ||||||
20 | not have been payable
if any rights of recovery existed under | ||||||
21 | this Act, then such amounts so
paid to the employee from any | ||||||
22 | such group plan as shall be consistent
with, and limited to, | ||||||
23 | the provisions of paragraph 2 hereof, shall be
credited to or | ||||||
24 | against any compensation payment for temporary total
| ||||||
25 | incapacity for work or any medical, surgical or hospital | ||||||
26 | benefits made
or to be made under this Act. In such event, the |
| |||||||
| |||||||
1 | period of time for
giving notice of accidental injury and | ||||||
2 | filing application for adjustment
of claim does not commence to | ||||||
3 | run until the termination of such
payments. This paragraph does | ||||||
4 | not apply to payments made under any
group plan which would | ||||||
5 | have been payable irrespective of an accidental
injury under | ||||||
6 | this Act. Any employer receiving such credit shall keep
such | ||||||
7 | employee safe and harmless from any and all claims or | ||||||
8 | liabilities
that may be made against him by reason of having | ||||||
9 | received such payments
only to the extent of such credit.
| ||||||
10 | Any excess benefits paid to or on behalf of a State | ||||||
11 | employee by the
State Employees' Retirement System under | ||||||
12 | Article 14 of the Illinois Pension
Code on a death claim or | ||||||
13 | disputed disability claim shall be credited
against any | ||||||
14 | payments made or to be made by the State of Illinois to or on
| ||||||
15 | behalf of such employee under this Act, except for payments for | ||||||
16 | medical
expenses which have already been incurred at the time | ||||||
17 | of the award. The
State of Illinois shall directly reimburse | ||||||
18 | the State Employees' Retirement
System to the extent of such | ||||||
19 | credit.
| ||||||
20 | 2. Nothing contained in this Act shall be construed to give | ||||||
21 | the
employer or the insurance carrier the right to credit for | ||||||
22 | any benefits
or payments received by the employee other than | ||||||
23 | compensation payments
provided by this Act, and where the | ||||||
24 | employee receives payments other
than compensation payments, | ||||||
25 | whether as full or partial salary, group
insurance benefits, | ||||||
26 | bonuses, annuities or any other payments, the
employer or |
| |||||||
| |||||||
1 | insurance carrier shall receive credit for each such payment
| ||||||
2 | only to the extent of the compensation that would have been | ||||||
3 | payable
during the period covered by such payment.
| ||||||
4 | 3. The extension of time for the filing of an Application | ||||||
5 | for
Adjustment of Claim as provided in paragraph 1 above shall | ||||||
6 | not apply to
those cases where the time for such filing had | ||||||
7 | expired prior to the date
on which payments or benefits | ||||||
8 | enumerated herein have been initiated or
resumed. Provided | ||||||
9 | however that this paragraph 3 shall apply only to
cases wherein | ||||||
10 | the payments or benefits hereinabove enumerated shall be
| ||||||
11 | received after July 1, 1969.
| ||||||
12 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||||||
13 | 94-695, eff. 11-16-05.)
| ||||||
14 | (820 ILCS 305/8.2)
| ||||||
15 | Sec. 8.2. Fee schedule.
| ||||||
16 | (a) Except as provided for in subsection (c), for | ||||||
17 | procedures, treatments, or services covered under this Act and | ||||||
18 | rendered or to be rendered on and after February 1, 2006, the | ||||||
19 | maximum allowable payment shall be 90% of the 80th percentile | ||||||
20 | of charges and fees as determined by the Commission utilizing | ||||||
21 | information provided by employers' and insurers' national | ||||||
22 | databases, with a minimum of 12,000,000 Illinois line item | ||||||
23 | charges and fees comprised of health care provider and hospital | ||||||
24 | charges and fees as of August 1, 2004 but not earlier than | ||||||
25 | August 1, 2002. These charges and fees are provider billed |
| |||||||
| |||||||
1 | amounts and shall not include discounted charges. The 80th | ||||||
2 | percentile is the point on an ordered data set from low to high | ||||||
3 | such that 80% of the cases are below or equal to that point and | ||||||
4 | at most 20% are above or equal to that point. The Commission | ||||||
5 | shall adjust these historical charges and fees as of August 1, | ||||||
6 | 2004 by the Consumer Price Index-U for the period August 1, | ||||||
7 | 2004 through September 30, 2005. The Commission shall establish | ||||||
8 | fee schedules for procedures, treatments, or services for | ||||||
9 | hospital inpatient, hospital outpatient, emergency room and | ||||||
10 | trauma, ambulatory surgical treatment centers, and | ||||||
11 | professional services. These charges and fees shall be | ||||||
12 | designated by geozip or any smaller geographic unit. The data | ||||||
13 | shall in no way identify or tend to identify any patient, | ||||||
14 | employer, or health care provider. As used in this Section, | ||||||
15 | "geozip" means a three-digit zip code based on data | ||||||
16 | similarities, geographical similarities, and frequencies. A | ||||||
17 | geozip does not cross state boundaries. As used in this | ||||||
18 | Section, "three-digit zip code" means a geographic area in | ||||||
19 | which all zip codes have the same first 3 digits. If a geozip | ||||||
20 | does not have the necessary number of charges and fees to | ||||||
21 | calculate a valid percentile for a specific procedure, | ||||||
22 | treatment, or service, the Commission may combine data from the | ||||||
23 | geozip with up to 4 other geozips that are demographically and | ||||||
24 | economically similar and exhibit similarities in data and | ||||||
25 | frequencies until the Commission reaches 9 charges or fees for | ||||||
26 | that specific procedure, treatment, or service. In cases where |
| |||||||
| |||||||
1 | the compiled data contains less than 9 charges or fees for a | ||||||
2 | procedure, treatment, or service, reimbursement shall occur at | ||||||
3 | 76% of charges and fees as determined by the Commission in a | ||||||
4 | manner consistent with the provisions of this paragraph. | ||||||
5 | Providers of out-of-state procedures, treatments, services, | ||||||
6 | products, or supplies shall be reimbursed at the lesser of that | ||||||
7 | state's fee schedule amount or the fee schedule amount that | ||||||
8 | would apply to Cook County, Illinois. If no fee schedule exists | ||||||
9 | in that state, the provider shall be reimbursed at the lesser | ||||||
10 | of the actual charge or the fee schedule amount in Cook County, | ||||||
11 | Illinois The Commission has the authority to set the maximum | ||||||
12 | allowable payment to providers of out-of-state procedures, | ||||||
13 | treatments, or services covered under this Act in a manner | ||||||
14 | consistent with this Section. Not later than September 30 in | ||||||
15 | 2006 and each year thereafter, the Commission shall | ||||||
16 | automatically increase or decrease the maximum allowable | ||||||
17 | payment for a procedure, treatment, or service established and | ||||||
18 | in effect on January 1 of that year by the percentage change in | ||||||
19 | the Consumer Price Index-U for the 12 month period ending | ||||||
20 | August 31 of that year. The increase or decrease shall become | ||||||
21 | effective on January 1 of the following year. As used in this | ||||||
22 | Section, "Consumer Price Index-U" means the index published by | ||||||
23 | the Bureau of Labor Statistics of the U.S. Department of Labor, | ||||||
24 | that measures the average change in prices of all goods and | ||||||
25 | services purchased by all urban consumers, U.S. city average, | ||||||
26 | all items, 1982-84=100. |
| |||||||
| |||||||
1 | (a-1) Notwithstanding the provisions of subsection (a), | ||||||
2 | the following provisions shall apply to the medical fee | ||||||
3 | schedule starting on April 1, 2011: | ||||||
4 | (1) The Commission shall establish and maintain fee | ||||||
5 | schedules for procedures, treatments, products, services, | ||||||
6 | or supplies for hospital inpatient, hospital outpatient, | ||||||
7 | emergency room, ambulatory surgical treatment centers, | ||||||
8 | accredited ambulatory treatment facilities, prescriptions | ||||||
9 | filled and dispensed outside of a licensed pharmacy, dental | ||||||
10 | services, and professional services. This fee schedule | ||||||
11 | shall be based on the fee schedule amounts already | ||||||
12 | established by the Commission pursuant to subsection (a) of | ||||||
13 | this Section. However, these fee schedule amounts shall be | ||||||
14 | grouped into 4 regions to be implemented as follows: | ||||||
15 | Region 1: Cook County. | ||||||
16 | Region 2: DuPage, Kane, Lake, and Will Counties. | ||||||
17 | Region 3: Bond, Calhoun, Clinton, Jersey, Macoupin, | ||||||
18 | Madison, Monroe, Montgomery, Randolph, St. Clair, and | ||||||
19 | Washington Counties. | ||||||
20 | Region 4: All counties in Illinois that are not | ||||||
21 | included in Regions 1, 2, or 3. | ||||||
22 | (2) In cases where the compiled data contains less than | ||||||
23 | 9 charges or fees for a procedure, treatment, product, | ||||||
24 | supply, or service or where the fee schedule amount cannot | ||||||
25 | be determined by the non-discounted charge data, | ||||||
26 | non-Medicare relative values and conversion factors |
| |||||||
| |||||||
1 | derived from established fee schedule amounts, coding | ||||||
2 | crosswalks, or other data as determined by the Commission, | ||||||
3 | reimbursement shall occur at 76% of charges and fees until | ||||||
4 | April 1, 2011 and 64.6% of charges and fees thereafter as | ||||||
5 | determined by the Commission in a manner consistent with | ||||||
6 | the provisions of this paragraph. If a geozip, as defined | ||||||
7 | in subsection (a) of this Section, overlaps into one or | ||||||
8 | more of the regions set forth in paragraph (1) of this | ||||||
9 | subsection (a-1), then the Commission shall average or | ||||||
10 | repeat the charges and fees in a geozip in order to | ||||||
11 | designate charges and fees for each region. | ||||||
12 | (3) To establish additional fee schedule amounts, the | ||||||
13 | Commission shall utilize provider non-discounted charge | ||||||
14 | data, non-Medicare relative values and conversion factors | ||||||
15 | derived from established fee schedule amounts, and coding | ||||||
16 | crosswalks. The Commission may establish additional fee | ||||||
17 | schedule amounts based on either the charge or cost of the | ||||||
18 | procedure, treatment, product, supply, or service. | ||||||
19 | (4) Implants shall be reimbursed at 25% above the net | ||||||
20 | manufacturer's invoice price less rebates, plus actual | ||||||
21 | reasonable and customary shipping charges whether or not | ||||||
22 | the implant charge is submitted by a provider in | ||||||
23 | conjunction with a bill for all other services associated | ||||||
24 | with the implant, submitted by a provider on a separate | ||||||
25 | claim form, submitted by a distributor, or submitted by the | ||||||
26 | manufacturer of the implant. "Implants" include the |
| |||||||
| |||||||
1 | following codes or any substantially similar updated code | ||||||
2 | as determined by the Commission: 0274 | ||||||
3 | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | ||||||
4 | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | ||||||
5 | (investigational devices); and 0636 (drugs requiring | ||||||
6 | detailed coding). Non-implantable devices or supplies | ||||||
7 | within these codes shall be reimbursed at 65% of actual | ||||||
8 | charge, which is the provider's normal rates under its | ||||||
9 | standard chargemaster. A standard chargemaster is the | ||||||
10 | provider's list of charges for procedures, treatments, | ||||||
11 | products, supplies, or services used to bill payers in a | ||||||
12 | consistent manner. | ||||||
13 | (5) The Commission shall automatically update all | ||||||
14 | codes and associated rules with the version of the codes | ||||||
15 | and rules valid on January 1 of that year. | ||||||
16 | (a-2) For procedures, treatments, services, or supplies | ||||||
17 | covered under this Act and rendered or to be rendered on or | ||||||
18 | after April 1, 2011, the maximum allowable payment shall be 85% | ||||||
19 | of the fee schedule amounts and any reimbursements for charges | ||||||
20 | and fees pursuant to paragraph (2) of subsection (a-1) in | ||||||
21 | effect on April 1, 2011 and thereafter be adjusted yearly by | ||||||
22 | the Consumer Price Index-U, as described in subsection (a) of | ||||||
23 | this Section. | ||||||
24 | (a-3) Prescriptions filled and dispensed outside of a | ||||||
25 | licensed pharmacy shall be subject to a fee schedule that shall | ||||||
26 | not exceed the Average Wholesale Price (AWP) or its equivalent |
| |||||||
| |||||||
1 | plus a dispensing fee of $4.18. AWP or its equivalent will be | ||||||
2 | as set forth for that drug on that date as published in | ||||||
3 | Medispan. | ||||||
4 | (b) Notwithstanding the provisions of subsections | ||||||
5 | subsection (a) and (a-1) of this Section , if
the Commission | ||||||
6 | finds that there is a significant limitation on
access to | ||||||
7 | quality health care in either a specific field of
health care | ||||||
8 | services for a specific procedure, treatment, product, | ||||||
9 | service, or supply or for a specific geographic limitation on
| ||||||
10 | access to health care, it may adjust fee schedule amounts in a | ||||||
11 | manner consistent with the provisions of this Act change the | ||||||
12 | Consumer Price Index-U
increase or decrease for that specific | ||||||
13 | field or specific
geographic limitation on access to health | ||||||
14 | care to address that
limitation. | ||||||
15 | (c) The Commission shall establish by rule a process to | ||||||
16 | review those medical cases or outliers that involve | ||||||
17 | extra-ordinary treatment to determine whether to make an | ||||||
18 | additional adjustment to the maximum payment within a fee | ||||||
19 | schedule for a procedure, treatment, or service. | ||||||
20 | (d) When a patient notifies a provider that the treatment, | ||||||
21 | procedure, or service being sought is for a work-related | ||||||
22 | illness or injury and furnishes the provider the name and | ||||||
23 | address of the responsible employer, the provider shall bill | ||||||
24 | the employer directly. The employer shall make payment and | ||||||
25 | providers shall submit bills and records in accordance with the | ||||||
26 | provisions of this Section. All payments to providers for |
| |||||||
| |||||||
1 | treatment provided pursuant to this Act shall be made within 60 | ||||||
2 | days of receipt of the bills as long as the claim contains | ||||||
3 | substantially all the required data elements necessary to | ||||||
4 | adjudicate the bills. In the case of nonpayment to a provider | ||||||
5 | within 60 days of receipt of the bill which contained | ||||||
6 | substantially all of the required data elements necessary to | ||||||
7 | adjudicate the bill or nonpayment to a provider of a portion of | ||||||
8 | such a bill up to the lesser of the actual charge or the | ||||||
9 | payment level set by the Commission in the fee schedule | ||||||
10 | established in this Section, the bill, or portion of the bill, | ||||||
11 | shall incur interest at a rate of 1% per month payable to the | ||||||
12 | provider. | ||||||
13 | (e) Except as provided in subsections (e-5), (e-10), and | ||||||
14 | (e-15), a provider shall not hold an employee liable for costs | ||||||
15 | related to a non-disputed procedure, treatment, or service | ||||||
16 | rendered in connection with a compensable injury. The | ||||||
17 | provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||||||
18 | shall not apply if an employee provides information to the | ||||||
19 | provider regarding participation in a group health plan. If the | ||||||
20 | employee participates in a group health plan, the provider may | ||||||
21 | submit a claim for services to the group health plan. If the | ||||||
22 | claim for service is covered by the group health plan, the | ||||||
23 | employee's responsibility shall be limited to applicable | ||||||
24 | deductibles, co-payments, or co-insurance. Except as provided | ||||||
25 | under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||||||
26 | shall not bill or otherwise attempt to recover from the |
| |||||||
| |||||||
1 | employee the difference between the provider's charge and the | ||||||
2 | amount paid by the employer or the insurer on a compensable | ||||||
3 | injury , or for medical services or treatment determined by the | ||||||
4 | Commission to be excessive or unnecessary . | ||||||
5 | (e-5) If an employer notifies a provider that the employer | ||||||
6 | does not consider the illness or injury to be compensable under | ||||||
7 | this Act, the provider may seek payment of the provider's | ||||||
8 | actual charges from the employee for any procedure, treatment, | ||||||
9 | or service rendered. Once an employee informs the provider that | ||||||
10 | there is an application filed with the Commission to resolve a | ||||||
11 | dispute over payment of such charges, the provider shall cease | ||||||
12 | any and all efforts to collect payment for the services that | ||||||
13 | are the subject of the dispute. Any statute of limitations or | ||||||
14 | statute of repose applicable to the provider's efforts to | ||||||
15 | collect payment from the employee shall be tolled from the date | ||||||
16 | that the employee files the application with the Commission | ||||||
17 | until the date that the provider is permitted to resume | ||||||
18 | collection efforts under the provisions of this Section. | ||||||
19 | (e-10) If an employer notifies a provider that the employer | ||||||
20 | will pay only a portion of a bill for any procedure, treatment, | ||||||
21 | or service rendered in connection with a compensable illness or | ||||||
22 | disease, the provider may seek payment from the employee for | ||||||
23 | the remainder of the amount of the bill up to the lesser of the | ||||||
24 | actual charge, negotiated rate, if applicable, or the payment | ||||||
25 | level set by the Commission in the fee schedule established in | ||||||
26 | this Section. Once an employee informs the provider that there |
| |||||||
| |||||||
1 | is an application filed with the Commission to resolve a | ||||||
2 | dispute over payment of such charges, the provider shall cease | ||||||
3 | any and all efforts to collect payment for the services that | ||||||
4 | are the subject of the dispute. Any statute of limitations or | ||||||
5 | statute of repose applicable to the provider's efforts to | ||||||
6 | collect payment from the employee shall be tolled from the date | ||||||
7 | that the employee files the application with the Commission | ||||||
8 | until the date that the provider is permitted to resume | ||||||
9 | collection efforts under the provisions of this Section. | ||||||
10 | (e-15) When there is a dispute over the compensability of | ||||||
11 | or amount of payment for a procedure, treatment, or service, | ||||||
12 | and a case is pending or proceeding before an Arbitrator or the | ||||||
13 | Commission, the provider may mail the employee reminders that | ||||||
14 | the employee will be responsible for payment of any procedure, | ||||||
15 | treatment or service rendered by the provider. The reminders | ||||||
16 | must state that they are not bills, to the extent practicable | ||||||
17 | include itemized information, and state that the employee need | ||||||
18 | not pay until such time as the provider is permitted to resume | ||||||
19 | collection efforts under this Section. The reminders shall not | ||||||
20 | be provided to any credit rating agency. The reminders may | ||||||
21 | request that the employee furnish the provider with information | ||||||
22 | about the proceeding under this Act, such as the file number, | ||||||
23 | names of parties, and status of the case. If an employee fails | ||||||
24 | to respond to such request for information or fails to furnish | ||||||
25 | the information requested within 90 days of the date of the | ||||||
26 | reminder, the provider is entitled to resume any and all |
| |||||||
| |||||||
1 | efforts to collect payment from the employee for the services | ||||||
2 | rendered to the employee and the employee shall be responsible | ||||||
3 | for payment of any outstanding bills for a procedure, | ||||||
4 | treatment, or service rendered by a provider. | ||||||
5 | (e-20) Upon a final award or judgment by an Arbitrator or | ||||||
6 | the Commission, or a settlement agreed to by the employer and | ||||||
7 | the employee, a provider may resume any and all efforts to | ||||||
8 | collect payment from the employee for the services rendered to | ||||||
9 | the employee and the employee shall be responsible for payment | ||||||
10 | of any outstanding bills for a procedure, treatment, or service | ||||||
11 | rendered by a provider as well as the interest awarded under | ||||||
12 | subsection (d) of this Section. In the case of a procedure, | ||||||
13 | treatment, or service deemed compensable, the provider shall | ||||||
14 | not require a payment rate, excluding the interest provisions | ||||||
15 | under subsection (d), greater than the lesser of the actual | ||||||
16 | charge or the payment level set by the Commission in the fee | ||||||
17 | schedule established in this Section. Payment for services | ||||||
18 | deemed not covered or not compensable under this Act is the | ||||||
19 | responsibility of the employee unless a provider and employee | ||||||
20 | have agreed otherwise in writing. Services not covered or not | ||||||
21 | compensable under this Act are not subject to the fee schedule | ||||||
22 | in this Section. | ||||||
23 | (f) Nothing in this Act shall prohibit an employer or
| ||||||
24 | insurer from contracting with a health care provider or group
| ||||||
25 | of health care providers for reimbursement levels for benefits | ||||||
26 | under this Act different
from those provided in this Section. |
| |||||||
| |||||||
1 | (g) On or before January 1, 2010 the Commission shall | ||||||
2 | provide to the Governor and General Assembly a report regarding | ||||||
3 | the implementation of the medical fee schedule and the index | ||||||
4 | used for annual adjustment to that schedule as described in | ||||||
5 | this Section.
| ||||||
6 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.) | ||||||
7 | (820 ILCS 305/8.3)
| ||||||
8 | Sec. 8.3. Workers' Compensation Medical Fee Advisory | ||||||
9 | Board. There is created a Workers' Compensation Medical Fee | ||||||
10 | Advisory Board consisting of 9 members appointed by the | ||||||
11 | Governor with the advice and consent of the Senate. Three | ||||||
12 | members of the Advisory Board shall be representative citizens | ||||||
13 | chosen from the employee class, 3 members shall be | ||||||
14 | representative citizens chosen from the employing class, and 3 | ||||||
15 | members shall be representative citizens chosen from the | ||||||
16 | medical provider class. Each member shall serve a 4-year term | ||||||
17 | and shall continue to serve until a successor is appointed. A | ||||||
18 | vacancy on the Advisory Board shall be filled by the Governor | ||||||
19 | for the unexpired term. | ||||||
20 | Members of the Advisory Board shall receive no compensation | ||||||
21 | for their services but shall be reimbursed for expenses | ||||||
22 | incurred in the performance of their duties by the Commission | ||||||
23 | from appropriations made to the Commission for that purpose. | ||||||
24 | The Advisory Board shall advise the Commission on | ||||||
25 | establishment of fees for medical services and accessibility of |
| |||||||
| |||||||
1 | medical treatment. Additionally, by April 1, 2011, the Board | ||||||
2 | shall issue a written report, to be delivered to the Chairman | ||||||
3 | of the Commission and the General Assembly, containing (i) | ||||||
4 | recommendations on how to streamline the process under which | ||||||
5 | workers' compensation insurers process and issue payments and | ||||||
6 | health care providers receive such payments and (ii) a | ||||||
7 | recommended set of best practices for workers' compensation | ||||||
8 | insurers to transition from a paper-based payment system to an | ||||||
9 | electronic-based payment system.
| ||||||
10 | (Source: P.A. 94-277, eff. 7-20-05.) | ||||||
11 | (820 ILCS 305/8.7) | ||||||
12 | Sec. 8.7. Utilization review programs. | ||||||
13 | (a) As used in this Section: | ||||||
14 | "Utilization review" means the evaluation of proposed or | ||||||
15 | provided health care services to determine the appropriateness | ||||||
16 | of both the level of health care services medically necessary | ||||||
17 | and the quality of health care services provided to a patient, | ||||||
18 | including evaluation of their efficiency, efficacy, and | ||||||
19 | appropriateness of treatment, hospitalization, or office | ||||||
20 | visits based on medically accepted standards. The evaluation | ||||||
21 | must be accomplished by means of a system that identifies the | ||||||
22 | utilization of health care services based on standards of care | ||||||
23 | of or nationally recognized peer review guidelines as well as | ||||||
24 | nationally recognized treatment guidelines and evidence-based | ||||||
25 | medicine evidence based upon standards as provided in this Act. |
| |||||||
| |||||||
1 | Utilization techniques may include prospective review, second | ||||||
2 | opinions, concurrent review, discharge planning, peer review, | ||||||
3 | independent medical examinations, and retrospective review | ||||||
4 | (for purposes of this sentence, retrospective review shall be | ||||||
5 | applicable to services rendered on or after July 20, 2005). | ||||||
6 | Nothing in this Section applies to prospective review of | ||||||
7 | necessary first aid or emergency treatment. | ||||||
8 | (b) No person may conduct a utilization review program for | ||||||
9 | workers' compensation services in this State unless once every | ||||||
10 | 2 years the person registers the utilization review program | ||||||
11 | with the Department of Insurance Financial and Professional | ||||||
12 | Regulation and certifies compliance with the Workers' | ||||||
13 | Compensation Utilization Management standards or Health | ||||||
14 | Utilization Management Standards of URAC sufficient to achieve | ||||||
15 | URAC accreditation or submits evidence of accreditation by URAC | ||||||
16 | for its Workers' Compensation Utilization Management Standards | ||||||
17 | or Health Utilization Management Standards. Nothing in this Act | ||||||
18 | shall be construed to require an employer or insurer or its | ||||||
19 | subcontractors to become URAC accredited. | ||||||
20 | (c) In addition, the Director Secretary of Insurance | ||||||
21 | Financial and Professional Regulation may certify alternative | ||||||
22 | utilization review standards of national accreditation | ||||||
23 | organizations or entities in order for plans to comply with | ||||||
24 | this Section. Any alternative utilization review standards | ||||||
25 | shall meet or exceed those standards required under subsection | ||||||
26 | (b). |
| |||||||
| |||||||
1 | (d) This registration shall include submission of all of | ||||||
2 | the following information regarding utilization review program | ||||||
3 | activities: | ||||||
4 | (1) The name, address, and telephone number of the | ||||||
5 | utilization review programs. | ||||||
6 | (2) The organization and governing structure of the | ||||||
7 | utilization review programs. | ||||||
8 | (3) The number of lives for which utilization review is | ||||||
9 | conducted by each utilization review program. | ||||||
10 | (4) Hours of operation of each utilization review | ||||||
11 | program. | ||||||
12 | (5) Description of the grievance process for each | ||||||
13 | utilization review program. | ||||||
14 | (6) Number of covered lives for which utilization | ||||||
15 | review was conducted for the previous calendar year for | ||||||
16 | each utilization review program. | ||||||
17 | (7) Written policies and procedures for protecting | ||||||
18 | confidential information according to applicable State and | ||||||
19 | federal laws for each utilization review program. | ||||||
20 | (e) A utilization review program shall have written | ||||||
21 | procedures to ensure that patient-specific information | ||||||
22 | obtained during the process of utilization review will be: | ||||||
23 | (1) kept confidential in accordance with applicable | ||||||
24 | State and federal laws; and | ||||||
25 | (2) shared only with the employee, the employee's | ||||||
26 | designee, and the employee's health care provider, and |
| |||||||
| |||||||
1 | those who are authorized by law to receive the information. | ||||||
2 | Summary data shall not be considered confidential if it | ||||||
3 | does not provide information to allow identification of | ||||||
4 | individual patients or health care providers. | ||||||
5 | Only a health care professional may make determinations | ||||||
6 | regarding the medical necessity of health care services during | ||||||
7 | the course of utilization review. | ||||||
8 | When making retrospective reviews, utilization review | ||||||
9 | programs shall base reviews solely on the medical information | ||||||
10 | available to the attending physician or ordering provider at | ||||||
11 | the time the health care services were provided. | ||||||
12 | (f) If the Department of Insurance Financial and | ||||||
13 | Professional Regulation finds that a utilization review | ||||||
14 | program is not in compliance with this Section, the Department | ||||||
15 | shall issue a corrective action plan and allow a reasonable | ||||||
16 | amount of time for compliance with the plan. If the utilization | ||||||
17 | review program does not come into compliance, the Department | ||||||
18 | may issue a cease and desist order. Before issuing a cease and | ||||||
19 | desist order under this Section, the Department shall provide | ||||||
20 | the utilization review program with a written notice of the | ||||||
21 | reasons for the order and allow a reasonable amount of time to | ||||||
22 | supply additional information demonstrating compliance with | ||||||
23 | the requirements of this Section and to request a hearing. The | ||||||
24 | hearing notice shall be sent by certified mail, return receipt | ||||||
25 | requested, and the hearing shall be conducted in accordance | ||||||
26 | with the Illinois Administrative Procedure Act. |
| |||||||
| |||||||
1 | (g) A utilization review program subject to a corrective | ||||||
2 | action may continue to conduct business until a final decision | ||||||
3 | has been issued by the Department. | ||||||
4 | (h) The Department of Insurance Secretary of Financial and | ||||||
5 | Professional Regulation may by rule establish a registration | ||||||
6 | fee for each person conducting a utilization review program. | ||||||
7 | (i) Upon receipt of written notice that the employer or the | ||||||
8 | employer's agent or insurer wishes to invoke the utilization | ||||||
9 | review process, the provider of medical, surgical or hospital | ||||||
10 | services shall submit to the utilization review, following URAC | ||||||
11 | procedural guidelines and appeal process. If the provider fails | ||||||
12 | to submit to utilization review of proposed treatment or | ||||||
13 | services, the charges for the treatment or service shall not be | ||||||
14 | compensable or collectible against the employer, the | ||||||
15 | employer's agent or insurer, or the employee. When an employer | ||||||
16 | denies payment of or refuses to authorize payment of first aid, | ||||||
17 | medical, surgical, or hospital services under Section 8(a) of | ||||||
18 | this Act that complies with subsection (b) of this Section, | ||||||
19 | that denial or refusal to authorize shall create a rebuttable | ||||||
20 | presumption that the extent and scope of medical treatment is | ||||||
21 | excessive and unnecessary. That presumption may be rebutted by | ||||||
22 | establishing by a preponderance of the evidence that a variance | ||||||
23 | from the standards of care or guidelines used pursuant to | ||||||
24 | subsection (a) of this Section is reasonably required to cure | ||||||
25 | and relieve the employee from the effects of his or her injury | ||||||
26 | or that the utilization review did not comply with subsection |
| |||||||
| |||||||
1 | (b) of this Section. A utilization review will be considered by | ||||||
2 | the Commission, along with all other evidence and in the same | ||||||
3 | manner as all other evidence, in the determination of the | ||||||
4 | reasonableness and necessity of the medical bills or treatment. | ||||||
5 | Nothing in this Section shall be construed to diminish the | ||||||
6 | rights of employees to reasonable and necessary medical | ||||||
7 | treatment or employee choice of health care provider under | ||||||
8 | Section 8(a) or the rights of employers to medical examinations | ||||||
9 | under Section 12. | ||||||
10 | (j) When an employer denies payment of or refuses to | ||||||
11 | authorize payment of first aid, medical, surgical, or hospital | ||||||
12 | services under Section 8(a) of this Act, if that denial or | ||||||
13 | refusal to authorize complies with a utilization review program | ||||||
14 | registered under this Section and complies with all other | ||||||
15 | requirements of this Section, then there shall be a rebuttable | ||||||
16 | presumption that the employer shall not be responsible for | ||||||
17 | payment of additional compensation pursuant to Section 19(k) of | ||||||
18 | this Act and if that denial or refusal to authorize does not | ||||||
19 | comply with a utilization review program registered under this | ||||||
20 | Section and does not comply with all other requirements of this | ||||||
21 | Section, then that will be considered by the Commission, along | ||||||
22 | with all other evidence and in the same manner as all other | ||||||
23 | evidence, in the determination of whether the employer may be | ||||||
24 | responsible for the payment of additional compensation | ||||||
25 | pursuant to Section 19(k) of this Act.
| ||||||
26 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/11) (from Ch. 48, par. 138.11)
| ||||||
2 | Sec. 11. The compensation herein provided, together with | ||||||
3 | the
provisions of this Act, shall be the measure of the | ||||||
4 | responsibility of
any employer engaged in any of the | ||||||
5 | enterprises or businesses enumerated
in Section 3 of this Act, | ||||||
6 | or of any employer who is not engaged in any
such enterprises | ||||||
7 | or businesses, but who has elected to provide and pay
| ||||||
8 | compensation for accidental injuries sustained by any employee | ||||||
9 | arising
out of and in the course of the employment according to | ||||||
10 | the provisions
of this Act, and whose election to continue | ||||||
11 | under this Act, has not been
nullified by any action of his | ||||||
12 | employees as provided for in this Act.
| ||||||
13 | Accidental injuries incurred while participating in | ||||||
14 | voluntary recreational
programs including but not limited to | ||||||
15 | athletic events, parties and picnics
do not arise out of and in | ||||||
16 | the course of the employment even though the
employer pays some | ||||||
17 | or all of the cost thereof. This exclusion shall not apply
in | ||||||
18 | the event that the injured employee was ordered or assigned by | ||||||
19 | his employer
to participate in the program.
| ||||||
20 | Accidental injuries incurred while participating as a | ||||||
21 | patient in a drug
or alcohol rehabilitation program do not | ||||||
22 | arise out of and in the course
of employment even though the | ||||||
23 | employer pays some or all of the costs thereof. | ||||||
24 | Any injury to or disease or death of an employee arising | ||||||
25 | from the administration of a vaccine, including without |
| |||||||
| |||||||
1 | limitation smallpox vaccine, to prepare for, or as a response | ||||||
2 | to, a threatened or potential bioterrorist incident to the | ||||||
3 | employee as part of a voluntary inoculation program in | ||||||
4 | connection with the person's employment or in connection with | ||||||
5 | any governmental program or recommendation for the inoculation | ||||||
6 | of workers in the employee's occupation, geographical area, or | ||||||
7 | other category that includes the employee is deemed to arise | ||||||
8 | out of and in the course of the employment for all purposes | ||||||
9 | under this Act. This paragraph added by this amendatory Act of | ||||||
10 | the 93rd General Assembly is declarative of existing law and is | ||||||
11 | not a new enactment.
| ||||||
12 | No compensation shall be payable if (i) the employee's | ||||||
13 | intoxication is the proximate cause of the employee's | ||||||
14 | accidental injury or (ii) at the time the employee incurred | ||||||
15 | accidental injury, the employee was so intoxicated that the | ||||||
16 | intoxication constituted a departure from the employment. | ||||||
17 | Admissible evidence of the concentration of (1) alcohol, (2) | ||||||
18 | cannabis as defined in the Cannabis Control Act, (3) a | ||||||
19 | controlled substance listed in the Illinois Controlled | ||||||
20 | Substances Act, or (4) an intoxicating compound listed in the | ||||||
21 | Use of Intoxicating Compounds Act in the employee's blood, | ||||||
22 | breath, or urine at the time the employee incurred the | ||||||
23 | accidental injury shall be considered in any hearing under this | ||||||
24 | Act to determine whether the employee was intoxicated at the | ||||||
25 | time the employee incurred the accidental injuries. If at the | ||||||
26 | time of the accidental injuries, there was 0.08% or more by |
| |||||||
| |||||||
1 | weight of alcohol in the employee's blood, breath, or urine or | ||||||
2 | if there is any evidence of impairment due to the unlawful or | ||||||
3 | unauthorized use of (1) cannabis as defined in the Cannabis | ||||||
4 | Control Act, (2) a controlled substance listed in the Illinois | ||||||
5 | Controlled Substances Act, or (3) an intoxicating compound | ||||||
6 | listed in the Use of Intoxicating Compounds Act or if the | ||||||
7 | employee refuses to submit to testing of blood, breath, or | ||||||
8 | urine, then there shall be a rebuttable presumption that the | ||||||
9 | employee was intoxicated and that the intoxication was the | ||||||
10 | proximate cause of the employee's injury. The employee may | ||||||
11 | overcome the rebuttable presumption by the preponderance of the | ||||||
12 | admissible evidence that the intoxication was not the sole | ||||||
13 | proximate cause or proximate cause of the accidental injuries. | ||||||
14 | Percentage by weight of alcohol in the blood shall be based on | ||||||
15 | grams of alcohol per 100 milliliters of blood. Percentage by | ||||||
16 | weight of alcohol in the breath shall be based upon grams of | ||||||
17 | alcohol per 210 liters of breath. Any testing that has not been | ||||||
18 | performed by an accredited or certified testing laboratory | ||||||
19 | shall not be admissible in any hearing under this Act to | ||||||
20 | determine whether the employee was intoxicated at the time the | ||||||
21 | employee incurred the accidental injury. | ||||||
22 | All sample collection and testing for alcohol and drugs | ||||||
23 | under this Section shall be performed in accordance with rules | ||||||
24 | to be adopted by the Commission. These rules shall ensure that: | ||||||
25 | (1) samples are collected and tested in conformance | ||||||
26 | with national and State legal and regulatory standards for |
| |||||||
| |||||||
1 | the privacy of the individual being tested, and in a manner | ||||||
2 | reasonably calculated to prevent substitutions or | ||||||
3 | interference with the collection or testing of reliable | ||||||
4 | sample; | ||||||
5 | (2) sample collection is documented, and the | ||||||
6 | documentation procedures include: | ||||||
7 | (A) the labeling of samples in a manner so as to | ||||||
8 | reasonably preclude the probability of erroneous | ||||||
9 | identification of test result; and | ||||||
10 | (B) an opportunity for the employee to provide | ||||||
11 | notification of any information which he or she | ||||||
12 | considers relevant to the test, including | ||||||
13 | identification of currently or recently used | ||||||
14 | prescription or nonprescription drugs and other | ||||||
15 | relevant medical information; | ||||||
16 | (3) sample collection, storage, and transportation to | ||||||
17 | the place of testing is performed in a manner so as to | ||||||
18 | reasonably preclude the probability of sample | ||||||
19 | contamination or adulteration; and | ||||||
20 | (4) chemical analyses of blood, urine, breath, or other | ||||||
21 | bodily substance are performed according to nationally | ||||||
22 | scientifically accepted analytical methods and procedures. | ||||||
23 | (Source: P.A. 93-829, eff. 7-28-04.)
| ||||||
24 | (820 ILCS 305/14) (from Ch. 48, par. 138.14)
| ||||||
25 | Sec. 14. The Commission shall appoint a secretary, an |
| |||||||
| |||||||
1 | assistant
secretary, and arbitrators and shall employ such
| ||||||
2 | assistants and clerical help as may be necessary.
| ||||||
3 | Each arbitrator appointed after November 22, 1977 shall be | ||||||
4 | required
to demonstrate in writing and in accordance with
the | ||||||
5 | rules and regulations of the Illinois Department of Central | ||||||
6 | Management
Services his or
her knowledge of and expertise in | ||||||
7 | the law of and judicial processes of
the Workers' Compensation | ||||||
8 | Act and the Occupational Diseases Act.
| ||||||
9 | A formal training program for newly-hired arbitrators | ||||||
10 | shall be
implemented. The training program shall include the | ||||||
11 | following:
| ||||||
12 | (a) substantive and procedural aspects of the | ||||||
13 | arbitrator position;
| ||||||
14 | (b) current issues in workers' compensation law and | ||||||
15 | practice;
| ||||||
16 | (c) medical lectures by specialists in areas such as | ||||||
17 | orthopedics,
ophthalmology, psychiatry, rehabilitation | ||||||
18 | counseling;
| ||||||
19 | (d) orientation to each operational unit of the | ||||||
20 | Illinois Workers' Compensation Commission;
| ||||||
21 | (e) observation of experienced arbitrators conducting | ||||||
22 | hearings of cases,
combined with the opportunity to discuss | ||||||
23 | evidence presented and rulings made;
| ||||||
24 | (f) the use of hypothetical cases requiring the trainee | ||||||
25 | to issue
judgments as a means to evaluating knowledge and | ||||||
26 | writing ability;
|
| |||||||
| |||||||
1 | (g) writing skills.
| ||||||
2 | A formal and ongoing professional development program | ||||||
3 | including, but not
limited to, the above-noted areas shall be | ||||||
4 | implemented to keep arbitrators
informed of recent | ||||||
5 | developments and issues and to assist them in
maintaining and | ||||||
6 | enhancing their professional competence.
| ||||||
7 | Each
arbitrator shall devote full time to his or her duties | ||||||
8 | and shall serve when
assigned as
an acting Commissioner when a | ||||||
9 | Commissioner is unavailable in accordance
with the provisions | ||||||
10 | of Section 13 of this Act. Any
arbitrator who is an | ||||||
11 | attorney-at-law shall not engage in the practice of
law, nor | ||||||
12 | shall any arbitrator hold any other office or position of
| ||||||
13 | profit under the United States or this State or any municipal
| ||||||
14 | corporation or political subdivision of this State.
| ||||||
15 | Notwithstanding any other provision of this Act to the | ||||||
16 | contrary, an arbitrator
who serves as an acting Commissioner in | ||||||
17 | accordance with the provisions of
Section 13 of this Act shall | ||||||
18 | continue to serve in the capacity of Commissioner
until a | ||||||
19 | decision is reached in every case heard by that arbitrator | ||||||
20 | while
serving as an acting Commissioner.
| ||||||
21 | Each arbitrator appointed after the effective date of this | ||||||
22 | amendatory
Act of 1989 shall be appointed for a term of 6 | ||||||
23 | years. Each arbitrator
shall be appointed for a subsequent term | ||||||
24 | unless the Chairman makes a
recommendation to the Commission, | ||||||
25 | no later than 60 days prior to the
expiration of the term, not | ||||||
26 | to reappoint the arbitrator. Notice of such a
recommendation |
| |||||||
| |||||||
1 | shall also be given to the arbitrator no later than 60 days
| ||||||
2 | prior to the expiration of the term. Upon
such recommendation | ||||||
3 | by the Chairman, the arbitrator shall be appointed for
a | ||||||
4 | subsequent term unless 8 of 10 members of the Commission, | ||||||
5 | including the
Chairman, vote not to reappoint the arbitrator.
| ||||||
6 | Each arbitrator appointed to a first term on or after the | ||||||
7 | effective date of this amendatory Act of the 96th General | ||||||
8 | Assembly shall be required to be authorized to practice law in | ||||||
9 | this State by the Supreme Court. | ||||||
10 | All arbitrators shall be subject to the provisions of the | ||||||
11 | Personnel Code,
and the performance of all arbitrators shall be | ||||||
12 | reviewed by the Chairman on
an annual basis. The Chairman shall | ||||||
13 | allow input from the Commissioners in
all such reviews.
| ||||||
14 | The Secretary and each arbitrator shall receive a per annum | ||||||
15 | salary of
$4,000 less than the per annum salary of members of | ||||||
16 | The
Illinois Workers' Compensation Commission as
provided in | ||||||
17 | Section 13 of this Act, payable in equal monthly installments.
| ||||||
18 | The members of the Commission, Arbitrators and other | ||||||
19 | employees whose
duties require them to travel, shall have | ||||||
20 | reimbursed to them their
actual traveling expenses and | ||||||
21 | disbursements made or incurred by them in
the discharge of | ||||||
22 | their official duties while away from their place of
residence | ||||||
23 | in the performance of their duties.
| ||||||
24 | The Commission shall provide itself with a seal for the
| ||||||
25 | authentication of its orders, awards and proceedings upon which | ||||||
26 | shall be
inscribed the name of the Commission and the words |
| |||||||
| |||||||
1 | "Illinois--Seal".
| ||||||
2 | The Secretary or Assistant Secretary, under the direction | ||||||
3 | of the
Commission, shall have charge and custody of the seal of | ||||||
4 | the Commission
and also have charge and custody of all records, | ||||||
5 | files, orders,
proceedings, decisions, awards and other | ||||||
6 | documents on file with the
Commission. He shall furnish | ||||||
7 | certified copies, under the seal of the
Commission, of any such | ||||||
8 | records, files, orders, proceedings, decisions,
awards and | ||||||
9 | other documents on file with the Commission as may be
required. | ||||||
10 | Certified copies so furnished by the Secretary or Assistant
| ||||||
11 | Secretary shall be received in evidence before the Commission | ||||||
12 | or any
Arbitrator thereof, and in all courts, provided that the | ||||||
13 | original of
such certified copy is otherwise competent and | ||||||
14 | admissible in evidence.
The Secretary or Assistant Secretary | ||||||
15 | shall perform such other duties as
may be prescribed from time | ||||||
16 | to time by the Commission.
| ||||||
17 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||||||
18 | (820 ILCS 305/16b new) | ||||||
19 | Sec. 16b. Signature constitutes certification. The | ||||||
20 | signature of a petitioner or respondent or his, her, or its | ||||||
21 | attorney or group of attorneys on any petition, motion, or | ||||||
22 | other paper filed with the Commission constitutes a | ||||||
23 | certification by him, her, or it that he, she, or it has read | ||||||
24 | the petition, motion, or other paper, and, that to the best of | ||||||
25 | his, her, or its knowledge, information, and belief formed |
| |||||||
| |||||||
1 | after reasonable inquiry that it is well grounded in fact and | ||||||
2 | that it is warranted by existing law and that it is not | ||||||
3 | interposed for any improper purpose, such as to harass or to | ||||||
4 | cause unnecessary delay or needless increase in the cost of | ||||||
5 | litigation. If a petition, motion, or other paper is signed in | ||||||
6 | violation of this Section, the Commission, upon motion or upon | ||||||
7 | its own initiative, may impose upon the petitioner or | ||||||
8 | respondent or his, her, or its attorney or group of attorneys | ||||||
9 | an appropriate penalty or may order him, her, or it to pay the | ||||||
10 | other party the amount of reasonable expenses incurred because | ||||||
11 | of the filing of the petition, motion, or other paper, | ||||||
12 | including reasonable attorneys' fees. | ||||||
13 | (820 ILCS 305/25.5)
| ||||||
14 | Sec. 25.5. Unlawful acts; penalties. | ||||||
15 | (a) It is unlawful for any person, company, corporation, | ||||||
16 | insurance carrier, healthcare provider, or other entity to: | ||||||
17 | (1) Intentionally present or cause to be presented any | ||||||
18 | false or
fraudulent claim for the payment of any workers' | ||||||
19 | compensation
benefit.
| ||||||
20 | (2) Intentionally make or cause to be made any false or
| ||||||
21 | fraudulent material statement or material representation | ||||||
22 | for the
purpose of obtaining or denying any workers' | ||||||
23 | compensation
benefit.
| ||||||
24 | (3) Intentionally make or cause to be made any false or
| ||||||
25 | fraudulent statements with regard to entitlement to |
| |||||||
| |||||||
1 | workers'
compensation benefits with the intent to prevent | ||||||
2 | an injured
worker from making a legitimate claim for any | ||||||
3 | workers'
compensation benefits.
| ||||||
4 | (4) Intentionally prepare or provide an invalid, | ||||||
5 | false, or
counterfeit certificate of insurance as proof of | ||||||
6 | workers'
compensation insurance.
| ||||||
7 | (5) Intentionally make or cause to be made any false or
| ||||||
8 | fraudulent material statement or material representation | ||||||
9 | for the
purpose of obtaining workers' compensation | ||||||
10 | insurance at less
than the proper rate for that insurance.
| ||||||
11 | (6) Intentionally make or cause to be made any false or
| ||||||
12 | fraudulent material statement or material representation | ||||||
13 | on an
initial or renewal self-insurance application or | ||||||
14 | accompanying
financial statement for the purpose of | ||||||
15 | obtaining self-insurance
status or reducing the amount of | ||||||
16 | security that may be required
to be furnished pursuant to | ||||||
17 | Section 4 of this Act.
| ||||||
18 | (7) Intentionally make or cause to be made any false or
| ||||||
19 | fraudulent material statement to the Department Division | ||||||
20 | of Insurance's
fraud and insurance non-compliance unit in | ||||||
21 | the course of an
investigation of fraud or insurance | ||||||
22 | non-compliance.
| ||||||
23 | (8) Intentionally assist, abet, solicit, or conspire | ||||||
24 | with any
person, company, or other entity to commit any of | ||||||
25 | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||||||
26 | of this subsection (a).
|
| |||||||
| |||||||
1 | For the purposes of paragraphs (2), (3), (5), (6), and (7), | ||||||
2 | the term "statement" includes any writing, notice, proof of | ||||||
3 | injury, bill for services, hospital or doctor records and | ||||||
4 | reports, or X-ray and test results.
| ||||||
5 | (b) Any person violating subsection (a) is guilty of a | ||||||
6 | Class 4 felony. Any person or entity convicted of any violation | ||||||
7 | of this Section shall be ordered to pay complete restitution to | ||||||
8 | any person or entity so defrauded in addition to any fine or | ||||||
9 | sentence imposed as a result of the conviction.
| ||||||
10 | (c) The Department Division of Insurance of the Department | ||||||
11 | of Financial and Professional Regulation shall establish a | ||||||
12 | fraud and insurance non-compliance unit responsible for | ||||||
13 | investigating incidences of fraud and insurance non-compliance | ||||||
14 | pursuant to this Section. The size of the staff of the unit | ||||||
15 | shall be subject to appropriation by the General Assembly. It | ||||||
16 | shall be the duty of the fraud and insurance non-compliance | ||||||
17 | unit to determine the identity of insurance carriers, | ||||||
18 | employers, employees, or other persons or entities who have | ||||||
19 | violated the fraud and insurance non-compliance provisions of | ||||||
20 | this Section. The fraud and insurance non-compliance unit shall | ||||||
21 | report violations of the fraud and insurance non-compliance | ||||||
22 | provisions of this Section to the Special Prosecutions Bureau | ||||||
23 | of the Criminal Division of the Office of the Attorney General | ||||||
24 | or to the State's Attorney of the county in which the offense | ||||||
25 | allegedly occurred, either of whom has the authority to | ||||||
26 | prosecute violations under this Section.
|
| |||||||
| |||||||
1 | With respect to the subject of any investigation being | ||||||
2 | conducted, the fraud and insurance non-compliance unit shall | ||||||
3 | have the general power of subpoena of the Department Division | ||||||
4 | of Insurance.
| ||||||
5 | (d) Any person may report allegations of insurance | ||||||
6 | non-compliance and fraud pursuant to this Section to the | ||||||
7 | Department Division of Insurance's fraud and insurance | ||||||
8 | non-compliance unit whose duty it shall be to investigate the | ||||||
9 | report. The unit shall notify the Commission of reports of | ||||||
10 | insurance non-compliance. Any person reporting an allegation | ||||||
11 | of insurance non-compliance or fraud against either an employee | ||||||
12 | or employer under this Section must identify himself. Except as | ||||||
13 | provided in this subsection and in subsection (e), all reports | ||||||
14 | shall remain confidential except to refer an investigation to | ||||||
15 | the Attorney General or State's Attorney for prosecution or if | ||||||
16 | the fraud and insurance non-compliance unit's investigation | ||||||
17 | reveals that the conduct reported may be in violation of other | ||||||
18 | laws or regulations of the State of Illinois, the unit may | ||||||
19 | report such conduct to the appropriate governmental agency | ||||||
20 | charged with administering such laws and regulations. Any | ||||||
21 | person who intentionally makes a false report under this | ||||||
22 | Section to the fraud and insurance non-compliance unit is | ||||||
23 | guilty of a Class A misdemeanor.
| ||||||
24 | (e) In order for the fraud and insurance non-compliance | ||||||
25 | unit to investigate a report of fraud by an employee, (i) the | ||||||
26 | employee must have filed with the Commission an Application for |
| |||||||
| |||||||
1 | Adjustment of Claim and the employee must have either received | ||||||
2 | or attempted to receive benefits under this Act that are | ||||||
3 | related to the reported fraud or (ii) the employee must have | ||||||
4 | made a written demand for the payment of benefits that are | ||||||
5 | related to the reported fraud. Upon receipt of a report of | ||||||
6 | fraud, the employee or employer shall receive immediate notice | ||||||
7 | of the reported conduct, including the verified name and | ||||||
8 | address of the complainant if that complainant is connected to | ||||||
9 | the case and the nature of the reported conduct. The fraud and | ||||||
10 | insurance non-compliance unit shall resolve all reports of | ||||||
11 | fraud against employees or employers within 120 days of receipt | ||||||
12 | of the report. There shall be no immunity, under this Act or | ||||||
13 | otherwise, for any person who files a false report or who files | ||||||
14 | a report without good and just cause. Confidentiality of | ||||||
15 | medical information shall be strictly maintained. | ||||||
16 | Investigations that are not referred for prosecution shall be | ||||||
17 | immediately expunged and shall not be disclosed except that the | ||||||
18 | employee or employer who was the subject of the report and the | ||||||
19 | person making the report shall be notified that the | ||||||
20 | investigation is being closed, at which time the name of any | ||||||
21 | complainant not connected to the case shall be disclosed to the | ||||||
22 | employee or the employer. It is unlawful for any employer, | ||||||
23 | insurance carrier, or service adjustment company to file or | ||||||
24 | threaten to file a report of fraud against an employee because | ||||||
25 | of the exercise by the employee of the rights and remedies | ||||||
26 | granted to the employee by this Act.
|
| |||||||
| |||||||
1 | For purposes of this subsection (e), "employer" means any | ||||||
2 | employer, insurance carrier, third party administrator, | ||||||
3 | self-insured, or similar entity.
| ||||||
4 | For purposes of this subsection (e), "complainant" refers | ||||||
5 | to the person contacting the fraud and insurance non-compliance | ||||||
6 | unit to initiate the complaint.
| ||||||
7 | (e-5) The fraud and insurance non-compliance unit shall | ||||||
8 | procure and implement a system utilizing advanced analytics | ||||||
9 | inclusive of predictive modeling, data mining, social network | ||||||
10 | analysis, and scoring algorithms for the detection and | ||||||
11 | prevention of fraud, waste, and abuse on or before July 1, | ||||||
12 | 2011. The fraud and insurance non-compliance unit shall procure | ||||||
13 | this system using a request for proposals process governed by | ||||||
14 | the Illinois Procurement Code and rules adopted under that | ||||||
15 | Code. The fraud and insurance non-compliance unit shall provide | ||||||
16 | a report to the President of the Senate, Speaker of the House | ||||||
17 | of Representatives, Minority Leader of the House of | ||||||
18 | Representatives, Minority Leader of the Senate, Governor, and | ||||||
19 | Director of Insurance on or before July 1, 2012 and annually | ||||||
20 | thereafter detailing its activities and providing | ||||||
21 | recommendations regarding opportunities for additional fraud | ||||||
22 | waste and abuse detection and prevention. | ||||||
23 | (f) Any person convicted of fraud related to workers' | ||||||
24 | compensation pursuant to this Section shall be subject to the | ||||||
25 | penalties prescribed in the Criminal Code of 1961 and shall be | ||||||
26 | ineligible to receive or retain any compensation, disability, |
| |||||||
| |||||||
1 | or medical benefits as defined in this Act if the compensation, | ||||||
2 | disability, or medical benefits were owed or received as a | ||||||
3 | result of fraud for which the recipient of the compensation, | ||||||
4 | disability, or medical benefit was convicted. This subsection | ||||||
5 | applies to accidental injuries or diseases that occur on or | ||||||
6 | after the effective date of this amendatory Act of the 94th | ||||||
7 | General Assembly.
| ||||||
8 | (g) Civil liability. Any person convicted of fraud who | ||||||
9 | knowingly obtains, attempts to obtain, or causes to be obtained | ||||||
10 | any benefits under this Act by the making of a false claim or | ||||||
11 | who knowingly misrepresents any material fact shall be civilly | ||||||
12 | liable to the payor of benefits or the insurer or the payor's | ||||||
13 | or insurer's subrogee or assignee in an amount equal to 3 times | ||||||
14 | the value of the benefits or insurance coverage wrongfully | ||||||
15 | obtained or twice the value of the benefits or insurance | ||||||
16 | coverage attempted to be obtained, plus reasonable attorney's | ||||||
17 | fees and expenses incurred by the payor or the payor's subrogee | ||||||
18 | or assignee who successfully brings a claim under this | ||||||
19 | subsection. This subsection applies to accidental injuries or | ||||||
20 | diseases that occur on or after the effective date of this | ||||||
21 | amendatory Act of the 94th General Assembly.
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22 | (h) The All proceedings under this Section shall be | ||||||
23 | reported by the fraud and insurance non-compliance unit shall | ||||||
24 | submit a written report on an annual basis to the Workers' | ||||||
25 | Compensation Advisory Board , the General Assembly, the | ||||||
26 | Governor, and the Attorney General by January 1st and July 1st |
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1 | of each year. This report shall include, at the minimum, the | ||||||
2 | following information: | ||||||
3 | (1) The number of allegations of insurance | ||||||
4 | non-compliance and fraud reported to the fraud and | ||||||
5 | insurance non-compliance unit. | ||||||
6 | (2) The source of the reported allegations | ||||||
7 | (individual, employer, or other). | ||||||
8 | (3) The number of allegations investigated by the fraud | ||||||
9 | and insurance non-compliance unit. | ||||||
10 | (4) The number of criminal referrals made in accordance | ||||||
11 | with this Section and the entity to which the referral was | ||||||
12 | made. | ||||||
13 | (5) All proceedings under this Section .
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14 | (Source: P.A. 94-277, eff. 7-20-05.) | ||||||
15 | (820 ILCS 305/29.1 new) | ||||||
16 | Sec. 29.1. Recalculation of premiums. On the effective date | ||||||
17 | of this amendatory Act of the 96th General Assembly, the | ||||||
18 | Director of Insurance shall immediately direct in writing any | ||||||
19 | workers' compensation rate setting advisory organization to | ||||||
20 | recalculate workers' compensation advisory premium rates and | ||||||
21 | assigned risk pool premium rates so that those premiums | ||||||
22 | incorporate the provisions of this amendatory Act of the 96th | ||||||
23 | General Assembly. | ||||||
24 | (820 ILCS 305/29.2 new) |
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1 | Sec. 29.2. Insurance oversight. The Department of | ||||||
2 | Insurance shall annually submit to the Governor, the President | ||||||
3 | of the Senate, the Speaker of the House of Representatives, the | ||||||
4 | Minority Leader of the Senate, and the Minority Leader of the | ||||||
5 | House of Representatives a written report that details the | ||||||
6 | state of the workers' compensation insurance market in | ||||||
7 | Illinois. The report shall be completed by April 1 of each | ||||||
8 | year, beginning in 2012, or later if necessary data or analyses | ||||||
9 | are only available to the Department at a later date. The | ||||||
10 | report shall be posted on the Department of Insurance's | ||||||
11 | Internet website. Information to be included in the report | ||||||
12 | shall be for the preceding calendar year. The report shall | ||||||
13 | include, at a minimum, the following: | ||||||
14 | (1) Gross premiums collected by workers' compensation | ||||||
15 | carriers in Illinois and the national rank of Illinois | ||||||
16 | based on premium volume. | ||||||
17 | (2) The number of insurance companies actively engaged | ||||||
18 | in Illinois in the workers' compensation insurance market, | ||||||
19 | including both holding companies and subsidiaries or | ||||||
20 | affiliates, and the national rank of Illinois based on | ||||||
21 | number of competing insurers. | ||||||
22 | (3) The total number of insured participants in the | ||||||
23 | Illinois workers' compensation assigned risk insurance | ||||||
24 | pool, and the size of the assigned risk pool as a | ||||||
25 | proportion of the total Illinois workers' compensation | ||||||
26 | insurance market. |
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1 | (4) The advisory organization premium rate for | ||||||
2 | workers' compensation insurance in Illinois for the | ||||||
3 | previous year. | ||||||
4 | (5) The advisory organization prescribed assigned risk | ||||||
5 | pool premium rate. | ||||||
6 | (6) The total amount of indemnity payments made by | ||||||
7 | workers' compensation insurers in Illinois. | ||||||
8 | (7) The total amount of medical payments made by | ||||||
9 | workers' compensation insurers in Illinois, and the | ||||||
10 | national rank of Illinois based on average cost of medical | ||||||
11 | claims per injured worker. | ||||||
12 | (8) The gross profitability of workers' compensation | ||||||
13 | insurers in Illinois, and the national rank of Illinois | ||||||
14 | based on profitability of workers' compensation insurers. | ||||||
15 | (9) The loss ratio of workers' compensation insurers in | ||||||
16 | Illinois and the national rank of Illinois based on the | ||||||
17 | loss ratio of workers' compensation insurers. For purposes | ||||||
18 | of this loss ratio calculation, the denominator shall | ||||||
19 | include all premiums and other fees collected by workers' | ||||||
20 | compensation insurers and the numerator shall include the | ||||||
21 | total amount paid by the insurer for care or compensation | ||||||
22 | to injured workers.
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.".
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