97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB1349

 

Introduced 2/8/2011, by Sen. Kyle McCarter

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Workers' Compensation Act. Defines "accident" and "injury." Deletes language allowing rebuttable presumptions for an employee employed as a firefighter, emergency medical technician (EMT), or paramedic. Deletes language allowing an employee to secure his own physician, surgeon and hospital services at the employer's expense. Provides that the employer shall choose all necessary medical, surgical and hospital services reasonably required to cure or relieve from the effects of the accidental injury at the employer's expense, except upon a finding by the Commission that the employer's choice of medical care threatens life, health, or recovery, then the employee may choose a second physician, surgeon, and hospital services at the employer's expense. Provides for a waiver of employee privacy for the employer to obtain necessary decision making information. Provides for a wage differential award and that such award shall cease when the employee reaches the full retirement age as defined by the Social Security Administration. Provides for reimbursement of out-of-state procedures, treatments, services, products or supplies. Provides for a new medical fee schedule after January 1, 2012, in accordance with the Medicare payment systems (160%). Moves the utilization review program registration and administration to the Department of Insurance. Makes numerous changes regarding employee intoxication, partial or total disability, implants, employment verification documents, and other changes.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 6, 8, 8.2, 8.7, 11, 16, and 19 as follows:
 
6    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
7    Sec. 1. This Act may be cited as the Workers' Compensation
8Act.
9    (a) The term "employer" as used in this Act means:
10    1. The State and each county, city, town, township,
11incorporated village, school district, body politic, or
12municipal corporation therein.
13    2. Every person, firm, public or private corporation,
14including hospitals, public service, eleemosynary, religious
15or charitable corporations or associations who has any person
16in service or under any contract for hire, express or implied,
17oral or written, and who is engaged in any of the enterprises
18or businesses enumerated in Section 3 of this Act, or who at or
19prior to the time of the accident to the employee for which
20compensation under this Act may be claimed, has in the manner
21provided in this Act elected to become subject to the
22provisions of this Act, and who has not, prior to such
23accident, effected a withdrawal of such election in the manner

 

 

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1provided in this Act.
2    3. Any one engaging in any business or enterprise referred
3to in subsections 1 and 2 of Section 3 of this Act who
4undertakes to do any work enumerated therein, is liable to pay
5compensation to his own immediate employees in accordance with
6the provisions of this Act, and in addition thereto if he
7directly or indirectly engages any contractor whether
8principal or sub-contractor to do any such work, he is liable
9to pay compensation to the employees of any such contractor or
10sub-contractor unless such contractor or sub-contractor has
11insured, in any company or association authorized under the
12laws of this State to insure the liability to pay compensation
13under this Act, or guaranteed his liability to pay such
14compensation. With respect to any time limitation on the filing
15of claims provided by this Act, the timely filing of a claim
16against a contractor or subcontractor, as the case may be,
17shall be deemed to be a timely filing with respect to all
18persons upon whom liability is imposed by this paragraph.
19    In the event any such person pays compensation under this
20subsection he may recover the amount thereof from the
21contractor or sub-contractor, if any, and in the event the
22contractor pays compensation under this subsection he may
23recover the amount thereof from the sub-contractor, if any.
24    This subsection does not apply in any case where the
25accident occurs elsewhere than on, in or about the immediate
26premises on which the principal has contracted that the work be

 

 

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1done.
2    4. Where an employer operating under and subject to the
3provisions of this Act loans an employee to another such
4employer and such loaned employee sustains a compensable
5accidental injury in the employment of such borrowing employer
6and where such borrowing employer does not provide or pay the
7benefits or payments due such injured employee, such loaning
8employer is liable to provide or pay all benefits or payments
9due such employee under this Act and as to such employee the
10liability of such loaning and borrowing employers is joint and
11several, provided that such loaning employer is in the absence
12of agreement to the contrary entitled to receive from such
13borrowing employer full reimbursement for all sums paid or
14incurred pursuant to this paragraph together with reasonable
15attorneys' fees and expenses in any hearings before the
16Illinois Workers' Compensation Commission or in any action to
17secure such reimbursement. Where any benefit is provided or
18paid by such loaning employer the employee has the duty of
19rendering reasonable cooperation in any hearings, trials or
20proceedings in the case, including such proceedings for
21reimbursement.
22    Where an employee files an Application for Adjustment of
23Claim with the Illinois Workers' Compensation Commission
24alleging that his claim is covered by the provisions of the
25preceding paragraph, and joining both the alleged loaning and
26borrowing employers, they and each of them, upon written demand

 

 

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1by the employee and within 7 days after receipt of such demand,
2shall have the duty of filing with the Illinois Workers'
3Compensation Commission a written admission or denial of the
4allegation that the claim is covered by the provisions of the
5preceding paragraph and in default of such filing or if any
6such denial be ultimately determined not to have been bona fide
7then the provisions of Paragraph K of Section 19 of this Act
8shall apply.
9    An employer whose business or enterprise or a substantial
10part thereof consists of hiring, procuring or furnishing
11employees to or for other employers operating under and subject
12to the provisions of this Act for the performance of the work
13of such other employers and who pays such employees their
14salary or wages notwithstanding that they are doing the work of
15such other employers shall be deemed a loaning employer within
16the meaning and provisions of this Section.
17    (b) The term "employee" as used in this Act means:
18    1. Every person in the service of the State, including
19members of the General Assembly, members of the Commerce
20Commission, members of the Illinois Workers' Compensation
21Commission, and all persons in the service of the University of
22Illinois, county, including deputy sheriffs and assistant
23state's attorneys, city, town, township, incorporated village
24or school district, body politic, or municipal corporation
25therein, whether by election, under appointment or contract of
26hire, express or implied, oral or written, including all

 

 

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1members of the Illinois National Guard while on active duty in
2the service of the State, and all probation personnel of the
3Juvenile Court appointed pursuant to Article VI of the Juvenile
4Court Act of 1987, and including any official of the State, any
5county, city, town, township, incorporated village, school
6district, body politic or municipal corporation therein except
7any duly appointed member of a police department in any city
8whose population exceeds 200,000 according to the last Federal
9or State census, and except any member of a fire insurance
10patrol maintained by a board of underwriters in this State. A
11duly appointed member of a fire department in any city, the
12population of which exceeds 200,000 according to the last
13federal or State census, is an employee under this Act only
14with respect to claims brought under paragraph (c) of Section
158.
16    One employed by a contractor who has contracted with the
17State, or a county, city, town, township, incorporated village,
18school district, body politic or municipal corporation
19therein, through its representatives, is not considered as an
20employee of the State, county, city, town, township,
21incorporated village, school district, body politic or
22municipal corporation which made the contract.
23    2. Every person in the service of another under any
24contract of hire, express or implied, oral or written,
25including persons whose employment is outside of the State of
26Illinois where the contract of hire is made within the State of

 

 

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1Illinois, persons whose employment results in fatal or
2non-fatal injuries within the State of Illinois where the
3contract of hire is made outside of the State of Illinois, and
4persons whose employment is principally localized within the
5State of Illinois, regardless of the place of the accident or
6the place where the contract of hire was made, and including
7aliens, and minors who, for the purpose of this Act are
8considered the same and have the same power to contract,
9receive payments and give quittances therefor, as adult
10employees.
11    3. Every sole proprietor and every partner of a business
12may elect to be covered by this Act.
13    An employee or his dependents under this Act who shall have
14a cause of action by reason of any injury, disablement or death
15arising out of and in the course of his employment may elect to
16pursue his remedy in the State where injured or disabled, or in
17the State where the contract of hire is made, or in the State
18where the employment is principally localized.
19    However, any employer may elect to provide and pay
20compensation to any employee other than those engaged in the
21usual course of the trade, business, profession or occupation
22of the employer by complying with Sections 2 and 4 of this Act.
23Employees are not included within the provisions of this Act
24when excluded by the laws of the United States relating to
25liability of employers to their employees for personal injuries
26where such laws are held to be exclusive.

 

 

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1    The term "employee" does not include persons performing
2services as real estate broker, broker-salesman, or salesman
3when such persons are paid by commission only.
4    (c) "Commission" means the Industrial Commission created
5by Section 5 of "The Civil Administrative Code of Illinois",
6approved March 7, 1917, as amended, or the Illinois Workers'
7Compensation Commission created by Section 13 of this Act.
8    (d) The term "accident" as used in this Act means an
9occurrence arising out of the employment resulting from a risk
10incidental to the employment and in the course of the
11employment at a time and place and under circumstances
12reasonably required by the employment.
13    (e) The term "injury" as used in this Act means a condition
14or impairment that arises out of and in the course of
15employment. A condition or impairment caused by accident is
16compensable only if the accident was the primary factor in
17causing both the resulting medical condition and disability.
18The "primary factor" is defined to be the major contributory
19factor, in relation to other factors, causing both the
20resulting medical condition and disability. "Injury" includes
21the aggravation of a pre-existing condition by an accident
22arising out of and in the course of the employment, but only
23for so long as the aggravation of the pre-existing condition
24continues to be the primary factor causing the disability.
25        (1) An injury is deemed to arise out of and in the
26    course of the employment only if:

 

 

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1            (A) it is reasonably apparent, upon consideration
2        of all circumstances, that the accident is the primary
3        factor in causing the injury; and
4            (B) it does not come from a hazard or risk
5        unrelated to the employment to which employees would
6        have been equally exposed outside of the employment.
7        (2) An injury resulting directly or indirectly from
8    idiopathic causes is not compensable.
9(Source: P.A. 93-721, eff. 1-1-05.)
 
10    (820 ILCS 305/6)  (from Ch. 48, par. 138.6)
11    Sec. 6. (a) Every employer within the provisions of this
12Act, shall, under the rules and regulations prescribed by the
13Commission, post printed notices in their respective places of
14employment in such number and at such places as may be
15determined by the Commission, containing such information
16relative to this Act as in the judgment of the Commission may
17be necessary to aid employees to safeguard their rights under
18this Act in event of injury.
19    In addition thereto, the employer shall post in a
20conspicuous place on the place of the employment a printed or
21typewritten notice stating whether he is insured or whether he
22has qualified and is operating as a self-insured employer. In
23the event the employer is insured, the notice shall state the
24name and address of his insurance carrier, the number of the
25insurance policy, its effective date and the date of

 

 

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1termination. In the event of the termination of the policy for
2any reason prior to the termination date stated, the posted
3notice shall promptly be corrected accordingly. In the event
4the employer is operating as a self-insured employer the notice
5shall state the name and address of the company, if any,
6servicing the compensation payments of the employer, and the
7name and address of the person in charge of making compensation
8payments.
9    (b) Every employer subject to this Act shall maintain
10accurate records of work-related deaths, injuries and illness
11other than minor injuries requiring only first aid treatment
12and which do not involve medical treatment, loss of
13consciousness, restriction of work or motion, or transfer to
14another job and file with the Commission, in writing, a report
15of all accidental deaths, injuries and illnesses arising out of
16and in the course of the employment resulting in the loss of
17more than 3 scheduled work days. In the case of death such
18report shall be made no later than 2 working days following the
19accidental death. In all other cases such report shall be made
20between the 15th and 25th of each month unless required to be
21made sooner by rule of the Commission. In case the injury
22results in permanent disability, a further report shall be made
23as soon as it is determined that such permanent disability has
24resulted or will result from the injury. All reports shall
25state the date of the injury, including the time of day or
26night, the nature of the employer's business, the name,

 

 

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1address, age, sex, conjugal condition of the injured person,
2the specific occupation of the injured person, the direct cause
3of the injury and the nature of the accident, the character of
4the injury, the length of disability, and in case of death the
5length of disability before death, the wages of the injured
6person, whether compensation has been paid to the injured
7person, or to his or her legal representative or his heirs or
8next of kin, the amount of compensation paid, the amount paid
9for physicians', surgeons' and hospital bills, and by whom
10paid, and the amount paid for funeral or burial expenses if
11known. The reports shall be made on forms and in the manner as
12prescribed by the Commission and shall contain such further
13information as the Commission shall deem necessary and require.
14The making of these reports releases the employer from making
15such reports to any other officer of the State and shall
16satisfy the reporting provisions as contained in the "Health
17and Safety Act" and "An Act in relation to safety inspections
18and education in industrial and commercial establishments and
19to repeal an Act therein named", approved July 18, 1955, as now
20or hereafter amended. The reports filed with the Commission
21pursuant to this Section shall be made available by the
22Commission to the Director of Labor or his representatives and
23to all other departments of the State of Illinois which shall
24require such information for the proper discharge of their
25official duties. Failure to file with the Commission any of the
26reports required in this Section is a petty offense.

 

 

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1    Except as provided in this paragraph, all reports filed
2hereunder shall be confidential and any person having access to
3such records filed with the Illinois Workers' Compensation
4Commission as herein required, who shall release any
5information therein contained including the names or otherwise
6identify any persons sustaining injuries or disabilities, or
7give access to such information to any unauthorized person,
8shall be subject to discipline or discharge, and in addition
9shall be guilty of a Class B misdemeanor. The Commission shall
10compile and distribute to interested persons aggregate
11statistics, taken from the reports filed hereunder. The
12aggregate statistics shall not give the names or otherwise
13identify persons sustaining injuries or disabilities or the
14employer of any injured or disabled person.
15    (c) Notice of the accident shall be given to the employer
16as soon as practicable, but not later than 45 days after the
17accident. Provided:
18    (1) In case of the legal disability of the employee or any
19dependent of a deceased employee who may be entitled to
20compensation under the provisions of this Act, the limitations
21of time by this Act provided do not begin to run against such
22person under legal disability until a guardian has been
23appointed.
24    (2) In cases of injuries sustained by exposure to
25radiological materials or equipment, notice shall be given to
26the employer within 90 days subsequent to the time that the

 

 

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1employee knows or suspects that he has received an excessive
2dose of radiation.
3    No defect or inaccuracy of such notice shall be a bar to
4the maintenance of proceedings on arbitration or otherwise by
5the employee unless the employer proves that he is unduly
6prejudiced in such proceedings by such defect or inaccuracy.
7    Notice of the accident shall give the approximate date and
8place of the accident, if known, and may be given orally or in
9writing.
10    (d) Every employer shall notify each injured employee who
11has been granted compensation under the provisions of Section 8
12of this Act of his rights to rehabilitation services and advise
13him of the locations of available public rehabilitation centers
14and any other such services of which the employer has
15knowledge.
16    In any case, other than one where the injury was caused by
17exposure to radiological materials or equipment or asbestos
18unless the application for compensation is filed with the
19Commission within 3 years after the date of the accident, where
20no compensation has been paid, or within 2 years after the date
21of the last payment of compensation, where any has been paid,
22whichever shall be later, the right to file such application
23shall be barred.
24    In any case of injury caused by exposure to radiological
25materials or equipment or asbestos, unless application for
26compensation is filed with the Commission within 25 years after

 

 

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1the last day that the employee was employed in an environment
2of hazardous radiological activity or asbestos, the right to
3file such application shall be barred.
4    If in any case except one where the injury was caused by
5exposure to radiological materials or equipment or asbestos,
6the accidental injury results in death application for
7compensation for death may be filed with the Commission within
83 years after the date of death where no compensation has been
9paid or within 2 years after the date of the last payment of
10compensation where any has been paid, whichever shall be later,
11but not thereafter.
12    If an accidental injury caused by exposure to radiological
13material or equipment or asbestos results in death within 25
14years after the last day that the employee was so exposed
15application for compensation for death may be filed with the
16Commission within 3 years after the date of death, where no
17compensation has been paid, or within 2 years after the date of
18the last payment of compensation where any has been paid,
19whichever shall be later, but not thereafter.
20    (e) Any contract or agreement made by any employer or his
21agent or attorney with any employee or any other beneficiary of
22any claim under the provisions of this Act within 7 days after
23the injury shall be presumed to be fraudulent.
24    (f) (Blank). Any condition or impairment of health of an
25employee employed as a firefighter, emergency medical
26technician (EMT), or paramedic which results directly or

 

 

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1indirectly from any bloodborne pathogen, lung or respiratory
2disease or condition, heart or vascular disease or condition,
3hypertension, tuberculosis, or cancer resulting in any
4disability (temporary, permanent, total, or partial) to the
5employee shall be rebuttably presumed to arise out of and in
6the course of the employee's firefighting, EMT, or paramedic
7employment and, further, shall be rebuttably presumed to be
8causally connected to the hazards or exposures of the
9employment. This presumption shall also apply to any hernia or
10hearing loss suffered by an employee employed as a firefighter,
11EMT, or paramedic. However, this presumption shall not apply to
12any employee who has been employed as a firefighter, EMT, or
13paramedic for less than 5 years at the time he or she files an
14Application for Adjustment of Claim concerning this condition
15or impairment with the Illinois Workers' Compensation
16Commission. The Finding and Decision of the Illinois Workers'
17Compensation Commission under only the rebuttable presumption
18provision of this subsection shall not be admissible or be
19deemed res judicata in any disability claim under the Illinois
20Pension Code arising out of the same medical condition;
21however, this sentence makes no change to the law set forth in
22Krohe v. City of Bloomington, 204 Ill.2d 392.
23(Source: P.A. 95-316, eff. 1-1-08.)
 
24    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
25    Sec. 8. The amount of compensation which shall be paid to

 

 

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1the employee for an accidental injury not resulting in death
2is:
3    (a) The employer shall provide and pay the negotiated rate,
4if applicable, or the lesser of the health care provider's
5actual charges or according to a fee schedule, subject to
6Section 8.2, in effect at the time the service was rendered for
7all the necessary first aid, medical and surgical services, and
8all necessary medical, surgical and hospital services
9thereafter incurred, limited, however, to that which is
10reasonably required to cure or relieve from the effects of the
11accidental injury. If the employer does not dispute payment of
12first aid, medical, surgical, and hospital services, the
13employer shall make such payment to the provider on behalf of
14the employee. The employer shall also pay for treatment,
15instruction and training necessary for the physical, mental and
16vocational rehabilitation of the employee, including all
17maintenance costs and expenses incidental thereto. If as a
18result of the injury the employee is unable to be
19self-sufficient the employer shall further pay for such
20maintenance or institutional care as shall be required.
21    The employer shall choose all necessary medical, surgical
22and hospital services reasonably required to cure or relieve
23from the effects of the accidental injury, at the employer's
24expense. The employee shall cooperate with and adhere to the
25plan of care or treatment recommendations of the providers
26selected by the employer, unless the proposed care and

 

 

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1treatment threatens the life, health or recovery of the injured
2employee. Upon a finding by the Commission, that the employer's
3choice of medical care threatens the life, health, or recovery
4of the injured employee, the employee may then choose a second
5physician, surgeon, and hospital services at the employer's
6expense. Initial emergency services, taking place within 45
7days of the accident, shall not constitute a choice of
8physician, surgeon, or hospital services by the employer or
9employee. employee may at any time elect to secure his own
10physician, surgeon and hospital services at the employer's
11expense, or,
12    Notwithstanding the foregoing, upon Upon agreement between
13the employer and the employees, or the employees' exclusive
14representative, and subject to the approval of the Illinois
15Workers' Compensation Commission, the employer shall maintain
16a list of physicians, to be known as a Panel of Physicians, who
17are accessible to the employees. The employer shall post this
18list in a place or places easily accessible to his employees.
19The employee shall have the right to make an alternative choice
20of physician from such Panel if he is not satisfied with the
21physician first selected. If, due to the nature of the injury
22or its occurrence away from the employer's place of business,
23the employee is unable to make a selection from the Panel, the
24selection process from the Panel shall not apply. The physician
25selected from the Panel may arrange for any consultation,
26referral or other specialized medical services outside the

 

 

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1Panel at the employer's expense. Provided that, in the event
2the Commission shall find that a doctor selected by the
3employee is rendering improper or inadequate care, the
4Commission may order the employee to select another doctor
5certified or qualified in the medical field for which treatment
6is required. If the employee refuses to make such change the
7Commission may relieve the employer of his obligation to pay
8the doctor's charges from the date of refusal to the date of
9compliance.
10    Any vocational rehabilitation counselors who provide
11service under this Act shall have appropriate certifications
12which designate the counselor as qualified to render opinions
13relating to vocational rehabilitation. Vocational
14rehabilitation may include, but is not limited to, counseling
15for job searches, supervising a job search program, and
16vocational retraining including education at an accredited
17learning institution. The employee or employer may petition to
18the Commission to decide disputes relating to vocational
19rehabilitation and the Commission shall resolve any such
20dispute, including payment of the vocational rehabilitation
21program by the employer.
22    The maintenance benefit shall not be less than the
23temporary total disability rate determined for the employee. In
24addition, maintenance shall include costs and expenses
25incidental to the vocational rehabilitation program.
26    When the employee is working light duty on a part-time

 

 

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1basis or full-time basis and earns less than he or she would be
2earning if employed in the full capacity of the job or jobs,
3then the employee shall be entitled to temporary partial
4disability benefits. Temporary partial disability benefits
5shall be equal to two-thirds of the difference between the
6average amount that the employee would be able to earn in the
7full performance of his or her duties in the occupation in
8which he or she was engaged at the time of accident and the net
9amount which he or she is earning in the modified job provided
10to the employee by the employer or in any other job that the
11employee is working.
12    Every hospital, physician, surgeon or other person
13rendering treatment or services in accordance with the
14provisions of this Section shall upon written request furnish
15full and complete reports thereof to, and permit their records
16to be copied by, the employer, the employee or his dependents,
17as the case may be, or any other party to any proceeding for
18compensation before the Commission, or their attorneys.
19    When an employee makes a claim for benefits under the Act,
20he or she waives their privacy privilege with any treating
21provider to the extent solely to allow the employer to obtain
22from a treating provider the necessary information to determine
23whether the condition of ill-being in question for which
24treatment is sought is work related, what that treatment is for
25purposes of approval of care, and whether or not, based upon
26the condition of ill-being, the employee is entitled to other

 

 

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1benefits. The employer shall be entitled to contact the
2treating provider to seek information and answers from the
3treating provider regarding whether the condition of ill-being
4in question for which treatment is sought is work related, what
5that treatment or course of treatment is for purposes of
6approval of care, and the return to work options that the
7employer may have for the employee.
8    Notwithstanding the foregoing, the employer's liability to
9pay for such medical services selected by the employer or
10employee shall be limited to:
11        (1) all first aid and emergency treatment; plus
12        (2) all medical, surgical and hospital services
13    provided by the physician, surgeon or hospital initially
14    chosen by the employer employee or by any other physician,
15    consultant, expert, institution or other provider of
16    services recommended by said initial service provider or
17    any subsequent provider of medical services in the chain of
18    referrals from said initial service provider; plus
19        (3) all medical, surgical and hospital services
20    provided by any second physician, surgeon or hospital
21    subsequently chosen by the employee or by any other
22    physician, consultant, expert, institution or other
23    provider of services recommended by said second service
24    provider or any subsequent provider of medical services in
25    the chain of referrals from said second service provider.
26    Thereafter the employer shall select and pay for all

 

 

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1    necessary medical, surgical and hospital treatment and the
2    employee may not select a provider of medical services at
3    the employer's expense unless the employer agrees to such
4    selection. At any time the employee may obtain any medical
5    treatment he or she desires at his or her own expense. This
6    paragraph shall not affect the duty to pay for
7    rehabilitation referred to above.
8    When an employer and employee so agree in writing, nothing
9in this Act prevents an employee whose injury or disability has
10been established under this Act, from relying in good faith, on
11treatment by prayer or spiritual means alone, in accordance
12with the tenets and practice of a recognized church or
13religious denomination, by a duly accredited practitioner
14thereof, and having nursing services appropriate therewith,
15without suffering loss or diminution of the compensation
16benefits under this Act. However, the employee shall submit to
17all physical examinations required by this Act. The cost of
18such treatment and nursing care shall be paid by the employee
19unless the employer agrees to make such payment.
20    Where the accidental injury results in the amputation of an
21arm, hand, leg or foot, or the enucleation of an eye, or the
22loss of any of the natural teeth, the employer shall furnish an
23artificial of any such members lost or damaged in accidental
24injury arising out of and in the course of employment, and
25shall also furnish the necessary braces in all proper and
26necessary cases. In cases of the loss of a member or members by

 

 

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1amputation, the employer shall, whenever necessary, maintain
2in good repair, refit or replace the artificial limbs during
3the lifetime of the employee. Where the accidental injury
4accompanied by physical injury results in damage to a denture,
5eye glasses or contact eye lenses, or where the accidental
6injury results in damage to an artificial member, the employer
7shall replace or repair such denture, glasses, lenses, or
8artificial member.
9    The furnishing by the employer of any such services or
10appliances is not an admission of liability on the part of the
11employer to pay compensation.
12    The furnishing of any such services or appliances or the
13servicing thereof by the employer is not the payment of
14compensation.
15    (b) If the period of temporary total incapacity for work
16lasts more than 3 working days, weekly compensation as
17hereinafter provided shall be paid beginning on the 4th day of
18such temporary total incapacity and continuing as long as the
19total temporary incapacity lasts. In cases where the temporary
20total incapacity for work continues for a period of 14 days or
21more from the day of the accident compensation shall commence
22on the day after the accident.
23        1. The compensation rate for temporary total
24    incapacity under this paragraph (b) of this Section shall
25    be equal to 66 2/3% of the employee's average weekly wage
26    computed in accordance with Section 10, provided that it

 

 

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

 

 

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1        2.1. The compensation rate in all cases of serious and
2    permanent disfigurement under paragraph (c) and of
3    permanent partial disability under subparagraph (2) of
4    paragraph (d) or under paragraph (e) of this Section shall
5    be equal to 60% of the employee's average weekly wage
6    computed in accordance with the provisions of Section 10,
7    provided that it shall be not less than 66 2/3% of the sum
8    of the Federal minimum wage under the Fair Labor Standards
9    Act, or the Illinois minimum wage under the Minimum Wage
10    Law, whichever is more, multiplied by 40 hours. This
11    percentage rate shall be increased by 10% for each spouse
12    and child, not to exceed 100% of the total minimum wage
13    calculation,
14    nor exceed the employee's average weekly wage computed in
15    accordance with the provisions of Section 10, whichever is
16    less.
17        3. As used in this Section the term "child" means a
18    child of the employee including any child legally adopted
19    before the accident or whom at the time of the accident the
20    employee was under legal obligation to support or to whom
21    the employee stood in loco parentis, and who at the time of
22    the accident was under 18 years of age and not emancipated.
23    The term "children" means the plural of "child".
24        4. All weekly compensation rates provided under
25    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
26    Section shall be subject to the following limitations:

 

 

SB1349- 24 -LRB097 07516 AEK 47626 b

1        The maximum weekly compensation rate from July 1, 1975,
2    except as hereinafter provided, shall be 100% of the
3    State's average weekly wage in covered industries under the
4    Unemployment Insurance Act, that being the wage that most
5    closely approximates the State's average weekly wage.
6        The maximum weekly compensation rate, for the period
7    July 1, 1984, through June 30, 1987, except as hereinafter
8    provided, shall be $293.61. Effective July 1, 1987 and on
9    July 1 of each year thereafter the maximum weekly
10    compensation rate, except as hereinafter provided, shall
11    be determined as follows: if during the preceding 12 month
12    period there shall have been an increase in the State's
13    average weekly wage in covered industries under the
14    Unemployment Insurance Act, the weekly compensation rate
15    shall be proportionately increased by the same percentage
16    as the percentage of increase in the State's average weekly
17    wage in covered industries under the Unemployment
18    Insurance Act during such period.
19        The maximum weekly compensation rate, for the period
20    January 1, 1981 through December 31, 1983, except as
21    hereinafter provided, shall be 100% of the State's average
22    weekly wage in covered industries under the Unemployment
23    Insurance Act in effect on January 1, 1981. Effective
24    January 1, 1984 and on January 1, of each year thereafter
25    the maximum weekly compensation rate, except as
26    hereinafter provided, shall be determined as follows: if

 

 

SB1349- 25 -LRB097 07516 AEK 47626 b

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

 

 

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

 

 

SB1349- 27 -LRB097 07516 AEK 47626 b

1    conclusive and shall be applicable as the basis of
2    computation of compensation rates until the next posting
3    and publication as aforesaid.
4        7. The payment of compensation by an employer or his
5    insurance carrier to an injured employee shall not
6    constitute an admission of the employer's liability to pay
7    compensation.
8    (c) For any serious and permanent disfigurement to the
9hand, head, face, neck, arm, leg below the knee or the chest
10above the axillary line, the employee is entitled to
11compensation for such disfigurement, the amount determined by
12agreement at any time or by arbitration under this Act, at a
13hearing not less than 6 months after the date of the accidental
14injury, which amount shall not exceed 150 weeks (if the
15accidental injury occurs on or after the effective date of this
16amendatory Act of the 94th General Assembly but before February
171, 2006) or 162 weeks (if the accidental injury occurs on or
18after February 1, 2006) at the applicable rate provided in
19subparagraph 2.1 of paragraph (b) of this Section.
20    No compensation is payable under this paragraph where
21compensation is payable under paragraphs (d), (e) or (f) of
22this Section.
23    A duly appointed member of a fire department in a city, the
24population of which exceeds 200,000 according to the last
25federal or State census, is eligible for compensation under
26this paragraph only where such serious and permanent

 

 

SB1349- 28 -LRB097 07516 AEK 47626 b

1disfigurement results from burns.
2    (d) 1. If, after the accidental injury has been sustained,
3the employee as a result thereof becomes partially
4incapacitated from pursuing his usual and customary line of
5employment, he shall, except in cases compensated under the
6specific schedule set forth in paragraph (e) of this Section,
7receive compensation for the duration of his disability,
8subject to the limitations as to maximum amounts fixed in
9paragraph (b) of this Section, equal to 66-2/3% of the
10difference between the average amount which he would be able to
11earn in the full performance of his duties in the occupation in
12which he was engaged at the time of the accident and the
13average amount which he is earning or is able to earn in some
14suitable employment or business after the accident. For
15injuries sustained on or after the effective date of this
16Amendatory Act of the 97th General Assembly, awards made
17pursuant to this subparagraph shall be known as a wage
18differential award and shall cease when the employee reaches
19full retirement age as defined by the Social Security
20Administration. In addition, after a wage differential award
21becomes final, the employer shall, on no more than a quarterly
22annual basis, upon written request to the employee, be entitled
23to verification of an employee's current employment status and
24earnings, including the name and address of the employee's
25current employer, rate of pay or method of compensation,
26duration of such employment, and true copies of the employee's

 

 

SB1349- 29 -LRB097 07516 AEK 47626 b

1paychecks or other evidence of payment for the duration of such
2employment. An employer can further request the employee to
3sign an authorization to permit the employer to then obtain
4from the employee's current employer the employee's earnings
5and payroll documentation. The employer may seek to modify or
6vacate a wage differential award based on a material increase
7in the earnings of the employee during the period that the wage
8differential award is in effect. Notwithstanding and in
9addition to Section 19(h), a final wage differential award may
10at any time be reviewed by the Commission in an evidentiary
11hearing at the request of the employer on the grounds that
12there has been a subsequent material increase in the average
13weekly wage which was the basis of the wage differential award
14and the average weekly wage the employee is earning currently
15after the accident. After review, the Commission shall modify
16or vacate a final wage differential award based where there is
17a finding of a material increase in the employee's current job
18earnings from the employee's earnings from which the wage
19differential award was based upon.
20    2. If, as a result of the accident, the employee sustains
21serious and permanent injuries not covered by paragraphs (c)
22and (e) of this Section or having sustained injuries covered by
23the aforesaid paragraphs (c) and (e), he shall have sustained
24in addition thereto other injuries which injuries do not
25incapacitate him from pursuing the duties of his employment but
26which would disable him from pursuing other suitable

 

 

SB1349- 30 -LRB097 07516 AEK 47626 b

1occupations, or which have otherwise resulted in physical
2impairment; or if such injuries partially incapacitate him from
3pursuing the duties of his usual and customary line of
4employment but do not result in an impairment of earning
5capacity, or having resulted in an impairment of earning
6capacity, the employee elects to waive his right to recover
7under the foregoing subparagraph 1 of paragraph (d) of this
8Section then in any of the foregoing events, he shall receive
9in addition to compensation for temporary total disability
10under paragraph (b) of this Section, compensation at the rate
11provided in subparagraph 2.1 of paragraph (b) of this Section
12for that percentage of 500 weeks that the partial disability
13resulting from the injuries covered by this paragraph bears to
14total disability. If the employee shall have sustained a
15fracture of one or more vertebra or fracture of the skull, the
16amount of compensation allowed under this Section shall be not
17less than 6 weeks for a fractured skull and 6 weeks for each
18fractured vertebra, and in the event the employee shall have
19sustained a fracture of any of the following facial bones:
20nasal, lachrymal, vomer, zygoma, maxilla, palatine or
21mandible, the amount of compensation allowed under this Section
22shall be not less than 2 weeks for each such fractured bone,
23and for a fracture of each transverse process not less than 3
24weeks. In the event such injuries shall result in the loss of a
25kidney, spleen or lung, the amount of compensation allowed
26under this Section shall be not less than 10 weeks for each

 

 

SB1349- 31 -LRB097 07516 AEK 47626 b

1such organ. Compensation awarded under this subparagraph 2
2shall not take into consideration injuries covered under
3paragraphs (c) and (e) of this Section and the compensation
4provided in this paragraph shall not affect the employee's
5right to compensation payable under paragraphs (b), (c) and (e)
6of this Section for the disabilities therein covered.
7    (e) For accidental injuries in the following schedule, the
8employee shall receive compensation for the period of temporary
9total incapacity for work resulting from such accidental
10injury, under subparagraph 1 of paragraph (b) of this Section,
11and shall receive in addition thereto compensation for a
12further period for the specific loss herein mentioned, but
13shall not receive any compensation under any other provisions
14of this Act. The following listed amounts apply to either the
15loss of or the permanent and complete loss of use of the member
16specified, such compensation for the length of time as follows:
17        1. Thumb-
18            70 weeks if the accidental injury occurs on or
19        after the effective date of this amendatory Act of the
20        94th General Assembly but before February 1, 2006.
21            76 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        2. First, or index finger-
24            40 weeks if the accidental injury occurs on or
25        after the effective date of this amendatory Act of the
26        94th General Assembly but before February 1, 2006.

 

 

SB1349- 32 -LRB097 07516 AEK 47626 b

1            43 weeks if the accidental injury occurs on or
2        after February 1, 2006.
3        3. Second, or middle finger-
4            35 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            38 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        4. Third, or ring finger-
10            25 weeks if the accidental injury occurs on or
11        after the effective date of this amendatory Act of the
12        94th General Assembly but before February 1, 2006.
13            27 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        5. Fourth, or little finger-
16            20 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            22 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        6. Great toe-
22            35 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            38 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

SB1349- 33 -LRB097 07516 AEK 47626 b

1        7. Each toe other than great toe-
2            12 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            13 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        8. The loss of the first or distal phalanx of the thumb
8    or of any finger or toe shall be considered to be equal to
9    the loss of one-half of such thumb, finger or toe and the
10    compensation payable shall be one-half of the amount above
11    specified. The loss of more than one phalanx shall be
12    considered as the loss of the entire thumb, finger or toe.
13    In no case shall the amount received for more than one
14    finger exceed the amount provided in this schedule for the
15    loss of a hand.
16        9. Hand-
17            190 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            205 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        The loss of 2 or more digits, or one or more phalanges
23    of 2 or more digits, of a hand may be compensated on the
24    basis of partial loss of use of a hand, provided, further,
25    that the loss of 4 digits, or the loss of use of 4 digits,
26    in the same hand shall constitute the complete loss of a

 

 

SB1349- 34 -LRB097 07516 AEK 47626 b

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

 

 

SB1349- 35 -LRB097 07516 AEK 47626 b

1        11. Foot-
2            155 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            167 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        12. Leg-
8            200 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            215 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        Where an accidental injury results in the amputation of
14    a leg below the knee, such injury shall be compensated as
15    loss of a leg. Where an accidental injury results in the
16    amputation of a leg above the knee, compensation for an
17    additional 25 weeks (if the accidental injury occurs on or
18    after the effective date of this amendatory Act of the 94th
19    General Assembly but before February 1, 2006) or an
20    additional 27 weeks (if the accidental injury occurs on or
21    after February 1, 2006) shall be paid, except where the
22    accidental injury results in the amputation of a leg at the
23    hip joint, or so close to the hip joint that an artificial
24    leg cannot be used, or results in the disarticulation of a
25    leg at the hip joint, in which case compensation for an
26    additional 75 weeks (if the accidental injury occurs on or

 

 

SB1349- 36 -LRB097 07516 AEK 47626 b

1    after the effective date of this amendatory Act of the 94th
2    General Assembly but before February 1, 2006) or an
3    additional 81 weeks (if the accidental injury occurs on or
4    after February 1, 2006) shall be paid.
5        13. Eye-
6            150 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            162 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        Where an accidental injury results in the enucleation
12    of an eye, compensation for an additional 10 weeks (if the
13    accidental injury occurs on or after the effective date of
14    this amendatory Act of the 94th General Assembly but before
15    February 1, 2006) or an additional 11 weeks (if the
16    accidental injury occurs on or after February 1, 2006)
17    shall be paid.
18        14. Loss of hearing of one ear-
19            50 weeks if the accidental injury occurs on or
20        after the effective date of this amendatory Act of the
21        94th General Assembly but before February 1, 2006.
22            54 weeks if the accidental injury occurs on or
23        after February 1, 2006.
24        Total and permanent loss of hearing of both ears-
25            200 weeks if the accidental injury occurs on or
26        after the effective date of this amendatory Act of the

 

 

SB1349- 37 -LRB097 07516 AEK 47626 b

1        94th General Assembly but before February 1, 2006.
2            215 weeks if the accidental injury occurs on or
3        after February 1, 2006.
4        15. Testicle-
5            50 weeks if the accidental injury occurs on or
6        after the effective date of this amendatory Act of the
7        94th General Assembly but before February 1, 2006.
8            54 weeks if the accidental injury occurs on or
9        after February 1, 2006.
10        Both testicles-
11            150 weeks if the accidental injury occurs on or
12        after the effective date of this amendatory Act of the
13        94th General Assembly but before February 1, 2006.
14            162 weeks if the accidental injury occurs on or
15        after February 1, 2006.
16        16. For the permanent partial loss of use of a member
17    or sight of an eye, or hearing of an ear, compensation
18    during that proportion of the number of weeks in the
19    foregoing schedule provided for the loss of such member or
20    sight of an eye, or hearing of an ear, which the partial
21    loss of use thereof bears to the total loss of use of such
22    member, or sight of eye, or hearing of an ear.
23            (a) Loss of hearing for compensation purposes
24        shall be confined to the frequencies of 1,000, 2,000
25        and 3,000 cycles per second. Loss of hearing ability
26        for frequency tones above 3,000 cycles per second are

 

 

SB1349- 38 -LRB097 07516 AEK 47626 b

1        not to be considered as constituting disability for
2        hearing.
3            (b) The percent of hearing loss, for purposes of
4        the determination of compensation claims for
5        occupational deafness, shall be calculated as the
6        average in decibels for the thresholds of hearing for
7        the frequencies of 1,000, 2,000 and 3,000 cycles per
8        second. Pure tone air conduction audiometric
9        instruments, approved by nationally recognized
10        authorities in this field, shall be used for measuring
11        hearing loss. If the losses of hearing average 30
12        decibels or less in the 3 frequencies, such losses of
13        hearing shall not then constitute any compensable
14        hearing disability. If the losses of hearing average 85
15        decibels or more in the 3 frequencies, then the same
16        shall constitute and be total or 100% compensable
17        hearing loss.
18            (c) In measuring hearing impairment, the lowest
19        measured losses in each of the 3 frequencies shall be
20        added together and divided by 3 to determine the
21        average decibel loss. For every decibel of loss
22        exceeding 30 decibels an allowance of 1.82% shall be
23        made up to the maximum of 100% which is reached at 85
24        decibels.
25            (d) If a hearing loss is established to have
26        existed on July 1, 1975 by audiometric testing the

 

 

SB1349- 39 -LRB097 07516 AEK 47626 b

1        employer shall not be liable for the previous loss so
2        established nor shall he be liable for any loss for
3        which compensation has been paid or awarded.
4            (e) No consideration shall be given to the question
5        of whether or not the ability of an employee to
6        understand speech is improved by the use of a hearing
7        aid.
8            (f) No claim for loss of hearing due to industrial
9        noise shall be brought against an employer or allowed
10        unless the employee has been exposed for a period of
11        time sufficient to cause permanent impairment to noise
12        levels in excess of the following:
13Sound Level DBA
14Slow ResponseHours Per Day
15908
16926
17954
18973
191002
201021-1/2
211051
221101/2
231151/4
24        This subparagraph (f) shall not be applied in cases of
25    hearing loss resulting from trauma or explosion.
26        17. In computing the compensation to be paid to any

 

 

SB1349- 40 -LRB097 07516 AEK 47626 b

1    employee who, before the accident for which he claims
2    compensation, had before that time sustained an injury
3    resulting in the loss by amputation or partial loss by
4    amputation of any member, including hand, arm, thumb or
5    fingers, leg, foot or any toes, such loss or partial loss
6    of any such member shall be deducted from any award made
7    for the subsequent injury. For the permanent loss of use or
8    the permanent partial loss of use of any such member or the
9    partial loss of sight of an eye, for which compensation has
10    been paid, then such loss shall be taken into consideration
11    and deducted from any award for the subsequent injury.
12        18. The specific case of loss of both hands, both arms,
13    or both feet, or both legs, or both eyes, or of any two
14    thereof, or the permanent and complete loss of the use
15    thereof, constitutes total and permanent disability, to be
16    compensated according to the compensation fixed by
17    paragraph (f) of this Section. These specific cases of
18    total and permanent disability do not exclude other cases.
19        Any employee who has previously suffered the loss or
20    permanent and complete loss of the use of any of such
21    members, and in a subsequent independent accident loses
22    another or suffers the permanent and complete loss of the
23    use of any one of such members the employer for whom the
24    injured employee is working at the time of the last
25    independent accident is liable to pay compensation only for
26    the loss or permanent and complete loss of the use of the

 

 

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1    member occasioned by the last independent accident.
2        19. In a case of specific loss and the subsequent death
3    of such injured employee from other causes than such injury
4    leaving a widow, widower, or dependents surviving before
5    payment or payment in full for such injury, then the amount
6    due for such injury is payable to the widow or widower and,
7    if there be no widow or widower, then to such dependents,
8    in the proportion which such dependency bears to total
9    dependency.
10    Beginning July 1, 1980, and every 6 months thereafter, the
11Commission shall examine the Second Injury Fund and when, after
12deducting all advances or loans made to such Fund, the amount
13therein is $500,000 then the amount required to be paid by
14employers pursuant to paragraph (f) of Section 7 shall be
15reduced by one-half. When the Second Injury Fund reaches the
16sum of $600,000 then the payments shall cease entirely.
17However, when the Second Injury Fund has been reduced to
18$400,000, payment of one-half of the amounts required by
19paragraph (f) of Section 7 shall be resumed, in the manner
20herein provided, and when the Second Injury Fund has been
21reduced to $300,000, payment of the full amounts required by
22paragraph (f) of Section 7 shall be resumed, in the manner
23herein provided. The Commission shall make the changes in
24payment effective by general order, and the changes in payment
25become immediately effective for all cases coming before the
26Commission thereafter either by settlement agreement or final

 

 

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1order, irrespective of the date of the accidental injury.
2    On August 1, 1996 and on February 1 and August 1 of each
3subsequent year, the Commission shall examine the special fund
4designated as the "Rate Adjustment Fund" and when, after
5deducting all advances or loans made to said fund, the amount
6therein is $4,000,000, the amount required to be paid by
7employers pursuant to paragraph (f) of Section 7 shall be
8reduced by one-half. When the Rate Adjustment Fund reaches the
9sum of $5,000,000 the payment therein shall cease entirely.
10However, when said Rate Adjustment Fund has been reduced to
11$3,000,000 the amounts required by paragraph (f) of Section 7
12shall be resumed in the manner herein provided.
13    (f) In case of complete disability, which renders the
14employee wholly and permanently incapable of work, or in the
15specific case of total and permanent disability as provided in
16subparagraph 18 of paragraph (e) of this Section, compensation
17shall be payable at the rate provided in subparagraph 2 of
18paragraph (b) of this Section for life.
19    An employee entitled to benefits under paragraph (f) of
20this Section shall also be entitled to receive from the Rate
21Adjustment Fund provided in paragraph (f) of Section 7 of the
22supplementary benefits provided in paragraph (g) of this
23Section 8.
24    If any employee who receives an award under this paragraph
25afterwards returns to work or is able to do so, and earns or is
26able to earn as much as before the accident, payments under

 

 

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1such award shall cease. If such employee returns to work, or is
2able to do so, and earns or is able to earn part but not as much
3as before the accident, such award shall be modified so as to
4conform to an award under paragraph (d) of this Section. If
5such award is terminated or reduced under the provisions of
6this paragraph, such employees have the right at any time
7within 30 months after the date of such termination or
8reduction to file petition with the Commission for the purpose
9of determining whether any disability exists as a result of the
10original accidental injury and the extent thereof.
11    Disability as enumerated in subdivision 18, paragraph (e)
12of this Section is considered complete disability.
13    If an employee who had previously incurred loss or the
14permanent and complete loss of use of one member, through the
15loss or the permanent and complete loss of the use of one hand,
16one arm, one foot, one leg, or one eye, incurs permanent and
17complete disability through the loss or the permanent and
18complete loss of the use of another member, he shall receive,
19in addition to the compensation payable by the employer and
20after such payments have ceased, an amount from the Second
21Injury Fund provided for in paragraph (f) of Section 7, which,
22together with the compensation payable from the employer in
23whose employ he was when the last accidental injury was
24incurred, will equal the amount payable for permanent and
25complete disability as provided in this paragraph of this
26Section.

 

 

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1    The custodian of the Second Injury Fund provided for in
2paragraph (f) of Section 7 shall be joined with the employer as
3a party respondent in the application for adjustment of claim.
4The application for adjustment of claim shall state briefly and
5in general terms the approximate time and place and manner of
6the loss of the first member.
7    In its award the Commission or the Arbitrator shall
8specifically find the amount the injured employee shall be
9weekly paid, the number of weeks compensation which shall be
10paid by the employer, the date upon which payments begin out of
11the Second Injury Fund provided for in paragraph (f) of Section
127 of this Act, the length of time the weekly payments continue,
13the date upon which the pension payments commence and the
14monthly amount of the payments. The Commission shall 30 days
15after the date upon which payments out of the Second Injury
16Fund have begun as provided in the award, and every month
17thereafter, prepare and submit to the State Comptroller a
18voucher for payment for all compensation accrued to that date
19at the rate fixed by the Commission. The State Comptroller
20shall draw a warrant to the injured employee along with a
21receipt to be executed by the injured employee and returned to
22the Commission. The endorsed warrant and receipt is a full and
23complete acquittance to the Commission for the payment out of
24the Second Injury Fund. No other appropriation or warrant is
25necessary for payment out of the Second Injury Fund. The Second
26Injury Fund is appropriated for the purpose of making payments

 

 

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1according to the terms of the awards.
2    As of July 1, 1980 to July 1, 1982, all claims against and
3obligations of the Second Injury Fund shall become claims
4against and obligations of the Rate Adjustment Fund to the
5extent there is insufficient money in the Second Injury Fund to
6pay such claims and obligations. In that case, all references
7to "Second Injury Fund" in this Section shall also include the
8Rate Adjustment Fund.
9    (g) Every award for permanent total disability entered by
10the Commission on and after July 1, 1965 under which
11compensation payments shall become due and payable after the
12effective date of this amendatory Act, and every award for
13death benefits or permanent total disability entered by the
14Commission on and after the effective date of this amendatory
15Act shall be subject to annual adjustments as to the amount of
16the compensation rate therein provided. Such adjustments shall
17first be made on July 15, 1977, and all awards made and entered
18prior to July 1, 1975 and on July 15 of each year thereafter.
19In all other cases such adjustment shall be made on July 15 of
20the second year next following the date of the entry of the
21award and shall further be made on July 15 annually thereafter.
22If during the intervening period from the date of the entry of
23the award, or the last periodic adjustment, there shall have
24been an increase in the State's average weekly wage in covered
25industries under the Unemployment Insurance Act, the weekly
26compensation rate shall be proportionately increased by the

 

 

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1same percentage as the percentage of increase in the State's
2average weekly wage in covered industries under the
3Unemployment Insurance Act. The increase in the compensation
4rate under this paragraph shall in no event bring the total
5compensation rate to an amount greater than the prevailing
6maximum rate at the time that the annual adjustment is made.
7Such increase shall be paid in the same manner as herein
8provided for payments under the Second Injury Fund to the
9injured employee, or his dependents, as the case may be, out of
10the Rate Adjustment Fund provided in paragraph (f) of Section 7
11of this Act. Payments shall be made at the same intervals as
12provided in the award or, at the option of the Commission, may
13be made in quarterly payment on the 15th day of January, April,
14July and October of each year. In the event of a decrease in
15such average weekly wage there shall be no change in the then
16existing compensation rate. The within paragraph shall not
17apply to cases where there is disputed liability and in which a
18compromise lump sum settlement between the employer and the
19injured employee, or his dependents, as the case may be, has
20been duly approved by the Illinois Workers' Compensation
21Commission.
22    Provided, that in cases of awards entered by the Commission
23for injuries occurring before July 1, 1975, the increases in
24the compensation rate adjusted under the foregoing provision of
25this paragraph (g) shall be limited to increases in the State's
26average weekly wage in covered industries under the

 

 

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1Unemployment Insurance Act occurring after July 1, 1975.
2    For every accident occurring on or after July 20, 2005 but
3before the effective date of this amendatory Act of the 94th
4General Assembly (Senate Bill 1283 of the 94th General
5Assembly), the annual adjustments to the compensation rate in
6awards for death benefits or permanent total disability, as
7provided in this Act, shall be paid by the employer. The
8adjustment shall be made by the employer on July 15 of the
9second year next following the date of the entry of the award
10and shall further be made on July 15 annually thereafter. If
11during the intervening period from the date of the entry of the
12award, or the last periodic adjustment, there shall have been
13an increase in the State's average weekly wage in covered
14industries under the Unemployment Insurance Act, the employer
15shall increase the weekly compensation rate proportionately by
16the same percentage as the percentage of increase in the
17State's average weekly wage in covered industries under the
18Unemployment Insurance Act. The increase in the compensation
19rate under this paragraph shall in no event bring the total
20compensation rate to an amount greater than the prevailing
21maximum rate at the time that the annual adjustment is made. In
22the event of a decrease in such average weekly wage there shall
23be no change in the then existing compensation rate. Such
24increase shall be paid by the employer in the same manner and
25at the same intervals as the payment of compensation in the
26award. This paragraph shall not apply to cases where there is

 

 

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1disputed liability and in which a compromise lump sum
2settlement between the employer and the injured employee, or
3his or her dependents, as the case may be, has been duly
4approved by the Illinois Workers' Compensation Commission.
5    The annual adjustments for every award of death benefits or
6permanent total disability involving accidents occurring
7before July 20, 2005 and accidents occurring on or after the
8effective date of this amendatory Act of the 94th General
9Assembly (Senate Bill 1283 of the 94th General Assembly) shall
10continue to be paid from the Rate Adjustment Fund pursuant to
11this paragraph and Section 7(f) of this Act.
12    (h) In case death occurs from any cause before the total
13compensation to which the employee would have been entitled has
14been paid, then in case the employee leaves any widow, widower,
15child, parent (or any grandchild, grandparent or other lineal
16heir or any collateral heir dependent at the time of the
17accident upon the earnings of the employee to the extent of 50%
18or more of total dependency) such compensation shall be paid to
19the beneficiaries of the deceased employee and distributed as
20provided in paragraph (g) of Section 7.
21    (h-1) In case an injured employee is under legal disability
22at the time when any right or privilege accrues to him or her
23under this Act, a guardian may be appointed pursuant to law,
24and may, on behalf of such person under legal disability, claim
25and exercise any such right or privilege with the same effect
26as if the employee himself or herself had claimed or exercised

 

 

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1the right or privilege. No limitations of time provided by this
2Act run so long as the employee who is under legal disability
3is without a conservator or guardian.
4    (i) In case the injured employee is under 16 years of age
5at the time of the accident and is illegally employed, the
6amount of compensation payable under paragraphs (b), (c), (d),
7(e) and (f) of this Section is increased 50%.
8    However, where an employer has on file an employment
9certificate issued pursuant to the Child Labor Law or work
10permit issued pursuant to the Federal Fair Labor Standards Act,
11as amended, or a birth certificate properly and duly issued,
12such certificate, permit or birth certificate is conclusive
13evidence as to the age of the injured minor employee for the
14purposes of this Section.
15    Nothing herein contained repeals or amends the provisions
16of the Child Labor Law relating to the employment of minors
17under the age of 16 years.
18    (j) 1. In the event the injured employee receives benefits,
19including medical, surgical or hospital benefits under any
20group plan covering non-occupational disabilities contributed
21to wholly or partially by the employer, which benefits should
22not have been payable if any rights of recovery existed under
23this Act, then such amounts so paid to the employee from any
24such group plan as shall be consistent with, and limited to,
25the provisions of paragraph 2 hereof, shall be credited to or
26against any compensation payment for temporary total

 

 

SB1349- 50 -LRB097 07516 AEK 47626 b

1incapacity for work or any medical, surgical or hospital
2benefits made or to be made under this Act. In such event, the
3period of time for giving notice of accidental injury and
4filing application for adjustment of claim does not commence to
5run until the termination of such payments. This paragraph does
6not apply to payments made under any group plan which would
7have been payable irrespective of an accidental injury under
8this Act. Any employer receiving such credit shall keep such
9employee safe and harmless from any and all claims or
10liabilities that may be made against him by reason of having
11received such payments only to the extent of such credit.
12    Any excess benefits paid to or on behalf of a State
13employee by the State Employees' Retirement System under
14Article 14 of the Illinois Pension Code on a death claim or
15disputed disability claim shall be credited against any
16payments made or to be made by the State of Illinois to or on
17behalf of such employee under this Act, except for payments for
18medical expenses which have already been incurred at the time
19of the award. The State of Illinois shall directly reimburse
20the State Employees' Retirement System to the extent of such
21credit.
22    2. Nothing contained in this Act shall be construed to give
23the employer or the insurance carrier the right to credit for
24any benefits or payments received by the employee other than
25compensation payments provided by this Act, and where the
26employee receives payments other than compensation payments,

 

 

SB1349- 51 -LRB097 07516 AEK 47626 b

1whether as full or partial salary, group insurance benefits,
2bonuses, annuities or any other payments, the employer or
3insurance carrier shall receive credit for each such payment
4only to the extent of the compensation that would have been
5payable during the period covered by such payment.
6    3. The extension of time for the filing of an Application
7for Adjustment of Claim as provided in paragraph 1 above shall
8not apply to those cases where the time for such filing had
9expired prior to the date on which payments or benefits
10enumerated herein have been initiated or resumed. Provided
11however that this paragraph 3 shall apply only to cases wherein
12the payments or benefits hereinabove enumerated shall be
13received after July 1, 1969.
14    (k) For accidental injuries that occur on or after the
15effective date of this amendatory Act of the 97th General
16Assembly, permanent partial or total disability shall be
17certified by a physician and demonstrated by use of medically
18defined objective measurements that include, but are not
19limited to: loss of range of motion; loss of strength; and
20measured atrophy of tissue mass consistent with the injury. In
21determining the impairment, subjective complaints shall not be
22considered unless supported by and clearly related to objective
23measurements. The most current edition of the American Medical
24Association's "Guides to the Evaluation of Permanent
25Impairment" shall be applied in determining the level of
26disability under this Act.

 

 

SB1349- 52 -LRB097 07516 AEK 47626 b

1(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
294-695, eff. 11-16-05.)
 
3    (820 ILCS 305/8.2)
4    Sec. 8.2. Fee schedule.
5    (a) Except as provided for in subsection (c), for
6procedures, treatments, or services covered under this Act and
7rendered or to be rendered on and after February 1, 2006 and
8until January 1, 2012, the maximum allowable payment shall be
990% of the 80th percentile of charges and fees as determined by
10the Commission utilizing information provided by employers'
11and insurers' national databases, with a minimum of 12,000,000
12Illinois line item charges and fees comprised of health care
13provider and hospital charges and fees as of August 1, 2004 but
14not earlier than August 1, 2002. These charges and fees are
15provider billed amounts and shall not include discounted
16charges. The 80th percentile is the point on an ordered data
17set from low to high such that 80% of the cases are below or
18equal to that point and at most 20% are above or equal to that
19point. The Commission shall adjust these historical charges and
20fees as of August 1, 2004 by the Consumer Price Index-U for the
21period August 1, 2004 through September 30, 2005. The
22Commission shall establish fee schedules for procedures,
23treatments, or services for hospital inpatient, hospital
24outpatient, emergency room and trauma, ambulatory surgical
25treatment centers, and professional services. These charges

 

 

SB1349- 53 -LRB097 07516 AEK 47626 b

1and fees shall be designated by geozip or any smaller
2geographic unit. The data shall in no way identify or tend to
3identify any patient, employer, or health care provider. As
4used in this Section, "geozip" means a three-digit zip code
5based on data similarities, geographical similarities, and
6frequencies. A geozip does not cross state boundaries. As used
7in this Section, "three-digit zip code" means a geographic area
8in which all zip codes have the same first 3 digits. If a
9geozip does not have the necessary number of charges and fees
10to calculate a valid percentile for a specific procedure,
11treatment, or service, the Commission may combine data from the
12geozip with up to 4 other geozips that are demographically and
13economically similar and exhibit similarities in data and
14frequencies until the Commission reaches 9 charges or fees for
15that specific procedure, treatment, or service. In cases where
16the compiled data contains fewer less than 9 charges or fees
17for a procedure, treatment, or service, reimbursement shall
18occur at 76% of charges and fees as determined by the
19Commission in a manner consistent with the provisions of this
20paragraph. Providers of out-of-state procedures, treatments,
21services, products, or supplies shall be reimbursed at the
22lesser of that State's fee schedule amount or the fee schedule
23amount that would apply to the region where the employer is
24located. If no fee schedule exists in that State, the provider
25shall be reimbursed at the lesser of the actual charge or the
26fee schedule amount that would apply to the region where the

 

 

SB1349- 54 -LRB097 07516 AEK 47626 b

1employer is located. If out-of-state treatment is being
2undertaken and the employer is also located outside the State
3of Illinois, the provider shall be reimbursed at the lesser of
4the actual charge or the fee schedule amount that would apply
5to the location of the accident. The Commission has the
6authority to set the maximum allowable payment to providers of
7out-of-state procedures, treatments, or services covered under
8this Act in a manner consistent with this Section. Not later
9than September 30 in 2006 and each year thereafter, the
10Commission shall automatically increase or decrease the
11maximum allowable payment for a procedure, treatment, or
12service established and in effect on January 1 of that year by
13the percentage change in the Consumer Price Index-U for the 12
14month period ending August 31 of that year. The increase or
15decrease shall become effective on January 1 of the following
16year. As used in this Section, "Consumer Price Index-U" means
17the index published by the Bureau of Labor Statistics of the
18U.S. Department of Labor, that measures the average change in
19prices of all goods and services purchased by all urban
20consumers, U.S. city average, all items, 1982-84=100.
21    (a-1) Except as provided for in subparagraph (c), for
22procedures, treatments, or services covered under this Act and
23rendered or to be rendered on and after January 1, 2012, The
24Commission shall adopt a medical fee schedule in accordance
25with the fee-related structure and rules of the relevant
26Medicare payment systems. Maximum reasonable fees shall be 160%

 

 

SB1349- 55 -LRB097 07516 AEK 47626 b

1of the estimated aggregate fees prescribed in the relevant
2Medicare payment system for the same class of services.
3    To ensure a reasonable standard of access to services and
4care for injured employees, the Commission may adopt different
5conversion factors, diagnostic related group weights, and
6other factors affecting payment amounts from those used in the
7Medicare payment system, provided estimated aggregate fees do
8not exceed 160% of the estimated aggregate fees paid for the
9same class of services in the relevant Medicare payment system.
10    If the Commission determines that a medical treatment,
11facility use, product, or service is not covered by a Medicare
12payment system, the Commission shall establish maximum fees for
13that item, provided that the maximum fee paid shall not exceed
14160% of the fees paid by Medicare for services that require
15comparable resources.
16    The medical fee schedule shall be adjusted to conform to
17any relevant changes in the Medicare payment systems no later
18than 60 days after the effective date of those changes.
19    Providers of out-of-state procedures, treatments,
20services, products, or supplies shall be reimbursed at the
21lesser of that State's fee schedule amount or the fee schedule
22amount that would apply to the region where the employer is
23located. If no fee schedule exists in that State, the provider
24shall be reimbursed at the lesser of the actual charge or the
25fee schedule amount that would apply to the region where the
26employer is located.

 

 

SB1349- 56 -LRB097 07516 AEK 47626 b

1    Nothing in this Section shall prohibit an employer or
2insurer from contracting with a medical provider for
3reimbursement rates different from those prescribed in the
4medical fee schedule.
5    (b) Notwithstanding the provisions of subsection (a), if
6the Commission finds that there is a significant limitation on
7access to quality health care in either a specific field of
8health care services or a specific geographic limitation on
9access to health care, it may change the Consumer Price Index-U
10increase or decrease for that specific field or specific
11geographic limitation on access to health care to address that
12limitation.
13    (c) The Commission shall establish by rule a process to
14review those medical cases or outliers that involve
15extra-ordinary treatment to determine whether to make an
16additional adjustment to the maximum payment within a fee
17schedule for a procedure, treatment, or service.
18    (c-1) For services provided on or after the effective date
19of this Amendatory Act of the 97th General Assembly until
20January 1, 2012, implants shall be reimbursed at 25% above the
21net manufacturer's invoice price less rebates, plus actual
22reasonable and customary shipping charges whether or not the
23implant charge is submitted by a provider in conjunction with a
24bill for all other services associated with the implant,
25submitted by a provider on a separate claim form, submitted by
26a distributor, or submitted by the manufacturer of the implant.

 

 

SB1349- 57 -LRB097 07516 AEK 47626 b

1"Implants" include the following codes or any substantially
2similar updated code as determined by the Commission: 0274
3(prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
4implant); 0278 (implants); 0540 and 0545 (ambulance);
50624(investigational devices); and 0636 (drugs requiring
6detailed coding). Non-implantable devices or supplies within
7these codes shall be reimbursed at 65% of actual charge, which
8is the provider's normal rates under its standard chargemaster.
9A standard chargemaster is the provider's list of charges for
10procedures, treatments, products, supplies, or services used
11to bill payers in a consistent manner.
12    (d) When a patient notifies a provider that the treatment,
13procedure, or service being sought is for a work-related
14illness or injury and furnishes the provider the name and
15address of the responsible employer, the provider shall bill
16the employer directly. The employer shall make payment and
17providers shall submit bills and records in accordance with the
18provisions of this Section. All payments to providers for
19treatment provided pursuant to this Act shall be made within 60
20days of receipt of the bills as long as the claim contains
21substantially all the required data elements necessary to
22adjudicate the bills. In the case of nonpayment to a provider
23within 60 days of receipt of the bill which contained
24substantially all of the required data elements necessary to
25adjudicate the bill or nonpayment to a provider of a portion of
26such a bill up to the lesser of the actual charge or the

 

 

SB1349- 58 -LRB097 07516 AEK 47626 b

1payment level set by the Commission in the fee schedule
2established in this Section, the bill, or portion of the bill,
3shall incur interest at a rate of 1% per month payable to the
4provider.
5    (e) Except as provided in subsections (e-5), (e-10), and
6(e-15), a provider shall not hold an employee liable for costs
7related to a non-disputed procedure, treatment, or service
8rendered in connection with a compensable injury. The
9provisions of subsections (e-5), (e-10), (e-15), and (e-20)
10shall not apply if an employee provides information to the
11provider regarding participation in a group health plan. If the
12employee participates in a group health plan, the provider may
13submit a claim for services to the group health plan. If the
14claim for service is covered by the group health plan, the
15employee's responsibility shall be limited to applicable
16deductibles, co-payments, or co-insurance. Except as provided
17under subsections (e-5), (e-10), (e-15), and (e-20), a provider
18shall not bill or otherwise attempt to recover from the
19employee the difference between the provider's charge and the
20amount paid by the employer or the insurer on a compensable
21injury.
22    (e-5) If an employer notifies a provider that the employer
23does not consider the illness or injury to be compensable under
24this Act, the provider may seek payment of the provider's
25actual charges from the employee for any procedure, treatment,
26or service rendered. Once an employee informs the provider that

 

 

SB1349- 59 -LRB097 07516 AEK 47626 b

1there is an application filed with the Commission to resolve a
2dispute over payment of such charges, the provider shall cease
3any and all efforts to collect payment for the services that
4are the subject of the dispute. Any statute of limitations or
5statute of repose applicable to the provider's efforts to
6collect payment from the employee shall be tolled from the date
7that the employee files the application with the Commission
8until the date that the provider is permitted to resume
9collection efforts under the provisions of this Section.
10    (e-10) If an employer notifies a provider that the employer
11will pay only a portion of a bill for any procedure, treatment,
12or service rendered in connection with a compensable illness or
13disease, the provider may seek payment from the employee for
14the remainder of the amount of the bill up to the lesser of the
15actual charge, negotiated rate, if applicable, or the payment
16level set by the Commission in the fee schedule established in
17this Section. Once an employee informs the provider that there
18is an application filed with the Commission to resolve a
19dispute over payment of such charges, the provider shall cease
20any and all efforts to collect payment for the services that
21are the subject of the dispute. Any statute of limitations or
22statute of repose applicable to the provider's efforts to
23collect payment from the employee shall be tolled from the date
24that the employee files the application with the Commission
25until the date that the provider is permitted to resume
26collection efforts under the provisions of this Section.

 

 

SB1349- 60 -LRB097 07516 AEK 47626 b

1    (e-15) When there is a dispute over the compensability of
2or amount of payment for a procedure, treatment, or service,
3and a case is pending or proceeding before an Arbitrator or the
4Commission, the provider may mail the employee reminders that
5the employee will be responsible for payment of any procedure,
6treatment or service rendered by the provider. The reminders
7must state that they are not bills, to the extent practicable
8include itemized information, and state that the employee need
9not pay until such time as the provider is permitted to resume
10collection efforts under this Section. The reminders shall not
11be provided to any credit rating agency. The reminders may
12request that the employee furnish the provider with information
13about the proceeding under this Act, such as the file number,
14names of parties, and status of the case. If an employee fails
15to respond to such request for information or fails to furnish
16the information requested within 90 days of the date of the
17reminder, the provider is entitled to resume any and all
18efforts to collect payment from the employee for the services
19rendered to the employee and the employee shall be responsible
20for payment of any outstanding bills for a procedure,
21treatment, or service rendered by a provider.
22    (e-20) Upon a final award or judgment by an Arbitrator or
23the Commission, or a settlement agreed to by the employer and
24the employee, a provider may resume any and all efforts to
25collect payment from the employee for the services rendered to
26the employee and the employee shall be responsible for payment

 

 

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1of any outstanding bills for a procedure, treatment, or service
2rendered by a provider as well as the interest awarded under
3subsection (d) of this Section. In the case of a procedure,
4treatment, or service deemed compensable, the provider shall
5not require a payment rate, excluding the interest provisions
6under subsection (d), greater than the lesser of the actual
7charge or the payment level set by the Commission in the fee
8schedule established in this Section. Payment for services
9deemed not covered or not compensable under this Act is the
10responsibility of the employee unless a provider and employee
11have agreed otherwise in writing. Services not covered or not
12compensable under this Act are not subject to the fee schedule
13in this Section.
14    (f) Nothing in this Act shall prohibit an employer or
15insurer from contracting with a health care provider or group
16of health care providers for reimbursement levels for benefits
17under this Act different from those provided in this Section.
18    (g) On or before January 1, 2015 2010 the Commission shall
19provide to the Governor and General Assembly a report regarding
20the implementation of the medical fee schedule indicating the
21impact on medical costs for employers and access to care for
22employees and the index used for annual adjustment to that
23schedule as described in this Section.
24(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
25    (820 ILCS 305/8.7)

 

 

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1    Sec. 8.7. Utilization review programs.
2    (a) As used in this Section:
3    "Utilization review" means the evaluation of proposed or
4provided health care services to determine the appropriateness
5of both the level of health care services medically necessary
6and the quality of health care services provided to a patient,
7including evaluation of their efficiency, efficacy, and
8appropriateness of treatment, hospitalization, or office
9visits based on medically accepted standards. The evaluation
10must be accomplished by means of a system that identifies the
11utilization of health care services based on nationally
12recognized standards of care or nationally recognized peer
13review guidelines as well as nationally recognized treatment
14guidelines and evidence-based medicine evidence based upon
15standards as provided in this Act. Utilization techniques may
16include prospective review, second opinions, concurrent
17review, discharge planning, peer review, independent medical
18examinations, and retrospective review (for purposes of this
19sentence, retrospective review shall be applicable to services
20rendered on or after July 20, 2005). Nothing in this Section
21applies to prospective review of necessary first aid or
22emergency treatment.
23    (b) No person may conduct a utilization review program for
24workers' compensation services in this State unless once every
252 years the person registers the utilization review program
26with the Department of Insurance Financial and Professional

 

 

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1Regulation and certifies compliance with the Workers'
2Compensation Utilization Management standards or Health
3Utilization Management Standards of URAC sufficient to achieve
4URAC accreditation or submits evidence of accreditation by URAC
5for its Workers' Compensation Utilization Management Standards
6or Health Utilization Management Standards. Nothing in this Act
7shall be construed to require an employer or insurer or its
8subcontractors to become URAC accredited.
9    (c) In addition, the Director Secretary of Insurance
10Financial and Professional Regulation may certify alternative
11utilization review standards of national accreditation
12organizations or entities in order for plans to comply with
13this Section. Any alternative utilization review standards
14shall meet or exceed those standards required under subsection
15(b).
16    (d) This registration shall include submission of all of
17the following information regarding utilization review program
18activities:
19        (1) The name, address, and telephone number of the
20    utilization review programs.
21        (2) The organization and governing structure of the
22    utilization review programs.
23        (3) The number of lives for which utilization review is
24    conducted by each utilization review program.
25        (4) Hours of operation of each utilization review
26    program.

 

 

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

 

 

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

 

 

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1to cooperate with the utilization review of proposed treatment
2or services, the charges for the treatment or service shall not
3be compensable or collectible against the employer, the
4employer's agent or insurer, or the employee. When an employer
5denies payment of or refuses to authorize payment of first aid,
6medical, surgical, or hospital services under Section 8(a) of
7this Act that complies with subsection (b) of this Section,
8that denial or refusal to authorize shall create a rebuttable
9presumption that the extent and scope of medical treatment is
10excessive and unnecessary. The Commission shall deny payment
11for any service which the utilization review has determined
12subject to subsection (a) of this Section to be excessive and
13unnecessary unless the presumption is rebutted by establishing
14by a preponderance of the evidence that a variance from the
15standards of care or guidelines used pursuant to subsection (a)
16of this Section is reasonably required to cure and relieve the
17employee from the effects of his or her injury or that the
18utilization review did not comply with subsection (b) of this
19Section. This subsection shall apply to medical, surgical, or
20hospital services rendered on or after the effective date of
21this Amendatory Act of the 97th General Assembly. A utilization
22review will be considered by the Commission, along with all
23other evidence and in the same manner as all other evidence, in
24the determination of the reasonableness and necessity of the
25medical bills or treatment. Nothing in this Section shall be
26construed to diminish the rights of employees to reasonable and

 

 

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1necessary medical treatment or employee choice of health care
2provider under Section 8(a) or the rights of employers to
3medical examinations under Section 12.
4    (j) When an employer denies payment of or refuses to
5authorize payment of first aid, medical, surgical, or hospital
6services under Section 8(a) of this Act, if that denial or
7refusal to authorize complies with a utilization review program
8registered under this Section and complies with all other
9requirements of this Section, then there shall be a rebuttable
10presumption that the employer shall not be responsible for
11payment of additional compensation pursuant to Section 19(k) of
12this Act and if that denial or refusal to authorize does not
13comply with a utilization review program registered under this
14Section and does not comply with all other requirements of this
15Section, then that will be considered by the Commission, along
16with all other evidence and in the same manner as all other
17evidence, in the determination of whether the employer may be
18responsible for the payment of additional compensation
19pursuant to Section 19(k) of this Act.
20(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 
21    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)
22    Sec. 11. The compensation herein provided, together with
23the provisions of this Act, shall be the measure of the
24responsibility of any employer engaged in any of the
25enterprises or businesses enumerated in Section 3 of this Act,

 

 

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1or of any employer who is not engaged in any such enterprises
2or businesses, but who has elected to provide and pay
3compensation for accidental injuries sustained by any employee
4arising out of and in the course of the employment according to
5the provisions of this Act, and whose election to continue
6under this Act, has not been nullified by any action of his
7employees as provided for in this Act.
8    Accidental injuries incurred while participating in
9voluntary recreational programs including but not limited to
10athletic events, parties and picnics do not arise out of and in
11the course of the employment even though the employer pays some
12or all of the cost thereof. This exclusion shall not apply in
13the event that the injured employee was ordered or assigned by
14his employer to participate in the program.
15    Accidental injuries incurred while participating as a
16patient in a drug or alcohol rehabilitation program do not
17arise out of and in the course of employment even though the
18employer pays some or all of the costs thereof.
19    Any injury to or disease or death of an employee arising
20from the administration of a vaccine, including without
21limitation smallpox vaccine, to prepare for, or as a response
22to, a threatened or potential bioterrorist incident to the
23employee as part of a voluntary inoculation program in
24connection with the person's employment or in connection with
25any governmental program or recommendation for the inoculation
26of workers in the employee's occupation, geographical area, or

 

 

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1other category that includes the employee is deemed to arise
2out of and in the course of the employment for all purposes
3under this Act. This paragraph added by this amendatory Act of
4the 93rd General Assembly is declarative of existing law and is
5not a new enactment.
6    There shall be a rebuttable presumption that no benefits
7under this Act shall be payable if (i) the employee's
8intoxication is the proximate cause of the employee's
9accidental injury or (ii) at the time the employee incurred
10accidental injury, the employee was so intoxicated that the
11intoxication constituted a departure from the employment.
12Admissible evidence of the concentration of (1) alcohol, (2)
13cannabis as defined in the Cannabis Control Act, (3) a
14controlled substance listed in the Illinois Controlled
15Substances Act, or (4) an intoxicating compound listed in the
16Use of Intoxicating Compounds Act in the employee's blood,
17breath, or urine at the time the employee incurred the
18accidental injury shall be considered in any hearing under this
19Act to determine whether the employee was intoxicated at the
20time the employee incurred the accidental injuries.
21Intoxication shall be defined as 0.08% or more by weight of
22alcohol in the employee's blood, breath, or urine or if there
23is any evidence of impairment due to the unlawful or
24unauthorized use of (1) cannabis as defined in the Cannabis
25Control Act, (2) a controlled substance listed in the Illinois
26Controlled Substances Act, or (3) an intoxicating compound

 

 

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1listed in the Use of Intoxicating Compounds Act. If the
2employee refuses to submit to testing of blood, breath, or
3urine as soon as practical after the accident, he or she shall
4be considered to have been intoxicated at the time of the
5accident. Percentage by weight of alcohol in the blood shall be
6based on grams of alcohol per 100 milliliters of blood.
7Percentage by weight of alcohol in the breath shall be based
8upon grams of alcohol per 210 liters of breath. Any testing
9that has not been performed by an accredited or certified
10testing laboratory shall not be admissible in any hearing under
11this Act to determine whether the employee was intoxicated at
12the time the employee incurred the accidental injury.
13    All sample collection and testing for alcohol and drugs
14under this Section shall be performed in accordance with rules
15to be adopted by the Commission. These rules shall ensure:
16        (1) compliance with the National Labor Relations Act
17    regarding collective bargaining agreements or regulations
18    promulgated by the United States Department of
19    Transportation;
20        (2) that samples are collected and tested in
21    conformance with national and State legal and regulatory
22    standards for the privacy of the individual being tested,
23    and in a manner reasonably calculated to prevent
24    substitutions or interference with the collection or
25    testing of reliable sample;
26        (3) that split testing procedures are utilized;

 

 

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1        (4) sample collection is documented, and the
2    documentation procedures include:
3            (A) the labeling of samples in a manner so as to
4        reasonably preclude the probability of erroneous
5        identification of test result; and
6            (B) an opportunity for the employee to provide
7        notification of any information which he or she
8        considers relevant to the test, including
9        identification of currently or recently used
10        prescription or nonprescription drugs and other
11        relevant medical information;
12        (5) that sample collection, storage, and
13    transportation to the place of testing is performed in a
14    manner so as to reasonably preclude the probability of
15    sample contamination or adulteration; and
16    (6) that chemical analyses of blood, urine, breath, or
17    other bodily substance are performed according to
18    nationally scientifically accepted analytical methods and
19    procedures.
20(Source: P.A. 93-829, eff. 7-28-04.)
 
21    (820 ILCS 305/16)  (from Ch. 48, par. 138.16)
22    Sec. 16. The Commission shall make and publish procedural
23rules and orders for carrying out the duties imposed upon it by
24law and for determining the extent of disability sustained,
25which rules and orders shall be deemed prima facie reasonable

 

 

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1and valid.
2    The process and procedure before the Commission shall be as
3simple and summary as reasonably may be.
4    The Commission upon application of either party may issue
5dedimus potestatem directed to a commissioner, notary public,
6justice of the peace or any other officer authorized by law to
7administer oaths, to take the depositions of such witness or
8witnesses as may be necessary in the judgment of such
9applicant. Such dedimus potestatem may issue to any of the
10officers aforesaid in any state or territory of the United
11States. When the deposition of any witness resident of a
12foreign country is desired to be taken, the dedimus shall be
13directed to and the deposition taken before a consul, vice
14consul or other authorized representative of the government of
15the United States of America, whose station is in the country
16where the witness whose deposition is to be taken resides. In
17countries where the government of the United States has no
18consul or other diplomatic representative, then depositions in
19such case shall be taken through the appropriate judicial
20authority of that country; or where treaties provide for other
21methods of taking depositions, then the same may be taken as in
22such treaties provided. The Commission shall have the power to
23adopt necessary rules to govern the issue of such dedimus
24potestatem.
25    The Commission, or any member thereof, or any Arbitrator
26designated by the Commission shall have the power to administer

 

 

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1oaths, subpoena and examine witnesses; to issue subpoenas duces
2tecum, requiring the production of such books, papers, records,
3including but not limited to employment verification documents
4pursuant to subsection 8(d)1 of this Act, and documents as may
5be evidence of any matter under inquiry and to examine and
6inspect the same and such places or premises as may relate to
7the question in dispute. The Commission, or any member thereof,
8or any Arbitrator designated by the Commission, shall on
9written request of either party to the dispute, issue subpoenas
10for the attendance of such witnesses and production of such
11books, papers, records, including but not limited to employment
12verification documents pursuant to subsection 8(d)1 of this
13Act, and documents as shall be designated in the applications,
14and the parties applying for such subpoena shall advance the
15officer and witness fees provided for in civil actions pending
16in circuit courts of this State, except as otherwise provided
17by Section 20 of this Act. Service of such subpoena shall be
18made by any sheriff or other person. In case any person refuses
19to comply with an order of the Commission or subpoenas issued
20by it or by any member thereof, or any Arbitrator designated by
21the Commission or to permit an inspection of places or
22premises, or to produce any books, papers, records or
23documents, or any witness refuses to testify to any matters
24regarding which he or she may be lawfully interrogated, the
25Circuit Court of the county in which the hearing or matter is
26pending, on application of any member of the Commission or any

 

 

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1Arbitrator designated by the Commission, shall compel
2obedience by attachment proceedings, as for contempt, as in a
3case of disobedience of the requirements of a subpoena from
4such court on a refusal to testify therein.
5    The records, reports, and bills kept by a treating
6hospital, treating physician, or other treating healthcare
7provider that renders treatment to the employee as a result of
8accidental injuries in question, certified to as true and
9correct by the hospital, physician, or other healthcare
10provider or by designated agents of the hospital, physician, or
11other healthcare provider, showing the medical and surgical
12treatment given an injured employee by such hospital,
13physician, or other healthcare provider, shall be admissible
14without any further proof as evidence of the medical and
15surgical matters stated therein, but shall not be conclusive
16proof of such matters. There shall be a rebuttable presumption
17that any such records, reports, and bills received in response
18to Commission subpoena are certified to be true and correct.
19This paragraph does not restrict, limit, or prevent the
20admissibility of records, reports, or bills that are otherwise
21admissible. This provision does not apply to reports prepared
22by treating providers for use in litigation.
23    The Commission at its expense shall provide an official
24court reporter to take the testimony and record of proceedings
25at the hearings before an Arbitrator or the Commission, who
26shall furnish a transcript of such testimony or proceedings to

 

 

SB1349- 75 -LRB097 07516 AEK 47626 b

1either party requesting it, upon payment therefor at the rate
2of $1.00 per page for the original and 35 cents per page for
3each copy of such transcript. Payment for photostatic copies of
4exhibits shall be extra. If the Commission has determined, as
5provided in Section 20 of this Act, that the employee is a poor
6person, a transcript of such testimony and proceedings,
7including photostatic copies of exhibits, shall be furnished to
8such employee at the Commission's expense.
9    The Commission shall have the power to determine the
10reasonableness and fix the amount of any fee of compensation
11charged by any person, including attorneys, physicians,
12surgeons and hospitals, for any service performed in connection
13with this Act, or for which payment is to be made under this
14Act or rendered in securing any right under this Act.
15    Whenever the Commission shall find that the employer, his
16or her agent, service company or insurance carrier has been
17guilty of delay or unfairness towards an employee in the
18adjustment, settlement or payment of benefits due such employee
19within the purview of the provisions of paragraph (c) of
20Section 4 of this Act; or has been guilty of unreasonable or
21vexatious delay, intentional under-payment of compensation
22benefits, or has engaged in frivolous defenses which do not
23present a real controversy, within the purview of the
24provisions of paragraph (k) of Section 19 of this Act, the
25Commission may assess all or any part of the attorney's fees
26and costs against such employer and his or her insurance

 

 

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1carrier.
2(Source: P.A. 94-277, eff. 7-20-05.)
 
3    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
4    Sec. 19. Any disputed questions of law or fact shall be
5determined as herein provided.
6    (a) It shall be the duty of the Commission upon
7notification that the parties have failed to reach an
8agreement, to designate an Arbitrator.
9        1. Whenever any claimant misconceives his remedy and
10    files an application for adjustment of claim under this Act
11    and it is subsequently discovered, at any time before final
12    disposition of such cause, that the claim for disability or
13    death which was the basis for such application should
14    properly have been made under the Workers' Occupational
15    Diseases Act, then the provisions of Section 19, paragraph
16    (a-1) of the Workers' Occupational Diseases Act having
17    reference to such application shall apply.
18        2. Whenever any claimant misconceives his remedy and
19    files an application for adjustment of claim under the
20    Workers' Occupational Diseases Act and it is subsequently
21    discovered, at any time before final disposition of such
22    cause that the claim for injury or death which was the
23    basis for such application should properly have been made
24    under this Act, then the application so filed under the
25    Workers' Occupational Diseases Act may be amended in form,

 

 

SB1349- 77 -LRB097 07516 AEK 47626 b

1    substance or both to assert claim for such disability or
2    death under this Act and it shall be deemed to have been so
3    filed as amended on the date of the original filing
4    thereof, and such compensation may be awarded as is
5    warranted by the whole evidence pursuant to this Act. When
6    such amendment is submitted, further or additional
7    evidence may be heard by the Arbitrator or Commission when
8    deemed necessary. Nothing in this Section contained shall
9    be construed to be or permit a waiver of any provisions of
10    this Act with reference to notice but notice if given shall
11    be deemed to be a notice under the provisions of this Act
12    if given within the time required herein.
13    (b) The Arbitrator shall make such inquiries and
14investigations as he or they shall deem necessary and may
15examine and inspect all books, papers, records, places, or
16premises relating to the questions in dispute and hear such
17proper evidence as the parties may submit.
18    The hearings before the Arbitrator shall be held in the
19vicinity where the injury occurred after 10 days' notice of the
20time and place of such hearing shall have been given to each of
21the parties or their attorneys of record.
22    The Arbitrator may find that the disabling condition is
23temporary and has not yet reached a permanent condition and may
24order the payment of compensation up to the date of the
25hearing, which award shall be reviewable and enforceable in the
26same manner as other awards, and in no instance be a bar to a

 

 

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1further hearing and determination of a further amount of
2temporary total compensation or of compensation for permanent
3disability, but shall be conclusive as to all other questions
4except the nature and extent of said disability.
5    The decision of the Arbitrator shall be filed with the
6Commission which Commission shall immediately send to each
7party or his attorney a copy of such decision, together with a
8notification of the time when it was filed. As of the effective
9date of this amendatory Act of the 94th General Assembly, all
10decisions of the Arbitrator shall set forth in writing findings
11of fact and conclusions of law, separately stated, if requested
12by either party. Unless a petition for review is filed by
13either party within 30 days after the receipt by such party of
14the copy of the decision and notification of time when filed,
15and unless such party petitioning for a review shall within 35
16days after the receipt by him of the copy of the decision, file
17with the Commission either an agreed statement of the facts
18appearing upon the hearing before the Arbitrator, or if such
19party shall so elect a correct transcript of evidence of the
20proceedings at such hearings, then the decision shall become
21the decision of the Commission and in the absence of fraud
22shall be conclusive. The Petition for Review shall contain a
23statement of the petitioning party's specific exceptions to the
24decision of the arbitrator. The jurisdiction of the Commission
25to review the decision of the arbitrator shall not be limited
26to the exceptions stated in the Petition for Review. The

 

 

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

 

 

SB1349- 80 -LRB097 07516 AEK 47626 b

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

 

 

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

 

 

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

 

 

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

 

 

SB1349- 84 -LRB097 07516 AEK 47626 b

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

 

 

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1names and addresses of any medical practitioners selected by
2the employer pursuant to Section 12 of this Act and the time
3and place of any examination scheduled to be made pursuant to
4such Section.
5    Any employer who does not timely file and serve a written
6response without good cause may not introduce any evidence to
7dispute any claim of the employee but may cross examine the
8employee or any witness brought by the employee and otherwise
9be heard.
10    No document or other evidence not previously identified by
11either party with the petition or written response, or by any
12other means before the hearing, may be introduced into evidence
13without good cause. If, at the hearing, material information is
14discovered which was not previously disclosed, the Arbitrator
15may extend the time for closing proof on the motion of a party
16for a reasonable period of time which may be more than 30 days.
17No evidence may be introduced pursuant to this paragraph as to
18permanent disability. No award may be entered for permanent
19disability pursuant to this paragraph. Either party may
20introduce into evidence the testimony taken by deposition of
21any medical practitioner.
22    The Commission shall adopt rules, regulations and
23procedures whereby the final decision of the Commission is
24filed not later than 90 days from the date the petition for
25review is filed but in no event later than 180 days from the
26date the petition for an emergency hearing is filed with the

 

 

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1Illinois Workers' Compensation Commission.
2    All service required pursuant to this paragraph (b-1) must
3be by personal service or by certified mail and with evidence
4of receipt. In addition for the purposes of this paragraph, all
5service on the employer must be at the premises where the
6accident occurred if the premises are owned or operated by the
7employer. Otherwise service must be at the employee's principal
8place of employment by the employer. If service on the employer
9is not possible at either of the above, then service shall be
10at the employer's principal place of business. After initial
11service in each case, service shall be made on the employer's
12attorney or designated representative.
13    (c) (1) At a reasonable time in advance of and in
14connection with the hearing under Section 19(e) or 19(h), the
15Commission may on its own motion order an impartial physical or
16mental examination of a petitioner whose mental or physical
17condition is in issue, when in the Commission's discretion it
18appears that such an examination will materially aid in the
19just determination of the case. The examination shall be made
20by a member or members of a panel of physicians chosen for
21their special qualifications by the Illinois State Medical
22Society. The Commission shall establish procedures by which a
23physician shall be selected from such list.
24    (2) Should the Commission at any time during the hearing
25find that compelling considerations make it advisable to have
26an examination and report at that time, the commission may in

 

 

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

 

 

SB1349- 88 -LRB097 07516 AEK 47626 b

1relying in good faith, on treatment by prayer or spiritual
2means alone, in accordance with the tenets and practice of a
3recognized church or religious denomination, by a duly
4accredited practitioner thereof.
5    (e) This paragraph shall apply to all hearings before the
6Commission. Such hearings may be held in its office or
7elsewhere as the Commission may deem advisable. The taking of
8testimony on such hearings may be had before any member of the
9Commission. If a petition for review and agreed statement of
10facts or transcript of evidence is filed, as provided herein,
11the Commission shall promptly review the decision of the
12Arbitrator and all questions of law or fact which appear from
13the statement of facts or transcript of evidence.
14    In all cases in which the hearing before the arbitrator is
15held after December 18, 1989, no additional evidence shall be
16introduced by the parties before the Commission on review of
17the decision of the Arbitrator. In reviewing decisions of an
18arbitrator the Commission shall award such temporary
19compensation, permanent compensation and other payments as are
20due under this Act. The Commission shall file in its office its
21decision thereon, and shall immediately send to each party or
22his attorney a copy of such decision and a notification of the
23time when it was filed. Decisions shall be filed within 60 days
24after the Statement of Exceptions and Supporting Brief and
25Response thereto are required to be filed or oral argument
26whichever is later.

 

 

SB1349- 89 -LRB097 07516 AEK 47626 b

1    In the event either party requests oral argument, such
2argument shall be had before a panel of 3 members of the
3Commission (or before all available members pursuant to the
4determination of 7 members of the Commission that such argument
5be held before all available members of the Commission)
6pursuant to the rules and regulations of the Commission. A
7panel of 3 members, which shall be comprised of not more than
8one representative citizen of the employing class and not more
9than one representative citizen of the employee class, shall
10hear the argument; provided that if all the issues in dispute
11are solely the nature and extent of the permanent partial
12disability, if any, a majority of the panel may deny the
13request for such argument and such argument shall not be held;
14and provided further that 7 members of the Commission may
15determine that the argument be held before all available
16members of the Commission. A decision of the Commission shall
17be approved by a majority of Commissioners present at such
18hearing if any; provided, if no such hearing is held, a
19decision of the Commission shall be approved by a majority of a
20panel of 3 members of the Commission as described in this
21Section. The Commission shall give 10 days' notice to the
22parties or their attorneys of the time and place of such taking
23of testimony and of such argument.
24    In any case the Commission in its decision may find
25specially upon any question or questions of law or fact which
26shall be submitted in writing by either party whether ultimate

 

 

SB1349- 90 -LRB097 07516 AEK 47626 b

1or otherwise; provided that on issues other than nature and
2extent of the disability, if any, the Commission in its
3decision shall find specially upon any question or questions of
4law or fact, whether ultimate or otherwise, which are submitted
5in writing by either party; provided further that not more than
65 such questions may be submitted by either party. Any party
7may, within 20 days after receipt of notice of the Commission's
8decision, or within such further time, not exceeding 30 days,
9as the Commission may grant, file with the Commission either an
10agreed statement of the facts appearing upon the hearing, or,
11if such party shall so elect, a correct transcript of evidence
12of the additional proceedings presented before the Commission,
13in which report the party may embody a correct statement of
14such other proceedings in the case as such party may desire to
15have reviewed, such statement of facts or transcript of
16evidence to be authenticated by the signature of the parties or
17their attorneys, and in the event that they do not agree, then
18the authentication of such transcript of evidence shall be by
19the signature of any member of the Commission.
20    If a reporter does not for any reason furnish a transcript
21of the proceedings before the Arbitrator in any case for use on
22a hearing for review before the Commission, within the
23limitations of time as fixed in this Section, the Commission
24may, in its discretion, order a trial de novo before the
25Commission in such case upon application of either party. The
26applications for adjustment of claim and other documents in the

 

 

SB1349- 91 -LRB097 07516 AEK 47626 b

1nature of pleadings filed by either party, together with the
2decisions of the Arbitrator and of the Commission and the
3statement of facts or transcript of evidence hereinbefore
4provided for in paragraphs (b) and (c) shall be the record of
5the proceedings of the Commission, and shall be subject to
6review as hereinafter provided.
7    At the request of either party or on its own motion, the
8Commission shall set forth in writing the reasons for the
9decision, including findings of fact and conclusions of law
10separately stated. The Commission shall by rule adopt a format
11for written decisions for the Commission and arbitrators. The
12written decisions shall be concise and shall succinctly state
13the facts and reasons for the decision. The Commission may
14adopt in whole or in part, the decision of the arbitrator as
15the decision of the Commission. When the Commission does so
16adopt the decision of the arbitrator, it shall do so by order.
17Whenever the Commission adopts part of the arbitrator's
18decision, but not all, it shall include in the order the
19reasons for not adopting all of the arbitrator's decision. When
20a majority of a panel, after deliberation, has arrived at its
21decision, the decision shall be filed as provided in this
22Section without unnecessary delay, and without regard to the
23fact that a member of the panel has expressed an intention to
24dissent. Any member of the panel may file a dissent. Any
25dissent shall be filed no later than 10 days after the decision
26of the majority has been filed.

 

 

SB1349- 92 -LRB097 07516 AEK 47626 b

1    Decisions rendered by the Commission and dissents, if any,
2shall be published together by the Commission. The conclusions
3of law set out in such decisions shall be regarded as
4precedents by arbitrators for the purpose of achieving a more
5uniform administration of this Act.
6    (f) The decision of the Commission acting within its
7powers, according to the provisions of paragraph (e) of this
8Section shall, in the absence of fraud, be conclusive unless
9reviewed as in this paragraph hereinafter provided. However,
10the Arbitrator or the Commission may on his or its own motion,
11or on the motion of either party, correct any clerical error or
12errors in computation within 15 days after the date of receipt
13of any award by such Arbitrator or any decision on review of
14the Commission and shall have the power to recall the original
15award on arbitration or decision on review, and issue in lieu
16thereof such corrected award or decision. Where such correction
17is made the time for review herein specified shall begin to run
18from the date of the receipt of the corrected award or
19decision.
20        (1) Except in cases of claims against the State of
21    Illinois, in which case the decision of the Commission
22    shall not be subject to judicial review, the Circuit Court
23    of the county where any of the parties defendant may be
24    found, or if none of the parties defendant can be found in
25    this State then the Circuit Court of the county where the
26    accident occurred, shall by summons to the Commission have

 

 

SB1349- 93 -LRB097 07516 AEK 47626 b

1    power to review all questions of law and fact presented by
2    such record.
3        A proceeding for review shall be commenced within 20
4    days of the receipt of notice of the decision of the
5    Commission. The summons shall be issued by the clerk of
6    such court upon written request returnable on a designated
7    return day, not less than 10 or more than 60 days from the
8    date of issuance thereof, and the written request shall
9    contain the last known address of other parties in interest
10    and their attorneys of record who are to be served by
11    summons. Service upon any member of the Commission or the
12    Secretary or the Assistant Secretary thereof shall be
13    service upon the Commission, and service upon other parties
14    in interest and their attorneys of record shall be by
15    summons, and such service shall be made upon the Commission
16    and other parties in interest by mailing notices of the
17    commencement of the proceedings and the return day of the
18    summons to the office of the Commission and to the last
19    known place of residence of other parties in interest or
20    their attorney or attorneys of record. The clerk of the
21    court issuing the summons shall on the day of issue mail
22    notice of the commencement of the proceedings which shall
23    be done by mailing a copy of the summons to the office of
24    the Commission, and a copy of the summons to the other
25    parties in interest or their attorney or attorneys of
26    record and the clerk of the court shall make certificate

 

 

SB1349- 94 -LRB097 07516 AEK 47626 b

1    that he has so sent said notices in pursuance of this
2    Section, which shall be evidence of service on the
3    Commission and other parties in interest.
4        The Commission shall not be required to certify the
5    record of their proceedings to the Circuit Court, unless
6    the party commencing the proceedings for review in the
7    Circuit Court as above provided, shall pay to the
8    Commission the sum of 80¢ per page of testimony taken
9    before the Commission, and 35¢ per page of all other
10    matters contained in such record, except as otherwise
11    provided by Section 20 of this Act. Payment for photostatic
12    copies of exhibit shall be extra. It shall be the duty of
13    the Commission upon such payment, or failure to pay as
14    permitted under Section 20 of this Act, to prepare a true
15    and correct typewritten copy of such testimony and a true
16    and correct copy of all other matters contained in such
17    record and certified to by the Secretary or Assistant
18    Secretary thereof.
19        In its decision on review the Commission shall
20    determine in each particular case the amount of the
21    probable cost of the record to be filed as a part of the
22    summons in that case and no request for a summons may be
23    filed and no summons shall issue unless the party seeking
24    to review the decision of the Commission shall exhibit to
25    the clerk of the Circuit Court proof of payment by filing a
26    receipt showing payment or an affidavit of the attorney

 

 

SB1349- 95 -LRB097 07516 AEK 47626 b

1    setting forth that payment has been made of the sums so
2    determined to the Secretary or Assistant Secretary of the
3    Commission, except as otherwise provided by Section 20 of
4    this Act.
5        (2) No such summons shall issue unless the one against
6    whom the Commission shall have rendered an award for the
7    payment of money shall upon the filing of his written
8    request for such summons file with the clerk of the court a
9    bond conditioned that if he shall not successfully
10    prosecute the review, he will pay the award and the costs
11    of the proceedings in the courts. The amount of the bond
12    shall be fixed by any member of the Commission and the
13    surety or sureties of the bond shall be approved by the
14    clerk of the court. The acceptance of the bond by the clerk
15    of the court shall constitute evidence of his approval of
16    the bond.
17        Every county, city, town, township, incorporated
18    village, school district, body politic or municipal
19    corporation against whom the Commission shall have
20    rendered an award for the payment of money shall not be
21    required to file a bond to secure the payment of the award
22    and the costs of the proceedings in the court to authorize
23    the court to issue such summons.
24        The court may confirm or set aside the decision of the
25    Commission. If the decision is set aside and the facts
26    found in the proceedings before the Commission are

 

 

SB1349- 96 -LRB097 07516 AEK 47626 b

1    sufficient, the court may enter such decision as is
2    justified by law, or may remand the cause to the Commission
3    for further proceedings and may state the questions
4    requiring further hearing, and give such other
5    instructions as may be proper. Appeals shall be taken to
6    the Appellate Court in accordance with Supreme Court Rules
7    22(g) and 303. Appeals shall be taken from the Appellate
8    Court to the Supreme Court in accordance with Supreme Court
9    Rule 315.
10        It shall be the duty of the clerk of any court
11    rendering a decision affecting or affirming an award of the
12    Commission to promptly furnish the Commission with a copy
13    of such decision, without charge.
14        The decision of a majority of the members of the panel
15    of the Commission, shall be considered the decision of the
16    Commission.
17    (g) Except in the case of a claim against the State of
18Illinois, either party may present a certified copy of the
19award of the Arbitrator, or a certified copy of the decision of
20the Commission when the same has become final, when no
21proceedings for review are pending, providing for the payment
22of compensation according to this Act, to the Circuit Court of
23the county in which such accident occurred or either of the
24parties are residents, whereupon the court shall enter a
25judgment in accordance therewith. In a case where the employer
26refuses to pay compensation according to such final award or

 

 

SB1349- 97 -LRB097 07516 AEK 47626 b

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

 

 

SB1349- 98 -LRB097 07516 AEK 47626 b

1    However, as to accidents occurring subsequent to July 1,
21955, which are covered by any agreement or award under this
3Act providing for compensation in installments made as a result
4of such accident, such agreement or award may at any time
5within 30 months, or 60 months in the case of an award under
6Section 8(d)1, after such agreement or award be reviewed by the
7Commission at the request of either the employer or the
8employee on the ground that the disability of the employee has
9subsequently recurred, increased, diminished or ended. The
10employer at any time may seek review by the Commission of any
11final award under Section 8(d)1 of this Act where there is a
12material increase in earnings by the employee.
13    On such review, compensation payments may be
14re-established, increased, diminished or ended. The Commission
15shall give 15 days' notice to the parties of the hearing for
16review. Any employee, upon any petition for such review being
17filed by the employer, shall be entitled to one day's notice
18for each 100 miles necessary to be traveled by him in attending
19the hearing of the Commission upon the petition, and 3 days in
20addition thereto. Such employee shall, at the discretion of the
21Commission, also be entitled to 5 cents per mile necessarily
22traveled by him within the State of Illinois in attending such
23hearing, not to exceed a distance of 300 miles, to be taxed by
24the Commission as costs and deposited with the petition of the
25employer.
26    When compensation which is payable in accordance with an

 

 

SB1349- 99 -LRB097 07516 AEK 47626 b

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

 

 

SB1349- 100 -LRB097 07516 AEK 47626 b

1compensation, or proceedings have been instituted or carried on
2by the one liable to pay the compensation, which do not present
3a real controversy, but are merely frivolous or for delay, then
4the Commission may award compensation additional to that
5otherwise payable under this Act equal to 50% of the amount
6payable at the time of such award. Failure to pay compensation
7in accordance with the provisions of Section 8, paragraph (b)
8of this Act, shall be considered unreasonable delay.
9    When determining whether this subsection (k) shall apply,
10the Commission shall consider whether an Arbitrator has
11determined that the claim is not compensable or whether the
12employer has made payments under Section 8(j).
13    (l) If the employee has made written demand for payment of
14benefits under Section 8(a) or Section 8(b), the employer shall
15have 14 days after receipt of the demand to set forth in
16writing the reason for the delay. In the case of demand for
17payment of medical benefits under Section 8(a), the time for
18the employer to respond shall not commence until the expiration
19of the allotted 60 days specified under Section 8.2(d). In case
20the employer or his or her insurance carrier shall without good
21and just cause fail, neglect, refuse, or unreasonably delay the
22payment of benefits under Section 8(a) or Section 8(b), the
23Arbitrator or the Commission shall allow to the employee
24additional compensation in the sum of $30 per day for each day
25that the benefits under Section 8(a) or Section 8(b) have been
26so withheld or refused, not to exceed $10,000. A delay in

 

 

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1payment of 14 days or more shall create a rebuttable
2presumption of unreasonable delay.
3    (m) If the commission finds that an accidental injury was
4directly and proximately caused by the employer's wilful
5violation of a health and safety standard under the Health and
6Safety Act in force at the time of the accident, the arbitrator
7or the Commission shall allow to the injured employee or his
8dependents, as the case may be, additional compensation equal
9to 25% of the amount which otherwise would be payable under the
10provisions of this Act exclusive of this paragraph. The
11additional compensation herein provided shall be allowed by an
12appropriate increase in the applicable weekly compensation
13rate.
14    (n) After June 30, 1984, decisions of the Illinois Workers'
15Compensation Commission reviewing an award of an arbitrator of
16the Commission shall draw interest at a rate equal to the yield
17on indebtedness issued by the United States Government with a
1826-week maturity next previously auctioned on the day on which
19the decision is filed. Said rate of interest shall be set forth
20in the Arbitrator's Decision. Interest shall be drawn from the
21date of the arbitrator's award on all accrued compensation due
22the employee through the day prior to the date of payments.
23However, when an employee appeals an award of an Arbitrator or
24the Commission, and the appeal results in no change or a
25decrease in the award, interest shall not further accrue from
26the date of such appeal.

 

 

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1    The employer or his insurance carrier may tender the
2payments due under the award to stop the further accrual of
3interest on such award notwithstanding the prosecution by
4either party of review, certiorari, appeal to the Supreme Court
5or other steps to reverse, vacate or modify the award.
6    (o) By the 15th day of each month each insurer providing
7coverage for losses under this Act shall notify each insured
8employer of any compensable claim incurred during the preceding
9month and the amounts paid or reserved on the claim including a
10summary of the claim and a brief statement of the reasons for
11compensability. A cumulative report of all claims incurred
12during a calendar year or continued from the previous year
13shall be furnished to the insured employer by the insurer
14within 30 days after the end of that calendar year.
15    The insured employer may challenge, in proceeding before
16the Commission, payments made by the insurer without
17arbitration and payments made after a case is determined to be
18noncompensable. If the Commission finds that the case was not
19compensable, the insurer shall purge its records as to that
20employer of any loss or expense associated with the claim,
21reimburse the employer for attorneys' fees arising from the
22challenge and for any payment required of the employer to the
23Rate Adjustment Fund or the Second Injury Fund, and may not
24reflect the loss or expense for rate making purposes. The
25employee shall not be required to refund the challenged
26payment. The decision of the Commission may be reviewed in the

 

 

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1same manner as in arbitrated cases. No challenge may be
2initiated under this paragraph more than 3 years after the
3payment is made. An employer may waive the right of challenge
4under this paragraph on a case by case basis.
5    (p) After filing an application for adjustment of claim but
6prior to the hearing on arbitration the parties may voluntarily
7agree to submit such application for adjustment of claim for
8decision by an arbitrator under this subsection (p) where such
9application for adjustment of claim raises only a dispute over
10temporary total disability, permanent partial disability or
11medical expenses. Such agreement shall be in writing in such
12form as provided by the Commission. Applications for adjustment
13of claim submitted for decision by an arbitrator under this
14subsection (p) shall proceed according to rule as established
15by the Commission. The Commission shall promulgate rules
16including, but not limited to, rules to ensure that the parties
17are adequately informed of their rights under this subsection
18(p) and of the voluntary nature of proceedings under this
19subsection (p). The findings of fact made by an arbitrator
20acting within his or her powers under this subsection (p) in
21the absence of fraud shall be conclusive. However, the
22arbitrator may on his own motion, or the motion of either
23party, correct any clerical errors or errors in computation
24within 15 days after the date of receipt of such award of the
25arbitrator and shall have the power to recall the original
26award on arbitration, and issue in lieu thereof such corrected

 

 

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1award. The decision of the arbitrator under this subsection (p)
2shall be considered the decision of the Commission and
3proceedings for review of questions of law arising from the
4decision may be commenced by either party pursuant to
5subsection (f) of Section 19. The Advisory Board established
6under Section 13.1 shall compile a list of certified Commission
7arbitrators, each of whom shall be approved by at least 7
8members of the Advisory Board. The chairman shall select 5
9persons from such list to serve as arbitrators under this
10subsection (p). By agreement, the parties shall select one
11arbitrator from among the 5 persons selected by the chairman
12except that if the parties do not agree on an arbitrator from
13among the 5 persons, the parties may, by agreement, select an
14arbitrator of the American Arbitration Association, whose fee
15shall be paid by the State in accordance with rules promulgated
16by the Commission. Arbitration under this subsection (p) shall
17be voluntary.
18(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    820 ILCS 305/1from Ch. 48, par. 138.1
4    820 ILCS 305/6from Ch. 48, par. 138.6
5    820 ILCS 305/8from Ch. 48, par. 138.8
6    820 ILCS 305/8.2
7    820 ILCS 305/8.7
8    820 ILCS 305/11from Ch. 48, par. 138.11
9    820 ILCS 305/16from Ch. 48, par. 138.16
10    820 ILCS 305/19from Ch. 48, par. 138.19