Sen. Kyle McCarter

Filed: 4/11/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1349

2    AMENDMENT NO. ______. Amend Senate Bill 1349 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 8, 8.1, 8.2, 8.3, 8.7, 11, 16, 19, and
625.5 and by adding Sections 1.1, 4b, 16b, and 16c.
 
7    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
8    Sec. 1. This Act may be cited as the Workers' Compensation
9Act.
10    (a) The term "employer" as used in this Act means:
11    1. The State and each county, city, town, township,
12incorporated village, school district, body politic, or
13municipal corporation therein.
14    2. Every person, firm, public or private corporation,
15including hospitals, public service, eleemosynary, religious
16or charitable corporations or associations who has any person

 

 

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1in service or under any contract for hire, express or implied,
2oral or written, and who is engaged in any of the enterprises
3or businesses enumerated in Section 3 of this Act, or who at or
4prior to the time of the accident to the employee for which
5compensation under this Act may be claimed, has in the manner
6provided in this Act elected to become subject to the
7provisions of this Act, and who has not, prior to such
8accident, effected a withdrawal of such election in the manner
9provided in this Act.
10    3. Any one engaging in any business or enterprise referred
11to in subsections 1 and 2 of Section 3 of this Act who
12undertakes to do any work enumerated therein, is liable to pay
13compensation to his own immediate employees in accordance with
14the provisions of this Act, and in addition thereto if he
15directly or indirectly engages any contractor whether
16principal or sub-contractor to do any such work, he is liable
17to pay compensation to the employees of any such contractor or
18sub-contractor unless such contractor or sub-contractor has
19insured, in any company or association authorized under the
20laws of this State to insure the liability to pay compensation
21under this Act, or guaranteed his liability to pay such
22compensation. With respect to any time limitation on the filing
23of claims provided by this Act, the timely filing of a claim
24against a contractor or subcontractor, as the case may be,
25shall be deemed to be a timely filing with respect to all
26persons upon whom liability is imposed by this paragraph.

 

 

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1    In the event any such person pays compensation under this
2subsection he may recover the amount thereof from the
3contractor or sub-contractor, if any, and in the event the
4contractor pays compensation under this subsection he may
5recover the amount thereof from the sub-contractor, if any.
6    This subsection does not apply in any case where the
7accident occurs elsewhere than on, in or about the immediate
8premises on which the principal has contracted that the work be
9done.
10    4. Where an employer operating under and subject to the
11provisions of this Act loans an employee to another such
12employer and such loaned employee sustains a compensable
13accidental injury in the employment of such borrowing employer
14and where such borrowing employer does not provide or pay the
15benefits or payments due such injured employee, such loaning
16employer is liable to provide or pay all benefits or payments
17due such employee under this Act and as to such employee the
18liability of such loaning and borrowing employers is joint and
19several, provided that such loaning employer is in the absence
20of agreement to the contrary entitled to receive from such
21borrowing employer full reimbursement for all sums paid or
22incurred pursuant to this paragraph together with reasonable
23attorneys' fees and expenses in any hearings before the
24Illinois Workers' Compensation Commission or in any action to
25secure such reimbursement. Where any benefit is provided or
26paid by such loaning employer the employee has the duty of

 

 

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1rendering reasonable cooperation in any hearings, trials or
2proceedings in the case, including such proceedings for
3reimbursement.
4    Where an employee files an Application for Adjustment of
5Claim with the Illinois Workers' Compensation Commission
6alleging that his claim is covered by the provisions of the
7preceding paragraph, and joining both the alleged loaning and
8borrowing employers, they and each of them, upon written demand
9by the employee and within 7 days after receipt of such demand,
10shall have the duty of filing with the Illinois Workers'
11Compensation Commission a written admission or denial of the
12allegation that the claim is covered by the provisions of the
13preceding paragraph and in default of such filing or if any
14such denial be ultimately determined not to have been bona fide
15then the provisions of Paragraph K of Section 19 of this Act
16shall apply.
17    An employer whose business or enterprise or a substantial
18part thereof consists of hiring, procuring or furnishing
19employees to or for other employers operating under and subject
20to the provisions of this Act for the performance of the work
21of such other employers and who pays such employees their
22salary or wages notwithstanding that they are doing the work of
23such other employers shall be deemed a loaning employer within
24the meaning and provisions of this Section.
25    (b) The term "employee" as used in this Act means:
26    1. Every person in the service of the State, including

 

 

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1members of the General Assembly, members of the Commerce
2Commission, members of the Illinois Workers' Compensation
3Commission, and all persons in the service of the University of
4Illinois, county, including deputy sheriffs and assistant
5state's attorneys, city, town, township, incorporated village
6or school district, body politic, or municipal corporation
7therein, whether by election, under appointment or contract of
8hire, express or implied, oral or written, including all
9members of the Illinois National Guard while on active duty in
10the service of the State, and all probation personnel of the
11Juvenile Court appointed pursuant to Article VI of the Juvenile
12Court Act of 1987, and including any official of the State, any
13county, city, town, township, incorporated village, school
14district, body politic or municipal corporation therein except
15any duly appointed member of a police department in any city
16whose population exceeds 200,000 according to the last Federal
17or State census, and except any member of a fire insurance
18patrol maintained by a board of underwriters in this State. A
19duly appointed member of a fire department in any city, the
20population of which exceeds 200,000 according to the last
21federal or State census, is an employee under this Act only
22with respect to claims brought under paragraph (c) of Section
238.
24    One employed by a contractor who has contracted with the
25State, or a county, city, town, township, incorporated village,
26school district, body politic or municipal corporation

 

 

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1therein, through its representatives, is not considered as an
2employee of the State, county, city, town, township,
3incorporated village, school district, body politic or
4municipal corporation which made the contract.
5    2. Every person in the service of another under any
6contract of hire, express or implied, oral or written,
7including persons whose employment is outside of the State of
8Illinois where the contract of hire is made within the State of
9Illinois, persons whose employment results in fatal or
10non-fatal injuries within the State of Illinois where the
11contract of hire is made outside of the State of Illinois, and
12persons whose employment is principally localized within the
13State of Illinois, regardless of the place of the accident or
14the place where the contract of hire was made, and including
15aliens, and minors who, for the purpose of this Act are
16considered the same and have the same power to contract,
17receive payments and give quittances therefor, as adult
18employees.
19    3. Every sole proprietor and every partner of a business
20may elect to be covered by this Act.
21    An employee or his dependents under this Act who shall have
22a cause of action by reason of any injury, disablement or death
23arising out of and in the course of his employment may elect to
24pursue his remedy in the State where injured or disabled, or in
25the State where the contract of hire is made, or in the State
26where the employment is principally localized.

 

 

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1    However, any employer may elect to provide and pay
2compensation to any employee other than those engaged in the
3usual course of the trade, business, profession or occupation
4of the employer by complying with Sections 2 and 4 of this Act.
5Employees are not included within the provisions of this Act
6when excluded by the laws of the United States relating to
7liability of employers to their employees for personal injuries
8where such laws are held to be exclusive.
9    The term "employee" does not include persons performing
10services as real estate broker, broker-salesman, or salesman
11when such persons are paid by commission only.
12    (c) "Commission" means the Industrial Commission created
13by Section 5 of "The Civil Administrative Code of Illinois",
14approved March 7, 1917, as amended, or the Illinois Workers'
15Compensation Commission created by Section 13 of this Act.
16    (d) The term "accident" as used in this Act means an
17occurrence arising out of the employment resulting from a risk
18incidental to the employment and in the course of the
19employment at a time and place and under circumstances
20reasonably required by the employment.
21    (e) The term "injury" as used in this Act means a condition
22or impairment that arises out of and in the course of
23employment. An injury, its occupational cause, and any
24resulting manifestations or disability must be established to a
25reasonable degree of medical certainty, based on objective
26relevant medical findings, and the accidental compensable

 

 

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1injury must be the major contributing cause of any resulting
2injuries. For the purposes of this Section, "major contributing
3cause" means the cause which is more than 50% responsible for
4the injury as compared to all other causes combined for which
5treatment or benefits are sought. "Injury" includes the
6aggravation of a pre-existing condition by an accident arising
7out of and in the course of the employment, but only for so
8long as the aggravation of the pre-existing condition continues
9to be the major contributing cause of the disability.
10        (1) An injury is deemed to arise out of and in the
11    course of the employment only if:
12            (A) it is reasonably apparent, upon consideration
13        of all circumstances, that the accident is the major
14        contributing cause of the injury; and
15            (B) it does not come from a hazard or risk
16        unrelated to the employment to which employees would
17        have been equally exposed outside of the employment.
18        (2) An injury resulting directly or indirectly from
19    idiopathic causes is not compensable.
20(Source: P.A. 93-721, eff. 1-1-05.)
 
21    (820 ILCS 305/1.1 new)
22    Sec. 1.1. Standards of Conduct.
23    (a) Commissioners and arbitrators shall dispose of all
24Workers' Compensation matters promptly, officially, and
25fairly, without bias or prejudice. Commissioners and

 

 

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1arbitrators shall be faithful to the law and maintain
2professional competence in it. Commissioners and arbitrators
3shall in a timely manner take appropriate action or initiate
4appropriate disciplinary measures against a Commissioner,
5arbitrator, lawyer, or others for unprofessional conduct which
6the Commissioner or arbitrator may become aware of.
7    (b) Except as otherwise provided in this Act, the Canons of
8the Code of Judicial Conduct as adopted by the Supreme Court of
9Illinois govern the hearing and non-hearing conduct of members
10of the Commission and arbitrators under this Act. The
11Commission may set additional rules and standards, not less
12stringent than those rules and standards established by the
13Code of Judicial Conduct, for the conduct of arbitrators.
14    (c) The following provisions of the Code of Judicial
15Conduct do not apply under this Section:
16        (1) Canon 3(B), relating to administrative
17    responsibilities.
18        (2) Canon 6(C), relating to annual filings of economic
19    interests. Instead of filing declarations of economic
20    interests with the Clerk of the Illinois Supreme Court
21    under Illinois Supreme Court Rule 68, members of the
22    Commission and arbitrators shall make filings
23    substantially similar to those required by Rule 68 with the
24    Chairman, and such filings shall be made available for
25    examination by the public.
26    (d) An arbitrator or a Commissioner may accept an

 

 

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1uncompensated appointment to a governmental committee,
2commission, or other position that is concerned with issues of
3policy on matters which may come before the arbitrator or
4Commissioner if such appointment neither affects his or her
5independent professional judgment nor the conduct of his or her
6duties.
7    (e) Decisions of an arbitrator or a Commissioner shall be
8based exclusively on evidence in the record of the proceeding
9and material that has been officially noticed.
 
10    (820 ILCS 305/4b new)
11    Sec. 4b. Collective Bargaining Agreements.
12    (a) Definitions.
13        For purposes of this Section, the term "construction
14    employer" means any person or legal entity or group of
15    persons or legal entities engaging in or planning to engage
16    in any constructing, altering, reconstructing, repairing,
17    rehabilitating, refinishing, refurbishing, remodeling,
18    remediating, renovating, custom fabricating, maintaining,
19    landscaping, improving, wrecking, painting, decorating,
20    demolishing, and adding to or subtracting from any
21    building, structure, airport facility, highway, roadway,
22    street, alley, bridge, sewer, drain, ditch, sewage
23    disposal plant, water works, parking facility, railroad,
24    excavation or other project, development, real property,
25    or improvement, or to do any part thereof, whether or not

 

 

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1    the performance of the work herein described involves the
2    addition to, or fabrication into, any structure, project,
3    development, real property, or improvement herein
4    described of any material or article of merchandise and
5    shall also include moving construction related materials
6    on the job site or to or from the job site.
7    (b) Provisions.
8        Upon appropriate filing, the Commission and the courts
9    of this State shall recognize as valid and binding any
10    provision in a collective bargaining agreement between any
11    construction employer or group of employers and a labor
12    organization which is recognized or certified and the
13    exclusive representative of the employer's employees under
14    the National Labor Relations Act, 29 U.S.C. § 151, et al.,
15    which contains certain obligations and procedures relating
16    to workers' compensation. This agreement must be limited
17    to, but need not include, all of the following:
18            (1) an alternative dispute resolution ("ADR")
19        system to supplement, modify, or replace the
20        procedural or dispute resolution provisions of this
21        Act. The system may include mediation, arbitration, or
22        other dispute resolution proceedings, the results of
23        which shall be final and binding upon the parties;
24            (2) an agreed list of medical treatment providers
25        that may be the exclusive source of all medical and
26        related treatment provided under this Act;

 

 

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1            (3) the use of a limited list of impartial
2        physicians to conduct independent medical
3        examinations;
4            (4) the creation of a light duty, modified job, or
5        return to work program;
6            (5) the use of a limited list of individuals and
7        companies for the establishment of vocational
8        rehabilitation or retraining programs that may be the
9        exclusive source of rehabilitation and retraining
10        services provided under this Act; or
11            (6) the establishment of joint labor management
12        safety committees and safety procedures.
13    (c) Void Agreements.
14        Nothing in this Section shall be construed to authorize
15    any agreement in a collective bargaining agreement that
16    diminishes or increases a construction employer's
17    entitlements under this Act or an employee's entitlement to
18    benefits as otherwise set forth in this Act. For the
19    purposes of this Section, the procedural rights and dispute
20    resolution agreements under subparagraphs (1) thru (6) of
21    subsection (b) of this Section are not agreements which
22    diminish or increase a construction employer's
23    entitlements under this Act or an employee's entitlement to
24    benefits under this Act. Any agreement that diminishes or
25    increases the construction employer's entitlements under
26    this Act or an employee's entitlement to benefits as set

 

 

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1    forth in this Act are null and void. Nothing in this
2    Section shall be construed as creating a mandatory subject
3    of bargaining.
4    (d) Form of Agreement.
5        The agreement reached herein shall demonstrate that:
6            (1) the construction employer or group of
7        employers and the recognized or certified exclusive
8        bargaining representative have entered into a binding
9        collective bargaining agreement adopting the ADR plan
10        for a period of no less than 2 years;
11            (2) contractual agreements have been reached with
12        the construction employer's workers' compensation
13        carrier, group self-insurance fund, and any excess
14        carriers relating to the ADR plan;
15            (3) procedures have been established by which
16        claims for benefits by employees will be lodged,
17        administered and decided while affording procedural
18        due process;
19            (4) the plan has designated forms upon which claims
20        for benefits shall be made;
21            (5) the system and means by which the construction
22        employer's obligation to furnish medical services and
23        vocational rehabilitation and retraining benefits
24        shall be fulfilled and provider selected;
25            (6) the method by which mediators or arbitrators
26        are to be selected.

 

 

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1    (e) Filing.
2        A copy of the agreement and a statement identifying the
3    parties to the agreement shall be filed with the
4    Commission. Within 21 days of receipt of an agreement, the
5    Chairman shall review the agreement for compliance with
6    this Section and notify the parties of its acceptance, or
7    notify the parties of any additional information required,
8    or any recommended modification that would bring the
9    agreement into compliance. If no additional information or
10    modification is required, the agreement shall be valid and
11    binding from the time the parties receive acceptance of the
12    agreement from the Chairman. Upon receipt of any requested
13    information or modification, the Chairman shall notify the
14    parties within 21 days whether the agreement is in
15    compliance with this Section. If no additional information
16    or modification is required, the agreement shall be valid
17    and binding from the time the parties receive acceptance of
18    the agreement from the Chairman. All rejections made by the
19    Chairman under this subsection shall be subject to review
20    by the courts of this State, said review to be taken in the
21    same manner and within the same time as provided by Section
22    19 of this Act for review of awards and decisions of the
23    Commission. Upon the review, the Circuit Court shall have
24    power to review all questions of fact as well as of law.
25    (f) Notice to Insurance carrier.
26        If the construction employer is insured under this Act,

 

 

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1    he, she, or it shall provide notice to and obtain consent
2    from his, her, or its insurance carrier, in the manner
3    provided in the insurance contract, of his, her, or its
4    intent to enter into an agreement as provided in this
5    Section with his, her, or its employees.
6    (g) Employees' Claims for Workers' Compensation Benefits.
7        (1) claims for benefits shall be filed with the ADR
8    plan administrator within those periods of limitation
9    prescribed by this Act. Within 10 days of the filing of a
10    claim, the ADR plan administrator shall serve a copy of the
11    claim application upon the Commission, which shall
12    maintain records of all ADR claims and resolutions.
13        (2) settlements of claims presented to the ADR plan
14    administrator shall be evidenced by a settlement
15    agreement. All such settlements shall be filed with the ADR
16    plan administrator, who within 10 days shall forward a copy
17    to the Commission for recording.
18        (3) upon assignment of claims, unless settled,
19    mediators and arbitrators shall render final orders
20    containing essential findings of fact, rulings of law and
21    referring to other matters as pertinent to the questions at
22    issue. The ADR plan administrator shall maintain a record
23    of the proceedings.
24    (h) Reporting Requirements.
25    Annually, each ADR plan administrator shall submit a report
26to the Commission containing the following information:

 

 

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1        (1) the number of employees within the ADR program;
2        (2) the number of occurrences of work-related injuries
3    or diseases;
4        (3) the breakdown within the ADR program of injuries
5    and diseases treated;
6        (4) the total amount of disability benefits paid within
7    the ADR program;
8        (5) the total medical treatment cost paid within the
9    ADR program;
10        (6) the number of claims filed within the ADR program;
11    and
12        (7) the disposition of all claims.
 
13    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
14    Sec. 8. The amount of compensation which shall be paid to
15the employee for an accidental injury not resulting in death
16is:
17    (a) The employer shall provide and pay the negotiated rate,
18if applicable, or the lesser of the health care provider's
19actual charges or according to a fee schedule, subject to
20Section 8.2, in effect at the time the service was rendered for
21all the necessary first aid, medical and surgical services, and
22all necessary medical, surgical and hospital services
23thereafter incurred, limited, however, to that which is
24reasonably required to cure or relieve from the effects of the
25accidental injury, even if a health care provider sells,

 

 

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1transfers, or otherwise assigns an account receivable for
2procedures, treatments, or services covered under this Act. If
3the employer does not dispute payment of first aid, medical,
4surgical, and hospital services, the employer shall make such
5payment to the provider on behalf of the employee. The employer
6shall also pay for treatment, instruction and training
7necessary for the physical, mental and vocational
8rehabilitation of the employee, including all maintenance
9costs and expenses incidental thereto. If as a result of the
10injury the employee is unable to be self-sufficient the
11employer shall further pay for such maintenance or
12institutional care as shall be required.
13    Except as provided in subsection (a-1) of this Section, for
14up to 60 days from the report of injury to the employer, the
15employer shall choose all necessary medical, surgical and
16hospital services reasonably required to cure or relieve from
17the effects of the accidental injury, at the employer's
18expense. The employee shall cooperate with and adhere to the
19plan of care or treatment recommendations of the providers
20selected by the employer, unless the proposed care and
21treatment threatens the life, health or recovery of the injured
22employee. Upon a finding by the Commission, that the employer's
23choice of medical care is rendering improper or inadequate
24care, the employee may then choose a second physician, surgeon,
25and hospital services at the employer's expense. Initial
26emergency services, taking place within 45 days of the

 

 

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1accident, shall not constitute a choice of physician, surgeon,
2or hospital services by the employer or employee. Except as
3provided in subsection (a-1) of this Section, the The employee
4may after 60 days from the report of injury at any time elect
5to secure his own physician, surgeon and hospital services at
6the employer's expense. , or,
7    Upon agreement between the employer and the employees, or
8the employees' exclusive representative, and subject to the
9approval of the Illinois Workers' Compensation Commission, the
10employer shall maintain a list of physicians, to be known as a
11Panel of Physicians, who are accessible to the employees. The
12employer shall post this list in a place or places easily
13accessible to his employees. The employee shall have the right
14to make an alternative choice of physician from such Panel if
15he is not satisfied with the physician first selected. If, due
16to the nature of the injury or its occurrence away from the
17employer's place of business, the employee is unable to make a
18selection from the Panel, the selection process from the Panel
19shall not apply. The physician selected from the Panel may
20arrange for any consultation, referral or other specialized
21medical services outside the Panel at the employer's expense.
22Provided that, in the event the Commission shall find that a
23doctor selected by the employee is rendering improper or
24inadequate care, the Commission may order the employee to
25select another doctor certified or qualified in the medical
26field for which treatment is required. If the employee refuses

 

 

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1to make such change the Commission may relieve the employer of
2his obligation to pay the doctor's charges from the date of
3refusal to the date of compliance.
4    Any vocational rehabilitation counselors who provide
5service under this Act shall have appropriate certifications
6which designate the counselor as qualified to render opinions
7relating to vocational rehabilitation. Vocational
8rehabilitation may include, but is not limited to, counseling
9for job searches, supervising a job search program, and
10vocational retraining including education at an accredited
11learning institution. The employee or employer may petition to
12the Commission to decide disputes relating to vocational
13rehabilitation and the Commission shall resolve any such
14dispute, including payment of the vocational rehabilitation
15program by the employer.
16    The maintenance benefit shall not be less than the
17temporary total disability rate determined for the employee. In
18addition, maintenance shall include costs and expenses
19incidental to the vocational rehabilitation program.
20    When the employee is working light duty on a part-time
21basis or full-time basis and earns less than he or she would be
22earning if employed in the full capacity of the job or jobs,
23then the employee shall be entitled to temporary partial
24disability benefits. Temporary partial disability benefits
25shall be equal to two-thirds of the difference between the
26average amount that the employee would be able to earn in the

 

 

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1full performance of his or her duties in the occupation in
2which he or she was engaged at the time of accident and the
3gross net amount which he or she is earning in the modified job
4provided to the employee by the employer or in any other job
5that the employee is working.
6    No employer shall be required to pay temporary partial
7disability benefits to an employee who has been discharged for
8cause on or after the effective date of this amendatory Act of
9the 97th General Assembly. Upon notification by the employer,
10the Commission shall suspend temporary partial disability
11benefits being paid to an employee who has been discharged for
12cause. Following a hearing, the Commission may reinstate the
13temporary partial benefits and retroactively restore any
14benefits the employer should have paid if it finds the
15employer's discharge of the employee was not for cause. If the
16Commission determines that the employee was discharged for
17cause, the temporary partial disability benefit shall be
18terminated. "Discharge for cause" means a discharge resulting
19from the employee's voluntary violation of a rule or policy of
20the employer not caused by the employee's disability.
21    Every hospital, physician, surgeon or other person
22rendering treatment or services in accordance with the
23provisions of this Section shall upon written request furnish
24full and complete reports thereof to, and permit their records
25to be copied by, the employer, the employee or his dependents,
26as the case may be, or any other party to any proceeding for

 

 

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1compensation before the Commission, or their attorneys.
2    When an employee makes a claim for benefits under the Act,
3he or she waives their privacy privilege with any treating
4provider to the extent solely to allow the employer to obtain
5from a treating provider the necessary information to determine
6whether the condition of ill-being in question for which
7treatment is sought is work related, what that treatment is for
8purposes of approval of care, and whether or not, based upon
9the condition of ill-being, the employee is entitled to other
10benefits. The employer shall be entitled to contact the
11treating provider to seek information and answers from the
12treating provider regarding whether the condition of ill-being
13in question for which treatment is sought is work related, what
14that treatment or course of treatment is for purposes of
15approval of care, and the return to work options that the
16employer may have for the employee.
17    Notwithstanding the foregoing, the employer's liability to
18pay for such medical services selected by the employee shall be
19limited to:
20        (1) all first aid and emergency treatment; plus
21        (2) all medical, surgical and hospital services
22    provided by the physician, surgeon or hospital initially
23    chosen by the employer employee or by any other physician,
24    consultant, expert, institution or other provider of
25    services recommended by said initial service provider or
26    any subsequent provider of medical services in the chain of

 

 

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1    referrals from said initial service provider; plus
2        (3) except as provided in subsection (a-1) of this
3    Section, all medical, surgical and hospital services
4    provided by any second physician, surgeon or hospital
5    subsequently chosen by the employee as allowed under this
6    Section or by any other physician, consultant, expert,
7    institution or other provider of services recommended by
8    said second service provider or any subsequent provider of
9    medical services in the chain of referrals from said second
10    service provider. Thereafter the employer shall select and
11    pay for all necessary medical, surgical and hospital
12    treatment and the employee may not select a provider of
13    medical services at the employer's expense unless the
14    employer agrees to such selection. At any time the employee
15    may obtain any medical treatment he or she desires at his
16    or her own expense. This paragraph shall not affect the
17    duty to pay for rehabilitation referred to above.
18    Where, as provided in Section 11 of this Act, an employee
19is determined to be so intoxicated that the intoxication
20constituted a departure from employment, the employer shall
21only be liable to pay inpatient and outpatient hospital
22services furnished by a provider qualified to furnish those
23services that are needed to evaluate or stabilize an emergency
24medical condition. Emergency treatment for injuries caused by
25intoxication does not include post stabilization medical
26services.

 

 

09700SB1349sam001- 23 -LRB097 07516 AEK 54114 a

1    When an employer and employee so agree in writing, nothing
2in this Act prevents an employee whose injury or disability has
3been established under this Act, from relying in good faith, on
4treatment by prayer or spiritual means alone, in accordance
5with the tenets and practice of a recognized church or
6religious denomination, by a duly accredited practitioner
7thereof, and having nursing services appropriate therewith,
8without suffering loss or diminution of the compensation
9benefits under this Act. However, the employee shall submit to
10all physical examinations required by this Act. The cost of
11such treatment and nursing care shall be paid by the employee
12unless the employer agrees to make such payment.
13    Where the accidental injury results in the amputation of an
14arm, hand, leg or foot, or the enucleation of an eye, or the
15loss of any of the natural teeth, the employer shall furnish an
16artificial of any such members lost or damaged in accidental
17injury arising out of and in the course of employment, and
18shall also furnish the necessary braces in all proper and
19necessary cases. In cases of the loss of a member or members by
20amputation, the employer shall, whenever necessary, maintain
21in good repair, refit or replace the artificial limbs during
22the lifetime of the employee. Where the accidental injury
23accompanied by physical injury results in damage to a denture,
24eye glasses or contact eye lenses, or where the accidental
25injury results in damage to an artificial member, the employer
26shall replace or repair such denture, glasses, lenses, or

 

 

09700SB1349sam001- 24 -LRB097 07516 AEK 54114 a

1artificial member.
2    The furnishing by the employer of any such services or
3appliances is not an admission of liability on the part of the
4employer to pay compensation.
5    The furnishing of any such services or appliances or the
6servicing thereof by the employer is not the payment of
7compensation.
8    Except for the changes to the first paragraph of this
9subsection (a), the changes to this subsection (a) apply only
10to accidental injuries that occur on or after the effective
11date of this amendatory Act of the 97th General Assembly.
12    (a-1) To satisfy its liabilities under this Section for the
13provision of medical treatment to injured employees, an
14employer may utilize a preferred provider program approved by
15the Illinois Department of Insurance pursuant to Article XX-1/2
16of the Illinois Insurance Code. The provider network shall
17include an adequate number and type of physicians or other
18providers to treat common injuries experienced by injured
19employees based on the type of occupation or industry in which
20the employee is engaged, and the geographic area where the
21employees are employed.
22    Medical treatment for injuries shall be readily available
23at reasonable times to all employees. To the extent feasible,
24all medical treatment for injuries shall be readily accessible
25to all employees.
26    All treatment provided shall be provided in accordance with

 

 

09700SB1349sam001- 25 -LRB097 07516 AEK 54114 a

1standards of care of nationally recognized peer review
2guidelines as well as nationally recognized treatment
3guidelines and evidence-based medicine, as appropriate.
4    Notwithstanding the provisions of subsection (a) of this
5Section and for injuries incurred after the effective day of
6this amendatory Act of the 97th General Assembly, an employee
7of an employer utilizing a preferred provider network shall
8only be allowed to select a participating provider from the
9network. An employer shall be responsible for all medical care
10provided by participating providers under this Section
11determined by the Commission to be reasonable or necessary.
12    (b) If the period of temporary total incapacity for work
13lasts more than 3 working days, weekly compensation as
14hereinafter provided shall be paid beginning on the 4th day of
15such temporary total incapacity and continuing as long as the
16total temporary incapacity lasts. In cases where the temporary
17total incapacity for work continues for a period of 14 days or
18more from the day of the accident compensation shall commence
19on the day after the accident.
20        1. The compensation rate for temporary total
21    incapacity under this paragraph (b) of this Section shall
22    be equal to 66 2/3% of the employee's average weekly wage
23    computed in accordance with Section 10, provided that it
24    shall be not less than 66 2/3% of the sum of the Federal
25    minimum wage under the Fair Labor Standards Act, or the
26    Illinois minimum wage under the Minimum Wage Law, whichever

 

 

09700SB1349sam001- 26 -LRB097 07516 AEK 54114 a

1    is more, multiplied by 40 hours. This percentage rate shall
2    be increased by 10% for each spouse and child, not to
3    exceed 100% of the total minimum wage calculation,
4    nor exceed the employee's average weekly wage computed in
5    accordance with the provisions of Section 10, whichever is
6    less.
7        2. The compensation rate in all cases other than for
8    temporary total disability under this paragraph (b), and
9    other than for serious and permanent disfigurement under
10    paragraph (c) and other than for permanent partial
11    disability under subparagraph (2) of paragraph (d) or under
12    paragraph (e), of this Section shall be equal to 66 2/3% of
13    the employee's average weekly wage computed in accordance
14    with the provisions of Section 10, provided that it shall
15    be not less than 66 2/3% of the sum of the Federal minimum
16    wage under the Fair Labor Standards Act, or the Illinois
17    minimum wage under the Minimum Wage Law, whichever is more,
18    multiplied by 40 hours. This percentage rate shall be
19    increased by 10% for each spouse and child, not to exceed
20    100% of the total minimum wage calculation, nor exceed the
21    employee's average weekly wage computed in accordance with
22    the provisions of Section 10, whichever is less.
23    No employer shall be required to pay temporary total
24disability benefits to an employee who has been discharged for
25cause on or after the effective date of this amendatory Act of
26the 97th General Assembly. Upon notification by the employer,

 

 

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1the Commission shall suspend temporary total disability
2benefits being paid to an employee who has been discharged for
3cause. Following a hearing, the Commission may reinstate the
4temporary total disability benefits and retroactively restore
5any benefits the employer should have paid if it finds the
6employer's discharge of the employee was not for cause. If the
7Commission determines that the employee was discharged for
8cause, the temporary total disability benefit shall be
9terminated. "Discharge for cause" means a discharge resulting
10from the employee's voluntary violation of a rule or policy of
11the employer not caused by the employee's disability.
12        2.1. The compensation rate in all cases of serious and
13    permanent disfigurement under paragraph (c) and of
14    permanent partial disability under subparagraph (2) of
15    paragraph (d) or under paragraph (e) of this Section shall
16    be equal to 60% of the employee's average weekly wage
17    computed in accordance with the provisions of Section 10,
18    provided that it shall be not less than 66 2/3% of the sum
19    of the Federal minimum wage under the Fair Labor Standards
20    Act, or the Illinois minimum wage under the Minimum Wage
21    Law, whichever is more, multiplied by 40 hours. This
22    percentage rate shall be increased by 10% for each spouse
23    and child, not to exceed 100% of the total minimum wage
24    calculation,
25    nor exceed the employee's average weekly wage computed in
26    accordance with the provisions of Section 10, whichever is

 

 

09700SB1349sam001- 28 -LRB097 07516 AEK 54114 a

1    less.
2        3. As used in this Section the term "child" means a
3    child of the employee including any child legally adopted
4    before the accident or whom at the time of the accident the
5    employee was under legal obligation to support or to whom
6    the employee stood in loco parentis, and who at the time of
7    the accident was under 18 years of age and not emancipated.
8    The term "children" means the plural of "child".
9        4. All weekly compensation rates provided under
10    subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
11    Section shall be subject to the following limitations:
12        The maximum weekly compensation rate from July 1, 1975,
13    except as hereinafter provided, shall be 100% of the
14    State's average weekly wage in covered industries under the
15    Unemployment Insurance Act, that being the wage that most
16    closely approximates the State's average weekly wage.
17        The maximum weekly compensation rate, for the period
18    July 1, 1984, through June 30, 1987, except as hereinafter
19    provided, shall be $293.61. Effective July 1, 1987 and on
20    July 1 of each year thereafter the maximum weekly
21    compensation rate, except as hereinafter provided, shall
22    be determined as follows: if during the preceding 12 month
23    period there shall have been an increase in the State's
24    average weekly wage in covered industries under the
25    Unemployment Insurance Act, the weekly compensation rate
26    shall be proportionately increased by the same percentage

 

 

09700SB1349sam001- 29 -LRB097 07516 AEK 54114 a

1    as the percentage of increase in the State's average weekly
2    wage in covered industries under the Unemployment
3    Insurance Act during such period.
4        The maximum weekly compensation rate, for the period
5    January 1, 1981 through December 31, 1983, except as
6    hereinafter provided, shall be 100% of the State's average
7    weekly wage in covered industries under the Unemployment
8    Insurance Act in effect on January 1, 1981. Effective
9    January 1, 1984 and on January 1, of each year thereafter
10    the maximum weekly compensation rate, except as
11    hereinafter provided, shall be determined as follows: if
12    during the preceding 12 month period there shall have been
13    an increase in the State's average weekly wage in covered
14    industries under the Unemployment Insurance Act, the
15    weekly compensation rate shall be proportionately
16    increased by the same percentage as the percentage of
17    increase in the State's average weekly wage in covered
18    industries under the Unemployment Insurance Act during
19    such period.
20        From July 1, 1977 and thereafter such maximum weekly
21    compensation rate in death cases under Section 7, and
22    permanent total disability cases under paragraph (f) or
23    subparagraph 18 of paragraph (3) of this Section and for
24    temporary total disability under paragraph (b) of this
25    Section and for amputation of a member or enucleation of an
26    eye under paragraph (e) of this Section shall be increased

 

 

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1    to 133-1/3% of the State's average weekly wage in covered
2    industries under the Unemployment Insurance Act.
3        For injuries occurring on or after February 1, 2006,
4    the maximum weekly benefit under paragraph (d)1 of this
5    Section shall be 100% of the State's average weekly wage in
6    covered industries under the Unemployment Insurance Act.
7        4.1. Any provision herein to the contrary
8    notwithstanding, the weekly compensation rate for
9    compensation payments under subparagraph 18 of paragraph
10    (e) of this Section and under paragraph (f) of this Section
11    and under paragraph (a) of Section 7 and for amputation of
12    a member or enucleation of an eye under paragraph (e) of
13    this Section, shall in no event be less than 50% of the
14    State's average weekly wage in covered industries under the
15    Unemployment Insurance Act.
16        4.2. Any provision to the contrary notwithstanding,
17    the total compensation payable under Section 7 shall not
18    exceed the greater of $500,000 or 25 years.
19        5. For the purpose of this Section this State's average
20    weekly wage in covered industries under the Unemployment
21    Insurance Act on July 1, 1975 is hereby fixed at $228.16
22    per week and the computation of compensation rates shall be
23    based on the aforesaid average weekly wage until modified
24    as hereinafter provided.
25        6. The Department of Employment Security of the State
26    shall on or before the first day of December, 1977, and on

 

 

09700SB1349sam001- 31 -LRB097 07516 AEK 54114 a

1    or before the first day of June, 1978, and on the first day
2    of each December and June of each year thereafter, publish
3    the State's average weekly wage in covered industries under
4    the Unemployment Insurance Act and the Illinois Workers'
5    Compensation Commission shall on the 15th day of January,
6    1978 and on the 15th day of July, 1978 and on the 15th day
7    of each January and July of each year thereafter, post and
8    publish the State's average weekly wage in covered
9    industries under the Unemployment Insurance Act as last
10    determined and published by the Department of Employment
11    Security. The amount when so posted and published shall be
12    conclusive and shall be applicable as the basis of
13    computation of compensation rates until the next posting
14    and publication as aforesaid.
15        7. The payment of compensation by an employer or his
16    insurance carrier to an injured employee shall not
17    constitute an admission of the employer's liability to pay
18    compensation.
19    (c) For any serious and permanent disfigurement to the
20hand, head, face, neck, arm, leg below the knee or the chest
21above the axillary line, the employee is entitled to
22compensation for such disfigurement, the amount determined by
23agreement at any time or by arbitration under this Act, at a
24hearing not less than 6 months after the date of the accidental
25injury, which amount shall not exceed 150 weeks (if the
26accidental injury occurs on or after the effective date of this

 

 

09700SB1349sam001- 32 -LRB097 07516 AEK 54114 a

1amendatory Act of the 94th General Assembly but before February
21, 2006) or 162 weeks (if the accidental injury occurs on or
3after February 1, 2006) at the applicable rate provided in
4subparagraph 2.1 of paragraph (b) of this Section.
5    No compensation is payable under this paragraph where
6compensation is payable under paragraphs (d), (e) or (f) of
7this Section.
8    A duly appointed member of a fire department in a city, the
9population of which exceeds 200,000 according to the last
10federal or State census, is eligible for compensation under
11this paragraph only where such serious and permanent
12disfigurement results from burns.
13    (d) 1. If, after the accidental injury has been sustained,
14the employee as a result thereof becomes partially
15incapacitated from pursuing his usual and customary line of
16employment, he shall, except in cases compensated under the
17specific schedule set forth in paragraph (e) of this Section,
18receive compensation for the duration of his disability,
19subject to the limitations as to maximum amounts fixed in
20paragraph (b) of this Section, equal to 66-2/3% of the
21difference between the average amount which he would be able to
22earn in the full performance of his duties in the occupation in
23which he was engaged at the time of the accident and the
24average amount which he is earning or is able to earn in some
25suitable employment or business after the accident. For
26accidental injuries that occur on and after the effective date

 

 

09700SB1349sam001- 33 -LRB097 07516 AEK 54114 a

1of this amendatory Act of the 97th General Assembly, an award
2for wage differential under this subsection shall be effective
3only until the employee reaches the age of 67 or 5 years from
4the date the award becomes final, whichever is later.
5    2. If, as a result of the accident, the employee sustains
6serious and permanent injuries not covered by paragraphs (c)
7and (e) of this Section or having sustained injuries covered by
8the aforesaid paragraphs (c) and (e), he shall have sustained
9in addition thereto other injuries which injuries do not
10incapacitate him from pursuing the duties of his employment but
11which would disable him from pursuing other suitable
12occupations, or which have otherwise resulted in physical
13impairment; or if such injuries partially incapacitate him from
14pursuing the duties of his usual and customary line of
15employment but do not result in an impairment of earning
16capacity, or having resulted in an impairment of earning
17capacity, the employee elects to waive his right to recover
18under the foregoing subparagraph 1 of paragraph (d) of this
19Section then in any of the foregoing events, he shall receive
20in addition to compensation for temporary total disability
21under paragraph (b) of this Section, compensation at the rate
22provided in subparagraph 2.1 of paragraph (b) of this Section
23for that percentage of 500 weeks that the partial disability
24resulting from the injuries covered by this paragraph bears to
25total disability. If the employee shall have sustained a
26fracture of one or more vertebra or fracture of the skull, the

 

 

09700SB1349sam001- 34 -LRB097 07516 AEK 54114 a

1amount of compensation allowed under this Section shall be not
2less than 6 weeks for a fractured skull and 6 weeks for each
3fractured vertebra, and in the event the employee shall have
4sustained a fracture of any of the following facial bones:
5nasal, lachrymal, vomer, zygoma, maxilla, palatine or
6mandible, the amount of compensation allowed under this Section
7shall be not less than 2 weeks for each such fractured bone,
8and for a fracture of each transverse process not less than 3
9weeks. In the event such injuries shall result in the loss of a
10kidney, spleen or lung, the amount of compensation allowed
11under this Section shall be not less than 10 weeks for each
12such organ. Compensation awarded under this subparagraph 2
13shall not take into consideration injuries covered under
14paragraphs (c) and (e) of this Section and the compensation
15provided in this paragraph shall not affect the employee's
16right to compensation payable under paragraphs (b), (c) and (e)
17of this Section for the disabilities therein covered.
18    (e) For accidental injuries in the following schedule, the
19employee shall receive compensation for the period of temporary
20total incapacity for work resulting from such accidental
21injury, under subparagraph 1 of paragraph (b) of this Section,
22and shall receive in addition thereto compensation for a
23further period for the specific loss herein mentioned, but
24shall not receive any compensation under any other provisions
25of this Act. The following listed amounts apply to either the
26loss of or the permanent and complete loss of use of the member

 

 

09700SB1349sam001- 35 -LRB097 07516 AEK 54114 a

1specified, such compensation for the length of time as follows:
2        1. Thumb-
3            70 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            76 weeks if the accidental injury occurs on or
7        after February 1, 2006.
8        2. First, or index finger-
9            40 weeks if the accidental injury occurs on or
10        after the effective date of this amendatory Act of the
11        94th General Assembly but before February 1, 2006.
12            43 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        3. Second, or middle finger-
15            35 weeks if the accidental injury occurs on or
16        after the effective date of this amendatory Act of the
17        94th General Assembly but before February 1, 2006.
18            38 weeks if the accidental injury occurs on or
19        after February 1, 2006.
20        4. Third, or ring finger-
21            25 weeks if the accidental injury occurs on or
22        after the effective date of this amendatory Act of the
23        94th General Assembly but before February 1, 2006.
24            27 weeks if the accidental injury occurs on or
25        after February 1, 2006.
26        5. Fourth, or little finger-

 

 

09700SB1349sam001- 36 -LRB097 07516 AEK 54114 a

1            20 weeks if the accidental injury occurs on or
2        after the effective date of this amendatory Act of the
3        94th General Assembly but before February 1, 2006.
4            22 weeks if the accidental injury occurs on or
5        after February 1, 2006.
6        6. Great toe-
7            35 weeks if the accidental injury occurs on or
8        after the effective date of this amendatory Act of the
9        94th General Assembly but before February 1, 2006.
10            38 weeks if the accidental injury occurs on or
11        after February 1, 2006.
12        7. Each toe other than great toe-
13            12 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            13 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        8. The loss of the first or distal phalanx of the thumb
19    or of any finger or toe shall be considered to be equal to
20    the loss of one-half of such thumb, finger or toe and the
21    compensation payable shall be one-half of the amount above
22    specified. The loss of more than one phalanx shall be
23    considered as the loss of the entire thumb, finger or toe.
24    In no case shall the amount received for more than one
25    finger exceed the amount provided in this schedule for the
26    loss of a hand.

 

 

09700SB1349sam001- 37 -LRB097 07516 AEK 54114 a

1        9. Hand-
2            190 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            205 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        The loss of 2 or more digits, or one or more phalanges
8    of 2 or more digits, of a hand may be compensated on the
9    basis of partial loss of use of a hand, provided, further,
10    that the loss of 4 digits, or the loss of use of 4 digits,
11    in the same hand shall constitute the complete loss of a
12    hand.
13        10. Arm-
14            235 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            253 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        Where an accidental injury results in the amputation of
20    an arm below the elbow, such injury shall be compensated as
21    a loss of an arm. Where an accidental injury results in the
22    amputation of an arm above the elbow, compensation for an
23    additional 15 weeks (if the accidental injury occurs on or
24    after the effective date of this amendatory Act of the 94th
25    General Assembly but before February 1, 2006) or an
26    additional 17 weeks (if the accidental injury occurs on or

 

 

09700SB1349sam001- 38 -LRB097 07516 AEK 54114 a

1    after February 1, 2006) shall be paid, except where the
2    accidental injury results in the amputation of an arm at
3    the shoulder joint, or so close to shoulder joint that an
4    artificial arm cannot be used, or results in the
5    disarticulation of an arm at the shoulder joint, in which
6    case compensation for an additional 65 weeks (if the
7    accidental injury occurs on or after the effective date of
8    this amendatory Act of the 94th General Assembly but before
9    February 1, 2006) or an additional 70 weeks (if the
10    accidental injury occurs on or after February 1, 2006)
11    shall be paid.
12        11. Foot-
13            155 weeks if the accidental injury occurs on or
14        after the effective date of this amendatory Act of the
15        94th General Assembly but before February 1, 2006.
16            167 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        12. Leg-
19            200 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            215 weeks if the accidental injury occurs on or
23        after February 1, 2006.
24        Where an accidental injury results in the amputation of
25    a leg below the knee, such injury shall be compensated as
26    loss of a leg. Where an accidental injury results in the

 

 

09700SB1349sam001- 39 -LRB097 07516 AEK 54114 a

1    amputation of a leg above the knee, compensation for an
2    additional 25 weeks (if the accidental injury occurs on or
3    after the effective date of this amendatory Act of the 94th
4    General Assembly but before February 1, 2006) or an
5    additional 27 weeks (if the accidental injury occurs on or
6    after February 1, 2006) shall be paid, except where the
7    accidental injury results in the amputation of a leg at the
8    hip joint, or so close to the hip joint that an artificial
9    leg cannot be used, or results in the disarticulation of a
10    leg at the hip joint, in which case compensation for an
11    additional 75 weeks (if the accidental injury occurs on or
12    after the effective date of this amendatory Act of the 94th
13    General Assembly but before February 1, 2006) or an
14    additional 81 weeks (if the accidental injury occurs on or
15    after February 1, 2006) shall be paid.
16        13. Eye-
17            150 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            162 weeks if the accidental injury occurs on or
21        after February 1, 2006.
22        Where an accidental injury results in the enucleation
23    of an eye, compensation for an additional 10 weeks (if the
24    accidental injury occurs on or after the effective date of
25    this amendatory Act of the 94th General Assembly but before
26    February 1, 2006) or an additional 11 weeks (if the

 

 

09700SB1349sam001- 40 -LRB097 07516 AEK 54114 a

1    accidental injury occurs on or after February 1, 2006)
2    shall be paid.
3        14. Loss of hearing of one ear-
4            50 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            54 weeks if the accidental injury occurs on or
8        after February 1, 2006.
9        Total and permanent loss of hearing of both ears-
10            200 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            215 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        15. Testicle-
16            50 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            54 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        Both testicles-
22            150 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            162 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

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1        16. For the permanent partial loss of use of a member
2    or sight of an eye, or hearing of an ear, compensation
3    during that proportion of the number of weeks in the
4    foregoing schedule provided for the loss of such member or
5    sight of an eye, or hearing of an ear, which the partial
6    loss of use thereof bears to the total loss of use of such
7    member, or sight of eye, or hearing of an ear.
8            (a) Loss of hearing for compensation purposes
9        shall be confined to the frequencies of 1,000, 2,000
10        and 3,000 cycles per second. Loss of hearing ability
11        for frequency tones above 3,000 cycles per second are
12        not to be considered as constituting disability for
13        hearing.
14            (b) The percent of hearing loss, for purposes of
15        the determination of compensation claims for
16        occupational deafness, shall be calculated as the
17        average in decibels for the thresholds of hearing for
18        the frequencies of 1,000, 2,000 and 3,000 cycles per
19        second. Pure tone air conduction audiometric
20        instruments, approved by nationally recognized
21        authorities in this field, shall be used for measuring
22        hearing loss. If the losses of hearing average 30
23        decibels or less in the 3 frequencies, such losses of
24        hearing shall not then constitute any compensable
25        hearing disability. If the losses of hearing average 85
26        decibels or more in the 3 frequencies, then the same

 

 

09700SB1349sam001- 42 -LRB097 07516 AEK 54114 a

1        shall constitute and be total or 100% compensable
2        hearing loss.
3            (c) In measuring hearing impairment, the lowest
4        measured losses in each of the 3 frequencies shall be
5        added together and divided by 3 to determine the
6        average decibel loss. For every decibel of loss
7        exceeding 30 decibels an allowance of 1.82% shall be
8        made up to the maximum of 100% which is reached at 85
9        decibels.
10            (d) If a hearing loss is established to have
11        existed on July 1, 1975 by audiometric testing the
12        employer shall not be liable for the previous loss so
13        established nor shall he be liable for any loss for
14        which compensation has been paid or awarded.
15            (e) No consideration shall be given to the question
16        of whether or not the ability of an employee to
17        understand speech is improved by the use of a hearing
18        aid.
19            (f) No claim for loss of hearing due to industrial
20        noise shall be brought against an employer or allowed
21        unless the employee has been exposed for a period of
22        time sufficient to cause permanent impairment to noise
23        levels in excess of the following:
24Sound Level DBA
25Slow ResponseHours Per Day
26908

 

 

09700SB1349sam001- 43 -LRB097 07516 AEK 54114 a

1926
2954
3973
41002
51021-1/2
61051
71101/2
81151/4
9        This subparagraph (f) shall not be applied in cases of
10    hearing loss resulting from trauma or explosion.
11        17. In computing the compensation to be paid to any
12    employee who, before the accident for which he claims
13    compensation, had before that time sustained an injury
14    resulting in the loss by amputation or partial loss by
15    amputation of any member, including hand, arm, thumb or
16    fingers, leg, foot or any toes, such loss or partial loss
17    of any such member shall be deducted from any award made
18    for the subsequent injury. For the permanent loss of use or
19    the permanent partial loss of use of any such member or the
20    partial loss of sight of an eye, for which compensation has
21    been paid, then such loss shall be taken into consideration
22    and deducted from any award for the subsequent injury.
23        18. The specific case of loss of both hands, both arms,
24    or both feet, or both legs, or both eyes, or of any two
25    thereof, or the permanent and complete loss of the use
26    thereof, constitutes total and permanent disability, to be

 

 

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1    compensated according to the compensation fixed by
2    paragraph (f) of this Section. These specific cases of
3    total and permanent disability do not exclude other cases.
4        Any employee who has previously suffered the loss or
5    permanent and complete loss of the use of any of such
6    members, and in a subsequent independent accident loses
7    another or suffers the permanent and complete loss of the
8    use of any one of such members the employer for whom the
9    injured employee is working at the time of the last
10    independent accident is liable to pay compensation only for
11    the loss or permanent and complete loss of the use of the
12    member occasioned by the last independent accident.
13        19. In a case of specific loss and the subsequent death
14    of such injured employee from other causes than such injury
15    leaving a widow, widower, or dependents surviving before
16    payment or payment in full for such injury, then the amount
17    due for such injury is payable to the widow or widower and,
18    if there be no widow or widower, then to such dependents,
19    in the proportion which such dependency bears to total
20    dependency.
21    Beginning July 1, 1980, and every 6 months thereafter, the
22Commission shall examine the Second Injury Fund and when, after
23deducting all advances or loans made to such Fund, the amount
24therein is $500,000 then the amount required to be paid by
25employers pursuant to paragraph (f) of Section 7 shall be
26reduced by one-half. When the Second Injury Fund reaches the

 

 

09700SB1349sam001- 45 -LRB097 07516 AEK 54114 a

1sum of $600,000 then the payments shall cease entirely.
2However, when the Second Injury Fund has been reduced to
3$400,000, payment of one-half of the amounts required by
4paragraph (f) of Section 7 shall be resumed, in the manner
5herein provided, and when the Second Injury Fund has been
6reduced to $300,000, payment of the full amounts required by
7paragraph (f) of Section 7 shall be resumed, in the manner
8herein provided. The Commission shall make the changes in
9payment effective by general order, and the changes in payment
10become immediately effective for all cases coming before the
11Commission thereafter either by settlement agreement or final
12order, irrespective of the date of the accidental injury.
13    On August 1, 1996 and on February 1 and August 1 of each
14subsequent year, the Commission shall examine the special fund
15designated as the "Rate Adjustment Fund" and when, after
16deducting all advances or loans made to said fund, the amount
17therein is $4,000,000, the amount required to be paid by
18employers pursuant to paragraph (f) of Section 7 shall be
19reduced by one-half. When the Rate Adjustment Fund reaches the
20sum of $5,000,000 the payment therein shall cease entirely.
21However, when said Rate Adjustment Fund has been reduced to
22$3,000,000 the amounts required by paragraph (f) of Section 7
23shall be resumed in the manner herein provided.
24    (f) In case of complete disability, which renders the
25employee wholly and permanently incapable of work, or in the
26specific case of total and permanent disability as provided in

 

 

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1subparagraph 18 of paragraph (e) of this Section, compensation
2shall be payable at the rate provided in subparagraph 2 of
3paragraph (b) of this Section for life.
4    An employee entitled to benefits under paragraph (f) of
5this Section shall also be entitled to receive from the Rate
6Adjustment Fund provided in paragraph (f) of Section 7 of the
7supplementary benefits provided in paragraph (g) of this
8Section 8.
9    If any employee who receives an award under this paragraph
10afterwards returns to work or is able to do so, and earns or is
11able to earn as much as before the accident, payments under
12such award shall cease. If such employee returns to work, or is
13able to do so, and earns or is able to earn part but not as much
14as before the accident, such award shall be modified so as to
15conform to an award under paragraph (d) of this Section. If
16such award is terminated or reduced under the provisions of
17this paragraph, such employees have the right at any time
18within 30 months after the date of such termination or
19reduction to file petition with the Commission for the purpose
20of determining whether any disability exists as a result of the
21original accidental injury and the extent thereof.
22    Disability as enumerated in subdivision 18, paragraph (e)
23of this Section is considered complete disability.
24    If an employee who had previously incurred loss or the
25permanent and complete loss of use of one member, through the
26loss or the permanent and complete loss of the use of one hand,

 

 

09700SB1349sam001- 47 -LRB097 07516 AEK 54114 a

1one arm, one foot, one leg, or one eye, incurs permanent and
2complete disability through the loss or the permanent and
3complete loss of the use of another member, he shall receive,
4in addition to the compensation payable by the employer and
5after such payments have ceased, an amount from the Second
6Injury Fund provided for in paragraph (f) of Section 7, which,
7together with the compensation payable from the employer in
8whose employ he was when the last accidental injury was
9incurred, will equal the amount payable for permanent and
10complete disability as provided in this paragraph of this
11Section.
12    The custodian of the Second Injury Fund provided for in
13paragraph (f) of Section 7 shall be joined with the employer as
14a party respondent in the application for adjustment of claim.
15The application for adjustment of claim shall state briefly and
16in general terms the approximate time and place and manner of
17the loss of the first member.
18    In its award the Commission or the Arbitrator shall
19specifically find the amount the injured employee shall be
20weekly paid, the number of weeks compensation which shall be
21paid by the employer, the date upon which payments begin out of
22the Second Injury Fund provided for in paragraph (f) of Section
237 of this Act, the length of time the weekly payments continue,
24the date upon which the pension payments commence and the
25monthly amount of the payments. The Commission shall 30 days
26after the date upon which payments out of the Second Injury

 

 

09700SB1349sam001- 48 -LRB097 07516 AEK 54114 a

1Fund have begun as provided in the award, and every month
2thereafter, prepare and submit to the State Comptroller a
3voucher for payment for all compensation accrued to that date
4at the rate fixed by the Commission. The State Comptroller
5shall draw a warrant to the injured employee along with a
6receipt to be executed by the injured employee and returned to
7the Commission. The endorsed warrant and receipt is a full and
8complete acquittance to the Commission for the payment out of
9the Second Injury Fund. No other appropriation or warrant is
10necessary for payment out of the Second Injury Fund. The Second
11Injury Fund is appropriated for the purpose of making payments
12according to the terms of the awards.
13    As of July 1, 1980 to July 1, 1982, all claims against and
14obligations of the Second Injury Fund shall become claims
15against and obligations of the Rate Adjustment Fund to the
16extent there is insufficient money in the Second Injury Fund to
17pay such claims and obligations. In that case, all references
18to "Second Injury Fund" in this Section shall also include the
19Rate Adjustment Fund.
20    (g) Every award for permanent total disability entered by
21the Commission on and after July 1, 1965 under which
22compensation payments shall become due and payable after the
23effective date of this amendatory Act, and every award for
24death benefits or permanent total disability entered by the
25Commission on and after the effective date of this amendatory
26Act shall be subject to annual adjustments as to the amount of

 

 

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1the compensation rate therein provided. Such adjustments shall
2first be made on July 15, 1977, and all awards made and entered
3prior to July 1, 1975 and on July 15 of each year thereafter.
4In all other cases such adjustment shall be made on July 15 of
5the second year next following the date of the entry of the
6award and shall further be made on July 15 annually thereafter.
7If during the intervening period from the date of the entry of
8the award, or the last periodic adjustment, there shall have
9been an increase in the State's average weekly wage in covered
10industries under the Unemployment Insurance Act, the weekly
11compensation rate shall be proportionately increased by the
12same percentage as the percentage of increase in the State's
13average weekly wage in covered industries under the
14Unemployment Insurance Act. The increase in the compensation
15rate under this paragraph shall in no event bring the total
16compensation rate to an amount greater than the prevailing
17maximum rate at the time that the annual adjustment is made.
18Such increase shall be paid in the same manner as herein
19provided for payments under the Second Injury Fund to the
20injured employee, or his dependents, as the case may be, out of
21the Rate Adjustment Fund provided in paragraph (f) of Section 7
22of this Act. Payments shall be made at the same intervals as
23provided in the award or, at the option of the Commission, may
24be made in quarterly payment on the 15th day of January, April,
25July and October of each year. In the event of a decrease in
26such average weekly wage there shall be no change in the then

 

 

09700SB1349sam001- 50 -LRB097 07516 AEK 54114 a

1existing compensation rate. The within paragraph shall not
2apply to cases where there is disputed liability and in which a
3compromise lump sum settlement between the employer and the
4injured employee, or his dependents, as the case may be, has
5been duly approved by the Illinois Workers' Compensation
6Commission.
7    Provided, that in cases of awards entered by the Commission
8for injuries occurring before July 1, 1975, the increases in
9the compensation rate adjusted under the foregoing provision of
10this paragraph (g) shall be limited to increases in the State's
11average weekly wage in covered industries under the
12Unemployment Insurance Act occurring after July 1, 1975.
13    For every accident occurring on or after July 20, 2005 but
14before the effective date of this amendatory Act of the 94th
15General Assembly (Senate Bill 1283 of the 94th General
16Assembly), the annual adjustments to the compensation rate in
17awards for death benefits or permanent total disability, as
18provided in this Act, shall be paid by the employer. The
19adjustment shall be made by the employer on July 15 of the
20second year next following the date of the entry of the award
21and shall further be made on July 15 annually thereafter. If
22during the intervening period from the date of the entry of the
23award, or the last periodic adjustment, there shall have been
24an increase in the State's average weekly wage in covered
25industries under the Unemployment Insurance Act, the employer
26shall increase the weekly compensation rate proportionately by

 

 

09700SB1349sam001- 51 -LRB097 07516 AEK 54114 a

1the same percentage as the percentage of increase in the
2State's average 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. In
7the event of a decrease in such average weekly wage there shall
8be no change in the then existing compensation rate. Such
9increase shall be paid by the employer in the same manner and
10at the same intervals as the payment of compensation in the
11award. This paragraph shall not apply to cases where there is
12disputed liability and in which a compromise lump sum
13settlement between the employer and the injured employee, or
14his or her dependents, as the case may be, has been duly
15approved by the Illinois Workers' Compensation Commission.
16    The annual adjustments for every award of death benefits or
17permanent total disability involving accidents occurring
18before July 20, 2005 and accidents occurring on or after the
19effective date of this amendatory Act of the 94th General
20Assembly (Senate Bill 1283 of the 94th General Assembly) shall
21continue to be paid from the Rate Adjustment Fund pursuant to
22this paragraph and Section 7(f) of this Act.
23    (h) In case death occurs from any cause before the total
24compensation to which the employee would have been entitled has
25been paid, then in case the employee leaves any widow, widower,
26child, parent (or any grandchild, grandparent or other lineal

 

 

09700SB1349sam001- 52 -LRB097 07516 AEK 54114 a

1heir or any collateral heir dependent at the time of the
2accident upon the earnings of the employee to the extent of 50%
3or more of total dependency) such compensation shall be paid to
4the beneficiaries of the deceased employee and distributed as
5provided in paragraph (g) of Section 7.
6    (h-1) In case an injured employee is under legal disability
7at the time when any right or privilege accrues to him or her
8under this Act, a guardian may be appointed pursuant to law,
9and may, on behalf of such person under legal disability, claim
10and exercise any such right or privilege with the same effect
11as if the employee himself or herself had claimed or exercised
12the right or privilege. No limitations of time provided by this
13Act run so long as the employee who is under legal disability
14is without a conservator or guardian.
15    (i) In case the injured employee is under 16 years of age
16at the time of the accident and is illegally employed, the
17amount of compensation payable under paragraphs (b), (c), (d),
18(e) and (f) of this Section is increased 50%.
19    However, where an employer has on file an employment
20certificate issued pursuant to the Child Labor Law or work
21permit issued pursuant to the Federal Fair Labor Standards Act,
22as amended, or a birth certificate properly and duly issued,
23such certificate, permit or birth certificate is conclusive
24evidence as to the age of the injured minor employee for the
25purposes of this Section.
26    Nothing herein contained repeals or amends the provisions

 

 

09700SB1349sam001- 53 -LRB097 07516 AEK 54114 a

1of the Child Labor Law relating to the employment of minors
2under the age of 16 years.
3    (j) 1. In the event the injured employee receives benefits,
4including medical, surgical or hospital benefits under any
5group plan covering non-occupational disabilities contributed
6to wholly or partially by the employer, which benefits should
7not have been payable if any rights of recovery existed under
8this Act, then such amounts so paid to the employee from any
9such group plan as shall be consistent with, and limited to,
10the provisions of paragraph 2 hereof, shall be credited to or
11against any compensation payment for temporary total
12incapacity for work or any medical, surgical or hospital
13benefits made or to be made under this Act. In such event, the
14period of time for giving notice of accidental injury and
15filing application for adjustment of claim does not commence to
16run until the termination of such payments. This paragraph does
17not apply to payments made under any group plan which would
18have been payable irrespective of an accidental injury under
19this Act. Any employer receiving such credit shall keep such
20employee safe and harmless from any and all claims or
21liabilities that may be made against him by reason of having
22received such payments only to the extent of such credit.
23    Any excess benefits paid to or on behalf of a State
24employee by the State Employees' Retirement System under
25Article 14 of the Illinois Pension Code on a death claim or
26disputed disability claim shall be credited against any

 

 

09700SB1349sam001- 54 -LRB097 07516 AEK 54114 a

1payments made or to be made by the State of Illinois to or on
2behalf of such employee under this Act, except for payments for
3medical expenses which have already been incurred at the time
4of the award. The State of Illinois shall directly reimburse
5the State Employees' Retirement System to the extent of such
6credit.
7    2. Nothing contained in this Act shall be construed to give
8the employer or the insurance carrier the right to credit for
9any benefits or payments received by the employee other than
10compensation payments provided by this Act, and where the
11employee receives payments other than compensation payments,
12whether as full or partial salary, group insurance benefits,
13bonuses, annuities or any other payments, the employer or
14insurance carrier shall receive credit for each such payment
15only to the extent of the compensation that would have been
16payable during the period covered by such payment.
17    3. The extension of time for the filing of an Application
18for Adjustment of Claim as provided in paragraph 1 above shall
19not apply to those cases where the time for such filing had
20expired prior to the date on which payments or benefits
21enumerated herein have been initiated or resumed. Provided
22however that this paragraph 3 shall apply only to cases wherein
23the payments or benefits hereinabove enumerated shall be
24received after July 1, 1969.
25(Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05;
2694-695, eff. 11-16-05.)
 

 

 

09700SB1349sam001- 55 -LRB097 07516 AEK 54114 a

1    (820 ILCS 305/8.1 new)
2    Sec. 8.1. Determination of permanent partial disability.
3For accidental injuries that occur on or after December 31,
42011, permanent partial disability shall be established using
5the following criteria:
6    (a) A physician licensed to practice medicine in all of its
7branches shall certify the level of impairment in writing. The
8certification shall include a demonstration using medically
9defined objective measurements of impairment that include, but
10are not limited to: loss of range of motion, loss of strength,
11and measured atrophy of tissue mass consistent with the injury.
12The most current edition of the American Medical Association's
13"Guides to the Evaluation of Permanent Impairment" shall be
14applied in determining the level of impairment.
15    (b) The certification of the physician shall establish the
16level of impairment.
17    (c) In determining the level of disability, the Commission
18shall base their determination on the level of impairment as
19certified by the physician. The Commission may deviate from the
20level of impairment only using the following additional
21factors: (i) the occupation of the injured employee, including
22whether the injured employee is able to perform their previous
23work activities, and (ii) the employee's future earning
24capacity. In determining the level of disability, the reasons
25for any deviation from the level of impairment as certified by

 

 

09700SB1349sam001- 56 -LRB097 07516 AEK 54114 a

1the physician licensed to practice medicine in all of its
2branches must be explained in detail in a written order and
3proven by a preponderance of the evidence.
 
4    (820 ILCS 305/8.2)
5    Sec. 8.2. Fee schedule.
6    (a) Except as provided for in subsection (c), for
7procedures, treatments, or services covered under this Act and
8rendered or to be rendered on and after February 1, 2006, the
9maximum allowable payment shall be 90% of the 80th percentile
10of charges and fees as determined by the Commission utilizing
11information provided by employers' and insurers' national
12databases, with a minimum of 12,000,000 Illinois line item
13charges and fees comprised of health care provider and hospital
14charges and fees as of August 1, 2004 but not earlier than
15August 1, 2002. These charges and fees are provider billed
16amounts and shall not include discounted charges. The 80th
17percentile is the point on an ordered data set from low to high
18such that 80% of the cases are below or equal to that point and
19at most 20% are above or equal to that point. The Commission
20shall adjust these historical charges and fees as of August 1,
212004 by the Consumer Price Index-U for the period August 1,
222004 through September 30, 2005. The Commission shall establish
23fee schedules for procedures, treatments, or services for
24hospital inpatient, hospital outpatient, emergency room and
25trauma, ambulatory surgical treatment centers, and

 

 

09700SB1349sam001- 57 -LRB097 07516 AEK 54114 a

1professional services.
2    (a-1) These charges and fees shall be designated by geozip
3or any smaller geographic unit. The data shall in no way
4identify or tend to identify any patient, employer, or health
5care provider. As used in this Section, "geozip" means a
6three-digit zip code based on data similarities, geographical
7similarities, and frequencies. A geozip does not cross state
8boundaries. As used in this Section, "three-digit zip code"
9means a geographic area in which all zip codes have the same
10first 3 digits. If a geozip does not have the necessary number
11of charges and fees to calculate a valid percentile for a
12specific procedure, treatment, or service, the Commission may
13combine data from the geozip with up to 4 other geozips that
14are demographically and economically similar and exhibit
15similarities in data and frequencies until the Commission
16reaches 9 charges or fees for that specific procedure,
17treatment, or service. In cases where the compiled data
18contains less than 9 charges or fees for a procedure,
19treatment, or service, reimbursement shall occur at 76% of
20charges and fees as determined by the Commission in a manner
21consistent with the provisions of this paragraph. This
22subsection shall apply until July 1, 2011.
23    (a-2) Providers of out-of-state procedures, treatments,
24services, products, or supplies shall be reimbursed at the
25lesser of that state's fee schedule amount or the fee schedule
26amount that would apply to the region where the employer is

 

 

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1located. If no fee schedule exists in that state, the provider
2shall be reimbursed at the lesser of the actual charge or the
3fee schedule amount that would apply to the region where the
4employer is located. If out-of-state treatment is being
5undertaken and the employer is also located outside the State
6of Illinois, the provider shall be reimbursed at the lesser of
7the actual charge or the fee schedule amount that would apply
8to the location of the accident. The Commission has the
9authority to set the maximum allowable payment to providers of
10out-of-state procedures, treatments, or services covered under
11this Act in a manner consistent with this Section.
12    (a-3) Not later than September 30 in 2006 and each year
13thereafter, the Commission shall automatically increase or
14decrease the maximum allowable payment for a procedure,
15treatment, or service established and in effect on January 1 of
16that year by the percentage change in the Consumer Price
17Index-U for the 12 month period ending August 31 of that year.
18The increase or decrease shall become effective on January 1 of
19the following year. As used in this Section, "Consumer Price
20Index-U" means the index published by the Bureau of Labor
21Statistics of the U.S. Department of Labor, that measures the
22average change in prices of all goods and services purchased by
23all urban consumers, U.S. city average, all items, 1982-84=100.
24    (a-4) Notwithstanding the provisions of subsection (a),
25the following provisions shall apply to the medical fee
26schedule starting on July 1, 2011:

 

 

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1        (1) The Commission shall establish and maintain fee
2    schedules for procedures, treatments, products, services,
3    or supplies for hospital inpatient, hospital outpatient,
4    emergency room, accredited ambulatory surgical treatment
5    facilities, prescriptions filled and dispensed outside of
6    a licensed pharmacy, dental services, and professional
7    services. An accredited ambulatory surgical treatment
8    facility is one defined by the Illinois Department of
9    Public Health or by accreditation organizations determined
10    by the Commission. Services provided at an unaccredited
11    ambulatory surgical treatment facilities shall not be
12    compensated under the Illinois Workers' Compensation
13    Medical Fee Schedules.
14    This fee schedule shall be based on the fee schedule
15amounts already established by the Commission pursuant to
16subsection (a) of this Section. However, these fee schedule
17amounts shall be grouped into regions consistent with
18nationally recognized reimbursement zip codes in Illinois and
19shall represent the average amount for a procedure, treatment
20or service for all the geozips reorganized into the new region.
21        (2) In cases where the compiled data contains less than
22    9 charges or fees for a procedure, treatment, product,
23    supply, or service or where the fee schedule amount cannot
24    be determined by the non-discounted charge data,
25    non-Medicare relative values and conversion factors
26    derived from established fee schedule amounts, coding

 

 

09700SB1349sam001- 60 -LRB097 07516 AEK 54114 a

1    crosswalks, or other data as determined by the Commission,
2    reimbursement shall occur at 76% of charges and fees until
3    July 1, 2011 and 53.2% of charges and fees thereafter as
4    determined by the Commission in a manner consistent with
5    the provisions of this paragraph.
6        (3) To establish additional fee schedule amounts, the
7    Commission shall utilize provider non-discounted charge
8    data, non-Medicare relative values and conversion factors
9    derived from established fee schedule amounts, and coding
10    crosswalks. The Commission may establish additional fee
11    schedule amounts based on either the charge or cost of the
12    procedure, treatment, product, supply, or service.
13        (4) Implants shall be reimbursed at 25% above the net
14    manufacturer's invoice price less rebates, plus actual
15    reasonable and customary shipping charges whether or not
16    the implant charge is submitted by a provider in
17    conjunction with a bill for all other services associated
18    with the implant, submitted by a provider on a separate
19    claim form, submitted by a distributor, or submitted by the
20    manufacturer of the implant. "Implants" include the
21    following codes or any substantially similar updated code
22    as determined by the Commission: 0274
23    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
24    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
25    (investigational devices); and 0636 (drugs requiring
26    detailed coding). Non-implantable devices or supplies

 

 

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1    within these codes shall be reimbursed at 65% of actual
2    charge, which is the provider's normal rates under its
3    standard chargemaster. A standard chargemaster is the
4    provider's list of charges for procedures, treatments,
5    products, supplies, or services used to bill payers in a
6    consistent manner.
7        (5) The Commission shall automatically update all
8    codes and associated rules with the version of the codes
9    and rules valid on January 1 of that year, including the
10    most current version of the National Correct Coding
11    Initiative Edits as published by the Center for Medicare
12    and Medicaid Services.
13    (a-5) For procedures, treatments, services, or supplies
14covered under this Act and rendered or to be rendered on or
15after July 1, 2011, the maximum allowable payment shall be 70%
16of the fee schedule amounts in place as of June 30, 2011, which
17shall be adjusted yearly by the Consumer Price Index-U, as
18described in subsection (a) of this Section.
19    (a-6) Prescriptions filled and dispensed outside of a
20licensed pharmacy shall be subject to a fee schedule that shall
21not exceed the Average Wholesale Price (AWP) plus a dispensing
22fee of $4.18. AWP or its equivalent as registered by the
23National Drug Code shall be set forth for that drug on that
24date as published in Medispan.
25    (b) Notwithstanding the provisions of subsection (a), if
26the Commission finds that there is a significant limitation on

 

 

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1access to quality health care in either a specific field of
2health care services or a specific geographic limitation on
3access to health care, it may change the Consumer Price Index-U
4increase or decrease for that specific field or specific
5geographic limitation on access to health care to address that
6limitation.
7    (c) The Commission shall establish by rule a process to
8review those medical cases or outliers that involve
9extra-ordinary treatment to determine whether to make an
10additional adjustment to the maximum payment within a fee
11schedule for a procedure, treatment, or service.
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.
19        (1) All payments to providers for treatment provided
20    pursuant to this Act shall be made within 60 days of
21    receipt of the bills as long as the claim contains
22    substantially all the required data elements necessary to
23    adjudicate the bills.
24        (2) In the case of nonpayment to a provider within 60
25    days of receipt of the bill which contained substantially
26    all of the required data elements necessary to adjudicate

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1    (820 ILCS 305/8.3)
2    Sec. 8.3. Workers' Compensation Medical Fee Advisory
3Board. There is created a Workers' Compensation Medical Fee
4Advisory Board consisting of 9 members appointed by the
5Governor with the advice and consent of the Senate. Three
6members of the Advisory Board shall be representative citizens
7chosen from the employee class, 3 members shall be
8representative citizens chosen from the employing class, and 3
9members shall be representative citizens chosen from the
10medical provider class. Each member shall serve a 4-year term
11and shall continue to serve until a successor is appointed. A
12vacancy on the Advisory Board shall be filled by the Governor
13for the unexpired term.
14    Members of the Advisory Board shall receive no compensation
15for their services but shall be reimbursed for expenses
16incurred in the performance of their duties by the Commission
17from appropriations made to the Commission for that purpose.
18    The Advisory Board shall advise the Commission on
19establishment of fees for medical services and accessibility of
20medical treatment. Additionally, by December 31, 2011, the
21Board shall issue a written report, to be delivered to the
22Chairman of the Commission and the General Assembly, containing
23(i) recommendations on how to streamline the process under
24which workers' compensation medical providers bill for their
25services, insurers process and issue payments and health care

 

 

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1providers receive such payments and (ii) a recommended set of
2best practices for workers' compensation insurers and medical
3providers to transition from a paper-based payment system to an
4electronic-based billing and payment system.
5(Source: P.A. 94-277, eff. 7-20-05.)
 
6    (820 ILCS 305/8.7)
7    Sec. 8.7. Utilization review programs.
8    (a) As used in this Section:
9    "Utilization review" means the evaluation of proposed or
10provided health care services to determine the appropriateness
11of both the level of health care services medically necessary
12and the quality of health care services provided to a patient,
13including evaluation of their efficiency, efficacy, and
14appropriateness of treatment, hospitalization, or office
15visits based on medically accepted standards. The evaluation
16must be accomplished by means of a system that identifies the
17utilization of health care services based on standards of care
18of or nationally recognized peer review guidelines as well as
19nationally recognized treatment guidelines and evidence-based
20medicine evidence based upon standards as provided in this Act.
21Utilization techniques may include prospective review, second
22opinions, concurrent review, discharge planning, peer review,
23independent medical examinations, and retrospective review
24(for purposes of this sentence, retrospective review shall be
25applicable to services rendered on or after July 20, 2005).

 

 

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

 

 

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

 

 

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

 

 

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1fee for each person conducting a utilization review program.
2    (i) Upon receipt of written notice that the employer or the
3employer's agent or insurer wishes to invoke the utilization
4review process, the provider of medical, surgical or hospital
5services shall submit to the utilization review, following URAC
6procedural guidelines and appeal process. If the provider fails
7to submit to utilization review of proposed treatment or
8services, the charges for the treatment or service shall not be
9compensable or collectible against the employer, the
10employer's agent or insurer, or the employee. When an employer
11denies payment of or refuses to authorize payment of first aid,
12medical, surgical, or hospital services under Section 8(a) of
13this Act that complies with subsection (b) of this Section,
14that denial or refusal to authorize shall create a rebuttable
15presumption that the extent and scope of medical treatment is
16excessive or unnecessary. That presumption may be rebutted by
17establishing by a preponderance of the evidence that a variance
18from the standards of care or guidelines used pursuant to
19subsection (a) of this Section is reasonably required to cure
20and relieve the employee from the effects of his or her injury
21or that the utilization review did not comply with subsection
22(b) of this Section.
23    (i) A utilization review will be considered by the
24Commission, along with all other evidence and in the same
25manner as all other evidence, in the determination of the
26reasonableness and necessity of the medical bills or treatment.

 

 

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1Nothing in this Section shall be construed to diminish the
2rights of employees to reasonable and necessary medical
3treatment or employee choice of health care provider under
4Section 8(a) or the rights of employers to medical examinations
5under Section 12.
6    (j) When an employer denies payment of or refuses to
7authorize payment of first aid, medical, surgical, or hospital
8services under Section 8(a) of this Act, if that denial or
9refusal to authorize complies with a utilization review program
10registered under this Section and complies with all other
11requirements of this Section, then there shall be a rebuttable
12presumption that the employer shall not be responsible for
13payment of additional compensation pursuant to Section 19(k) of
14this Act and if that denial or refusal to authorize does not
15comply with a utilization review program registered under this
16Section and does not comply with all other requirements of this
17Section, then that will be considered by the Commission, along
18with all other evidence and in the same manner as all other
19evidence, in the determination of whether the employer may be
20responsible for the payment of additional compensation
21pursuant to Section 19(k) of this Act.
22    The changes to this Section made by this amendatory Act of
23the 97th General Assembly apply only to medical services
24provided on or after the effective date of this amendatory Act
25of the 97th General Assembly.
26(Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
 

 

 

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1    (820 ILCS 305/11)  (from Ch. 48, par. 138.11)
2    Sec. 11. The compensation herein provided, together with
3the provisions of this Act, shall be the measure of the
4responsibility of any employer engaged in any of the
5enterprises or businesses enumerated in Section 3 of this Act,
6or of any employer who is not engaged in any such enterprises
7or businesses, but who has elected to provide and pay
8compensation for accidental injuries sustained by any employee
9arising out of and in the course of the employment according to
10the provisions of this Act, and whose election to continue
11under this Act, has not been nullified by any action of his
12employees as provided for in this Act.
13    Accidental injuries incurred while participating in
14voluntary recreational programs including but not limited to
15athletic events, parties and picnics do not arise out of and in
16the course of the employment even though the employer pays some
17or all of the cost thereof. This exclusion shall not apply in
18the event that the injured employee was ordered or assigned by
19his employer to participate in the program.
20    Accidental injuries incurred while participating as a
21patient in a drug or alcohol rehabilitation program do not
22arise out of and in the course of employment even though the
23employer pays some or all of the costs thereof.
24    Any injury to or disease or death of an employee arising
25from the administration of a vaccine, including without

 

 

09700SB1349sam001- 75 -LRB097 07516 AEK 54114 a

1limitation smallpox vaccine, to prepare for, or as a response
2to, a threatened or potential bioterrorist incident to the
3employee as part of a voluntary inoculation program in
4connection with the person's employment or in connection with
5any governmental program or recommendation for the inoculation
6of workers in the employee's occupation, geographical area, or
7other category that includes the employee is deemed to arise
8out of and in the course of the employment for all purposes
9under this Act. This paragraph added by this amendatory Act of
10the 93rd General Assembly is declarative of existing law and is
11not a new enactment.
12    No compensation shall be payable if (i) the employee's
13intoxication is the proximate cause of the employee's
14accidental injury or (ii) at the time the employee incurred
15accidental injury, the employee was so intoxicated that the
16intoxication constituted a departure from the employment.
17Admissible evidence of the concentration of (1) alcohol, (2)
18cannabis as defined in the Cannabis Control Act, (3) a
19controlled substance listed in the Illinois Controlled
20Substances Act, or (4) an intoxicating compound listed in the
21Use of Intoxicating Compounds Act in the employee's blood,
22breath, or urine at the time the employee incurred the
23accidental injury shall be considered in any hearing under this
24Act to determine whether the employee was intoxicated at the
25time the employee incurred the accidental injuries. If at the
26time of the accidental injuries, there was 0.08% or more by

 

 

09700SB1349sam001- 76 -LRB097 07516 AEK 54114 a

1weight of alcohol in the employee's blood, breath, or urine or
2if there is any evidence of impairment due to the unlawful or
3unauthorized use of (1) cannabis as defined in the Cannabis
4Control Act, (2) a controlled substance listed in the Illinois
5Controlled Substances Act, or (3) an intoxicating compound
6listed in the Use of Intoxicating Compounds Act or if the
7employee refuses to submit to testing of blood, breath, or
8urine, then there shall be a rebuttable presumption that the
9employee was intoxicated and that the intoxication was the
10proximate cause of the employee's injury. The employee may
11overcome the rebuttable presumption by the preponderance of the
12admissible evidence that the intoxication was not the proximate
13cause of the accidental injuries. Percentage by weight of
14alcohol in the blood shall be based on grams of alcohol per 100
15milliliters of blood. Percentage by weight of alcohol in the
16breath shall be based upon grams of alcohol per 210 liters of
17breath. Any testing that has not been performed by an
18accredited or certified testing laboratory shall not be
19admissible in any hearing under this Act to determine whether
20the employee was intoxicated at the time the employee incurred
21the accidental injury.
22    All sample collection and testing for alcohol and drugs
23under this Section shall be performed in accordance with rules
24to be adopted by the Commission. These rules shall ensure:
25        (1) compliance with the National Labor Relations Act
26    regarding collective bargaining agreements or regulations

 

 

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1    promulgated by the United States Department of
2    Transportation;
3        (2) that samples are collected and tested in
4    conformance with national and State legal and regulatory
5    standards for the privacy of the individual being tested,
6    and in a manner reasonably calculated to prevent
7    substitutions or interference with the collection or
8    testing of reliable sample;
9        (3) that split testing procedures are utilized;
10        (4) sample collection is documented, and the
11    documentation procedures include:
12            (A) the labeling of samples in a manner so as to
13        reasonably preclude the probability of erroneous
14        identification of test result; and
15            (B) an opportunity for the employee to provide
16        notification of any information which he or she
17        considers relevant to the test, including
18        identification of currently or recently used
19        prescription or nonprescription drugs and other
20        relevant medical information;
21        (5) that sample collection, storage, and
22    transportation to the place of testing is performed in a
23    manner so as to reasonably preclude the probability of
24    sample contamination or adulteration; and
25        (6) that chemical analyses of blood, urine, breath, or
26    other bodily substance are performed according to

 

 

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1    nationally scientifically accepted analytical methods and
2    procedures.
3    The changes to this Section made by this amendatory Act of
4the 97th General Assembly apply only to accidental injuries
5that occur on or after the effective date of this amendatory
6Act of the 97th General Assembly.
7(Source: P.A. 93-829, eff. 7-28-04.)
 
8    (820 ILCS 305/16)  (from Ch. 48, par. 138.16)
9    Sec. 16. The Commission shall make and publish procedural
10rules and orders for carrying out the duties imposed upon it by
11law and for determining the extent of disability sustained,
12which rules and orders shall be deemed prima facie reasonable
13and valid.
14    The process and procedure before the Commission shall be as
15simple and summary as reasonably may be.
16    The Commission upon application of either party may issue
17dedimus potestatem directed to a commissioner, notary public,
18justice of the peace or any other officer authorized by law to
19administer oaths, to take the depositions of such witness or
20witnesses as may be necessary in the judgment of such
21applicant. Such dedimus potestatem may issue to any of the
22officers aforesaid in any state or territory of the United
23States. When the deposition of any witness resident of a
24foreign country is desired to be taken, the dedimus shall be
25directed to and the deposition taken before a consul, vice

 

 

09700SB1349sam001- 79 -LRB097 07516 AEK 54114 a

1consul or other authorized representative of the government of
2the United States of America, whose station is in the country
3where the witness whose deposition is to be taken resides. In
4countries where the government of the United States has no
5consul or other diplomatic representative, then depositions in
6such case shall be taken through the appropriate judicial
7authority of that country; or where treaties provide for other
8methods of taking depositions, then the same may be taken as in
9such treaties provided. The Commission shall have the power to
10adopt necessary rules to govern the issue of such dedimus
11potestatem.
12    The Commission, or any member thereof, or any Arbitrator
13designated by the Commission shall have the power to administer
14oaths, subpoena and examine witnesses; to issue subpoenas duces
15tecum, requiring the production of such books, papers, records
16and documents as may be evidence of any matter under inquiry
17and to examine and inspect the same and such places or premises
18as may relate to the question in dispute. The Commission, or
19any member thereof, or any Arbitrator designated by the
20Commission, shall on written request of either party to the
21dispute, issue subpoenas for the attendance of such witnesses
22and production of such books, papers, records and documents as
23shall be designated in the applications, and the parties
24applying for such subpoena shall advance the officer and
25witness fees provided for in civil actions pending in circuit
26courts of this State, except as otherwise provided by Section

 

 

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120 of this Act. Service of such subpoena shall be made by any
2sheriff or other person. In case any person refuses to comply
3with an order of the Commission or subpoenas issued by it or by
4any member thereof, or any Arbitrator designated by the
5Commission or to permit an inspection of places or premises, or
6to produce any books, papers, records or documents, or any
7witness refuses to testify to any matters regarding which he or
8she may be lawfully interrogated, the Circuit Court of the
9county in which the hearing or matter is pending, on
10application of any member of the Commission or any Arbitrator
11designated by the Commission, shall compel obedience by
12attachment proceedings, as for contempt, as in a case of
13disobedience of the requirements of a subpoena from such court
14on a refusal to testify therein.
15    The records, reports, and bills kept by a treating
16hospital, treating physician, or other treating healthcare
17provider that renders treatment to the employee as a result of
18accidental injuries in question, certified to as true and
19correct by the hospital, physician, or other healthcare
20provider or by designated agents of the hospital, physician, or
21other healthcare provider, showing the medical and surgical
22treatment given an injured employee by such hospital,
23physician, or other healthcare provider, shall be admissible
24without any further proof as evidence of the medical and
25surgical matters stated therein, but shall not be conclusive
26proof of such matters. Any records, reports and bills submitted

 

 

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1under this Section shall be limited for the purpose of
2establishing that the care and treatment was rendered and shall
3not be for the purpose of establishing causal connection, need
4for care or degree of disability. There shall be a rebuttable
5presumption that any such records, reports, and bills received
6in response to Commission subpoena are certified to be true and
7correct. This paragraph does not restrict, limit, or prevent
8the admissibility of records, reports, or bills that are
9otherwise admissible. This provision does not apply to reports
10prepared by treating providers for use in litigation.
11    The Commission at its expense shall provide an official
12court reporter to take the testimony and record of proceedings
13at the hearings before an Arbitrator or the Commission, who
14shall furnish a transcript of such testimony or proceedings to
15either party requesting it, upon payment therefor at the rate
16of $1.00 per page for the original and 35 cents per page for
17each copy of such transcript. Payment for photostatic copies of
18exhibits shall be extra. If the Commission has determined, as
19provided in Section 20 of this Act, that the employee is a poor
20person, a transcript of such testimony and proceedings,
21including photostatic copies of exhibits, shall be furnished to
22such employee at the Commission's expense.
23    The Commission shall have the power to determine the
24reasonableness and fix the amount of any fee of compensation
25charged by any person, including attorneys, physicians,
26surgeons and hospitals, for any service performed in connection

 

 

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1with this Act, or for which payment is to be made under this
2Act or rendered in securing any right under this Act.
3    Whenever the Commission shall find that the employer, his
4or her agent, service company or insurance carrier has been
5guilty of delay or unfairness towards an employee in the
6adjustment, settlement or payment of benefits due such employee
7within the purview of the provisions of paragraph (c) of
8Section 4 of this Act; or has been guilty of unreasonable or
9vexatious delay, intentional under-payment of compensation
10benefits, or has engaged in frivolous defenses which do not
11present a real controversy, within the purview of the
12provisions of paragraph (k) of Section 19 of this Act, the
13Commission may assess all or any part of the attorney's fees
14and costs against such employer and his or her insurance
15carrier.
16(Source: P.A. 94-277, eff. 7-20-05.)
 
17    (820 ILCS 305/16b new)
18    Sec. 16b. Signature constitutes certification. The
19signature of an attorney on any petition, motion, or other
20paper filed with the Commission constitutes a certification by
21he or she that he or she has read the petition, motion, or
22other paper, and, that to the best of his or her knowledge,
23information, and belief formed after reasonable inquiry that it
24is well grounded in fact, that it is warranted by existing law
25or a good faith argument for an extension, modification, or

 

 

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1reversal of existing law, and that it is not interposed for any
2improper purpose, such as to harass or to cause unnecessary
3delay or needless increase in the cost of litigation. If a
4petition, motion, or other paper is signed in violation of this
5Section, the Commission, upon motion or upon its own
6initiative, may impose on the attorney an appropriate penalty
7or may order him or her to pay the other party the amount of
8reasonable expenses incurred because of the filing of the
9petition, motion, or other paper, including reasonable
10attorneys' fees.
 
11    (820 ILCS 305/16c new)
12    Sec. 16c. Gift Ban.
13    (a) An attorney appearing before the Commission shall not
14provide compensation or any gift to any person in exchange for
15the referral of a client involving a matter to be heard before
16the Commission except for a division of a fee between lawyers
17who are not in the same firm in accordance with Rule 1.5 of the
18Code of Professional Responsibility. For purposes of this
19Section, "gift" means any gratuity, discount, entertainment,
20hospitality, loan, forbearance, or any other tangible or
21intangible item having monetary value including, but not
22limited to, cash food and drink and honoraria except for up to
23$75 per day per person for food and beverage.
24    (b) Violation of this Section is a Class A misdemeanor.
 

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1law or fact, whether ultimate or otherwise, which are submitted
2in writing by either party; provided further that not more than
35 such questions may be submitted by either party. Any party
4may, within 20 days after receipt of notice of the Commission's
5decision, or within such further time, not exceeding 30 days,
6as the Commission may grant, file with the Commission either an
7agreed statement of the facts appearing upon the hearing, or,
8if such party shall so elect, a correct transcript of evidence
9of the additional proceedings presented before the Commission,
10in which report the party may embody a correct statement of
11such other proceedings in the case as such party may desire to
12have reviewed, such statement of facts or transcript of
13evidence to be authenticated by the signature of the parties or
14their attorneys, and in the event that they do not agree, then
15the authentication of such transcript of evidence shall be by
16the signature of any member of the Commission.
17    If a reporter does not for any reason furnish a transcript
18of the proceedings before the Arbitrator in any case for use on
19a hearing for review before the Commission, within the
20limitations of time as fixed in this Section, the Commission
21may, in its discretion, order a trial de novo before the
22Commission in such case upon application of either party. The
23applications for adjustment of claim and other documents in the
24nature of pleadings filed by either party, together with the
25decisions of the Arbitrator and of the Commission and the
26statement of facts or transcript of evidence hereinbefore

 

 

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

 

 

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

 

 

09700SB1349sam001- 101 -LRB097 07516 AEK 54114 a

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

 

 

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

 

 

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

 

 

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

 

 

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1proceedings and in the court entering the judgment for the
2person in whose favor the judgment is entered, which judgment
3and costs taxed as therein provided shall, until and unless set
4aside, have the same effect as though duly entered in an action
5duly tried and determined by the court, and shall with like
6effect, be entered and docketed. The Circuit Court shall have
7power at any time upon application to make any such judgment
8conform to any modification required by any subsequent decision
9of the Supreme Court upon appeal, or as the result of any
10subsequent proceedings for review, as provided in this Act.
11    Judgment shall not be entered until 15 days' notice of the
12time and place of the application for the entry of judgment
13shall be served upon the employer by filing such notice with
14the Commission, which Commission shall, in case it has on file
15the address of the employer or the name and address of its
16agent upon whom notices may be served, immediately send a copy
17of the notice to the employer or such designated agent.
18    (h) An agreement or award under this Act providing for
19compensation in installments, may at any time within 18 months
20after such agreement or award be reviewed by the Commission at
21the request of either the employer or the employee, on the
22ground that the disability of the employee has subsequently
23recurred, increased, diminished or ended.
24    However, as to accidents occurring subsequent to July 1,
251955, which are covered by any agreement or award under this
26Act providing for compensation in installments made as a result

 

 

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1of such accident, such agreement or award may at any time
2within 30 months, or 60 months in the case of an award under
3Section 8(d)1, after such agreement or award be reviewed by the
4Commission at the request of either the employer or the
5employee on the ground that the disability of the employee has
6subsequently recurred, increased, diminished or ended.
7    On such review, compensation payments may be
8re-established, increased, diminished or ended. The Commission
9shall give 15 days' notice to the parties of the hearing for
10review. Any employee, upon any petition for such review being
11filed by the employer, shall be entitled to one day's notice
12for each 100 miles necessary to be traveled by him in attending
13the hearing of the Commission upon the petition, and 3 days in
14addition thereto. Such employee shall, at the discretion of the
15Commission, also be entitled to 5 cents per mile necessarily
16traveled by him within the State of Illinois in attending such
17hearing, not to exceed a distance of 300 miles, to be taxed by
18the Commission as costs and deposited with the petition of the
19employer.
20    When compensation which is payable in accordance with an
21award or settlement contract approved by the Commission, is
22ordered paid in a lump sum by the Commission, no review shall
23be had as in this paragraph mentioned.
24    (i) Each party, upon taking any proceedings or steps
25whatsoever before any Arbitrator, Commission or court, shall
26file with the Commission his address, or the name and address

 

 

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1of any agent upon whom all notices to be given to such party
2shall be served, either personally or by registered mail,
3addressed to such party or agent at the last address so filed
4with the Commission. In the event such party has not filed his
5address, or the name and address of an agent as above provided,
6service of any notice may be had by filing such notice with the
7Commission.
8    (j) Whenever in any proceeding testimony has been taken or
9a final decision has been rendered and after the taking of such
10testimony or after such decision has become final, the injured
11employee dies, then in any subsequent proceedings brought by
12the personal representative or beneficiaries of the deceased
13employee, such testimony in the former proceeding may be
14introduced with the same force and effect as though the witness
15having so testified were present in person in such subsequent
16proceedings and such final decision, if any, shall be taken as
17final adjudication of any of the issues which are the same in
18both proceedings.
19    (k) In case where there has been any unreasonable or
20vexatious delay of payment or intentional underpayment of
21compensation, or proceedings have been instituted or carried on
22by the one liable to pay the compensation, which do not present
23a real controversy, but are merely frivolous or for delay, then
24the Commission may award compensation additional to that
25otherwise payable under this Act equal to 50% of the amount
26payable at the time of such award. Failure to pay compensation

 

 

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1in accordance with the provisions of Section 8, paragraph (b)
2of this Act, shall be considered unreasonable delay.
3    When determining whether this subsection (k) shall apply,
4the Commission shall consider whether an Arbitrator has
5determined that the claim is not compensable or whether the
6employer has made payments under Section 8(j).
7    (l) If the employee has made written demand for payment of
8benefits under Section 8(a) or Section 8(b), the employer shall
9have 14 days after receipt of the demand to set forth in
10writing the reason for the delay. In the case of demand for
11payment of medical benefits under Section 8(a), the time for
12the employer to respond shall not commence until the expiration
13of the allotted 60 days specified under Section 8.2(d). In case
14the employer or his or her insurance carrier shall without good
15and just cause fail, neglect, refuse, or unreasonably delay the
16payment of benefits under Section 8(a) or Section 8(b), the
17Arbitrator or the Commission shall allow to the employee
18additional compensation in the sum of $30 per day for each day
19that the benefits under Section 8(a) or Section 8(b) have been
20so withheld or refused, not to exceed $10,000. A delay in
21payment of 14 days or more shall create a rebuttable
22presumption of unreasonable delay. Notwithstanding the
23foregoing, any such additional compensation awarded on or after
24the effective date of this amendatory Act of the 97th General
25Assembly that is awarded because the benefits under Section
268(a) have been so withheld or refused shall be distributed

 

 

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1first to the provider of medical services to pay any unpaid
2amounts due and any interest due under Section 8.2.
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.)
 
19    (820 ILCS 305/25.5)
20    Sec. 25.5. Unlawful acts; penalties.
21    (a) It is unlawful for any person, company, corporation,
22insurance carrier, healthcare provider, or other entity to:
23        (1) Intentionally present or cause to be presented any
24    false or fraudulent claim for the payment of any workers'
25    compensation benefit.

 

 

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1        (2) Intentionally make or cause to be made any false or
2    fraudulent material statement or material representation
3    for the purpose of obtaining or denying any workers'
4    compensation benefit.
5        (3) Intentionally make or cause to be made any false or
6    fraudulent statements with regard to entitlement to
7    workers' compensation benefits with the intent to prevent
8    an injured worker from making a legitimate claim for any
9    workers' compensation benefits.
10        (4) Intentionally prepare or provide an invalid,
11    false, or counterfeit certificate of insurance as proof of
12    workers' compensation insurance.
13        (5) Intentionally make or cause to be made any false or
14    fraudulent material statement or material representation
15    for the purpose of obtaining workers' compensation
16    insurance at less than the proper rate for that insurance.
17        (6) Intentionally make or cause to be made any false or
18    fraudulent material statement or material representation
19    on an initial or renewal self-insurance application or
20    accompanying financial statement for the purpose of
21    obtaining self-insurance status or reducing the amount of
22    security that may be required to be furnished pursuant to
23    Section 4 of this Act.
24        (7) Intentionally make or cause to be made any false or
25    fraudulent material statement to the Division of
26    Insurance's fraud and insurance non-compliance unit in the

 

 

09700SB1349sam001- 114 -LRB097 07516 AEK 54114 a

1    course of an investigation of fraud or insurance
2    non-compliance.
3        (8) Intentionally assist, abet, solicit, or conspire
4    with any person, company, or other entity to commit any of
5    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
6    of this subsection (a).
7        (9) Intentionally present a bill or statement for the
8    payment for medical services that were not provided.
9    For the purposes of paragraphs (2), (3), (5), (6), and (7),
10and (9), the term "statement" includes any writing, notice,
11proof of injury, bill for services, hospital or doctor records
12and reports, or X-ray and test results.
13    (b) Sentence for violations of subsection (a): Any person
14violating subsection (a) is guilty of a Class 4 felony. Any
15person or entity convicted of any violation of this Section
16shall be ordered to pay complete restitution to any person or
17entity so defrauded in addition to any fine or sentence imposed
18as a result of the conviction.
19        (1) A violation in which the value of the property
20    obtained or attempted to be obtained is $300 or less is a
21    Class A misdemeanor.
22        (2) A violation in which the value of the property
23    obtained or attempted to be obtained is more than $300 but
24    not more than $10,000 is a Class 3 felony.
25        (3) A violation in which the value of the property
26    obtained or attempted to be obtained is more than $10,000

 

 

09700SB1349sam001- 115 -LRB097 07516 AEK 54114 a

1    but not more than $100,000 is a Class 2 felony.
2        (4) A violation in which the value of the property
3    obtained or attempted to be obtained is more than $100,000
4    is a Class 1 felony.
5        (5) A person convicted under this Section shall be
6    ordered to pay monetary restitution to the insurance
7    company or self-insured entity or any other person for any
8    financial loss sustained as a result of a violation of this
9    Section, including any court costs and attorney fees. An
10    order of restitution also includes expenses incurred and
11    paid by the State of Illinois or an insurance company or
12    self-insured entity in connection with any medical
13    evaluation or treatment services.
14        (6) For the purposes of this Section, where the exact
15    value of property obtained or attempted to be obtained is
16    either not alleged or is not specifically set by the terms
17    of a policy of insurance, the value of the property shall
18    be the fair market replacement value of the property
19    claimed to be lost, the reasonable costs of reimbursing a
20    vendor or other claimant for services to be rendered, or
21    both.
22    (c) The Department Division of Insurance of the Department
23of Financial and Professional Regulation shall establish a
24fraud and insurance non-compliance unit responsible for
25investigating incidences of fraud and insurance non-compliance
26pursuant to this Section. The size of the staff of the unit

 

 

09700SB1349sam001- 116 -LRB097 07516 AEK 54114 a

1shall be subject to appropriation by the General Assembly. It
2shall be the duty of the fraud and insurance non-compliance
3unit to determine the identity of insurance carriers,
4employers, employees, or other persons or entities who have
5violated the fraud and insurance non-compliance provisions of
6this Section. The fraud and insurance non-compliance unit shall
7report violations of the fraud and insurance non-compliance
8provisions of this Section to the Special Prosecutions Bureau
9of the Criminal Division of the Office of the Attorney General
10or to the State's Attorney of the county in which the offense
11allegedly occurred, either of whom has the authority to
12prosecute violations under this Section.
13    With respect to the subject of any investigation being
14conducted, the fraud and insurance non-compliance unit shall
15have the general power of subpoena of the Department Division
16of Insurance.
17    (d) Any person may report allegations of insurance
18non-compliance and fraud pursuant to this Section to the
19Division of Insurance's fraud and insurance non-compliance
20unit whose duty it shall be to investigate the report. The unit
21shall notify the Commission of reports of insurance
22non-compliance. Any person reporting an allegation of
23insurance non-compliance or fraud against either an employee or
24employer under this Section must identify himself. Except as
25provided in this subsection and in subsection (e), all reports
26shall remain confidential except to refer an investigation to

 

 

09700SB1349sam001- 117 -LRB097 07516 AEK 54114 a

1the Attorney General or State's Attorney for prosecution or if
2the fraud and insurance non-compliance unit's investigation
3reveals that the conduct reported may be in violation of other
4laws or regulations of the State of Illinois, the unit may
5report such conduct to the appropriate governmental agency
6charged with administering such laws and regulations. Any
7person who intentionally makes a false report under this
8Section to the fraud and insurance non-compliance unit is
9guilty of a Class A misdemeanor.
10    (e) In order for the fraud and insurance non-compliance
11unit to investigate a report of fraud related to an employee's
12claim by an employee, (i) the employee must have filed with the
13Commission an Application for Adjustment of Claim and the
14employee must have either received or attempted to receive
15benefits under this Act that are related to the reported fraud
16or (ii) the employee must have made a written demand for the
17payment of benefits that are related to the reported fraud.
18Upon receipt of a report of fraud, the employee or employer
19shall receive immediate notice of the reported conduct,
20including the verified name and address of the complainant if
21that complainant is connected to the case and the nature of the
22reported conduct. The fraud and insurance non-compliance unit
23shall resolve all reports of fraud against employees or
24employers within 120 days of receipt of the report. There shall
25be no immunity, under this Act or otherwise, for any person who
26files a false report or who files a report without good and

 

 

09700SB1349sam001- 118 -LRB097 07516 AEK 54114 a

1just cause. Confidentiality of medical information shall be
2strictly maintained. Investigations that are not referred for
3prosecution shall be destroyed upon the expiration of the
4statute of limitations for the acts under investigation
5immediately expunged and shall not be disclosed except that the
6employee or employer who was the subject of the report and the
7person making the report shall be notified that the
8investigation is being closed, at which time the name of any
9complainant not connected to the case shall be disclosed to the
10employee or the employer. It is unlawful for any employer,
11insurance carrier, or service adjustment company, third party
12administrator, self-insured, or similar entity to file or
13threaten to file a report of fraud against an employee because
14of the exercise by the employee of the rights and remedies
15granted to the employee by this Act.
16    For purposes of this subsection (e), "employer" means any
17employer, insurance carrier, third party administrator,
18self-insured, or similar entity.
19    For purposes of this subsection (e), "complainant" refers
20to the person contacting the fraud and insurance non-compliance
21unit to initiate the complaint.
22    (f) Any person convicted of fraud related to workers'
23compensation pursuant to this Section shall be subject to the
24penalties prescribed in the Criminal Code of 1961 and shall be
25ineligible to receive or retain any compensation, disability,
26or medical benefits as defined in this Act if the compensation,

 

 

09700SB1349sam001- 119 -LRB097 07516 AEK 54114 a

1disability, or medical benefits were owed or received as a
2result of fraud for which the recipient of the compensation,
3disability, or medical benefit was convicted. This subsection
4applies to accidental injuries or diseases that occur on or
5after the effective date of this amendatory Act of the 94th
6General Assembly.
7    (g) Civil liability. Any person convicted of fraud who
8knowingly obtains, attempts to obtain, or causes to be obtained
9any benefits under this Act by the making of a false claim or
10who knowingly misrepresents any material fact shall be civilly
11liable to the payor of benefits or the insurer or the payor's
12or insurer's subrogee or assignee in an amount equal to 3 times
13the value of the benefits or insurance coverage wrongfully
14obtained or twice the value of the benefits or insurance
15coverage attempted to be obtained, plus reasonable attorney's
16fees and expenses incurred by the payor or the payor's subrogee
17or assignee who successfully brings a claim under this
18subsection. This subsection applies to accidental injuries or
19diseases that occur on or after the effective date of this
20amendatory Act of the 94th General Assembly.
21    (h) The All proceedings under this Section shall be
22reported by the fraud and insurance non-compliance unit shall
23submit a written report on an annual basis to the Workers'
24Compensation Advisory Board the General Assembly, the
25Governor, and the Attorney General by January 1st and July 1st
26of each year. This report shall include, at the minimum, the

 

 

09700SB1349sam001- 120 -LRB097 07516 AEK 54114 a

1following information:
2        (1) The number of allegations of insurance
3    non-compliance and fraud reported to the fraud and
4    insurance non-compliance unit.
5        (2) The source of the reported allegations
6    (individual, employer, or other).
7        (3) The number of allegations investigated by the fraud
8    and insurance non-compliance unit.
9        (4) The number of criminal referrals made in accordance
10    with this Section and the entity to which the referral was
11    made.
12        (5) All proceedings under this Section.
13(Source: P.A. 94-277, eff. 7-20-05.)
 
14    Section 99. Effective date. This Act takes effect upon
15becoming law.".