99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB2154

 

Introduced 7/14/2015, by Sen. Christine Radogno

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Workers' Compensation Act. Provides that, to obtain compensation under the Act, an employee bears the burden of showing, by a preponderance of the credible evidence, that he or she has sustained accidental injuries arising out of and in the course of the employment and the accidental injuries arising out of and in the course of the employment are the major contributing cause of the medical condition or injury for which compensation is being sought. Defines "major contributing cause". Provides that accidental injuries are not considered to be arising out of and in the course of employment under specified circumstances; adds provisions regarding certain injuries; provides that an injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings; and adds provisions regarding employees who are traveling or on a break. Makes changes regarding workers' compensation insurance. Provides for a reduction of an award by amounts an injured worker has previously received for prior injuries that resulted in permanency awards. Reduces certain payments under fee schedules. Provides that the Illinois Workers' Compensation Commission, rather than the Director of Insurance, shall adopt rules regarding electronic claims. Provides that the Commission shall establish the Workers' Compensation Ombudsman Program within the Commission and sets forth the Program's responsibilities. Creates the Workers' Compensation Edit, Alignment, and Reform Commission to develop a proposed recodification of the Workers' Compensation Act. Provides that the Commission shall procure and implement a computer system to replace its current computer system. Makes changes regarding unlawful acts and penalties. Makes other changes.


LRB099 13035 SXM 36947 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2154LRB099 13035 SXM 36947 b

1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 4, 8, 8.1b, 8.2, 8.2a, 14, 19, and 25.5
6and by adding Sections 14.2, 14.3, and 14.4 as follows:
 
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
17in service or under any contract for hire, express or implied,
18oral or written, and who is engaged in any of the enterprises
19or businesses enumerated in Section 3 of this Act, or who at or
20prior to the time of the accident to the employee for which
21compensation under this Act may be claimed, has in the manner
22provided in this Act elected to become subject to the
23provisions of this Act, and who has not, prior to such

 

 

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

 

 

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

 

 

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

 

 

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1hire, express or implied, oral or written, including all
2members of the Illinois National Guard while on active duty in
3the service of the State, and all probation personnel of the
4Juvenile Court appointed pursuant to Article VI of the Juvenile
5Court Act of 1987, and including any official of the State, any
6county, city, town, township, incorporated village, school
7district, body politic or municipal corporation therein except
8any duly appointed member of a police department in any city
9whose population exceeds 500,000 according to the last Federal
10or State census, and except any member of a fire insurance
11patrol maintained by a board of underwriters in this State. A
12duly appointed member of a fire department in any city, the
13population of which exceeds 500,000 according to the last
14federal or State census, is an employee under this Act only
15with respect to claims brought under paragraph (c) of Section
168.
17    One employed by a contractor who has contracted with the
18State, or a county, city, town, township, incorporated village,
19school district, body politic or municipal corporation
20therein, through its representatives, is not considered as an
21employee of the State, county, city, town, township,
22incorporated village, school district, body politic or
23municipal corporation which made the contract.
24    2. Every person in the service of another under any
25contract of hire, express or implied, oral or written,
26including persons whose employment is outside of the State of

 

 

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

 

 

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1where such laws are held to be exclusive.
2    The term "employee" does not include persons performing
3services as real estate broker, broker-salesman, or salesman
4when such persons are paid by commission only.
5    (c) "Commission" means the Industrial Commission created
6by Section 5 of "The Civil Administrative Code of Illinois",
7approved March 7, 1917, as amended, or the Illinois Workers'
8Compensation Commission created by Section 13 of this Act.
9    (d) (1) To obtain compensation under this Act, an employee
10bears the burden of showing, by a preponderance of the credible
11evidence, that (i) he or she has sustained accidental injuries
12arising out of and in the course of the employment and (ii) the
13accidental injuries arising out of and in the course of the
14employment are the major contributing cause of the medical
15condition or injury for which compensation is being sought. The
16"major contributing cause" of a medical condition or injury is
17the cause that is greater than 50% of all combined causes of
18the medical condition or injury.
19    Accidental injuries shall not be considered to be "arising
20out of and in the course of employment" if, without limitation:
21(A) the accident resulted from a hazard or risk that was not
22incidental to the employment or the accident resulted from a
23hazard or risk to which the general public is also exposed, (B)
24the accident did not occur at a time and place and under
25circumstances reasonably required by the employment, or (C) the
26medical condition or injury for which compensation is being

 

 

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1sought resulted from a personal or neutral risk.
2    (2) For the purposes of clause (ii) of paragraph (1) only,
3if an employee has suffered cumulative or repetitive accidental
4injuries while employed in the same occupation or industry by
5multiple employers over time, the accidental injuries arising
6out of and in the course of the employment shall be considered
7to be the major contributing cause of the medical condition or
8injury for which compensation is being sought if those
9cumulative or repetitive accidental injuries suffered during
10employment in that occupation or industry are greater than 50%
11of all combined causes of the medical condition or injury. In
12that circumstance, the employer liable for compensation under
13this Act shall be the most recent current or former employer
14who has employed the employee for at least 3 months.
15    (3) An injury, its occupational cause, and any resulting
16manifestations or disability must be established to a
17reasonable degree of medical certainty, based on objective
18relevant medical findings.
19    (e) An employee who is required to travel in connection
20with his or her employment and who suffers an injury while in
21travel status shall be eligible for benefits only if the injury
22arises out of and in the course of employment and the travel is
23necessary for the performance of job duties. Travel is
24necessary for the performance of job duties if (i) the employer
25furnishes the transportation or the employee receives
26reimbursement from the employer for costs of travel, gas, or

 

 

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1lodging as part of the employee's benefits or employment
2agreement and (ii) travel is required by the employer as part
3of the employee's job duties.
4    An injury suffered by a traveling employee is deemed to
5arise out of his or her employment if caused by a risk
6incidental to or connected with the employment. Risk is not to
7be determined by a reasonable and foreseeable standard.
8    Arising in and out of the course of employment does not
9include travel to and from work or when an employee is on a
10paid or unpaid break and is not performing any specific tasks
11for the employer during the break. Common risks associated with
12travel even where the traveling employee is exposed to a
13greater degree than the general public do not arise out of the
14employment.
15(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
16eff. 7-13-12.)
 
17    (820 ILCS 305/4)  (from Ch. 48, par. 138.4)
18    Sec. 4. (a) Any employer, including but not limited to
19general contractors and their subcontractors, who shall come
20within the provisions of Section 3 of this Act, and any other
21employer who shall elect to provide and pay the compensation
22provided for in this Act shall:
23        (1) File with the Commission annually an application
24    for approval as a self-insurer which shall include a
25    current financial statement, and annually, thereafter, an

 

 

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1    application for renewal of self-insurance, which shall
2    include a current financial statement. Said application
3    and financial statement shall be signed and sworn to by the
4    president or vice president and secretary or assistant
5    secretary of the employer if it be a corporation, or by all
6    of the partners, if it be a copartnership, or by the owner
7    if it be neither a copartnership nor a corporation. All
8    initial applications and all applications for renewal of
9    self-insurance must be submitted at least 60 days prior to
10    the requested effective date of self-insurance. An
11    employer may elect to provide and pay compensation as
12    provided for in this Act as a member of a group workers'
13    compensation pool under Article V 3/4 of the Illinois
14    Insurance Code. If an employer becomes a member of a group
15    workers' compensation pool, the employer shall not be
16    relieved of any obligations imposed by this Act.
17        If the sworn application and financial statement of any
18    such employer does not satisfy the Commission of the
19    financial ability of the employer who has filed it, the
20    Commission shall require such employer to,
21        (2) Furnish security, indemnity or a bond guaranteeing
22    the payment by the employer of the compensation provided
23    for in this Act, provided that any such employer whose
24    application and financial statement shall not have
25    satisfied the commission of his or her financial ability
26    and who shall have secured his liability in part by excess

 

 

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1    workers' compensation liability insurance shall be
2    required to furnish to the Commission security, indemnity
3    or bond guaranteeing his or her payment up to the effective
4    limits of the excess coverage, or
5        (3) Insure his entire liability to pay such
6    compensation in some workers' compensation insurance
7    carrier authorized, licensed, or permitted to do such
8    insurance business in this State. Every policy of a
9    workers' compensation an insurance carrier, insuring the
10    payment of compensation under this Act shall cover all the
11    employees and the entire compensation liability of the
12    insured: Provided, however, that any employer may insure
13    his or her compensation liability with 2 or more workers'
14    compensation insurance carriers or may insure a part and
15    qualify under subsection 1, 2, or 4 for the remainder of
16    his or her liability to pay such compensation, subject to
17    the following two provisions:
18            Firstly, the entire compensation liability of the
19        employer to employees working at or from one location
20        shall be insured in one such workers' compensation
21        insurance carrier or shall be self-insured, and
22            Secondly, the employer shall submit evidence
23        satisfactorily to the Commission that his or her entire
24        liability for the compensation provided for in this Act
25        will be secured. Any provisions in any policy, or in
26        any endorsement attached thereto, attempting to limit

 

 

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1        or modify in any way, the liability of the workers'
2        compensation insurance carriers issuing the same
3        except as otherwise provided herein shall be wholly
4        void.
5        Nothing herein contained shall apply to policies of
6    excess liability carriage secured by employers who have
7    been approved by the Commission as self-insurers, or
8        (4) Make some other provision, satisfactory to the
9    Commission, for the securing of the payment of compensation
10    provided for in this Act, and
11        (5) Upon becoming subject to this Act and thereafter as
12    often as the Commission may in writing demand, file with
13    the Commission in form prescribed by it evidence of his or
14    her compliance with the provision of this Section.
15    (a-1) Regardless of its state of domicile or its principal
16place of business, an employer shall make payments to its
17workers' compensation insurance carrier or group
18self-insurance fund, where applicable, based upon the premium
19rates of the situs where the work or project is located in
20Illinois if:
21        (A) the employer is engaged primarily in the building
22    and construction industry; and
23        (B) subdivision (a)(3) of this Section applies to the
24    employer or the employer is a member of a group
25    self-insurance plan as defined in subsection (1) of Section
26    4a.

 

 

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1    The Illinois Workers' Compensation Commission shall impose
2a penalty upon an employer for violation of this subsection
3(a-1) if:
4        (i) the employer is given an opportunity at a hearing
5    to present evidence of its compliance with this subsection
6    (a-1); and
7        (ii) after the hearing, the Commission finds that the
8    employer failed to make payments upon the premium rates of
9    the situs where the work or project is located in Illinois.
10    The penalty shall not exceed $1,000 for each day of work
11for which the employer failed to make payments upon the premium
12rates of the situs where the work or project is located in
13Illinois, but the total penalty shall not exceed $50,000 for
14each project or each contract under which the work was
15performed.
16    Any penalty under this subsection (a-1) must be imposed not
17later than one year after the expiration of the applicable
18limitation period specified in subsection (d) of Section 6 of
19this Act. Penalties imposed under this subsection (a-1) shall
20be deposited into the Illinois Workers' Compensation
21Commission Operations Fund, a special fund that is created in
22the State treasury. Subject to appropriation, moneys in the
23Fund shall be used solely for the operations of the Illinois
24Workers' Compensation Commission and by the Department of
25Insurance for the purposes authorized in subsection (c) of
26Section 25.5 of this Act.

 

 

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1    (a-2) Every Employee Leasing Company (ELC), as defined in
2Section 15 of the Employee Leasing Company Act, shall at a
3minimum provide the following information to the Commission or
4any entity designated by the Commission regarding each workers'
5compensation insurance policy issued to the ELC:
6        (1) Any client company of the ELC listed as an
7    additional named insured.
8        (2) Any informational schedule attached to the master
9    policy that identifies any individual client company's
10    name, FEIN, and job location.
11        (3) Any certificate of workers' compensation insurance
12    coverage document issued to a client company specifying its
13    rights and obligations under the master policy that
14    establishes both the identity and status of the client, as
15    well as the dates of inception and termination of coverage,
16    if applicable.
17    (b) The sworn application and financial statement, or
18security, indemnity or bond, or amount of insurance, or other
19provisions, filed, furnished, carried, or made by the employer,
20as the case may be, shall be subject to the approval of the
21Commission.
22    Deposits under escrow agreements shall be cash, negotiable
23United States government bonds or negotiable general
24obligation bonds of the State of Illinois. Such cash or bonds
25shall be deposited in escrow with any State or National Bank or
26Trust Company having trust authority in the State of Illinois.

 

 

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1    Upon the approval of the sworn application and financial
2statement, security, indemnity or bond or amount of insurance,
3filed, furnished or carried, as the case may be, the Commission
4shall send to the employer written notice of its approval
5thereof. The certificate of compliance by the employer with the
6provisions of subparagraphs (2) and (3) of paragraph (a) of
7this Section shall be delivered by the workers' compensation
8insurance carrier to the Illinois Workers' Compensation
9Commission within five days after the effective date of the
10policy so certified. The workers' compensation insurance so
11certified shall cover all compensation liability occurring
12during the time that the insurance is in effect and no further
13certificate need be filed in case such insurance is renewed,
14extended or otherwise continued by such carrier. The insurance
15so certified shall not be cancelled or in the event that such
16insurance is not renewed, extended or otherwise continued, such
17insurance shall not be terminated until at least 10 days after
18receipt by the Illinois Workers' Compensation Commission of
19notice of the cancellation or termination of said insurance;
20provided, however, that if the employer has secured insurance
21from another workers' compensation insurance carrier, or has
22otherwise secured the payment of compensation in accordance
23with this Section, and such insurance or other security becomes
24effective prior to the expiration of the 10 days, cancellation
25or termination may, at the option of the insurance carrier
26indicated in such notice, be effective as of the effective date

 

 

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1of such other insurance or security.
2    (c) Whenever the Commission shall find that any
3corporation, company, association, aggregation of individuals,
4reciprocal or interinsurers exchange, or other insurer
5effecting workers' compensation insurance in this State shall
6be insolvent, financially unsound, or unable to fully meet all
7payments and liabilities assumed or to be assumed for workers'
8compensation insurance in this State, or shall practice a
9policy of delay or unfairness toward employees in the
10adjustment, settlement, or payment of benefits due such
11employees, the Commission may after reasonable notice and
12hearing order and direct that such corporation, company,
13association, aggregation of individuals, reciprocal or
14interinsurers exchange, or insurer, shall from and after a date
15fixed in such order discontinue the writing of any such
16workers' compensation insurance in this State. Subject to such
17modification of the order as the Commission may later make on
18review of the order, as herein provided, it shall thereupon be
19unlawful for any such corporation, company, association,
20aggregation of individuals, reciprocal or interinsurers
21exchange, or insurer to effect any workers' compensation
22insurance in this State. A copy of the order shall be served
23upon the Director of Insurance by registered mail. Whenever the
24Commission finds that any service or adjustment company used or
25employed by a self-insured employer or by an insurance carrier
26to process, adjust, investigate, compromise or otherwise

 

 

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1handle claims under this Act, has practiced or is practicing a
2policy of delay or unfairness toward employees in the
3adjustment, settlement or payment of benefits due such
4employees, the Commission may after reasonable notice and
5hearing order and direct that such service or adjustment
6company shall from and after a date fixed in such order be
7prohibited from processing, adjusting, investigating,
8compromising or otherwise handling claims under this Act.
9    Whenever the Commission finds that any self-insured
10employer has practiced or is practicing delay or unfairness
11toward employees in the adjustment, settlement or payment of
12benefits due such employees, the Commission may, after
13reasonable notice and hearing, order and direct that after a
14date fixed in the order such self-insured employer shall be
15disqualified to operate as a self-insurer and shall be required
16to insure his entire liability to pay compensation in some
17workers' compensation insurance carrier authorized, licensed
18and permitted to do such insurance business in this State, as
19provided in subparagraph 3 of paragraph (a) of this Section.
20    All orders made by the Commission under this Section shall
21be subject to review by the courts, said review to be taken in
22the same manner and within the same time as provided by Section
2319 of this Act for review of awards and decisions of the
24Commission, upon the party seeking the review filing with the
25clerk of the court to which said review is taken a bond in an
26amount to be fixed and approved by the court to which the

 

 

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1review is taken, conditioned upon the payment of all
2compensation awarded against the person taking said review
3pending a decision thereof and further conditioned upon such
4other obligations as the court may impose. Upon the review the
5Circuit Court shall have power to review all questions of fact
6as well as of law. The penalty hereinafter provided for in this
7paragraph shall not attach and shall not begin to run until the
8final determination of the order of the Commission.
9    (d) Whenever a panel of 3 Commissioners comprised of one
10member of the employing class, one member of the employee
11class, and one member not identified with either the employing
12or employee class, with due process and after a hearing,
13determines an employer has knowingly failed to provide coverage
14as required by paragraph (a) of this Section, the failure shall
15be deemed an immediate serious danger to public health, safety,
16and welfare sufficient to justify service by the Commission of
17a work-stop order on such employer, requiring the cessation of
18all business operations of such employer at the place of
19employment or job site. Any law enforcement agency in the State
20shall, at the request of the Commission, render any assistance
21necessary to carry out the provisions of this Section,
22including, but not limited to, preventing any employee of such
23employer from remaining at a place of employment or job site
24after a work-stop order has taken effect. Any work-stop order
25shall be lifted upon proof of workers' compensation insurance
26as required by this Act. Any orders under this Section are

 

 

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1appealable under Section 19(f) to the Circuit Court.
2    Any individual employer, corporate officer or director of a
3corporate employer, partner of an employer partnership, or
4member of an employer limited liability company who knowingly
5fails to provide coverage as required by paragraph (a) of this
6Section is guilty of a Class 4 felony. This provision shall not
7apply to any corporate officer or director of any
8publicly-owned corporation. Each day's violation constitutes a
9separate offense. The State's Attorney of the county in which
10the violation occurred, or the Attorney General, shall bring
11such actions in the name of the People of the State of
12Illinois, or may, in addition to other remedies provided in
13this Section, bring an action for an injunction to restrain the
14violation or to enjoin the operation of any such employer.
15    Any individual employer, corporate officer or director of a
16corporate employer, partner of an employer partnership, or
17member of an employer limited liability company who negligently
18fails to provide coverage as required by paragraph (a) of this
19Section is guilty of a Class A misdemeanor. This provision
20shall not apply to any corporate officer or director of any
21publicly-owned corporation. Each day's violation constitutes a
22separate offense. The State's Attorney of the county in which
23the violation occurred, or the Attorney General, shall bring
24such actions in the name of the People of the State of
25Illinois.
26    The criminal penalties in this subsection (d) shall not

 

 

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1apply where there exists a good faith dispute as to the
2existence of an employment relationship. Evidence of good faith
3shall include, but not be limited to, compliance with the
4definition of employee as used by the Internal Revenue Service.
5    Employers who are subject to and who knowingly fail to
6comply with this Section shall not be entitled to the benefits
7of this Act during the period of noncompliance, but shall be
8liable in an action under any other applicable law of this
9State. In the action, such employer shall not avail himself or
10herself of the defenses of assumption of risk or negligence or
11that the injury was due to a co-employee. In the action, proof
12of the injury shall constitute prima facie evidence of
13negligence on the part of such employer and the burden shall be
14on such employer to show freedom of negligence resulting in the
15injury. The employer shall not join any other defendant in any
16such civil action. Nothing in this amendatory Act of the 94th
17General Assembly shall affect the employee's rights under
18subdivision (a)3 of Section 1 of this Act. Any employer or
19carrier who makes payments under subdivision (a)3 of Section 1
20of this Act shall have a right of reimbursement from the
21proceeds of any recovery under this Section.
22    An employee of an uninsured employer, or the employee's
23dependents in case death ensued, may, instead of proceeding
24against the employer in a civil action in court, file an
25application for adjustment of claim with the Commission in
26accordance with the provisions of this Act and the Commission

 

 

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1shall hear and determine the application for adjustment of
2claim in the manner in which other claims are heard and
3determined before the Commission.
4    All proceedings under this subsection (d) shall be reported
5on an annual basis to the Workers' Compensation Advisory Board.
6    An investigator with the Illinois Workers' Compensation
7Commission Insurance Compliance Division may issue a citation
8to any employer that is not in compliance with its obligation
9to have workers' compensation insurance under this Act. The
10amount of the fine shall be based on the period of time the
11employer was in non-compliance, but shall be no less than $500,
12and shall not exceed $2,500. An employer that has been issued a
13citation shall pay the fine to the Commission and provide to
14the Commission proof that it obtained the required workers'
15compensation insurance within 10 days after the citation was
16issued. This Section does not affect any other obligations this
17Act imposes on employers.
18    Upon a finding by the Commission, after reasonable notice
19and hearing, of the knowing and wilful failure or refusal of an
20employer to comply with any of the provisions of paragraph (a)
21of this Section, the failure or refusal of an employer, service
22or adjustment company, or an insurance carrier to comply with
23any order of the Illinois Workers' Compensation Commission
24pursuant to paragraph (c) of this Section disqualifying him or
25her to operate as a self insurer and requiring him or her to
26insure his or her liability, or the knowing and willful failure

 

 

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1of an employer to comply with a citation issued by an
2investigator with the Illinois Workers' Compensation
3Commission Insurance Compliance Division, the Commission may
4assess a civil penalty of up to $500 per day for each day of
5such failure or refusal after the effective date of this
6amendatory Act of 1989. The minimum penalty under this Section
7shall be the sum of $10,000. Each day of such failure or
8refusal shall constitute a separate offense. The Commission may
9assess the civil penalty personally and individually against
10the corporate officers and directors of a corporate employer,
11the partners of an employer partnership, and the members of an
12employer limited liability company, after a finding of a
13knowing and willful refusal or failure of each such named
14corporate officer, director, partner, or member to comply with
15this Section. The liability for the assessed penalty shall be
16against the named employer first, and if the named employer
17fails or refuses to pay the penalty to the Commission within 30
18days after the final order of the Commission, then the named
19corporate officers, directors, partners, or members who have
20been found to have knowingly and willfully refused or failed to
21comply with this Section shall be liable for the unpaid penalty
22or any unpaid portion of the penalty. Upon investigation by the
23insurance non-compliance unit of the Commission, the Attorney
24General shall have the authority to prosecute all proceedings
25to enforce the civil and administrative provisions of this
26Section before the Commission. The Commission shall promulgate

 

 

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1procedural rules for enforcing this Section.
2    Upon the failure or refusal of any employer, service or
3adjustment company or insurance carrier to comply with the
4provisions of this Section and with the orders of the
5Commission under this Section, or the order of the court on
6review after final adjudication, the Commission may bring a
7civil action to recover the amount of the penalty in Cook
8County or in Sangamon County in which litigation the Commission
9shall be represented by the Attorney General. The Commission
10shall send notice of its finding of non-compliance and
11assessment of the civil penalty to the Attorney General. It
12shall be the duty of the Attorney General within 30 days after
13receipt of the notice, to institute prosecutions and promptly
14prosecute all reported violations of this Section.
15    Any individual employer, corporate officer or director of a
16corporate employer, partner of an employer partnership, or
17member of an employer limited liability company who, with the
18intent to avoid payment of compensation under this Act to an
19injured employee or the employee's dependents, knowingly
20transfers, sells, encumbers, assigns, or in any manner disposes
21of, conceals, secretes, or destroys any property belonging to
22the employer, officer, director, partner, or member is guilty
23of a Class 4 felony.
24    Penalties and fines collected pursuant to this paragraph
25(d) shall be deposited upon receipt into a special fund which
26shall be designated the Injured Workers' Benefit Fund, of which

 

 

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1the State Treasurer is ex-officio custodian, such special fund
2to be held and disbursed in accordance with this paragraph (d)
3for the purposes hereinafter stated in this paragraph (d), upon
4the final order of the Commission. The Injured Workers' Benefit
5Fund shall be deposited the same as are State funds and any
6interest accruing thereon shall be added thereto every 6
7months. The Injured Workers' Benefit Fund is subject to audit
8the same as State funds and accounts and is protected by the
9general bond given by the State Treasurer. The Injured Workers'
10Benefit Fund is considered always appropriated for the purposes
11of disbursements as provided in this paragraph, and shall be
12paid out and disbursed as herein provided and shall not at any
13time be appropriated or diverted to any other use or purpose.
14Moneys in the Injured Workers' Benefit Fund shall be used only
15for payment of workers' compensation benefits for injured
16employees when the employer has failed to provide coverage as
17determined under this paragraph (d) and has failed to pay the
18benefits due to the injured employee. The Commission shall have
19the right to obtain reimbursement from the employer for
20compensation obligations paid by the Injured Workers' Benefit
21Fund. Any such amounts obtained shall be deposited by the
22Commission into the Injured Workers' Benefit Fund. If an
23injured employee or his or her personal representative receives
24payment from the Injured Workers' Benefit Fund, the State of
25Illinois has the same rights under paragraph (b) of Section 5
26that the employer who failed to pay the benefits due to the

 

 

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1injured employee would have had if the employer had paid those
2benefits, and any moneys recovered by the State as a result of
3the State's exercise of its rights under paragraph (b) of
4Section 5 shall be deposited into the Injured Workers' Benefit
5Fund. The custodian of the Injured Workers' Benefit Fund shall
6be joined with the employer as a party respondent in the
7application for adjustment of claim. After July 1, 2006, the
8Commission shall make disbursements from the Fund once each
9year to each eligible claimant. An eligible claimant is an
10injured worker who has within the previous fiscal year obtained
11a final award for benefits from the Commission against the
12employer and the Injured Workers' Benefit Fund and has notified
13the Commission within 90 days of receipt of such award. Within
14a reasonable time after the end of each fiscal year, the
15Commission shall make a disbursement to each eligible claimant.
16At the time of disbursement, if there are insufficient moneys
17in the Fund to pay all claims, each eligible claimant shall
18receive a pro-rata share, as determined by the Commission, of
19the available moneys in the Fund for that year. Payment from
20the Injured Workers' Benefit Fund to an eligible claimant
21pursuant to this provision shall discharge the obligations of
22the Injured Workers' Benefit Fund regarding the award entered
23by the Commission.
24    (e) This Act shall not affect or disturb the continuance of
25any existing workers' compensation insurance, mutual aid,
26benefit, or relief association or department, whether

 

 

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1maintained in whole or in part by the employer or whether
2maintained by the employees, the payment of benefits of such
3association or department being guaranteed by the employer or
4by some person, firm or corporation for him or her: Provided,
5the employer contributes to such association or department an
6amount not less than the full compensation herein provided,
7exclusive of the cost of the maintenance of such association or
8department and without any expense to the employee. This Act
9shall not prevent the organization and maintaining under the
10insurance laws of this State of any benefit or insurance
11company for the purpose of insuring against the compensation
12provided for in this Act, the expense of which is maintained by
13the employer. This Act shall not prevent the organization or
14maintaining under the insurance laws of this State of any
15voluntary mutual aid, benefit or relief association among
16employees for the payment of additional accident or sick
17benefits.
18    (f) No existing workers' compensation insurance, mutual
19aid, benefit or relief association or department shall, by
20reason of anything herein contained, be authorized to
21discontinue its operation without first discharging its
22obligations to any and all persons carrying insurance in the
23same or entitled to relief or benefits therein.
24    (g) Any contract, oral, written or implied, of employment
25providing for relief benefit, or workers' compensation
26insurance or any other device whereby the employee is required

 

 

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1to pay any premium or premiums for insurance against the
2compensation provided for in this Act shall be null and void.
3Any employer withholding from the wages of any employee any
4amount for the purpose of paying any such premium shall be
5guilty of a Class B misdemeanor.
6    In the event the employer does not pay the compensation for
7which he or she is liable, then a workers' compensation an
8insurance company, association or insurer which may have
9insured such employer against such liability shall become
10primarily liable to pay to the employee, his or her personal
11representative or beneficiary the compensation required by the
12provisions of this Act to be paid by such employer. The
13insurance carrier may be made a party to the proceedings in
14which the employer is a party and an award may be entered
15jointly against the employer and the insurance carrier.
16    (h) It shall be unlawful for any employer, insurance
17company or service or adjustment company to interfere with,
18restrain or coerce an employee in any manner whatsoever in the
19exercise of the rights or remedies granted to him or her by
20this Act or to discriminate, attempt to discriminate, or
21threaten to discriminate against an employee in any way because
22of his or her exercise of the rights or remedies granted to him
23or her by this Act.
24    It shall be unlawful for any employer, individually or
25through any insurance company or service or adjustment company,
26to discharge or to threaten to discharge, or to refuse to

 

 

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1rehire or recall to active service in a suitable capacity an
2employee because of the exercise of his or her rights or
3remedies granted to him or her by this Act.
4    (i) If an employer elects to obtain a life insurance policy
5on his employees, he may also elect to apply such benefits in
6satisfaction of all or a portion of the death benefits payable
7under this Act, in which case, the employer's compensation
8premium shall be reduced accordingly.
9    (j) Within 45 days of receipt of an initial application or
10application to renew self-insurance privileges the
11Self-Insurers Advisory Board shall review and submit for
12approval by the Chairman of the Commission recommendations of
13disposition of all initial applications to self-insure and all
14applications to renew self-insurance privileges filed by
15private self-insurers pursuant to the provisions of this
16Section and Section 4a-9 of this Act. Each private self-insurer
17shall submit with its initial and renewal applications the
18application fee required by Section 4a-4 of this Act.
19    The Chairman of the Commission shall promptly act upon all
20initial applications and applications for renewal in full
21accordance with the recommendations of the Board or, should the
22Chairman disagree with any recommendation of disposition of the
23Self-Insurer's Advisory Board, he shall within 30 days of
24receipt of such recommendation provide to the Board in writing
25the reasons supporting his decision. The Chairman shall also
26promptly notify the employer of his decision within 15 days of

 

 

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1receipt of the recommendation of the Board.
2    If an employer is denied a renewal of self-insurance
3privileges pursuant to application it shall retain said
4privilege for 120 days after receipt of a notice of
5cancellation of the privilege from the Chairman of the
6Commission.
7    All orders made by the Chairman under this Section shall be
8subject to review by the courts, such review to be taken in the
9same manner and within the same time as provided by subsection
10(f) of Section 19 of this Act for review of awards and
11decisions of the Commission, upon the party seeking the review
12filing with the clerk of the court to which such review is
13taken a bond in an amount to be fixed and approved by the court
14to which the review is taken, conditioned upon the payment of
15all compensation awarded against the person taking such review
16pending a decision thereof and further conditioned upon such
17other obligations as the court may impose. Upon the review the
18Circuit Court shall have power to review all questions of fact
19as well as of law.
20(Source: P.A. 97-18, eff. 6-28-11.)
 
21    (820 ILCS 305/8)  (from Ch. 48, par. 138.8)
22    Sec. 8. The amount of compensation which shall be paid to
23the employee for an accidental injury not resulting in death
24is:
25    (a) The employer shall provide and pay the negotiated rate,

 

 

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1if applicable, or the lesser of the health care provider's
2actual charges or according to a fee schedule, subject to
3Section 8.2, in effect at the time the service was rendered for
4all the necessary first aid, medical and surgical services, and
5all necessary medical, surgical and hospital services
6thereafter incurred, limited, however, to that which is
7reasonably required to cure or relieve from the effects of the
8accidental injury, even if a health care provider sells,
9transfers, or otherwise assigns an account receivable for
10procedures, treatments, or services covered under this Act. If
11the employer does not dispute payment of first aid, medical,
12surgical, and hospital services, the employer shall make such
13payment to the provider on behalf of the employee. The employer
14shall also pay for treatment, instruction and training
15necessary for the physical, mental and vocational
16rehabilitation of the employee, including all maintenance
17costs and expenses incidental thereto. If as a result of the
18injury the employee is unable to be self-sufficient the
19employer shall further pay for such maintenance or
20institutional care as shall be required.
21    The employee may at any time elect to secure his own
22physician, surgeon and hospital services at the employer's
23expense, or,
24    Upon agreement between the employer and the employees, or
25the employees' exclusive representative, and subject to the
26approval of the Illinois Workers' Compensation Commission, the

 

 

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1employer shall maintain a list of physicians, to be known as a
2Panel of Physicians, who are accessible to the employees. The
3employer shall post this list in a place or places easily
4accessible to his employees. The employee shall have the right
5to make an alternative choice of physician from such Panel if
6he is not satisfied with the physician first selected. If, due
7to the nature of the injury or its occurrence away from the
8employer's place of business, the employee is unable to make a
9selection from the Panel, the selection process from the Panel
10shall not apply. The physician selected from the Panel may
11arrange for any consultation, referral or other specialized
12medical services outside the Panel at the employer's expense.
13Provided that, in the event the Commission shall find that a
14doctor selected by the employee is rendering improper or
15inadequate care, the Commission may order the employee to
16select another doctor certified or qualified in the medical
17field for which treatment is required. If the employee refuses
18to make such change the Commission may relieve the employer of
19his obligation to pay the doctor's charges from the date of
20refusal to the date of compliance.
21    Any vocational rehabilitation counselors who provide
22service under this Act shall have appropriate certifications
23which designate the counselor as qualified to render opinions
24relating to vocational rehabilitation. Vocational
25rehabilitation may include, but is not limited to, counseling
26for job searches, supervising a job search program, and

 

 

SB2154- 32 -LRB099 13035 SXM 36947 b

1vocational retraining including education at an accredited
2learning institution. The employee or employer may petition to
3the Commission to decide disputes relating to vocational
4rehabilitation and the Commission shall resolve any such
5dispute, including payment of the vocational rehabilitation
6program by the employer.
7    The maintenance benefit shall not be less than the
8temporary total disability rate determined for the employee. In
9addition, maintenance shall include costs and expenses
10incidental to the vocational rehabilitation program.
11    When the employee is working light duty on a part-time
12basis or full-time basis and earns less than he or she would be
13earning if employed in the full capacity of the job or jobs,
14then the employee shall be entitled to temporary partial
15disability benefits. Temporary partial disability benefits
16shall be equal to two-thirds of the difference between the
17average amount that the employee would be able to earn in the
18full performance of his or her duties in the occupation in
19which he or she was engaged at the time of accident and the
20gross amount which he or she is earning in the modified job
21provided to the employee by the employer or in any other job
22that the employee is working.
23    Every hospital, physician, surgeon or other person
24rendering treatment or services in accordance with the
25provisions of this Section shall upon written request furnish
26full and complete reports thereof to, and permit their records

 

 

SB2154- 33 -LRB099 13035 SXM 36947 b

1to be copied by, the employer, the employee or his dependents,
2as the case may be, or any other party to any proceeding for
3compensation before the Commission, or their attorneys.
4    Notwithstanding the foregoing, the employer's liability to
5pay for such medical services selected by the employee shall be
6limited to:
7        (1) all first aid and emergency treatment; plus
8        (2) all medical, surgical and hospital services
9    provided by the physician, surgeon or hospital initially
10    chosen by the employee or by any other physician,
11    consultant, expert, institution or other provider of
12    services recommended by said initial service provider or
13    any subsequent provider of medical services in the chain of
14    referrals from said initial service provider; plus
15         (3) all medical, surgical and hospital services
16    provided by any second physician, surgeon or hospital
17    subsequently chosen by the employee or by any other
18    physician, consultant, expert, institution or other
19    provider of services recommended by said second service
20    provider or any subsequent provider of medical services in
21    the chain of referrals from said second service provider.
22    Thereafter the employer shall select and pay for all
23    necessary medical, surgical and hospital treatment and the
24    employee may not select a provider of medical services at
25    the employer's expense unless the employer agrees to such
26    selection. At any time the employee may obtain any medical

 

 

SB2154- 34 -LRB099 13035 SXM 36947 b

1    treatment he desires at his own expense. This paragraph
2    shall not affect the duty to pay for rehabilitation
3    referred to above.
4        (4) The following shall apply for injuries occurring on
5    or after June 28, 2011 (the effective date of Public Act
6    97-18) and only when an employer has an approved preferred
7    provider program pursuant to Section 8.1a on the date the
8    employee sustained his or her accidental injuries:
9            (A) The employer shall, in writing, on a form
10        promulgated by the Commission, inform the employee of
11        the preferred provider program;
12            (B) Subsequent to the report of an injury by an
13        employee, the employee may choose in writing at any
14        time to decline the preferred provider program, in
15        which case that would constitute one of the two choices
16        of medical providers to which the employee is entitled
17        under subsection (a)(2) or (a)(3); and
18            (C) Prior to the report of an injury by an
19        employee, when an employee chooses non-emergency
20        treatment from a provider not within the preferred
21        provider program, that would constitute the employee's
22        one choice of medical providers to which the employee
23        is entitled under subsection (a)(2) or (a)(3).
24    When an employer and employee so agree in writing, nothing
25in this Act prevents an employee whose injury or disability has
26been established under this Act, from relying in good faith, on

 

 

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1treatment by prayer or spiritual means alone, in accordance
2with the tenets and practice of a recognized church or
3religious denomination, by a duly accredited practitioner
4thereof, and having nursing services appropriate therewith,
5without suffering loss or diminution of the compensation
6benefits under this Act. However, the employee shall submit to
7all physical examinations required by this Act. The cost of
8such treatment and nursing care shall be paid by the employee
9unless the employer agrees to make such payment.
10    Where the accidental injury results in the amputation of an
11arm, hand, leg or foot, or the enucleation of an eye, or the
12loss of any of the natural teeth, the employer shall furnish an
13artificial of any such members lost or damaged in accidental
14injury arising out of and in the course of employment, and
15shall also furnish the necessary braces in all proper and
16necessary cases. In cases of the loss of a member or members by
17amputation, the employer shall, whenever necessary, maintain
18in good repair, refit or replace the artificial limbs during
19the lifetime of the employee. Where the accidental injury
20accompanied by physical injury results in damage to a denture,
21eye glasses or contact eye lenses, or where the accidental
22injury results in damage to an artificial member, the employer
23shall replace or repair such denture, glasses, lenses, or
24artificial member.
25    The furnishing by the employer of any such services or
26appliances is not an admission of liability on the part of the

 

 

SB2154- 36 -LRB099 13035 SXM 36947 b

1employer to pay compensation.
2    The furnishing of any such services or appliances or the
3servicing thereof by the employer is not the payment of
4compensation.
5    (b) If the period of temporary total incapacity for work
6lasts more than 3 working days, weekly compensation as
7hereinafter provided shall be paid beginning on the 4th day of
8such temporary total incapacity and continuing as long as the
9total temporary incapacity lasts. In cases where the temporary
10total incapacity for work continues for a period of 14 days or
11more from the day of the accident compensation shall commence
12on the day after the accident.
13        1. The compensation rate for temporary total
14    incapacity under this paragraph (b) of this Section shall
15    be equal to 66 2/3% of the employee's average weekly wage
16    computed in accordance with Section 10, provided that it
17    shall be not less than 66 2/3% of the sum of the Federal
18    minimum wage under the Fair Labor Standards Act, or the
19    Illinois minimum wage under the Minimum Wage Law, whichever
20    is more, multiplied by 40 hours. This percentage rate shall
21    be increased by 10% for each spouse and child, not to
22    exceed 100% of the total minimum wage calculation,
23    nor exceed the employee's average weekly wage computed in
24    accordance with the provisions of Section 10, whichever is
25    less.
26        2. The compensation rate in all cases other than for

 

 

SB2154- 37 -LRB099 13035 SXM 36947 b

1    temporary total disability under this paragraph (b), and
2    other than for serious and permanent disfigurement under
3    paragraph (c) and other than for permanent partial
4    disability under subparagraph (2) of paragraph (d) or under
5    paragraph (e), of this Section shall be equal to 66 2/3% of
6    the employee's average weekly wage computed in accordance
7    with the provisions of Section 10, provided that it shall
8    be not less than 66 2/3% of the sum of the Federal minimum
9    wage under the Fair Labor Standards Act, or the Illinois
10    minimum wage under the Minimum Wage Law, whichever is more,
11    multiplied by 40 hours. This percentage rate shall be
12    increased by 10% for each spouse and child, not to exceed
13    100% of the total minimum wage calculation,
14    nor exceed the employee's average weekly wage computed in
15    accordance with the provisions of Section 10, whichever is
16    less.
17        2.1. The compensation rate in all cases of serious and
18    permanent disfigurement under paragraph (c) and of
19    permanent partial disability under subparagraph (2) of
20    paragraph (d) or under paragraph (e) of this Section shall
21    be equal to 60% of the employee's average weekly wage
22    computed in accordance with the provisions of Section 10,
23    provided that it shall be not less than 66 2/3% of the sum
24    of the Federal minimum wage under the Fair Labor Standards
25    Act, or the Illinois minimum wage under the Minimum Wage
26    Law, whichever is more, multiplied by 40 hours. This

 

 

SB2154- 38 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 39 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 40 -LRB099 13035 SXM 36947 b

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

 

 

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1    per week and the computation of compensation rates shall be
2    based on the aforesaid average weekly wage until modified
3    as hereinafter provided.
4        6. The Department of Employment Security of the State
5    shall on or before the first day of December, 1977, and on
6    or before the first day of June, 1978, and on the first day
7    of each December and June of each year thereafter, publish
8    the State's average weekly wage in covered industries under
9    the Unemployment Insurance Act and the Illinois Workers'
10    Compensation Commission shall on the 15th day of January,
11    1978 and on the 15th day of July, 1978 and on the 15th day
12    of each January and July of each year thereafter, post and
13    publish the State's average weekly wage in covered
14    industries under the Unemployment Insurance Act as last
15    determined and published by the Department of Employment
16    Security. The amount when so posted and published shall be
17    conclusive and shall be applicable as the basis of
18    computation of compensation rates until the next posting
19    and publication as aforesaid.
20        7. The payment of compensation by an employer or his
21    insurance carrier to an injured employee shall not
22    constitute an admission of the employer's liability to pay
23    compensation.
24    (c) For any serious and permanent disfigurement to the
25hand, head, face, neck, arm, leg below the knee or the chest
26above the axillary line, the employee is entitled to

 

 

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1compensation for such disfigurement, the amount determined by
2agreement at any time or by arbitration under this Act, at a
3hearing not less than 6 months after the date of the accidental
4injury, which amount shall not exceed 150 weeks (if the
5accidental injury occurs on or after the effective date of this
6amendatory Act of the 94th General Assembly but before February
71, 2006) or 162 weeks (if the accidental injury occurs on or
8after February 1, 2006) at the applicable rate provided in
9subparagraph 2.1 of paragraph (b) of this Section.
10    No compensation is payable under this paragraph where
11compensation is payable under paragraphs (d), (e) or (f) of
12this Section.
13    A duly appointed member of a fire department in a city, the
14population of which exceeds 500,000 according to the last
15federal or State census, is eligible for compensation under
16this paragraph only where such serious and permanent
17disfigurement results from burns.
18    (d) 1. If, after the accidental injury has been sustained,
19the employee as a result thereof becomes partially
20incapacitated from pursuing his usual and customary line of
21employment, he shall, except in cases compensated under the
22specific schedule set forth in paragraph (e) of this Section,
23receive compensation for the duration of his disability,
24subject to the limitations as to maximum amounts fixed in
25paragraph (b) of this Section, equal to 66-2/3% of the
26difference between the average amount which he would be able to

 

 

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1earn in the full performance of his duties in the occupation in
2which he was engaged at the time of the accident and the
3average amount which he is earning or is able to earn in some
4suitable employment or business after the accident. For
5accidental injuries that occur on or after September 1, 2011,
6an award for wage differential under this subsection shall be
7effective only until the employee reaches the age of 67 or 5
8years from the date the award becomes final, whichever is
9later.
10    2. If, as a result of the accident, the employee sustains
11serious and permanent injuries not covered by paragraphs (c)
12and (e) of this Section or having sustained injuries covered by
13the aforesaid paragraphs (c) and (e), he shall have sustained
14in addition thereto other injuries which injuries do not
15incapacitate him from pursuing the duties of his employment but
16which would disable him from pursuing other suitable
17occupations, or which have otherwise resulted in physical
18impairment; or if such injuries partially incapacitate him from
19pursuing the duties of his usual and customary line of
20employment but do not result in an impairment of earning
21capacity, or having resulted in an impairment of earning
22capacity, the employee elects to waive his right to recover
23under the foregoing subparagraph 1 of paragraph (d) of this
24Section then in any of the foregoing events, he shall receive
25in addition to compensation for temporary total disability
26under paragraph (b) of this Section, compensation at the rate

 

 

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1provided in subparagraph 2.1 of paragraph (b) of this Section
2for that percentage of 500 weeks that the partial disability
3resulting from the injuries covered by this paragraph bears to
4total disability. If the employee shall have sustained a
5fracture of one or more vertebra or fracture of the skull, the
6amount of compensation allowed under this Section shall be not
7less than 6 weeks for a fractured skull and 6 weeks for each
8fractured vertebra, and in the event the employee shall have
9sustained a fracture of any of the following facial bones:
10nasal, lachrymal, vomer, zygoma, maxilla, palatine or
11mandible, the amount of compensation allowed under this Section
12shall be not less than 2 weeks for each such fractured bone,
13and for a fracture of each transverse process not less than 3
14weeks. In the event such injuries shall result in the loss of a
15kidney, spleen or lung, the amount of compensation allowed
16under this Section shall be not less than 10 weeks for each
17such organ. Compensation awarded under this subparagraph 2
18shall not take into consideration injuries covered under
19paragraphs (c) and (e) of this Section and the compensation
20provided in this paragraph shall not affect the employee's
21right to compensation payable under paragraphs (b), (c) and (e)
22of this Section for the disabilities therein covered.
23    In computing the compensation to be paid to any employee
24who, before the accident for which he or she claims
25compensation, had before that time sustained an injury
26resulting in an award or settlement for permanency given under

 

 

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1paragraph 2 of paragraph (d) of this Section, such award shall
2be deducted from any award made for the subsequent injury
3resulting in an award or settlement for permanency given under
4paragraph 2 of paragraph (d) of this Section.
5    (e) For accidental injuries in the following schedule, the
6employee shall receive compensation for the period of temporary
7total incapacity for work resulting from such accidental
8injury, under subparagraph 1 of paragraph (b) of this Section,
9and shall receive in addition thereto compensation for a
10further period for the specific loss herein mentioned, but
11shall not receive any compensation under any other provisions
12of this Act. The following listed amounts apply to either the
13loss of or the permanent and complete loss of use of the member
14specified, such compensation for the length of time as follows:
15        1. Thumb-
16            70 weeks if the accidental injury occurs on or
17        after the effective date of this amendatory Act of the
18        94th General Assembly but before February 1, 2006.
19            76 weeks if the accidental injury occurs on or
20        after February 1, 2006.
21        2. First, or index finger-
22            40 weeks if the accidental injury occurs on or
23        after the effective date of this amendatory Act of the
24        94th General Assembly but before February 1, 2006.
25            43 weeks if the accidental injury occurs on or
26        after February 1, 2006.

 

 

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1        3. Second, or middle finger-
2            35 weeks if the accidental injury occurs on or
3        after the effective date of this amendatory Act of the
4        94th General Assembly but before February 1, 2006.
5            38 weeks if the accidental injury occurs on or
6        after February 1, 2006.
7        4. Third, or ring finger-
8            25 weeks if the accidental injury occurs on or
9        after the effective date of this amendatory Act of the
10        94th General Assembly but before February 1, 2006.
11            27 weeks if the accidental injury occurs on or
12        after February 1, 2006.
13        5. Fourth, or little finger-
14            20 weeks if the accidental injury occurs on or
15        after the effective date of this amendatory Act of the
16        94th General Assembly but before February 1, 2006.
17            22 weeks if the accidental injury occurs on or
18        after February 1, 2006.
19        6. Great toe-
20            35 weeks if the accidental injury occurs on or
21        after the effective date of this amendatory Act of the
22        94th General Assembly but before February 1, 2006.
23            38 weeks if the accidental injury occurs on or
24        after February 1, 2006.
25        7. Each toe other than great toe-
26            12 weeks if the accidental injury occurs on or

 

 

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1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            13 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        8. The loss of the first or distal phalanx of the thumb
6    or of any finger or toe shall be considered to be equal to
7    the loss of one-half of such thumb, finger or toe and the
8    compensation payable shall be one-half of the amount above
9    specified. The loss of more than one phalanx shall be
10    considered as the loss of the entire thumb, finger or toe.
11    In no case shall the amount received for more than one
12    finger exceed the amount provided in this schedule for the
13    loss of a hand.
14        9. Hand-
15            190 weeks if the accidental injury occurs on or
16        after the effective date of this amendatory Act of the
17        94th General Assembly but before February 1, 2006.
18            205 weeks if the accidental injury occurs on or
19        after February 1, 2006.
20            190 weeks if the accidental injury occurs on or
21        after June 28, 2011 (the effective date of Public Act
22        97-18) and if the accidental injury involves carpal
23        tunnel syndrome due to repetitive or cumulative
24        trauma, in which case the permanent partial disability
25        shall not exceed 15% loss of use of the hand, except
26        for cause shown by clear and convincing evidence and in

 

 

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1        which case the award shall not exceed 30% loss of use
2        of the hand.
3        The loss of 2 or more digits, or one or more phalanges
4    of 2 or more digits, of a hand may be compensated on the
5    basis of partial loss of use of a hand, provided, further,
6    that the loss of 4 digits, or the loss of use of 4 digits,
7    in the same hand shall constitute the complete loss of a
8    hand.
9        10. Arm-
10            235 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            253 weeks if the accidental injury occurs on or
14        after February 1, 2006.
15        Where an accidental injury results in the amputation of
16    an arm below the elbow, such injury shall be compensated as
17    a loss of an arm. Where an accidental injury results in the
18    amputation of an arm above the elbow, compensation for an
19    additional 15 weeks (if the accidental injury occurs on or
20    after the effective date of this amendatory Act of the 94th
21    General Assembly but before February 1, 2006) or an
22    additional 17 weeks (if the accidental injury occurs on or
23    after February 1, 2006) shall be paid, except where the
24    accidental injury results in the amputation of an arm at
25    the shoulder joint, or so close to shoulder joint that an
26    artificial arm cannot be used, or results in the

 

 

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1    disarticulation of an arm at the shoulder joint, in which
2    case compensation for an additional 65 weeks (if the
3    accidental injury occurs on or after the effective date of
4    this amendatory Act of the 94th General Assembly but before
5    February 1, 2006) or an additional 70 weeks (if the
6    accidental injury occurs on or after February 1, 2006)
7    shall be paid.
8        11. Foot-
9            155 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            167 weeks if the accidental injury occurs on or
13        after February 1, 2006.
14        12. Leg-
15            200 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            215 weeks if the accidental injury occurs on or
19        after February 1, 2006.
20        Where an accidental injury results in the amputation of
21    a leg below the knee, such injury shall be compensated as
22    loss of a leg. Where an accidental injury results in the
23    amputation of a leg above the knee, compensation for an
24    additional 25 weeks (if the accidental injury occurs on or
25    after the effective date of this amendatory Act of the 94th
26    General Assembly but before February 1, 2006) or an

 

 

SB2154- 50 -LRB099 13035 SXM 36947 b

1    additional 27 weeks (if the accidental injury occurs on or
2    after February 1, 2006) shall be paid, except where the
3    accidental injury results in the amputation of a leg at the
4    hip joint, or so close to the hip joint that an artificial
5    leg cannot be used, or results in the disarticulation of a
6    leg at the hip joint, in which case compensation for an
7    additional 75 weeks (if the accidental injury occurs on or
8    after the effective date of this amendatory Act of the 94th
9    General Assembly but before February 1, 2006) or an
10    additional 81 weeks (if the accidental injury occurs on or
11    after February 1, 2006) shall be paid.
12        13. Eye-
13            150 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            162 weeks if the accidental injury occurs on or
17        after February 1, 2006.
18        Where an accidental injury results in the enucleation
19    of an eye, compensation for an additional 10 weeks (if the
20    accidental injury occurs on or after the effective date of
21    this amendatory Act of the 94th General Assembly but before
22    February 1, 2006) or an additional 11 weeks (if the
23    accidental injury occurs on or after February 1, 2006)
24    shall be paid.
25        14. Loss of hearing of one ear-
26            50 weeks if the accidental injury occurs on or

 

 

SB2154- 51 -LRB099 13035 SXM 36947 b

1        after the effective date of this amendatory Act of the
2        94th General Assembly but before February 1, 2006.
3            54 weeks if the accidental injury occurs on or
4        after February 1, 2006.
5        Total and permanent loss of hearing of both ears-
6            200 weeks if the accidental injury occurs on or
7        after the effective date of this amendatory Act of the
8        94th General Assembly but before February 1, 2006.
9            215 weeks if the accidental injury occurs on or
10        after February 1, 2006.
11        15. Testicle-
12            50 weeks if the accidental injury occurs on or
13        after the effective date of this amendatory Act of the
14        94th General Assembly but before February 1, 2006.
15            54 weeks if the accidental injury occurs on or
16        after February 1, 2006.
17        Both testicles-
18            150 weeks if the accidental injury occurs on or
19        after the effective date of this amendatory Act of the
20        94th General Assembly but before February 1, 2006.
21            162 weeks if the accidental injury occurs on or
22        after February 1, 2006.
23        16. For the permanent partial loss of use of a member
24    or sight of an eye, or hearing of an ear, compensation
25    during that proportion of the number of weeks in the
26    foregoing schedule provided for the loss of such member or

 

 

SB2154- 52 -LRB099 13035 SXM 36947 b

1    sight of an eye, or hearing of an ear, which the partial
2    loss of use thereof bears to the total loss of use of such
3    member, or sight of eye, or hearing of an ear.
4            (a) Loss of hearing for compensation purposes
5        shall be confined to the frequencies of 1,000, 2,000
6        and 3,000 cycles per second. Loss of hearing ability
7        for frequency tones above 3,000 cycles per second are
8        not to be considered as constituting disability for
9        hearing.
10            (b) The percent of hearing loss, for purposes of
11        the determination of compensation claims for
12        occupational deafness, shall be calculated as the
13        average in decibels for the thresholds of hearing for
14        the frequencies of 1,000, 2,000 and 3,000 cycles per
15        second. Pure tone air conduction audiometric
16        instruments, approved by nationally recognized
17        authorities in this field, shall be used for measuring
18        hearing loss. If the losses of hearing average 30
19        decibels or less in the 3 frequencies, such losses of
20        hearing shall not then constitute any compensable
21        hearing disability. If the losses of hearing average 85
22        decibels or more in the 3 frequencies, then the same
23        shall constitute and be total or 100% compensable
24        hearing loss.
25            (c) In measuring hearing impairment, the lowest
26        measured losses in each of the 3 frequencies shall be

 

 

SB2154- 53 -LRB099 13035 SXM 36947 b

1        added together and divided by 3 to determine the
2        average decibel loss. For every decibel of loss
3        exceeding 30 decibels an allowance of 1.82% shall be
4        made up to the maximum of 100% which is reached at 85
5        decibels.
6            (d) If a hearing loss is established to have
7        existed on July 1, 1975 by audiometric testing the
8        employer shall not be liable for the previous loss so
9        established nor shall he be liable for any loss for
10        which compensation has been paid or awarded.
11            (e) No consideration shall be given to the question
12        of whether or not the ability of an employee to
13        understand speech is improved by the use of a hearing
14        aid.
15            (f) No claim for loss of hearing due to industrial
16        noise shall be brought against an employer or allowed
17        unless the employee has been exposed for a period of
18        time sufficient to cause permanent impairment to noise
19        levels in excess of the following:
20Sound Level DBA
21Slow ResponseHours Per Day
22908
23926
24954
25973
261002

 

 

SB2154- 54 -LRB099 13035 SXM 36947 b

11021-1/2
21051
31101/2
41151/4
5        This subparagraph (f) shall not be applied in cases of
6    hearing loss resulting from trauma or explosion.
7        17. In computing the compensation to be paid to any
8    employee who, before the accident for which he claims
9    compensation, had before that time sustained an injury
10    resulting in any permanency award, including without
11    limitation the loss by amputation or partial loss by
12    amputation of any member, including hand, arm, thumb or
13    fingers, leg, foot or any toes, the partial loss of sight
14    of an eye, or an award given under paragraph (2) of
15    paragraph (d) of Section 8, such award loss or partial loss
16    of any such member shall be deducted from any award made
17    for the subsequent injury. For the permanent loss of use or
18    the permanent partial loss of use of any such member or the
19    partial loss of sight of an eye, for which compensation has
20    been paid, then such loss shall be taken into consideration
21    and deducted from any award for the subsequent injury.
22        18. The specific case of loss of both hands, both arms,
23    or both feet, or both legs, or both eyes, or of any two
24    thereof, or the permanent and complete loss of the use
25    thereof, constitutes total and permanent disability, to be
26    compensated according to the compensation fixed by

 

 

SB2154- 55 -LRB099 13035 SXM 36947 b

1    paragraph (f) of this Section. These specific cases of
2    total and permanent disability do not exclude other cases.
3        Any employee who has previously suffered the loss or
4    permanent and complete loss of the use of any of such
5    members, and in a subsequent independent accident loses
6    another or suffers the permanent and complete loss of the
7    use of any one of such members the employer for whom the
8    injured employee is working at the time of the last
9    independent accident is liable to pay compensation only for
10    the loss or permanent and complete loss of the use of the
11    member occasioned by the last independent accident.
12        19. In a case of specific loss and the subsequent death
13    of such injured employee from other causes than such injury
14    leaving a widow, widower, or dependents surviving before
15    payment or payment in full for such injury, then the amount
16    due for such injury is payable to the widow or widower and,
17    if there be no widow or widower, then to such dependents,
18    in the proportion which such dependency bears to total
19    dependency.
20    Beginning July 1, 1980, and every 6 months thereafter, the
21Commission shall examine the Second Injury Fund and when, after
22deducting all advances or loans made to such Fund, the amount
23therein is $500,000 then the amount required to be paid by
24employers pursuant to paragraph (f) of Section 7 shall be
25reduced by one-half. When the Second Injury Fund reaches the
26sum of $600,000 then the payments shall cease entirely.

 

 

SB2154- 56 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 57 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 58 -LRB099 13035 SXM 36947 b

1complete disability through the loss or the permanent and
2complete loss of the use of another member, he shall receive,
3in addition to the compensation payable by the employer and
4after such payments have ceased, an amount from the Second
5Injury Fund provided for in paragraph (f) of Section 7, which,
6together with the compensation payable from the employer in
7whose employ he was when the last accidental injury was
8incurred, will equal the amount payable for permanent and
9complete disability as provided in this paragraph of this
10Section.
11    The custodian of the Second Injury Fund provided for in
12paragraph (f) of Section 7 shall be joined with the employer as
13a party respondent in the application for adjustment of claim.
14The application for adjustment of claim shall state briefly and
15in general terms the approximate time and place and manner of
16the loss of the first member.
17    In its award the Commission or the Arbitrator shall
18specifically find the amount the injured employee shall be
19weekly paid, the number of weeks compensation which shall be
20paid by the employer, the date upon which payments begin out of
21the Second Injury Fund provided for in paragraph (f) of Section
227 of this Act, the length of time the weekly payments continue,
23the date upon which the pension payments commence and the
24monthly amount of the payments. The Commission shall 30 days
25after the date upon which payments out of the Second Injury
26Fund have begun as provided in the award, and every month

 

 

SB2154- 59 -LRB099 13035 SXM 36947 b

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

 

 

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1first be made on July 15, 1977, and all awards made and entered
2prior to July 1, 1975 and on July 15 of each year thereafter.
3In all other cases such adjustment shall be made on July 15 of
4the second year next following the date of the entry of the
5award and shall further be made on July 15 annually thereafter.
6If during the intervening period from the date of the entry of
7the award, or the last periodic adjustment, there shall have
8been an increase in the State's average weekly wage in covered
9industries under the Unemployment Insurance Act, the weekly
10compensation rate shall be proportionately increased by the
11same percentage as the percentage of increase in the State's
12average weekly wage in covered industries under the
13Unemployment Insurance Act. The increase in the compensation
14rate under this paragraph shall in no event bring the total
15compensation rate to an amount greater than the prevailing
16maximum rate at the time that the annual adjustment is made.
17Such increase shall be paid in the same manner as herein
18provided for payments under the Second Injury Fund to the
19injured employee, or his dependents, as the case may be, out of
20the Rate Adjustment Fund provided in paragraph (f) of Section 7
21of this Act. Payments shall be made at the same intervals as
22provided in the award or, at the option of the Commission, may
23be made in quarterly payment on the 15th day of January, April,
24July and October of each year. In the event of a decrease in
25such average weekly wage there shall be no change in the then
26existing compensation rate. The within paragraph shall not

 

 

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1apply to cases where there is disputed liability and in which a
2compromise lump sum settlement between the employer and the
3injured employee, or his dependents, as the case may be, has
4been duly approved by the Illinois Workers' Compensation
5Commission.
6    Provided, that in cases of awards entered by the Commission
7for injuries occurring before July 1, 1975, the increases in
8the compensation rate adjusted under the foregoing provision of
9this paragraph (g) shall be limited to increases in the State's
10average weekly wage in covered industries under the
11Unemployment Insurance Act occurring after July 1, 1975.
12    For every accident occurring on or after July 20, 2005 but
13before the effective date of this amendatory Act of the 94th
14General Assembly (Senate Bill 1283 of the 94th General
15Assembly), the annual adjustments to the compensation rate in
16awards for death benefits or permanent total disability, as
17provided in this Act, shall be paid by the employer. The
18adjustment shall be made by the employer on July 15 of the
19second year next following the date of the entry of the award
20and shall further be made on July 15 annually thereafter. If
21during the intervening period from the date of the entry of the
22award, or the last periodic adjustment, there shall have been
23an increase in the State's average weekly wage in covered
24industries under the Unemployment Insurance Act, the employer
25shall increase the weekly compensation rate proportionately by
26the same percentage as the percentage of increase in the

 

 

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1State's average weekly wage in covered industries under the
2Unemployment Insurance Act. The increase in the compensation
3rate under this paragraph shall in no event bring the total
4compensation rate to an amount greater than the prevailing
5maximum rate at the time that the annual adjustment is made. In
6the event of a decrease in such average weekly wage there shall
7be no change in the then existing compensation rate. Such
8increase shall be paid by the employer in the same manner and
9at the same intervals as the payment of compensation in the
10award. This paragraph shall not apply to cases where there is
11disputed liability and in which a compromise lump sum
12settlement between the employer and the injured employee, or
13his or her dependents, as the case may be, has been duly
14approved by the Illinois Workers' Compensation Commission.
15    The annual adjustments for every award of death benefits or
16permanent total disability involving accidents occurring
17before July 20, 2005 and accidents occurring on or after the
18effective date of this amendatory Act of the 94th General
19Assembly (Senate Bill 1283 of the 94th General Assembly) shall
20continue to be paid from the Rate Adjustment Fund pursuant to
21this paragraph and Section 7(f) of this Act.
22    (h) In case death occurs from any cause before the total
23compensation to which the employee would have been entitled has
24been paid, then in case the employee leaves any widow, widower,
25child, parent (or any grandchild, grandparent or other lineal
26heir or any collateral heir dependent at the time of the

 

 

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

 

 

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

 

 

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1behalf of such employee under this Act, except for payments for
2medical expenses which have already been incurred at the time
3of the award. The State of Illinois shall directly reimburse
4the State Employees' Retirement System to the extent of such
5credit.
6    2. Nothing contained in this Act shall be construed to give
7the employer or the insurance carrier the right to credit for
8any benefits or payments received by the employee other than
9compensation payments provided by this Act, and where the
10employee receives payments other than compensation payments,
11whether as full or partial salary, group insurance benefits,
12bonuses, annuities or any other payments, the employer or
13insurance carrier shall receive credit for each such payment
14only to the extent of the compensation that would have been
15payable during the period covered by such payment.
16    3. The extension of time for the filing of an Application
17for Adjustment of Claim as provided in paragraph 1 above shall
18not apply to those cases where the time for such filing had
19expired prior to the date on which payments or benefits
20enumerated herein have been initiated or resumed. Provided
21however that this paragraph 3 shall apply only to cases wherein
22the payments or benefits hereinabove enumerated shall be
23received after July 1, 1969.
24(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
25eff. 7-13-12.)
 

 

 

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1    (820 ILCS 305/8.1b)
2    Sec. 8.1b. Determination of permanent partial disability.
3For accidental injuries that occur on or after September 1,
42011, permanent partial disability shall be established using
5the following criteria:
6    (a) A physician licensed to practice medicine in all of its
7branches preparing a permanent partial disability impairment
8report shall report the level of impairment in writing. The
9report shall include an evaluation of medically defined and
10professionally appropriate measurements of impairment that
11include, but are not limited to: loss of range of motion; loss
12of strength; measured atrophy of tissue mass consistent with
13the injury; and any other measurements that establish the
14nature and extent of the impairment. The most current edition
15of the American Medical Association's "Guides to the Evaluation
16of Permanent Impairment" shall be used by the physician in
17determining the level of impairment.
18    (b) In determining the level of permanent partial
19disability, the Commission shall base its determination on the
20following factors: (i) the reported level of impairment
21pursuant to subsection (a) if such a report exists; (ii) the
22occupation of the injured employee; (iii) the age of the
23employee at the time of the injury; (iv) the employee's future
24earning capacity; and (v) evidence of disability corroborated
25by objective findings in the treating medical records and
26independent medical examinations. No single enumerated factor

 

 

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1shall be the sole determinant of disability. In determining the
2level of disability, the relevance and weight of any factors
3used in addition to the level of impairment as reported by the
4physician must be explained in a written order.
5    (c) A report of impairment prepared pursuant to subsection
6(a) is not required for the arbitrator or Commission to approve
7a Settlement Contract Lump Sum Petition.
8(Source: P.A. 97-18, eff. 6-28-11.)
 
9    (820 ILCS 305/8.2)
10    Sec. 8.2. Fee schedule.
11    (a) Except as provided for in subsection (c), for
12procedures, treatments, or services covered under this Act and
13rendered or to be rendered on and after February 1, 2006, the
14maximum allowable payment shall be 90% of the 80th percentile
15of charges and fees as determined by the Commission utilizing
16information provided by employers' and insurers' national
17databases, with a minimum of 12,000,000 Illinois line item
18charges and fees comprised of health care provider and hospital
19charges and fees as of August 1, 2004 but not earlier than
20August 1, 2002. These charges and fees are provider billed
21amounts and shall not include discounted charges. The 80th
22percentile is the point on an ordered data set from low to high
23such that 80% of the cases are below or equal to that point and
24at most 20% are above or equal to that point. The Commission
25shall adjust these historical charges and fees as of August 1,

 

 

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12004 by the Consumer Price Index-U for the period August 1,
22004 through September 30, 2005. The Commission shall establish
3fee schedules for procedures, treatments, or services for
4hospital inpatient, hospital outpatient, emergency room and
5trauma, ambulatory surgical treatment centers, and
6professional services. These charges and fees shall be
7designated by geozip or any smaller geographic unit. The data
8shall in no way identify or tend to identify any patient,
9employer, or health care provider. As used in this Section,
10"geozip" means a three-digit zip code based on data
11similarities, geographical similarities, and frequencies. A
12geozip does not cross state boundaries. As used in this
13Section, "three-digit zip code" means a geographic area in
14which all zip codes have the same first 3 digits. If a geozip
15does not have the necessary number of charges and fees to
16calculate a valid percentile for a specific procedure,
17treatment, or service, the Commission may combine data from the
18geozip with up to 4 other geozips that are demographically and
19economically similar and exhibit similarities in data and
20frequencies until the Commission reaches 9 charges or fees for
21that specific procedure, treatment, or service. In cases where
22the compiled data contains less than 9 charges or fees for a
23procedure, treatment, or service, reimbursement shall occur at
2476% of charges and fees as determined by the Commission in a
25manner consistent with the provisions of this paragraph.
26Providers of out-of-state procedures, treatments, services,

 

 

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1products, or supplies shall be reimbursed at the lesser of that
2state's fee schedule amount or the fee schedule amount for the
3region in which the employee resides. If no fee schedule exists
4in that state, the provider shall be reimbursed at the lesser
5of the actual charge or the fee schedule amount for the region
6in which the employee resides. Not later than September 30 in
72006 and each year thereafter, the Commission shall
8automatically increase or decrease the maximum allowable
9payment for a procedure, treatment, or service established and
10in effect on January 1 of that year by the percentage change in
11the Consumer Price Index-U for the 12 month period ending
12August 31 of that year. The increase or decrease shall become
13effective on January 1 of the following year. As used in this
14Section, "Consumer Price Index-U" means the index published by
15the Bureau of Labor Statistics of the U.S. Department of Labor,
16that measures the average change in prices of all goods and
17services purchased by all urban consumers, U.S. city average,
18all items, 1982-84=100.
19    (a-1) Notwithstanding the provisions of subsection (a) and
20unless otherwise indicated, the following provisions shall
21apply to the medical fee schedule starting on September 1,
222011:
23        (1) The Commission shall establish and maintain fee
24    schedules for procedures, treatments, products, services,
25    or supplies for hospital inpatient, hospital outpatient,
26    emergency room, ambulatory surgical treatment centers,

 

 

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

 

 

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

 

 

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

 

 

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1        (6) The Commission shall automatically update all
2    codes and associated rules with the version of the codes
3    and rules valid on January 1 of that year.
4    (a-2) For procedures, treatments, services, or supplies
5covered under this Act and rendered or to be rendered on or
6after September 1, 2011, the maximum allowable payment shall be
770% of the fee schedule amounts, which shall be adjusted yearly
8by the Consumer Price Index-U, as described in subsection (a)
9of this Section.
10    (a-2.5) For procedures, treatments, services, or supplies
11covered under this Act and rendered or to be rendered on or
12after June 1, 2016, the maximum allowable payment for the
13following service categories set forth in Title 50, Section
147110.90 of the Illinois Administrative Code shall be 70% of the
15fee schedule amounts in effect on May 31, 2016, which shall be
16adjusted yearly by the Consumer Price Index-U, as described in
17subsection (a) of this Section:
18        (1) Section 1: Ambulatory Surgical Treatment Center
19    (ASTC) and Accredited Ambulatory Surgical Treatment
20    Facility (ASTF).
21        (2) Section 2: Anesthesia.
22        (3) Section 6: Hospital Inpatient Services: Standard
23    and Trauma.
24        (4) Section 7: Hospital Outpatient.
25        (5) Section 8: Professional Services.
26    The 30% reduction shall not apply to any procedure,

 

 

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1treatment, or service classified by an evaluation and
2management code or a physical medicine code on the fee
3schedule.
4    (a-3) Prescriptions filled and dispensed outside of a
5licensed pharmacy shall be subject to a fee schedule that shall
6not exceed the Average Wholesale Price (AWP) plus a dispensing
7fee of $4.18. AWP or its equivalent as registered by the
8National Drug Code shall be set forth for that drug on that
9date as published in Medispan.
10    (b) Notwithstanding the provisions of subsection (a), if
11the Commission finds that there is a significant limitation on
12access to quality health care in either a specific field of
13health care services or a specific geographic limitation on
14access to health care, it may change the Consumer Price Index-U
15increase or decrease for that specific field or specific
16geographic limitation on access to health care to address that
17limitation.
18    (c) The Commission shall establish by rule a process to
19review those medical cases or outliers that involve
20extra-ordinary treatment to determine whether to make an
21additional adjustment to the maximum payment within a fee
22schedule for a procedure, treatment, or service.
23    (d) When a patient notifies a provider that the treatment,
24procedure, or service being sought is for a work-related
25illness or injury and furnishes the provider the name and
26address of the responsible employer, the provider shall bill

 

 

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1the employer directly. The employer shall make payment and
2providers shall submit bills and records in accordance with the
3provisions of this Section.
4        (1) All payments to providers for treatment provided
5    pursuant to this Act shall be made within 30 days of
6    receipt of the bills as long as the claim contains
7    substantially all the required data elements necessary to
8    adjudicate the bills.
9        (2) If the claim does not contain substantially all the
10    required data elements necessary to adjudicate the bill, or
11    the claim is denied for any other reason, in whole or in
12    part, the employer or insurer shall provide written
13    notification, explaining the basis for the denial and
14    describing any additional necessary data elements, to the
15    provider within 30 days of receipt of the bill.
16        (3) In the case of nonpayment to a provider within 30
17    days of receipt of the bill which contained substantially
18    all of the required data elements necessary to adjudicate
19    the bill or nonpayment to a provider of a portion of such a
20    bill up to the lesser of the actual charge or the payment
21    level set by the Commission in the fee schedule established
22    in this Section, the bill, or portion of the bill, shall
23    incur interest at a rate of 1% per month payable to the
24    provider. Any required interest payments shall be made
25    within 30 days after payment.
26    (e) Except as provided in subsections (e-5), (e-10), and

 

 

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1(e-15), a provider shall not hold an employee liable for costs
2related to a non-disputed procedure, treatment, or service
3rendered in connection with a compensable injury. The
4provisions of subsections (e-5), (e-10), (e-15), and (e-20)
5shall not apply if an employee provides information to the
6provider regarding participation in a group health plan. If the
7employee participates in a group health plan, the provider may
8submit a claim for services to the group health plan. If the
9claim for service is covered by the group health plan, the
10employee's responsibility shall be limited to applicable
11deductibles, co-payments, or co-insurance. Except as provided
12under subsections (e-5), (e-10), (e-15), and (e-20), a provider
13shall not bill or otherwise attempt to recover from the
14employee the difference between the provider's charge and the
15amount paid by the employer or the insurer on a compensable
16injury, or for medical services or treatment determined by the
17Commission to be excessive or unnecessary.
18    (e-5) If an employer notifies a provider that the employer
19does not consider the illness or injury to be compensable under
20this Act, the provider may seek payment of the provider's
21actual charges from the employee for any procedure, treatment,
22or service rendered. Once an employee informs the provider that
23there is an application filed with the Commission to resolve a
24dispute over payment of such charges, the provider shall cease
25any and all efforts to collect payment for the services that
26are the subject of the dispute. Any statute of limitations or

 

 

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

 

 

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

 

 

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1not require a payment rate, excluding the interest provisions
2under subsection (d), greater than the lesser of the actual
3charge or the payment level set by the Commission in the fee
4schedule established in this Section. Payment for services
5deemed not covered or not compensable under this Act is the
6responsibility of the employee unless a provider and employee
7have agreed otherwise in writing. Services not covered or not
8compensable under this Act are not subject to the fee schedule
9in this Section.
10    (f) Nothing in this Act shall prohibit an employer or
11insurer from contracting with a health care provider or group
12of health care providers for reimbursement levels for benefits
13under this Act different from those provided in this Section.
14    (g) On or before January 1, 2010 the Commission shall
15provide to the Governor and General Assembly a report regarding
16the implementation of the medical fee schedule and the index
17used for annual adjustment to that schedule as described in
18this Section.
19(Source: P.A. 97-18, eff. 6-28-11.)
 
20    (820 ILCS 305/8.2a)
21    Sec. 8.2a. Electronic claims.
22    (a) The Illinois Workers' Compensation Commission Director
23of Insurance shall adopt rules to do all of the following:
24        (1) Ensure that all health care providers and
25    facilities submit medical bills for payment on

 

 

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1    standardized forms.
2        (2) Require acceptance by employers and insurers of
3    electronic claims for payment of medical services.
4        (3) Ensure confidentiality of medical information
5    submitted on electronic claims for payment of medical
6    services.
7        (4) Ensure that the rules establishing electronic
8    claims include a specific enforcement mechanism to ensure
9    compliance with these rules.
10        (5) Ensure that health care providers have at least 15
11    business days to comply with records requested by employers
12    and insurers for the authorization of the payment of
13    workers' compensation claims.
14    (b) To the extent feasible, standards adopted pursuant to
15subdivision (a) shall be consistent with existing standards
16under the federal Health Insurance Portability and
17Accountability Act of 1996 and standards adopted under the
18Illinois Health Information Exchange and Technology Act.
19    (c) The rules requiring employers and insurers to accept
20electronic claims for payment of medical services shall be
21proposed on or before May 31, 2016 January 1, 2012, and shall
22require all employers and insurers to accept electronic claims
23for payment of medical services on or before January 1, 2017
24June 30, 2012.
25    (d) The Illinois Workers' Compensation Commission Director
26of Insurance shall by rule establish criteria for granting

 

 

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1exceptions to employers, insurance carriers, and health care
2providers who are unable to submit or accept medical bills
3electronically.
4(Source: P.A. 97-18, eff. 6-28-11.)
 
5    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
6    Sec. 14. The Commission shall appoint a secretary, an
7assistant secretary, and arbitrators and shall employ such
8assistants and clerical help as may be necessary. Arbitrators
9shall be appointed pursuant to this Section, notwithstanding
10any provision of the Personnel Code.
11    Each arbitrator appointed after June 28, 2011 shall be
12required to demonstrate in writing his or her knowledge of and
13expertise in the law of and judicial processes of the Workers'
14Compensation Act and the Occupational Diseases Act.
15    A formal training program for newly-hired arbitrators
16shall be implemented. The training program shall include the
17following:
18        (a) substantive and procedural aspects of the
19    arbitrator position;
20        (b) current issues in workers' compensation law and
21    practice;
22        (c) medical lectures by specialists in areas such as
23    orthopedics, ophthalmology, psychiatry, rehabilitation
24    counseling;
25        (d) orientation to each operational unit of the

 

 

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1    Illinois Workers' Compensation Commission;
2        (e) observation of experienced arbitrators conducting
3    hearings of cases, combined with the opportunity to discuss
4    evidence presented and rulings made;
5        (f) the use of hypothetical cases requiring the trainee
6    to issue judgments as a means to evaluating knowledge and
7    writing ability;
8        (g) writing skills;
9        (h) professional and ethical standards pursuant to
10    Section 1.1 of this Act;
11        (i) detection of workers' compensation fraud and
12    reporting obligations of Commission employees and
13    appointees;
14        (j) standards of evidence-based medical treatment and
15    best practices for measuring and improving quality and
16    health care outcomes in the workers' compensation system,
17    including but not limited to the use of the American
18    Medical Association's "Guides to the Evaluation of
19    Permanent Impairment" and the practice of utilization
20    review; and
21        (k) substantive and procedural aspects of coal
22    workers' pneumoconiosis (black lung) cases.
23    A formal and ongoing professional development program
24including, but not limited to, the above-noted areas shall be
25implemented to keep arbitrators informed of recent
26developments and issues and to assist them in maintaining and

 

 

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1enhancing their professional competence. Each arbitrator shall
2complete 20 hours of training in the above-noted areas during
3every 2 years such arbitrator shall remain in office.
4    Each arbitrator shall devote full time to his or her duties
5and shall serve when assigned as an acting Commissioner when a
6Commissioner is unavailable in accordance with the provisions
7of Section 13 of this Act. Any arbitrator who is an
8attorney-at-law shall not engage in the practice of law, nor
9shall any arbitrator hold any other office or position of
10profit under the United States or this State or any municipal
11corporation or political subdivision of this State.
12Notwithstanding any other provision of this Act to the
13contrary, an arbitrator who serves as an acting Commissioner in
14accordance with the provisions of Section 13 of this Act shall
15continue to serve in the capacity of Commissioner until a
16decision is reached in every case heard by that arbitrator
17while serving as an acting Commissioner.
18    Notwithstanding any other provision of this Section, the
19term of all arbitrators serving on the effective date of this
20amendatory Act of the 97th General Assembly, including any
21arbitrators on administrative leave, shall terminate at the
22close of business on July 1, 2011, but the incumbents shall
23continue to exercise all of their duties until they are
24reappointed or their successors are appointed.
25    On and after the effective date of this amendatory Act of
26the 97th General Assembly, arbitrators shall be appointed to

 

 

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13-year terms as follows:
2        (1) All appointments shall be made by the Governor with
3    the advice and consent of the Senate.
4        (2) For their initial appointments, 12 arbitrators
5    shall be appointed to terms expiring July 1, 2012; 12
6    arbitrators shall be appointed to terms expiring July 1,
7    2013; and all additional arbitrators shall be appointed to
8    terms expiring July 1, 2014. Thereafter, all arbitrators
9    shall be appointed to 3-year terms.
10    Upon the expiration of a term, the Chairman shall evaluate
11the performance of the arbitrator and may recommend to the
12Governor that he or she be reappointed to a second or
13subsequent term by the Governor with the advice and consent of
14the Senate.
15    Each arbitrator appointed on or after the effective date of
16this amendatory Act of the 97th General Assembly and who has
17not previously served as an arbitrator for the Commission shall
18be required to be authorized to practice law in this State by
19the Supreme Court, and to maintain this authorization
20throughout his or her term of employment.
21    The performance of all arbitrators shall be reviewed by the
22Chairman on an annual basis. The Chairman shall allow input
23from the Commissioners in all such reviews.
24    The Commission shall assign no fewer than 3 arbitrators to
25each hearing site. The Commission shall establish a procedure
26to ensure that the arbitrators assigned to each hearing site

 

 

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1are assigned cases on a random basis. The Chairman of the
2Workers' Compensation Commission shall have discretion to
3assign and reassign arbitrators to each hearing site as needed.
4No arbitrator shall hear cases in any county, other than Cook
5County, for more than 2 years in each 3-year term.
6    The Secretary and each arbitrator shall receive a per annum
7salary of $4,000 less than the per annum salary of members of
8The Illinois Workers' Compensation Commission as provided in
9Section 13 of this Act, payable in equal monthly installments.
10    The members of the Commission, Arbitrators and other
11employees whose duties require them to travel, shall have
12reimbursed to them their actual traveling expenses and
13disbursements made or incurred by them in the discharge of
14their official duties while away from their place of residence
15in the performance of their duties.
16    The Commission shall provide itself with a seal for the
17authentication of its orders, awards and proceedings upon which
18shall be inscribed the name of the Commission and the words
19"Illinois--Seal".
20    The Secretary or Assistant Secretary, under the direction
21of the Commission, shall have charge and custody of the seal of
22the Commission and also have charge and custody of all records,
23files, orders, proceedings, decisions, awards and other
24documents on file with the Commission. He shall furnish
25certified copies, under the seal of the Commission, of any such
26records, files, orders, proceedings, decisions, awards and

 

 

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1other documents on file with the Commission as may be required.
2Certified copies so furnished by the Secretary or Assistant
3Secretary shall be received in evidence before the Commission
4or any Arbitrator thereof, and in all courts, provided that the
5original of such certified copy is otherwise competent and
6admissible in evidence. The Secretary or Assistant Secretary
7shall perform such other duties as may be prescribed from time
8to time by the Commission.
9(Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40,
10eff. 6-28-13.)
 
11    (820 ILCS 305/14.2 new)
12    Sec. 14.2. Workers' Compensation Ombudsman Program.
13    (a) The Illinois Workers' Compensation Commission shall
14establish the Workers' Compensation Ombudsman Program as a
15program within the Commission no later than July 1, 2016. The
16Ombudsman Program shall provide assistance to all regions of
17the State. The Ombudsman Program shall be staffed with
18personnel who are trained in techniques performed by ombudsmen
19and who are familiar with the Commission.
20    The Ombudsman Program may:
21        (1) assist injured workers with the use of the
22    Commission's information portal;
23        (2) provide information to employers, employees, and
24    medical provider with questions about workers'
25    compensation fraud;

 

 

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1        (3) assist injured employees with referral to local,
2    State, and federal financial assistance, rehabilitation,
3    and work placement programs, as well as other social
4    services that the Ombudsman Program considers appropriate;
5        (4) respond to inquiries and complaints relative to the
6    workers' compensation program; and
7        (5) serve as an information source for employees,
8    employers, medical, vocational, and rehabilitation
9    personnel, insurers, third-party administrators, and
10    self-insurers.
11    (b) Individuals within the Ombudsman Program may not appear
12or intervene, as a party or otherwise, before the Commission on
13behalf of an injured employee, employer, or medical provider.
14This Section shall not construed as requiring or allowing legal
15representation for an injured employee by the Ombudsman Program
16in any proceeding for the Commission.
 
17    (820 ILCS 305/14.3 new)
18    Sec. 14.3. WEAR Commission.
19    (a) There is created the Workers' Compensation Edit,
20Alignment, and Reform Commission, which shall be known as the
21WEAR Commission. The purpose of the WEAR Commission is to
22develop a proposed recodification of the Workers' Compensation
23Act that meets the following goals:
24        (1) to make this Act more accessible to laypeople
25    seeking benefits under this Act and employers seeking

 

 

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1    insurance coverage for their responsibilities under this
2    Act;
3        (2) to aid the Commission, attorneys, and judges in
4    understanding and applying the provisions of this Act;
5        (3) to prevent disputes over interpretations of this
6    Act that can add additional costs to the function and
7    administration of the workers' compensation system;
8        (4) to reduce the size of each Section of this Act to
9    promote understanding, interpretation, and indexing of
10    this Act;
11        (5) to assist policymakers so that they can more easily
12    understand the implications of amendments to this Act that
13    may be proposed in the future;
14        (6) to replace outdated and obsolete language within
15    this Act;
16        (7) to limit the opportunity for lengthy and expensive
17    appeals due to confusion or contrary language within this
18    Act; and
19        (8) to meet the preceding objectives without changing
20    substantive law or disturbing established case law
21    precedent.
22    (b) The members of the WEAR Commission shall be as follows:
23        (1) One Senator appointed the President of the Senate;
24        (2) One Senator appointed by the Minority Leader of the
25    Senate;
26        (3) One Representative appointed by the Speaker of the

 

 

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1    House of Representatives;
2        (4) One Representative appointed by the Minority
3    Leader of the House of Representatives;
4        (5) Four attorneys representing petitioners, one each
5    appointed by the President of the Senate, the Minority
6    Leader of the Senate, Speaker of the House of
7    Representatives, and Minority Leader of the House of
8    Representatives; and
9        (6) Four attorneys representing respondents, one each
10    appointed by the President of the Senate, Minority Leader
11    of the Senate, Speaker of the House of Representatives, and
12    Minority Leader of the House of Representatives.
13    The members of the WEAR Commission shall serve without
14compensation. The Chairperson of the Illinois Workers'
15Compensation Commission shall serve as Chairperson of the WEAR
16Commission.
17    (c) The Illinois Workers' Compensation Commission, the
18Workers' Compensation Insurance Compliance Unit, and the
19Legislative Reference Bureau shall provide administrative
20support for the WEAR Commission.
21    (d) The WEAR Commission shall present a report to the
22General Assembly no later than July 1, 2017. This report shall
23include a draft of proposed legislation for the reorganization
24of the Workers' Compensation Act that accomplishes the goals
25set forth by this Section.
26    (e) This Section is repealed on January 1, 2018.
 

 

 

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1    (820 ILCS 305/14.4 new)
2    Sec. 14.4. System improvements.
3    (a) By January 1, 2017, the Commission shall procure and
4implement a computer system to replace its current outdated and
5obsolete mainframe computer system. The Commission shall use
6the funds allocated for this purpose as set forth in the
7settlement agreement for the case entitled Illinois State
8Chamber of Commerce v. Filan.
9    (b) The system procured by the Commission shall have all of
10the following capabilities:
11        (1) require the electronic filing of claims before the
12    Commission, including the Application for Adjustment of
13    Claim and all subsequent filings by a petitioner or
14    respondent; the electronic filing fields for the
15    Application of Adjustment of Claim shall include the
16    following:
17            (i) for cases involving the State of Illinois, a
18        data field for the specific agency, department,
19        constitutional officer, board, or commission;
20            (ii) a data field for the petitioner to indicate
21        that the claim involves a repetitive injury;
22            (iii) a data field for the petitioner to indicate
23        that the claim involved an injury incurred when the
24        petitioner was traveling as part of his or her
25        employment; and

 

 

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1            (iv) a data field for the petitioner to indicate
2        that he or she is pro se;
3        (2) allow for a searchable portal for injured workers
4    to access their cases status, including respondent or
5    respondent's attorney contact information, arbitrator
6    name, call location, and date;
7        (3) allow for the respondent to indicate the insurance
8    carrier of the employer, or third-party administrator of
9    the employer, if self-insured;
10        (4) allow for documents and exhibits to be uploaded
11    electronically;
12        (5) allow for the case history of each claim to be
13    viewed in a summary format arranged by the date of each
14    filing or hearing, which shall be available to the public;
15        (6) allow for the attorney of record for the
16    petitioner, if any, and the respondent to be clearly
17    indicated on any summary format, including the attorney who
18    actually tried or argued the case before an arbitrator or
19    Commissioner;
20        (7) allow for the decision of the arbitrator or the
21    Commission to be uploaded electronically;
22        (8) allow for the following data reports to be produced
23    from the electronic system:
24            (i) the total number of decisions by each
25        arbitrator within any time period;
26            (ii) the total number of awards by injury type,

 

 

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1        including repetitive injury or injuries suffered by
2        employees when traveling in the course of their
3        employment or alleged to be suffered by employees when
4        traveling in the course of their employment;
5            (iii) the penalties assessed against employers,
6        searchable by each employer;
7            (iv) the total number of decisions by each panel of
8        Commissioners;
9            (v) the total number of claims filed by State
10        employees within any time period;
11            (vi) the total number of new claims filed in each
12        arbitration zone;
13            (vii) the total number of Settlement Contract Lump
14        Sum Petitions; and
15            (viii) the industry types of employers against
16        whom claims are filed;
17        (9) allow for an electronic, searchable record of any
18    approved Settlement Contract Lump Petitions, including the
19    amount of such Settlement Contract Lump Sum Petitions, the
20    type of injury, and the attorneys representing each party,
21    if any, for such Settlement Contract Lump Sum Petitions;
22        (10) allow for the random assignment of cases by
23    arbitrator and to the Commission panels, if appealed;
24        (11) allow for the electronic transmission of the
25    record of proceedings before the Commission to be
26    transmitted to the circuit court in the event of an appeal

 

 

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1    from the Commission; and
2        (12) ensure the confidentiality of all protected
3    information, including medical records.
4    (c) The Commission shall make all efforts to ensure that
5parties practicing before the Commission, including injured
6employees, are aware of the changes required by the procurement
7of the computer system required by this Section.
 
8    (820 ILCS 305/19)  (from Ch. 48, par. 138.19)
9    Sec. 19. Any disputed questions of law or fact shall be
10determined as herein provided.
11    (a) It shall be the duty of the Commission upon
12notification that the parties have failed to reach an
13agreement, to designate an Arbitrator.
14        1. Whenever any claimant misconceives his remedy and
15    files an application for adjustment of claim under this Act
16    and it is subsequently discovered, at any time before final
17    disposition of such cause, that the claim for disability or
18    death which was the basis for such application should
19    properly have been made under the Workers' Occupational
20    Diseases Act, then the provisions of Section 19, paragraph
21    (a-1) of the Workers' Occupational Diseases Act having
22    reference to such application shall apply.
23        2. Whenever any claimant misconceives his remedy and
24    files an application for adjustment of claim under the
25    Workers' Occupational Diseases Act and it is subsequently

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1days from the date that the Petition for Review is filed with
2the Commission.
3    Where 2 or more insurance carriers, private self-insureds,
4or a group workers' compensation pool under Article V 3/4 of
5the Illinois Insurance Code dispute coverage for the same
6injury, any such insurance carrier, private self-insured, or
7group workers' compensation pool may request an expedited
8hearing pursuant to this paragraph to determine the issue of
9coverage, provided coverage is the only issue in dispute and
10all other issues are stipulated and agreed to and further
11provided that all compensation benefits including medical
12benefits pursuant to Section 8(a) continue to be paid to or on
13behalf of petitioner. Any insurance carrier, private
14self-insured, or group workers' compensation pool that is
15determined to be liable for coverage for the injury in issue
16shall reimburse any insurance carrier, private self-insured,
17or group workers' compensation pool that has paid benefits to
18or on behalf of petitioner for the injury.
19    (b-1) If the employee is not receiving medical, surgical or
20hospital services as provided in paragraph (a) of Section 8 or
21compensation as provided in paragraph (b) of Section 8, the
22employee, in accordance with Commission Rules, may file a
23petition for an emergency hearing by an Arbitrator on the issue
24of whether or not he is entitled to receive payment of such
25compensation or services as provided therein. Such petition
26shall have priority over all other petitions and shall be heard

 

 

SB2154- 99 -LRB099 13035 SXM 36947 b

1by the Arbitrator and Commission with all convenient speed.
2    Such petition shall contain the following information and
3shall be served on the employer at least 15 days before it is
4filed:
5        (i) the date and approximate time of accident;
6        (ii) the approximate location of the accident;
7        (iii) a description of the accident;
8        (iv) the nature of the injury incurred by the employee;
9        (v) the identity of the person, if known, to whom the
10    accident was reported and the date on which it was
11    reported;
12        (vi) the name and title of the person, if known,
13    representing the employer with whom the employee conferred
14    in any effort to obtain compensation pursuant to paragraph
15    (b) of Section 8 of this Act or medical, surgical or
16    hospital services pursuant to paragraph (a) of Section 8 of
17    this Act and the date of such conference;
18        (vii) a statement that the employer has refused to pay
19    compensation pursuant to paragraph (b) of Section 8 of this
20    Act or for medical, surgical or hospital services pursuant
21    to paragraph (a) of Section 8 of this Act;
22        (viii) the name and address, if known, of each witness
23    to the accident and of each other person upon whom the
24    employee will rely to support his allegations;
25        (ix) the dates of treatment related to the accident by
26    medical practitioners, and the names and addresses of such

 

 

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

 

 

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

 

 

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

 

 

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1    The Commission shall adopt rules, regulations and
2procedures whereby the final decision of the Commission is
3filed not later than 90 days from the date the petition for
4review is filed but in no event later than 180 days from the
5date the petition for an emergency hearing is filed with the
6Illinois Workers' Compensation Commission.
7    All service required pursuant to this paragraph (b-1) must
8be by personal service or by certified mail and with evidence
9of receipt. In addition for the purposes of this paragraph, all
10service on the employer must be at the premises where the
11accident occurred if the premises are owned or operated by the
12employer. Otherwise service must be at the employee's principal
13place of employment by the employer. If service on the employer
14is not possible at either of the above, then service shall be
15at the employer's principal place of business. After initial
16service in each case, service shall be made on the employer's
17attorney or designated representative.
18    (c)(1) At a reasonable time in advance of and in connection
19with the hearing under Section 19(e) or 19(h), the Commission
20may on its own motion order an impartial physical or mental
21examination of a petitioner whose mental or physical condition
22is in issue, when in the Commission's discretion it appears
23that such an examination will materially aid in the just
24determination of the case. The examination shall be made by a
25member or members of a panel of physicians chosen for their
26special qualifications by the Illinois State Medical Society.

 

 

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1The Commission shall establish procedures by which a physician
2shall be selected from such list.
3    (2) Should the Commission at any time during the hearing
4find that compelling considerations make it advisable to have
5an examination and report at that time, the commission may in
6its discretion so order.
7    (3) A copy of the report of examination shall be given to
8the Commission and to the attorneys for the parties.
9    (4) Either party or the Commission may call the examining
10physician or physicians to testify. Any physician so called
11shall be subject to cross-examination.
12    (5) The examination shall be made, and the physician or
13physicians, if called, shall testify, without cost to the
14parties. The Commission shall determine the compensation and
15the pay of the physician or physicians. The compensation for
16this service shall not exceed the usual and customary amount
17for such service.
18    (6) The fees and payment thereof of all attorneys and
19physicians for services authorized by the Commission under this
20Act shall, upon request of either the employer or the employee
21or the beneficiary affected, be subject to the review and
22decision of the Commission.
23    (d) If any employee shall persist in insanitary or
24injurious practices which tend to either imperil or retard his
25recovery or shall refuse to submit to such medical, surgical,
26or hospital treatment as is reasonably essential to promote his

 

 

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1recovery, the Commission may, in its discretion, reduce or
2suspend the compensation of any such injured employee. However,
3when an employer and employee so agree in writing, the
4foregoing provision shall not be construed to authorize the
5reduction or suspension of compensation of an employee who is
6relying in good faith, on treatment by prayer or spiritual
7means alone, in accordance with the tenets and practice of a
8recognized church or religious denomination, by a duly
9accredited practitioner thereof.
10    (e) This paragraph shall apply to all hearings before the
11Commission. Such hearings may be held in its office or
12elsewhere as the Commission may deem advisable. The taking of
13testimony on such hearings may be had before any member of the
14Commission. If a petition for review and agreed statement of
15facts or transcript of evidence is filed, as provided herein,
16the Commission shall promptly review the decision of the
17Arbitrator and all questions of law or fact which appear from
18the statement of facts or transcript of evidence.
19    In all cases in which the hearing before the arbitrator is
20held after December 18, 1989, no additional evidence shall be
21introduced by the parties before the Commission on review of
22the decision of the Arbitrator. In reviewing decisions of an
23arbitrator the Commission shall award such temporary
24compensation, permanent compensation and other payments as are
25due under this Act. The Commission shall file in its office its
26decision thereon, and shall immediately send to each party or

 

 

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1his attorney a copy of such decision and a notification of the
2time when it was filed. Decisions shall be filed within 60 days
3after the Statement of Exceptions and Supporting Brief and
4Response thereto are required to be filed or oral argument
5whichever is later.
6    In the event either party requests oral argument, such
7argument shall be had before a panel of 3 members of the
8Commission (or before all available members pursuant to the
9determination of 7 members of the Commission that such argument
10be held before all available members of the Commission)
11pursuant to the rules and regulations of the Commission. A
12panel of 3 members, which shall be comprised of not more than
13one representative citizen of the employing class and not more
14than one representative citizen of the employee class, shall
15hear the argument; provided that if all the issues in dispute
16are solely the nature and extent of the permanent partial
17disability, if any, a majority of the panel may deny the
18request for such argument and such argument shall not be held;
19and provided further that 7 members of the Commission may
20determine that the argument be held before all available
21members of the Commission. A decision of the Commission shall
22be approved by a majority of Commissioners present at such
23hearing if any; provided, if no such hearing is held, a
24decision of the Commission shall be approved by a majority of a
25panel of 3 members of the Commission as described in this
26Section. The Commission shall give 10 days' notice to the

 

 

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1parties or their attorneys of the time and place of such taking
2of testimony and of such argument.
3    In any case the Commission in its decision may find
4specially upon any question or questions of law or fact which
5shall be submitted in writing by either party whether ultimate
6or otherwise; provided that on issues other than nature and
7extent of the disability, if any, the Commission in its
8decision shall find specially upon any question or questions of
9law or fact, whether ultimate or otherwise, which are submitted
10in writing by either party; provided further that not more than
115 such questions may be submitted by either party. Any party
12may, within 20 days after receipt of notice of the Commission's
13decision, or within such further time, not exceeding 30 days,
14as the Commission may grant, file with the Commission either an
15agreed statement of the facts appearing upon the hearing, or,
16if such party shall so elect, a correct transcript of evidence
17of the additional proceedings presented before the Commission,
18in which report the party may embody a correct statement of
19such other proceedings in the case as such party may desire to
20have reviewed, such statement of facts or transcript of
21evidence to be authenticated by the signature of the parties or
22their attorneys, and in the event that they do not agree, then
23the authentication of such transcript of evidence shall be by
24the signature of any member of the Commission.
25    If a reporter does not for any reason furnish a transcript
26of the proceedings before the Arbitrator in any case for use on

 

 

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

 

 

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1Section without unnecessary delay, and without regard to the
2fact that a member of the panel has expressed an intention to
3dissent. Any member of the panel may file a dissent. Any
4dissent shall be filed no later than 10 days after the decision
5of the majority has been filed.
6    Decisions rendered by the Commission and dissents, if any,
7shall be published together by the Commission. The conclusions
8of law set out in such decisions shall be regarded as
9precedents by arbitrators for the purpose of achieving a more
10uniform administration of this Act.
11    (f) The decision of the Commission acting within its
12powers, according to the provisions of paragraph (e) of this
13Section shall, in the absence of fraud, be conclusive unless
14reviewed as in this paragraph hereinafter provided. However,
15the Arbitrator or the Commission may on his or its own motion,
16or on the motion of either party, correct any clerical error or
17errors in computation within 15 days after the date of receipt
18of any award by such Arbitrator or any decision on review of
19the Commission and shall have the power to recall the original
20award on arbitration or decision on review, and issue in lieu
21thereof such corrected award or decision. Where such correction
22is made the time for review herein specified shall begin to run
23from the date of the receipt of the corrected award or
24decision.
25        (1) Except in cases of claims against the State of
26    Illinois other than those claims under Section 18.1, in

 

 

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

 

 

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1    court issuing the summons shall on the day of issue mail
2    notice of the commencement of the proceedings which shall
3    be done by mailing a copy of the summons to the office of
4    the Commission, and a copy of the summons to the other
5    parties in interest or their attorney or attorneys of
6    record and the clerk of the court shall make certificate
7    that he has so sent said notices in pursuance of this
8    Section, which shall be evidence of service on the
9    Commission and other parties in interest.
10        The Commission shall not be required to certify the
11    record of their proceedings to the Circuit Court, unless
12    the party commencing the proceedings for review in the
13    Circuit Court as above provided, shall file with the
14    Commission notice of intent to file for review in Circuit
15    Court. It shall be the duty of the Commission upon such
16    filing of notice of intent to file for review in the
17    Circuit Court to prepare a true and correct copy of such
18    testimony and a true and correct copy of all other matters
19    contained in such record and certified to by the Secretary
20    or Assistant Secretary thereof. The changes made to this
21    subdivision (f)(1) by this amendatory Act of the 98th
22    General Assembly apply to any Commission decision entered
23    after the effective date of this amendatory Act of the 98th
24    General Assembly.
25        No request for a summons may be filed and no summons
26    shall issue unless the party seeking to review the decision

 

 

SB2154- 112 -LRB099 13035 SXM 36947 b

1    of the Commission shall exhibit to the clerk of the Circuit
2    Court proof of filing with the Commission of the notice of
3    the intent to file for review in the Circuit Court or an
4    affidavit of the attorney setting forth that notice of
5    intent to file for review in the Circuit Court has been
6    given in writing to the Secretary or Assistant Secretary of
7    the Commission.
8        (2) No such summons shall issue unless the one against
9    whom the Commission shall have rendered an award for the
10    payment of money shall upon the filing of his written
11    request for such summons file with the clerk of the court a
12    bond conditioned that if he shall not successfully
13    prosecute the review, he will pay the award and the costs
14    of the proceedings in the courts. The amount of the bond
15    shall be fixed by any member of the Commission and the
16    surety or sureties of the bond shall be approved by the
17    clerk of the court. The acceptance of the bond by the clerk
18    of the court shall constitute evidence of his approval of
19    the bond.
20        The State of Illinois, including its constitutional
21    officers, boards, commissions, agencies, public
22    institutions of higher learning, and funds administered by
23    the Treasurer ex officio, and every Every county, city,
24    town, township, incorporated village, school district,
25    body politic or municipal corporation against whom the
26    Commission shall have rendered an award for the payment of

 

 

SB2154- 113 -LRB099 13035 SXM 36947 b

1    money shall not be required to file a bond to secure the
2    payment of the award and the costs of the proceedings in
3    the court to authorize the court to issue such summons.
4        The court may confirm or set aside the decision of the
5    Commission. If the decision is set aside and the facts
6    found in the proceedings before the Commission are
7    sufficient, the court may enter such decision as is
8    justified by law, or may remand the cause to the Commission
9    for further proceedings and may state the questions
10    requiring further hearing, and give such other
11    instructions as may be proper. Appeals shall be taken to
12    the Appellate Court in accordance with Supreme Court Rules
13    22(g) and 303. Appeals shall be taken from the Appellate
14    Court to the Supreme Court in accordance with Supreme Court
15    Rule 315.
16        It shall be the duty of the clerk of any court
17    rendering a decision affecting or affirming an award of the
18    Commission to promptly furnish the Commission with a copy
19    of such decision, without charge.
20        The decision of a majority of the members of the panel
21    of the Commission, shall be considered the decision of the
22    Commission.
23    (g) Except in the case of a claim against the State of
24Illinois, either party may present a certified copy of the
25award of the Arbitrator, or a certified copy of the decision of
26the Commission when the same has become final, when no

 

 

SB2154- 114 -LRB099 13035 SXM 36947 b

1proceedings for review are pending, providing for the payment
2of compensation according to this Act, to the Circuit Court of
3the county in which such accident occurred or either of the
4parties are residents, whereupon the court shall enter a
5judgment in accordance therewith. In a case where the employer
6refuses to pay compensation according to such final award or
7such final decision upon which such judgment is entered the
8court shall in entering judgment thereon, tax as costs against
9him the reasonable costs and attorney fees in the arbitration
10proceedings and in the court entering the judgment for the
11person in whose favor the judgment is entered, which judgment
12and costs taxed as therein provided shall, until and unless set
13aside, have the same effect as though duly entered in an action
14duly tried and determined by the court, and shall with like
15effect, be entered and docketed. The Circuit Court shall have
16power at any time upon application to make any such judgment
17conform to any modification required by any subsequent decision
18of the Supreme Court upon appeal, or as the result of any
19subsequent proceedings for review, as provided in this Act.
20    Judgment shall not be entered until 15 days' notice of the
21time and place of the application for the entry of judgment
22shall be served upon the employer by filing such notice with
23the Commission, which Commission shall, in case it has on file
24the address of the employer or the name and address of its
25agent upon whom notices may be served, immediately send a copy
26of the notice to the employer or such designated agent.

 

 

SB2154- 115 -LRB099 13035 SXM 36947 b

1    (h) An agreement or award under this Act providing for
2compensation in installments, may at any time within 18 months
3after such agreement or award be reviewed by the Commission at
4the request of either the employer or the employee, on the
5ground that the disability of the employee has subsequently
6recurred, increased, diminished or ended.
7    However, as to accidents occurring subsequent to July 1,
81955, which are covered by any agreement or award under this
9Act providing for compensation in installments made as a result
10of such accident, such agreement or award may at any time
11within 30 months, or 60 months in the case of an award under
12Section 8(d)1, after such agreement or award be reviewed by the
13Commission at the request of either the employer or the
14employee on the ground that the disability of the employee has
15subsequently recurred, increased, diminished or ended.
16    On such review, compensation payments may be
17re-established, increased, diminished or ended. The Commission
18shall give 15 days' notice to the parties of the hearing for
19review. Any employee, upon any petition for such review being
20filed by the employer, shall be entitled to one day's notice
21for each 100 miles necessary to be traveled by him in attending
22the hearing of the Commission upon the petition, and 3 days in
23addition thereto. Such employee shall, at the discretion of the
24Commission, also be entitled to 5 cents per mile necessarily
25traveled by him within the State of Illinois in attending such
26hearing, not to exceed a distance of 300 miles, to be taxed by

 

 

SB2154- 116 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 117 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 118 -LRB099 13035 SXM 36947 b

1additional compensation in the sum of $30 per day for each day
2that the benefits under Section 8(a) or Section 8(b) have been
3so withheld or refused, not to exceed $10,000. A delay in
4payment of 14 days or more shall create a rebuttable
5presumption of unreasonable delay.
6    (m) If the commission finds that an accidental injury was
7directly and proximately caused by the employer's wilful
8violation of a health and safety standard under the Health and
9Safety Act or the Occupational Safety and Health Act in force
10at the time of the accident, the arbitrator or the Commission
11shall allow to the injured employee or his dependents, as the
12case may be, additional compensation equal to 25% of the amount
13which otherwise would be payable under the provisions of this
14Act exclusive of this paragraph. The additional compensation
15herein provided shall be allowed by an appropriate increase in
16the applicable weekly compensation rate.
17    (n) After June 30, 1984, decisions of the Illinois Workers'
18Compensation Commission reviewing an award of an arbitrator of
19the Commission shall draw interest at a rate equal to the yield
20on indebtedness issued by the United States Government with a
2126-week maturity next previously auctioned on the day on which
22the decision is filed. Said rate of interest shall be set forth
23in the Arbitrator's Decision. Interest shall be drawn from the
24date of the arbitrator's award on all accrued compensation due
25the employee through the day prior to the date of payments.
26However, when an employee appeals an award of an Arbitrator or

 

 

SB2154- 119 -LRB099 13035 SXM 36947 b

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

 

 

SB2154- 120 -LRB099 13035 SXM 36947 b

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

 

 

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1within 15 days after the date of receipt of such award of the
2arbitrator and shall have the power to recall the original
3award on arbitration, and issue in lieu thereof such corrected
4award. The decision of the arbitrator under this subsection (p)
5shall be considered the decision of the Commission and
6proceedings for review of questions of law arising from the
7decision may be commenced by either party pursuant to
8subsection (f) of Section 19. The Advisory Board established
9under Section 13.1 shall compile a list of certified Commission
10arbitrators, each of whom shall be approved by at least 7
11members of the Advisory Board. The chairman shall select 5
12persons from such list to serve as arbitrators under this
13subsection (p). By agreement, the parties shall select one
14arbitrator from among the 5 persons selected by the chairman
15except that if the parties do not agree on an arbitrator from
16among the 5 persons, the parties may, by agreement, select an
17arbitrator of the American Arbitration Association, whose fee
18shall be paid by the State in accordance with rules promulgated
19by the Commission. Arbitration under this subsection (p) shall
20be voluntary.
21(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
22eff. 1-1-15.)
 
23    (820 ILCS 305/25.5)
24    Sec. 25.5. Unlawful acts; penalties.
25    (a) It is unlawful for any person, company, corporation,

 

 

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

 

 

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1    Section 4 of this Act.
2        (7) Intentionally make or cause to be made any false or
3    fraudulent material statement to the Illinois Workers'
4    Compensation Commission's Department of Insurance's fraud
5    and insurance non-compliance unit in the course of an
6    investigation of fraud or insurance non-compliance.
7        (8) Intentionally assist, abet, solicit, or conspire
8    with any person, company, or other entity to commit any of
9    the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
10    of this subsection (a).
11        (9) Intentionally present a bill or statement for the
12    payment for medical services that were not provided.
13    For the purposes of paragraphs (2), (3), (5), (6), (7), and
14(9), the term "statement" includes any writing, notice, proof
15of injury, bill for services, hospital or doctor records and
16reports, or X-ray and test results.
17    (b) Sentences for violations of subsection (a) are as
18follows:
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

 

 

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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    For the purposes of this Section, where the exact value of
15property obtained or attempted to be obtained is either not
16alleged or is not specifically set by the terms of a policy of
17insurance, the value of the property shall be the fair market
18replacement value of the property claimed to be lost, the
19reasonable costs of reimbursing a vendor or other claimant for
20services to be rendered, or both. Notwithstanding the
21foregoing, an insurance company, self-insured entity, or any
22other person suffering financial loss sustained as a result of
23violation of this Section may seek restitution, including court
24costs and attorney's fees in a civil action in a court of
25competent jurisdiction.
26    (c) The Illinois Workers' Compensation Commission

 

 

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1Department of Insurance shall establish a fraud and insurance
2non-compliance unit responsible for investigating incidences
3of fraud and insurance non-compliance pursuant to this Section.
4The size of the staff of the unit shall be subject to
5appropriation by the General Assembly. It shall be the duty of
6the fraud and insurance non-compliance unit to determine the
7identity of insurance carriers, employers, employees, or other
8persons or entities who have violated the fraud and insurance
9non-compliance provisions of this Section. The fraud and
10insurance non-compliance unit shall report violations of the
11fraud and insurance non-compliance provisions of this Section
12to the Special Prosecutions Bureau of the Criminal Division of
13the Office of the Attorney General or to the State's Attorney
14of the county in which the offense allegedly occurred, either
15of whom has the authority to prosecute violations under this
16Section.
17    With respect to the subject of any investigation being
18conducted, the fraud and insurance non-compliance unit shall
19have the general power of subpoena of the Department of
20Insurance, including the authority to issue a subpoena to a
21medical provider, pursuant to Section 8-802 of the Code of
22Civil Procedure.
23    (d) Any person may report allegations of insurance
24non-compliance and fraud pursuant to this Section to the
25Illinois Workers' Compensation Commission's Department of
26Insurance's fraud and insurance non-compliance unit whose duty

 

 

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1it shall be to investigate the report. The unit shall notify
2the Commission of reports of insurance non-compliance. Any
3person reporting an allegation of insurance non-compliance or
4fraud against either an employee or employer under this Section
5must identify himself. Except as provided in this subsection
6and in subsection (e), all reports shall remain confidential
7except to refer an investigation to the Attorney General or
8State's Attorney for prosecution or if the fraud and insurance
9non-compliance unit's investigation reveals that the conduct
10reported may be in violation of other laws or regulations of
11the State of Illinois, the unit may report such conduct to the
12appropriate governmental agency charged with administering
13such laws and regulations. Any person who intentionally makes a
14false report under this Section to the fraud and insurance
15non-compliance unit is guilty of a Class A misdemeanor.
16    (e) In order for the fraud and insurance non-compliance
17unit to investigate a report of fraud related to an employee's
18claim, (i) the employee must have filed with the Commission an
19Application for Adjustment of Claim and the employee must have
20either received or attempted to receive benefits under this Act
21that are related to the reported fraud or (ii) the employee
22must have made a written demand for the payment of benefits
23that are related to the reported fraud. There shall be no
24immunity, under this Act or otherwise, for any person who files
25a false report or who files a report without good and just
26cause. Confidentiality of medical information shall be

 

 

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1strictly maintained. Investigations that are not referred for
2prosecution shall be destroyed upon the expiration of the
3statute of limitations for the acts under investigation and
4shall not be disclosed except that the person making the report
5shall be notified that the investigation is being closed. It is
6unlawful for any employer, insurance carrier, service
7adjustment company, third party administrator, self-insured,
8or similar entity to file or threaten to file a report of fraud
9against an employee because of the exercise by the employee of
10the rights and remedies granted to the employee by this Act.
11    (e-5) The fraud and insurance non-compliance unit shall
12procure and implement a system utilizing advanced analytics
13inclusive of predictive modeling, data mining, social network
14analysis, and scoring algorithms for the detection and
15prevention of fraud, waste, and abuse on or before January 1,
162012. The fraud and insurance non-compliance unit shall procure
17this system using a request for proposals process governed by
18the Illinois Procurement Code and rules adopted under that
19Code. The fraud and insurance non-compliance unit shall provide
20a report to the President of the Senate, Speaker of the House
21of Representatives, Minority Leader of the House of
22Representatives, Minority Leader of the Senate, Governor,
23Chairman of the Commission, and Director of Insurance on or
24before July 1, 2012 and annually thereafter detailing its
25activities and providing recommendations regarding
26opportunities for additional fraud waste and abuse detection

 

 

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1and prevention.
2    (f) Any person convicted of fraud related to workers'
3compensation pursuant to this Section shall be subject to the
4penalties prescribed in the Criminal Code of 2012 and shall be
5ineligible to receive or retain any compensation, disability,
6or medical benefits as defined in this Act if the compensation,
7disability, or medical benefits were owed or received as a
8result of fraud for which the recipient of the compensation,
9disability, or medical benefit was convicted. This subsection
10applies to accidental injuries or diseases that occur on or
11after the effective date of this amendatory Act of the 94th
12General Assembly.
13    (g) Civil liability. Any person convicted of fraud who
14knowingly obtains, attempts to obtain, or causes to be obtained
15any benefits under this Act by the making of a false claim or
16who knowingly misrepresents any material fact shall be civilly
17liable to the payor of benefits or the insurer or the payor's
18or insurer's subrogee or assignee in an amount equal to 3 times
19the value of the benefits or insurance coverage wrongfully
20obtained or twice the value of the benefits or insurance
21coverage attempted to be obtained, plus reasonable attorney's
22fees and expenses incurred by the payor or the payor's subrogee
23or assignee who successfully brings a claim under this
24subsection. This subsection applies to accidental injuries or
25diseases that occur on or after the effective date of this
26amendatory Act of the 94th General Assembly.

 

 

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1    (h) The fraud and insurance non-compliance unit shall
2submit a written report on an annual basis to the Chairman of
3the Commission, the Workers' Compensation Advisory Board, the
4General Assembly, the Governor, and the Attorney General by
5January 1 and July 1 of each year. This report shall include,
6at the minimum, the following information:
7        (1) The number of allegations of insurance
8    non-compliance and fraud reported to the fraud and
9    insurance non-compliance unit.
10        (2) The source of the reported allegations
11    (individual, employer, or other).
12        (3) The number of allegations investigated by the fraud
13    and insurance non-compliance unit.
14        (4) The number of criminal referrals made in accordance
15    with this Section and the entity to which the referral was
16    made.
17        (5) All proceedings under this Section.
18(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    820 ILCS 305/1from Ch. 48, par. 138.1
4    820 ILCS 305/4from Ch. 48, par. 138.4
5    820 ILCS 305/8from Ch. 48, par. 138.8
6    820 ILCS 305/8.1b
7    820 ILCS 305/8.2
8    820 ILCS 305/8.2a
9    820 ILCS 305/14from Ch. 48, par. 138.14
10    820 ILCS 305/14.2 new
11    820 ILCS 305/14.3 new
12    820 ILCS 305/14.4 new
13    820 ILCS 305/19from Ch. 48, par. 138.19
14    820 ILCS 305/25.5