Full Text of SB0782 95th General Assembly
SB0782ham001 95TH GENERAL ASSEMBLY
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Veterans Affairs Committee
Filed: 2/28/2008
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| AMENDMENT TO SENATE BILL 782
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| AMENDMENT NO. ______. Amend Senate Bill 782 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 1. Short title. This Act may be cited as the | 5 |
| Veterans' Health Insurance Program Act of 2008. | 6 |
| Section 3. Legislative intent. The General Assembly finds | 7 |
| that those who have served their country honorably in military | 8 |
| service and who are residing in this State deserve access to | 9 |
| affordable, comprehensive health insurance. Many veterans are | 10 |
| uninsured and unable to afford healthcare. This lack of | 11 |
| healthcare, including preventative care, often exacerbates | 12 |
| health conditions. The effects of lack of insurance negatively | 13 |
| impact those residents of the State who are insured because the | 14 |
| cost of paying for care to the uninsured is often shifted to | 15 |
| those who have insurance in the form of higher health insurance | 16 |
| premiums. It is, therefore, the intent of this legislation to |
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| provide access to affordable health insurance for veterans | 2 |
| residing in Illinois who are unable to afford such coverage. | 3 |
| However, the State has only a limited amount of resources, and | 4 |
| the General Assembly therefore declares that while it intends | 5 |
| to cover as many such veterans as possible, the State may not | 6 |
| be able to cover every eligible person who qualifies for this | 7 |
| Program as a matter of entitlement due to limited funding. | 8 |
| Section 5. Definitions. The following words have the | 9 |
| following meanings: | 10 |
| "Department" means the Department of Healthcare and Family | 11 |
| Services, or any successor agency. | 12 |
| "Director" means the Director of Healthcare and Family | 13 |
| Services, or any successor agency. | 14 |
| "Medical assistance" means health care benefits provided | 15 |
| under Article V of the Illinois Public Aid Code. | 16 |
| "Program" means the Veterans' Health Insurance Program. | 17 |
| "Resident" means an individual who has an Illinois | 18 |
| residence, as provided in Section 5-3 of the Illinois Public | 19 |
| Aid Code. | 20 |
| "Veteran" means any person who has served in a branch of | 21 |
| the United States military for greater than 180 consecutive | 22 |
| days after initial training. | 23 |
| "Veterans' Affairs" or "VA" means the United States | 24 |
| Department of Veterans' Affairs. |
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| Section 10. Operation of the Program. | 2 |
| (a) The Veterans' Health Insurance Program is created. This | 3 |
| Program is not an entitlement. Enrollment is based on the | 4 |
| availability of funds, and enrollment may be capped based on | 5 |
| funds appropriated for the Program. As soon as practical after | 6 |
| the effective date of this Act, coverage for this Program shall | 7 |
| begin. The Program shall be administered by the Department of | 8 |
| Healthcare and Family Services in collaboration with the | 9 |
| Department of Veterans' Affairs. The Department shall have the | 10 |
| same powers and authority to administer the Program as are | 11 |
| provided to the Department in connection with the Department's | 12 |
| administration of the Illinois Public Aid Code. The Department | 13 |
| shall coordinate the Program with other health programs | 14 |
| operated by the Department and other State and federal | 15 |
| agencies. | 16 |
| (b) The Department shall operate the Program in a manner so | 17 |
| that the estimated cost of the Program during the fiscal year | 18 |
| will not exceed the total appropriation for the Program. The | 19 |
| Department may take any appropriate action to limit spending or | 20 |
| enrollment into the Program, including, but not limited to, | 21 |
| ceasing to accept or process applications, reviewing | 22 |
| eligibility more frequently than annually, adjusting | 23 |
| cost-sharing, or reducing the income threshold for eligibility | 24 |
| as necessary to control expenditures for the Program. | 25 |
| Section 15. Eligibility. |
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| (a) To be eligible for the Program, a person must: | 2 |
| (1) be a veteran who is not on active duty and who has | 3 |
| not been dishonorably discharged from service; | 4 |
| (2) be a resident of the State of Illinois; | 5 |
| (3) be at least 19 years of age and no older than 64 | 6 |
| years of age; | 7 |
| (4) be uninsured, as defined by the Department by rule, | 8 |
| for a period of time established by the Department by rule, | 9 |
| which shall be no less than 6 months; | 10 |
| (5) not be eligible for medical assistance under the | 11 |
| Illinois Public Aid Code; | 12 |
| (6) not be eligible for medical benefits through the | 13 |
| Veterans Health Administration; and | 14 |
| (7) have a household income no greater than the sum of | 15 |
| (i) an amount equal to 25% of the federal poverty level | 16 |
| plus (ii) an amount equal to the Veterans Administration | 17 |
| means test income threshold at the initiation of the | 18 |
| Program; depending on the availability of funds, this level | 19 |
| may be increased to an amount equal to the sum of (iii) an | 20 |
| amount equal to 50% of the federal poverty level plus (iv) | 21 |
| an amount equal to the Veterans Administration means test | 22 |
| income threshold. This means test income threshold is | 23 |
| subject to alteration by the Department as set forth in | 24 |
| subsection (b) of Section 10. | 25 |
| (b) A veteran who is determined eligible for the Program | 26 |
| shall remain eligible for 12 months, provided the veteran |
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| remains a resident of the State and is not excluded under | 2 |
| subsection (c) of this Section and provided the Department has | 3 |
| not limited the enrollment period as set forth in subsection | 4 |
| (b) of Section 10. | 5 |
| (c) A veteran is not eligible for coverage under the | 6 |
| Program if: | 7 |
| (1) the premium required under Section 35 of this Act | 8 |
| has not been timely paid; if the required premiums are not | 9 |
| paid, the liability of the Program shall be limited to | 10 |
| benefits incurred under the Program for the time period for | 11 |
| which premiums have been paid and for grace periods as | 12 |
| established under subsection (d); if the required monthly | 13 |
| premium is not paid, the veteran is ineligible for | 14 |
| re-enrollment for a minimum period of 3 months; or | 15 |
| (2) the veteran is a resident of a nursing facility or | 16 |
| an inmate of a public institution, as defined by 42 CFR | 17 |
| 435.1009. | 18 |
| (d) The Department shall adopt rules for the Program, | 19 |
| including, but not limited to, rules relating to eligibility, | 20 |
| re-enrollment, grace periods, notice requirements, hearing | 21 |
| procedures, cost-sharing, covered services, and provider | 22 |
| requirements.
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| Section 20. Notice of decisions to terminate eligibility. | 24 |
| Whenever the Department decides to either deny or terminate | 25 |
| eligibility under this Act, the veteran shall have a right to |
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| notice and a hearing, as provided by the Department by rule. | 2 |
| Section 25. Illinois Department of Veterans' Affairs. The | 3 |
| Department shall coordinate with the Illinois Department of | 4 |
| Veterans' Affairs and the Veterans Assistance Commissions to | 5 |
| allow State Veterans' Affairs service officers and the Veterans | 6 |
| Assistance Commissions to assist veterans to apply for the | 7 |
| Program. All applicants must be reviewed for Veterans Health | 8 |
| Administration eligibility or other existing health benefits | 9 |
| prior to consideration for the Program. | 10 |
| Section 30. Health care benefits. | 11 |
| (a) For veterans eligible and enrolled, the Department | 12 |
| shall purchase or provide health care benefits for eligible | 13 |
| veterans that are identical to the benefits provided to adults | 14 |
| under the State's approved plan under Title XIX of the Social | 15 |
| Security Act, except for nursing facility services and | 16 |
| non-emergency transportation. | 17 |
| (b) Providers shall be subject to approval by the | 18 |
| Department to provide health care under the Illinois Public Aid | 19 |
| Code and shall be reimbursed at the same rates as providers | 20 |
| reimbursed under the State's approved plan under Title XIX of | 21 |
| the Social Security Act. | 22 |
| (c) As an alternative to the benefits set forth in | 23 |
| subsection (a) of this Section, and when cost-effective, the | 24 |
| Department may offer veterans subsidies toward the cost of |
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| privately sponsored health insurance, including | 2 |
| employer-sponsored health insurance.
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| Section 35. Cost-sharing. The Department, by rule, shall | 4 |
| set forth requirements concerning co-payments and monthly | 5 |
| premiums for health care services. This cost-sharing shall be | 6 |
| based on household income, as defined by the Department by | 7 |
| rule, and is subject to alteration by the Department as set | 8 |
| forth in subsection (b) of Section 10. | 9 |
| Section 40. Charge upon claims and causes of action; right | 10 |
| of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, | 11 |
| and 11-22c of the Illinois Public Aid Code apply to health | 12 |
| benefits provided to veterans under this Act, as provided in | 13 |
| those Sections. | 14 |
| Section 45. Reporting. The Department shall prepare an | 15 |
| annual report for submission to the General Assembly. The | 16 |
| report shall be due to the General Assembly by January 1 of | 17 |
| each year beginning in 2009. This report shall include | 18 |
| information regarding implementation of the Program, including | 19 |
| the number of veterans enrolled and any available information | 20 |
| regarding other benefits derived from the Program, including | 21 |
| screening for and acquisition of other veterans' benefits | 22 |
| through the Veterans' Service Officers and the Veterans' | 23 |
| Assistance Commissions. This report may also include |
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| recommendations regarding improvements that may be made to the | 2 |
| Program and regarding the extension of the repeal date set | 3 |
| forth in Section 85 of this Act. | 4 |
| Section 50. Emergency rulemaking. The Department may adopt | 5 |
| rules necessary to establish and implement this Act through the | 6 |
| use of emergency rulemaking in accordance with Section 5-45 of | 7 |
| the Illinois Administrative Procedure Act. For the purposes of | 8 |
| that Act, the General Assembly finds that the adoption of rules | 9 |
| to implement this Act is deemed an emergency and necessary for | 10 |
| the public interest, safety, and welfare. | 11 |
| Section 85. Repeal. This Act is repealed on January 1, | 12 |
| 2012. | 13 |
| Section 90. The Illinois Public Aid Code is amended by | 14 |
| changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
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| (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
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| Sec. 11-22. Charge upon claims and causes of action for | 17 |
| injuries. The Illinois Department shall have a charge upon all | 18 |
| claims, demands and
causes of action for injuries to an | 19 |
| applicant for or recipient of (i)
financial aid under Articles | 20 |
| III, IV, and V, (ii) health care benefits provided under the | 21 |
| Covering ALL KIDS Health Insurance Act, or (iii) health care | 22 |
| benefits provided under the Veterans' Health Insurance Program |
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| Act or the Veterans' Health Insurance Program Act of 2008 for | 2 |
| the total
amount of
medical assistance provided the recipient | 3 |
| from the time of injury to the
date of recovery upon such | 4 |
| claim, demand or cause of action. In addition, if
the applicant | 5 |
| or recipient was employable, as defined by the Department, at
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| the time of the injury, the Department shall also have a charge | 7 |
| upon any
such claims, demands and causes of action for the | 8 |
| total amount of aid
provided to the recipient and his
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| dependents, including all cash assistance and medical | 10 |
| assistance
only to the extent includable in the claimant's | 11 |
| action, from the
time of injury to the date of recovery upon | 12 |
| such
claim, demand or cause of action. Any definition of | 13 |
| "employable"
adopted by the Department shall apply only to | 14 |
| persons above the age of
compulsory school attendance.
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| If the injured person was employable at the time of the | 16 |
| injury and is
provided aid under Articles III, IV, or V and any | 17 |
| dependent or
member of his family is provided aid under Article | 18 |
| VI, or vice versa,
both the Illinois Department and the local | 19 |
| governmental unit shall have
a charge upon such claims, demands | 20 |
| and causes of action for the aid
provided to the injured person | 21 |
| and any
dependent member of his family, including all cash | 22 |
| assistance, medical
assistance and food stamps, from the time | 23 |
| of the injury to the date
of recovery.
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| "Recipient", as used herein, means (i) in the case of | 25 |
| financial aid provided under this Code, the grantee of record | 26 |
| and any
persons whose needs are included in the financial aid |
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| provided to the
grantee of record or otherwise met by grants | 2 |
| under the appropriate
Article of this Code for which such | 3 |
| person is eligible, (ii) in the case of health care benefits | 4 |
| provided under the Covering ALL KIDS Health Insurance Act, the | 5 |
| child to whom those benefits are provided, and (iii) in the | 6 |
| case of health care benefits provided under the Veterans' | 7 |
| Health Insurance Program Act or the Veterans' Health Insurance | 8 |
| Program Act of 2008 , the veteran to whom benefits are provided.
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| In each case, the notice shall be served by certified mail | 10 |
| or
registered mail, upon the party or parties against whom the | 11 |
| applicant or
recipient has a claim, demand or cause of action. | 12 |
| The notice shall
claim the charge and describe the interest the | 13 |
| Illinois Department, the
local governmental unit, or the | 14 |
| county, has in the claim, demand, or
cause of action. The | 15 |
| charge shall attach to any verdict or judgment
entered and to | 16 |
| any money or property which may be recovered on account
of such | 17 |
| claim, demand, cause of action or suit from and after the time
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| of the service of the notice.
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| On petition filed by the Illinois Department, or by the | 20 |
| local
governmental unit or county if either is claiming a | 21 |
| charge, or by the
recipient, or by the defendant, the court, on | 22 |
| written notice to all
interested parties, may adjudicate the | 23 |
| rights of the parties and enforce
the charge. The court may | 24 |
| approve the settlement of any claim, demand
or cause of action | 25 |
| either before or after a verdict, and nothing in this
Section | 26 |
| shall be construed as requiring the actual trial or final
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| adjudication of any claim, demand or cause of action upon which | 2 |
| the
Illinois Department, the local governmental unit or county | 3 |
| has charge.
The court may determine what portion of the | 4 |
| recovery shall be paid to
the injured person and what portion | 5 |
| shall be paid to the Illinois
Department, the local | 6 |
| governmental unit or county having a charge
against the | 7 |
| recovery.
In making this determination, the court shall conduct | 8 |
| an evidentiary hearing
and shall consider competent evidence | 9 |
| pertaining
to the following matters:
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| (1) the amount of the charge sought to be enforced | 11 |
| against the recovery
when expressed as a percentage of the | 12 |
| gross amount of the recovery; the
amount of the charge | 13 |
| sought to be enforced against the recovery when expressed
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| as a percentage of the amount obtained by subtracting from | 15 |
| the gross amount
of the recovery the total attorney's fees | 16 |
| and other costs incurred by the
recipient incident to the | 17 |
| recovery; and whether the Department, unit of
local | 18 |
| government or county seeking to enforce the charge against | 19 |
| the recovery
should as a matter of fairness and equity bear | 20 |
| its proportionate share of
the fees and costs incurred to | 21 |
| generate the recovery from which the charge
is sought to be | 22 |
| satisfied;
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| (2) the amount, if any, of the attorney's fees and | 24 |
| other costs incurred
by the recipient incident to the | 25 |
| recovery and paid by the recipient up to the
time of | 26 |
| recovery, and the amount of such fees and costs remaining |
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| unpaid
at the time of recovery;
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| (3) the total hospital, doctor and other medical | 3 |
| expenses incurred for
care and treatment of the injury to | 4 |
| the date of recovery therefor, the portion
of such expenses | 5 |
| theretofore paid by the recipient, by insurance provided
by | 6 |
| the recipient, and by the Department, unit of local | 7 |
| government and county
seeking to enforce a charge against | 8 |
| the recovery, and the amount of such
previously incurred | 9 |
| expenses which remain unpaid at the time of recovery
and by | 10 |
| whom such incurred, unpaid expenses are to be paid;
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| (4) whether the recovery represents less than | 12 |
| substantially full
recompense
for the injury and the | 13 |
| hospital, doctor and other medical expenses incurred
to the | 14 |
| date of recovery for the care and treatment of the injury, | 15 |
| so that
reduction of the charge sought to be enforced | 16 |
| against the recovery would
not likely result in a double | 17 |
| recovery or unjust enrichment to the recipient;
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| (5) the age of the recipient and of persons dependent | 19 |
| for support upon
the recipient, the nature and permanency | 20 |
| of the recipient's injuries as
they affect not only the | 21 |
| future employability and education of the recipient
but | 22 |
| also the reasonably necessary and foreseeable future | 23 |
| material, maintenance,
medical, rehabilitative and | 24 |
| training needs of the recipient, the cost of
such | 25 |
| reasonably necessary and foreseeable future needs, and the | 26 |
| resources
available to meet such needs and pay such costs;
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| (6) the realistic ability of the recipient to repay in | 2 |
| whole or in part
the charge sought to be enforced against | 3 |
| the recovery when judged in light
of the factors enumerated | 4 |
| above.
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| The burden of producing evidence sufficient to support the | 6 |
| exercise by
the court of its discretion to reduce the amount of | 7 |
| a proven charge sought
to be enforced against the recovery | 8 |
| shall rest with the party seeking such reduction.
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| The court may reduce and apportion the Illinois
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| Department's lien proportionate to the recovery of the | 11 |
| claimant. The court may
consider the nature and extent of the | 12 |
| injury, economic and noneconomic
loss, settlement offers, | 13 |
| comparative negligence as it applies to the case
at hand, | 14 |
| hospital costs, physician costs, and all other appropriate | 15 |
| costs.
The Illinois Department shall pay its pro rata share of | 16 |
| the attorney fees
based on the Illinois Department's lien as it | 17 |
| compares to the total
settlement agreed upon. This Section | 18 |
| shall not affect the priority of an
attorney's lien under the | 19 |
| Attorneys Lien Act. The charges of
the Illinois Department | 20 |
| described in this Section, however, shall take
priority over | 21 |
| all other liens and charges existing under the laws of the
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| State of Illinois with the exception of the attorney's lien | 23 |
| under said statute.
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| Whenever the Department or any unit of local government
has | 25 |
| a statutory charge under this Section against a recovery for | 26 |
| damages
incurred by a recipient because of its advancement of |
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| any assistance, such
charge shall not be satisfied out of any | 2 |
| recovery until the attorney's claim
for fees is satisfied, | 3 |
| irrespective of whether or not an action based on
recipient's | 4 |
| claim has been filed in court.
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| This Section shall be inapplicable to any claim, demand or | 6 |
| cause of
action arising under (a) the Workers' Compensation Act | 7 |
| or the predecessor
Workers' Compensation Act
of
June 28, 1913, | 8 |
| (b) the Workers' Occupational Diseases Act or the predecessor
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| Workers' Occupational
Diseases Act of March 16, 1936; and (c) | 10 |
| the Wrongful Death Act.
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| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06.)
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| (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
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| Sec. 11-22a. Right of Subrogation. To the extent of the | 14 |
| amount of (i) medical
assistance provided by the Department to | 15 |
| or on behalf of a recipient under
Article V or VI, (ii) health | 16 |
| care benefits provided for a child under the Covering ALL KIDS | 17 |
| Health Insurance Act, or (iii) health care benefits provided to | 18 |
| a veteran under the Veterans' Health Insurance Program Act or | 19 |
| the Veterans' Health Insurance Program Act of 2008 , the | 20 |
| Department shall be
subrogated
to any right of
recovery such | 21 |
| recipient may have under the terms of any private or public
| 22 |
| health care coverage or casualty coverage, including coverage | 23 |
| under the
"Workers' Compensation Act", approved July 9, 1951, | 24 |
| as amended, or the
"Workers' Occupational Diseases Act", | 25 |
| approved July 9, 1951, as amended,
without the necessity of |
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| assignment of claim or other authorization to secure
the right | 2 |
| of recovery to the Department. To enforce its subrogation | 3 |
| right, the
Department may (i) intervene or join in an action or | 4 |
| proceeding brought by the
recipient, his or her guardian, | 5 |
| personal representative, estate, dependents, or
survivors | 6 |
| against any person or public or private entity that may be | 7 |
| liable;
(ii) institute and prosecute legal proceedings against | 8 |
| any person or public or
private entity that may be liable for | 9 |
| the cost of such services; or (iii)
institute and prosecute | 10 |
| legal proceedings, to the extent necessary to reimburse
the | 11 |
| Illinois Department for its costs, against any noncustodial | 12 |
| parent who (A)
is required by court or administrative order to | 13 |
| provide insurance or other
coverage of the cost of health care | 14 |
| services for a child eligible for medical
assistance under this | 15 |
| Code and (B) has received payment from a third party for
the | 16 |
| costs of those services but has not used the payments to | 17 |
| reimburse either
the other parent or the guardian of the child | 18 |
| or the provider of the services.
| 19 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06.)
| 20 |
| (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
| 21 |
| Sec. 11-22b. Recoveries.
| 22 |
| (a) As used in this Section:
| 23 |
| (1) "Carrier" means any insurer, including any private | 24 |
| company,
corporation, mutual association, trust fund, | 25 |
| reciprocal or interinsurance
exchange authorized under the |
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| laws of this State to insure persons against
liability or | 2 |
| injuries caused to another and any insurer providing
| 3 |
| benefits under a policy of bodily injury liability | 4 |
| insurance covering
liability arising out of the ownership, | 5 |
| maintenance or use of a motor
vehicle which provides | 6 |
| uninsured motorist endorsement or coverage.
| 7 |
| (2) "Beneficiary" means any person or their dependents | 8 |
| who has received
benefits or will be provided benefits | 9 |
| under this Code, under the Covering ALL KIDS Health | 10 |
| Insurance Act, or under the Veterans' Health Insurance | 11 |
| Program Act or the Veterans' Health Insurance Program Act | 12 |
| of 2008
because of an injury for
which another person may | 13 |
| be liable. It includes such beneficiary's guardian,
| 14 |
| conservator or other personal representative, his estate | 15 |
| or survivors.
| 16 |
| (b)(1) When benefits are provided or will be provided to a | 17 |
| beneficiary
under this Code, under the Covering ALL KIDS Health | 18 |
| Insurance Act, or under the Veterans' Health Insurance Program | 19 |
| Act or the Veterans' Health Insurance Program Act of 2008 | 20 |
| because of an injury for which another person is liable, or
for | 21 |
| which a carrier is liable in accordance with the provisions of | 22 |
| any
policy of insurance issued pursuant to the Illinois | 23 |
| Insurance Code, the
Illinois Department shall have a right to | 24 |
| recover from such person or carrier
the reasonable value of | 25 |
| benefits so provided. The Attorney General may, to
enforce such | 26 |
| right, institute and prosecute legal proceedings against the
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| third person or carrier who may be liable for the injury in an | 2 |
| appropriate
court, either in the name of the Illinois | 3 |
| Department or in the name of the
injured person, his guardian, | 4 |
| personal representative, estate, or survivors.
| 5 |
| (2) The Department may:
| 6 |
| (A) compromise or settle and release any such claim for | 7 |
| benefits
provided under this Code, or
| 8 |
| (B) waive any such claims for benefits provided under | 9 |
| this Code, in
whole or in part, for the convenience of the | 10 |
| Department or if the Department
determines that collection | 11 |
| would result in undue hardship upon the person who
suffered | 12 |
| the injury or, in a wrongful death action, upon the heirs | 13 |
| of the
deceased.
| 14 |
| (3) No action taken on behalf of the Department pursuant to | 15 |
| this Section
or any judgment rendered in such action shall be a | 16 |
| bar to any action upon
the claim or cause of action of the | 17 |
| beneficiary, his guardian, conservator,
personal | 18 |
| representative, estate, dependents or survivors against the | 19 |
| third
person who may be liable for the injury, or shall operate | 20 |
| to deny to the
beneficiary the recovery for that portion of any | 21 |
| damages not covered hereunder.
| 22 |
| (c)(1) When an action is brought by the Department pursuant | 23 |
| to
subsection (b), it shall be commenced within the period | 24 |
| prescribed by
Article XIII of the Code of Civil Procedure.
| 25 |
| However, the Department may not commence the action prior | 26 |
| to 5 months
before the end of the applicable period prescribed |
|
|
|
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| 1 |
| by Article XIII of the
Code of Civil Procedure. Thirty days | 2 |
| prior to commencing an action, the
Department shall notify the | 3 |
| beneficiary of the Department's intent to
commence such an | 4 |
| action.
| 5 |
| (2) The death of the beneficiary does not abate any right | 6 |
| of action
established by subsection (b).
| 7 |
| (3) When an action or claim is brought by persons entitled | 8 |
| to bring such
actions or assert such claims against a third | 9 |
| person who may be liable for
causing the death of a | 10 |
| beneficiary, any settlement, judgment or award
obtained is | 11 |
| subject to the Department's claim for reimbursement of the
| 12 |
| benefits provided to the beneficiary under this Code, under the | 13 |
| Covering ALL KIDS Health Insurance Act, or under the Veterans' | 14 |
| Health Insurance Program Act or the Veterans' Health Insurance | 15 |
| Program Act of 2008 .
| 16 |
| (4) When the action or claim is brought by the beneficiary | 17 |
| alone and
the beneficiary incurs a personal liability to pay | 18 |
| attorney's fees and
costs of litigation, the Department's claim | 19 |
| for reimbursement of the
benefits provided to the beneficiary | 20 |
| shall be the full amount of benefits
paid on behalf of the | 21 |
| beneficiary under this Code, under the Covering ALL KIDS Health | 22 |
| Insurance Act, or under the Veterans' Health Insurance Program | 23 |
| Act or the Veterans' Health Insurance Program Act of 2008 less | 24 |
| a pro rata
share which represents the Department's reasonable | 25 |
| share of attorney's fees
paid by the beneficiary and that | 26 |
| portion of the cost of litigation expenses
determined by |
|
|
|
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| 1 |
| multiplying by the ratio of the full amount of the
expenditures | 2 |
| of the full amount of the judgment, award or settlement.
| 3 |
| (d)(1) If either the beneficiary or the Department brings | 4 |
| an action or
claim against such third party or carrier, the | 5 |
| beneficiary or the
Department shall within 30 days of filing | 6 |
| the action give to the other
written notice by personal service | 7 |
| or registered mail of the action or
claim and of the name of | 8 |
| the court in which the
action or claim is brought. Proof of | 9 |
| such notice shall be filed in such
action or claim. If an | 10 |
| action or claim is brought by either the Department
or the | 11 |
| beneficiary, the other may, at any time before trial on the | 12 |
| facts,
become a party to such action or claim or shall | 13 |
| consolidate his action or
claim with the other if brought | 14 |
| independently.
| 15 |
| (2) If an action or claim is brought by the Department | 16 |
| pursuant to
subsection (b)(1), written notice to the | 17 |
| beneficiary, guardian, personal
representative, estate or | 18 |
| survivor given pursuant to this Section shall
advise him of his | 19 |
| right to intervene in the proceeding, his right to obtain
a | 20 |
| private attorney of his choice and the Department's right to | 21 |
| recover the
reasonable value of the benefits provided.
| 22 |
| (e) In the event of judgment or award in a suit or claim | 23 |
| against such
third person or carrier:
| 24 |
| (1) If the action or claim is prosecuted by the | 25 |
| beneficiary alone, the
court shall first order paid from | 26 |
| any judgment or award the
reasonable litigation expenses |
|
|
|
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LRB095 05439 DRJ 47193 a |
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| 1 |
| incurred in preparation and prosecution of
such action or | 2 |
| claim, together with reasonable attorney's fees, when an
| 3 |
| attorney has been retained. After payment of such expenses | 4 |
| and attorney's
fees the court shall, on the application of | 5 |
| the Department, allow
as a first lien against the amount of | 6 |
| such judgment or award the amount of
the Department's | 7 |
| expenditures for the benefit of the beneficiary under this
| 8 |
| Code, under the Covering ALL KIDS Health Insurance Act, or | 9 |
| under the Veterans' Health Insurance Program Act or the | 10 |
| Veterans' Health Insurance Program Act of 2008 , as provided | 11 |
| in subsection (c)(4).
| 12 |
| (2) If the action or claim is prosecuted both by the | 13 |
| beneficiary and the
Department, the court shall first order | 14 |
| paid from any judgment or
award the reasonable litigation | 15 |
| expenses incurred in preparation and
prosecution of such | 16 |
| action or claim, together with reasonable attorney's
fees | 17 |
| for plaintiffs attorneys based solely on the services | 18 |
| rendered for the
benefit of the beneficiary. After payment | 19 |
| of such expenses and attorney's
fees, the court shall apply | 20 |
| out of the balance of such judgment or award an
amount | 21 |
| sufficient to reimburse the Department the full amount of | 22 |
| benefits
paid on behalf of the beneficiary under this Code, | 23 |
| under the Covering ALL KIDS Health Insurance Act, or under | 24 |
| the Veterans' Health Insurance Program Act or the Veterans' | 25 |
| Health Insurance Program Act of 2008 .
| 26 |
| (f) The court shall, upon further application at any time
|
|
|
|
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LRB095 05439 DRJ 47193 a |
|
| 1 |
| before the judgment or award is satisfied, allow as a further | 2 |
| lien the
amount of any expenditures of the Department in | 3 |
| payment of additional
benefits arising out of the same cause of | 4 |
| action or claim provided on
behalf of the beneficiary under | 5 |
| this Code, under the Covering ALL KIDS Health Insurance Act, or | 6 |
| under the Veterans' Health Insurance Program Act or the | 7 |
| Veterans' Health Insurance Program Act of 2008 , when such | 8 |
| benefits were
provided or became payable subsequent to the | 9 |
| original order.
| 10 |
| (g) No judgment, award, or settlement in any action or | 11 |
| claim by a
beneficiary to recover damages for injuries, when | 12 |
| the Department has an
interest, shall be satisfied without | 13 |
| first giving the Department notice and
a reasonable opportunity | 14 |
| to perfect and satisfy its lien.
| 15 |
| (h) When the Department has perfected a lien upon a | 16 |
| judgment or award in
favor of a beneficiary against any third | 17 |
| party for an injury for which the
beneficiary has received | 18 |
| benefits under this Code, under the Covering ALL KIDS Health | 19 |
| Insurance Act, or under the Veterans' Health Insurance Program | 20 |
| Act or the Veterans' Health Insurance Program Act of 2008 , the | 21 |
| Department shall be
entitled to a writ of execution as lien | 22 |
| claimant to enforce payment of said
lien against such third | 23 |
| party with interest and other accruing costs as in
the case of | 24 |
| other executions. In the event the amount of such judgment or
| 25 |
| award so recovered has been paid to the beneficiary, the | 26 |
| Department shall
be entitled to a writ of execution against |
|
|
|
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|
| 1 |
| such beneficiary to the extent of
the Department's lien, with | 2 |
| interest and other accruing costs as in the case
of other | 3 |
| executions.
| 4 |
| (i) Except as otherwise provided in this Section, | 5 |
| notwithstanding any
other provision of law, the entire amount | 6 |
| of any settlement of the injured
beneficiary's action or claim, | 7 |
| with or without suit, is subject to the
Department's claim for | 8 |
| reimbursement of the benefits provided and any lien
filed | 9 |
| pursuant thereto to the same extent and subject to the same
| 10 |
| limitations as in Section 11-22 of this Code.
| 11 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06.)
| 12 |
| (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| 13 |
| Sec. 11-22c. Recovery of back wages. | 14 |
| (a) As used in this Section, "recipient" means any person
| 15 |
| receiving financial assistance under Article IV or Article VI | 16 |
| of this Code, receiving health care benefits under the Covering | 17 |
| ALL KIDS Health Insurance Act, or receiving health care | 18 |
| benefits under the Veterans' Health Insurance Program Act or | 19 |
| the Veterans' Health Insurance Program Act of 2008 .
| 20 |
| (b) If a recipient maintains any suit, charge or other | 21 |
| court or
administrative action against an employer seeking back | 22 |
| pay for a period
during which the recipient received financial | 23 |
| assistance under Article IV
or Article VI of this Code, health | 24 |
| care benefits under the Covering ALL KIDS Health Insurance Act, | 25 |
| or health care benefits under the Veterans' Health Insurance |
|
|
|
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LRB095 05439 DRJ 47193 a |
|
| 1 |
| Program Act or the Veterans' Health Insurance Program Act of | 2 |
| 2008 , the recipient shall report such fact to the
Department. | 3 |
| To the extent of the amount of assistance provided to or on
| 4 |
| behalf of the recipient under Article IV or Article VI, health | 5 |
| care benefits provided under the Covering ALL KIDS Health | 6 |
| Insurance Act, or health care benefits provided under the | 7 |
| Veterans' Health Insurance Program Act or the Veterans' Health | 8 |
| Insurance Program Act of 2008 , the Department may
by | 9 |
| intervention or otherwise without the necessity of assignment | 10 |
| of claim,
attach a lien on the recovery of back wages equal to | 11 |
| the amount of
assistance provided by the Department to the | 12 |
| recipient under Article IV or
Article VI, under the Covering | 13 |
| ALL KIDS Health Insurance Act, or under the Veterans' Health | 14 |
| Insurance Program Act or the Veterans' Health Insurance Program | 15 |
| Act of 2008 .
| 16 |
| (Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06.)
| 17 |
| Section 97. Severability. The provisions of this Act are | 18 |
| severable under Section 1.31 of the Statute on Statutes.
| 19 |
| Section 99. Effective date. This Act takes effect upon | 20 |
| becoming law.".
|
|