Full Text of SB1066 96th General Assembly
SB1066ham003 96TH GENERAL ASSEMBLY | Rep. John E. Bradley Filed: 1/9/2011
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| 1 | | AMENDMENT TO SENATE BILL 1066
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1066, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Department of Central Management Services | 6 | | Law of the
Civil Administrative Code of Illinois is amended by | 7 | | changing Section 405-411 as follows: | 8 | | (20 ILCS 405/405-411) | 9 | | Sec. 405-411. Consolidation of workers' compensation | 10 | | functions. | 11 | | (a) Notwithstanding any other law to the contrary, the | 12 | | Director of Central Management Services, working in | 13 | | cooperation with the Director of any other agency, department, | 14 | | board, or commission directly responsible to the Governor, may | 15 | | direct the consolidation, within the Department of Central | 16 | | Management Services, of those workers' compensation functions |
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| 1 | | at that agency, department, board, or commission that are | 2 | | suitable for centralization. | 3 | | Upon receipt of the written direction to transfer workers' | 4 | | compensation functions to the Department of Central Management | 5 | | Services, the personnel, equipment, and property (both real and | 6 | | personal) directly relating to the transferred functions shall | 7 | | be transferred to the Department of Central Management | 8 | | Services, and the relevant documents, records, and | 9 | | correspondence shall be transferred or copied, as the Director | 10 | | may prescribe. | 11 | | (b) Upon receiving written direction from the Director of | 12 | | Central Management Services, the Comptroller and Treasurer are | 13 | | authorized to transfer the unexpended balance of any | 14 | | appropriations related to the workers' compensation functions | 15 | | transferred to the Department of Central Management Services | 16 | | and shall make the necessary fund transfers from the General | 17 | | Revenue Fund, any special fund in the State treasury, or any | 18 | | other federal or State trust fund held by the Treasurer to the | 19 | | Workers' Compensation Revolving Fund for use by the Department | 20 | | of Central Management Services in support of workers' | 21 | | compensation functions or any other related costs or expenses | 22 | | of the Department of Central Management Services. | 23 | | (c) The rights of employees and the State and its agencies | 24 | | under the Personnel Code and applicable collective bargaining | 25 | | agreements or under any pension, retirement, or annuity plan | 26 | | shall not be affected by any transfer under this Section. |
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| 1 | | (d) The functions transferred to the Department of Central | 2 | | Management Services by this Section shall be vested in and | 3 | | shall be exercised by the Department of Central Management | 4 | | Services. Each act done in the exercise of those functions | 5 | | shall have the same legal effect as if done by the agencies, | 6 | | offices, divisions, departments, bureaus, boards and | 7 | | commissions from which they were transferred. | 8 | | Every person or other entity shall be subject to the same | 9 | | obligations and duties and any penalties, civil or criminal, | 10 | | arising therefrom, and shall have the same rights arising from | 11 | | the exercise of such rights, powers, and duties as had been | 12 | | exercised by the agencies, offices, divisions, departments, | 13 | | bureaus, boards, and commissions from which they were | 14 | | transferred. | 15 | | Whenever reports or notices are now required to be made or | 16 | | given or papers or documents furnished or served by any person | 17 | | in regards to the functions transferred to or upon the | 18 | | agencies, offices, divisions, departments, bureaus, boards, | 19 | | and commissions from which the functions were transferred, the | 20 | | same shall be made, given, furnished or served in the same | 21 | | manner to or upon the Department of Central Management | 22 | | Services. | 23 | | This Section does not affect any act done, ratified, or | 24 | | cancelled or any right occurring or established or any action | 25 | | or proceeding had or commenced in an administrative, civil, or | 26 | | criminal cause regarding the functions transferred, but those |
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| 1 | | proceedings may be continued by the Department of Central | 2 | | Management Services. | 3 | | This Section does not affect the legality of any rules in | 4 | | the Illinois Administrative Code regarding the functions | 5 | | transferred in this Section that are in force on the effective | 6 | | date of this Section. If necessary, however, the affected | 7 | | agencies shall propose, adopt, or repeal rules, rule | 8 | | amendments, and rule recodifications as appropriate to | 9 | | effectuate this Section.
| 10 | | (e) There is hereby created within the Department of | 11 | | Central Management Services an advisory body to be known as the | 12 | | Workers' Compensation Advisory Board to review, assess, and | 13 | | provide recommendations to improve the State workers' | 14 | | compensation program and to ensure that the State manages the | 15 | | program in the interests of injured workers and taxpayers. The | 16 | | Governor, the Speaker of the House of Representatives, the | 17 | | Minority Leader of the House of Representatives, the President | 18 | | of the Senate, and the Minority Leader of the Senate shall each | 19 | | appoint one person to the Board. Each Board member initially | 20 | | appointed to the Board shall serve a term ending December 31, | 21 | | 2013. Each Board member appointed thereafter shall serve a | 22 | | 3-year term, and a Board member shall continue to serve on the | 23 | | Board until his or her successor is appointed. In addition, the | 24 | | Director of the Department of Central Management Services, the | 25 | | Attorney General, the Director of the Department of Insurance, | 26 | | the Director of the Department of Corrections, the Secretary of |
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| 1 | | the Department of Transportation, the Secretary of the | 2 | | Department of Human Services, the Director of the Department of | 3 | | Revenue, and the Commissioner of the Illinois Workers' | 4 | | Compensation Commission, or their designees, shall serve on the | 5 | | Board. The Board shall select one of its members to serve as | 6 | | Chairperson. Members of the Board shall not receive | 7 | | compensation but shall be reimbursed from the Workers' | 8 | | Compensation Revolving Fund for reasonable expenses incurred | 9 | | in the necessary performance of their duties, and the | 10 | | Department of Central Management Services shall provide | 11 | | administrative support to the Board. The Board shall meet at | 12 | | least 3 times per year, or more often if the Board deems it | 13 | | necessary or proper. By July 1, 2011, the Board shall issue a | 14 | | written report, to be delivered to the Governor, the Director | 15 | | of the Department of Central Management Services, and the | 16 | | General Assembly, with a recommended set of best practices for | 17 | | the State workers' compensation program. By July 1st of each | 18 | | year thereafter, the Board shall issue a written report, to be | 19 | | delivered to those same persons or entities, with | 20 | | recommendations on how to improve upon such practices. | 21 | | (Source: P.A. 93-839, eff. 7-30-04.) | 22 | | Section 10. The Workers' Compensation Act is amended by | 23 | | changing Sections 4, 8, 8.2, 8.3, 8.7, 11, 14, and 25.5 and | 24 | | adding Sections 16b, 29.1, and 29.2 as follows:
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| 1 | | (820 ILCS 305/4) (from Ch. 48, par. 138.4)
| 2 | | Sec. 4. (a) Any employer, including but not limited to | 3 | | general contractors
and their subcontractors, who shall come | 4 | | within the provisions of
Section 3 of this Act, and any other | 5 | | employer who shall elect to provide
and pay the compensation | 6 | | provided for in this Act shall:
| 7 | | (1) File with the Commission annually an application | 8 | | for approval as a
self-insurer which shall include a | 9 | | current financial statement, and
annually, thereafter, an | 10 | | application for renewal of self-insurance, which
shall | 11 | | include a current financial statement. Said
application | 12 | | and financial statement shall be signed and sworn to by the
| 13 | | president or vice president and secretary or assistant | 14 | | secretary of the
employer if it be a corporation, or by all | 15 | | of the partners, if it be a
copartnership, or by the owner | 16 | | if it be neither a copartnership nor a
corporation. All | 17 | | initial applications and all applications for renewal of
| 18 | | self-insurance must be submitted at least 60 days prior to | 19 | | the requested
effective date of self-insurance. An | 20 | | employer may elect to provide and pay
compensation as | 21 | | provided
for in this Act as a member of a group workers' | 22 | | compensation pool under Article
V 3/4 of the Illinois | 23 | | Insurance Code. If an employer becomes a member of a
group | 24 | | workers' compensation pool, the employer shall not be | 25 | | relieved of any
obligations imposed by this Act.
| 26 | | If the sworn application and financial statement of any |
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| 1 | | such employer
does not satisfy the Commission of the | 2 | | financial ability of the employer
who has filed it, the | 3 | | Commission shall require such employer to,
| 4 | | (2) Furnish security, indemnity or a bond guaranteeing | 5 | | the payment
by the employer of the compensation provided | 6 | | for in this Act, provided
that any such employer whose | 7 | | application and financial statement shall
not have | 8 | | satisfied the commission of his or her financial ability | 9 | | and
who shall have secured his liability in part by excess | 10 | | liability insurance
shall be required to furnish to the | 11 | | Commission security, indemnity or bond
guaranteeing his or | 12 | | her payment up to the effective limits of the excess
| 13 | | coverage, or
| 14 | | (3) Insure his entire liability to pay such | 15 | | compensation in some
insurance carrier authorized, | 16 | | licensed, or permitted to do such
insurance business in | 17 | | this State. Every policy of an insurance carrier,
insuring | 18 | | the payment of compensation under this Act shall cover all | 19 | | the
employees and the entire compensation liability of the | 20 | | insured:
Provided, however, that any employer may insure | 21 | | his or her compensation
liability with 2 or more insurance | 22 | | carriers or may insure a part and
qualify under subsection | 23 | | 1, 2, or 4 for the remainder of his or her
liability to pay | 24 | | such compensation, subject to the following two | 25 | | provisions:
| 26 | | Firstly, the entire compensation liability of the |
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| 1 | | employer to
employees working at or from one location | 2 | | shall be insured in one such
insurance carrier or shall | 3 | | be self-insured, and
| 4 | | Secondly, the employer shall submit evidence | 5 | | satisfactorily to the
Commission that his or her entire | 6 | | liability for the compensation provided
for in this Act | 7 | | will be secured. Any provisions in any policy, or in | 8 | | any
endorsement attached thereto, attempting to limit | 9 | | or modify in any way,
the liability of the insurance | 10 | | carriers issuing the same except as
otherwise provided | 11 | | herein shall be wholly void.
| 12 | | Nothing herein contained shall apply to policies of | 13 | | excess liability
carriage secured by employers who have | 14 | | been approved by the Commission
as self-insurers, or
| 15 | | (4) Make some other provision, satisfactory to the | 16 | | Commission, for
the securing of the payment of compensation | 17 | | provided for in this Act,
and
| 18 | | (5) Upon becoming subject to this Act and thereafter as | 19 | | often as the
Commission may in writing demand, file with | 20 | | the Commission in form prescribed
by it evidence of his or | 21 | | her compliance with the provision of this Section.
| 22 | | (a-1) Regardless of its state of domicile or its principal | 23 | | place of
business, an employer shall make payments to its | 24 | | insurance carrier or group
self-insurance fund, where | 25 | | applicable, based upon the premium rates of the
situs where the | 26 | | work or project is located in Illinois if:
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| 1 | | (A) the employer is engaged primarily in the building | 2 | | and
construction industry; and
| 3 | | (B) subdivision (a)(3) of this Section applies to the | 4 | | employer or
the employer is a member of a group | 5 | | self-insurance plan as defined in
subsection (1) of Section | 6 | | 4a.
| 7 | | The Illinois Workers' Compensation Commission shall impose | 8 | | a penalty upon an employer
for violation of this subsection | 9 | | (a-1) if:
| 10 | | (i) the employer is given an opportunity at a hearing | 11 | | to present
evidence of its compliance with this subsection | 12 | | (a-1); and
| 13 | | (ii) after the hearing, the Commission finds that the | 14 | | employer
failed to make payments upon the premium rates of | 15 | | the situs where the work or
project is located in Illinois.
| 16 | | The penalty shall not exceed $1,000 for each day of work | 17 | | for which
the employer failed to make payments upon the premium | 18 | | rates of the situs where
the
work or project is located in | 19 | | Illinois, but the total penalty shall not exceed
$50,000 for | 20 | | each project or each contract under which the work was
| 21 | | performed.
| 22 | | Any penalty under this subsection (a-1) must be imposed not | 23 | | later
than one year after the expiration of the applicable | 24 | | limitation period
specified in subsection (d) of Section 6 of | 25 | | this Act. Penalties imposed under
this subsection (a-1) shall | 26 | | be deposited into the Illinois Workers' Compensation |
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| 1 | | Commission
Operations Fund, a special fund that is created in | 2 | | the State treasury. Subject
to appropriation, moneys in the | 3 | | Fund shall be used solely for the operations
of the Illinois | 4 | | Workers' Compensation Commission and by the Department of | 5 | | Financial and Professional Regulation for the purposes | 6 | | authorized in subsection (c) of Section 25.5 of this Act.
| 7 | | (a-2) For purposes of this subsection, "Professional | 8 | | Employer Organization" or "PEO" means an entity or group of | 9 | | entities that provides the services of its workers to its | 10 | | client or clients through an arrangement for a fee pursuant to | 11 | | an agreement, written or otherwise. "Professional Employer | 12 | | Organization" or "PEO" also includes an employee leasing | 13 | | company or other similarly administered arrangement. Any | 14 | | workers' compensation insurance policy issued to a PEO shall at | 15 | | a minimum provide the following information to the Commission | 16 | | or any entity designated by the Commission regarding each | 17 | | policy issued to the PEO: | 18 | | (1) Each client company of the PEO listed as an | 19 | | additional named insured. | 20 | | (2) Information schedules attached to the master | 21 | | policy to identify each individual company's name, FEIN, | 22 | | and job location. | 23 | | (3) A certificate of insurance coverage document | 24 | | issued to each client company specifying its rights and | 25 | | obligations under the master policy that clearly | 26 | | establishes both the identity and status of the client, as |
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| 1 | | well as the dates of inception and termination of coverage, | 2 | | if applicable. | 3 | | (b) The sworn application and financial statement, or | 4 | | security,
indemnity or bond, or amount of insurance, or other | 5 | | provisions, filed,
furnished, carried, or made by the employer, | 6 | | as the case may be, shall
be subject to the approval of the | 7 | | Commission.
| 8 | | Deposits under escrow agreements shall be cash, negotiable | 9 | | United
States government bonds or negotiable general | 10 | | obligation bonds of the
State of Illinois. Such cash or bonds | 11 | | shall be deposited in
escrow with any State or National Bank or | 12 | | Trust Company having trust
authority in the State of Illinois.
| 13 | | Upon the approval of the sworn application and financial | 14 | | statement,
security, indemnity or bond or amount of insurance, | 15 | | filed, furnished or
carried, as the case may be, the Commission | 16 | | shall send to the employer
written notice of its approval | 17 | | thereof. The certificate of compliance
by the employer with the | 18 | | provisions of subparagraphs (2) and (3) of
paragraph (a) of | 19 | | this Section shall be delivered by the insurance
carrier to the | 20 | | Illinois Workers' Compensation Commission within five days | 21 | | after the
effective date of the policy so certified. The | 22 | | insurance so certified
shall cover all compensation liability | 23 | | occurring during the time that
the insurance is in effect and | 24 | | no further certificate need be filed in case
such insurance is | 25 | | renewed, extended or otherwise continued by such
carrier. The | 26 | | insurance so certified shall not be cancelled or in the
event |
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| 1 | | that such insurance is not renewed, extended or otherwise
| 2 | | continued, such insurance shall not be terminated until at | 3 | | least 10
days after receipt by the Illinois Workers' | 4 | | Compensation Commission of notice of the
cancellation or | 5 | | termination of said insurance; provided, however, that
if the | 6 | | employer has secured insurance from another insurance carrier, | 7 | | or
has otherwise secured the payment of compensation in | 8 | | accordance with
this Section, and such insurance or other | 9 | | security becomes effective
prior to the expiration of the 10 | 10 | | days, cancellation or termination may, at
the option of the | 11 | | insurance carrier indicated in such notice, be effective
as of | 12 | | the effective date of such other insurance or security.
| 13 | | (c) Whenever the Commission shall find that any | 14 | | corporation,
company, association, aggregation of individuals, | 15 | | reciprocal or
interinsurers exchange, or other insurer | 16 | | effecting workers' compensation
insurance in this State shall | 17 | | be insolvent, financially unsound, or
unable to fully meet all | 18 | | payments and liabilities assumed or to be
assumed for | 19 | | compensation insurance in this State, or shall practice a
| 20 | | policy of delay or unfairness toward employees in the | 21 | | adjustment,
settlement, or payment of benefits due such | 22 | | employees, the Commission
may after reasonable notice and | 23 | | hearing order and direct that such
corporation, company, | 24 | | association, aggregation of individuals,
reciprocal or | 25 | | interinsurers exchange, or insurer, shall from and after a
date | 26 | | fixed in such order discontinue the writing of any such |
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| 1 | | workers'
compensation insurance in this State. Subject to such | 2 | | modification of
the order as the Commission may later make on | 3 | | review of the order,
as herein provided, it shall thereupon be | 4 | | unlawful for any such
corporation, company, association, | 5 | | aggregation of individuals,
reciprocal or interinsurers | 6 | | exchange, or insurer to effect any workers'
compensation | 7 | | insurance in this State. A copy of the order shall be served
| 8 | | upon the Director of Insurance by registered mail. Whenever the | 9 | | Commission
finds that any service or adjustment company used or | 10 | | employed
by a self-insured employer or by an insurance carrier | 11 | | to process,
adjust, investigate, compromise or otherwise | 12 | | handle claims under this
Act, has practiced or is practicing a | 13 | | policy of delay or unfairness
toward employees in the | 14 | | adjustment, settlement or payment of benefits
due such | 15 | | employees, the Commission may after reasonable notice and
| 16 | | hearing order and direct that such service or adjustment | 17 | | company shall
from and after a date fixed in such order be | 18 | | prohibited from processing,
adjusting, investigating, | 19 | | compromising or otherwise handling claims
under this Act.
| 20 | | Whenever the Commission finds that any self-insured | 21 | | employer has
practiced or is practicing delay or unfairness | 22 | | toward employees in the
adjustment, settlement or payment of | 23 | | benefits due such employees, the
Commission may, after | 24 | | reasonable notice and hearing, order and direct
that after a | 25 | | date fixed in the order such self-insured employer shall be
| 26 | | disqualified to operate as a self-insurer and shall be required |
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| 1 | | to
insure his entire liability to pay compensation in some | 2 | | insurance
carrier authorized, licensed and permitted to do such | 3 | | insurance business
in this State, as provided in subparagraph 3 | 4 | | of paragraph (a) of this
Section.
| 5 | | All orders made by the Commission under this Section shall | 6 | | be subject
to review by the courts, said review to be taken in | 7 | | the same manner and
within the same time as provided by Section | 8 | | 19 of this Act for review of
awards and decisions of the | 9 | | Commission, upon the party seeking the
review filing with the | 10 | | clerk of the court to which said review is taken
a bond in an | 11 | | amount to be fixed and approved by the court to which the
| 12 | | review is taken, conditioned upon the payment of all | 13 | | compensation awarded
against the person taking said review | 14 | | pending a decision thereof and
further conditioned upon such | 15 | | other obligations as the court may impose.
Upon the review the | 16 | | Circuit Court shall have power to review all questions
of fact | 17 | | as well as of law. The penalty hereinafter provided for in this
| 18 | | paragraph shall not attach and shall not begin to run until the | 19 | | final
determination of the order of the Commission.
| 20 | | (d) Whenever a panel of 3 Commissioners comprised of one | 21 | | member of the employing class, one member of the employee | 22 | | class, and one member not identified with either the employing | 23 | | or employee class, with due process and after a hearing, | 24 | | determines : (1) an employer has knowingly failed to provide | 25 | | coverage as required by paragraph (a) of this Section, and (2) | 26 | | that the failure is shall be deemed an immediate serious danger |
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| 1 | | to public health, safety, and welfare sufficient to justify | 2 | | service by the Commission of a work-stop order on such | 3 | | employer, then that panel of 3 Commissioners may enter a | 4 | | work-stop order requiring the cessation of all business | 5 | | operations of such employer at the place of employment or job | 6 | | site. Any law enforcement agency in the State shall, at the | 7 | | request of the Commission, render any assistance necessary to | 8 | | carry out the provisions of this Section, including, but not | 9 | | limited to, preventing any employee of such employer from | 10 | | remaining at a place of employment or job site after a | 11 | | work-stop order has taken effect. Any work-stop order shall be | 12 | | lifted immediately upon proof of insurance as required by this | 13 | | Act and payment of any applicable fines or penalties . Any | 14 | | orders under this Section are appealable under Section 19(f) to | 15 | | the Circuit Court.
| 16 | | Any individual employer, corporate officer or director of a | 17 | | corporate employer, partner of an employer partnership, or | 18 | | member of an employer limited liability company who knowingly | 19 | | fails to provide coverage as required by paragraph (a) of this | 20 | | Section is guilty of a Class 4 felony. This provision shall not | 21 | | apply to any corporate officer or director of any | 22 | | publicly-owned corporation. Each day's violation constitutes a | 23 | | separate offense. The State's Attorney of the county in which | 24 | | the violation occurred, or the Attorney General, shall bring | 25 | | such actions in the name of the People of the State of | 26 | | Illinois, or may, in addition to other remedies provided in |
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| 1 | | this Section, bring an action for an injunction to restrain the | 2 | | violation or to enjoin the operation of any such employer.
| 3 | | Any individual employer, corporate officer or director of a | 4 | | corporate employer, partner of an employer partnership, or | 5 | | member of an employer limited liability company who negligently | 6 | | fails to provide coverage as required by paragraph (a) of this | 7 | | Section is guilty of a Class A misdemeanor. This provision | 8 | | shall not apply to any corporate officer or director of any | 9 | | publicly-owned corporation. Each day's violation constitutes a | 10 | | separate offense. The State's Attorney of the county in which | 11 | | the violation occurred, or the Attorney General, shall bring | 12 | | such actions in the name of the People of the State of | 13 | | Illinois.
| 14 | | The criminal penalties in this subsection (d) shall not | 15 | | apply where
there exists a good faith dispute as to the | 16 | | existence of an
employment relationship. Evidence of good faith | 17 | | shall
include, but not be limited to, compliance with the | 18 | | definition
of employee as used by the Internal Revenue Service.
| 19 | | Employers who are subject to and who knowingly fail to | 20 | | comply with this Section shall not be entitled to the benefits | 21 | | of this Act during the period of noncompliance, but shall be | 22 | | liable in an action under any other applicable law of this | 23 | | State. In the action, such employer shall not avail himself or | 24 | | herself of the defenses of assumption of risk or negligence or | 25 | | that the injury was due to a co-employee. In the action, proof | 26 | | of the injury shall constitute prima facie evidence of |
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| 1 | | negligence on the part of such employer and the burden shall be | 2 | | on such employer to show freedom of negligence resulting in the | 3 | | injury. The employer shall not join any other defendant in any | 4 | | such civil action. Nothing in this amendatory Act of the 94th | 5 | | General Assembly shall affect the employee's rights under | 6 | | subdivision (a)3 of Section 1 of this Act. Any employer or | 7 | | carrier who makes payments under subdivision (a)3 of Section 1 | 8 | | of this Act shall have a right of reimbursement from the | 9 | | proceeds of any recovery under this Section.
| 10 | | An employee of an uninsured employer, or the employee's | 11 | | dependents in case death ensued, may, instead of proceeding | 12 | | against the employer in a civil action in court, file an | 13 | | application for adjustment of claim with the Commission in | 14 | | accordance with the provisions of this Act and the Commission | 15 | | shall hear and determine the application for adjustment of | 16 | | claim in the manner in which other claims are heard and | 17 | | determined before the Commission.
| 18 | | All proceedings under this subsection (d) shall be reported | 19 | | on an annual basis to the Workers' Compensation Advisory Board.
| 20 | | An investigator with the Illinois Workers' Compensation | 21 | | Commission Insurance Compliance Division may issue a citation | 22 | | to any employer that is not in compliance with its obligation | 23 | | to have workers' compensation insurance under this Act. The | 24 | | amount of the fine shall be based on the period of time the | 25 | | employer was in non-compliance, but shall be no less than $500, | 26 | | and shall not exceed $2,500. An employer that has been issued a |
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| 1 | | citation shall pay the fine to the Commission and provide to | 2 | | the Commission proof that it obtained the required workers' | 3 | | compensation insurance within 10 days after the citation was | 4 | | issued. This Section does not affect any other obligations this | 5 | | Act imposes on employers. | 6 | | Upon a finding by the Commission, after reasonable notice | 7 | | and
hearing, of the knowing and wilful failure or refusal of an | 8 | | employer to
comply with
any of the provisions of paragraph (a) | 9 | | of this Section , or the failure or
refusal of an employer, | 10 | | service or adjustment company, or an insurance
carrier to | 11 | | comply with any order of the Illinois Workers' Compensation | 12 | | Commission pursuant to
paragraph (c) of this Section | 13 | | disqualifying him or her to operate as a self
insurer and | 14 | | requiring him or her to insure his or her liability, or the | 15 | | knowing and willful failure of an employer to comply with a | 16 | | citation issued by an investigator with the Illinois Workers' | 17 | | Compensation Commission Insurance Compliance Division, the
| 18 | | Commission may assess a civil penalty of up to $500 per day for | 19 | | each day of
such failure or refusal after the effective date of | 20 | | this amendatory Act of
1989. The minimum penalty under this | 21 | | Section shall be the sum of $10,000.
Each day of such failure | 22 | | or refusal shall constitute a separate offense.
The Commission | 23 | | may assess the civil penalty personally and individually
| 24 | | against the corporate officers and directors of a corporate | 25 | | employer, the
partners of an employer partnership, and the | 26 | | members of an employer limited
liability company, after a |
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| 1 | | finding of a knowing and willful refusal or failure
of each | 2 | | such named corporate officer, director, partner, or member to | 3 | | comply
with this Section. The liability for the assessed | 4 | | penalty shall be
against the named employer first, and
if the | 5 | | named employer fails or refuses to pay the penalty to the
| 6 | | Commission within 30 days after the final order of the | 7 | | Commission, then the
named
corporate officers, directors, | 8 | | partners, or members who have been found to have
knowingly and | 9 | | willfully refused or failed to comply with this Section shall | 10 | | be
liable for the unpaid penalty or any unpaid portion of the | 11 | | penalty. Upon investigation by the insurance non-compliance | 12 | | unit of the Commission, the Attorney General shall have the | 13 | | authority to prosecute all proceedings to enforce the civil and | 14 | | administrative provisions of this Section before the | 15 | | Commission. The Commission shall promulgate procedural rules | 16 | | for enforcing this Section.
| 17 | | Upon the failure or refusal of any employer, service or | 18 | | adjustment
company or insurance carrier to comply with the | 19 | | provisions of this Section
and with the orders of the | 20 | | Commission under this Section, or the order of
the court on | 21 | | review after final adjudication, the Commission may bring a
| 22 | | civil action to recover the amount of the penalty in Cook | 23 | | County or in
Sangamon County in which litigation the Commission | 24 | | shall be represented by
the Attorney General. The Commission | 25 | | shall send notice of its finding of
non-compliance and | 26 | | assessment of the civil penalty to the Attorney General.
It |
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| 1 | | shall be the duty of the Attorney General within 30 days after | 2 | | receipt
of the notice, to institute prosecutions and promptly | 3 | | prosecute all
reported violations of this Section.
| 4 | | Any individual employer, corporate officer or director of a | 5 | | corporate employer, partner of an employer partnership, or | 6 | | member of an employer limited liability company who, with the | 7 | | intent to avoid payment of compensation under this Act to an | 8 | | injured employee or the employee's dependents, knowingly | 9 | | transfers, sells, encumbers, assigns, or in any manner disposes | 10 | | of, conceals, secretes, or destroys any property belonging to | 11 | | the employer, officer, director, partner, or member is guilty | 12 | | of a Class 4 felony.
| 13 | | Penalties and fines collected pursuant to this paragraph | 14 | | (d) shall be deposited upon receipt into a special fund which | 15 | | shall be designated the Injured Workers' Benefit Fund, of which | 16 | | the State Treasurer is ex-officio custodian, such special fund | 17 | | to be held and disbursed in accordance with this paragraph (d) | 18 | | for the purposes hereinafter stated in this paragraph (d), upon | 19 | | the final order of the Commission. The Injured Workers' Benefit | 20 | | Fund shall be deposited the same as are State funds and any | 21 | | interest accruing thereon shall be added thereto every 6 | 22 | | months. The Injured Workers' Benefit Fund is subject to audit | 23 | | the same as State funds and accounts and is protected by the | 24 | | general bond given by the State Treasurer. The Injured Workers' | 25 | | Benefit Fund is considered always appropriated for the purposes | 26 | | of disbursements as provided in this paragraph, and shall be |
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| 1 | | paid out and disbursed as herein provided and shall not at any | 2 | | time be appropriated or diverted to any other use or purpose. | 3 | | Moneys in the Injured Workers' Benefit Fund shall be used only | 4 | | for payment of workers' compensation benefits for injured | 5 | | employees when the employer has failed to provide coverage as | 6 | | determined under this paragraph (d) and has failed to pay the | 7 | | benefits due to the injured employee. The Commission shall have | 8 | | the right to obtain reimbursement from the employer for | 9 | | compensation obligations paid by the Injured Workers' Benefit | 10 | | Fund. Any such amounts obtained shall be deposited by the | 11 | | Commission into the Injured Workers' Benefit Fund. If an | 12 | | injured employee or his or her personal representative receives | 13 | | payment from the Injured Workers' Benefit Fund, the State of | 14 | | Illinois has the same rights under paragraph (b) of Section 5 | 15 | | that the employer who failed to pay the benefits due to the | 16 | | injured employee would have had if the employer had paid those | 17 | | benefits, and any moneys recovered by the State as a result of | 18 | | the State's exercise of its rights under paragraph (b) of | 19 | | Section 5 shall be deposited into the Injured Workers' Benefit | 20 | | Fund. The custodian of the Injured Workers' Benefit Fund shall | 21 | | be joined with the employer as a party respondent in the | 22 | | application for adjustment of claim. After July 1, 2006, the | 23 | | Commission shall make disbursements from the Fund once each | 24 | | year to each eligible claimant. An eligible claimant is an | 25 | | injured worker who has within the previous fiscal year obtained | 26 | | a final award for benefits from the Commission against the |
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| 1 | | employer and the Injured Workers' Benefit Fund and has notified | 2 | | the Commission within 90 days of receipt of such award. Within | 3 | | a reasonable time after the end of each fiscal year, the | 4 | | Commission shall make a disbursement to each eligible claimant. | 5 | | At the time of disbursement, if there are insufficient moneys | 6 | | in the Fund to pay all claims, each eligible claimant shall | 7 | | receive a pro-rata share, as determined by the Commission, of | 8 | | the available moneys in the Fund for that year. Payment from | 9 | | the Injured Workers' Benefit Fund to an eligible claimant | 10 | | pursuant to this provision shall discharge the obligations of | 11 | | the Injured Workers' Benefit Fund regarding the award entered | 12 | | by the Commission.
| 13 | | (e) This Act shall not affect or disturb the continuance of | 14 | | any
existing insurance, mutual aid, benefit, or relief | 15 | | association or
department, whether maintained in whole or in | 16 | | part by the employer or
whether maintained by the employees, | 17 | | the payment of benefits of such
association or department being | 18 | | guaranteed by the employer or by some
person, firm or | 19 | | corporation for him or her: Provided, the employer contributes
| 20 | | to such association or department an amount not less than the | 21 | | full
compensation herein provided, exclusive of the cost of the | 22 | | maintenance
of such association or department and without any | 23 | | expense to the
employee. This Act shall not prevent the | 24 | | organization and maintaining
under the insurance laws of this | 25 | | State of any benefit or insurance
company for the purpose of | 26 | | insuring against the compensation provided
for in this Act, the |
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| 1 | | expense of which is maintained by the employer.
This Act shall | 2 | | not prevent the organization or maintaining under the
insurance | 3 | | laws of this State of any voluntary mutual aid, benefit or
| 4 | | relief association among employees for the payment of | 5 | | additional
accident or sick benefits.
| 6 | | (f) No existing insurance, mutual aid, benefit or relief | 7 | | association
or department shall, by reason of anything herein | 8 | | contained, be
authorized to discontinue its operation without | 9 | | first discharging its
obligations to any and all persons | 10 | | carrying insurance in the same or
entitled to relief or | 11 | | benefits therein.
| 12 | | (g) Any contract, oral, written or implied, of employment | 13 | | providing
for relief benefit, or insurance or any other device | 14 | | whereby the
employee is required to pay any premium or premiums | 15 | | for insurance
against the compensation provided for in this Act | 16 | | shall be null and
void. Any employer withholding from the wages | 17 | | of any employee any
amount for the purpose of paying any such | 18 | | premium shall be guilty of a
Class B misdemeanor.
| 19 | | In the event the employer does not pay the compensation for | 20 | | which he or
she is liable, then an insurance company, | 21 | | association or insurer which may
have insured such employer | 22 | | against such liability shall become primarily
liable to pay to | 23 | | the employee, his or her personal representative or
beneficiary | 24 | | the compensation required by the provisions of this Act to
be | 25 | | paid by such employer. The insurance carrier may be made a | 26 | | party to
the proceedings in which the employer is a party and |
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| 1 | | an award may be
entered jointly against the employer and the | 2 | | insurance carrier.
| 3 | | (h) It shall be unlawful for any employer, insurance | 4 | | company or
service or adjustment company to interfere with, | 5 | | restrain or coerce an
employee in any manner whatsoever in the | 6 | | exercise of the rights or
remedies granted to him or her by | 7 | | this Act or to discriminate, attempt to
discriminate, or | 8 | | threaten to discriminate against an employee in any way
because | 9 | | of his or her exercise of the rights or remedies granted to
him | 10 | | or her by this Act.
| 11 | | It shall be unlawful for any employer, individually or | 12 | | through any
insurance company or service or adjustment company, | 13 | | to discharge or to
threaten to discharge, or to refuse to | 14 | | rehire or recall to active
service in a suitable capacity an | 15 | | employee because of the exercise of
his or her rights or | 16 | | remedies granted to him or her by this Act.
| 17 | | (i) If an employer elects to obtain a life insurance policy | 18 | | on his
employees, he may also elect to apply such benefits in | 19 | | satisfaction of all
or a portion of the death benefits payable | 20 | | under this Act, in which case,
the employer's compensation | 21 | | premium shall be reduced accordingly.
| 22 | | (j) Within 45 days of receipt of an initial application or | 23 | | application
to renew self-insurance privileges the | 24 | | Self-Insurers Advisory Board shall
review and submit for | 25 | | approval by the Chairman of the Commission
recommendations of | 26 | | disposition of all initial applications to self-insure
and all |
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| 1 | | applications to renew self-insurance privileges filed by | 2 | | private
self-insurers pursuant to the provisions of this | 3 | | Section and Section 4a-9
of this Act. Each private self-insurer | 4 | | shall submit with its initial and
renewal applications the | 5 | | application fee required by Section 4a-4 of this Act.
| 6 | | The Chairman of the Commission shall promptly act upon all | 7 | | initial
applications and applications for renewal in full | 8 | | accordance with the
recommendations of the Board or, should the | 9 | | Chairman disagree with any
recommendation of disposition of the | 10 | | Self-Insurer's Advisory Board, he
shall within 30 days of | 11 | | receipt of such recommendation provide to the Board
in writing | 12 | | the reasons supporting his decision. The Chairman shall also
| 13 | | promptly notify the employer of his decision within 15 days of | 14 | | receipt of
the recommendation of the Board.
| 15 | | If an employer is denied a renewal of self-insurance | 16 | | privileges pursuant
to application it shall retain said | 17 | | privilege for 120 days after receipt of
a notice of | 18 | | cancellation of the privilege from the Chairman of the | 19 | | Commission.
| 20 | | All orders made by the Chairman under this Section shall be | 21 | | subject to
review by the courts, such review to be taken in the | 22 | | same manner and within
the same time as provided by subsection | 23 | | (f) of Section 19 of this Act for
review of awards and | 24 | | decisions of the Commission, upon the party seeking
the review | 25 | | filing with the clerk of the court to which such review is | 26 | | taken
a bond in an amount to be fixed and approved by the court |
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| 1 | | to which the
review is taken, conditioned upon the payment of | 2 | | all compensation awarded
against the person taking such review | 3 | | pending a decision thereof and
further conditioned upon such | 4 | | other obligations as the court may impose.
Upon the review the | 5 | | Circuit Court shall have power to review all questions
of fact | 6 | | as well as of law.
| 7 | | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | 8 | | 94-839, eff. 6-6-06.)
| 9 | | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
| 10 | | Sec. 8. The amount of compensation which shall be paid to | 11 | | the
employee for an accidental injury not resulting in death | 12 | | is:
| 13 | | (a) The employer shall provide and pay the employer's | 14 | | negotiated rate, if applicable, or the lesser of the health | 15 | | care provider's actual charges or according to a fee schedule, | 16 | | subject to Section 8.2, in effect at the time the service was | 17 | | rendered for all the necessary first
aid, medical and surgical | 18 | | services, and all necessary medical, surgical
and hospital | 19 | | services thereafter incurred, limited, however, to that
which | 20 | | is reasonably required to cure or relieve from the effects of | 21 | | the
accidental injury , even if a health care provider sells, | 22 | | transfers, or otherwise assigns an account receivable for | 23 | | procedures, treatments, or services covered under this Act . If | 24 | | the employer does not dispute payment of first aid, medical, | 25 | | surgical,
and hospital services, the employer shall make such |
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| 1 | | payment to the provider on behalf of the employee. The employer | 2 | | shall also pay for treatment,
instruction and training | 3 | | necessary for the physical, mental and
vocational | 4 | | rehabilitation of the employee, including all maintenance
| 5 | | costs and expenses incidental thereto. If as a result of the | 6 | | injury the
employee is unable to be self-sufficient the | 7 | | employer shall further pay
for such maintenance or | 8 | | institutional care as shall be required.
| 9 | | The employer shall select the employee's first physician, | 10 | | surgeon, or provider of hospital services at the employer's | 11 | | expense. However, in the event the employer fails to exercise | 12 | | his, her, or its right to select the first physician, surgeon, | 13 | | or provider of hospital services or where it is impracticable | 14 | | for the employer to exercise this right, the selection shall be | 15 | | made by the employee at the employer's expense. In the event | 16 | | the employee is dissatisfied with the first physician, surgeon, | 17 | | or provider of hospital services, the employee has an absolute | 18 | | right to select a second physician, surgeon, or provider of | 19 | | hospital services at the employer's expense. Emergency | 20 | | services and "chains-of-referral" shall not constitute a | 21 | | choice of physician, surgeon, or provider of hospital services | 22 | | by the employer or employee. The employee may at any time elect | 23 | | to secure his own physician,
surgeon and hospital services at | 24 | | the employer's expense , or,
| 25 | | Notwithstanding the foregoing, upon Upon agreement between | 26 | | the employer and the employees, or the employees'
exclusive |
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| 1 | | representative, and subject to the approval of the Illinois | 2 | | Workers' Compensation
Commission, the employer shall maintain | 3 | | a list of physicians, to be
known as a Panel of Physicians, who | 4 | | are accessible to the employees.
The employer shall post this | 5 | | list in a place or places easily accessible
to his employees. | 6 | | The employee shall have the right to make an
alternative choice | 7 | | of physician from such Panel if he is not satisfied
with the | 8 | | physician first selected. If, due to the nature of the injury
| 9 | | or its occurrence away from the employer's place of business, | 10 | | the
employee is unable to make a selection from the Panel, the | 11 | | selection
process from the Panel shall not apply. The physician | 12 | | selected from the
Panel may arrange for any consultation, | 13 | | referral or other specialized
medical services outside the | 14 | | Panel at the employer's expense. Provided
that, in the event | 15 | | the Commission shall find that a doctor selected by
the | 16 | | employee is rendering improper or inadequate care, the | 17 | | Commission
may order the employee to select another doctor | 18 | | certified or qualified
in the medical field for which treatment | 19 | | is required. If the employee
refuses to make such change the | 20 | | Commission may relieve the employer of
his obligation to pay | 21 | | the doctor's charges from the date of refusal to
the date of | 22 | | compliance.
| 23 | | Any vocational rehabilitation counselors who provide | 24 | | service under this Act shall have
appropriate certifications | 25 | | which designate the counselor as qualified to render
opinions | 26 | | relating to vocational rehabilitation. Vocational |
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| 1 | | rehabilitation
may include, but is not limited to, counseling | 2 | | for job searches, supervising
a job search program, and | 3 | | vocational retraining including education at an
accredited | 4 | | learning institution. The employee or employer may petition to | 5 | | the Commission to decide disputes relating to vocational | 6 | | rehabilitation and the Commission shall resolve any such | 7 | | dispute, including payment of the vocational rehabilitation | 8 | | program by the employer. | 9 | | The maintenance benefit shall not be less than the | 10 | | temporary total disability
rate determined for the employee. In | 11 | | addition, maintenance shall include costs
and expenses | 12 | | incidental to the vocational rehabilitation program. | 13 | | When the employee is working light duty on a part-time | 14 | | basis or full-time
basis
and earns less than he or she would be | 15 | | earning if employed in the full capacity
of the job or jobs, | 16 | | then the employee shall be entitled to temporary partial | 17 | | disability benefits. Temporary partial disability benefits | 18 | | shall be
equal to two-thirds of
the difference between the | 19 | | average amount that the employee would be able to
earn in the | 20 | | full performance of his or her duties in the occupation in | 21 | | which he
or she was engaged at the time of accident and the net | 22 | | amount which he or she
is
earning in the modified job provided | 23 | | to the employee by the employer or in any other job that the | 24 | | employee is working. | 25 | | Every hospital, physician, surgeon or other person | 26 | | rendering
treatment or services in accordance with the |
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| 1 | | provisions of this Section
shall upon written request furnish | 2 | | full and complete reports thereof to,
and permit their records | 3 | | to be copied by, the employer, the employee or
his dependents, | 4 | | as the case may be, or any other party to any proceeding
for | 5 | | compensation before the Commission, or their attorneys.
| 6 | | Notwithstanding the foregoing, the employer's liability to | 7 | | pay for such
medical services selected by the employee shall be | 8 | | limited to:
| 9 | | (1) all first aid and emergency treatment; plus
| 10 | | (2) all medical, surgical and hospital services | 11 | | provided by the
first physician, surgeon or hospital | 12 | | initially chosen by the employee or by any
other physician, | 13 | | consultant, expert, institution or other provider of
| 14 | | services recommended by said initial service provider or | 15 | | any subsequent
provider of medical services in the chain of | 16 | | referrals from said
initial service provider; plus
| 17 | | (3) all medical, surgical and hospital services | 18 | | provided by any second
physician, surgeon or hospital | 19 | | subsequently chosen by the employee or by
any other | 20 | | physician, consultant, expert, institution or other | 21 | | provider of
services recommended by said second service | 22 | | provider or any subsequent provider
of medical services in | 23 | | the chain of referrals
from said second service provider. | 24 | | Thereafter the employer shall select
and pay for all | 25 | | necessary medical, surgical and hospital treatment and the
| 26 | | employee may not select a provider of medical services at |
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| 1 | | the employer's
expense unless the employer agrees to such | 2 | | selection. | 3 | | At any time the employee
may obtain any medical treatment | 4 | | he desires at his own expense. This paragraph
shall not affect | 5 | | the duty to pay for rehabilitation referred to above.
| 6 | | When an employer and employee so agree in writing, nothing | 7 | | in this
Act prevents an employee whose injury or disability has | 8 | | been established
under this Act, from relying in good faith, on | 9 | | treatment by prayer or
spiritual means alone, in accordance | 10 | | with the tenets and practice of a
recognized church or | 11 | | religious denomination, by a duly accredited
practitioner | 12 | | thereof, and having nursing services appropriate therewith,
| 13 | | without suffering loss or diminution of the compensation | 14 | | benefits under
this Act. However, the employee shall submit to | 15 | | all physical
examinations required by this Act. The cost of | 16 | | such treatment and
nursing care shall be paid by the employee | 17 | | unless the employer agrees to
make such payment.
| 18 | | Where the accidental injury results in the amputation of an | 19 | | arm,
hand, leg or foot, or the enucleation of an eye, or the | 20 | | loss of any of
the natural teeth, the employer shall furnish an | 21 | | artificial of any such
members lost or damaged in accidental | 22 | | injury arising out of and in the
course of employment, and | 23 | | shall also furnish the necessary braces in all
proper and | 24 | | necessary cases. In cases of the loss of a member or members
by | 25 | | amputation, the employer shall, whenever necessary, maintain | 26 | | in good
repair, refit or replace the artificial limbs during |
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| 1 | | the lifetime of the
employee. Where the accidental injury | 2 | | accompanied by physical injury
results in damage to a denture, | 3 | | eye glasses or contact eye lenses, or
where the accidental | 4 | | injury results in damage to an artificial member,
the employer | 5 | | shall replace or repair such denture, glasses, lenses, or
| 6 | | artificial member.
| 7 | | The furnishing by the employer of any such services or | 8 | | appliances is
not an admission of liability on the part of the | 9 | | employer to pay
compensation.
| 10 | | The furnishing of any such services or appliances or the | 11 | | servicing
thereof by the employer is not the payment of | 12 | | compensation.
| 13 | | (b) If the period of temporary total incapacity for work | 14 | | lasts more
than 3 working days, weekly compensation as | 15 | | hereinafter provided shall
be paid beginning on the 4th day of | 16 | | such temporary total incapacity and
continuing as long as the | 17 | | total temporary incapacity lasts. In cases
where the temporary | 18 | | total incapacity for work continues for a period of
14 days or | 19 | | more from the day of the accident compensation shall commence
| 20 | | on the day after the accident.
| 21 | | 1. The compensation rate for temporary total | 22 | | incapacity under this
paragraph (b) of this Section shall | 23 | | be equal to 66 2/3% of the
employee's average weekly wage | 24 | | computed in accordance with Section 10,
provided that it | 25 | | shall be not less than 66 2/3% of the sum of the Federal | 26 | | minimum wage under the Fair Labor
Standards Act, or the |
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| 1 | | Illinois minimum wage under the Minimum Wage Law,
whichever | 2 | | is more, multiplied by 40 hours. This percentage rate shall | 3 | | be
increased by 10% for each spouse and child, not to | 4 | | exceed 100% of the total
minimum wage calculation,
| 5 | | nor exceed the employee's average weekly wage computed in | 6 | | accordance
with the provisions of Section 10, whichever is | 7 | | less.
| 8 | | 2. The compensation rate in all cases other than for | 9 | | temporary total
disability under this paragraph (b), and | 10 | | other than for serious and
permanent disfigurement under | 11 | | paragraph (c) and other than for permanent
partial | 12 | | disability under subparagraph (2) of paragraph (d) or under
| 13 | | paragraph (e), of this Section shall be equal to 66
2/3% of | 14 | | the employee's average weekly wage computed in accordance | 15 | | with
the provisions of Section 10, provided that it shall | 16 | | be not less than
66 2/3% of the sum of the Federal minimum | 17 | | wage under the Fair Labor Standards Act, or the Illinois | 18 | | minimum wage under the Minimum Wage Law, whichever is more, | 19 | | multiplied by 40 hours. This percentage rate shall be | 20 | | increased by 10% for each spouse and child, not to exceed | 21 | | 100% of the total minimum wage calculation,
| 22 | | nor exceed the employee's average weekly wage computed in | 23 | | accordance
with the provisions of Section 10, whichever is | 24 | | less.
| 25 | | 2.1. The compensation rate in all cases of serious and | 26 | | permanent
disfigurement under paragraph (c) and of |
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| 1 | | permanent partial disability
under subparagraph (2) of | 2 | | paragraph (d) or under paragraph (e) of this
Section shall | 3 | | be equal to
60% of the employee's average
weekly wage | 4 | | computed in accordance with
the provisions of Section 10, | 5 | | provided that it shall be not less than
66 2/3% of the sum | 6 | | of the Federal minimum wage under the Fair Labor Standards | 7 | | Act, or the Illinois minimum wage under the Minimum Wage | 8 | | Law, whichever is more, multiplied by 40 hours. This | 9 | | percentage rate shall be increased by 10% for each spouse | 10 | | and child, not to exceed 100% of the total minimum wage | 11 | | calculation,
| 12 | | nor exceed the employee's average weekly wage computed in | 13 | | accordance
with the provisions of Section 10, whichever is | 14 | | less.
| 15 | | 3. As used in this Section the term "child" means a | 16 | | child of the
employee including any child legally adopted | 17 | | before the accident or whom
at the time of the accident the | 18 | | employee was under legal obligation to
support or to whom | 19 | | the employee stood in loco parentis, and who at the
time of | 20 | | the accident was under 18 years of age and not emancipated. | 21 | | The
term "children" means the plural of "child".
| 22 | | 4. All weekly compensation rates provided under | 23 | | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | 24 | | Section shall be subject to the
following limitations:
| 25 | | The maximum weekly compensation rate from July 1, 1975, | 26 | | except as
hereinafter provided, shall be 100% of the |
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| 1 | | State's average weekly wage in
covered industries under the | 2 | | Unemployment Insurance Act, that being the
wage that most | 3 | | closely approximates the State's average weekly wage.
| 4 | | The maximum weekly compensation rate, for the period | 5 | | July 1, 1984,
through June 30, 1987, except as hereinafter | 6 | | provided, shall be $293.61.
Effective July 1, 1987 and on | 7 | | July 1 of each year thereafter the maximum
weekly | 8 | | compensation rate, except as hereinafter provided, shall | 9 | | be
determined as follows: if during the preceding 12 month | 10 | | period there shall
have been an increase in the State's | 11 | | average weekly wage in covered
industries under the | 12 | | Unemployment Insurance Act, the weekly compensation
rate | 13 | | shall be proportionately increased by the same percentage | 14 | | as the
percentage of increase in the State's average weekly | 15 | | wage in covered
industries under the Unemployment | 16 | | Insurance Act during such period.
| 17 | | The maximum weekly compensation rate, for the period | 18 | | January 1, 1981
through December 31, 1983, except as | 19 | | hereinafter provided, shall be 100% of
the State's average | 20 | | weekly wage in covered industries under the
Unemployment | 21 | | Insurance Act in effect on January 1, 1981. Effective | 22 | | January
1, 1984 and on January 1, of each year thereafter | 23 | | the maximum weekly
compensation rate, except as | 24 | | hereinafter provided, shall be determined as
follows: if | 25 | | during the preceding 12 month period there shall have been | 26 | | an
increase in the State's average weekly wage in covered |
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| 1 | | industries under the
Unemployment Insurance Act, the | 2 | | weekly compensation rate shall be
proportionately | 3 | | increased by the same percentage as the percentage of
| 4 | | increase in the State's average weekly wage in covered | 5 | | industries under the
Unemployment Insurance Act during | 6 | | such period.
| 7 | | From July 1, 1977 and thereafter such maximum weekly | 8 | | compensation
rate in death cases under Section 7, and | 9 | | permanent total disability
cases under paragraph (f) or | 10 | | subparagraph 18 of paragraph (3) of this
Section and for | 11 | | temporary total disability under paragraph (b) of this
| 12 | | Section and for amputation of a member or enucleation of an | 13 | | eye under
paragraph (e) of this Section shall be increased | 14 | | to 133-1/3% of the
State's average weekly wage in covered | 15 | | industries under the
Unemployment Insurance Act.
| 16 | | For injuries occurring on or after February 1, 2006, | 17 | | the maximum weekly benefit under paragraph (d)1 of this | 18 | | Section shall be 100% of the State's average weekly wage in | 19 | | covered industries under the Unemployment Insurance Act.
| 20 | | 4.1. Any provision herein to the contrary | 21 | | notwithstanding, the
weekly compensation rate for | 22 | | compensation payments under subparagraph 18
of paragraph | 23 | | (e) of this Section and under paragraph (f) of this
Section | 24 | | and under paragraph (a) of Section 7 and for amputation of | 25 | | a member or enucleation of an eye under paragraph (e) of | 26 | | this Section, shall in no event be less
than 50% of the |
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| 1 | | State's average weekly wage in covered industries under
the | 2 | | Unemployment Insurance Act.
| 3 | | 4.2. Any provision to the contrary notwithstanding, | 4 | | the total
compensation payable under Section 7 shall not | 5 | | exceed the greater of $500,000
or 25
years.
| 6 | | 5. For the purpose of this Section this State's average | 7 | | weekly wage
in covered industries under the Unemployment | 8 | | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | 9 | | per
week and the computation of compensation rates shall be | 10 | | based on the
aforesaid average weekly wage until modified | 11 | | as hereinafter provided.
| 12 | | 6. The Department of Employment Security of the State | 13 | | shall
on or before the first day of December, 1977, and on | 14 | | or before the first
day of June, 1978, and on the first day | 15 | | of each December and June of each
year thereafter, publish | 16 | | the State's average weekly wage in covered
industries under | 17 | | the Unemployment Insurance Act and the Illinois Workers' | 18 | | Compensation
Commission shall on the 15th day of January, | 19 | | 1978 and on the 15th day of
July, 1978 and on the 15th day | 20 | | of each January and July of each year
thereafter, post and | 21 | | publish the State's average weekly wage in covered
| 22 | | industries under the Unemployment Insurance Act as last | 23 | | determined and
published by the Department of Employment | 24 | | Security. The amount when so
posted and published shall be | 25 | | conclusive and shall be applicable as the
basis of | 26 | | computation of compensation rates until the next posting |
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| 1 | | and
publication as aforesaid.
| 2 | | 7. The payment of compensation by an employer or his | 3 | | insurance
carrier to an injured employee shall not | 4 | | constitute an admission of the
employer's liability to pay | 5 | | compensation.
| 6 | | (c) For any serious and permanent disfigurement to the | 7 | | hand, head,
face, neck, arm, leg below the knee or the chest | 8 | | above the axillary
line, the employee is entitled to | 9 | | compensation for such disfigurement,
the amount determined by | 10 | | agreement at any time or by arbitration under
this Act, at a | 11 | | hearing not less than 6 months after the date of the
accidental | 12 | | injury, which amount shall not exceed 150 weeks (if the | 13 | | accidental injury occurs on or after the effective date of this | 14 | | amendatory Act of the 94th General Assembly
but before February
| 15 | | 1, 2006) or 162
weeks (if the accidental injury occurs on or | 16 | | after February
1, 2006) at the
applicable rate provided in | 17 | | subparagraph 2.1 of paragraph (b) of this Section.
| 18 | | No compensation is payable under this paragraph where | 19 | | compensation is
payable under paragraphs (d), (e) or (f) of | 20 | | this Section.
| 21 | | A duly appointed member of a fire department in a city, the | 22 | | population of
which exceeds 200,000 according to the last | 23 | | federal or State census, is
eligible for compensation under | 24 | | this paragraph only where such serious and
permanent | 25 | | disfigurement results from burns.
| 26 | | (d) 1. If, after the accidental injury has been sustained, |
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| 1 | | the
employee as a result thereof becomes partially | 2 | | incapacitated from
pursuing his usual and customary line of | 3 | | employment, he shall, except in
cases compensated under the | 4 | | specific schedule set forth in paragraph (e)
of this Section, | 5 | | receive compensation for the duration of his
disability, | 6 | | subject to the limitations as to maximum amounts fixed in
| 7 | | paragraph (b) of this Section, equal to 66-2/3% of the | 8 | | difference
between the average amount which he would be able to | 9 | | earn in the full
performance of his duties in the occupation in | 10 | | which he was engaged at
the time of the accident and the | 11 | | average amount which he is earning or
is able to earn in some | 12 | | suitable employment or business after the accident. An award | 13 | | for wage differential under this subsection shall be effective | 14 | | only until the employee reaches the age of 67 or 5 years from | 15 | | the date the award becomes final, whichever is later.
| 16 | | 2. If, as a result of the accident, the employee sustains | 17 | | serious
and permanent injuries not covered by paragraphs (c) | 18 | | and (e) of this
Section or having sustained injuries covered by | 19 | | the aforesaid
paragraphs (c) and (e), he shall have sustained | 20 | | in addition thereto
other injuries which injuries do not | 21 | | incapacitate him from pursuing the
duties of his employment but | 22 | | which would disable him from pursuing other
suitable | 23 | | occupations, or which have otherwise resulted in physical
| 24 | | impairment; or if such injuries partially incapacitate him from | 25 | | pursuing
the duties of his usual and customary line of | 26 | | employment but do not
result in an impairment of earning |
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| 1 | | capacity, or having resulted in an
impairment of earning | 2 | | capacity, the employee elects to waive his right
to recover | 3 | | under the foregoing subparagraph 1 of paragraph (d) of this
| 4 | | Section then in any of the foregoing events, he shall receive | 5 | | in
addition to compensation for temporary total disability | 6 | | under paragraph
(b) of this Section, compensation at the rate | 7 | | provided in subparagraph 2.1
of paragraph (b) of this Section | 8 | | for that percentage of 500 weeks that
the partial disability | 9 | | resulting from the injuries covered by this
paragraph bears to | 10 | | total disability. If the employee shall have
sustained a | 11 | | fracture of one or more vertebra or fracture of the skull,
the | 12 | | amount of compensation allowed under this Section shall be not | 13 | | less
than 6 weeks for a fractured skull and 6 weeks for each | 14 | | fractured
vertebra, and in the event the employee shall have | 15 | | sustained a fracture
of any of the following facial bones: | 16 | | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | 17 | | mandible, the amount of compensation allowed under
this Section | 18 | | shall be not less than 2 weeks for each such fractured
bone, | 19 | | and for a fracture of each transverse process not less than 3
| 20 | | weeks. In the event such injuries shall result in the loss of a | 21 | | kidney,
spleen or lung, the amount of compensation allowed | 22 | | under this Section
shall be not less than 10 weeks for each | 23 | | such organ. Compensation
awarded under this subparagraph 2 | 24 | | shall not take into consideration
injuries covered under | 25 | | paragraphs (c) and (e) of this Section and the
compensation | 26 | | provided in this paragraph shall not affect the employee's
|
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| 1 | | right to compensation payable under paragraphs (b), (c) and (e) | 2 | | of this
Section for the disabilities therein covered.
| 3 | | (e) For accidental injuries in the following schedule, the | 4 | | employee
shall receive compensation for the period of temporary | 5 | | total incapacity
for work resulting from such accidental | 6 | | injury, under subparagraph 1 of
paragraph (b) of this Section, | 7 | | and shall receive in addition thereto
compensation for a | 8 | | further period for the specific loss herein
mentioned, but | 9 | | shall not receive any compensation under any other
provisions | 10 | | of this Act. The following listed amounts apply to either
the | 11 | | loss of or the permanent and complete loss of use of the member
| 12 | | specified, such compensation for the length of time as follows:
| 13 | | 1. Thumb- | 14 | | 70 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 | | 76
weeks if the accidental injury occurs on or | 18 | | after February
1, 2006.
| 19 | | 2. First, or index finger- | 20 | | 40 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 | | 43
weeks if the accidental injury occurs on or | 24 | | after February
1, 2006.
| 25 | | 3. Second, or middle finger- | 26 | | 35 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 | | 38
weeks if the accidental injury occurs on or | 4 | | after February
1, 2006.
| 5 | | 4. Third, or ring finger- | 6 | | 25 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 | | 27
weeks if the accidental injury occurs on or | 10 | | after February
1, 2006.
| 11 | | 5. Fourth, or little finger- | 12 | | 20 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 | | 22
weeks if the accidental injury occurs on or | 16 | | after February
1, 2006.
| 17 | | 6. Great toe- | 18 | | 35 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 | | 38
weeks if the accidental injury occurs on or | 22 | | after February
1, 2006.
| 23 | | 7. Each toe other than great toe- | 24 | | 12 weeks if the accidental injury occurs on or | 25 | | after the effective date of this amendatory Act of the | 26 | | 94th General Assembly
but before February
1, 2006.
|
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| 1 | | 13
weeks if the accidental injury occurs on or | 2 | | after February
1, 2006.
| 3 | | 8. The loss of the first or distal phalanx of the thumb | 4 | | or of any
finger or toe shall be considered to be equal to | 5 | | the loss of one-half of
such thumb, finger or toe and the | 6 | | compensation payable shall be one-half
of the amount above | 7 | | specified. The loss of more than one phalanx shall
be | 8 | | considered as the loss of the entire thumb, finger or toe. | 9 | | In no
case shall the amount received for more than one | 10 | | finger exceed the
amount provided in this schedule for the | 11 | | loss of a hand.
| 12 | | 9. Hand- | 13 | | 190 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 | | 205
weeks if the accidental injury occurs on or | 17 | | after February
1, 2006. | 18 | | The loss of 2 or more digits, or one or more
phalanges | 19 | | of 2 or more digits, of a hand may be compensated on the | 20 | | basis
of partial loss of use of a hand, provided, further, | 21 | | that the loss of 4
digits, or the loss of use of 4 digits, | 22 | | in the same hand shall
constitute the complete loss of a | 23 | | hand.
| 24 | | 10. Arm- | 25 | | 235 weeks if the accidental injury occurs on or | 26 | | after the effective date of this amendatory Act of the |
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| 1 | | 94th General Assembly
but before February
1, 2006.
| 2 | | 253
weeks if the accidental injury occurs on or | 3 | | after February
1, 2006. | 4 | | Where an accidental injury results in the
amputation of | 5 | | an arm below the elbow, such injury shall be compensated
as | 6 | | a loss of an arm. Where an accidental injury results in the
| 7 | | amputation of an arm above the elbow, compensation for an | 8 | | additional 15 weeks (if the accidental injury occurs on or | 9 | | after the effective date of this amendatory Act of the 94th | 10 | | General Assembly
but before February
1, 2006) or an | 11 | | additional 17
weeks (if the accidental injury occurs on or | 12 | | after February
1, 2006) shall be paid, except where the | 13 | | accidental injury results in the
amputation of an arm at | 14 | | the shoulder joint, or so close to shoulder
joint that an | 15 | | artificial arm cannot be used, or results in the
| 16 | | disarticulation of an arm at the shoulder joint, in which | 17 | | case
compensation for an additional 65 weeks (if the | 18 | | accidental injury occurs on or after the effective date of | 19 | | this amendatory Act of the 94th General Assembly
but before | 20 | | February
1, 2006) or an additional 70
weeks (if the | 21 | | accidental injury occurs on or after February
1, 2006)
| 22 | | shall be paid.
| 23 | | 11. Foot- | 24 | | 155 weeks if the accidental injury occurs on or | 25 | | after the effective date of this amendatory Act of the | 26 | | 94th General Assembly
but before February
1, 2006.
|
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| 1 | | 167
weeks if the accidental injury occurs on or | 2 | | after February
1, 2006.
| 3 | | 12. Leg- | 4 | | 200 weeks if the accidental injury occurs on or | 5 | | after the effective date of this amendatory Act of the | 6 | | 94th General Assembly
but before February
1, 2006.
| 7 | | 215
weeks if the accidental injury occurs on or | 8 | | after February
1, 2006. | 9 | | Where an accidental injury results in the
amputation of | 10 | | a leg below the knee, such injury shall be compensated as
| 11 | | loss of a leg. Where an accidental injury results in the | 12 | | amputation of a
leg above the knee, compensation for an | 13 | | additional 25 weeks (if the accidental injury occurs on or | 14 | | after the effective date of this amendatory Act of the 94th | 15 | | General Assembly
but before February
1, 2006) or an | 16 | | additional 27
weeks (if the accidental injury occurs on or | 17 | | after February
1, 2006) shall be
paid, except where the | 18 | | accidental injury results in the amputation of a
leg at the | 19 | | hip joint, or so close to the hip joint that an artificial
| 20 | | leg cannot be used, or results in the disarticulation of a | 21 | | leg at the
hip joint, in which case compensation for an | 22 | | additional 75 weeks (if the accidental injury occurs on or | 23 | | after the effective date of this amendatory Act of the 94th | 24 | | General Assembly
but before February
1, 2006) or an | 25 | | additional 81
weeks (if the accidental injury occurs on or | 26 | | after February
1, 2006) shall
be paid.
|
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|
| 1 | | 13. Eye- | 2 | | 150 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 | | 162
weeks if the accidental injury occurs on or | 6 | | after February
1, 2006. | 7 | | Where an accidental injury results in the
enucleation | 8 | | of an eye, compensation for an additional 10 weeks (if the | 9 | | accidental injury occurs on or after the effective date of | 10 | | this amendatory Act of the 94th General Assembly
but before | 11 | | February
1, 2006) or an additional 11
weeks (if the | 12 | | accidental injury occurs on or after February
1, 2006)
| 13 | | shall be
paid.
| 14 | | 14. Loss of hearing of one ear- | 15 | | 50 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 | | 54
weeks if the accidental injury occurs on or | 19 | | after February
1, 2006.
| 20 | | Total and permanent loss of
hearing of both ears- | 21 | | 200 weeks if the accidental injury occurs on or | 22 | | after the effective date of this amendatory Act of the | 23 | | 94th General Assembly
but before February
1, 2006. | 24 | | 215
weeks if the accidental injury occurs on or | 25 | | after February
1, 2006.
| 26 | | 15. Testicle- |
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|
| 1 | | 50 weeks if the accidental injury occurs on or | 2 | | after the effective date of this amendatory Act of the | 3 | | 94th General Assembly
but before February
1, 2006.
| 4 | | 54
weeks if the accidental injury occurs on or | 5 | | after February
1, 2006.
| 6 | | Both testicles- | 7 | | 150 weeks if the accidental injury occurs on or | 8 | | after the effective date of this amendatory Act of the | 9 | | 94th General Assembly
but before February
1, 2006.
| 10 | | 162
weeks if the accidental injury occurs on or | 11 | | after February
1, 2006.
| 12 | | 16. For the permanent partial loss of use of a member | 13 | | or sight of an
eye, or hearing of an ear, compensation | 14 | | during that proportion of the
number of weeks in the | 15 | | foregoing schedule provided for the loss of such
member or | 16 | | sight of an eye, or hearing of an ear, which the partial | 17 | | loss
of use thereof bears to the total loss of use of such | 18 | | member, or sight
of eye, or hearing of an ear.
| 19 | | (a) Loss of hearing for compensation purposes | 20 | | shall be
confined to the frequencies of 1,000, 2,000 | 21 | | and 3,000 cycles per second.
Loss of hearing ability | 22 | | for frequency tones above 3,000 cycles per second
are | 23 | | not to be considered as constituting disability for | 24 | | hearing.
| 25 | | (b) The percent of hearing loss, for purposes of | 26 | | the
determination of compensation claims for |
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| 1 | | occupational deafness,
shall be calculated as the | 2 | | average in decibels for the thresholds
of hearing for | 3 | | the frequencies of 1,000, 2,000 and 3,000 cycles per | 4 | | second.
Pure tone air conduction audiometric | 5 | | instruments, approved by
nationally recognized | 6 | | authorities in this field, shall be used for measuring
| 7 | | hearing loss. If the losses of hearing average 30 | 8 | | decibels or less in the
3 frequencies, such losses of | 9 | | hearing shall not then constitute any
compensable | 10 | | hearing disability. If the losses of hearing average 85
| 11 | | decibels or more in the 3 frequencies, then the same | 12 | | shall constitute and
be total or 100% compensable | 13 | | hearing loss.
| 14 | | (c) In measuring hearing impairment, the lowest | 15 | | measured
losses in each of the 3 frequencies shall be | 16 | | added together and
divided by 3 to determine the | 17 | | average decibel loss. For every decibel
of loss | 18 | | exceeding 30 decibels an allowance of 1.82% shall be | 19 | | made up to
the maximum of 100% which is reached at 85 | 20 | | decibels.
| 21 | | (d) If a hearing loss is established to have | 22 | | existed on July 1, 1975 by
audiometric testing the | 23 | | employer shall not be liable for the previous loss
so | 24 | | established nor shall he be liable for any loss for | 25 | | which compensation
has been paid or awarded.
| 26 | | (e) No consideration shall be given to the question |
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| 1 | | of
whether or not the ability of an employee to | 2 | | understand speech
is improved by the use of a hearing | 3 | | aid.
| 4 | | (f) No claim for loss of hearing due to industrial | 5 | | noise
shall be brought against an employer or allowed | 6 | | unless the employee has
been exposed for a period of | 7 | | time sufficient to cause permanent impairment
to noise | 8 | | levels in excess of the following:
|
|
9 | | Sound Level DBA |
|
|
10 | | Slow Response |
Hours Per Day |
|
11 | | 90 |
8 |
|
12 | | 92 |
6 |
|
13 | | 95 |
4 |
|
14 | | 97 |
3 |
|
15 | | 100 |
2 |
|
16 | | 102 |
1-1/2 |
|
17 | | 105 |
1 |
|
18 | | 110 |
1/2 |
|
19 | | 115 |
1/4 |
|
20 | | This subparagraph (f) shall not be applied in cases of | 21 | | hearing loss
resulting from trauma or explosion.
| 22 | | 17. In computing the compensation to be paid to any | 23 | | employee who,
before the accident for which he claims | 24 | | compensation, had before that
time sustained an injury | 25 | | resulting in the loss by amputation or partial
loss by | 26 | | amputation of any member, including hand, arm, thumb or |
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| 1 | | fingers,
leg, foot or any toes, such loss or partial loss | 2 | | of any such member
shall be deducted from any award made | 3 | | for the subsequent injury. For
the permanent loss of use or | 4 | | the permanent partial loss of use of any
such member or the | 5 | | partial loss of sight of an eye, for which
compensation has | 6 | | been paid, then such loss shall be taken into
consideration | 7 | | and deducted from any award for the subsequent injury.
| 8 | | 18. The specific case of loss of both hands, both arms, | 9 | | or both
feet, or both legs, or both eyes, or of any two | 10 | | thereof, or the
permanent and complete loss of the use | 11 | | thereof, constitutes total and
permanent disability, to be | 12 | | compensated according to the compensation
fixed by | 13 | | paragraph (f) of this Section. These specific cases of | 14 | | total
and permanent disability do not exclude other cases.
| 15 | | Any employee who has previously suffered the loss or | 16 | | permanent and
complete loss of the use of any of such | 17 | | members, and in a subsequent
independent accident loses | 18 | | another or suffers the permanent and complete
loss of the | 19 | | use of any one of such members the employer for whom the
| 20 | | injured employee is working at the time of the last | 21 | | independent accident
is liable to pay compensation only for | 22 | | the loss or permanent and
complete loss of the use of the | 23 | | member occasioned by the last
independent accident.
| 24 | | 19. In a case of specific loss and the subsequent death | 25 | | of such
injured employee from other causes than such injury | 26 | | leaving a widow,
widower, or dependents surviving before |
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| 1 | | payment or payment in full for
such injury, then the amount | 2 | | due for such injury is payable to the widow
or widower and, | 3 | | if there be no widow or widower, then to such
dependents, | 4 | | in the proportion which such dependency bears to total
| 5 | | dependency.
| 6 | | Beginning July 1, 1980, and every 6 months thereafter, the | 7 | | Commission
shall examine the Second Injury Fund and when, after | 8 | | deducting all
advances or loans made to such Fund, the amount | 9 | | therein is $500,000
then the amount required to be paid by | 10 | | employers pursuant to paragraph
(f) of Section 7 shall be | 11 | | reduced by one-half. When the Second Injury Fund
reaches the | 12 | | sum of $600,000 then the payments shall cease entirely.
| 13 | | However, when the Second Injury Fund has been reduced to | 14 | | $400,000, payment
of one-half of the amounts required by | 15 | | paragraph (f) of Section 7
shall be resumed, in the manner | 16 | | herein provided, and when the Second Injury
Fund has been | 17 | | reduced to $300,000, payment of the full amounts required by
| 18 | | paragraph (f) of Section 7 shall be resumed, in the manner | 19 | | herein provided.
The Commission shall make the changes in | 20 | | payment effective by
general order, and the changes in payment | 21 | | become immediately effective
for all cases coming before the | 22 | | Commission thereafter either by
settlement agreement or final | 23 | | order, irrespective of the date of the
accidental injury.
| 24 | | On August 1, 1996 and on February 1 and August 1 of each | 25 | | subsequent year, the Commission
shall examine the special fund | 26 | | designated as the "Rate
Adjustment Fund" and when, after |
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| 1 | | deducting all advances or loans made to
said fund, the amount | 2 | | therein is $4,000,000, the amount required to be
paid by | 3 | | employers pursuant to paragraph (f) of Section 7 shall be
| 4 | | reduced by one-half. When the Rate Adjustment Fund reaches the | 5 | | sum of
$5,000,000 the payment therein shall cease entirely. | 6 | | However, when said
Rate Adjustment Fund has been reduced to | 7 | | $3,000,000 the amounts required by
paragraph (f) of Section 7 | 8 | | shall be resumed in the manner herein provided.
| 9 | | (f) In case of complete disability, which renders the | 10 | | employee
wholly and permanently incapable of work, or in the | 11 | | specific case of
total and permanent disability as provided in | 12 | | subparagraph 18 of
paragraph (e) of this Section, compensation | 13 | | shall be payable at the rate
provided in subparagraph 2 of | 14 | | paragraph (b) of this Section for life.
| 15 | | An employee entitled to benefits under paragraph (f) of | 16 | | this Section
shall also be entitled to receive from the Rate | 17 | | Adjustment
Fund provided in paragraph (f) of Section 7 of the | 18 | | supplementary benefits
provided in paragraph (g) of this | 19 | | Section 8.
| 20 | | If any employee who receives an award under this paragraph | 21 | | afterwards
returns to work or is able to do so, and earns or is | 22 | | able to earn as
much as before the accident, payments under | 23 | | such award shall cease. If
such employee returns to work, or is | 24 | | able to do so, and earns or is able
to earn part but not as much | 25 | | as before the accident, such award shall be
modified so as to | 26 | | conform to an award under paragraph (d) of this
Section. If |
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| 1 | | such award is terminated or reduced under the provisions of
| 2 | | this paragraph, such employees have the right at any time | 3 | | within 30
months after the date of such termination or | 4 | | reduction to file petition
with the Commission for the purpose | 5 | | of determining whether any
disability exists as a result of the | 6 | | original accidental injury and the
extent thereof.
| 7 | | Disability as enumerated in subdivision 18, paragraph (e) | 8 | | of this
Section is considered complete disability.
| 9 | | If an employee who had previously incurred loss or the | 10 | | permanent and
complete loss of use of one member, through the | 11 | | loss or the permanent
and complete loss of the use of one hand, | 12 | | one arm, one foot, one leg, or
one eye, incurs permanent and | 13 | | complete disability through the loss or
the permanent and | 14 | | complete loss of the use of another member, he shall
receive, | 15 | | in addition to the compensation payable by the employer and
| 16 | | after such payments have ceased, an amount from the Second | 17 | | Injury Fund
provided for in paragraph (f) of Section 7, which, | 18 | | together with the
compensation payable from the employer in | 19 | | whose employ he was when the
last accidental injury was | 20 | | incurred, will equal the amount payable for
permanent and | 21 | | complete disability as provided in this paragraph of this
| 22 | | Section.
| 23 | | The custodian of the Second Injury Fund provided for in | 24 | | paragraph (f)
of Section 7 shall be joined with the employer as | 25 | | a party respondent in
the application for adjustment of claim. | 26 | | The application for adjustment
of claim shall state briefly and |
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| 1 | | in general terms the approximate time
and place and manner of | 2 | | the loss of the first member.
| 3 | | In its award the Commission or the Arbitrator shall | 4 | | specifically find
the amount the injured employee shall be | 5 | | weekly paid, the number of
weeks compensation which shall be | 6 | | paid by the employer, the date upon
which payments begin out of | 7 | | the Second Injury Fund provided for in
paragraph (f) of Section | 8 | | 7 of this Act, the length of time the weekly
payments continue, | 9 | | the date upon which the pension payments commence and
the | 10 | | monthly amount of the payments. The Commission shall 30 days | 11 | | after
the date upon which payments out of the Second Injury | 12 | | Fund have begun as
provided in the award, and every month | 13 | | thereafter, prepare and submit to
the State Comptroller a | 14 | | voucher for payment for all compensation accrued
to that date | 15 | | at the rate fixed by the Commission. The State Comptroller
| 16 | | shall draw a warrant to the injured employee along with a | 17 | | receipt to be
executed by the injured employee and returned to | 18 | | the Commission. The
endorsed warrant and receipt is a full and | 19 | | complete acquittance to the
Commission for the payment out of | 20 | | the Second Injury Fund. No other
appropriation or warrant is | 21 | | necessary for payment out of the Second
Injury Fund. The Second | 22 | | Injury Fund is appropriated for the purpose of
making payments | 23 | | according to the terms of the awards.
| 24 | | As of July 1, 1980 to July 1, 1982, all claims against and | 25 | | obligations
of the Second Injury Fund shall become claims | 26 | | against and obligations of
the Rate Adjustment Fund to the |
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| 1 | | extent there is insufficient money in the
Second Injury Fund to | 2 | | pay such claims and obligations. In that case, all
references | 3 | | to "Second Injury Fund" in this Section shall also include the
| 4 | | Rate Adjustment Fund.
| 5 | | (g) Every award for permanent total disability entered by | 6 | | the
Commission on and after July 1, 1965 under which | 7 | | compensation payments
shall become due and payable after the | 8 | | effective date of this amendatory
Act, and every award for | 9 | | death benefits or permanent total disability
entered by the | 10 | | Commission on and after the effective date of this
amendatory | 11 | | Act shall be subject to annual adjustments as to the amount
of | 12 | | the compensation rate therein provided. Such adjustments shall | 13 | | first
be made on July 15, 1977, and all awards made and entered | 14 | | prior to July
1, 1975 and on July 15 of each year
thereafter. | 15 | | In all other cases such adjustment shall be made on July 15
of | 16 | | the second year next following the date of the entry of the | 17 | | award and
shall further be made on July 15 annually thereafter. | 18 | | If during the
intervening period from the date of the entry of | 19 | | the award, or the last
periodic adjustment, there shall have | 20 | | been an increase in the State's
average weekly wage in covered | 21 | | industries under the Unemployment
Insurance Act, the weekly | 22 | | compensation rate shall be proportionately
increased by the | 23 | | same percentage as the percentage of increase in the
State's | 24 | | average weekly wage in covered industries under the
| 25 | | Unemployment Insurance Act. The increase in the compensation | 26 | | rate
under this paragraph shall in no event bring the total |
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| 1 | | compensation rate
to an amount greater than the prevailing | 2 | | maximum rate at the time that the annual adjustment is made. | 3 | | Such increase
shall be paid in the same manner as herein | 4 | | provided for payments under
the Second Injury Fund to the | 5 | | injured employee, or his dependents, as
the case may be, out of | 6 | | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | 7 | | of this Act. Payments shall be made at
the same intervals as | 8 | | provided in the award or, at the option of the
Commission, may | 9 | | be made in quarterly payment on the 15th day of January,
April, | 10 | | July and October of each year. In the event of a decrease in
| 11 | | such average weekly wage there shall be no change in the then | 12 | | existing
compensation rate. The within paragraph shall not | 13 | | apply to cases where
there is disputed liability and in which a | 14 | | compromise lump sum settlement
between the employer and the | 15 | | injured employee, or his dependents, as the
case may be, has | 16 | | been duly approved by the Illinois Workers' Compensation
| 17 | | Commission.
| 18 | | Provided, that in cases of awards entered by the Commission | 19 | | for
injuries occurring before July 1, 1975, the increases in | 20 | | the
compensation rate adjusted under the foregoing provision of | 21 | | this
paragraph (g) shall be limited to increases in the State's | 22 | | average
weekly wage in covered industries under the | 23 | | Unemployment Insurance Act
occurring after July 1, 1975.
| 24 | | For every accident occurring on or after July 20, 2005 but | 25 | | before the effective date of this amendatory Act of the 94th | 26 | | General Assembly (Senate Bill 1283 of the 94th General |
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| 1 | | Assembly), the annual adjustments to the compensation rate in | 2 | | awards for death benefits or permanent total disability, as | 3 | | provided in this Act, shall be paid by the employer. The | 4 | | adjustment shall be made by the employer on July 15 of the | 5 | | second year next following the date of the entry of the award | 6 | | and shall further be made on July 15 annually thereafter. If | 7 | | during the intervening period from the date of the entry of the | 8 | | award, or the last periodic adjustment, there shall have been | 9 | | an increase in the State's average weekly wage in covered | 10 | | industries under the Unemployment Insurance Act, the employer | 11 | | shall increase the weekly compensation rate proportionately by | 12 | | the same percentage as the percentage of increase in the | 13 | | State's average weekly wage in covered industries under the | 14 | | Unemployment Insurance Act. The increase in the compensation | 15 | | rate under this paragraph shall in no event bring the total | 16 | | compensation rate to an amount greater than the prevailing | 17 | | maximum rate at the time that the annual adjustment is made. In | 18 | | the event of a decrease in such average weekly wage there shall | 19 | | be no change in the then existing compensation rate. Such | 20 | | increase shall be paid by the employer in the same manner and | 21 | | at the same intervals as the payment of compensation in the | 22 | | award. This paragraph shall not apply to cases where there is | 23 | | disputed liability and in which a compromise lump sum | 24 | | settlement between the employer and the injured employee, or | 25 | | his or her dependents, as the case may be, has been duly | 26 | | approved by the Illinois Workers' Compensation Commission. |
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| 1 | | The annual adjustments for every award of death benefits or | 2 | | permanent total disability involving accidents occurring | 3 | | before July 20, 2005 and accidents occurring on or after the | 4 | | effective date of this amendatory Act of the 94th General | 5 | | Assembly (Senate Bill 1283 of the 94th General Assembly) shall | 6 | | continue to be paid from the Rate Adjustment Fund pursuant to | 7 | | this paragraph and Section 7(f) of this Act.
| 8 | | (h) In case death occurs from any cause before the total
| 9 | | compensation to which the employee would have been entitled has | 10 | | been
paid, then in case the employee leaves any widow, widower, | 11 | | child, parent
(or any grandchild, grandparent or other lineal | 12 | | heir or any collateral
heir dependent at the time of the | 13 | | accident upon the earnings of the
employee to the extent of 50% | 14 | | or more of total dependency) such
compensation shall be paid to | 15 | | the beneficiaries of the deceased employee
and distributed as | 16 | | provided in paragraph (g) of Section 7.
| 17 | | (h-1) In case an injured employee is under legal disability
| 18 | | at the time when any right or privilege accrues to him or her | 19 | | under this
Act, a guardian may be appointed pursuant to law, | 20 | | and may, on behalf
of such person under legal disability, claim | 21 | | and exercise any
such right or privilege with the same effect | 22 | | as if the employee himself
or herself had claimed or exercised | 23 | | the right or privilege. No limitations
of time provided by this | 24 | | Act run so long as the employee who is under legal
disability | 25 | | is without a conservator or guardian.
| 26 | | (i) In case the injured employee is under 16 years of age |
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| 1 | | at the
time of the accident and is illegally employed, the | 2 | | amount of
compensation payable under paragraphs (b), (c), (d), | 3 | | (e) and (f) of this
Section is increased 50%.
| 4 | | However, where an employer has on file an employment | 5 | | certificate
issued pursuant to the Child Labor Law or work | 6 | | permit issued pursuant
to the Federal Fair Labor Standards Act, | 7 | | as amended, or a birth
certificate properly and duly issued, | 8 | | such certificate, permit or birth
certificate is conclusive | 9 | | evidence as to the age of the injured minor
employee for the | 10 | | purposes of this Section.
| 11 | | Nothing herein contained repeals or amends the provisions | 12 | | of the
Child Labor Law relating to the employment of minors | 13 | | under the age of 16 years.
| 14 | | (j) 1. In the event the injured employee receives benefits,
| 15 | | including medical, surgical or hospital benefits under any | 16 | | group plan
covering non-occupational disabilities contributed | 17 | | to wholly or
partially by the employer, which benefits should | 18 | | not have been payable
if any rights of recovery existed under | 19 | | this Act, then such amounts so
paid to the employee from any | 20 | | such group plan as shall be consistent
with, and limited to, | 21 | | the provisions of paragraph 2 hereof, shall be
credited to or | 22 | | against any compensation payment for temporary total
| 23 | | incapacity for work or any medical, surgical or hospital | 24 | | benefits made
or to be made under this Act. In such event, the | 25 | | period of time for
giving notice of accidental injury and | 26 | | filing application for adjustment
of claim does not commence to |
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| 1 | | run until the termination of such
payments. This paragraph does | 2 | | not apply to payments made under any
group plan which would | 3 | | have been payable irrespective of an accidental
injury under | 4 | | this Act. Any employer receiving such credit shall keep
such | 5 | | employee safe and harmless from any and all claims or | 6 | | liabilities
that may be made against him by reason of having | 7 | | received such payments
only to the extent of such credit.
| 8 | | Any excess benefits paid to or on behalf of a State | 9 | | employee by the
State Employees' Retirement System under | 10 | | Article 14 of the Illinois Pension
Code on a death claim or | 11 | | disputed disability claim shall be credited
against any | 12 | | payments made or to be made by the State of Illinois to or on
| 13 | | behalf of such employee under this Act, except for payments for | 14 | | medical
expenses which have already been incurred at the time | 15 | | of the award. The
State of Illinois shall directly reimburse | 16 | | the State Employees' Retirement
System to the extent of such | 17 | | credit.
| 18 | | 2. Nothing contained in this Act shall be construed to give | 19 | | the
employer or the insurance carrier the right to credit for | 20 | | any benefits
or payments received by the employee other than | 21 | | compensation payments
provided by this Act, and where the | 22 | | employee receives payments other
than compensation payments, | 23 | | whether as full or partial salary, group
insurance benefits, | 24 | | bonuses, annuities or any other payments, the
employer or | 25 | | insurance carrier shall receive credit for each such payment
| 26 | | only to the extent of the compensation that would have been |
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| 1 | | payable
during the period covered by such payment.
| 2 | | 3. The extension of time for the filing of an Application | 3 | | for
Adjustment of Claim as provided in paragraph 1 above shall | 4 | | not apply to
those cases where the time for such filing had | 5 | | expired prior to the date
on which payments or benefits | 6 | | enumerated herein have been initiated or
resumed. Provided | 7 | | however that this paragraph 3 shall apply only to
cases wherein | 8 | | the payments or benefits hereinabove enumerated shall be
| 9 | | received after July 1, 1969.
| 10 | | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | 11 | | 94-695, eff. 11-16-05.)
| 12 | | (820 ILCS 305/8.2)
| 13 | | Sec. 8.2. Fee schedule.
| 14 | | (a) Except as provided for in subsection (c), for | 15 | | procedures, treatments, or services covered under this Act and | 16 | | rendered or to be rendered on and after February 1, 2006, the | 17 | | maximum allowable payment shall be 90% of the 80th percentile | 18 | | of charges and fees as determined by the Commission utilizing | 19 | | information provided by employers' and insurers' national | 20 | | databases, with a minimum of 12,000,000 Illinois line item | 21 | | charges and fees comprised of health care provider and hospital | 22 | | charges and fees as of August 1, 2004 but not earlier than | 23 | | August 1, 2002. These charges and fees are provider billed | 24 | | amounts and shall not include discounted charges. The 80th | 25 | | percentile is the point on an ordered data set from low to high |
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| 1 | | such that 80% of the cases are below or equal to that point and | 2 | | at most 20% are above or equal to that point. The Commission | 3 | | shall adjust these historical charges and fees as of August 1, | 4 | | 2004 by the Consumer Price Index-U for the period August 1, | 5 | | 2004 through September 30, 2005. The Commission shall establish | 6 | | fee schedules for procedures, treatments, or services for | 7 | | hospital inpatient, hospital outpatient, emergency room and | 8 | | trauma, ambulatory surgical treatment centers, and | 9 | | professional services. These charges and fees shall be | 10 | | designated by geozip or any smaller geographic unit. The data | 11 | | shall in no way identify or tend to identify any patient, | 12 | | employer, or health care provider. As used in this Section, | 13 | | "geozip" means a three-digit zip code based on data | 14 | | similarities, geographical similarities, and frequencies. A | 15 | | geozip does not cross state boundaries. As used in this | 16 | | Section, "three-digit zip code" means a geographic area in | 17 | | which all zip codes have the same first 3 digits. If a geozip | 18 | | does not have the necessary number of charges and fees to | 19 | | calculate a valid percentile for a specific procedure, | 20 | | treatment, or service, the Commission may combine data from the | 21 | | geozip with up to 4 other geozips that are demographically and | 22 | | economically similar and exhibit similarities in data and | 23 | | frequencies until the Commission reaches 9 charges or fees for | 24 | | that specific procedure, treatment, or service. In cases where | 25 | | the compiled data contains less than 9 charges or fees for a | 26 | | procedure, treatment, or service, reimbursement shall occur at |
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| 1 | | 76% of charges and fees as determined by the Commission in a | 2 | | manner consistent with the provisions of this paragraph. | 3 | | Providers of out-of-state procedures, treatments, services, | 4 | | products, or supplies shall be reimbursed at the lesser of that | 5 | | state's fee schedule amount or the fee schedule amount that | 6 | | would apply to Cook County, Illinois. If no fee schedule exists | 7 | | in that state, the provider shall be reimbursed at the lesser | 8 | | of the actual charge or the fee schedule amount in Cook County, | 9 | | Illinois The Commission has the authority to set the maximum | 10 | | allowable payment to providers of out-of-state procedures, | 11 | | treatments, or services covered under this Act in a manner | 12 | | consistent with this Section. Not later than September 30 in | 13 | | 2006 and each year thereafter, the Commission shall | 14 | | automatically increase or decrease the maximum allowable | 15 | | payment for a procedure, treatment, or service established and | 16 | | in effect on January 1 of that year by the percentage change in | 17 | | the Consumer Price Index-U for the 12 month period ending | 18 | | August 31 of that year. The increase or decrease shall become | 19 | | effective on January 1 of the following year. As used in this | 20 | | Section, "Consumer Price Index-U" means the index published by | 21 | | the Bureau of Labor Statistics of the U.S. Department of Labor, | 22 | | that measures the average change in prices of all goods and | 23 | | services purchased by all urban consumers, U.S. city average, | 24 | | all items, 1982-84=100. | 25 | | (a-1) Notwithstanding the provisions of subsection (a), | 26 | | the following provisions shall apply to the medical fee |
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| 1 | | schedule starting on April 1, 2011: | 2 | | (1) The Commission shall establish and maintain fee | 3 | | schedules for procedures, treatments, products, services, | 4 | | or supplies for hospital inpatient, hospital outpatient, | 5 | | emergency room, ambulatory surgical treatment centers, | 6 | | accredited ambulatory treatment facilities, prescriptions | 7 | | filled and dispensed outside of a licensed pharmacy, dental | 8 | | services, and professional services. This fee schedule | 9 | | shall be based on the fee schedule amounts already | 10 | | established by the Commission pursuant to subsection (a) of | 11 | | this Section. However, these fee schedule amounts shall be | 12 | | grouped into regions consistent with nationally recognized | 13 | | reimbursement zip codes in Illinois. | 14 | | (2) In cases where the compiled data contains less than | 15 | | 9 charges or fees for a procedure, treatment, product, | 16 | | supply, or service or where the fee schedule amount cannot | 17 | | be determined by the non-discounted charge data, | 18 | | non-Medicare relative values and conversion factors | 19 | | derived from established fee schedule amounts, coding | 20 | | crosswalks, or other data as determined by the Commission, | 21 | | reimbursement shall occur at 76% of charges and fees until | 22 | | April 1, 2011 and 64.6% of charges and fees thereafter as | 23 | | determined by the Commission in a manner consistent with | 24 | | the provisions of this paragraph. If a geozip, as defined | 25 | | in subsection (a) of this Section, overlaps into one or | 26 | | more of the regions set forth in paragraph (1) of this |
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| 1 | | subsection (a-1), then the Commission shall average or | 2 | | repeat the charges and fees in a geozip in order to | 3 | | designate charges and fees for each region. | 4 | | (3) To establish additional fee schedule amounts, the | 5 | | Commission shall utilize provider non-discounted charge | 6 | | data, non-Medicare relative values and conversion factors | 7 | | derived from established fee schedule amounts, and coding | 8 | | crosswalks. The Commission may establish additional fee | 9 | | schedule amounts based on either the charge or cost of the | 10 | | procedure, treatment, product, supply, or service. | 11 | | (4) Implants shall be reimbursed at 25% above the net | 12 | | manufacturer's invoice price less rebates, plus actual | 13 | | reasonable and customary shipping charges whether or not | 14 | | the implant charge is submitted by a provider in | 15 | | conjunction with a bill for all other services associated | 16 | | with the implant, submitted by a provider on a separate | 17 | | claim form, submitted by a distributor, or submitted by the | 18 | | manufacturer of the implant. "Implants" include the | 19 | | following codes or any substantially similar updated code | 20 | | as determined by the Commission: 0274 | 21 | | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | 22 | | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | 23 | | (investigational devices); and 0636 (drugs requiring | 24 | | detailed coding). Non-implantable devices or supplies | 25 | | within these codes shall be reimbursed at 65% of actual | 26 | | charge, which is the provider's normal rates under its |
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| 1 | | standard chargemaster. A standard chargemaster is the | 2 | | provider's list of charges for procedures, treatments, | 3 | | products, supplies, or services used to bill payers in a | 4 | | consistent manner. | 5 | | (5) The Commission shall automatically update all | 6 | | codes and associated rules with the version of the codes | 7 | | and rules valid on January 1 of that year. | 8 | | (a-2) For procedures, treatments, services, or supplies | 9 | | covered under this Act and rendered or to be rendered on or | 10 | | after April 1, 2011, the maximum allowable payment shall be 85% | 11 | | of the fee schedule amounts and any reimbursements for charges | 12 | | and fees pursuant to paragraph (2) of subsection (a-1) in | 13 | | effect on April 1, 2011 and thereafter be adjusted yearly by | 14 | | the Consumer Price Index-U, as described in subsection (a) of | 15 | | this Section. | 16 | | (a-3) Prescriptions filled and dispensed outside of a | 17 | | licensed pharmacy shall be subject to a fee schedule that shall | 18 | | not exceed the Average Wholesale Price (AWP) plus a dispensing | 19 | | fee of $4.18. AWP or its equivalent as registered by the | 20 | | National Drug Code shall be set forth for that drug on that | 21 | | date as published in Medispan. | 22 | | (b) Notwithstanding the provisions of subsection (a), if
| 23 | | the Commission finds that there is a significant limitation on
| 24 | | access to quality health care in either a specific field of
| 25 | | health care services or a specific geographic limitation on
| 26 | | access to health care, it may change the Consumer Price Index-U
|
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| 1 | | increase or decrease for that specific field or specific
| 2 | | geographic limitation on access to health care to address that
| 3 | | limitation. | 4 | | (c) The Commission shall establish by rule a process to | 5 | | review those medical cases or outliers that involve | 6 | | extra-ordinary treatment to determine whether to make an | 7 | | additional adjustment to the maximum payment within a fee | 8 | | schedule for a procedure, treatment, or service. | 9 | | (d) When a patient notifies a provider that the treatment, | 10 | | procedure, or service being sought is for a work-related | 11 | | illness or injury and furnishes the provider the name and | 12 | | address of the responsible employer, the provider shall bill | 13 | | the employer directly. The employer shall make payment and | 14 | | providers shall submit bills and records in accordance with the | 15 | | provisions of this Section. All payments to providers for | 16 | | treatment provided pursuant to this Act shall be made within 60 | 17 | | days of receipt of the bills as long as the claim contains | 18 | | substantially all the required data elements necessary to | 19 | | adjudicate the bills. In the case of nonpayment to a provider | 20 | | within 60 days of receipt of the bill which contained | 21 | | substantially all of the required data elements necessary to | 22 | | adjudicate the bill or nonpayment to a provider of a portion of | 23 | | such a bill up to the lesser of the actual charge or the | 24 | | payment level set by the Commission in the fee schedule | 25 | | established in this Section, the bill, or portion of the bill, | 26 | | shall incur interest at a rate of 1% per month payable to the |
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| 1 | | provider. | 2 | | (e) Except as provided in subsections (e-5), (e-10), and | 3 | | (e-15), a provider shall not hold an employee liable for costs | 4 | | related to a non-disputed procedure, treatment, or service | 5 | | rendered in connection with a compensable injury. The | 6 | | provisions of subsections (e-5), (e-10), (e-15), and (e-20) | 7 | | shall not apply if an employee provides information to the | 8 | | provider regarding participation in a group health plan. If the | 9 | | employee participates in a group health plan, the provider may | 10 | | submit a claim for services to the group health plan. If the | 11 | | claim for service is covered by the group health plan, the | 12 | | employee's responsibility shall be limited to applicable | 13 | | deductibles, co-payments, or co-insurance. Except as provided | 14 | | under subsections (e-5), (e-10), (e-15), and (e-20), a provider | 15 | | shall not bill or otherwise attempt to recover from the | 16 | | employee the difference between the provider's charge and the | 17 | | amount paid by the employer or the insurer on a compensable | 18 | | injury , or for medical services or treatment determined by the | 19 | | Commission to be excessive or unnecessary . | 20 | | (e-5) If an employer notifies a provider that the employer | 21 | | does not consider the illness or injury to be compensable under | 22 | | this Act, the provider may seek payment of the provider's | 23 | | actual charges from the employee for any procedure, treatment, | 24 | | or service rendered. Once an employee informs the provider that | 25 | | there is an application filed with the Commission to resolve a | 26 | | dispute over payment of such charges, the provider shall cease |
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| 1 | | any and all efforts to collect payment for the services that | 2 | | are the subject of the dispute. Any statute of limitations or | 3 | | statute of repose applicable to the provider's efforts to | 4 | | collect payment from the employee shall be tolled from the date | 5 | | that the employee files the application with the Commission | 6 | | until the date that the provider is permitted to resume | 7 | | collection efforts under the provisions of this Section. | 8 | | (e-10) If an employer notifies a provider that the employer | 9 | | will pay only a portion of a bill for any procedure, treatment, | 10 | | or service rendered in connection with a compensable illness or | 11 | | disease, the provider may seek payment from the employee for | 12 | | the remainder of the amount of the bill up to the lesser of the | 13 | | actual charge, negotiated rate, if applicable, or the payment | 14 | | level set by the Commission in the fee schedule established in | 15 | | this Section. Once an employee informs the provider that there | 16 | | is an application filed with the Commission to resolve a | 17 | | dispute over payment of such charges, the provider shall cease | 18 | | any and all efforts to collect payment for the services that | 19 | | are the subject of the dispute. Any statute of limitations or | 20 | | statute of repose applicable to the provider's efforts to | 21 | | collect payment from the employee shall be tolled from the date | 22 | | that the employee files the application with the Commission | 23 | | until the date that the provider is permitted to resume | 24 | | collection efforts under the provisions of this Section. | 25 | | (e-15) When there is a dispute over the compensability of | 26 | | or amount of payment for a procedure, treatment, or service, |
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| 1 | | and a case is pending or proceeding before an Arbitrator or the | 2 | | Commission, the provider may mail the employee reminders that | 3 | | the employee will be responsible for payment of any procedure, | 4 | | treatment or service rendered by the provider. The reminders | 5 | | must state that they are not bills, to the extent practicable | 6 | | include itemized information, and state that the employee need | 7 | | not pay until such time as the provider is permitted to resume | 8 | | collection efforts under this Section. The reminders shall not | 9 | | be provided to any credit rating agency. The reminders may | 10 | | request that the employee furnish the provider with information | 11 | | about the proceeding under this Act, such as the file number, | 12 | | names of parties, and status of the case. If an employee fails | 13 | | to respond to such request for information or fails to furnish | 14 | | the information requested within 90 days of the date of the | 15 | | reminder, the provider is entitled to resume any and all | 16 | | efforts to collect payment from the employee for the services | 17 | | rendered to the employee and the employee shall be responsible | 18 | | for payment of any outstanding bills for a procedure, | 19 | | treatment, or service rendered by a provider. | 20 | | (e-20) Upon a final award or judgment by an Arbitrator or | 21 | | the Commission, or a settlement agreed to by the employer and | 22 | | the employee, a provider may resume any and all efforts to | 23 | | collect payment from the employee for the services rendered to | 24 | | the employee and the employee shall be responsible for payment | 25 | | of any outstanding bills for a procedure, treatment, or service | 26 | | rendered by a provider as well as the interest awarded under |
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| 1 | | subsection (d) of this Section. In the case of a procedure, | 2 | | treatment, or service deemed compensable, the provider shall | 3 | | not require a payment rate, excluding the interest provisions | 4 | | under subsection (d), greater than the lesser of the actual | 5 | | charge or the payment level set by the Commission in the fee | 6 | | schedule established in this Section. Payment for services | 7 | | deemed not covered or not compensable under this Act is the | 8 | | responsibility of the employee unless a provider and employee | 9 | | have agreed otherwise in writing. Services not covered or not | 10 | | compensable under this Act are not subject to the fee schedule | 11 | | in this Section. | 12 | | (f) Nothing in this Act shall prohibit an employer or
| 13 | | insurer from contracting with a health care provider or group
| 14 | | of health care providers for reimbursement levels for benefits | 15 | | under this Act different
from those provided in this Section. | 16 | | (g) On or before January 1, 2010 the Commission shall | 17 | | provide to the Governor and General Assembly a report regarding | 18 | | the implementation of the medical fee schedule and the index | 19 | | used for annual adjustment to that schedule as described in | 20 | | this Section.
| 21 | | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.) | 22 | | (820 ILCS 305/8.3)
| 23 | | Sec. 8.3. Workers' Compensation Medical Fee Advisory | 24 | | Board. There is created a Workers' Compensation Medical Fee | 25 | | Advisory Board consisting of 9 members appointed by the |
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| 1 | | Governor with the advice and consent of the Senate. Three | 2 | | members of the Advisory Board shall be representative citizens | 3 | | chosen from the employee class, 3 members shall be | 4 | | representative citizens chosen from the employing class, and 3 | 5 | | members shall be representative citizens chosen from the | 6 | | medical provider class. Each member shall serve a 4-year term | 7 | | and shall continue to serve until a successor is appointed. A | 8 | | vacancy on the Advisory Board shall be filled by the Governor | 9 | | for the unexpired term. | 10 | | Members of the Advisory Board shall receive no compensation | 11 | | for their services but shall be reimbursed for expenses | 12 | | incurred in the performance of their duties by the Commission | 13 | | from appropriations made to the Commission for that purpose. | 14 | | The Advisory Board shall advise the Commission on | 15 | | establishment of fees for medical services and accessibility of | 16 | | medical treatment. Additionally, by April 1, 2011, the Board | 17 | | shall issue a written report, to be delivered to the Chairman | 18 | | of the Commission and the General Assembly, containing (i) | 19 | | recommendations on how to streamline the process under which | 20 | | workers' compensation insurers process and issue payments and | 21 | | health care providers receive such payments and (ii) a | 22 | | recommended set of best practices for workers' compensation | 23 | | insurers to transition from a paper-based payment system to an | 24 | | electronic-based payment system.
| 25 | | (Source: P.A. 94-277, eff. 7-20-05.) |
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| 1 | | (820 ILCS 305/8.7) | 2 | | Sec. 8.7. Utilization review programs. | 3 | | (a) As used in this Section: | 4 | | "Utilization review" means the evaluation of proposed or | 5 | | provided health care services to determine the appropriateness | 6 | | of both the level of health care services medically necessary | 7 | | and the quality of health care services provided to a patient, | 8 | | including evaluation of their efficiency, efficacy, and | 9 | | appropriateness of treatment, hospitalization, or office | 10 | | visits based on medically accepted standards. The evaluation | 11 | | must be accomplished by means of a system that identifies the | 12 | | utilization of health care services based on standards of care | 13 | | of or nationally recognized peer review guidelines as well as | 14 | | nationally recognized treatment guidelines and evidence-based | 15 | | medicine evidence based upon standards as provided in this Act. | 16 | | Utilization techniques may include prospective review, second | 17 | | opinions, concurrent review, discharge planning, peer review, | 18 | | independent medical examinations, and retrospective review | 19 | | (for purposes of this sentence, retrospective review shall be | 20 | | applicable to services rendered on or after July 20, 2005). | 21 | | Nothing in this Section applies to prospective review of | 22 | | necessary first aid or emergency treatment. | 23 | | (b) No person may conduct a utilization review program for | 24 | | workers' compensation services in this State unless once every | 25 | | 2 years the person registers the utilization review program | 26 | | with the Department of Insurance Financial and Professional |
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| 1 | | Regulation and certifies compliance with the Workers' | 2 | | Compensation Utilization Management standards or Health | 3 | | Utilization Management Standards of URAC sufficient to achieve | 4 | | URAC accreditation or submits evidence of accreditation by URAC | 5 | | for its Workers' Compensation Utilization Management Standards | 6 | | or Health Utilization Management Standards. Nothing in this Act | 7 | | shall be construed to require an employer or insurer or its | 8 | | subcontractors to become URAC accredited. | 9 | | (c) In addition, the Director Secretary of Insurance | 10 | | Financial and Professional Regulation may certify alternative | 11 | | utilization review standards of national accreditation | 12 | | organizations or entities in order for plans to comply with | 13 | | this Section. Any alternative utilization review standards | 14 | | shall meet or exceed those standards required under subsection | 15 | | (b). | 16 | | (d) This registration shall include submission of all of | 17 | | the following information regarding utilization review program | 18 | | activities: | 19 | | (1) The name, address, and telephone number of the | 20 | | utilization review programs. | 21 | | (2) The organization and governing structure of the | 22 | | utilization review programs. | 23 | | (3) The number of lives for which utilization review is | 24 | | conducted by each utilization review program. | 25 | | (4) Hours of operation of each utilization review | 26 | | program. |
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| 1 | | (5) Description of the grievance process for each | 2 | | utilization review program. | 3 | | (6) Number of covered lives for which utilization | 4 | | review was conducted for the previous calendar year for | 5 | | each utilization review program. | 6 | | (7) Written policies and procedures for protecting | 7 | | confidential information according to applicable State and | 8 | | federal laws for each utilization review program. | 9 | | (e) A utilization review program shall have written | 10 | | procedures to ensure that patient-specific information | 11 | | obtained during the process of utilization review will be: | 12 | | (1) kept confidential in accordance with applicable | 13 | | State and federal laws; and | 14 | | (2) shared only with the employee, the employee's | 15 | | designee, and the employee's health care provider, and | 16 | | those who are authorized by law to receive the information. | 17 | | Summary data shall not be considered confidential if it | 18 | | does not provide information to allow identification of | 19 | | individual patients or health care providers. | 20 | | Only a health care professional may make determinations | 21 | | regarding the medical necessity of health care services during | 22 | | the course of utilization review. | 23 | | When making retrospective reviews, utilization review | 24 | | programs shall base reviews solely on the medical information | 25 | | available to the attending physician or ordering provider at | 26 | | the time the health care services were provided. |
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| 1 | | (f) If the Department of Insurance Financial and | 2 | | Professional Regulation finds that a utilization review | 3 | | program is not in compliance with this Section, the Department | 4 | | shall issue a corrective action plan and allow a reasonable | 5 | | amount of time for compliance with the plan. If the utilization | 6 | | review program does not come into compliance, the Department | 7 | | may issue a cease and desist order. Before issuing a cease and | 8 | | desist order under this Section, the Department shall provide | 9 | | the utilization review program with a written notice of the | 10 | | reasons for the order and allow a reasonable amount of time to | 11 | | supply additional information demonstrating compliance with | 12 | | the requirements of this Section and to request a hearing. The | 13 | | hearing notice shall be sent by certified mail, return receipt | 14 | | requested, and the hearing shall be conducted in accordance | 15 | | with the Illinois Administrative Procedure Act. | 16 | | (g) A utilization review program subject to a corrective | 17 | | action may continue to conduct business until a final decision | 18 | | has been issued by the Department. | 19 | | (h) The Department of Insurance Secretary of Financial and | 20 | | Professional Regulation may by rule establish a registration | 21 | | fee for each person conducting a utilization review program. | 22 | | (i) Upon receipt of written notice that the employer or the | 23 | | employer's agent or insurer wishes to invoke the utilization | 24 | | review process, the provider of medical, surgical or hospital | 25 | | services shall submit to the utilization review, following URAC | 26 | | procedural guidelines and appeal process. If the provider fails |
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| 1 | | to submit to utilization review of proposed treatment or | 2 | | services, the charges for the treatment or service shall not be | 3 | | compensable or collectible against the employer, the | 4 | | employer's agent or insurer, or the employee. When an employer | 5 | | denies payment of or refuses to authorize payment of first aid, | 6 | | medical, surgical, or hospital services under Section 8(a) of | 7 | | this Act that complies with subsection (b) of this Section, | 8 | | that denial or refusal to authorize shall create a rebuttable | 9 | | presumption that the extent and scope of medical treatment is | 10 | | excessive and unnecessary. That presumption may be rebutted by | 11 | | establishing by a preponderance of the evidence that a variance | 12 | | from the standards of care or guidelines used pursuant to | 13 | | subsection (a) of this Section is reasonably required to cure | 14 | | or relieve the employee from the effects of his or her injury | 15 | | or that the utilization review did not comply with subsection | 16 | | (b) of this Section. A utilization review will be considered by | 17 | | the Commission, along with all other evidence and in the same | 18 | | manner as all other evidence, in the determination of the | 19 | | reasonableness and necessity of the medical bills or treatment. | 20 | | Nothing in this Section shall be construed to diminish the | 21 | | rights of employees to reasonable and necessary medical | 22 | | treatment or employee choice of health care provider under | 23 | | Section 8(a) or the rights of employers to medical examinations | 24 | | under Section 12. | 25 | | (j) When an employer denies payment of or refuses to | 26 | | authorize payment of first aid, medical, surgical, or hospital |
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| 1 | | services under Section 8(a) of this Act, if that denial or | 2 | | refusal to authorize complies with a utilization review program | 3 | | registered under this Section and complies with all other | 4 | | requirements of this Section, then there shall be a rebuttable | 5 | | presumption that the employer shall not be responsible for | 6 | | payment of additional compensation pursuant to Section 19(k) of | 7 | | this Act and if that denial or refusal to authorize does not | 8 | | comply with a utilization review program registered under this | 9 | | Section and does not comply with all other requirements of this | 10 | | Section, then that will be considered by the Commission, along | 11 | | with all other evidence and in the same manner as all other | 12 | | evidence, in the determination of whether the employer may be | 13 | | responsible for the payment of additional compensation | 14 | | pursuant to Section 19(k) of this Act.
| 15 | | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
| 16 | | (820 ILCS 305/11) (from Ch. 48, par. 138.11)
| 17 | | Sec. 11. The compensation herein provided, together with | 18 | | the
provisions of this Act, shall be the measure of the | 19 | | responsibility of
any employer engaged in any of the | 20 | | enterprises or businesses enumerated
in Section 3 of this Act, | 21 | | or of any employer who is not engaged in any
such enterprises | 22 | | or businesses, but who has elected to provide and pay
| 23 | | compensation for accidental injuries sustained by any employee | 24 | | arising
out of and in the course of the employment according to | 25 | | the provisions
of this Act, and whose election to continue |
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| 1 | | under this Act, has not been
nullified by any action of his | 2 | | employees as provided for in this Act.
| 3 | | Accidental injuries incurred while participating in | 4 | | voluntary recreational
programs including but not limited to | 5 | | athletic events, parties and picnics
do not arise out of and in | 6 | | the course of the employment even though the
employer pays some | 7 | | or all of the cost thereof. This exclusion shall not apply
in | 8 | | the event that the injured employee was ordered or assigned by | 9 | | his employer
to participate in the program.
| 10 | | Accidental injuries incurred while participating as a | 11 | | patient in a drug
or alcohol rehabilitation program do not | 12 | | arise out of and in the course
of employment even though the | 13 | | employer pays some or all of the costs thereof. | 14 | | Any injury to or disease or death of an employee arising | 15 | | from the administration of a vaccine, including without | 16 | | limitation smallpox vaccine, to prepare for, or as a response | 17 | | to, a threatened or potential bioterrorist incident to the | 18 | | employee as part of a voluntary inoculation program in | 19 | | connection with the person's employment or in connection with | 20 | | any governmental program or recommendation for the inoculation | 21 | | of workers in the employee's occupation, geographical area, or | 22 | | other category that includes the employee is deemed to arise | 23 | | out of and in the course of the employment for all purposes | 24 | | under this Act. This paragraph added by this amendatory Act of | 25 | | the 93rd General Assembly is declarative of existing law and is | 26 | | not a new enactment.
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| 1 | | No compensation shall be payable if (i) the employee's | 2 | | intoxication is the proximate cause of the employee's | 3 | | accidental injury or (ii) at the time the employee incurred | 4 | | accidental injury, the employee was so intoxicated that the | 5 | | intoxication constituted a departure from the employment. | 6 | | Admissible evidence of the concentration of (1) alcohol, (2) | 7 | | cannabis as defined in the Cannabis Control Act, (3) a | 8 | | controlled substance listed in the Illinois Controlled | 9 | | Substances Act, or (4) an intoxicating compound listed in the | 10 | | Use of Intoxicating Compounds Act in the employee's blood, | 11 | | breath, or urine at the time the employee incurred the | 12 | | accidental injury shall be considered in any hearing under this | 13 | | Act to determine whether the employee was intoxicated at the | 14 | | time the employee incurred the accidental injuries. If at the | 15 | | time of the accidental injuries, there was 0.08% or more by | 16 | | weight of alcohol in the employee's blood, breath, or urine or | 17 | | if there is any evidence of impairment due to the unlawful or | 18 | | unauthorized use of (1) cannabis as defined in the Cannabis | 19 | | Control Act, (2) a controlled substance listed in the Illinois | 20 | | Controlled Substances Act, or (3) an intoxicating compound | 21 | | listed in the Use of Intoxicating Compounds Act or if the | 22 | | employee refuses to submit to testing of blood, breath, or | 23 | | urine, then there shall be a rebuttable presumption that the | 24 | | employee was intoxicated and that the intoxication was the | 25 | | proximate cause of the employee's injury. The employee may | 26 | | overcome the rebuttable presumption by the preponderance of the |
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| 1 | | admissible evidence that the intoxication was not the sole | 2 | | proximate cause or proximate cause of the accidental injuries. | 3 | | Percentage by weight of alcohol in the blood shall be based on | 4 | | grams of alcohol per 100 milliliters of blood. Percentage by | 5 | | weight of alcohol in the breath shall be based upon grams of | 6 | | alcohol per 210 liters of breath. Any testing that has not been | 7 | | performed by an accredited or certified testing laboratory | 8 | | shall not be admissible in any hearing under this Act to | 9 | | determine whether the employee was intoxicated at the time the | 10 | | employee incurred the accidental injury. | 11 | | All sample collection and testing for alcohol and drugs | 12 | | under this Section shall be performed in accordance with rules | 13 | | to be adopted by the Commission. These rules shall ensure: | 14 | | (1) compliance with the National Labor Relations Act | 15 | | regarding collective bargaining agreements or regulations | 16 | | promulgated by the United States Department of | 17 | | Transportation; | 18 | | (2) that samples are collected and tested in | 19 | | conformance with national and State legal and regulatory | 20 | | standards for the privacy of the individual being tested, | 21 | | and in a manner reasonably calculated to prevent | 22 | | substitutions or interference with the collection or | 23 | | testing of reliable sample; | 24 | | (3) that split testing procedures are utilized; | 25 | | (4) sample collection is documented, and the | 26 | | documentation procedures include: |
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| 1 | | (A) the labeling of samples in a manner so as to | 2 | | reasonably preclude the probability of erroneous | 3 | | identification of test result; and | 4 | | (B) an opportunity for the employee to provide | 5 | | notification of any information which he or she | 6 | | considers relevant to the test, including | 7 | | identification of currently or recently used | 8 | | prescription or nonprescription drugs and other | 9 | | relevant medical information; | 10 | | (5) that sample collection, storage, and | 11 | | transportation to the place of testing is performed in a | 12 | | manner so as to reasonably preclude the probability of | 13 | | sample contamination or adulteration; and | 14 | | (6) that chemical analyses of blood, urine, breath, or | 15 | | other bodily substance are performed according to | 16 | | nationally scientifically accepted analytical methods and | 17 | | procedures. | 18 | | (Source: P.A. 93-829, eff. 7-28-04.)
| 19 | | (820 ILCS 305/14) (from Ch. 48, par. 138.14)
| 20 | | Sec. 14. The Commission shall appoint a secretary, an | 21 | | assistant
secretary, and arbitrators and shall employ such
| 22 | | assistants and clerical help as may be necessary.
| 23 | | Each arbitrator appointed after November 22, 1977 shall be | 24 | | required
to demonstrate in writing and in accordance with
the | 25 | | rules and regulations of the Illinois Department of Central |
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| 1 | | Management
Services his or
her knowledge of and expertise in | 2 | | the law of and judicial processes of
the Workers' Compensation | 3 | | Act and the Occupational Diseases Act.
| 4 | | A formal training program for newly-hired arbitrators | 5 | | shall be
implemented. The training program shall include the | 6 | | following:
| 7 | | (a) substantive and procedural aspects of the | 8 | | arbitrator position;
| 9 | | (b) current issues in workers' compensation law and | 10 | | practice;
| 11 | | (c) medical lectures by specialists in areas such as | 12 | | orthopedics,
ophthalmology, psychiatry, rehabilitation | 13 | | counseling;
| 14 | | (d) orientation to each operational unit of the | 15 | | Illinois Workers' Compensation Commission;
| 16 | | (e) observation of experienced arbitrators conducting | 17 | | hearings of cases,
combined with the opportunity to discuss | 18 | | evidence presented and rulings made;
| 19 | | (f) the use of hypothetical cases requiring the trainee | 20 | | to issue
judgments as a means to evaluating knowledge and | 21 | | writing ability;
| 22 | | (g) writing skills.
| 23 | | A formal and ongoing professional development program | 24 | | including, but not
limited to, the above-noted areas shall be | 25 | | implemented to keep arbitrators
informed of recent | 26 | | developments and issues and to assist them in
maintaining and |
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| 1 | | enhancing their professional competence.
| 2 | | Each
arbitrator shall devote full time to his or her duties | 3 | | and shall serve when
assigned as
an acting Commissioner when a | 4 | | Commissioner is unavailable in accordance
with the provisions | 5 | | of Section 13 of this Act. Any
arbitrator who is an | 6 | | attorney-at-law shall not engage in the practice of
law, nor | 7 | | shall any arbitrator hold any other office or position of
| 8 | | profit under the United States or this State or any municipal
| 9 | | corporation or political subdivision of this State.
| 10 | | Notwithstanding any other provision of this Act to the | 11 | | contrary, an arbitrator
who serves as an acting Commissioner in | 12 | | accordance with the provisions of
Section 13 of this Act shall | 13 | | continue to serve in the capacity of Commissioner
until a | 14 | | decision is reached in every case heard by that arbitrator | 15 | | while
serving as an acting Commissioner.
| 16 | | Each arbitrator appointed after the effective date of this | 17 | | amendatory
Act of 1989 shall be appointed for a term of 6 | 18 | | years. Each arbitrator
shall be appointed for a subsequent term | 19 | | unless the Chairman makes a
recommendation to the Commission, | 20 | | no later than 60 days prior to the
expiration of the term, not | 21 | | to reappoint the arbitrator. Notice of such a
recommendation | 22 | | shall also be given to the arbitrator no later than 60 days
| 23 | | prior to the expiration of the term. Upon
such recommendation | 24 | | by the Chairman, the arbitrator shall be appointed for
a | 25 | | subsequent term unless 8 of 10 members of the Commission, | 26 | | including the
Chairman, vote not to reappoint the arbitrator.
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| 1 | | Each arbitrator appointed to a first term on or after the | 2 | | effective date of this amendatory Act of the 96th General | 3 | | Assembly shall be required to be authorized to practice law in | 4 | | this State by the Supreme Court. | 5 | | All arbitrators shall be subject to the provisions of the | 6 | | Personnel Code,
and the performance of all arbitrators shall be | 7 | | reviewed by the Chairman on
an annual basis. The Chairman shall | 8 | | allow input from the Commissioners in
all such reviews.
| 9 | | The Secretary and each arbitrator shall receive a per annum | 10 | | salary of
$4,000 less than the per annum salary of members of | 11 | | The
Illinois Workers' Compensation Commission as
provided in | 12 | | Section 13 of this Act, payable in equal monthly installments.
| 13 | | The members of the Commission, Arbitrators and other | 14 | | employees whose
duties require them to travel, shall have | 15 | | reimbursed to them their
actual traveling expenses and | 16 | | disbursements made or incurred by them in
the discharge of | 17 | | their official duties while away from their place of
residence | 18 | | in the performance of their duties.
| 19 | | The Commission shall provide itself with a seal for the
| 20 | | authentication of its orders, awards and proceedings upon which | 21 | | shall be
inscribed the name of the Commission and the words | 22 | | "Illinois--Seal".
| 23 | | The Secretary or Assistant Secretary, under the direction | 24 | | of the
Commission, shall have charge and custody of the seal of | 25 | | the Commission
and also have charge and custody of all records, | 26 | | files, orders,
proceedings, decisions, awards and other |
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| 1 | | documents on file with the
Commission. He shall furnish | 2 | | certified copies, under the seal of the
Commission, of any such | 3 | | records, files, orders, proceedings, decisions,
awards and | 4 | | other documents on file with the Commission as may be
required. | 5 | | Certified copies so furnished by the Secretary or Assistant
| 6 | | Secretary shall be received in evidence before the Commission | 7 | | or any
Arbitrator thereof, and in all courts, provided that the | 8 | | original of
such certified copy is otherwise competent and | 9 | | admissible in evidence.
The Secretary or Assistant Secretary | 10 | | shall perform such other duties as
may be prescribed from time | 11 | | to time by the Commission.
| 12 | | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| 13 | | (820 ILCS 305/16b new) | 14 | | Sec. 16b. Signature constitutes certification. The | 15 | | signature of a petitioner or respondent or his, her, or its | 16 | | attorney or group of attorneys on any petition, motion, or | 17 | | other paper filed with the Commission constitutes a | 18 | | certification by him, her, or it that he, she, or it has read | 19 | | the petition, motion, or other paper, and, that to the best of | 20 | | his, her, or its knowledge, information, and belief formed | 21 | | after reasonable inquiry that it is well grounded in fact, that | 22 | | it is warranted by existing law or a good faith argument for an | 23 | | extension, modification, or reversal of existing law, and that | 24 | | it is not interposed for any improper purpose, such as to | 25 | | harass or to cause unnecessary delay or needless increase in |
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| 1 | | the cost of litigation. If a petition, motion, or other paper | 2 | | is signed in violation of this Section, the Commission, upon | 3 | | motion or upon its own initiative, may impose upon the | 4 | | petitioner or respondent or his, her, or its attorney or group | 5 | | of attorneys an appropriate penalty or may order him, her, or | 6 | | it to pay the other party the amount of reasonable expenses | 7 | | incurred because of the filing of the petition, motion, or | 8 | | other paper, including reasonable attorneys' fees. | 9 | | (820 ILCS 305/25.5)
| 10 | | Sec. 25.5. Unlawful acts; penalties. | 11 | | (a) It is unlawful for any person, company, corporation, | 12 | | insurance carrier, healthcare provider, or other entity to: | 13 | | (1) Intentionally present or cause to be presented any | 14 | | false or
fraudulent claim for the payment of any workers' | 15 | | compensation
benefit.
| 16 | | (2) Intentionally make or cause to be made any false or
| 17 | | fraudulent material statement or material representation | 18 | | for the
purpose of obtaining or denying any workers' | 19 | | compensation
benefit.
| 20 | | (3) Intentionally make or cause to be made any false or
| 21 | | fraudulent statements with regard to entitlement to | 22 | | workers'
compensation benefits with the intent to prevent | 23 | | an injured
worker from making a legitimate claim for any | 24 | | workers'
compensation benefits.
| 25 | | (4) Intentionally prepare or provide an invalid, |
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| 1 | | false, or
counterfeit certificate of insurance as proof of | 2 | | workers'
compensation insurance.
| 3 | | (5) Intentionally make or cause to be made any false or
| 4 | | fraudulent material statement or material representation | 5 | | for the
purpose of obtaining workers' compensation | 6 | | insurance at less
than the proper rate for that insurance.
| 7 | | (6) Intentionally make or cause to be made any false or
| 8 | | fraudulent material statement or material representation | 9 | | on an
initial or renewal self-insurance application or | 10 | | accompanying
financial statement for the purpose of | 11 | | obtaining self-insurance
status or reducing the amount of | 12 | | security that may be required
to be furnished pursuant to | 13 | | Section 4 of this Act.
| 14 | | (7) Intentionally make or cause to be made any false or
| 15 | | fraudulent material statement to the Department Division | 16 | | of Insurance's
fraud and insurance non-compliance unit in | 17 | | the course of an
investigation of fraud or insurance | 18 | | non-compliance.
| 19 | | (8) Intentionally assist, abet, solicit, or conspire | 20 | | with any
person, company, or other entity to commit any of | 21 | | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | 22 | | of this subsection (a).
| 23 | | For the purposes of paragraphs (2), (3), (5), (6), and (7), | 24 | | the term "statement" includes any writing, notice, proof of | 25 | | injury, bill for services, hospital or doctor records and | 26 | | reports, or X-ray and test results.
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| 1 | | (b) Any person violating subsection (a) is guilty of a | 2 | | Class 4 felony. Any person or entity convicted of any violation | 3 | | of this Section shall be ordered to pay complete restitution to | 4 | | any person or entity so defrauded in addition to any fine or | 5 | | sentence imposed as a result of the conviction.
| 6 | | (c) The Department Division of Insurance of the Department | 7 | | of Financial and Professional Regulation shall establish a | 8 | | fraud and insurance non-compliance unit responsible for | 9 | | investigating incidences of fraud and insurance non-compliance | 10 | | pursuant to this Section. The size of the staff of the unit | 11 | | shall be subject to appropriation by the General Assembly. It | 12 | | shall be the duty of the fraud and insurance non-compliance | 13 | | unit to determine the identity of insurance carriers, | 14 | | employers, employees, or other persons or entities who have | 15 | | violated the fraud and insurance non-compliance provisions of | 16 | | this Section. The fraud and insurance non-compliance unit shall | 17 | | report violations of the fraud and insurance non-compliance | 18 | | provisions of this Section to the Special Prosecutions Bureau | 19 | | of the Criminal Division of the Office of the Attorney General | 20 | | or to the State's Attorney of the county in which the offense | 21 | | allegedly occurred, either of whom has the authority to | 22 | | prosecute violations under this Section.
| 23 | | With respect to the subject of any investigation being | 24 | | conducted, the fraud and insurance non-compliance unit shall | 25 | | have the general power of subpoena of the Department Division | 26 | | of Insurance.
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| 1 | | (d) Any person may report allegations of insurance | 2 | | non-compliance and fraud pursuant to this Section to the | 3 | | Department Division of Insurance's fraud and insurance | 4 | | non-compliance unit whose duty it shall be to investigate the | 5 | | report. The unit shall notify the Commission of reports of | 6 | | insurance non-compliance. Any person reporting an allegation | 7 | | of insurance non-compliance or fraud against either an employee | 8 | | or employer under this Section must identify himself. Except as | 9 | | provided in this subsection and in subsection (e), all reports | 10 | | shall remain confidential except to refer an investigation to | 11 | | the Attorney General or State's Attorney for prosecution or if | 12 | | the fraud and insurance non-compliance unit's investigation | 13 | | reveals that the conduct reported may be in violation of other | 14 | | laws or regulations of the State of Illinois, the unit may | 15 | | report such conduct to the appropriate governmental agency | 16 | | charged with administering such laws and regulations. Any | 17 | | person who intentionally makes a false report under this | 18 | | Section to the fraud and insurance non-compliance unit is | 19 | | guilty of a Class A misdemeanor.
| 20 | | (e) In order for the fraud and insurance non-compliance | 21 | | unit to investigate a report of fraud by an employee, (i) the | 22 | | employee must have filed with the Commission an Application for | 23 | | Adjustment of Claim and the employee must have either received | 24 | | or attempted to receive benefits under this Act that are | 25 | | related to the reported fraud or (ii) the employee must have | 26 | | made a written demand for the payment of benefits that are |
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| 1 | | related to the reported fraud. Upon receipt of a report of | 2 | | fraud, the employee or employer shall receive immediate notice | 3 | | of the reported conduct, including the verified name and | 4 | | address of the complainant if that complainant is connected to | 5 | | the case and the nature of the reported conduct. The fraud and | 6 | | insurance non-compliance unit shall resolve all reports of | 7 | | fraud against employees or employers within 120 days of receipt | 8 | | of the report. There shall be no immunity, under this Act or | 9 | | otherwise, for any person who files a false report or who files | 10 | | a report without good and just cause. Confidentiality of | 11 | | medical information shall be strictly maintained. | 12 | | Investigations that are not referred for prosecution shall be | 13 | | immediately expunged and shall not be disclosed except that the | 14 | | employee or employer who was the subject of the report and the | 15 | | person making the report shall be notified that the | 16 | | investigation is being closed, at which time the name of any | 17 | | complainant not connected to the case shall be disclosed to the | 18 | | employee or the employer. It is unlawful for any employer, | 19 | | insurance carrier, or service adjustment company to file or | 20 | | threaten to file a report of fraud against an employee because | 21 | | of the exercise by the employee of the rights and remedies | 22 | | granted to the employee by this Act.
| 23 | | For purposes of this subsection (e), "employer" means any | 24 | | employer, insurance carrier, third party administrator, | 25 | | self-insured, or similar entity.
| 26 | | For purposes of this subsection (e), "complainant" refers |
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| 1 | | to the person contacting the fraud and insurance non-compliance | 2 | | unit to initiate the complaint.
| 3 | | (e-5) The fraud and insurance non-compliance unit shall | 4 | | procure and implement a system utilizing advanced analytics | 5 | | inclusive of predictive modeling, data mining, social network | 6 | | analysis, and scoring algorithms for the detection and | 7 | | prevention of fraud, waste, and abuse on or before July 1, | 8 | | 2011. The fraud and insurance non-compliance unit shall procure | 9 | | this system using a request for proposals process governed by | 10 | | the Illinois Procurement Code and rules adopted under that | 11 | | Code. The fraud and insurance non-compliance unit shall provide | 12 | | a report to the President of the Senate, Speaker of the House | 13 | | of Representatives, Minority Leader of the House of | 14 | | Representatives, Minority Leader of the Senate, Governor, and | 15 | | Director of Insurance on or before July 1, 2012 and annually | 16 | | thereafter detailing its activities and providing | 17 | | recommendations regarding opportunities for additional fraud | 18 | | waste and abuse detection and prevention. | 19 | | (f) Any person convicted of fraud related to workers' | 20 | | compensation pursuant to this Section shall be subject to the | 21 | | penalties prescribed in the Criminal Code of 1961 and shall be | 22 | | ineligible to receive or retain any compensation, disability, | 23 | | or medical benefits as defined in this Act if the compensation, | 24 | | disability, or medical benefits were owed or received as a | 25 | | result of fraud for which the recipient of the compensation, | 26 | | disability, or medical benefit was convicted. This subsection |
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| 1 | | applies to accidental injuries or diseases that occur on or | 2 | | after the effective date of this amendatory Act of the 94th | 3 | | General Assembly.
| 4 | | (g) Civil liability. Any person convicted of fraud who | 5 | | knowingly obtains, attempts to obtain, or causes to be obtained | 6 | | any benefits under this Act by the making of a false claim or | 7 | | who knowingly misrepresents any material fact shall be civilly | 8 | | liable to the payor of benefits or the insurer or the payor's | 9 | | or insurer's subrogee or assignee in an amount equal to 3 times | 10 | | the value of the benefits or insurance coverage wrongfully | 11 | | obtained or twice the value of the benefits or insurance | 12 | | coverage attempted to be obtained, plus reasonable attorney's | 13 | | fees and expenses incurred by the payor or the payor's subrogee | 14 | | or assignee who successfully brings a claim under this | 15 | | subsection. This subsection applies to accidental injuries or | 16 | | diseases that occur on or after the effective date of this | 17 | | amendatory Act of the 94th General Assembly.
| 18 | | (h) The All proceedings under this Section shall be | 19 | | reported by the fraud and insurance non-compliance unit shall | 20 | | submit a written report on an annual basis to the Workers' | 21 | | Compensation Advisory Board , the General Assembly, the | 22 | | Governor, and the Attorney General by January 1st and July 1st | 23 | | of each year. This report shall include, at the minimum, the | 24 | | following information: | 25 | | (1) The number of allegations of insurance | 26 | | non-compliance and fraud reported to the fraud and |
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| 1 | | insurance non-compliance unit. | 2 | | (2) The source of the reported allegations | 3 | | (individual, employer, or other). | 4 | | (3) The number of allegations investigated by the fraud | 5 | | and insurance non-compliance unit. | 6 | | (4) The number of criminal referrals made in accordance | 7 | | with this Section and the entity to which the referral was | 8 | | made. | 9 | | (5) All proceedings under this Section .
| 10 | | (Source: P.A. 94-277, eff. 7-20-05.) | 11 | | (820 ILCS 305/29.1 new) | 12 | | Sec. 29.1. Recalculation of premiums. On the effective date | 13 | | of this amendatory Act of the 96th General Assembly, the | 14 | | Director of Insurance shall immediately direct in writing any | 15 | | workers' compensation rate setting advisory organization to | 16 | | recalculate workers' compensation advisory premium rates and | 17 | | assigned risk pool premium rates so that those premiums | 18 | | incorporate the provisions of this amendatory Act of the 96th | 19 | | General Assembly. | 20 | | (820 ILCS 305/29.2 new) | 21 | | Sec. 29.2. Insurance oversight. The Department of | 22 | | Insurance shall annually submit to the Governor, the President | 23 | | of the Senate, the Speaker of the House of Representatives, the | 24 | | Minority Leader of the Senate, and the Minority Leader of the |
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| 1 | | House of Representatives a written report that details the | 2 | | state of the workers' compensation insurance market in | 3 | | Illinois. The report shall be completed by April 1 of each | 4 | | year, beginning in 2012, or later if necessary data or analyses | 5 | | are only available to the Department at a later date. The | 6 | | report shall be posted on the Department of Insurance's | 7 | | Internet website. Information to be included in the report | 8 | | shall be for the preceding calendar year. The report shall | 9 | | include, at a minimum, the following: | 10 | | (1) Gross premiums collected by workers' compensation | 11 | | carriers in Illinois and the national rank of Illinois | 12 | | based on premium volume. | 13 | | (2) The number of insurance companies actively engaged | 14 | | in Illinois in the workers' compensation insurance market, | 15 | | including both holding companies and subsidiaries or | 16 | | affiliates, and the national rank of Illinois based on | 17 | | number of competing insurers. | 18 | | (3) The total number of insured participants in the | 19 | | Illinois workers' compensation assigned risk insurance | 20 | | pool, and the size of the assigned risk pool as a | 21 | | proportion of the total Illinois workers' compensation | 22 | | insurance market. | 23 | | (4) The advisory organization premium rate for | 24 | | workers' compensation insurance in Illinois for the | 25 | | previous year. | 26 | | (5) The advisory organization prescribed assigned risk |
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| 1 | | pool premium rate. | 2 | | (6) The total amount of indemnity payments made by | 3 | | workers' compensation insurers in Illinois. | 4 | | (7) The total amount of medical payments made by | 5 | | workers' compensation insurers in Illinois, and the | 6 | | national rank of Illinois based on average cost of medical | 7 | | claims per injured worker. | 8 | | (8) The gross profitability of workers' compensation | 9 | | insurers in Illinois, and the national rank of Illinois | 10 | | based on profitability of workers' compensation insurers. | 11 | | (9) The loss ratio of workers' compensation insurers in | 12 | | Illinois and the national rank of Illinois based on the | 13 | | loss ratio of workers' compensation insurers. For purposes | 14 | | of this loss ratio calculation, the denominator shall | 15 | | include all premiums and other fees collected by workers' | 16 | | compensation insurers and the numerator shall include the | 17 | | total amount paid by the insurer for care or compensation | 18 | | to injured workers.
| 19 | | Section 99. Effective date. This Act takes effect upon | 20 | | becoming law.".
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