Illinois General Assembly - Full Text of SB0162
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Full Text of SB0162  99th General Assembly

SB0162sam001 99TH GENERAL ASSEMBLY

Sen. Kwame Raoul

Filed: 8/4/2015

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 162

2    AMENDMENT NO. ______. Amend Senate Bill 162 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Workers' Compensation Act is amended by
5changing Sections 1, 8.1b, 8.2a, 14, and 25.5 and by adding
6Sections 14.2, 14.3, and 14.4 as follows:
 
7    (820 ILCS 305/1)  (from Ch. 48, par. 138.1)
8    Sec. 1. This Act may be cited as the Workers' Compensation
9Act.
10    (a) The term "employer" as used in this Act means:
11    1. The State and each county, city, town, township,
12incorporated village, school district, body politic, or
13municipal corporation therein.
14    2. Every person, firm, public or private corporation,
15including hospitals, public service, eleemosynary, religious
16or charitable corporations or associations who has any person

 

 

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

 

 

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

 

 

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

 

 

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1members of the General Assembly, members of the Commerce
2Commission, members of the Illinois Workers' Compensation
3Commission, and all persons in the service of the University of
4Illinois, county, including deputy sheriffs and assistant
5state's attorneys, city, town, township, incorporated village
6or school district, body politic, or municipal corporation
7therein, whether by election, under appointment or contract of
8hire, express or implied, oral or written, including all
9members of the Illinois National Guard while on active duty in
10the service of the State, and all probation personnel of the
11Juvenile Court appointed pursuant to Article VI of the Juvenile
12Court Act of 1987, and including any official of the State, any
13county, city, town, township, incorporated village, school
14district, body politic or municipal corporation therein except
15any duly appointed member of a police department in any city
16whose population exceeds 500,000 according to the last Federal
17or State census, and except any member of a fire insurance
18patrol maintained by a board of underwriters in this State. A
19duly appointed member of a fire department in any city, the
20population of which exceeds 500,000 according to the last
21federal or State census, is an employee under this Act only
22with respect to claims brought under paragraph (c) of Section
238.
24    One employed by a contractor who has contracted with the
25State, or a county, city, town, township, incorporated village,
26school district, body politic or municipal corporation

 

 

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

 

 

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1    However, any employer may elect to provide and pay
2compensation to any employee other than those engaged in the
3usual course of the trade, business, profession or occupation
4of the employer by complying with Sections 2 and 4 of this Act.
5Employees are not included within the provisions of this Act
6when excluded by the laws of the United States relating to
7liability of employers to their employees for personal injuries
8where such laws are held to be exclusive.
9    The term "employee" does not include persons performing
10services as real estate broker, broker-salesman, or salesman
11when such persons are paid by commission only.
12    (c) "Commission" means the Industrial Commission created
13by Section 5 of "The Civil Administrative Code of Illinois",
14approved March 7, 1917, as amended, or the Illinois Workers'
15Compensation Commission created by Section 13 of this Act.
16    (d) For the purposes of this subsection (d):
17    "In the course of employment" means the time, place, and
18circumstances surrounding the accidental injuries.
19    "Arising out of the employment" means causal connection. It
20must be shown that the injury had its origin in some risk
21connected with, or incidental to, the employment so as to
22create a causal connection between the employment and the
23accidental injuries. An injury arises out of the employment if,
24at the time of the occurrence, the employee was performing acts
25he or she was instructed to perform by his or her employer,
26acts which he or she had a common law or statutory duty to

 

 

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1perform, or acts which the employee might reasonably be
2expected to perform incident to his or her assigned duties. A
3risk is incidental to the employment where it belongs to or is
4connected with what an employee has to do in fulfilling his or
5her duties.
6    To obtain compensation under this Act, an employee bears
7the burden of showing, by a preponderance of the evidence, that
8he or she has sustained accidental injuries arising out of and
9in the course of the employment. Except as provided in
10subsection (e) of this Section, accidental injuries sustained
11while traveling to or from work do not arise out of and in the
12course of employment.
13    (e) Where an employee is required to travel away from his
14or her employer's premises in order to perform his or her job,
15the traveling employee's accidental injuries arise out of his
16or her employment, and are in the course of his or her
17employment, when the conduct in which he or she was engaged at
18the time of the injury is reasonable and when that conduct
19might have been anticipated or foreseen by the employer.
20Accidental injuries while traveling do not occur in the course
21of employment if the accident occurs during a purely personal
22deviation or personal errand unless such deviation or errand is
23insubstantial.
24    In determining whether an employee is required to travel
25away from his or her employer's premises in order to perform
26his or her job, along with all other relevant factors, the

 

 

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1following factors may be considered: whether the employer had
2knowledge that the employee may be required to travel to
3perform the job; whether the employer furnished any mode of
4transportation to or from the employee; whether the employee
5received or the employer paid or agreed to pay any remuneration
6or reimbursement for costs or expenses of any form of travel;
7whether the employer in any way directed the course or method
8of travel; whether the employer in any way assisted the
9employee in making any travel arrangements; whether the
10employer furnished lodging or in any way reimbursed the
11employee for lodging; or whether the employer received any
12benefit from the employee traveling.
13(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
14eff. 7-13-12.)
 
15    (820 ILCS 305/8.1b)
16    Sec. 8.1b. Determination of permanent partial disability.
17For accidental injuries that occur on or after September 1,
182011, permanent partial disability shall be established using
19the following criteria:
20    (a) A physician licensed to practice medicine in all of its
21branches preparing a permanent partial disability impairment
22report shall report the level of impairment in writing. The
23report shall include an evaluation of medically defined and
24professionally appropriate measurements of impairment that
25include, but are not limited to: loss of range of motion; loss

 

 

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1of strength; measured atrophy of tissue mass consistent with
2the injury; and any other measurements that establish the
3nature and extent of the impairment. The most current edition
4of the American Medical Association's "Guides to the Evaluation
5of Permanent Impairment" shall be used by the physician in
6determining the level of impairment.
7    (b) In determining the level of permanent partial
8disability, the Commission shall base its determination on the
9following factors: (i) the reported level of impairment
10pursuant to subsection (a), if such report exists; (ii) the
11occupation of the injured employee; (iii) the age of the
12employee at the time of the injury; (iv) the employee's future
13earning capacity; and (v) evidence of disability corroborated
14by the treating medical records or examination under Section 12
15of this Act. No single enumerated factor shall be the sole
16determinant of disability. In determining the level of
17disability, the relevance and weight of any factors used in
18addition to the level of impairment as reported by the
19physician must be explained in a written order.
20    (c) A report of impairment prepared pursuant to subsection
21(a) is not required for an arbitrator or the Commission to make
22an award for permanent partial disability or permanent total
23disability benefits or any award for benefits under subsection
24(c) of Section 8 or subsection (d) of Section 8 of this Act or
25to approve a Settlement Contract Lump Sum Petition.
26(Source: P.A. 97-18, eff. 6-28-11.)
 

 

 

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1    (820 ILCS 305/8.2a)
2    Sec. 8.2a. Electronic claims.
3    (a) The Director of Insurance shall adopt rules to do all
4of the following:
5        (1) Ensure that all health care providers and
6    facilities submit medical bills for payment on
7    standardized forms.
8        (2) Require acceptance by employers and insurers of
9    electronic claims for payment of medical services.
10        (3) Ensure confidentiality of medical information
11    submitted on electronic claims for payment of medical
12    services.
13        (4) Ensure that the rules establishing electronic
14    claims include a specific enforcement mechanism to ensure
15    compliance with these rules.
16        (5) Ensure that health care providers have at least 15
17    business days to comply with records requested by employers
18    and insurers for the authorization of the payment of
19    workers' compensation claims.
20        (6) Ensure that health care providers are responsible
21    for supplying only those medical records pertaining to the
22    provider's own claims that are minimally necessary under
23    the federal Health Insurance Portability and
24    Accountability Act of 1996.
25    (b) To the extent feasible, standards adopted pursuant to

 

 

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1subdivision (a) shall be consistent with existing standards
2under the federal Health Insurance Portability and
3Accountability Act of 1996 and standards adopted under the
4Illinois Health Information Exchange and Technology Act.
5    (c) The rules requiring employers and insurers to accept
6electronic claims for payment of medical services shall be
7proposed on or before May 31, 2016, January 1, 2012, and shall
8require all employers and insurers to accept electronic claims
9for payment of medical services on or before January 1, 2017
10June 30, 2012.
11    (d) The Director of Insurance shall by rule establish
12criteria for granting exceptions to employers, insurance
13carriers, and health care providers who are unable to submit or
14accept medical bills electronically.
15(Source: P.A. 97-18, eff. 6-28-11.)
 
16    (820 ILCS 305/14)  (from Ch. 48, par. 138.14)
17    Sec. 14. The Commission shall appoint a secretary, an
18assistant secretary, and arbitrators and shall employ such
19assistants and clerical help as may be necessary. Arbitrators
20shall be appointed pursuant to this Section, notwithstanding
21any provision of the Personnel Code.
22    Each arbitrator appointed after June 28, 2011 shall be
23required to demonstrate in writing his or her knowledge of and
24expertise in the law of and judicial processes of the Workers'
25Compensation Act and the Occupational Diseases Act.

 

 

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1    A formal training program for newly-hired arbitrators
2shall be implemented. The training program shall include the
3following:
4        (a) substantive and procedural aspects of the
5    arbitrator position;
6        (b) current issues in workers' compensation law and
7    practice;
8        (c) medical lectures by specialists in areas such as
9    orthopedics, ophthalmology, psychiatry, rehabilitation
10    counseling;
11        (d) orientation to each operational unit of the
12    Illinois Workers' Compensation Commission;
13        (e) observation of experienced arbitrators conducting
14    hearings of cases, combined with the opportunity to discuss
15    evidence presented and rulings made;
16        (f) the use of hypothetical cases requiring the trainee
17    to issue judgments as a means to evaluating knowledge and
18    writing ability;
19        (g) writing skills;
20        (h) professional and ethical standards pursuant to
21    Section 1.1 of this Act;
22        (i) detection of workers' compensation fraud and
23    reporting obligations of Commission employees and
24    appointees;
25        (j) standards of evidence-based medical treatment and
26    best practices for measuring and improving quality and

 

 

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1    health care outcomes in the workers' compensation system,
2    including but not limited to the use of the American
3    Medical Association's "Guides to the Evaluation of
4    Permanent Impairment" and the practice of utilization
5    review; and
6        (k) substantive and procedural aspects of coal
7    workers' pneumoconiosis (black lung) cases.
8    A formal and ongoing professional development program
9including, but not limited to, the above-noted areas shall be
10implemented to keep arbitrators informed of recent
11developments and issues and to assist them in maintaining and
12enhancing their professional competence. Each arbitrator shall
13complete 20 hours of training in the above-noted areas during
14every 2 years such arbitrator shall remain in office.
15    Each arbitrator shall devote full time to his or her duties
16and shall serve when assigned as an acting Commissioner when a
17Commissioner is unavailable in accordance with the provisions
18of Section 13 of this Act. Any arbitrator who is an
19attorney-at-law shall not engage in the practice of law, nor
20shall any arbitrator hold any other office or position of
21profit under the United States or this State or any municipal
22corporation or political subdivision of this State.
23Notwithstanding any other provision of this Act to the
24contrary, an arbitrator who serves as an acting Commissioner in
25accordance with the provisions of Section 13 of this Act shall
26continue to serve in the capacity of Commissioner until a

 

 

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1decision is reached in every case heard by that arbitrator
2while serving as an acting Commissioner.
3    Notwithstanding any other provision of this Section, the
4term of all arbitrators serving on the effective date of this
5amendatory Act of the 97th General Assembly, including any
6arbitrators on administrative leave, shall terminate at the
7close of business on July 1, 2011, but the incumbents shall
8continue to exercise all of their duties until they are
9reappointed or their successors are appointed.
10    On and after the effective date of this amendatory Act of
11the 97th General Assembly, arbitrators shall be appointed to
123-year terms as follows:
13        (1) All appointments shall be made by the Governor with
14    the advice and consent of the Senate.
15        (2) For their initial appointments, 12 arbitrators
16    shall be appointed to terms expiring July 1, 2012; 12
17    arbitrators shall be appointed to terms expiring July 1,
18    2013; and all additional arbitrators shall be appointed to
19    terms expiring July 1, 2014. Thereafter, all arbitrators
20    shall be appointed to 3-year terms.
21    Upon the expiration of a term, the Chairman shall evaluate
22the performance of the arbitrator and may recommend to the
23Governor that he or she be reappointed to a second or
24subsequent term by the Governor with the advice and consent of
25the Senate.
26    Each arbitrator appointed on or after the effective date of

 

 

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1this amendatory Act of the 97th General Assembly and who has
2not previously served as an arbitrator for the Commission shall
3be required to be authorized to practice law in this State by
4the Supreme Court, and to maintain this authorization
5throughout his or her term of employment.
6    The performance of all arbitrators shall be reviewed by the
7Chairman on an annual basis. The Chairman shall allow input
8from the Commissioners in all such reviews.
9    The Commission shall assign no fewer than 3 arbitrators to
10each hearing site. The Commission shall establish a procedure
11to ensure that the arbitrators assigned to each hearing site
12are assigned cases on a random basis. The Chairperson of the
13Commission shall have discretion to assign and reassign
14arbitrators to each hearing site as needed. No arbitrator shall
15hear cases in any county, other than Cook County, for more than
162 years in each 3-year term.
17    The Secretary and each arbitrator shall receive a per annum
18salary of $4,000 less than the per annum salary of members of
19The Illinois Workers' Compensation Commission as provided in
20Section 13 of this Act, payable in equal monthly installments.
21    The members of the Commission, Arbitrators and other
22employees whose duties require them to travel, shall have
23reimbursed to them their actual traveling expenses and
24disbursements made or incurred by them in the discharge of
25their official duties while away from their place of residence
26in the performance of their duties.

 

 

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1    The Commission shall provide itself with a seal for the
2authentication of its orders, awards and proceedings upon which
3shall be inscribed the name of the Commission and the words
4"Illinois--Seal".
5    The Secretary or Assistant Secretary, under the direction
6of the Commission, shall have charge and custody of the seal of
7the Commission and also have charge and custody of all records,
8files, orders, proceedings, decisions, awards and other
9documents on file with the Commission. He shall furnish
10certified copies, under the seal of the Commission, of any such
11records, files, orders, proceedings, decisions, awards and
12other documents on file with the Commission as may be required.
13Certified copies so furnished by the Secretary or Assistant
14Secretary shall be received in evidence before the Commission
15or any Arbitrator thereof, and in all courts, provided that the
16original of such certified copy is otherwise competent and
17admissible in evidence. The Secretary or Assistant Secretary
18shall perform such other duties as may be prescribed from time
19to time by the Commission.
20(Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40,
21eff. 6-28-13.)
 
22    (820 ILCS 305/14.2 new)
23    Sec. 14.2. Ombudsman Program.
24    (a) The Commission shall establish the Workers'
25Compensation Ombudsman Program as an office within the Illinois

 

 

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1Workers' Compensation Commission no later than July 1, 2016.
2The Ombudsman Program shall be composed of at least one
3full-time ombudsman who shall develop a plan to provide
4assistance to all regions of this State. One full-time
5Ombudsman shall be designated as the Chief Ombudsman and the
6Chief Ombudsman shall be an attorney licensed to practice law
7in the State of Illinois and shall have demonstrated experience
8in Illinois workers' compensation law. The Ombudsman Program
9shall be staffed with personnel who are trained in techniques
10performed by ombudsmen and who are familiar with the provisions
11of this Act and its rules, vocational rehabilitation
12principles, the obligations of medical providers under this
13Act, the provisions of the Medical Fee Schedule, an employer's
14responsibility to maintain workers' compensation insurance,
15the duties and obligations of self-insurers, and workers'
16compensation fraud.
17    (b) The duties of the Ombudsman Program shall be as
18follows:
19        (1) assist injured employees in understanding their
20    rights and obligations under this Act, including, but not
21    limited to, filing their own claims with the Commission and
22    obtaining medical records, job descriptions, and other
23    materials pertinent to filing a claim before the
24    Commission;
25        (2) assist employers seeking information regarding
26    their rights and obligations under this Act, including

 

 

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1    their obligation to maintain workers' compensation
2    insurance;
3        (3) assist medical providers with their rights and
4    obligations under this Act;
5        (4) provide information to employers, employees, and
6    medical providers with questions about workers'
7    compensation fraud;
8        (5) assist injured employees with referral to local,
9    State, and federal financial assistance, rehabilitation,
10    and work placement programs, as well as other social
11    services that the Ombudsman Program considers appropriate;
12        (6) respond to inquiries and complaints relative to the
13    workers' compensation program;
14        (7) serve as an information source for employees,
15    employers, medical, vocational, and rehabilitation
16    personnel, insurers, third-party administrators, and
17    self-insurers; and
18        (8) perform other duties as required by the Chairman.
19    (c) The Ombudsman Program may not appear or intervene, as a
20party or otherwise, before the Commission on behalf of an
21injured employee, employer, or medical provider. This Section
22shall not be construed as requiring or allowing legal
23representation for an injured employee by the Ombudsman Program
24in any proceeding before the Commission.
25    (d) The Ombudsman Program shall prepare a report to the
26Commission, which shall also be included in the Commission's

 

 

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1annual report required under Section 15 of this Act. The report
2prepared by the Ombudsman Program shall include the following
3information for the preceding fiscal year:
4        (1) the total number of persons and entities assisted
5    during the fiscal year;
6        (2) the number of injured employers assisted during the
7    fiscal year;
8        (3) the number of employers, insurers, self-insureds,
9    and third-party administrators assisted during the fiscal
10    year;
11        (4) the total number of medical providers assisted
12    during the fiscal year;
13        (5) the number of referrals made to the Workers'
14    Compensation Fraud Unit;
15        (6) an analysis of the areas of workers' compensation
16    law requiring the most assistance for injured workers,
17    employers, and medical providers; and
18        (7) recommendations, if any, for legislation or rules
19    to be initiated by the Commission, based on the inquires
20    received by the Ombudsman Program.
 
21    (820 ILCS 305/14.3 new)
22    Sec. 14.3. WEAR Commission.
23    (a) There is created the Workers' Compensation Edit,
24Alignment, and Reform Commission, which shall be known as the
25WEAR Commission. The purpose of the WEAR Commission is to

 

 

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1develop a proposed recodification of the Workers' Compensation
2Act that meets the following goals:
3        (1) to make this Act more accessible to laypeople
4    seeking benefits under this Act and employers seeking
5    insurance coverage for their responsibilities under this
6    Act;
7        (2) to aid the Commission, attorneys, and judges in
8    understanding and applying the provisions of this Act;
9        (3) to prevent disputes over interpretations of this
10    Act that can add additional costs to the function and
11    administration of the workers' compensation system;
12        (4) to reduce the size of each Section of this Act to
13    promote understanding, interpretation, and indexing of
14    this Act;
15        (5) to assist policymakers so that they can more easily
16    understand the implication of amendments to this Act that
17    may be proposed in the future;
18        (6) to replace outdated and obsolete language within
19    this Act;
20        (7) to limit the opportunity for lengthy and expensive
21    appeals due to confusion or contrary language within this
22    Act; and
23        (8) to meet the preceding objectives without changing
24    substantive law or disturbing established case law
25    precedent. Nothing in this Section 14.3 shall be construed
26    to allow or authorize the WEAR Commission to seek to or to

 

 

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1    diminish, restrict, limit, expand, abrogate, alter, or
2    change in way the current interpretation of any substantive
3    or procedural provision of this Act by the Commission or
4    any Court.
5    (b) The members of the WEAR Commission shall be as follows:
6        (1) one Senator appointed by the President of the
7    Senate;
8        (2) one Senator appointed by the Minority Leader of the
9    Senate;
10        (3) one Representative appointed by the Speaker of the
11    House of Representatives;
12        (4) one Representative appointed by the Minority
13    Leader of the House of Representatives;
14        (5) four attorneys representing petitioners, one each
15    appointed by the President of the Senate, Minority Leader
16    of the Senate, Speaker of the House of Representatives, and
17    Minority Leader of the House of Representatives; and
18        (6) four attorneys representing respondents, one each
19    appointed by the President of the Senate, Minority Leader
20    of the Senate, Speaker of the House of Representatives, and
21    Minority Leader of the House of Representatives.
22    The members of the WEAR Commission shall serve without
23compensation. The Chairperson of the Illinois Workers'
24Compensation Commission shall serve as the Chairperson of the
25WEAR Commission.
26    (c) The Illinois Workers' Compensation Commission, the

 

 

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1Workers' Compensation Insurance Compliance Unit, and the
2Legislative Reference Bureau shall provide administrative
3support for the WEAR Commission.
4    (d) The WEAR Commission shall present a report to the
5General Assembly no later than July 1, 2017. This report shall
6include a draft of proposed legislation for the reorganization
7of the Workers' Compensation Act that accomplishes the goals
8set forth by this Section.
9    (e) This Section is repealed on January 1, 2018.
 
10    (820 ILCS 305/14.4 new)
11    Sec. 14.4. System improvements.
12    (a) By January 1, 2017, the Commission shall procure and
13implement a computer system to replace its current outdated and
14obsolete mainframe computer system. The Commission shall use
15the funds allocated for this purpose as set forth in the
16settlement agreement for the case entitled Illinois State
17Chamber of Commerce v. Filan.
18    (b) The system procured by the Commission shall have all of
19the following capabilities:
20        (1) require the electronic filing of claims before the
21    Commission, including the Application for Adjustment of
22    Claim and all subsequent filings by a petitioner or
23    respondent; the electronic filing fields for the
24    Application of Adjustment of Claim shall include the
25    following:

 

 

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1            (i) for cases involving the State of Illinois, a
2        data field for the specific agency, department,
3        constitutional officer, board, or commission;
4            (ii) a data field for the petitioner to indicate
5        that the claim involves a repetitive injury;
6            (iii) a data field for the petitioner to indicate
7        that the claim involved an injury incurred when the
8        petitioner was traveling as part of his or her
9        employment; and
10            (iv) a data field for the petitioner to indicate
11        that he or she is pro se;
12        (2) allow for a respondent to indicate the insurance
13    carrier of the employer, or the third-party administrator
14    of the employer, if self-insured;
15        (3) allow for documents and exhibits to be uploaded
16    electronically;
17        (4) allow for the case history of each claim to be
18    viewed in a summary format arranged by the date of each
19    filing or hearing, which shall be available to the public;
20        (5) allow for the attorney of record for the
21    petitioner, if any, and the respondent to be clearly
22    indicated on any summary format, including the attorney who
23    actually tried or argued the case before an arbitrator or
24    Commissioner;
25        (6) allow for the decision of the arbitrator or the
26    Commission to be uploaded electronically;

 

 

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

 

 

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1    Petitions;
2        (8) allow for the random assignment of cases by
3    arbitrator and to Commission panels, if appealed;
4        (9) allow for the electronic transmission of the record
5    of proceedings before the Commission to be transmitted to
6    the circuit court in the event of an appeal from the
7    Commission; and
8        (10) ensure the confidentiality of all protected
9    information, including medical records.
10    (c) The Commission shall make all efforts to ensure that
11parties practicing before the Commission, including injured
12employees, are aware of the changes required by the procurement
13of the computer system required by this Section.
 
14    (820 ILCS 305/25.5)
15    Sec. 25.5. Unlawful acts; penalties.
16    (a) It is unlawful for any person, company, corporation,
17insurance carrier, healthcare provider, or other entity to:
18        (1) Intentionally present or cause to be presented any
19    false or fraudulent claim for the payment of any workers'
20    compensation benefit.
21        (2) Intentionally make or cause to be made any false or
22    fraudulent material statement or material representation
23    for the purpose of obtaining or denying any workers'
24    compensation benefit.
25        (3) Intentionally make or cause to be made any false or

 

 

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

 

 

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1    of this subsection (a).
2        (9) Intentionally present a bill or statement for the
3    payment for medical services that were not provided.
4    For the purposes of paragraphs (2), (3), (5), (6), (7), and
5(9), the term "statement" includes any writing, notice, proof
6of injury, bill for services, hospital or doctor records and
7reports, or X-ray and test results.
8    (b) Sentences for violations of subsection (a) are as
9follows:
10        (1) A violation in which the value of the property
11    obtained or attempted to be obtained is $300 or less is a
12    Class A misdemeanor.
13        (2) A violation in which the value of the property
14    obtained or attempted to be obtained is more than $300 but
15    not more than $10,000 is a Class 3 felony.
16        (3) A violation in which the value of the property
17    obtained or attempted to be obtained is more than $10,000
18    but not more than $100,000 is a Class 2 felony.
19        (4) A violation in which the value of the property
20    obtained or attempted to be obtained is more than $100,000
21    is a Class 1 felony.
22        (5) A person convicted under this Section shall be
23    ordered to pay monetary restitution to the insurance
24    company or self-insured entity or any other person for any
25    financial loss sustained as a result of a violation of this
26    Section, including any court costs and attorney fees. An

 

 

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1    order of restitution also includes expenses incurred and
2    paid by the State of Illinois or an insurance company or
3    self-insured entity in connection with any medical
4    evaluation or treatment services.
5    For the purposes of this Section, where the exact value of
6property obtained or attempted to be obtained is either not
7alleged or is not specifically set by the terms of a policy of
8insurance, the value of the property shall be the fair market
9replacement value of the property claimed to be lost, the
10reasonable costs of reimbursing a vendor or other claimant for
11services to be rendered, or both. Notwithstanding the
12foregoing, an insurance company, self-insured entity, or any
13other person suffering financial loss sustained as a result of
14violation of this Section may seek restitution, including court
15costs and attorney's fees in a civil action in a court of
16competent jurisdiction.
17    (c) The Illinois Workers' Compensation Commission
18Department of Insurance shall establish a fraud and insurance
19non-compliance unit responsible for investigating incidences
20of fraud and insurance non-compliance pursuant to this Section.
21The size of the staff of the unit shall be subject to
22appropriation by the General Assembly. It shall be the duty of
23the fraud and insurance non-compliance unit to determine the
24identity of insurance carriers, employers, employees, or other
25persons or entities who have violated the fraud and insurance
26non-compliance provisions of this Section. The fraud and

 

 

09900SB0162sam001- 30 -LRB099 03387 SXM 37576 a

1insurance non-compliance unit shall report violations of the
2fraud and insurance non-compliance provisions of this Section
3to the Special Prosecutions Bureau of the Criminal Division of
4the Office of the Attorney General or to the State's Attorney
5of the county in which the offense allegedly occurred, either
6of whom has the authority to prosecute violations under this
7Section.
8    With respect to the subject of any investigation being
9conducted, the fraud and insurance non-compliance unit shall
10have the general power of subpoena of the Department of
11Insurance, including the authority to issue a subpoena to a
12medical provider, pursuant to Section 8-802 of the Code of
13Civil Procedure.
14    (d) Any person may report allegations of insurance
15non-compliance and fraud pursuant to this Section to the
16Illinois Workers' Compensation Commission's Department of
17Insurance's fraud and insurance non-compliance unit whose duty
18it shall be to investigate the report. The unit shall notify
19the Commission of reports of insurance non-compliance. Any
20person reporting an allegation of insurance non-compliance or
21fraud against either an employee or employer under this Section
22must identify himself. Except as provided in this subsection
23and in subsection (e), all reports shall remain confidential
24except to refer an investigation to the Attorney General or
25State's Attorney for prosecution or if the fraud and insurance
26non-compliance unit's investigation reveals that the conduct

 

 

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1reported may be in violation of other laws or regulations of
2the State of Illinois, the unit may report such conduct to the
3appropriate governmental agency charged with administering
4such laws and regulations. Any person who intentionally makes a
5false report under this Section to the fraud and insurance
6non-compliance unit is guilty of a Class A misdemeanor.
7    (e) In order for the fraud and insurance non-compliance
8unit to investigate a report of fraud related to an employee's
9claim, (i) the employee must have filed with the Commission an
10Application for Adjustment of Claim and the employee must have
11either received or attempted to receive benefits under this Act
12that are related to the reported fraud or (ii) the employee
13must have made a written demand for the payment of benefits
14that are related to the reported fraud. There shall be no
15immunity, under this Act or otherwise, for any person who files
16a false report or who files a report without good and just
17cause. Confidentiality of medical information shall be
18strictly maintained. Investigations that are not referred for
19prosecution shall be destroyed upon the expiration of the
20statute of limitations for the acts under investigation and
21shall not be disclosed except that the person making the report
22shall be notified that the investigation is being closed. It is
23unlawful for any employer, insurance carrier, service
24adjustment company, third party administrator, self-insured,
25or similar entity to file or threaten to file a report of fraud
26against an employee because of the exercise by the employee of

 

 

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1the rights and remedies granted to the employee by this Act.
2    (e-5) The fraud and insurance non-compliance unit shall
3procure and implement a system utilizing advanced analytics
4inclusive of predictive modeling, data mining, social network
5analysis, and scoring algorithms for the detection and
6prevention of fraud, waste, and abuse on or before January 1,
72012. The fraud and insurance non-compliance unit shall procure
8this system using a request for proposals process governed by
9the Illinois Procurement Code and rules adopted under that
10Code. The fraud and insurance non-compliance unit shall provide
11a report to the President of the Senate, Speaker of the House
12of Representatives, Minority Leader of the House of
13Representatives, Minority Leader of the Senate, Governor,
14Chairman of the Commission, and Director of Insurance on or
15before July 1, 2012 and annually thereafter detailing its
16activities and providing recommendations regarding
17opportunities for additional fraud waste and abuse detection
18and prevention.
19    (f) Any person convicted of fraud related to workers'
20compensation pursuant to this Section shall be subject to the
21penalties prescribed in the Criminal Code of 2012 and shall be
22ineligible to receive or retain any compensation, disability,
23or medical benefits as defined in this Act if the compensation,
24disability, or medical benefits were owed or received as a
25result of fraud for which the recipient of the compensation,
26disability, or medical benefit was convicted. This subsection

 

 

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

 

 

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1        (2) The source of the reported allegations
2    (individual, employer, or other).
3        (3) The number of allegations investigated by the fraud
4    and insurance non-compliance unit.
5        (4) The number of criminal referrals made in accordance
6    with this Section and the entity to which the referral was
7    made.
8        (5) All proceedings under this Section.
9(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)".