Bill Text: IL HB2602 | 2011-2012 | 97th General Assembly | Amended
Bill Title: Amends the Workers' Compensation Act. Makes a technical change in a Section concerning the computation of time.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2013-01-08 - Session Sine Die [HB2602 Detail]
Download: Illinois-2011-HB2602-Amended.html
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1 | AMENDMENT TO HOUSE BILL 2602
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2 | AMENDMENT NO. ______. Amend House Bill 2602 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Workers' Compensation Act is amended by | ||||||
5 | changing Sections 1, 8, 8.1, 8.2, 8.3, 8.7, 11, 16, 19, and | ||||||
6 | 25.5 and by adding Sections 1.1, 4b, 16b, and 16c.
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7 | (820 ILCS 305/1) (from Ch. 48, par. 138.1)
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8 | Sec. 1. This Act may be cited as the Workers' Compensation | ||||||
9 | Act.
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10 | (a) The term "employer" as used in this Act means:
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11 | 1. The State and each county, city, town, township, | ||||||
12 | incorporated
village, school district, body politic, or | ||||||
13 | municipal corporation
therein.
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14 | 2. Every person, firm, public or private corporation, | ||||||
15 | including
hospitals, public service, eleemosynary, religious | ||||||
16 | or charitable
corporations or associations who has any person |
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1 | in service or under any
contract for hire, express or implied, | ||||||
2 | oral or written, and who is
engaged in any of the enterprises | ||||||
3 | or businesses enumerated in Section 3
of this Act, or who at or | ||||||
4 | prior to the time of the accident to the
employee for which | ||||||
5 | compensation under this Act may be claimed, has in
the manner | ||||||
6 | provided in this Act elected to become subject to the
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7 | provisions of this Act, and who has not, prior to such | ||||||
8 | accident,
effected a withdrawal of such election in the manner | ||||||
9 | provided in this Act.
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10 | 3. Any one engaging in any business or enterprise referred | ||||||
11 | to in
subsections 1 and 2 of Section 3 of this Act who | ||||||
12 | undertakes to do any
work enumerated therein, is liable to pay | ||||||
13 | compensation to his own
immediate employees in accordance with | ||||||
14 | the provisions of this Act, and
in addition thereto if he | ||||||
15 | directly or indirectly engages any contractor
whether | ||||||
16 | principal or sub-contractor to do any such work, he is liable | ||||||
17 | to
pay compensation to the employees of any such contractor or
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18 | sub-contractor unless such contractor or sub-contractor has | ||||||
19 | insured, in
any company or association authorized under the | ||||||
20 | laws of this State to
insure the liability to pay compensation | ||||||
21 | under this Act, or guaranteed
his liability to pay such | ||||||
22 | compensation. With respect to any time
limitation on the filing | ||||||
23 | of claims provided by this Act, the timely
filing of a claim | ||||||
24 | against a contractor or subcontractor, as the case may
be, | ||||||
25 | shall be deemed to be a timely filing with respect to all | ||||||
26 | persons
upon whom liability is imposed by this paragraph.
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1 | In the event any such person pays compensation under this | ||||||
2 | subsection
he may recover the amount thereof from the | ||||||
3 | contractor or sub-contractor,
if any, and in the event the | ||||||
4 | contractor pays compensation under this
subsection he may | ||||||
5 | recover the amount thereof from the sub-contractor, if any.
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6 | This subsection does not apply in any case where the | ||||||
7 | accident occurs
elsewhere than on, in or about the immediate | ||||||
8 | premises on which the
principal has contracted that the work be | ||||||
9 | done.
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10 | 4. Where an employer operating under and subject to the | ||||||
11 | provisions
of this Act loans an employee to another such | ||||||
12 | employer and such loaned
employee sustains a compensable | ||||||
13 | accidental injury in the employment of
such borrowing employer | ||||||
14 | and where such borrowing employer does not
provide or pay the | ||||||
15 | benefits or payments due such injured employee, such
loaning | ||||||
16 | employer is liable to provide or pay all benefits or payments
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17 | due such employee under this Act and as to such employee the | ||||||
18 | liability
of such loaning and borrowing employers is joint and | ||||||
19 | several, provided
that such loaning employer is in the absence | ||||||
20 | of agreement to the
contrary entitled to receive from such | ||||||
21 | borrowing employer full
reimbursement for all sums paid or | ||||||
22 | incurred pursuant to this paragraph
together with reasonable | ||||||
23 | attorneys' fees and expenses in any hearings
before the | ||||||
24 | Illinois Workers' Compensation Commission or in any action to | ||||||
25 | secure such
reimbursement. Where any benefit is provided or | ||||||
26 | paid by such loaning
employer the employee has the duty of |
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1 | rendering reasonable cooperation
in any hearings, trials or | ||||||
2 | proceedings in the case, including such
proceedings for | ||||||
3 | reimbursement.
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4 | Where an employee files an Application for Adjustment of | ||||||
5 | Claim with
the Illinois Workers' Compensation
Commission | ||||||
6 | alleging that his claim is covered by the
provisions of the | ||||||
7 | preceding paragraph, and joining both the alleged
loaning and | ||||||
8 | borrowing employers, they and each of them, upon written
demand | ||||||
9 | by the employee and within 7 days after receipt of such demand,
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10 | shall have the duty of filing with the Illinois Workers' | ||||||
11 | Compensation Commission a written
admission or denial of the | ||||||
12 | allegation that the claim is covered by the
provisions of the | ||||||
13 | preceding paragraph and in default of such filing or
if any | ||||||
14 | such denial be ultimately determined not to have been bona fide
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15 | then the provisions of Paragraph K of Section 19 of this Act | ||||||
16 | shall apply.
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17 | An employer whose business or enterprise or a substantial | ||||||
18 | part
thereof consists of hiring, procuring or furnishing | ||||||
19 | employees to or for
other employers operating under and subject | ||||||
20 | to the provisions of this
Act for the performance of the work | ||||||
21 | of such other employers and who pays
such employees their | ||||||
22 | salary or wages notwithstanding that they are doing
the work of | ||||||
23 | such other employers shall be deemed a loaning employer
within | ||||||
24 | the meaning and provisions of this Section.
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25 | (b) The term "employee" as used in this Act means:
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26 | 1. Every person in the service of the State, including |
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1 | members of
the General Assembly, members of the Commerce | ||||||
2 | Commission, members of the
Illinois Workers' Compensation | ||||||
3 | Commission, and all persons in the service of the University
of | ||||||
4 | Illinois, county, including deputy sheriffs and assistant | ||||||
5 | state's
attorneys, city, town, township, incorporated village | ||||||
6 | or school
district, body politic, or municipal corporation | ||||||
7 | therein, whether by
election, under appointment or contract of | ||||||
8 | hire, express or implied,
oral or written, including all | ||||||
9 | members of the Illinois National Guard
while on active duty in | ||||||
10 | the service of the State, and all probation
personnel of the | ||||||
11 | Juvenile Court appointed pursuant to Article VI
of the Juvenile | ||||||
12 | Court Act of 1987, and including any official of the
State, any | ||||||
13 | county, city, town, township, incorporated village, school
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14 | district, body politic or municipal corporation therein except | ||||||
15 | any duly
appointed member of a police department in any city | ||||||
16 | whose
population exceeds 200,000 according to the last Federal | ||||||
17 | or State
census, and except any member of a fire insurance | ||||||
18 | patrol maintained by a
board of underwriters in this State. A | ||||||
19 | duly appointed member of a fire
department in any city, the | ||||||
20 | population of which exceeds 200,000 according
to the last | ||||||
21 | federal or State census, is an employee under this Act only
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22 | with respect to claims brought under paragraph (c) of Section | ||||||
23 | 8.
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24 | One employed by a contractor who has contracted with the | ||||||
25 | State, or a
county, city, town, township, incorporated village, | ||||||
26 | school district,
body politic or municipal corporation |
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1 | therein, through its
representatives, is not considered as an | ||||||
2 | employee of the State, county,
city, town, township, | ||||||
3 | incorporated village, school district, body
politic or | ||||||
4 | municipal corporation which made the contract.
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5 | 2. Every person in the service of another under any | ||||||
6 | contract of
hire, express or implied, oral or written, | ||||||
7 | including persons whose
employment is outside of the State of | ||||||
8 | Illinois where the contract of
hire is made within the State of | ||||||
9 | Illinois, persons whose employment
results in fatal or | ||||||
10 | non-fatal injuries within the State of Illinois
where the | ||||||
11 | contract of hire is made outside of the State of Illinois, and
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12 | persons whose employment is principally localized within the | ||||||
13 | State of
Illinois, regardless of the place of the accident or | ||||||
14 | the place where the
contract of hire was made, and including | ||||||
15 | aliens, and minors who, for the
purpose of this Act are | ||||||
16 | considered the same and have the same power to
contract, | ||||||
17 | receive payments and give quittances therefor, as adult | ||||||
18 | employees.
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19 | 3. Every sole proprietor and every partner of a business | ||||||
20 | may elect to
be covered by this Act.
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21 | An employee or his dependents under this Act who shall have | ||||||
22 | a cause
of action by reason of any injury, disablement or death | ||||||
23 | arising out of
and in the course of his employment may elect to | ||||||
24 | pursue his remedy in
the State where injured or disabled, or in | ||||||
25 | the State where the contract
of hire is made, or in the State | ||||||
26 | where the employment is principally
localized.
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1 | However, any employer may elect to provide and pay | ||||||
2 | compensation to
any employee other than those engaged in the | ||||||
3 | usual course of the trade,
business, profession or occupation | ||||||
4 | of the employer by complying with
Sections 2 and 4 of this Act. | ||||||
5 | Employees are not included within the
provisions of this Act | ||||||
6 | when excluded by the laws of the United States
relating to | ||||||
7 | liability of employers to their employees for personal
injuries | ||||||
8 | where such laws are held to be exclusive.
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9 | The term "employee" does not include persons performing | ||||||
10 | services as real
estate broker, broker-salesman, or salesman | ||||||
11 | when such persons are paid by
commission only.
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12 | (c) "Commission" means the Industrial Commission created | ||||||
13 | by Section
5 of "The Civil Administrative Code of Illinois", | ||||||
14 | approved March 7,
1917, as amended, or the Illinois Workers' | ||||||
15 | Compensation Commission created by Section 13 of
this Act.
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16 | (d) The term "accident" as used in this Act means an
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17 | occurrence arising out of the employment resulting from a risk
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18 | incidental to the employment and in the course of the
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19 | employment at a time and place and under circumstances
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20 | reasonably required by the employment. | ||||||
21 | (e) The term "injury" as used in this Act means a condition | ||||||
22 | or impairment that arises out of and in the course of | ||||||
23 | employment. An injury, its occupational cause, and any
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24 | resulting manifestations or disability must be established to a
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25 | reasonable degree of medical certainty, based on objective
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26 | relevant medical findings, and the accidental compensable
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1 | injury must be the major contributing cause of any resulting
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2 | injuries. For the purposes of this Section, "major contributing
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3 | cause" means the cause which is more than 50% responsible for
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4 | the injury as compared to all other causes combined for which
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5 | treatment or benefits are sought. "Injury" includes the | ||||||
6 | aggravation of a pre-existing condition by an accident arising | ||||||
7 | out of and in the course of the employment, but only for so | ||||||
8 | long as the aggravation of the pre-existing condition continues | ||||||
9 | to be the major contributing cause of the disability. | ||||||
10 | (1) An injury is deemed to arise out of and in the
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11 | course of the employment only if: | ||||||
12 | (A) it is reasonably apparent, upon consideration
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13 | of all circumstances, that the accident is the major | ||||||
14 | contributing cause of the injury; and | ||||||
15 | (B) it does not come from a hazard or risk
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16 | unrelated to the employment to which employees would
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17 | have been equally exposed outside of the employment. | ||||||
18 | (2) An injury resulting directly or indirectly from
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19 | idiopathic causes is not compensable. | ||||||
20 | (Source: P.A. 93-721, eff. 1-1-05.)
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21 | (820 ILCS 305/1.1 new) | ||||||
22 | Sec. 1.1. Standards of Conduct. | ||||||
23 | (a) Commissioners and arbitrators shall dispose of all | ||||||
24 | Workers' Compensation matters promptly, officially, and | ||||||
25 | fairly, without bias or prejudice. Commissioners and |
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1 | arbitrators shall be faithful to the law and maintain | ||||||
2 | professional competence in it. Commissioners and arbitrators | ||||||
3 | shall in a timely manner take appropriate action or initiate | ||||||
4 | appropriate disciplinary measures against a Commissioner, | ||||||
5 | arbitrator, lawyer, or others for unprofessional conduct which | ||||||
6 | the Commissioner or arbitrator may become aware of. | ||||||
7 | (b) Except as otherwise provided in this Act, the Canons of | ||||||
8 | the Code of Judicial Conduct as adopted by the Supreme Court of | ||||||
9 | Illinois govern the hearing and non-hearing conduct of members | ||||||
10 | of the Commission and arbitrators under this Act. The | ||||||
11 | Commission may set additional rules and standards, not less | ||||||
12 | stringent than those rules and standards established by the | ||||||
13 | Code of Judicial Conduct, for the conduct of arbitrators. | ||||||
14 | (c) The following provisions of the Code of Judicial | ||||||
15 | Conduct do not apply under this Section: | ||||||
16 | (1) Canon 3(B), relating to administrative | ||||||
17 | responsibilities. | ||||||
18 | (2) Canon 6(C), relating to annual filings of economic | ||||||
19 | interests. Instead of filing declarations of economic | ||||||
20 | interests with the Clerk of the Illinois Supreme Court | ||||||
21 | under Illinois Supreme Court Rule 68, members of the | ||||||
22 | Commission and arbitrators shall make filings | ||||||
23 | substantially similar to those required by Rule 68 with the | ||||||
24 | Chairman, and such filings shall be made available for | ||||||
25 | examination by the public. | ||||||
26 | (d) An arbitrator or a Commissioner may accept an |
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1 | uncompensated appointment to a governmental committee, | ||||||
2 | commission, or other position that is concerned with issues of | ||||||
3 | policy on matters which may come before the arbitrator or | ||||||
4 | Commissioner if such appointment neither affects his or her | ||||||
5 | independent professional judgment nor the conduct of his or her | ||||||
6 | duties. | ||||||
7 | (e) Decisions of an arbitrator or a Commissioner shall be | ||||||
8 | based exclusively on evidence in the record of the proceeding | ||||||
9 | and material that has been officially noticed.
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10 | (820 ILCS 305/4b new) | ||||||
11 | Sec. 4b. Collective Bargaining Agreements. | ||||||
12 | (a) Definitions. | ||||||
13 | For purposes of this Section, the term "construction | ||||||
14 | employer" means any person or legal entity or group of | ||||||
15 | persons or legal entities engaging in or planning to engage | ||||||
16 | in any constructing, altering, reconstructing, repairing, | ||||||
17 | rehabilitating, refinishing, refurbishing, remodeling, | ||||||
18 | remediating, renovating, custom fabricating, maintaining, | ||||||
19 | landscaping, improving, wrecking, painting, decorating, | ||||||
20 | demolishing, and adding to or subtracting from any | ||||||
21 | building, structure, airport facility, highway, roadway, | ||||||
22 | street, alley, bridge, sewer, drain, ditch, sewage | ||||||
23 | disposal plant, water works, parking facility, railroad, | ||||||
24 | excavation or other project, development, real property, | ||||||
25 | or improvement, or to do any part thereof, whether or not |
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1 | the performance of the work herein described involves the | ||||||
2 | addition to, or fabrication into, any structure, project, | ||||||
3 | development, real property, or improvement herein | ||||||
4 | described of any material or article of merchandise and | ||||||
5 | shall also include moving construction related materials | ||||||
6 | on the job site or to or from the job site. | ||||||
7 | (b) Provisions. | ||||||
8 | Upon appropriate filing, the Commission and the courts | ||||||
9 | of this State shall recognize as valid and binding any | ||||||
10 | provision in a collective bargaining agreement between any | ||||||
11 | construction employer or group of employers and a labor | ||||||
12 | organization which is recognized or certified and the | ||||||
13 | exclusive representative of the employer's employees under | ||||||
14 | the National Labor Relations Act, 29 U.S.C. § 151, et al., | ||||||
15 | which contains certain obligations and procedures relating | ||||||
16 | to workers' compensation. This agreement must be limited | ||||||
17 | to, but need not include, all of the following: | ||||||
18 | (1) an alternative dispute resolution ("ADR") | ||||||
19 | system to supplement, modify, or replace the | ||||||
20 | procedural or dispute resolution provisions of this | ||||||
21 | Act. The system may include mediation, arbitration, or | ||||||
22 | other dispute resolution proceedings, the results of | ||||||
23 | which shall be final and binding upon the parties; | ||||||
24 | (2) an agreed list of medical treatment providers | ||||||
25 | that may be the exclusive source of all medical and | ||||||
26 | related treatment provided under this Act; |
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1 | (3) the use of a limited list of impartial | ||||||
2 | physicians to conduct independent medical | ||||||
3 | examinations; | ||||||
4 | (4) the creation of a light duty, modified job, or | ||||||
5 | return to work program; | ||||||
6 | (5) the use of a limited list of individuals and | ||||||
7 | companies for the establishment of vocational | ||||||
8 | rehabilitation or retraining programs that may be the | ||||||
9 | exclusive source of rehabilitation and retraining | ||||||
10 | services provided under this Act; or | ||||||
11 | (6) the establishment of joint labor management | ||||||
12 | safety committees and safety procedures. | ||||||
13 | (c) Void Agreements. | ||||||
14 | Nothing in this Section shall be construed to authorize | ||||||
15 | any agreement in a collective bargaining agreement that | ||||||
16 | diminishes or increases a construction employer's | ||||||
17 | entitlements under this Act or an employee's entitlement to | ||||||
18 | benefits as otherwise set forth in this Act. For the | ||||||
19 | purposes of this Section, the procedural rights and dispute | ||||||
20 | resolution agreements under subparagraphs (1) thru (6) of | ||||||
21 | subsection (b) of this Section are not agreements which | ||||||
22 | diminish or increase a construction employer's | ||||||
23 | entitlements under this Act or an employee's entitlement to | ||||||
24 | benefits under this Act. Any agreement that diminishes or | ||||||
25 | increases the construction employer's entitlements under | ||||||
26 | this Act or an employee's entitlement to benefits as set |
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1 | forth in this Act are null and void. Nothing in this | ||||||
2 | Section shall be construed as creating a mandatory subject | ||||||
3 | of bargaining. | ||||||
4 | (d) Form of Agreement. | ||||||
5 | The agreement reached herein shall demonstrate that: | ||||||
6 | (1) the construction employer or group of | ||||||
7 | employers and the recognized or certified exclusive | ||||||
8 | bargaining representative have entered into a binding | ||||||
9 | collective bargaining agreement adopting the ADR plan | ||||||
10 | for a period of no less than 2 years; | ||||||
11 | (2) contractual agreements have been reached with | ||||||
12 | the construction employer's workers' compensation | ||||||
13 | carrier, group self-insurance fund, and any excess | ||||||
14 | carriers relating to the ADR plan; | ||||||
15 | (3) procedures have been established by which | ||||||
16 | claims for benefits by employees will be lodged, | ||||||
17 | administered and decided while affording procedural | ||||||
18 | due process; | ||||||
19 | (4) the plan has designated forms upon which claims | ||||||
20 | for benefits shall be made; | ||||||
21 | (5) the system and means by which the construction | ||||||
22 | employer's obligation to furnish medical services and | ||||||
23 | vocational rehabilitation and retraining benefits | ||||||
24 | shall be fulfilled and provider selected; | ||||||
25 | (6) the method by which mediators or arbitrators | ||||||
26 | are to be selected. |
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1 | (e) Filing. | ||||||
2 | A copy of the agreement and a statement identifying the | ||||||
3 | parties to the agreement shall be filed with the | ||||||
4 | Commission. Within 21 days of receipt of an agreement, the | ||||||
5 | Chairman shall review the agreement for compliance with | ||||||
6 | this Section and notify the parties of its acceptance, or | ||||||
7 | notify the parties of any additional information required, | ||||||
8 | or any recommended modification that would bring the | ||||||
9 | agreement into compliance. If no additional information or | ||||||
10 | modification is required, the agreement shall be valid and | ||||||
11 | binding from the time the parties receive acceptance of the | ||||||
12 | agreement from the Chairman. Upon receipt of any requested | ||||||
13 | information or modification, the Chairman shall notify the | ||||||
14 | parties within 21 days whether the agreement is in | ||||||
15 | compliance with this Section. If no additional information | ||||||
16 | or modification is required, the agreement shall be valid | ||||||
17 | and binding from the time the parties receive acceptance of | ||||||
18 | the agreement from the Chairman. All rejections made by the | ||||||
19 | Chairman under this subsection shall be subject to review | ||||||
20 | by the courts of this State, said review to be taken in the | ||||||
21 | same manner and within the same time as provided by Section | ||||||
22 | 19 of this Act for review of awards and decisions of the | ||||||
23 | Commission. Upon the review, the Circuit Court shall have | ||||||
24 | power to review all questions of fact as well as of law. | ||||||
25 | (f) Notice to Insurance carrier. | ||||||
26 | If the construction employer is insured under this Act, |
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1 | he, she, or it shall provide notice to and obtain consent | ||||||
2 | from his, her, or its insurance carrier, in the manner | ||||||
3 | provided in the insurance contract, of his, her, or its | ||||||
4 | intent to enter into an agreement as provided in this | ||||||
5 | Section with his, her, or its employees. | ||||||
6 | (g) Employees' Claims for Workers' Compensation Benefits. | ||||||
7 | (1) claims for benefits shall be filed with the ADR | ||||||
8 | plan administrator within those periods of limitation | ||||||
9 | prescribed by this Act. Within 10 days of the filing of a | ||||||
10 | claim, the ADR plan administrator shall serve a copy of the | ||||||
11 | claim application upon the Commission, which shall | ||||||
12 | maintain records of all ADR claims and resolutions. | ||||||
13 | (2) settlements of claims presented to the ADR plan | ||||||
14 | administrator shall be evidenced by a settlement | ||||||
15 | agreement. All such settlements shall be filed with the ADR | ||||||
16 | plan administrator, who within 10 days shall forward a copy | ||||||
17 | to the Commission for recording. | ||||||
18 | (3) upon assignment of claims, unless settled, | ||||||
19 | mediators and arbitrators shall render final orders | ||||||
20 | containing essential findings of fact, rulings of law and | ||||||
21 | referring to other matters as pertinent to the questions at | ||||||
22 | issue. The ADR plan administrator shall maintain a record | ||||||
23 | of the proceedings. | ||||||
24 | (h) Reporting Requirements. | ||||||
25 | Annually, each ADR plan administrator shall submit a report | ||||||
26 | to the Commission containing the following information: |
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1 | (1) the number of employees within the ADR program; | ||||||
2 | (2) the number of occurrences of work-related injuries | ||||||
3 | or diseases; | ||||||
4 | (3) the breakdown within the ADR program of injuries | ||||||
5 | and diseases treated; | ||||||
6 | (4) the total amount of disability benefits paid within | ||||||
7 | the ADR program; | ||||||
8 | (5) the total medical treatment cost paid within the | ||||||
9 | ADR program; | ||||||
10 | (6) the number of claims filed within the ADR program; | ||||||
11 | and | ||||||
12 | (7) the disposition of all claims.
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13 | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
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14 | Sec. 8. The amount of compensation which shall be paid to | ||||||
15 | the
employee for an accidental injury not resulting in death | ||||||
16 | is:
| ||||||
17 | (a) The employer shall provide and pay the negotiated rate, | ||||||
18 | if applicable, or the lesser of the health care provider's | ||||||
19 | actual charges or according to a fee schedule, subject to | ||||||
20 | Section 8.2, in effect at the time the service was rendered for | ||||||
21 | all the necessary first
aid, medical and surgical services, and | ||||||
22 | all necessary medical, surgical
and hospital services | ||||||
23 | thereafter incurred, limited, however, to that
which is | ||||||
24 | reasonably required to cure or relieve from the effects of the
| ||||||
25 | accidental injury , even if a health care provider sells, |
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1 | transfers, or otherwise assigns an account receivable for | ||||||
2 | procedures, treatments, or services covered under this Act . If | ||||||
3 | the employer does not dispute payment of first aid, medical, | ||||||
4 | surgical,
and hospital services, the employer shall make such | ||||||
5 | payment to the provider on behalf of the employee. The employer | ||||||
6 | shall also pay for treatment,
instruction and training | ||||||
7 | necessary for the physical, mental and
vocational | ||||||
8 | rehabilitation of the employee, including all maintenance
| ||||||
9 | costs and expenses incidental thereto. If as a result of the | ||||||
10 | injury the
employee is unable to be self-sufficient the | ||||||
11 | employer shall further pay
for such maintenance or | ||||||
12 | institutional care as shall be required.
| ||||||
13 | Except as provided in subsection (a-1) of this Section, for | ||||||
14 | up to 60 days from the report of injury to the employer, the | ||||||
15 | employer shall choose all necessary medical, surgical and | ||||||
16 | hospital services reasonably required to cure or relieve from | ||||||
17 | the effects of the accidental injury, at the employer's | ||||||
18 | expense. The employee shall cooperate with and adhere to the | ||||||
19 | plan of care or treatment recommendations of the providers | ||||||
20 | selected by the employer, unless the proposed care and | ||||||
21 | treatment threatens the life, health or recovery of the injured | ||||||
22 | employee. Upon a finding by the Commission, that the employer's | ||||||
23 | choice of medical care is rendering improper or inadequate | ||||||
24 | care, the employee may then choose a second physician, surgeon, | ||||||
25 | and hospital services at the employer's expense. Initial | ||||||
26 | emergency services, taking place within 45 days of the |
| |||||||
| |||||||
1 | accident, shall not constitute a choice of physician, surgeon, | ||||||
2 | or hospital services by the employer or employee. Except as | ||||||
3 | provided in subsection (a-1) of this Section, the The employee | ||||||
4 | may after 60 days from the report of injury at any time elect | ||||||
5 | to secure his own physician,
surgeon and hospital services at | ||||||
6 | the employer's expense . , or,
| ||||||
7 | Upon agreement between the employer and the employees, or | ||||||
8 | the employees'
exclusive representative, and subject to the | ||||||
9 | approval of the Illinois Workers' Compensation
Commission, the | ||||||
10 | employer shall maintain a list of physicians, to be
known as a | ||||||
11 | Panel of Physicians, who are accessible to the employees.
The | ||||||
12 | employer shall post this list in a place or places easily | ||||||
13 | accessible
to his employees. The employee shall have the right | ||||||
14 | to make an
alternative choice of physician from such Panel if | ||||||
15 | he is not satisfied
with the physician first selected. If, due | ||||||
16 | to the nature of the injury
or its occurrence away from the | ||||||
17 | employer's place of business, the
employee is unable to make a | ||||||
18 | selection from the Panel, the selection
process from the Panel | ||||||
19 | shall not apply. The physician selected from the
Panel may | ||||||
20 | arrange for any consultation, referral or other specialized
| ||||||
21 | medical services outside the Panel at the employer's expense. | ||||||
22 | Provided
that, in the event the Commission shall find that a | ||||||
23 | doctor selected by
the employee is rendering improper or | ||||||
24 | inadequate care, the Commission
may order the employee to | ||||||
25 | select another doctor certified or qualified
in the medical | ||||||
26 | field for which treatment is required. If the employee
refuses |
| |||||||
| |||||||
1 | to make such change the Commission may relieve the employer of
| ||||||
2 | his obligation to pay the doctor's charges from the date of | ||||||
3 | refusal to
the date of compliance.
| ||||||
4 | Any vocational rehabilitation counselors who provide | ||||||
5 | service under this Act shall have
appropriate certifications | ||||||
6 | which designate the counselor as qualified to render
opinions | ||||||
7 | relating to vocational rehabilitation. Vocational | ||||||
8 | rehabilitation
may include, but is not limited to, counseling | ||||||
9 | for job searches, supervising
a job search program, and | ||||||
10 | vocational retraining including education at an
accredited | ||||||
11 | learning institution. The employee or employer may petition to | ||||||
12 | the Commission to decide disputes relating to vocational | ||||||
13 | rehabilitation and the Commission shall resolve any such | ||||||
14 | dispute, including payment of the vocational rehabilitation | ||||||
15 | program by the employer. | ||||||
16 | The maintenance benefit shall not be less than the | ||||||
17 | temporary total disability
rate determined for the employee. In | ||||||
18 | addition, maintenance shall include costs
and expenses | ||||||
19 | incidental to the vocational rehabilitation program. | ||||||
20 | When the employee is working light duty on a part-time | ||||||
21 | basis or full-time
basis
and earns less than he or she would be | ||||||
22 | earning if employed in the full capacity
of the job or jobs, | ||||||
23 | then the employee shall be entitled to temporary partial | ||||||
24 | disability benefits. Temporary partial disability benefits | ||||||
25 | shall be
equal to two-thirds of
the difference between the | ||||||
26 | average amount that the employee would be able to
earn in the |
| |||||||
| |||||||
1 | full performance of his or her duties in the occupation in | ||||||
2 | which he
or she was engaged at the time of accident and the | ||||||
3 | gross net amount which he or she
is
earning in the modified job | ||||||
4 | provided to the employee by the employer or in any other job | ||||||
5 | that the employee is working. | ||||||
6 | No employer shall be required to pay temporary partial
| ||||||
7 | disability benefits to an employee who has been discharged for
| ||||||
8 | cause on or after the effective date of this amendatory Act of
| ||||||
9 | the 97th General Assembly. Upon notification by the employer,
| ||||||
10 | the Commission shall suspend temporary partial disability
| ||||||
11 | benefits being paid to an employee who has been discharged for
| ||||||
12 | cause. Following a hearing, the Commission may reinstate the
| ||||||
13 | temporary partial benefits and retroactively restore any
| ||||||
14 | benefits the employer should have paid if it finds the
| ||||||
15 | employer's discharge of the employee was not for cause. If the
| ||||||
16 | Commission determines that the employee was discharged for
| ||||||
17 | cause, the temporary partial disability benefit shall be
| ||||||
18 | terminated. "Discharge for cause" means a discharge resulting
| ||||||
19 | from the employee's voluntary violation of a rule or policy of | ||||||
20 | the employer not caused by the employee's disability. | ||||||
21 | Every hospital, physician, surgeon or other person | ||||||
22 | rendering
treatment or services in accordance with the | ||||||
23 | provisions of this Section
shall upon written request furnish | ||||||
24 | full and complete reports thereof to,
and permit their records | ||||||
25 | to be copied by, the employer, the employee or
his dependents, | ||||||
26 | as the case may be, or any other party to any proceeding
for |
| |||||||
| |||||||
1 | compensation before the Commission, or their attorneys.
| ||||||
2 | When an employee makes a claim for benefits under the Act, | ||||||
3 | he or she waives their privacy privilege with any treating
| ||||||
4 | provider to the extent solely to allow the employer to obtain
| ||||||
5 | from a treating provider the necessary information to determine
| ||||||
6 | whether the condition of ill-being in question for which
| ||||||
7 | treatment is sought is work related, what that treatment is for
| ||||||
8 | purposes of approval of care, and whether or not, based upon
| ||||||
9 | the condition of ill-being, the employee is entitled to other | ||||||
10 | benefits. The employer shall be entitled to contact the
| ||||||
11 | treating provider to seek information and answers from the
| ||||||
12 | treating provider regarding whether the condition of ill-being
| ||||||
13 | in question for which treatment is sought is work related, what
| ||||||
14 | that treatment or course of treatment is for purposes of
| ||||||
15 | approval of care, and the return to work options that the | ||||||
16 | employer may have for the employee. | ||||||
17 | Notwithstanding the foregoing, the employer's liability to | ||||||
18 | pay for such
medical services selected by the employee shall be | ||||||
19 | limited to:
| ||||||
20 | (1) all first aid and emergency treatment; plus
| ||||||
21 | (2) all medical, surgical and hospital services | ||||||
22 | provided by the
physician, surgeon or hospital initially | ||||||
23 | chosen by the employer employee or by any
other physician, | ||||||
24 | consultant, expert, institution or other provider of
| ||||||
25 | services recommended by said initial service provider or | ||||||
26 | any subsequent
provider of medical services in the chain of |
| |||||||
| |||||||
1 | referrals from said
initial service provider; plus
| ||||||
2 | (3) except as provided in subsection (a-1) of this | ||||||
3 | Section, all medical, surgical and hospital services | ||||||
4 | provided by any second
physician, surgeon or hospital | ||||||
5 | subsequently chosen by the employee as allowed under this | ||||||
6 | Section or by
any other physician, consultant, expert, | ||||||
7 | institution or other provider of
services recommended by | ||||||
8 | said second service provider or any subsequent provider
of | ||||||
9 | medical services in the chain of referrals
from said second | ||||||
10 | service provider. Thereafter the employer shall select
and | ||||||
11 | pay for all necessary medical, surgical and hospital | ||||||
12 | treatment and the
employee may not select a provider of | ||||||
13 | medical services at the employer's
expense unless the | ||||||
14 | employer agrees to such selection. At any time the employee
| ||||||
15 | may obtain any medical treatment he or she desires at his | ||||||
16 | or her own expense. This paragraph
shall not affect the | ||||||
17 | duty to pay for rehabilitation referred to above.
| ||||||
18 | Where, as provided in Section 11 of this Act, an employee | ||||||
19 | is determined to be so intoxicated that the intoxication | ||||||
20 | constituted a departure from employment, the employer shall | ||||||
21 | only be liable to pay inpatient and outpatient hospital | ||||||
22 | services furnished by a provider qualified to furnish those | ||||||
23 | services that are needed to evaluate or stabilize an emergency | ||||||
24 | medical condition. Emergency treatment for injuries caused by | ||||||
25 | intoxication does not include post stabilization medical | ||||||
26 | services. |
| |||||||
| |||||||
1 | When an employer and employee so agree in writing, nothing | ||||||
2 | in this
Act prevents an employee whose injury or disability has | ||||||
3 | been established
under this Act, from relying in good faith, on | ||||||
4 | treatment by prayer or
spiritual means alone, in accordance | ||||||
5 | with the tenets and practice of a
recognized church or | ||||||
6 | religious denomination, by a duly accredited
practitioner | ||||||
7 | thereof, and having nursing services appropriate therewith,
| ||||||
8 | without suffering loss or diminution of the compensation | ||||||
9 | benefits under
this Act. However, the employee shall submit to | ||||||
10 | all physical
examinations required by this Act. The cost of | ||||||
11 | such treatment and
nursing care shall be paid by the employee | ||||||
12 | unless the employer agrees to
make such payment.
| ||||||
13 | Where the accidental injury results in the amputation of an | ||||||
14 | arm,
hand, leg or foot, or the enucleation of an eye, or the | ||||||
15 | loss of any of
the natural teeth, the employer shall furnish an | ||||||
16 | artificial of any such
members lost or damaged in accidental | ||||||
17 | injury arising out of and in the
course of employment, and | ||||||
18 | shall also furnish the necessary braces in all
proper and | ||||||
19 | necessary cases. In cases of the loss of a member or members
by | ||||||
20 | amputation, the employer shall, whenever necessary, maintain | ||||||
21 | in good
repair, refit or replace the artificial limbs during | ||||||
22 | the lifetime of the
employee. Where the accidental injury | ||||||
23 | accompanied by physical injury
results in damage to a denture, | ||||||
24 | eye glasses or contact eye lenses, or
where the accidental | ||||||
25 | injury results in damage to an artificial member,
the employer | ||||||
26 | shall replace or repair such denture, glasses, lenses, or
|
| |||||||
| |||||||
1 | artificial member.
| ||||||
2 | The furnishing by the employer of any such services or | ||||||
3 | appliances is
not an admission of liability on the part of the | ||||||
4 | employer to pay
compensation.
| ||||||
5 | The furnishing of any such services or appliances or the | ||||||
6 | servicing
thereof by the employer is not the payment of | ||||||
7 | compensation.
| ||||||
8 | Except for the changes to the first paragraph of this | ||||||
9 | subsection (a), the changes to this subsection (a) apply only | ||||||
10 | to accidental injuries that occur on or after the effective | ||||||
11 | date of this amendatory Act of the 97th General Assembly. | ||||||
12 | (a-1) To satisfy its liabilities under this Section for the | ||||||
13 | provision of medical treatment to injured employees, an | ||||||
14 | employer may utilize a preferred provider program approved by | ||||||
15 | the Illinois Department of Insurance pursuant to Article XX-1/2 | ||||||
16 | of the Illinois Insurance Code. The provider network shall | ||||||
17 | include an adequate number and type of physicians or other | ||||||
18 | providers to treat common injuries experienced by injured | ||||||
19 | employees based on the type of occupation or industry in which | ||||||
20 | the employee is engaged, and the geographic area where the | ||||||
21 | employees are employed. | ||||||
22 | Medical treatment for injuries shall be readily available | ||||||
23 | at reasonable times to all employees. To the extent feasible, | ||||||
24 | all medical treatment for injuries shall be readily accessible | ||||||
25 | to all employees. | ||||||
26 | All treatment provided shall be provided in accordance with |
| |||||||
| |||||||
1 | standards of care of nationally recognized peer review | ||||||
2 | guidelines as well as nationally recognized treatment | ||||||
3 | guidelines and evidence-based medicine, as appropriate. | ||||||
4 | Notwithstanding the provisions of subsection (a) of this | ||||||
5 | Section and for injuries incurred after the effective day of | ||||||
6 | this amendatory Act of the 97th General Assembly, an employee | ||||||
7 | of an employer utilizing a preferred provider network shall | ||||||
8 | only be allowed to select a participating provider from the | ||||||
9 | network. An employer shall be responsible for all medical care | ||||||
10 | provided by participating providers under this Section | ||||||
11 | determined by the Commission to be reasonable or necessary. | ||||||
12 | (b) If the period of temporary total incapacity for work | ||||||
13 | lasts more
than 3 working days, weekly compensation as | ||||||
14 | hereinafter provided shall
be paid beginning on the 4th day of | ||||||
15 | such temporary total incapacity and
continuing as long as the | ||||||
16 | total temporary incapacity lasts. In cases
where the temporary | ||||||
17 | total incapacity for work continues for a period of
14 days or | ||||||
18 | more from the day of the accident compensation shall commence
| ||||||
19 | on the day after the accident.
| ||||||
20 | 1. The compensation rate for temporary total | ||||||
21 | incapacity under this
paragraph (b) of this Section shall | ||||||
22 | be equal to 66 2/3% of the
employee's average weekly wage | ||||||
23 | computed in accordance with Section 10,
provided that it | ||||||
24 | shall be not less than 66 2/3% of the sum of the Federal | ||||||
25 | minimum wage under the Fair Labor
Standards Act, or the | ||||||
26 | Illinois minimum wage under the Minimum Wage Law,
whichever |
| |||||||
| |||||||
1 | is more, multiplied by 40 hours. This percentage rate shall | ||||||
2 | be
increased by 10% for each spouse and child, not to | ||||||
3 | exceed 100% of the total
minimum wage calculation,
| ||||||
4 | nor exceed the employee's average weekly wage computed in | ||||||
5 | accordance
with the provisions of Section 10, whichever is | ||||||
6 | less.
| ||||||
7 | 2. The compensation rate in all cases other than for | ||||||
8 | temporary total
disability under this paragraph (b), and | ||||||
9 | other than for serious and
permanent disfigurement under | ||||||
10 | paragraph (c) and other than for permanent
partial | ||||||
11 | disability under subparagraph (2) of paragraph (d) or under
| ||||||
12 | paragraph (e), of this Section shall be equal to 66
2/3% of | ||||||
13 | the employee's average weekly wage computed in accordance | ||||||
14 | with
the provisions of Section 10, provided that it shall | ||||||
15 | be not less than
66 2/3% of the sum of the Federal minimum | ||||||
16 | wage under the Fair Labor Standards Act, or the Illinois | ||||||
17 | minimum wage under the Minimum Wage Law, whichever is more, | ||||||
18 | multiplied by 40 hours. This percentage rate shall be | ||||||
19 | increased by 10% for each spouse and child, not to exceed | ||||||
20 | 100% of the total minimum wage calculation,
nor exceed the | ||||||
21 | employee's average weekly wage computed in accordance
with | ||||||
22 | the provisions of Section 10, whichever is less.
| ||||||
23 | No employer shall be required to pay temporary total
| ||||||
24 | disability benefits to an employee who has been discharged
for | ||||||
25 | cause on or after the effective date of this amendatory
Act of | ||||||
26 | the 97th General Assembly. Upon notification by the
employer, |
| |||||||
| |||||||
1 | the Commission shall suspend temporary total disability | ||||||
2 | benefits being paid to an employee who has been
discharged for | ||||||
3 | cause. Following a hearing, the Commission
may reinstate the | ||||||
4 | temporary total disability benefits and
retroactively restore | ||||||
5 | any benefits the employer should
have paid if it finds the | ||||||
6 | employer's discharge of the
employee was not for cause. If the | ||||||
7 | Commission determines
that the employee was discharged for | ||||||
8 | cause, the temporary
total disability benefit shall be | ||||||
9 | terminated. "Discharge
for cause" means a discharge resulting | ||||||
10 | from the employee's
voluntary violation of a rule or policy of | ||||||
11 | the employer not
caused by the employee's disability.
| ||||||
12 | 2.1. The compensation rate in all cases of serious and | ||||||
13 | permanent
disfigurement under paragraph (c) and of | ||||||
14 | permanent partial disability
under subparagraph (2) of | ||||||
15 | paragraph (d) or under paragraph (e) of this
Section shall | ||||||
16 | be equal to
60% of the employee's average
weekly wage | ||||||
17 | computed in accordance with
the provisions of Section 10, | ||||||
18 | provided that it shall be not less than
66 2/3% of the sum | ||||||
19 | of the Federal minimum wage under the Fair Labor Standards | ||||||
20 | Act, or the Illinois minimum wage under the Minimum Wage | ||||||
21 | Law, whichever is more, multiplied by 40 hours. This | ||||||
22 | percentage rate shall be increased by 10% for each spouse | ||||||
23 | and child, not to exceed 100% of the total minimum wage | ||||||
24 | calculation,
| ||||||
25 | nor exceed the employee's average weekly wage computed in | ||||||
26 | accordance
with the provisions of Section 10, whichever is |
| |||||||
| |||||||
1 | less.
| ||||||
2 | 3. As used in this Section the term "child" means a | ||||||
3 | child of the
employee including any child legally adopted | ||||||
4 | before the accident or whom
at the time of the accident the | ||||||
5 | employee was under legal obligation to
support or to whom | ||||||
6 | the employee stood in loco parentis, and who at the
time of | ||||||
7 | the accident was under 18 years of age and not emancipated. | ||||||
8 | The
term "children" means the plural of "child".
| ||||||
9 | 4. All weekly compensation rates provided under | ||||||
10 | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||||||
11 | Section shall be subject to the
following limitations:
| ||||||
12 | The maximum weekly compensation rate from July 1, 1975, | ||||||
13 | except as
hereinafter provided, shall be 100% of the | ||||||
14 | State's average weekly wage in
covered industries under the | ||||||
15 | Unemployment Insurance Act, that being the
wage that most | ||||||
16 | closely approximates the State's average weekly wage.
| ||||||
17 | The maximum weekly compensation rate, for the period | ||||||
18 | July 1, 1984,
through June 30, 1987, except as hereinafter | ||||||
19 | provided, shall be $293.61.
Effective July 1, 1987 and on | ||||||
20 | July 1 of each year thereafter the maximum
weekly | ||||||
21 | compensation rate, except as hereinafter provided, shall | ||||||
22 | be
determined as follows: if during the preceding 12 month | ||||||
23 | period there shall
have been an increase in the State's | ||||||
24 | average weekly wage in covered
industries under the | ||||||
25 | Unemployment Insurance Act, the weekly compensation
rate | ||||||
26 | shall be proportionately increased by the same percentage |
| |||||||
| |||||||
1 | as the
percentage of increase in the State's average weekly | ||||||
2 | wage in covered
industries under the Unemployment | ||||||
3 | Insurance Act during such period.
| ||||||
4 | The maximum weekly compensation rate, for the period | ||||||
5 | January 1, 1981
through December 31, 1983, except as | ||||||
6 | hereinafter provided, shall be 100% of
the State's average | ||||||
7 | weekly wage in covered industries under the
Unemployment | ||||||
8 | Insurance Act in effect on January 1, 1981. Effective | ||||||
9 | January
1, 1984 and on January 1, of each year thereafter | ||||||
10 | the maximum weekly
compensation rate, except as | ||||||
11 | hereinafter provided, shall be determined as
follows: if | ||||||
12 | during the preceding 12 month period there shall have been | ||||||
13 | an
increase in the State's average weekly wage in covered | ||||||
14 | industries under the
Unemployment Insurance Act, the | ||||||
15 | weekly compensation rate shall be
proportionately | ||||||
16 | increased by the same percentage as the percentage of
| ||||||
17 | increase in the State's average weekly wage in covered | ||||||
18 | industries under the
Unemployment Insurance Act during | ||||||
19 | such period.
| ||||||
20 | From July 1, 1977 and thereafter such maximum weekly | ||||||
21 | compensation
rate in death cases under Section 7, and | ||||||
22 | permanent total disability
cases under paragraph (f) or | ||||||
23 | subparagraph 18 of paragraph (3) of this
Section and for | ||||||
24 | temporary total disability under paragraph (b) of this
| ||||||
25 | Section and for amputation of a member or enucleation of an | ||||||
26 | eye under
paragraph (e) of this Section shall be increased |
| |||||||
| |||||||
1 | to 133-1/3% of the
State's average weekly wage in covered | ||||||
2 | industries under the
Unemployment Insurance Act.
| ||||||
3 | For injuries occurring on or after February 1, 2006, | ||||||
4 | the maximum weekly benefit under paragraph (d)1 of this | ||||||
5 | Section shall be 100% of the State's average weekly wage in | ||||||
6 | covered industries under the Unemployment Insurance Act.
| ||||||
7 | 4.1. Any provision herein to the contrary | ||||||
8 | notwithstanding, the
weekly compensation rate for | ||||||
9 | compensation payments under subparagraph 18
of paragraph | ||||||
10 | (e) of this Section and under paragraph (f) of this
Section | ||||||
11 | and under paragraph (a) of Section 7 and for amputation of | ||||||
12 | a member or enucleation of an eye under paragraph (e) of | ||||||
13 | this Section, shall in no event be less
than 50% of the | ||||||
14 | State's average weekly wage in covered industries under
the | ||||||
15 | Unemployment Insurance Act.
| ||||||
16 | 4.2. Any provision to the contrary notwithstanding, | ||||||
17 | the total
compensation payable under Section 7 shall not | ||||||
18 | exceed the greater of $500,000
or 25
years.
| ||||||
19 | 5. For the purpose of this Section this State's average | ||||||
20 | weekly wage
in covered industries under the Unemployment | ||||||
21 | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | ||||||
22 | per
week and the computation of compensation rates shall be | ||||||
23 | based on the
aforesaid average weekly wage until modified | ||||||
24 | as hereinafter provided.
| ||||||
25 | 6. The Department of Employment Security of the State | ||||||
26 | shall
on or before the first day of December, 1977, and on |
| |||||||
| |||||||
1 | or before the first
day of June, 1978, and on the first day | ||||||
2 | of each December and June of each
year thereafter, publish | ||||||
3 | the State's average weekly wage in covered
industries under | ||||||
4 | the Unemployment Insurance Act and the Illinois Workers' | ||||||
5 | Compensation
Commission shall on the 15th day of January, | ||||||
6 | 1978 and on the 15th day of
July, 1978 and on the 15th day | ||||||
7 | of each January and July of each year
thereafter, post and | ||||||
8 | publish the State's average weekly wage in covered
| ||||||
9 | industries under the Unemployment Insurance Act as last | ||||||
10 | determined and
published by the Department of Employment | ||||||
11 | Security. The amount when so
posted and published shall be | ||||||
12 | conclusive and shall be applicable as the
basis of | ||||||
13 | computation of compensation rates until the next posting | ||||||
14 | and
publication as aforesaid.
| ||||||
15 | 7. The payment of compensation by an employer or his | ||||||
16 | insurance
carrier to an injured employee shall not | ||||||
17 | constitute an admission of the
employer's liability to pay | ||||||
18 | compensation.
| ||||||
19 | (c) For any serious and permanent disfigurement to the | ||||||
20 | hand, head,
face, neck, arm, leg below the knee or the chest | ||||||
21 | above the axillary
line, the employee is entitled to | ||||||
22 | compensation for such disfigurement,
the amount determined by | ||||||
23 | agreement at any time or by arbitration under
this Act, at a | ||||||
24 | hearing not less than 6 months after the date of the
accidental | ||||||
25 | injury, which amount shall not exceed 150 weeks (if the | ||||||
26 | accidental injury occurs on or after the effective date of this |
| |||||||
| |||||||
1 | amendatory Act of the 94th General Assembly
but before February
| ||||||
2 | 1, 2006) or 162
weeks (if the accidental injury occurs on or | ||||||
3 | after February
1, 2006) at the
applicable rate provided in | ||||||
4 | subparagraph 2.1 of paragraph (b) of this Section.
| ||||||
5 | No compensation is payable under this paragraph where | ||||||
6 | compensation is
payable under paragraphs (d), (e) or (f) of | ||||||
7 | this Section.
| ||||||
8 | A duly appointed member of a fire department in a city, the | ||||||
9 | population of
which exceeds 200,000 according to the last | ||||||
10 | federal or State census, is
eligible for compensation under | ||||||
11 | this paragraph only where such serious and
permanent | ||||||
12 | disfigurement results from burns.
| ||||||
13 | (d) 1. If, after the accidental injury has been sustained, | ||||||
14 | the
employee as a result thereof becomes partially | ||||||
15 | incapacitated from
pursuing his usual and customary line of | ||||||
16 | employment, he shall, except in
cases compensated under the | ||||||
17 | specific schedule set forth in paragraph (e)
of this Section, | ||||||
18 | receive compensation for the duration of his
disability, | ||||||
19 | subject to the limitations as to maximum amounts fixed in
| ||||||
20 | paragraph (b) of this Section, equal to 66-2/3% of the | ||||||
21 | difference
between the average amount which he would be able to | ||||||
22 | earn in the full
performance of his duties in the occupation in | ||||||
23 | which he was engaged at
the time of the accident and the | ||||||
24 | average amount which he is earning or
is able to earn in some | ||||||
25 | suitable employment or business after the accident. For | ||||||
26 | accidental injuries that occur on and after the effective date |
| |||||||
| |||||||
1 | of this amendatory Act of the 97th General Assembly, an award | ||||||
2 | for wage differential under this subsection shall be effective | ||||||
3 | only until the employee reaches the age of 67 or 5 years from | ||||||
4 | the date the award becomes final, whichever is later.
| ||||||
5 | 2. If, as a result of the accident, the employee sustains | ||||||
6 | serious
and permanent injuries not covered by paragraphs (c) | ||||||
7 | and (e) of this
Section or having sustained injuries covered by | ||||||
8 | the aforesaid
paragraphs (c) and (e), he shall have sustained | ||||||
9 | in addition thereto
other injuries which injuries do not | ||||||
10 | incapacitate him from pursuing the
duties of his employment but | ||||||
11 | which would disable him from pursuing other
suitable | ||||||
12 | occupations, or which have otherwise resulted in physical
| ||||||
13 | impairment; or if such injuries partially incapacitate him from | ||||||
14 | pursuing
the duties of his usual and customary line of | ||||||
15 | employment but do not
result in an impairment of earning | ||||||
16 | capacity, or having resulted in an
impairment of earning | ||||||
17 | capacity, the employee elects to waive his right
to recover | ||||||
18 | under the foregoing subparagraph 1 of paragraph (d) of this
| ||||||
19 | Section then in any of the foregoing events, he shall receive | ||||||
20 | in
addition to compensation for temporary total disability | ||||||
21 | under paragraph
(b) of this Section, compensation at the rate | ||||||
22 | provided in subparagraph 2.1
of paragraph (b) of this Section | ||||||
23 | for that percentage of 500 weeks that
the partial disability | ||||||
24 | resulting from the injuries covered by this
paragraph bears to | ||||||
25 | total disability. If the employee shall have
sustained a | ||||||
26 | fracture of one or more vertebra or fracture of the skull,
the |
| |||||||
| |||||||
1 | amount of compensation allowed under this Section shall be not | ||||||
2 | less
than 6 weeks for a fractured skull and 6 weeks for each | ||||||
3 | fractured
vertebra, and in the event the employee shall have | ||||||
4 | sustained a fracture
of any of the following facial bones: | ||||||
5 | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||||||
6 | mandible, the amount of compensation allowed under
this Section | ||||||
7 | shall be not less than 2 weeks for each such fractured
bone, | ||||||
8 | and for a fracture of each transverse process not less than 3
| ||||||
9 | weeks. In the event such injuries shall result in the loss of a | ||||||
10 | kidney,
spleen or lung, the amount of compensation allowed | ||||||
11 | under this Section
shall be not less than 10 weeks for each | ||||||
12 | such organ. Compensation
awarded under this subparagraph 2 | ||||||
13 | shall not take into consideration
injuries covered under | ||||||
14 | paragraphs (c) and (e) of this Section and the
compensation | ||||||
15 | provided in this paragraph shall not affect the employee's
| ||||||
16 | right to compensation payable under paragraphs (b), (c) and (e) | ||||||
17 | of this
Section for the disabilities therein covered.
| ||||||
18 | (e) For accidental injuries in the following schedule, the | ||||||
19 | employee
shall receive compensation for the period of temporary | ||||||
20 | total incapacity
for work resulting from such accidental | ||||||
21 | injury, under subparagraph 1 of
paragraph (b) of this Section, | ||||||
22 | and shall receive in addition thereto
compensation for a | ||||||
23 | further period for the specific loss herein
mentioned, but | ||||||
24 | shall not receive any compensation under any other
provisions | ||||||
25 | of this Act. The following listed amounts apply to either
the | ||||||
26 | loss of or the permanent and complete loss of use of the member
|
| |||||||
| |||||||
1 | specified, such compensation for the length of time as follows:
| ||||||
2 | 1. Thumb- | ||||||
3 | 70 weeks if the accidental injury occurs on or | ||||||
4 | after the effective date of this amendatory Act of the | ||||||
5 | 94th General Assembly
but before February
1, 2006.
| ||||||
6 | 76
weeks if the accidental injury occurs on or | ||||||
7 | after February
1, 2006.
| ||||||
8 | 2. First, or index finger- | ||||||
9 | 40 weeks if the accidental injury occurs on or | ||||||
10 | after the effective date of this amendatory Act of the | ||||||
11 | 94th General Assembly
but before February
1, 2006.
| ||||||
12 | 43
weeks if the accidental injury occurs on or | ||||||
13 | after February
1, 2006.
| ||||||
14 | 3. Second, or middle finger- | ||||||
15 | 35 weeks if the accidental injury occurs on or | ||||||
16 | after the effective date of this amendatory Act of the | ||||||
17 | 94th General Assembly
but before February
1, 2006.
| ||||||
18 | 38
weeks if the accidental injury occurs on or | ||||||
19 | after February
1, 2006.
| ||||||
20 | 4. Third, or ring finger- | ||||||
21 | 25 weeks if the accidental injury occurs on or | ||||||
22 | after the effective date of this amendatory Act of the | ||||||
23 | 94th General Assembly
but before February
1, 2006.
| ||||||
24 | 27
weeks if the accidental injury occurs on or | ||||||
25 | after February
1, 2006.
| ||||||
26 | 5. Fourth, or little finger- |
| |||||||
| |||||||
1 | 20 weeks if the accidental injury occurs on or | ||||||
2 | after the effective date of this amendatory Act of the | ||||||
3 | 94th General Assembly
but before February
1, 2006.
| ||||||
4 | 22
weeks if the accidental injury occurs on or | ||||||
5 | after February
1, 2006.
| ||||||
6 | 6. Great toe- | ||||||
7 | 35 weeks if the accidental injury occurs on or | ||||||
8 | after the effective date of this amendatory Act of the | ||||||
9 | 94th General Assembly
but before February
1, 2006.
| ||||||
10 | 38
weeks if the accidental injury occurs on or | ||||||
11 | after February
1, 2006.
| ||||||
12 | 7. Each toe other than great toe- | ||||||
13 | 12 weeks if the accidental injury occurs on or | ||||||
14 | after the effective date of this amendatory Act of the | ||||||
15 | 94th General Assembly
but before February
1, 2006.
| ||||||
16 | 13
weeks if the accidental injury occurs on or | ||||||
17 | after February
1, 2006.
| ||||||
18 | 8. The loss of the first or distal phalanx of the thumb | ||||||
19 | or of any
finger or toe shall be considered to be equal to | ||||||
20 | the loss of one-half of
such thumb, finger or toe and the | ||||||
21 | compensation payable shall be one-half
of the amount above | ||||||
22 | specified. The loss of more than one phalanx shall
be | ||||||
23 | considered as the loss of the entire thumb, finger or toe. | ||||||
24 | In no
case shall the amount received for more than one | ||||||
25 | finger exceed the
amount provided in this schedule for the | ||||||
26 | loss of a hand.
|
| |||||||
| |||||||
1 | 9. Hand- | ||||||
2 | 190 weeks if the accidental injury occurs on or | ||||||
3 | after the effective date of this amendatory Act of the | ||||||
4 | 94th General Assembly
but before February
1, 2006.
| ||||||
5 | 205
weeks if the accidental injury occurs on or | ||||||
6 | after February
1, 2006. | ||||||
7 | The loss of 2 or more digits, or one or more
phalanges | ||||||
8 | of 2 or more digits, of a hand may be compensated on the | ||||||
9 | basis
of partial loss of use of a hand, provided, further, | ||||||
10 | that the loss of 4
digits, or the loss of use of 4 digits, | ||||||
11 | in the same hand shall
constitute the complete loss of a | ||||||
12 | hand.
| ||||||
13 | 10. Arm- | ||||||
14 | 235 weeks if the accidental injury occurs on or | ||||||
15 | after the effective date of this amendatory Act of the | ||||||
16 | 94th General Assembly
but before February
1, 2006.
| ||||||
17 | 253
weeks if the accidental injury occurs on or | ||||||
18 | after February
1, 2006. | ||||||
19 | Where an accidental injury results in the
amputation of | ||||||
20 | an arm below the elbow, such injury shall be compensated
as | ||||||
21 | a loss of an arm. Where an accidental injury results in the
| ||||||
22 | amputation of an arm above the elbow, compensation for an | ||||||
23 | additional 15 weeks (if the accidental injury occurs on or | ||||||
24 | after the effective date of this amendatory Act of the 94th | ||||||
25 | General Assembly
but before February
1, 2006) or an | ||||||
26 | additional 17
weeks (if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after February
1, 2006) shall be paid, except where the | ||||||
2 | accidental injury results in the
amputation of an arm at | ||||||
3 | the shoulder joint, or so close to shoulder
joint that an | ||||||
4 | artificial arm cannot be used, or results in the
| ||||||
5 | disarticulation of an arm at the shoulder joint, in which | ||||||
6 | case
compensation for an additional 65 weeks (if the | ||||||
7 | accidental injury occurs on or after the effective date of | ||||||
8 | this amendatory Act of the 94th General Assembly
but before | ||||||
9 | February
1, 2006) or an additional 70
weeks (if the | ||||||
10 | accidental injury occurs on or after February
1, 2006)
| ||||||
11 | shall be paid.
| ||||||
12 | 11. Foot- | ||||||
13 | 155 weeks if the accidental injury occurs on or | ||||||
14 | after the effective date of this amendatory Act of the | ||||||
15 | 94th General Assembly
but before February
1, 2006.
| ||||||
16 | 167
weeks if the accidental injury occurs on or | ||||||
17 | after February
1, 2006.
| ||||||
18 | 12. Leg- | ||||||
19 | 200 weeks if the accidental injury occurs on or | ||||||
20 | after the effective date of this amendatory Act of the | ||||||
21 | 94th General Assembly
but before February
1, 2006.
| ||||||
22 | 215
weeks if the accidental injury occurs on or | ||||||
23 | after February
1, 2006. | ||||||
24 | Where an accidental injury results in the
amputation of | ||||||
25 | a leg below the knee, such injury shall be compensated as
| ||||||
26 | loss of a leg. Where an accidental injury results in the |
| |||||||
| |||||||
1 | amputation of a
leg above the knee, compensation for an | ||||||
2 | additional 25 weeks (if the accidental injury occurs on or | ||||||
3 | after the effective date of this amendatory Act of the 94th | ||||||
4 | General Assembly
but before February
1, 2006) or an | ||||||
5 | additional 27
weeks (if the accidental injury occurs on or | ||||||
6 | after February
1, 2006) shall be
paid, except where the | ||||||
7 | accidental injury results in the amputation of a
leg at the | ||||||
8 | hip joint, or so close to the hip joint that an artificial
| ||||||
9 | leg cannot be used, or results in the disarticulation of a | ||||||
10 | leg at the
hip joint, in which case compensation for an | ||||||
11 | additional 75 weeks (if the accidental injury occurs on or | ||||||
12 | after the effective date of this amendatory Act of the 94th | ||||||
13 | General Assembly
but before February
1, 2006) or an | ||||||
14 | additional 81
weeks (if the accidental injury occurs on or | ||||||
15 | after February
1, 2006) shall
be paid.
| ||||||
16 | 13. Eye- | ||||||
17 | 150 weeks if the accidental injury occurs on or | ||||||
18 | after the effective date of this amendatory Act of the | ||||||
19 | 94th General Assembly
but before February
1, 2006.
| ||||||
20 | 162
weeks if the accidental injury occurs on or | ||||||
21 | after February
1, 2006. | ||||||
22 | Where an accidental injury results in the
enucleation | ||||||
23 | of an eye, compensation for an additional 10 weeks (if the | ||||||
24 | accidental injury occurs on or after the effective date of | ||||||
25 | this amendatory Act of the 94th General Assembly
but before | ||||||
26 | February
1, 2006) or an additional 11
weeks (if the |
| |||||||
| |||||||
1 | accidental injury occurs on or after February
1, 2006)
| ||||||
2 | shall be
paid.
| ||||||
3 | 14. Loss of hearing of one ear- | ||||||
4 | 50 weeks if the accidental injury occurs on or | ||||||
5 | after the effective date of this amendatory Act of the | ||||||
6 | 94th General Assembly
but before February
1, 2006.
| ||||||
7 | 54
weeks if the accidental injury occurs on or | ||||||
8 | after February
1, 2006.
| ||||||
9 | Total and permanent loss of
hearing of both ears- | ||||||
10 | 200 weeks if the accidental injury occurs on or | ||||||
11 | after the effective date of this amendatory Act of the | ||||||
12 | 94th General Assembly
but before February
1, 2006. | ||||||
13 | 215
weeks if the accidental injury occurs on or | ||||||
14 | after February
1, 2006.
| ||||||
15 | 15. Testicle- | ||||||
16 | 50 weeks if the accidental injury occurs on or | ||||||
17 | after the effective date of this amendatory Act of the | ||||||
18 | 94th General Assembly
but before February
1, 2006.
| ||||||
19 | 54
weeks if the accidental injury occurs on or | ||||||
20 | after February
1, 2006.
| ||||||
21 | Both testicles- | ||||||
22 | 150 weeks if the accidental injury occurs on or | ||||||
23 | after the effective date of this amendatory Act of the | ||||||
24 | 94th General Assembly
but before February
1, 2006.
| ||||||
25 | 162
weeks if the accidental injury occurs on or | ||||||
26 | after February
1, 2006.
|
| |||||||
| |||||||
1 | 16. For the permanent partial loss of use of a member | ||||||
2 | or sight of an
eye, or hearing of an ear, compensation | ||||||
3 | during that proportion of the
number of weeks in the | ||||||
4 | foregoing schedule provided for the loss of such
member or | ||||||
5 | sight of an eye, or hearing of an ear, which the partial | ||||||
6 | loss
of use thereof bears to the total loss of use of such | ||||||
7 | member, or sight
of eye, or hearing of an ear.
| ||||||
8 | (a) Loss of hearing for compensation purposes | ||||||
9 | shall be
confined to the frequencies of 1,000, 2,000 | ||||||
10 | and 3,000 cycles per second.
Loss of hearing ability | ||||||
11 | for frequency tones above 3,000 cycles per second
are | ||||||
12 | not to be considered as constituting disability for | ||||||
13 | hearing.
| ||||||
14 | (b) The percent of hearing loss, for purposes of | ||||||
15 | the
determination of compensation claims for | ||||||
16 | occupational deafness,
shall be calculated as the | ||||||
17 | average in decibels for the thresholds
of hearing for | ||||||
18 | the frequencies of 1,000, 2,000 and 3,000 cycles per | ||||||
19 | second.
Pure tone air conduction audiometric | ||||||
20 | instruments, approved by
nationally recognized | ||||||
21 | authorities in this field, shall be used for measuring
| ||||||
22 | hearing loss. If the losses of hearing average 30 | ||||||
23 | decibels or less in the
3 frequencies, such losses of | ||||||
24 | hearing shall not then constitute any
compensable | ||||||
25 | hearing disability. If the losses of hearing average 85
| ||||||
26 | decibels or more in the 3 frequencies, then the same |
| ||||||||||||||
| ||||||||||||||
1 | shall constitute and
be total or 100% compensable | |||||||||||||
2 | hearing loss.
| |||||||||||||
3 | (c) In measuring hearing impairment, the lowest | |||||||||||||
4 | measured
losses in each of the 3 frequencies shall be | |||||||||||||
5 | added together and
divided by 3 to determine the | |||||||||||||
6 | average decibel loss. For every decibel
of loss | |||||||||||||
7 | exceeding 30 decibels an allowance of 1.82% shall be | |||||||||||||
8 | made up to
the maximum of 100% which is reached at 85 | |||||||||||||
9 | decibels.
| |||||||||||||
10 | (d) If a hearing loss is established to have | |||||||||||||
11 | existed on July 1, 1975 by
audiometric testing the | |||||||||||||
12 | employer shall not be liable for the previous loss
so | |||||||||||||
13 | established nor shall he be liable for any loss for | |||||||||||||
14 | which compensation
has been paid or awarded.
| |||||||||||||
15 | (e) No consideration shall be given to the question | |||||||||||||
16 | of
whether or not the ability of an employee to | |||||||||||||
17 | understand speech
is improved by the use of a hearing | |||||||||||||
18 | aid.
| |||||||||||||
19 | (f) No claim for loss of hearing due to industrial | |||||||||||||
20 | noise
shall be brought against an employer or allowed | |||||||||||||
21 | unless the employee has
been exposed for a period of | |||||||||||||
22 | time sufficient to cause permanent impairment
to noise | |||||||||||||
23 | levels in excess of the following:
| |||||||||||||
|
| ||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||
9 | This subparagraph (f) shall not be applied in cases of | |||||||||||||||||||||||||||||||||
10 | hearing loss
resulting from trauma or explosion.
| |||||||||||||||||||||||||||||||||
11 | 17. In computing the compensation to be paid to any | |||||||||||||||||||||||||||||||||
12 | employee who,
before the accident for which he claims | |||||||||||||||||||||||||||||||||
13 | compensation, had before that
time sustained an injury | |||||||||||||||||||||||||||||||||
14 | resulting in the loss by amputation or partial
loss by | |||||||||||||||||||||||||||||||||
15 | amputation of any member, including hand, arm, thumb or | |||||||||||||||||||||||||||||||||
16 | fingers,
leg, foot or any toes, such loss or partial loss | |||||||||||||||||||||||||||||||||
17 | of any such member
shall be deducted from any award made | |||||||||||||||||||||||||||||||||
18 | for the subsequent injury. For
the permanent loss of use or | |||||||||||||||||||||||||||||||||
19 | the permanent partial loss of use of any
such member or the | |||||||||||||||||||||||||||||||||
20 | partial loss of sight of an eye, for which
compensation has | |||||||||||||||||||||||||||||||||
21 | been paid, then such loss shall be taken into
consideration | |||||||||||||||||||||||||||||||||
22 | and deducted from any award for the subsequent injury.
| |||||||||||||||||||||||||||||||||
23 | 18. The specific case of loss of both hands, both arms, | |||||||||||||||||||||||||||||||||
24 | or both
feet, or both legs, or both eyes, or of any two | |||||||||||||||||||||||||||||||||
25 | thereof, or the
permanent and complete loss of the use | |||||||||||||||||||||||||||||||||
26 | thereof, constitutes total and
permanent disability, to be |
| |||||||
| |||||||
1 | compensated according to the compensation
fixed by | ||||||
2 | paragraph (f) of this Section. These specific cases of | ||||||
3 | total
and permanent disability do not exclude other cases.
| ||||||
4 | Any employee who has previously suffered the loss or | ||||||
5 | permanent and
complete loss of the use of any of such | ||||||
6 | members, and in a subsequent
independent accident loses | ||||||
7 | another or suffers the permanent and complete
loss of the | ||||||
8 | use of any one of such members the employer for whom the
| ||||||
9 | injured employee is working at the time of the last | ||||||
10 | independent accident
is liable to pay compensation only for | ||||||
11 | the loss or permanent and
complete loss of the use of the | ||||||
12 | member occasioned by the last
independent accident.
| ||||||
13 | 19. In a case of specific loss and the subsequent death | ||||||
14 | of such
injured employee from other causes than such injury | ||||||
15 | leaving a widow,
widower, or dependents surviving before | ||||||
16 | payment or payment in full for
such injury, then the amount | ||||||
17 | due for such injury is payable to the widow
or widower and, | ||||||
18 | if there be no widow or widower, then to such
dependents, | ||||||
19 | in the proportion which such dependency bears to total
| ||||||
20 | dependency.
| ||||||
21 | Beginning July 1, 1980, and every 6 months thereafter, the | ||||||
22 | Commission
shall examine the Second Injury Fund and when, after | ||||||
23 | deducting all
advances or loans made to such Fund, the amount | ||||||
24 | therein is $500,000
then the amount required to be paid by | ||||||
25 | employers pursuant to paragraph
(f) of Section 7 shall be | ||||||
26 | reduced by one-half. When the Second Injury Fund
reaches the |
| |||||||
| |||||||
1 | sum of $600,000 then the payments shall cease entirely.
| ||||||
2 | However, when the Second Injury Fund has been reduced to | ||||||
3 | $400,000, payment
of one-half of the amounts required by | ||||||
4 | paragraph (f) of Section 7
shall be resumed, in the manner | ||||||
5 | herein provided, and when the Second Injury
Fund has been | ||||||
6 | reduced to $300,000, payment of the full amounts required by
| ||||||
7 | paragraph (f) of Section 7 shall be resumed, in the manner | ||||||
8 | herein provided.
The Commission shall make the changes in | ||||||
9 | payment effective by
general order, and the changes in payment | ||||||
10 | become immediately effective
for all cases coming before the | ||||||
11 | Commission thereafter either by
settlement agreement or final | ||||||
12 | order, irrespective of the date of the
accidental injury.
| ||||||
13 | On August 1, 1996 and on February 1 and August 1 of each | ||||||
14 | subsequent year, the Commission
shall examine the special fund | ||||||
15 | designated as the "Rate
Adjustment Fund" and when, after | ||||||
16 | deducting all advances or loans made to
said fund, the amount | ||||||
17 | therein is $4,000,000, the amount required to be
paid by | ||||||
18 | employers pursuant to paragraph (f) of Section 7 shall be
| ||||||
19 | reduced by one-half. When the Rate Adjustment Fund reaches the | ||||||
20 | sum of
$5,000,000 the payment therein shall cease entirely. | ||||||
21 | However, when said
Rate Adjustment Fund has been reduced to | ||||||
22 | $3,000,000 the amounts required by
paragraph (f) of Section 7 | ||||||
23 | shall be resumed in the manner herein provided.
| ||||||
24 | (f) In case of complete disability, which renders the | ||||||
25 | employee
wholly and permanently incapable of work, or in the | ||||||
26 | specific case of
total and permanent disability as provided in |
| |||||||
| |||||||
1 | subparagraph 18 of
paragraph (e) of this Section, compensation | ||||||
2 | shall be payable at the rate
provided in subparagraph 2 of | ||||||
3 | paragraph (b) of this Section for life.
| ||||||
4 | An employee entitled to benefits under paragraph (f) of | ||||||
5 | this Section
shall also be entitled to receive from the Rate | ||||||
6 | Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||||||
7 | supplementary benefits
provided in paragraph (g) of this | ||||||
8 | Section 8.
| ||||||
9 | If any employee who receives an award under this paragraph | ||||||
10 | afterwards
returns to work or is able to do so, and earns or is | ||||||
11 | able to earn as
much as before the accident, payments under | ||||||
12 | such award shall cease. If
such employee returns to work, or is | ||||||
13 | able to do so, and earns or is able
to earn part but not as much | ||||||
14 | as before the accident, such award shall be
modified so as to | ||||||
15 | conform to an award under paragraph (d) of this
Section. If | ||||||
16 | such award is terminated or reduced under the provisions of
| ||||||
17 | this paragraph, such employees have the right at any time | ||||||
18 | within 30
months after the date of such termination or | ||||||
19 | reduction to file petition
with the Commission for the purpose | ||||||
20 | of determining whether any
disability exists as a result of the | ||||||
21 | original accidental injury and the
extent thereof.
| ||||||
22 | Disability as enumerated in subdivision 18, paragraph (e) | ||||||
23 | of this
Section is considered complete disability.
| ||||||
24 | If an employee who had previously incurred loss or the | ||||||
25 | permanent and
complete loss of use of one member, through the | ||||||
26 | loss or the permanent
and complete loss of the use of one hand, |
| |||||||
| |||||||
1 | one arm, one foot, one leg, or
one eye, incurs permanent and | ||||||
2 | complete disability through the loss or
the permanent and | ||||||
3 | complete loss of the use of another member, he shall
receive, | ||||||
4 | in addition to the compensation payable by the employer and
| ||||||
5 | after such payments have ceased, an amount from the Second | ||||||
6 | Injury Fund
provided for in paragraph (f) of Section 7, which, | ||||||
7 | together with the
compensation payable from the employer in | ||||||
8 | whose employ he was when the
last accidental injury was | ||||||
9 | incurred, will equal the amount payable for
permanent and | ||||||
10 | complete disability as provided in this paragraph of this
| ||||||
11 | Section.
| ||||||
12 | The custodian of the Second Injury Fund provided for in | ||||||
13 | paragraph (f)
of Section 7 shall be joined with the employer as | ||||||
14 | a party respondent in
the application for adjustment of claim. | ||||||
15 | The application for adjustment
of claim shall state briefly and | ||||||
16 | in general terms the approximate time
and place and manner of | ||||||
17 | the loss of the first member.
| ||||||
18 | In its award the Commission or the Arbitrator shall | ||||||
19 | specifically find
the amount the injured employee shall be | ||||||
20 | weekly paid, the number of
weeks compensation which shall be | ||||||
21 | paid by the employer, the date upon
which payments begin out of | ||||||
22 | the Second Injury Fund provided for in
paragraph (f) of Section | ||||||
23 | 7 of this Act, the length of time the weekly
payments continue, | ||||||
24 | the date upon which the pension payments commence and
the | ||||||
25 | monthly amount of the payments. The Commission shall 30 days | ||||||
26 | after
the date upon which payments out of the Second Injury |
| |||||||
| |||||||
1 | Fund have begun as
provided in the award, and every month | ||||||
2 | thereafter, prepare and submit to
the State Comptroller a | ||||||
3 | voucher for payment for all compensation accrued
to that date | ||||||
4 | at the rate fixed by the Commission. The State Comptroller
| ||||||
5 | shall draw a warrant to the injured employee along with a | ||||||
6 | receipt to be
executed by the injured employee and returned to | ||||||
7 | the Commission. The
endorsed warrant and receipt is a full and | ||||||
8 | complete acquittance to the
Commission for the payment out of | ||||||
9 | the Second Injury Fund. No other
appropriation or warrant is | ||||||
10 | necessary for payment out of the Second
Injury Fund. The Second | ||||||
11 | Injury Fund is appropriated for the purpose of
making payments | ||||||
12 | according to the terms of the awards.
| ||||||
13 | As of July 1, 1980 to July 1, 1982, all claims against and | ||||||
14 | obligations
of the Second Injury Fund shall become claims | ||||||
15 | against and obligations of
the Rate Adjustment Fund to the | ||||||
16 | extent there is insufficient money in the
Second Injury Fund to | ||||||
17 | pay such claims and obligations. In that case, all
references | ||||||
18 | to "Second Injury Fund" in this Section shall also include the
| ||||||
19 | Rate Adjustment Fund.
| ||||||
20 | (g) Every award for permanent total disability entered by | ||||||
21 | the
Commission on and after July 1, 1965 under which | ||||||
22 | compensation payments
shall become due and payable after the | ||||||
23 | effective date of this amendatory
Act, and every award for | ||||||
24 | death benefits or permanent total disability
entered by the | ||||||
25 | Commission on and after the effective date of this
amendatory | ||||||
26 | Act shall be subject to annual adjustments as to the amount
of |
| |||||||
| |||||||
1 | the compensation rate therein provided. Such adjustments shall | ||||||
2 | first
be made on July 15, 1977, and all awards made and entered | ||||||
3 | prior to July
1, 1975 and on July 15 of each year
thereafter. | ||||||
4 | In all other cases such adjustment shall be made on July 15
of | ||||||
5 | the second year next following the date of the entry of the | ||||||
6 | award and
shall further be made on July 15 annually thereafter. | ||||||
7 | If during the
intervening period from the date of the entry of | ||||||
8 | the award, or the last
periodic adjustment, there shall have | ||||||
9 | been an increase in the State's
average weekly wage in covered | ||||||
10 | industries under the Unemployment
Insurance Act, the weekly | ||||||
11 | compensation rate shall be proportionately
increased by the | ||||||
12 | same percentage as the percentage of increase in the
State's | ||||||
13 | 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. | ||||||
18 | Such increase
shall be paid in the same manner as herein | ||||||
19 | provided for payments under
the Second Injury Fund to the | ||||||
20 | injured employee, or his dependents, as
the case may be, out of | ||||||
21 | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||||||
22 | of this Act. Payments shall be made at
the same intervals as | ||||||
23 | provided in the award or, at the option of the
Commission, may | ||||||
24 | be made in quarterly payment on the 15th day of January,
April, | ||||||
25 | July and October of each year. In the event of a decrease in
| ||||||
26 | such average weekly wage there shall be no change in the then |
| |||||||
| |||||||
1 | existing
compensation rate. The within paragraph shall not | ||||||
2 | apply to cases where
there is disputed liability and in which a | ||||||
3 | compromise lump sum settlement
between the employer and the | ||||||
4 | injured employee, or his dependents, as the
case may be, has | ||||||
5 | been duly approved by the Illinois Workers' Compensation
| ||||||
6 | Commission.
| ||||||
7 | Provided, that in cases of awards entered by the Commission | ||||||
8 | for
injuries occurring before July 1, 1975, the increases in | ||||||
9 | the
compensation rate adjusted under the foregoing provision of | ||||||
10 | this
paragraph (g) shall be limited to increases in the State's | ||||||
11 | average
weekly wage in covered industries under the | ||||||
12 | Unemployment Insurance Act
occurring after July 1, 1975.
| ||||||
13 | For every accident occurring on or after July 20, 2005 but | ||||||
14 | before the effective date of this amendatory Act of the 94th | ||||||
15 | General Assembly (Senate Bill 1283 of the 94th General | ||||||
16 | Assembly), the annual adjustments to the compensation rate in | ||||||
17 | awards for death benefits or permanent total disability, as | ||||||
18 | provided in this Act, shall be paid by the employer. The | ||||||
19 | adjustment shall be made by the employer on July 15 of the | ||||||
20 | second year next following the date of the entry of the award | ||||||
21 | and shall further be made on July 15 annually thereafter. If | ||||||
22 | during the intervening period from the date of the entry of the | ||||||
23 | award, or the last periodic adjustment, there shall have been | ||||||
24 | an increase in the State's average weekly wage in covered | ||||||
25 | industries under the Unemployment Insurance Act, the employer | ||||||
26 | shall increase the weekly compensation rate proportionately by |
| |||||||
| |||||||
1 | the same percentage as the percentage of increase in the | ||||||
2 | State's average weekly wage in covered industries under the | ||||||
3 | Unemployment Insurance Act. The increase in the compensation | ||||||
4 | rate under this paragraph shall in no event bring the total | ||||||
5 | compensation rate to an amount greater than the prevailing | ||||||
6 | maximum rate at the time that the annual adjustment is made. In | ||||||
7 | the event of a decrease in such average weekly wage there shall | ||||||
8 | be no change in the then existing compensation rate. Such | ||||||
9 | increase shall be paid by the employer in the same manner and | ||||||
10 | at the same intervals as the payment of compensation in the | ||||||
11 | award. This paragraph shall not apply to cases where there is | ||||||
12 | disputed liability and in which a compromise lump sum | ||||||
13 | settlement between the employer and the injured employee, or | ||||||
14 | his or her dependents, as the case may be, has been duly | ||||||
15 | approved by the Illinois Workers' Compensation Commission. | ||||||
16 | The annual adjustments for every award of death benefits or | ||||||
17 | permanent total disability involving accidents occurring | ||||||
18 | before July 20, 2005 and accidents occurring on or after the | ||||||
19 | effective date of this amendatory Act of the 94th General | ||||||
20 | Assembly (Senate Bill 1283 of the 94th General Assembly) shall | ||||||
21 | continue to be paid from the Rate Adjustment Fund pursuant to | ||||||
22 | this paragraph and Section 7(f) of this Act.
| ||||||
23 | (h) In case death occurs from any cause before the total
| ||||||
24 | compensation to which the employee would have been entitled has | ||||||
25 | been
paid, then in case the employee leaves any widow, widower, | ||||||
26 | child, parent
(or any grandchild, grandparent or other lineal |
| |||||||
| |||||||
1 | heir or any collateral
heir dependent at the time of the | ||||||
2 | accident upon the earnings of the
employee to the extent of 50% | ||||||
3 | or more of total dependency) such
compensation shall be paid to | ||||||
4 | the beneficiaries of the deceased employee
and distributed as | ||||||
5 | provided in paragraph (g) of Section 7.
| ||||||
6 | (h-1) In case an injured employee is under legal disability
| ||||||
7 | at the time when any right or privilege accrues to him or her | ||||||
8 | under this
Act, a guardian may be appointed pursuant to law, | ||||||
9 | and may, on behalf
of such person under legal disability, claim | ||||||
10 | and exercise any
such right or privilege with the same effect | ||||||
11 | as if the employee himself
or herself had claimed or exercised | ||||||
12 | the right or privilege. No limitations
of time provided by this | ||||||
13 | Act run so long as the employee who is under legal
disability | ||||||
14 | is without a conservator or guardian.
| ||||||
15 | (i) In case the injured employee is under 16 years of age | ||||||
16 | at the
time of the accident and is illegally employed, the | ||||||
17 | amount of
compensation payable under paragraphs (b), (c), (d), | ||||||
18 | (e) and (f) of this
Section is increased 50%.
| ||||||
19 | However, where an employer has on file an employment | ||||||
20 | certificate
issued pursuant to the Child Labor Law or work | ||||||
21 | permit issued pursuant
to the Federal Fair Labor Standards Act, | ||||||
22 | as amended, or a birth
certificate properly and duly issued, | ||||||
23 | such certificate, permit or birth
certificate is conclusive | ||||||
24 | evidence as to the age of the injured minor
employee for the | ||||||
25 | purposes of this Section.
| ||||||
26 | Nothing herein contained repeals or amends the provisions |
| |||||||
| |||||||
1 | of the
Child Labor Law relating to the employment of minors | ||||||
2 | under the age of 16 years.
| ||||||
3 | (j) 1. In the event the injured employee receives benefits,
| ||||||
4 | including medical, surgical or hospital benefits under any | ||||||
5 | group plan
covering non-occupational disabilities contributed | ||||||
6 | to wholly or
partially by the employer, which benefits should | ||||||
7 | not have been payable
if any rights of recovery existed under | ||||||
8 | this Act, then such amounts so
paid to the employee from any | ||||||
9 | such group plan as shall be consistent
with, and limited to, | ||||||
10 | the provisions of paragraph 2 hereof, shall be
credited to or | ||||||
11 | against any compensation payment for temporary total
| ||||||
12 | incapacity for work or any medical, surgical or hospital | ||||||
13 | benefits made
or to be made under this Act. In such event, the | ||||||
14 | period of time for
giving notice of accidental injury and | ||||||
15 | filing application for adjustment
of claim does not commence to | ||||||
16 | run until the termination of such
payments. This paragraph does | ||||||
17 | not apply to payments made under any
group plan which would | ||||||
18 | have been payable irrespective of an accidental
injury under | ||||||
19 | this Act. Any employer receiving such credit shall keep
such | ||||||
20 | employee safe and harmless from any and all claims or | ||||||
21 | liabilities
that may be made against him by reason of having | ||||||
22 | received such payments
only to the extent of such credit.
| ||||||
23 | Any excess benefits paid to or on behalf of a State | ||||||
24 | employee by the
State Employees' Retirement System under | ||||||
25 | Article 14 of the Illinois Pension
Code on a death claim or | ||||||
26 | disputed disability claim shall be credited
against any |
| |||||||
| |||||||
1 | payments made or to be made by the State of Illinois to or on
| ||||||
2 | behalf of such employee under this Act, except for payments for | ||||||
3 | medical
expenses which have already been incurred at the time | ||||||
4 | of the award. The
State of Illinois shall directly reimburse | ||||||
5 | the State Employees' Retirement
System to the extent of such | ||||||
6 | credit.
| ||||||
7 | 2. Nothing contained in this Act shall be construed to give | ||||||
8 | the
employer or the insurance carrier the right to credit for | ||||||
9 | any benefits
or payments received by the employee other than | ||||||
10 | compensation payments
provided by this Act, and where the | ||||||
11 | employee receives payments other
than compensation payments, | ||||||
12 | whether as full or partial salary, group
insurance benefits, | ||||||
13 | bonuses, annuities or any other payments, the
employer or | ||||||
14 | insurance carrier shall receive credit for each such payment
| ||||||
15 | only to the extent of the compensation that would have been | ||||||
16 | payable
during the period covered by such payment.
| ||||||
17 | 3. The extension of time for the filing of an Application | ||||||
18 | for
Adjustment of Claim as provided in paragraph 1 above shall | ||||||
19 | not apply to
those cases where the time for such filing had | ||||||
20 | expired prior to the date
on which payments or benefits | ||||||
21 | enumerated herein have been initiated or
resumed. Provided | ||||||
22 | however that this paragraph 3 shall apply only to
cases wherein | ||||||
23 | the payments or benefits hereinabove enumerated shall be
| ||||||
24 | received after July 1, 1969.
| ||||||
25 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||||||
26 | 94-695, eff. 11-16-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/8.1 new) | ||||||
2 | Sec. 8.1. Determination of permanent partial disability. | ||||||
3 | For accidental injuries that occur on or after December 31, | ||||||
4 | 2011, permanent partial disability shall be established using | ||||||
5 | the following criteria: | ||||||
6 | (a) A physician licensed to practice medicine in all of its | ||||||
7 | branches shall certify the level of impairment in writing. The | ||||||
8 | certification shall include a demonstration using medically | ||||||
9 | defined objective measurements of impairment that include, but | ||||||
10 | are not limited to: loss of range of motion, loss of strength, | ||||||
11 | and measured atrophy of tissue mass consistent with the injury. | ||||||
12 | The most current edition of the American Medical Association's | ||||||
13 | "Guides to the Evaluation of Permanent Impairment" shall be | ||||||
14 | applied in determining the level of impairment. | ||||||
15 | (b) The certification of the physician shall establish the | ||||||
16 | level of impairment. | ||||||
17 | (c) In determining the level of disability, the Commission | ||||||
18 | shall base their determination on the level of impairment as | ||||||
19 | certified by the physician. The Commission may deviate from the | ||||||
20 | level of impairment only using the following additional | ||||||
21 | factors: (i) the occupation of the injured employee, including | ||||||
22 | whether the injured employee is able to perform their previous | ||||||
23 | work activities, and (ii) the employee's future earning | ||||||
24 | capacity. In determining the level of disability, the reasons | ||||||
25 | for any deviation from the level of impairment as certified by |
| |||||||
| |||||||
1 | the physician licensed to practice medicine in all of its | ||||||
2 | branches must be explained in detail in a written order and | ||||||
3 | proven by a preponderance of the evidence.
| ||||||
4 | (820 ILCS 305/8.2)
| ||||||
5 | Sec. 8.2. Fee schedule.
| ||||||
6 | (a) Except as provided for in subsection (c), for | ||||||
7 | procedures, treatments, or services covered under this Act and | ||||||
8 | rendered or to be rendered on and after February 1, 2006, the | ||||||
9 | maximum allowable payment shall be 90% of the 80th percentile | ||||||
10 | of charges and fees as determined by the Commission utilizing | ||||||
11 | information provided by employers' and insurers' national | ||||||
12 | databases, with a minimum of 12,000,000 Illinois line item | ||||||
13 | charges and fees comprised of health care provider and hospital | ||||||
14 | charges and fees as of August 1, 2004 but not earlier than | ||||||
15 | August 1, 2002. These charges and fees are provider billed | ||||||
16 | amounts and shall not include discounted charges. The 80th | ||||||
17 | percentile is the point on an ordered data set from low to high | ||||||
18 | such that 80% of the cases are below or equal to that point and | ||||||
19 | at most 20% are above or equal to that point. The Commission | ||||||
20 | shall adjust these historical charges and fees as of August 1, | ||||||
21 | 2004 by the Consumer Price Index-U for the period August 1, | ||||||
22 | 2004 through September 30, 2005. The Commission shall establish | ||||||
23 | fee schedules for procedures, treatments, or services for | ||||||
24 | hospital inpatient, hospital outpatient, emergency room and | ||||||
25 | trauma, ambulatory surgical treatment centers, and |
| |||||||
| |||||||
1 | professional services. | ||||||
2 | (a-1) These charges and fees shall be designated by geozip | ||||||
3 | or any smaller geographic unit. The data shall in no way | ||||||
4 | identify or tend to identify any patient, employer, or health | ||||||
5 | care provider. As used in this Section, "geozip" means a | ||||||
6 | three-digit zip code based on data similarities, geographical | ||||||
7 | similarities, and frequencies. A geozip does not cross state | ||||||
8 | boundaries. As used in this Section, "three-digit zip code" | ||||||
9 | means a geographic area in which all zip codes have the same | ||||||
10 | first 3 digits. If a geozip does not have the necessary number | ||||||
11 | of charges and fees to calculate a valid percentile for a | ||||||
12 | specific procedure, treatment, or service, the Commission may | ||||||
13 | combine data from the geozip with up to 4 other geozips that | ||||||
14 | are demographically and economically similar and exhibit | ||||||
15 | similarities in data and frequencies until the Commission | ||||||
16 | reaches 9 charges or fees for that specific procedure, | ||||||
17 | treatment, or service. In cases where the compiled data | ||||||
18 | contains less than 9 charges or fees for a procedure, | ||||||
19 | treatment, or service, reimbursement shall occur at 76% of | ||||||
20 | charges and fees as determined by the Commission in a manner | ||||||
21 | consistent with the provisions of this paragraph. This | ||||||
22 | subsection shall apply until July 1, 2011. | ||||||
23 | (a-2) Providers of out-of-state procedures, treatments, | ||||||
24 | services, products, or supplies shall be reimbursed at the
| ||||||
25 | lesser of that state's fee schedule amount or the fee schedule
| ||||||
26 | amount that would apply to the region where the employer is
|
| |||||||
| |||||||
1 | located. If no fee schedule exists in that state, the provider
| ||||||
2 | shall be reimbursed at the lesser of the actual charge or the | ||||||
3 | fee schedule amount that would apply to the region where the | ||||||
4 | employer is located. If out-of-state treatment is being
| ||||||
5 | undertaken and the employer is also located outside the State
| ||||||
6 | of Illinois, the provider shall be reimbursed at the lesser of
| ||||||
7 | the actual charge or the fee schedule amount that would apply
| ||||||
8 | to the location of the accident. The Commission has the | ||||||
9 | authority to set the maximum allowable payment to providers of | ||||||
10 | out-of-state procedures, treatments, or services covered under | ||||||
11 | this Act in a manner consistent with this Section. | ||||||
12 | (a-3) Not later than September 30 in 2006 and each year | ||||||
13 | thereafter, the Commission shall automatically increase or | ||||||
14 | decrease the maximum allowable payment for a procedure, | ||||||
15 | treatment, or service established and in effect on January 1 of | ||||||
16 | that year by the percentage change in the Consumer Price | ||||||
17 | Index-U for the 12 month period ending August 31 of that year. | ||||||
18 | The increase or decrease shall become effective on January 1 of | ||||||
19 | the following year. As used in this Section, "Consumer Price | ||||||
20 | Index-U" means the index published by the Bureau of Labor | ||||||
21 | Statistics of the U.S. Department of Labor, that measures the | ||||||
22 | average change in prices of all goods and services purchased by | ||||||
23 | all urban consumers, U.S. city average, all items, 1982-84=100. | ||||||
24 | (a-4) Notwithstanding the provisions of subsection (a), | ||||||
25 | the following provisions shall apply to the medical fee | ||||||
26 | schedule starting on July 1, 2011: |
| |||||||
| |||||||
1 | (1) The Commission shall establish and maintain fee | ||||||
2 | schedules for procedures, treatments, products, services, | ||||||
3 | or supplies for hospital inpatient, hospital outpatient, | ||||||
4 | emergency room, accredited ambulatory surgical treatment | ||||||
5 | facilities, prescriptions filled and dispensed outside of | ||||||
6 | a licensed pharmacy, dental services, and professional | ||||||
7 | services. An accredited ambulatory surgical treatment | ||||||
8 | facility is one defined by the Illinois Department of | ||||||
9 | Public Health or by accreditation organizations determined | ||||||
10 | by the Commission. Services provided at an unaccredited | ||||||
11 | ambulatory surgical treatment facilities shall not be | ||||||
12 | compensated under the Illinois Workers' Compensation | ||||||
13 | Medical Fee Schedules. | ||||||
14 | This fee schedule shall be based on the fee schedule | ||||||
15 | amounts already established by the Commission pursuant to | ||||||
16 | subsection (a) of this Section. However, these fee schedule | ||||||
17 | amounts shall be grouped into regions consistent with | ||||||
18 | nationally recognized reimbursement zip codes in Illinois and | ||||||
19 | shall represent the average amount for a procedure, treatment | ||||||
20 | or service for all the geozips reorganized into the new region. | ||||||
21 | (2) In cases where the compiled data contains less than | ||||||
22 | 9 charges or fees for a procedure, treatment, product, | ||||||
23 | supply, or service or where the fee schedule amount cannot | ||||||
24 | be determined by the non-discounted charge data, | ||||||
25 | non-Medicare relative values and conversion factors | ||||||
26 | derived from established fee schedule amounts, coding |
| |||||||
| |||||||
1 | crosswalks, or other data as determined by the Commission, | ||||||
2 | reimbursement shall occur at 76% of charges and fees until | ||||||
3 | July 1, 2011 and 53.2% of charges and fees thereafter as | ||||||
4 | determined by the Commission in a manner consistent with | ||||||
5 | the provisions of this paragraph. | ||||||
6 | (3) To establish additional fee schedule amounts, the | ||||||
7 | Commission shall utilize provider non-discounted charge | ||||||
8 | data, non-Medicare relative values and conversion factors | ||||||
9 | derived from established fee schedule amounts, and coding | ||||||
10 | crosswalks. The Commission may establish additional fee | ||||||
11 | schedule amounts based on either the charge or cost of the | ||||||
12 | procedure, treatment, product, supply, or service. | ||||||
13 | (4) Implants shall be reimbursed at 25% above the net | ||||||
14 | manufacturer's invoice price less rebates, plus actual | ||||||
15 | reasonable and customary shipping charges whether or not | ||||||
16 | the implant charge is submitted by a provider in | ||||||
17 | conjunction with a bill for all other services associated | ||||||
18 | with the implant, submitted by a provider on a separate | ||||||
19 | claim form, submitted by a distributor, or submitted by the | ||||||
20 | manufacturer of the implant. "Implants" include the | ||||||
21 | following codes or any substantially similar updated code | ||||||
22 | as determined by the Commission: 0274 | ||||||
23 | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | ||||||
24 | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | ||||||
25 | (investigational devices); and 0636 (drugs requiring | ||||||
26 | detailed coding). Non-implantable devices or supplies |
| |||||||
| |||||||
1 | within these codes shall be reimbursed at 65% of actual | ||||||
2 | charge, which is the provider's normal rates under its | ||||||
3 | standard chargemaster. A standard chargemaster is the | ||||||
4 | provider's list of charges for procedures, treatments, | ||||||
5 | products, supplies, or services used to bill payers in a | ||||||
6 | consistent manner. | ||||||
7 | (5) The Commission shall automatically update all | ||||||
8 | codes and associated rules with the version of the codes | ||||||
9 | and rules valid on January 1 of that year, including the | ||||||
10 | most current version of the National Correct Coding | ||||||
11 | Initiative Edits as published by the Center for Medicare | ||||||
12 | and Medicaid Services. | ||||||
13 | (a-5) For procedures, treatments, services, or supplies | ||||||
14 | covered under this Act and rendered or to be rendered on or | ||||||
15 | after July 1, 2011, the maximum allowable payment shall be 70% | ||||||
16 | of the fee schedule amounts in place as of June 30, 2011, which | ||||||
17 | shall be adjusted yearly by the Consumer Price Index-U, as | ||||||
18 | described in subsection (a) of this Section. | ||||||
19 | (a-6) Prescriptions filled and dispensed outside of a | ||||||
20 | licensed pharmacy shall be subject to a fee schedule that shall | ||||||
21 | not exceed the Average Wholesale Price (AWP) plus a dispensing | ||||||
22 | fee of $4.18. AWP or its equivalent as registered by the | ||||||
23 | National Drug Code shall be set forth for that drug on that | ||||||
24 | date as published in Medispan. | ||||||
25 | (b) Notwithstanding the provisions of subsection (a), if
| ||||||
26 | the Commission finds that there is a significant limitation on
|
| |||||||
| |||||||
1 | access to quality health care in either a specific field of
| ||||||
2 | health care services or a specific geographic limitation on
| ||||||
3 | access to health care, it may change the Consumer Price Index-U
| ||||||
4 | increase or decrease for that specific field or specific
| ||||||
5 | geographic limitation on access to health care to address that
| ||||||
6 | limitation. | ||||||
7 | (c) The Commission shall establish by rule a process to | ||||||
8 | review those medical cases or outliers that involve | ||||||
9 | extra-ordinary treatment to determine whether to make an | ||||||
10 | additional adjustment to the maximum payment within a fee | ||||||
11 | schedule for a procedure, treatment, or service. | ||||||
12 | (d) When a patient notifies a provider that the treatment, | ||||||
13 | procedure, or service being sought is for a work-related | ||||||
14 | illness or injury and furnishes the provider the name and | ||||||
15 | address of the responsible employer, the provider shall bill | ||||||
16 | the employer directly. The employer shall make payment and | ||||||
17 | providers shall submit bills and records in accordance with the | ||||||
18 | provisions of this Section. | ||||||
19 | (1) All payments to providers for treatment provided | ||||||
20 | pursuant to this Act shall be made within 60 days of | ||||||
21 | receipt of the bills as long as the claim contains | ||||||
22 | substantially all the required data elements necessary to | ||||||
23 | adjudicate the bills. | ||||||
24 | (2) In the case of nonpayment to a provider within 60 | ||||||
25 | days of receipt of the bill which contained substantially | ||||||
26 | all of the required data elements necessary to adjudicate |
| |||||||
| |||||||
1 | the bill or nonpayment to a provider of a portion of such a | ||||||
2 | bill up to the lesser of the actual charge or the payment | ||||||
3 | level set by the Commission in the fee schedule established | ||||||
4 | in this Section, the bill, or portion of the bill, shall | ||||||
5 | incur interest at a rate of 1% per month payable to the | ||||||
6 | provider. | ||||||
7 | (e) Except as provided in subsections (e-5), (e-10), and | ||||||
8 | (e-15), a provider shall not hold an employee liable for costs | ||||||
9 | related to a non-disputed procedure, treatment, or service | ||||||
10 | rendered in connection with a compensable injury. The | ||||||
11 | provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||||||
12 | shall not apply if an employee provides information to the | ||||||
13 | provider regarding participation in a group health plan. If the | ||||||
14 | employee participates in a group health plan, the provider may | ||||||
15 | submit a claim for services to the group health plan. If the | ||||||
16 | claim for service is covered by the group health plan, the | ||||||
17 | employee's responsibility shall be limited to applicable | ||||||
18 | deductibles, co-payments, or co-insurance. Except as provided | ||||||
19 | under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||||||
20 | shall not bill or otherwise attempt to recover from the | ||||||
21 | employee the difference between the provider's charge and the | ||||||
22 | amount paid by the employer or the insurer on a compensable | ||||||
23 | injury , or for medical services or treatment determined by the | ||||||
24 | Commission to be excessive or unnecessary . | ||||||
25 | (e-5) If an employer notifies a provider that the employer | ||||||
26 | does not consider the illness or injury to be compensable under |
| |||||||
| |||||||
1 | this Act, the provider may seek payment of the provider's | ||||||
2 | actual charges from the employee for any procedure, treatment, | ||||||
3 | or service rendered. Once an employee informs the provider that | ||||||
4 | there is an application filed with the Commission to resolve a | ||||||
5 | dispute over payment of such charges, the provider shall cease | ||||||
6 | any and all efforts to collect payment for the services that | ||||||
7 | are the subject of the dispute. Any statute of limitations or | ||||||
8 | statute of repose applicable to the provider's efforts to | ||||||
9 | collect payment from the employee shall be tolled from the date | ||||||
10 | that the employee files the application with the Commission | ||||||
11 | until the date that the provider is permitted to resume | ||||||
12 | collection efforts under the provisions of this Section. | ||||||
13 | (e-10) If an employer notifies a provider that the employer | ||||||
14 | will pay only a portion of a bill for any procedure, treatment, | ||||||
15 | or service rendered in connection with a compensable illness or | ||||||
16 | disease, the provider may seek payment from the employee for | ||||||
17 | the remainder of the amount of the bill up to the lesser of the | ||||||
18 | actual charge, negotiated rate, if applicable, or the payment | ||||||
19 | level set by the Commission in the fee schedule established in | ||||||
20 | this Section. Once an employee informs the provider that there | ||||||
21 | is an application filed with the Commission to resolve a | ||||||
22 | dispute over payment of such charges, the provider shall cease | ||||||
23 | any and all efforts to collect payment for the services that | ||||||
24 | are the subject of the dispute. Any statute of limitations or | ||||||
25 | statute of repose applicable to the provider's efforts to | ||||||
26 | collect payment from the employee shall be tolled from the date |
| |||||||
| |||||||
1 | that the employee files the application with the Commission | ||||||
2 | until the date that the provider is permitted to resume | ||||||
3 | collection efforts under the provisions of this Section. | ||||||
4 | (e-15) When there is a dispute over the compensability of | ||||||
5 | or amount of payment for a procedure, treatment, or service, | ||||||
6 | and a case is pending or proceeding before an Arbitrator or the | ||||||
7 | Commission, the provider may mail the employee reminders that | ||||||
8 | the employee will be responsible for payment of any procedure, | ||||||
9 | treatment or service rendered by the provider. The reminders | ||||||
10 | must state that they are not bills, to the extent practicable | ||||||
11 | include itemized information, and state that the employee need | ||||||
12 | not pay until such time as the provider is permitted to resume | ||||||
13 | collection efforts under this Section. The reminders shall not | ||||||
14 | be provided to any credit rating agency. The reminders may | ||||||
15 | request that the employee furnish the provider with information | ||||||
16 | about the proceeding under this Act, such as the file number, | ||||||
17 | names of parties, and status of the case. If an employee fails | ||||||
18 | to respond to such request for information or fails to furnish | ||||||
19 | the information requested within 90 days of the date of the | ||||||
20 | reminder, the provider is entitled to resume any and all | ||||||
21 | efforts to collect payment from the employee for the services | ||||||
22 | rendered to the employee and the employee shall be responsible | ||||||
23 | for payment of any outstanding bills for a procedure, | ||||||
24 | treatment, or service rendered by a provider. | ||||||
25 | (e-20) Upon a final award or judgment by an Arbitrator or | ||||||
26 | the Commission, or a settlement agreed to by the employer and |
| |||||||
| |||||||
1 | the employee, a provider may resume any and all efforts to | ||||||
2 | collect payment from the employee for the services rendered to | ||||||
3 | the employee and the employee shall be responsible for payment | ||||||
4 | of any outstanding bills for a procedure, treatment, or service | ||||||
5 | rendered by a provider as well as the interest awarded under | ||||||
6 | subsection (d) of this Section. In the case of a procedure, | ||||||
7 | treatment, or service deemed compensable, the provider shall | ||||||
8 | not require a payment rate, excluding the interest provisions | ||||||
9 | under subsection (d), greater than the lesser of the actual | ||||||
10 | charge or the payment level set by the Commission in the fee | ||||||
11 | schedule established in this Section. Payment for services | ||||||
12 | deemed not covered or not compensable under this Act is the | ||||||
13 | responsibility of the employee unless a provider and employee | ||||||
14 | have agreed otherwise in writing. Services not covered or not | ||||||
15 | compensable under this Act are not subject to the fee schedule | ||||||
16 | in this Section. | ||||||
17 | (f) Nothing in this Act shall prohibit an employer or
| ||||||
18 | insurer from contracting with a health care provider or group
| ||||||
19 | of health care providers for reimbursement levels for benefits | ||||||
20 | under this Act different
from those provided in this Section. | ||||||
21 | (g) On or before January 1, 2010 the Commission shall | ||||||
22 | provide to the Governor and General Assembly a report regarding | ||||||
23 | the implementation of the medical fee schedule and the index | ||||||
24 | used for annual adjustment to that schedule as described in | ||||||
25 | this Section.
| ||||||
26 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/8.3)
| ||||||
2 | Sec. 8.3. Workers' Compensation Medical Fee Advisory | ||||||
3 | Board. There is created a Workers' Compensation Medical Fee | ||||||
4 | Advisory Board consisting of 9 members appointed by the | ||||||
5 | Governor with the advice and consent of the Senate. Three | ||||||
6 | members of the Advisory Board shall be representative citizens | ||||||
7 | chosen from the employee class, 3 members shall be | ||||||
8 | representative citizens chosen from the employing class, and 3 | ||||||
9 | members shall be representative citizens chosen from the | ||||||
10 | medical provider class. Each member shall serve a 4-year term | ||||||
11 | and shall continue to serve until a successor is appointed. A | ||||||
12 | vacancy on the Advisory Board shall be filled by the Governor | ||||||
13 | for the unexpired term. | ||||||
14 | Members of the Advisory Board shall receive no compensation | ||||||
15 | for their services but shall be reimbursed for expenses | ||||||
16 | incurred in the performance of their duties by the Commission | ||||||
17 | from appropriations made to the Commission for that purpose. | ||||||
18 | The Advisory Board shall advise the Commission on | ||||||
19 | establishment of fees for medical services and accessibility of | ||||||
20 | medical treatment. Additionally, by December 31, 2011, the | ||||||
21 | Board shall issue a written report, to be delivered to the | ||||||
22 | Chairman of the Commission and the General Assembly, containing | ||||||
23 | (i) recommendations on how to streamline the process under | ||||||
24 | which workers' compensation medical providers bill for their | ||||||
25 | services, insurers process and issue payments and health care |
| |||||||
| |||||||
1 | providers receive such payments and (ii) a recommended set of | ||||||
2 | best practices for workers' compensation insurers and medical | ||||||
3 | providers to transition from a paper-based payment system to an | ||||||
4 | electronic-based billing and payment system.
| ||||||
5 | (Source: P.A. 94-277, eff. 7-20-05.)
| ||||||
6 | (820 ILCS 305/8.7) | ||||||
7 | Sec. 8.7. Utilization review programs. | ||||||
8 | (a) As used in this Section: | ||||||
9 | "Utilization review" means the evaluation of proposed or | ||||||
10 | provided health care services to determine the appropriateness | ||||||
11 | of both the level of health care services medically necessary | ||||||
12 | and the quality of health care services provided to a patient, | ||||||
13 | including evaluation of their efficiency, efficacy, and | ||||||
14 | appropriateness of treatment, hospitalization, or office | ||||||
15 | visits based on medically accepted standards. The evaluation | ||||||
16 | must be accomplished by means of a system that identifies the | ||||||
17 | utilization of health care services based on standards of care | ||||||
18 | of or nationally recognized peer review guidelines as well as | ||||||
19 | nationally recognized treatment guidelines and evidence-based | ||||||
20 | medicine evidence based upon standards as provided in this Act . | ||||||
21 | Utilization techniques may include prospective review, second | ||||||
22 | opinions, concurrent review, discharge planning, peer review, | ||||||
23 | independent medical examinations, and retrospective review | ||||||
24 | (for purposes of this sentence, retrospective review shall be | ||||||
25 | applicable to services rendered on or after July 20, 2005). |
| |||||||
| |||||||
1 | Nothing in this Section applies to prospective review of | ||||||
2 | necessary first aid or emergency treatment. | ||||||
3 | (b) No person may conduct a utilization review program for | ||||||
4 | workers' compensation services in this State unless once every | ||||||
5 | 2 years the person registers the utilization review program | ||||||
6 | with the Department of Insurance Financial and Professional | ||||||
7 | Regulation and certifies compliance with the Workers' | ||||||
8 | Compensation Utilization Management standards or Health | ||||||
9 | Utilization Management Standards of URAC sufficient to achieve | ||||||
10 | URAC accreditation or submits evidence of accreditation by URAC | ||||||
11 | for its Workers' Compensation Utilization Management Standards | ||||||
12 | or Health Utilization Management Standards. Nothing in this Act | ||||||
13 | shall be construed to require an employer or insurer or its | ||||||
14 | subcontractors to become URAC accredited. | ||||||
15 | (c) In addition, the Director Secretary of Insurance | ||||||
16 | Financial and Professional Regulation may certify alternative | ||||||
17 | utilization review standards of national accreditation | ||||||
18 | organizations or entities in order for plans to comply with | ||||||
19 | this Section. Any alternative utilization review standards | ||||||
20 | shall meet or exceed those standards required under subsection | ||||||
21 | (b). | ||||||
22 | (d) This registration shall include submission of all of | ||||||
23 | the following information regarding utilization review program | ||||||
24 | activities: | ||||||
25 | (1) The name, address, and telephone number of the | ||||||
26 | utilization review programs. |
| |||||||
| |||||||
1 | (2) The organization and governing structure of the | ||||||
2 | utilization review programs. | ||||||
3 | (3) The number of lives for which utilization review is | ||||||
4 | conducted by each utilization review program. | ||||||
5 | (4) Hours of operation of each utilization review | ||||||
6 | program. | ||||||
7 | (5) Description of the grievance process for each | ||||||
8 | utilization review program. | ||||||
9 | (6) Number of covered lives for which utilization | ||||||
10 | review was conducted for the previous calendar year for | ||||||
11 | each utilization review program. | ||||||
12 | (7) Written policies and procedures for protecting | ||||||
13 | confidential information according to applicable State and | ||||||
14 | federal laws for each utilization review program. | ||||||
15 | (e) A utilization review program shall have written | ||||||
16 | procedures to ensure that patient-specific information | ||||||
17 | obtained during the process of utilization review will be: | ||||||
18 | (1) kept confidential in accordance with applicable | ||||||
19 | State and federal laws; and | ||||||
20 | (2) shared only with the employee, the employee's | ||||||
21 | designee, and the employee's health care provider, and | ||||||
22 | those who are authorized by law to receive the information. | ||||||
23 | Summary data shall not be considered confidential if it | ||||||
24 | does not provide information to allow identification of | ||||||
25 | individual patients or health care providers. | ||||||
26 | Only a health care professional may make determinations |
| |||||||
| |||||||
1 | regarding the medical necessity of health care services during | ||||||
2 | the course of utilization review. | ||||||
3 | When making retrospective reviews, utilization review | ||||||
4 | programs shall base reviews solely on the medical information | ||||||
5 | available to the attending physician or ordering provider at | ||||||
6 | the time the health care services were provided. | ||||||
7 | (f) If the Department of Insurance Financial and | ||||||
8 | Professional Regulation finds that a utilization review | ||||||
9 | program is not in compliance with this Section, the Department | ||||||
10 | shall issue a corrective action plan and allow a reasonable | ||||||
11 | amount of time for compliance with the plan. If the utilization | ||||||
12 | review program does not come into compliance, the Department | ||||||
13 | may issue a cease and desist order. Before issuing a cease and | ||||||
14 | desist order under this Section, the Department shall provide | ||||||
15 | the utilization review program with a written notice of the | ||||||
16 | reasons for the order and allow a reasonable amount of time to | ||||||
17 | supply additional information demonstrating compliance with | ||||||
18 | the requirements of this Section and to request a hearing. The | ||||||
19 | hearing notice shall be sent by certified mail, return receipt | ||||||
20 | requested, and the hearing shall be conducted in accordance | ||||||
21 | with the Illinois Administrative Procedure Act. | ||||||
22 | (g) A utilization review program subject to a corrective | ||||||
23 | action may continue to conduct business until a final decision | ||||||
24 | has been issued by the Department. | ||||||
25 | (h) The Department of Insurance Secretary of Financial and | ||||||
26 | Professional Regulation may by rule establish a registration |
| |||||||
| |||||||
1 | fee for each person conducting a utilization review program. | ||||||
2 | (i) Upon receipt of written notice that the employer or the | ||||||
3 | employer's agent or insurer wishes to invoke the utilization | ||||||
4 | review process, the provider of medical, surgical or hospital | ||||||
5 | services shall submit to the utilization review, following URAC | ||||||
6 | procedural guidelines and appeal process. If the provider fails | ||||||
7 | to submit to utilization review of proposed treatment or | ||||||
8 | services, the charges for the treatment or service shall not be | ||||||
9 | compensable or collectible against the employer, the | ||||||
10 | employer's agent or insurer, or the employee. When an employer | ||||||
11 | denies payment of or refuses to authorize payment of first aid, | ||||||
12 | medical, surgical, or hospital services under Section 8(a) of | ||||||
13 | this Act that complies with subsection (b) of this Section, | ||||||
14 | that denial or refusal to authorize shall create a rebuttable | ||||||
15 | presumption that the extent and scope of medical treatment is | ||||||
16 | excessive or unnecessary. That presumption may be rebutted by | ||||||
17 | establishing by a preponderance of the evidence that a variance | ||||||
18 | from the standards of care or guidelines used pursuant to | ||||||
19 | subsection (a) of this Section is reasonably required to cure | ||||||
20 | and relieve the employee from the effects of his or her injury | ||||||
21 | or that the utilization review did not comply with subsection | ||||||
22 | (b) of this Section. | ||||||
23 | (i) A utilization review will be considered by the | ||||||
24 | Commission, along with all other evidence and in the same | ||||||
25 | manner as all other evidence, in the determination of the | ||||||
26 | reasonableness and necessity of the medical bills or treatment. |
| |||||||
| |||||||
1 | Nothing in this Section shall be construed to diminish the | ||||||
2 | rights of employees to reasonable and necessary medical | ||||||
3 | treatment or employee choice of health care provider under | ||||||
4 | Section 8(a) or the rights of employers to medical examinations | ||||||
5 | under Section 12. | ||||||
6 | (j) When an employer denies payment of or refuses to | ||||||
7 | authorize payment of first aid, medical, surgical, or hospital | ||||||
8 | services under Section 8(a) of this Act, if that denial or | ||||||
9 | refusal to authorize complies with a utilization review program | ||||||
10 | registered under this Section and complies with all other | ||||||
11 | requirements of this Section, then there shall be a rebuttable | ||||||
12 | presumption that the employer shall not be responsible for | ||||||
13 | payment of additional compensation pursuant to Section 19(k) of | ||||||
14 | this Act and if that denial or refusal to authorize does not | ||||||
15 | comply with a utilization review program registered under this | ||||||
16 | Section and does not comply with all other requirements of this | ||||||
17 | Section, then that will be considered by the Commission, along | ||||||
18 | with all other evidence and in the same manner as all other | ||||||
19 | evidence, in the determination of whether the employer may be | ||||||
20 | responsible for the payment of additional compensation | ||||||
21 | pursuant to Section 19(k) of this Act.
| ||||||
22 | The changes to this Section made by this amendatory Act of | ||||||
23 | the 97th General Assembly apply only to medical services | ||||||
24 | provided on or after the effective date of this amendatory Act | ||||||
25 | of the 97th General Assembly. | ||||||
26 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/11) (from Ch. 48, par. 138.11)
| ||||||
2 | Sec. 11. The compensation herein provided, together with | ||||||
3 | the
provisions of this Act, shall be the measure of the | ||||||
4 | responsibility of
any employer engaged in any of the | ||||||
5 | enterprises or businesses enumerated
in Section 3 of this Act, | ||||||
6 | or of any employer who is not engaged in any
such enterprises | ||||||
7 | or businesses, but who has elected to provide and pay
| ||||||
8 | compensation for accidental injuries sustained by any employee | ||||||
9 | arising
out of and in the course of the employment according to | ||||||
10 | the provisions
of this Act, and whose election to continue | ||||||
11 | under this Act, has not been
nullified by any action of his | ||||||
12 | employees as provided for in this Act.
| ||||||
13 | Accidental injuries incurred while participating in | ||||||
14 | voluntary recreational
programs including but not limited to | ||||||
15 | athletic events, parties and picnics
do not arise out of and in | ||||||
16 | the course of the employment even though the
employer pays some | ||||||
17 | or all of the cost thereof. This exclusion shall not apply
in | ||||||
18 | the event that the injured employee was ordered or assigned by | ||||||
19 | his employer
to participate in the program.
| ||||||
20 | Accidental injuries incurred while participating as a | ||||||
21 | patient in a drug
or alcohol rehabilitation program do not | ||||||
22 | arise out of and in the course
of employment even though the | ||||||
23 | employer pays some or all of the costs thereof. | ||||||
24 | Any injury to or disease or death of an employee arising | ||||||
25 | from the administration of a vaccine, including without |
| |||||||
| |||||||
1 | limitation smallpox vaccine, to prepare for, or as a response | ||||||
2 | to, a threatened or potential bioterrorist incident to the | ||||||
3 | employee as part of a voluntary inoculation program in | ||||||
4 | connection with the person's employment or in connection with | ||||||
5 | any governmental program or recommendation for the inoculation | ||||||
6 | of workers in the employee's occupation, geographical area, or | ||||||
7 | other category that includes the employee is deemed to arise | ||||||
8 | out of and in the course of the employment for all purposes | ||||||
9 | under this Act. This paragraph added by this amendatory Act of | ||||||
10 | the 93rd General Assembly is declarative of existing law and is | ||||||
11 | not a new enactment.
| ||||||
12 | No compensation shall be payable if (i) the employee's | ||||||
13 | intoxication is the proximate cause of the employee's | ||||||
14 | accidental injury or (ii) at the time the employee incurred | ||||||
15 | accidental injury, the employee was so intoxicated that the | ||||||
16 | intoxication constituted a departure from the employment. | ||||||
17 | Admissible evidence of the concentration of (1) alcohol, (2) | ||||||
18 | cannabis as defined in the Cannabis Control Act, (3) a | ||||||
19 | controlled substance listed in the Illinois Controlled | ||||||
20 | Substances Act, or (4) an intoxicating compound listed in the | ||||||
21 | Use of Intoxicating Compounds Act in the employee's blood, | ||||||
22 | breath, or urine at the time the employee incurred the | ||||||
23 | accidental injury shall be considered in any hearing under this | ||||||
24 | Act to determine whether the employee was intoxicated at the | ||||||
25 | time the employee incurred the accidental injuries. If at the | ||||||
26 | time of the accidental injuries, there was 0.08% or more by |
| |||||||
| |||||||
1 | weight of alcohol in the employee's blood, breath, or urine or | ||||||
2 | if there is any evidence of impairment due to the unlawful or | ||||||
3 | unauthorized use of (1) cannabis as defined in the Cannabis | ||||||
4 | Control Act, (2) a controlled substance listed in the Illinois | ||||||
5 | Controlled Substances Act, or (3) an intoxicating compound | ||||||
6 | listed in the Use of Intoxicating Compounds Act or if the | ||||||
7 | employee refuses to submit to testing of blood, breath, or | ||||||
8 | urine, then there shall be a rebuttable presumption that the | ||||||
9 | employee was intoxicated and that the intoxication was the | ||||||
10 | proximate cause of the employee's injury. The employee may | ||||||
11 | overcome the rebuttable presumption by the preponderance of the | ||||||
12 | admissible evidence that the intoxication was not the proximate | ||||||
13 | cause of the accidental injuries. Percentage by weight of | ||||||
14 | alcohol in the blood shall be based on grams of alcohol per 100 | ||||||
15 | milliliters of blood. Percentage by weight of alcohol in the | ||||||
16 | breath shall be based upon grams of alcohol per 210 liters of | ||||||
17 | breath. Any testing that has not been performed by an | ||||||
18 | accredited or certified testing laboratory shall not be | ||||||
19 | admissible in any hearing under this Act to determine whether | ||||||
20 | the employee was intoxicated at the time the employee incurred | ||||||
21 | the accidental injury. | ||||||
22 | All sample collection and testing for alcohol and drugs | ||||||
23 | under this Section shall be performed in accordance with rules | ||||||
24 | to be adopted by the Commission. These rules shall ensure: | ||||||
25 | (1) compliance with the National Labor Relations Act | ||||||
26 | regarding collective bargaining agreements or regulations |
| |||||||
| |||||||
1 | promulgated by the United States Department of | ||||||
2 | Transportation; | ||||||
3 | (2) that samples are collected and tested in | ||||||
4 | conformance with national and State legal and regulatory | ||||||
5 | standards for the privacy of the individual being tested, | ||||||
6 | and in a manner reasonably calculated to prevent | ||||||
7 | substitutions or interference with the collection or | ||||||
8 | testing of reliable sample; | ||||||
9 | (3) that split testing procedures are utilized; | ||||||
10 | (4) sample collection is documented, and the | ||||||
11 | documentation procedures include: | ||||||
12 | (A) the labeling of samples in a manner so as to | ||||||
13 | reasonably preclude the probability of erroneous | ||||||
14 | identification of test result; and | ||||||
15 | (B) an opportunity for the employee to provide | ||||||
16 | notification of any information which he or she | ||||||
17 | considers relevant to the test, including | ||||||
18 | identification of currently or recently used | ||||||
19 | prescription or nonprescription drugs and other | ||||||
20 | relevant medical information; | ||||||
21 | (5) that sample collection, storage, and | ||||||
22 | transportation to the place of testing is performed in a | ||||||
23 | manner so as to reasonably preclude the probability of | ||||||
24 | sample contamination or adulteration; and | ||||||
25 | (6) that chemical analyses of blood, urine, breath, or | ||||||
26 | other bodily substance are performed according to |
| |||||||
| |||||||
1 | nationally scientifically accepted analytical methods and | ||||||
2 | procedures. | ||||||
3 | The changes to this Section made by this amendatory Act of | ||||||
4 | the 97th General Assembly apply only to accidental injuries | ||||||
5 | that occur on or after the effective date of this amendatory | ||||||
6 | Act of the 97th General Assembly. | ||||||
7 | (Source: P.A. 93-829, eff. 7-28-04.)
| ||||||
8 | (820 ILCS 305/16) (from Ch. 48, par. 138.16)
| ||||||
9 | Sec. 16. The Commission shall make and publish procedural | ||||||
10 | rules and
orders for carrying out the duties imposed upon it by | ||||||
11 | law and for
determining the extent of disability sustained, | ||||||
12 | which rules and orders
shall be deemed prima facie reasonable | ||||||
13 | and valid.
| ||||||
14 | The process and procedure before the Commission shall be as | ||||||
15 | simple
and summary as reasonably may be.
| ||||||
16 | The Commission upon application of either party may issue | ||||||
17 | dedimus
potestatem directed to a commissioner, notary public, | ||||||
18 | justice of the
peace or any other officer authorized by law to | ||||||
19 | administer oaths, to
take the depositions of such witness or | ||||||
20 | witnesses as may be necessary in
the judgment of such | ||||||
21 | applicant. Such dedimus potestatem may issue to
any of the | ||||||
22 | officers aforesaid in any state or territory of the United
| ||||||
23 | States. When the deposition of any witness resident of a | ||||||
24 | foreign
country is desired to be taken, the dedimus shall be | ||||||
25 | directed to and the
deposition taken before a consul, vice |
| |||||||
| |||||||
1 | consul or other authorized
representative of the government of | ||||||
2 | the United States of America, whose
station is in the country | ||||||
3 | where the witness whose deposition is to be
taken resides. In | ||||||
4 | countries where the government of the United States
has no | ||||||
5 | consul or other diplomatic representative, then depositions in
| ||||||
6 | such case shall be taken through the appropriate judicial | ||||||
7 | authority of
that country; or where treaties provide for other | ||||||
8 | methods of taking
depositions, then the same may be taken as in | ||||||
9 | such treaties provided.
The Commission shall have the power to | ||||||
10 | adopt necessary rules to govern
the issue of such dedimus | ||||||
11 | potestatem.
| ||||||
12 | The Commission, or any member thereof, or any Arbitrator | ||||||
13 | designated
by the Commission shall have the power to administer | ||||||
14 | oaths, subpoena
and examine witnesses; to issue subpoenas duces | ||||||
15 | tecum, requiring the
production of such books, papers, records | ||||||
16 | and documents as may be
evidence of any matter under inquiry | ||||||
17 | and to examine and inspect the same
and such places or premises | ||||||
18 | as may relate to the question in dispute.
The Commission, or | ||||||
19 | any member thereof, or any Arbitrator designated by
the | ||||||
20 | Commission, shall on written request of either party to the
| ||||||
21 | dispute, issue subpoenas for the attendance of such witnesses | ||||||
22 | and
production of such books, papers, records and documents as | ||||||
23 | shall be
designated in the applications, and the parties
| ||||||
24 | applying for such subpoena shall advance the officer and | ||||||
25 | witness fees
provided for in civil actions pending in circuit | ||||||
26 | courts of this State, except
as otherwise
provided by Section |
| |||||||
| |||||||
1 | 20 of this Act. Service of such subpoena shall be
made by any | ||||||
2 | sheriff or other person. In case any person
refuses to comply | ||||||
3 | with an order of the Commission or subpoenas issued by
it or by | ||||||
4 | any member thereof, or any Arbitrator designated by the
| ||||||
5 | Commission or to permit an inspection of places or premises, or | ||||||
6 | to
produce any books, papers, records or documents, or any | ||||||
7 | witness refuses
to testify to any matters regarding which he or | ||||||
8 | she may be lawfully
interrogated, the Circuit Court of the | ||||||
9 | county in which the hearing or
matter is pending, on | ||||||
10 | application of any member of the Commission or any
Arbitrator | ||||||
11 | designated by the Commission, shall compel obedience by
| ||||||
12 | attachment proceedings, as for contempt, as in a case of | ||||||
13 | disobedience of
the requirements of a subpoena from such court | ||||||
14 | on a refusal to testify
therein.
| ||||||
15 | The records, reports, and bills kept by a treating | ||||||
16 | hospital, treating physician, or other treating healthcare | ||||||
17 | provider that renders treatment to the employee as a result of | ||||||
18 | accidental injuries in question, certified to as true and | ||||||
19 | correct by
the hospital, physician, or other healthcare | ||||||
20 | provider or by designated agents of the hospital, physician, or | ||||||
21 | other healthcare provider, showing the medical and
surgical | ||||||
22 | treatment given an injured employee by such hospital, | ||||||
23 | physician, or other healthcare provider, shall be
admissible | ||||||
24 | without any further proof as evidence of the medical and
| ||||||
25 | surgical matters stated therein, but shall not be conclusive | ||||||
26 | proof of
such matters. Any records, reports and bills submitted |
| |||||||
| |||||||
1 | under this Section shall be limited for the purpose of | ||||||
2 | establishing that the care and treatment was rendered and shall | ||||||
3 | not be for the purpose of establishing causal connection, need | ||||||
4 | for care or degree of disability. There shall be a rebuttable | ||||||
5 | presumption that any such records, reports, and bills received | ||||||
6 | in response to Commission subpoena are certified to be true and | ||||||
7 | correct. This paragraph does not restrict, limit, or prevent | ||||||
8 | the admissibility of records, reports, or bills that are | ||||||
9 | otherwise admissible. This provision does not apply to reports | ||||||
10 | prepared by treating providers for use in litigation.
| ||||||
11 | The Commission at its expense shall provide an official | ||||||
12 | court
reporter to take the testimony and record of proceedings | ||||||
13 | at the hearings
before an Arbitrator or the Commission, who
| ||||||
14 | shall furnish a transcript of such testimony or proceedings to | ||||||
15 | either
party requesting it, upon payment therefor at the rate | ||||||
16 | of $1.00
per page for the original and 35 cents per page for | ||||||
17 | each copy of such
transcript. Payment for photostatic copies of | ||||||
18 | exhibits shall be extra.
If the Commission has determined, as | ||||||
19 | provided in Section 20
of this Act, that the employee is a poor | ||||||
20 | person, a transcript of such
testimony and proceedings, | ||||||
21 | including photostatic copies of exhibits,
shall be furnished to | ||||||
22 | such employee at the
Commission's expense.
| ||||||
23 | The Commission shall have the power to determine the | ||||||
24 | reasonableness
and fix the amount of any fee of compensation | ||||||
25 | charged by any person,
including attorneys, physicians, | ||||||
26 | surgeons and hospitals, for any service
performed in connection |
| |||||||
| |||||||
1 | with this Act, or for which payment is to be
made under this | ||||||
2 | Act or rendered in securing any right under this Act.
| ||||||
3 | Whenever the Commission shall find that the employer, his | ||||||
4 | or her agent,
service company or insurance carrier has been | ||||||
5 | guilty of delay or
unfairness towards an employee in the | ||||||
6 | adjustment, settlement or payment
of benefits due such employee | ||||||
7 | within the purview of the provisions of
paragraph (c) of | ||||||
8 | Section 4 of this Act; or has been guilty of
unreasonable or | ||||||
9 | vexatious delay, intentional under-payment of
compensation | ||||||
10 | benefits, or has engaged in frivolous defenses which do not
| ||||||
11 | present a real controversy, within the purview of the | ||||||
12 | provisions of
paragraph (k) of Section 19 of this Act, the | ||||||
13 | Commission may assess all
or any part of the attorney's fees | ||||||
14 | and costs against such employer and
his or her insurance | ||||||
15 | carrier.
| ||||||
16 | (Source: P.A. 94-277, eff. 7-20-05.)
| ||||||
17 | (820 ILCS 305/16b new) | ||||||
18 | Sec. 16b. Signature constitutes certification. The | ||||||
19 | signature of an attorney on any petition, motion, or other | ||||||
20 | paper filed with the Commission constitutes a certification by | ||||||
21 | he or she that he or she has read the petition, motion, or | ||||||
22 | other paper, and, that to the best of his or her knowledge, | ||||||
23 | information, and belief formed after reasonable inquiry that it | ||||||
24 | is well grounded in fact, that it is warranted by existing law | ||||||
25 | or a good faith argument for an extension, modification, or |
| |||||||
| |||||||
1 | reversal of existing law, and that it is not interposed for any | ||||||
2 | improper purpose, such as to harass or to cause unnecessary | ||||||
3 | delay or needless increase in the cost of litigation. If a | ||||||
4 | petition, motion, or other paper is signed in violation of this | ||||||
5 | Section, the Commission, upon motion or upon its own | ||||||
6 | initiative, may impose on the attorney an appropriate penalty | ||||||
7 | or may order him or her to pay the other party the amount of | ||||||
8 | reasonable expenses incurred because of the filing of the | ||||||
9 | petition, motion, or other paper, including reasonable | ||||||
10 | attorneys' fees.
| ||||||
11 | (820 ILCS 305/16c new) | ||||||
12 | Sec. 16c. Gift Ban. | ||||||
13 | (a) An attorney appearing before the Commission shall not | ||||||
14 | provide compensation or any gift to any person in exchange for | ||||||
15 | the referral of a client involving a matter to be heard before | ||||||
16 | the Commission except for a division of a fee between lawyers | ||||||
17 | who are not in the same firm in accordance with Rule 1.5 of the | ||||||
18 | Code of Professional Responsibility. For purposes of this | ||||||
19 | Section, "gift" means any gratuity, discount, entertainment, | ||||||
20 | hospitality, loan, forbearance, or any other tangible or | ||||||
21 | intangible item having monetary value including, but not | ||||||
22 | limited to, cash food and drink and honoraria except for up to | ||||||
23 | $75 per day per person for food and beverage. | ||||||
24 | (b) Violation of this Section is a Class A misdemeanor.
|
| |||||||
| |||||||
1 | (820 ILCS 305/19) (from Ch. 48, par. 138.19)
| ||||||
2 | Sec. 19. Any disputed questions of law or fact shall be | ||||||
3 | determined
as herein provided.
| ||||||
4 | (a) It shall be the duty of the Commission upon | ||||||
5 | notification that
the parties have failed to reach an | ||||||
6 | agreement, to designate an Arbitrator.
| ||||||
7 | 1. Whenever any claimant misconceives his remedy and | ||||||
8 | files an
application for adjustment of claim under this Act | ||||||
9 | and it is
subsequently discovered, at any time before final | ||||||
10 | disposition of such
cause, that the claim for disability or | ||||||
11 | death which was the basis for
such application should | ||||||
12 | properly have been made under the Workers'
Occupational | ||||||
13 | Diseases Act, then the provisions of Section 19, paragraph
| ||||||
14 | (a-1) of the Workers' Occupational Diseases Act having | ||||||
15 | reference to such
application shall apply.
| ||||||
16 | 2. Whenever any claimant misconceives his remedy and | ||||||
17 | files an
application for adjustment of claim under the | ||||||
18 | Workers' Occupational
Diseases Act and it is subsequently | ||||||
19 | discovered, at any time before final
disposition of such | ||||||
20 | cause that the claim for injury or death which was
the | ||||||
21 | basis for such application should properly have been made | ||||||
22 | under this
Act, then the application so filed under the | ||||||
23 | Workers' Occupational
Diseases Act may be amended in form, | ||||||
24 | substance or both to assert claim
for such disability or | ||||||
25 | death under this Act and it shall be deemed to
have been so | ||||||
26 | filed as amended on the date of the original filing
|
| |||||||
| |||||||
1 | thereof, and such compensation may be awarded as is | ||||||
2 | warranted by the
whole evidence pursuant to this Act. When | ||||||
3 | such amendment is submitted,
further or additional | ||||||
4 | evidence may be heard by the Arbitrator or
Commission when | ||||||
5 | deemed necessary. Nothing in this Section contained
shall | ||||||
6 | be construed to be or permit a waiver of any provisions of | ||||||
7 | this
Act with reference to notice but notice if given shall | ||||||
8 | be deemed to be a
notice under the provisions of this Act | ||||||
9 | if given within the time
required herein.
| ||||||
10 | (b) The Arbitrator shall make such inquiries and | ||||||
11 | investigations as he or
they shall deem necessary and may | ||||||
12 | examine and inspect all books, papers,
records, places, or | ||||||
13 | premises relating to the questions in dispute and hear
such | ||||||
14 | proper evidence as the parties may submit.
| ||||||
15 | The hearings before the Arbitrator shall be held in the | ||||||
16 | vicinity where
the injury occurred after 10 days' notice of the | ||||||
17 | time and place of such
hearing shall have been given to each of | ||||||
18 | the parties or their attorneys
of record.
| ||||||
19 | The Arbitrator may find that the disabling condition is | ||||||
20 | temporary and has
not yet reached a permanent condition and may | ||||||
21 | order the payment of
compensation up to the date of the | ||||||
22 | hearing, which award shall be reviewable
and enforceable in the | ||||||
23 | same manner as other awards, and in no instance be a
bar to a | ||||||
24 | further hearing and determination of a further amount of | ||||||
25 | temporary
total compensation or of compensation for permanent | ||||||
26 | disability, but shall
be conclusive as to all other questions |
| |||||||
| |||||||
1 | except the nature and extent of said
disability.
| ||||||
2 | The decision of the Arbitrator shall be filed with the | ||||||
3 | Commission which
Commission shall immediately send to each | ||||||
4 | party or his attorney a copy of
such decision, together with a | ||||||
5 | notification of the time when it was filed.
As of the effective | ||||||
6 | date of this amendatory Act of the 94th General Assembly, all | ||||||
7 | decisions of the Arbitrator shall set forth
in writing findings | ||||||
8 | of fact and conclusions of law, separately stated, if requested | ||||||
9 | by either party.
Unless a petition for review is filed by | ||||||
10 | either party within 30 days after
the receipt by such party of | ||||||
11 | the copy of the decision and notification of
time when filed, | ||||||
12 | and unless such party petitioning for a review shall
within 35 | ||||||
13 | days after the receipt by him of the copy of the decision, file
| ||||||
14 | with the Commission either an agreed statement of the facts | ||||||
15 | appearing upon
the hearing before the Arbitrator, or if such
| ||||||
16 | party shall so elect a correct transcript of evidence of the | ||||||
17 | proceedings
at such hearings, then the decision shall become | ||||||
18 | the decision of the
Commission and in the absence of fraud | ||||||
19 | shall be conclusive.
The Petition for Review shall contain a | ||||||
20 | statement of the petitioning party's
specific exceptions to the | ||||||
21 | decision of the arbitrator. The jurisdiction
of the Commission | ||||||
22 | to review the decision of the arbitrator shall not be
limited | ||||||
23 | to the exceptions stated in the Petition for Review.
The | ||||||
24 | Commission, or any member thereof, may grant further time not | ||||||
25 | exceeding
30 days, in which to file such agreed statement or | ||||||
26 | transcript of
evidence. Such agreed statement of facts or |
| |||||||
| |||||||
1 | correct transcript of
evidence, as the case may be, shall be | ||||||
2 | authenticated by the signatures
of the parties or their | ||||||
3 | attorneys, and in the event they do not agree as
to the | ||||||
4 | correctness of the transcript of evidence it shall be | ||||||
5 | authenticated
by the signature of the Arbitrator designated by | ||||||
6 | the Commission.
| ||||||
7 | Whether the employee is working or not, if the employee is | ||||||
8 | not receiving or has not received medical, surgical, or | ||||||
9 | hospital services or other services or compensation as provided | ||||||
10 | in paragraph (a) of Section 8, or compensation as provided in | ||||||
11 | paragraph (b) of Section 8, the employee may at any time | ||||||
12 | petition for an expedited hearing by an Arbitrator on the issue | ||||||
13 | of whether or not he or she is entitled to receive payment of | ||||||
14 | the services or compensation. Provided the employer continues | ||||||
15 | to pay compensation pursuant to paragraph (b) of Section 8, the | ||||||
16 | employer may at any time petition for an expedited hearing on | ||||||
17 | the issue of whether or not the employee is entitled to receive | ||||||
18 | medical, surgical, or hospital services or other services or | ||||||
19 | compensation as provided in paragraph (a) of Section 8, or | ||||||
20 | compensation as provided in paragraph (b) of Section 8. When an | ||||||
21 | employer has petitioned for an expedited hearing, the employer | ||||||
22 | shall continue to pay compensation as provided in paragraph (b) | ||||||
23 | of Section 8 unless the arbitrator renders a decision that the | ||||||
24 | employee is not entitled to the benefits that are the subject | ||||||
25 | of the expedited hearing or unless the employee's treating | ||||||
26 | physician has released the employee to return to work at his or |
| |||||||
| |||||||
1 | her regular job with the employer or the employee actually | ||||||
2 | returns to work at any other job. If the arbitrator renders a | ||||||
3 | decision that the employee is not entitled to the benefits that | ||||||
4 | are the subject of the expedited hearing, a petition for review | ||||||
5 | filed by the employee shall receive the same priority as if the | ||||||
6 | employee had filed a petition for an expedited hearing by an | ||||||
7 | Arbitrator. Neither party shall be entitled to an expedited | ||||||
8 | hearing when the employee has returned to work and the sole | ||||||
9 | issue in dispute amounts to less than 12 weeks of unpaid | ||||||
10 | compensation pursuant to paragraph (b) of Section 8. | ||||||
11 | Expedited hearings shall have priority over all other | ||||||
12 | petitions and shall be heard by the Arbitrator and Commission | ||||||
13 | with all convenient speed. Any party requesting an expedited | ||||||
14 | hearing shall give notice of a request for an expedited hearing | ||||||
15 | under this paragraph. A copy of the Application for Adjustment | ||||||
16 | of Claim shall be attached to the notice. The Commission shall | ||||||
17 | adopt rules and procedures under which the final decision of | ||||||
18 | the Commission under this paragraph is filed not later than 180 | ||||||
19 | days from the date that the Petition for Review is filed with | ||||||
20 | the Commission. | ||||||
21 | Where 2 or more insurance carriers, private self-insureds, | ||||||
22 | or a group workers' compensation pool under Article V 3/4 of | ||||||
23 | the Illinois Insurance Code dispute coverage for the same | ||||||
24 | injury, any such insurance carrier, private self-insured, or | ||||||
25 | group workers' compensation pool may request an expedited | ||||||
26 | hearing pursuant to this paragraph to determine the issue of |
| |||||||
| |||||||
1 | coverage, provided coverage is the only issue in dispute and | ||||||
2 | all other issues are stipulated and agreed to and further | ||||||
3 | provided that all compensation benefits including medical | ||||||
4 | benefits pursuant to Section 8(a) continue to be paid to or on | ||||||
5 | behalf of petitioner. Any insurance carrier, private | ||||||
6 | self-insured, or group workers' compensation pool that is | ||||||
7 | determined to be liable for coverage for the injury in issue | ||||||
8 | shall reimburse any insurance carrier, private self-insured, | ||||||
9 | or group workers' compensation pool that has paid benefits to | ||||||
10 | or on behalf of petitioner for the injury.
| ||||||
11 | (b-1) If the employee is not receiving medical, surgical or | ||||||
12 | hospital
services as provided in paragraph (a) of Section 8 or | ||||||
13 | compensation as
provided in paragraph (b) of Section 8, the | ||||||
14 | employee, in accordance with
Commission Rules, may file a | ||||||
15 | petition for an emergency hearing by an
Arbitrator on the issue | ||||||
16 | of whether or not he is entitled to receive payment
of such | ||||||
17 | compensation or services as provided therein. Such petition | ||||||
18 | shall
have priority over all other petitions and shall be heard | ||||||
19 | by the Arbitrator
and Commission with all convenient speed.
| ||||||
20 | Such petition shall contain the following information and | ||||||
21 | shall be served
on the employer at least 15 days before it is | ||||||
22 | filed:
| ||||||
23 | (i) the date and approximate time of accident;
| ||||||
24 | (ii) the approximate location of the accident;
| ||||||
25 | (iii) a description of the accident;
| ||||||
26 | (iv) the nature of the injury incurred by the employee;
|
| |||||||
| |||||||
1 | (v) the identity of the person, if known, to whom the | ||||||
2 | accident was
reported and the date on which it was | ||||||
3 | reported;
| ||||||
4 | (vi) the name and title of the person, if known, | ||||||
5 | representing the
employer with whom the employee conferred | ||||||
6 | in any effort to obtain
compensation pursuant to paragraph | ||||||
7 | (b) of Section 8 of this Act or medical,
surgical or | ||||||
8 | hospital services pursuant to paragraph (a) of Section 8 of
| ||||||
9 | this Act and the date of such conference;
| ||||||
10 | (vii) a statement that the employer has refused to pay | ||||||
11 | compensation
pursuant to paragraph (b) of Section 8 of this | ||||||
12 | Act or for medical, surgical
or hospital services pursuant | ||||||
13 | to paragraph (a) of Section 8 of this Act;
| ||||||
14 | (viii) the name and address, if known, of each witness | ||||||
15 | to the accident
and of each other person upon whom the | ||||||
16 | employee will rely to support his
allegations;
| ||||||
17 | (ix) the dates of treatment related to the accident by | ||||||
18 | medical
practitioners, and the names and addresses of such | ||||||
19 | practitioners, including
the dates of treatment related to | ||||||
20 | the accident at any hospitals and the
names and addresses | ||||||
21 | of such hospitals, and a signed authorization
permitting | ||||||
22 | the employer to examine all medical records of all | ||||||
23 | practitioners
and hospitals named pursuant to this | ||||||
24 | paragraph;
| ||||||
25 | (x) a copy of a signed report by a medical | ||||||
26 | practitioner, relating to the
employee's current inability |
| |||||||
| |||||||
1 | to return to work because of the injuries
incurred as a | ||||||
2 | result of the accident or such other documents or | ||||||
3 | affidavits
which show that the employee is entitled to | ||||||
4 | receive compensation pursuant
to paragraph (b) of Section 8 | ||||||
5 | of this Act or medical, surgical or hospital
services | ||||||
6 | pursuant to paragraph (a) of Section 8 of this Act. Such | ||||||
7 | reports,
documents or affidavits shall state, if possible, | ||||||
8 | the history of the
accident given by the employee, and | ||||||
9 | describe the injury and medical
diagnosis, the medical | ||||||
10 | services for such injury which the employee has
received | ||||||
11 | and is receiving, the physical activities which the | ||||||
12 | employee
cannot currently perform as a result of any | ||||||
13 | impairment or disability due to
such injury, and the | ||||||
14 | prognosis for recovery;
| ||||||
15 | (xi) complete copies of any reports, records, | ||||||
16 | documents and affidavits
in the possession of the employee | ||||||
17 | on which the employee will rely to
support his allegations, | ||||||
18 | provided that the employer shall pay the
reasonable cost of | ||||||
19 | reproduction thereof;
| ||||||
20 | (xii) a list of any reports, records, documents and | ||||||
21 | affidavits which
the employee has demanded by subpoena and | ||||||
22 | on which he intends to
rely to support his allegations;
| ||||||
23 | (xiii) a certification signed by the employee or his | ||||||
24 | representative that
the employer has received the petition | ||||||
25 | with the required information 15
days before filing.
| ||||||
26 | Fifteen days after receipt by the employer of the petition |
| |||||||
| |||||||
1 | with the
required information the employee may file said | ||||||
2 | petition and required
information and shall serve notice of the | ||||||
3 | filing upon the employer. The
employer may file a motion | ||||||
4 | addressed to the sufficiency of the petition.
If an objection | ||||||
5 | has been filed to the sufficiency of the petition, the
| ||||||
6 | arbitrator shall rule on the objection within 2 working days. | ||||||
7 | If such an
objection is filed, the time for filing the final | ||||||
8 | decision of the
Commission as provided in this paragraph shall | ||||||
9 | be tolled until the
arbitrator has determined that the petition | ||||||
10 | is sufficient.
| ||||||
11 | The employer shall, within 15 days after receipt of the | ||||||
12 | notice that such
petition is filed, file with the Commission | ||||||
13 | and serve on the employee or
his representative a written | ||||||
14 | response to each claim set forth in the
petition, including the | ||||||
15 | legal and factual basis for each disputed
allegation and the | ||||||
16 | following information: (i) complete copies of any
reports, | ||||||
17 | records, documents and affidavits in the possession of the
| ||||||
18 | employer on which the employer intends to rely in support of | ||||||
19 | his response,
(ii) a list of any reports, records, documents | ||||||
20 | and affidavits which the
employer has demanded by subpoena and | ||||||
21 | on which the employer intends to rely
in support of his | ||||||
22 | response, (iii) the name and address of each witness on
whom | ||||||
23 | the employer will rely to support his response, and (iv) the | ||||||
24 | names and
addresses of any medical practitioners selected by | ||||||
25 | the employer pursuant to
Section 12 of this Act and the time | ||||||
26 | and place of any examination scheduled
to be made pursuant to |
| |||||||
| |||||||
1 | such Section.
| ||||||
2 | Any employer who does not timely file and serve a written | ||||||
3 | response
without good cause may not introduce any evidence to | ||||||
4 | dispute any claim of
the employee but may cross examine the | ||||||
5 | employee or any witness brought by
the employee and otherwise | ||||||
6 | be heard.
| ||||||
7 | No document or other evidence not previously identified by | ||||||
8 | either party
with the petition or written response, or by any | ||||||
9 | other means before the
hearing, may be introduced into evidence | ||||||
10 | without good cause.
If, at the hearing, material information is | ||||||
11 | discovered which was
not previously disclosed, the Arbitrator | ||||||
12 | may extend the time for closing
proof on the motion of a party | ||||||
13 | for a reasonable period of time which may
be more than 30 days. | ||||||
14 | No evidence may be introduced pursuant
to this paragraph as to | ||||||
15 | permanent disability. No award may be entered for
permanent | ||||||
16 | disability pursuant to this paragraph. Either party may | ||||||
17 | introduce
into evidence the testimony taken by deposition of | ||||||
18 | any medical practitioner.
| ||||||
19 | The Commission shall adopt rules, regulations and | ||||||
20 | procedures whereby the
final decision of the Commission is | ||||||
21 | filed not later than 90 days from the
date the petition for | ||||||
22 | review is filed but in no event later than 180 days from
the | ||||||
23 | date the petition for an emergency hearing is filed with the | ||||||
24 | Illinois Workers' Compensation
Commission.
| ||||||
25 | All service required pursuant to this paragraph (b-1) must | ||||||
26 | be by personal
service or by certified mail and with evidence |
| |||||||
| |||||||
1 | of receipt. In addition for
the purposes of this paragraph, all | ||||||
2 | service on the employer must be at the
premises where the | ||||||
3 | accident occurred if the premises are owned or operated
by the | ||||||
4 | employer. Otherwise service must be at the employee's principal
| ||||||
5 | place of employment by the employer. If service on the employer | ||||||
6 | is not
possible at either of the above, then service shall be | ||||||
7 | at the employer's
principal place of business. After initial | ||||||
8 | service in each case, service
shall be made on the employer's | ||||||
9 | attorney or designated representative.
| ||||||
10 | (c) (1) At a reasonable time in advance of and in | ||||||
11 | connection with the
hearing under Section 19(e) or 19(h), the | ||||||
12 | Commission may on its own motion
order an impartial physical or | ||||||
13 | mental examination of a petitioner whose
mental or physical | ||||||
14 | condition is in issue, when in the Commission's
discretion it | ||||||
15 | appears that such an examination will materially aid in the
| ||||||
16 | just determination of the case. The examination shall be made | ||||||
17 | by a member
or members of a panel of physicians chosen for | ||||||
18 | their special qualifications
by the Illinois State Medical | ||||||
19 | Society. The Commission shall establish
procedures by which a | ||||||
20 | physician shall be selected from such list.
| ||||||
21 | (2) Should the Commission at any time during the hearing | ||||||
22 | find that
compelling considerations make it advisable to have | ||||||
23 | an examination and
report at that time, the commission may in | ||||||
24 | its discretion so order.
| ||||||
25 | (3) A copy of the report of examination shall be given to | ||||||
26 | the Commission
and to the attorneys for the parties.
|
| |||||||
| |||||||
1 | (4) Either party or the Commission may call the examining | ||||||
2 | physician or
physicians to testify. Any physician so called | ||||||
3 | shall be subject to
cross-examination.
| ||||||
4 | (5) The examination shall be made, and the physician or | ||||||
5 | physicians, if
called, shall testify, without cost to the | ||||||
6 | parties. The Commission shall
determine the compensation and | ||||||
7 | the pay of the physician or physicians. The
compensation for | ||||||
8 | this service shall not exceed the usual and customary amount
| ||||||
9 | for such service.
| ||||||
10 | (6) The fees and payment thereof of all attorneys and | ||||||
11 | physicians for
services authorized by the Commission under this | ||||||
12 | Act shall, upon request
of either the employer or the employee | ||||||
13 | or the beneficiary affected, be
subject to the review and | ||||||
14 | decision of the Commission.
| ||||||
15 | (d) If any employee shall persist in insanitary or | ||||||
16 | injurious
practices which tend to either imperil or retard his | ||||||
17 | recovery or shall
refuse to submit to such medical, surgical, | ||||||
18 | or hospital treatment as is
reasonably essential to promote his | ||||||
19 | recovery, the Commission may, in its
discretion, reduce or | ||||||
20 | suspend the compensation of any such injured
employee. However, | ||||||
21 | when an employer and employee so agree in writing,
the | ||||||
22 | foregoing provision shall not be construed to authorize the
| ||||||
23 | reduction or suspension of compensation of an employee who is | ||||||
24 | relying in
good faith, on treatment by prayer or spiritual | ||||||
25 | means alone, in
accordance with the tenets and practice of a | ||||||
26 | recognized church or
religious denomination, by a duly |
| |||||||
| |||||||
1 | accredited practitioner thereof.
| ||||||
2 | (e) This paragraph shall apply to all hearings before the | ||||||
3 | Commission.
Such hearings may be held in its office or | ||||||
4 | elsewhere as the Commission
may deem advisable. The taking of | ||||||
5 | testimony on such hearings may be had
before any member of the | ||||||
6 | Commission. If a petition for review and agreed
statement of | ||||||
7 | facts or transcript of evidence is filed, as provided herein,
| ||||||
8 | the Commission shall promptly review the decision of the | ||||||
9 | Arbitrator and all
questions of law or fact which appear from | ||||||
10 | the statement of facts or
transcript of evidence.
| ||||||
11 | In all cases in which the hearing before the arbitrator is | ||||||
12 | held after
December 18, 1989, no additional evidence shall be | ||||||
13 | introduced by the
parties before the Commission on review of | ||||||
14 | the decision of the Arbitrator.
In reviewing decisions of an | ||||||
15 | arbitrator the Commission shall award such
temporary | ||||||
16 | compensation, permanent compensation and other payments as are
| ||||||
17 | due under this Act. The Commission shall file in its office its | ||||||
18 | decision
thereon, and shall immediately send to each party or | ||||||
19 | his attorney a copy of
such decision and a notification of the | ||||||
20 | time when it was filed. Decisions
shall be filed within 60 days | ||||||
21 | after the Statement of Exceptions and
Supporting Brief and | ||||||
22 | Response thereto are required to be filed or oral
argument | ||||||
23 | whichever is later.
| ||||||
24 | In the event either party requests oral argument, such | ||||||
25 | argument shall be
had before a panel of 3 members of the | ||||||
26 | Commission (or before all available
members pursuant to the |
| |||||||
| |||||||
1 | determination of 7 members of the Commission that
such argument | ||||||
2 | be held before all available members of the Commission)
| ||||||
3 | pursuant to the rules and regulations of the Commission. A | ||||||
4 | panel of 3
members, which shall be comprised of not more than | ||||||
5 | one representative
citizen of the employing class and not more | ||||||
6 | than one representative citizen
of the employee class, shall | ||||||
7 | hear the argument; provided that if all the
issues in dispute | ||||||
8 | are solely the nature and extent of the permanent partial
| ||||||
9 | disability, if any, a majority of the panel may deny the | ||||||
10 | request for such
argument and such argument shall not be held; | ||||||
11 | and provided further that 7
members of the Commission may | ||||||
12 | determine that the argument be held before
all available | ||||||
13 | members of the Commission. A decision of the Commission
shall | ||||||
14 | be approved by a majority of Commissioners present at such | ||||||
15 | hearing if
any; provided, if no such hearing is held, a | ||||||
16 | decision of the Commission
shall be approved by a majority of a | ||||||
17 | panel of 3 members of the Commission
as described in this | ||||||
18 | Section. The Commission shall give 10 days' notice to
the | ||||||
19 | parties or their attorneys of the time and place of such taking | ||||||
20 | of
testimony and of such argument.
| ||||||
21 | In any case the Commission in its decision may find | ||||||
22 | specially
upon any question or questions of law or fact which | ||||||
23 | shall be submitted
in writing by either party whether ultimate | ||||||
24 | or otherwise;
provided that on issues other than nature and | ||||||
25 | extent of the disability,
if any, the Commission in its | ||||||
26 | decision shall find specially upon any
question or questions of |
| |||||||
| |||||||
1 | law or fact, whether ultimate or otherwise,
which are submitted | ||||||
2 | in writing by either party; provided further that
not more than | ||||||
3 | 5 such questions may be submitted by either party. Any
party | ||||||
4 | may, within 20 days after receipt of notice of the Commission's
| ||||||
5 | decision, or within such further time, not exceeding 30 days, | ||||||
6 | as the
Commission may grant, file with the Commission either an | ||||||
7 | agreed
statement of the facts appearing upon the hearing, or, | ||||||
8 | if such party
shall so elect, a correct transcript of evidence | ||||||
9 | of the additional
proceedings presented before the Commission, | ||||||
10 | in which report the party
may embody a correct statement of | ||||||
11 | such other proceedings in the case as
such party may desire to | ||||||
12 | have reviewed, such statement of facts or
transcript of | ||||||
13 | evidence to be authenticated by the signature of the
parties or | ||||||
14 | their attorneys, and in the event that they do not agree,
then | ||||||
15 | the authentication of such transcript of evidence shall be by | ||||||
16 | the
signature of any member of the Commission.
| ||||||
17 | If a reporter does not for any reason furnish a transcript | ||||||
18 | of the
proceedings before the Arbitrator in any case for use on | ||||||
19 | a hearing for
review before the Commission, within the | ||||||
20 | limitations of time as fixed in
this Section, the Commission | ||||||
21 | may, in its discretion, order a trial de
novo before the | ||||||
22 | Commission in such case upon application of either
party. The | ||||||
23 | applications for adjustment of claim and other documents in
the | ||||||
24 | nature of pleadings filed by either party, together with the
| ||||||
25 | decisions of the Arbitrator and of the Commission and the | ||||||
26 | statement of
facts or transcript of evidence hereinbefore |
| |||||||
| |||||||
1 | provided for in paragraphs
(b) and (c) shall be the record of | ||||||
2 | the proceedings of the Commission,
and shall be subject to | ||||||
3 | review as hereinafter provided.
| ||||||
4 | At the request of either party or on its own motion, the | ||||||
5 | Commission shall
set forth in writing the reasons for the | ||||||
6 | decision, including findings of
fact and conclusions of law | ||||||
7 | separately stated. The Commission shall by rule
adopt a format | ||||||
8 | for written decisions for the Commission and arbitrators.
The | ||||||
9 | written decisions shall be concise and shall succinctly state | ||||||
10 | the facts
and reasons for the decision. The Commission may | ||||||
11 | adopt in whole or in part,
the decision of the arbitrator as | ||||||
12 | the decision of the Commission. When the
Commission does so | ||||||
13 | adopt the decision of the arbitrator, it shall do so by
order. | ||||||
14 | Whenever the Commission adopts part of the arbitrator's | ||||||
15 | decision,
but not all, it shall include in the order the | ||||||
16 | reasons for not adopting all
of the arbitrator's decision. When | ||||||
17 | a majority of a panel, after
deliberation, has arrived at its | ||||||
18 | decision, the decision shall be filed as
provided in this | ||||||
19 | Section without unnecessary delay, and without regard to
the | ||||||
20 | fact that a member of the panel has expressed an intention to | ||||||
21 | dissent.
Any member of the panel may file a dissent. Any | ||||||
22 | dissent shall be filed no
later than 10 days after the decision | ||||||
23 | of the majority has been filed.
| ||||||
24 | Decisions rendered by the Commission and dissents, if any, | ||||||
25 | shall be
published together by the Commission. The conclusions | ||||||
26 | of law set out in
such decisions shall be regarded as |
| |||||||
| |||||||
1 | precedents by arbitrators for the purpose
of achieving a more | ||||||
2 | uniform administration of this Act.
| ||||||
3 | (f) The decision of the Commission acting within its | ||||||
4 | powers,
according to the provisions of paragraph (e) of this | ||||||
5 | Section shall, in
the absence of fraud, be conclusive unless | ||||||
6 | reviewed as in this paragraph
hereinafter provided. However, | ||||||
7 | the Arbitrator or the Commission may on
his or its own motion, | ||||||
8 | or on the motion of either party, correct any
clerical error or | ||||||
9 | errors in computation within 15 days after the date of
receipt | ||||||
10 | of any award by such Arbitrator or any decision on review of | ||||||
11 | the
Commission and shall have the power to recall the original | ||||||
12 | award on
arbitration or decision on review, and issue in lieu | ||||||
13 | thereof such
corrected award or decision. Where such correction | ||||||
14 | is made the time for
review herein specified shall begin to run | ||||||
15 | from the date of
the receipt of the corrected award or | ||||||
16 | decision.
| ||||||
17 | (1) Except in cases of claims against the State of | ||||||
18 | Illinois, in
which case the decision of the Commission | ||||||
19 | shall not be subject to
judicial review, the Circuit Court | ||||||
20 | of the county where any of the
parties defendant may be | ||||||
21 | found, or if none of the parties defendant can
be found in | ||||||
22 | this State then the Circuit Court of the county where the
| ||||||
23 | accident occurred, shall by summons to the Commission have
| ||||||
24 | power to review all questions of law and fact presented by | ||||||
25 | such record.
| ||||||
26 | A proceeding for review shall be commenced within 20 |
| |||||||
| |||||||
1 | days of
the receipt of notice of the decision of the | ||||||
2 | Commission. The summons shall
be issued by the clerk of | ||||||
3 | such court upon written request returnable on a
designated | ||||||
4 | return day, not less than 10 or more than 60 days from the | ||||||
5 | date
of issuance thereof, and the written request shall | ||||||
6 | contain the last known
address of other parties in interest | ||||||
7 | and their attorneys of record who are
to be served by | ||||||
8 | summons. Service upon any member of the Commission or the
| ||||||
9 | Secretary or the Assistant Secretary thereof shall be | ||||||
10 | service upon the
Commission, and service upon other parties | ||||||
11 | in interest and their attorneys
of record shall be by | ||||||
12 | summons, and such service shall be made upon the
Commission | ||||||
13 | and other parties in interest by mailing notices of the
| ||||||
14 | commencement of the proceedings and the return day of the | ||||||
15 | summons to the
office of the Commission and to the last | ||||||
16 | known place of residence of other
parties in interest or | ||||||
17 | their attorney or attorneys of record. The clerk of
the | ||||||
18 | court issuing the summons shall on the day of issue mail | ||||||
19 | notice of the
commencement of the proceedings which shall | ||||||
20 | be done by mailing a copy of
the summons to the office of | ||||||
21 | the Commission, and a copy of the summons to
the other | ||||||
22 | parties in interest or their attorney or attorneys of | ||||||
23 | record and
the clerk of the court shall make certificate | ||||||
24 | that he has so sent said
notices in pursuance of this | ||||||
25 | Section, which shall be evidence of service on
the | ||||||
26 | Commission and other parties in interest.
|
| |||||||
| |||||||
1 | The Commission shall not be required to certify the | ||||||
2 | record of their
proceedings to the Circuit Court, unless | ||||||
3 | the party commencing the
proceedings for review in the | ||||||
4 | Circuit Court as above provided, shall pay
to the | ||||||
5 | Commission the sum of 80¢ per page of testimony taken | ||||||
6 | before the
Commission, and 35¢ per page of all other | ||||||
7 | matters contained in such
record, except as otherwise | ||||||
8 | provided by Section 20 of this Act. Payment
for photostatic | ||||||
9 | copies of exhibit shall be extra. It shall be the duty
of | ||||||
10 | the Commission upon such payment, or failure to pay as | ||||||
11 | permitted
under Section 20 of this Act, to prepare a true | ||||||
12 | and correct typewritten
copy of such testimony and a true | ||||||
13 | and correct copy of all other matters
contained in such | ||||||
14 | record and certified to by the Secretary or Assistant
| ||||||
15 | Secretary thereof.
| ||||||
16 | In its decision on review the Commission shall | ||||||
17 | determine in each
particular case the amount of the | ||||||
18 | probable cost of the record to be
filed as a part of the | ||||||
19 | summons in that case and no request for a summons
may be | ||||||
20 | filed and no summons shall issue unless the party seeking | ||||||
21 | to review
the decision of the Commission shall exhibit to | ||||||
22 | the clerk of the Circuit
Court proof of payment by filing a | ||||||
23 | receipt showing payment or an affidavit
of the attorney | ||||||
24 | setting forth that payment has been made of the sums so
| ||||||
25 | determined to the Secretary or Assistant Secretary of the | ||||||
26 | Commission,
except as otherwise provided by Section 20 of |
| |||||||
| |||||||
1 | this Act.
| ||||||
2 | (2) No such summons shall issue unless the one against | ||||||
3 | whom the
Commission shall have rendered an award for the | ||||||
4 | payment of money shall upon
the filing of his written | ||||||
5 | request for such summons file with the clerk of
the court a | ||||||
6 | bond conditioned that if he shall not successfully
| ||||||
7 | prosecute the review, he will pay the award and the costs | ||||||
8 | of the
proceedings in the courts. The amount of the bond | ||||||
9 | shall be fixed by any
member of the Commission and the | ||||||
10 | surety or sureties of the bond shall be
approved by the | ||||||
11 | clerk of the court. The acceptance of the bond by the
clerk | ||||||
12 | of the court shall constitute evidence of his approval of | ||||||
13 | the bond.
| ||||||
14 | Every county, city, town, township, incorporated | ||||||
15 | village, school
district, body politic or municipal | ||||||
16 | corporation against whom the
Commission shall have | ||||||
17 | rendered an award for the payment of money shall
not be | ||||||
18 | required to file a bond to secure the payment of the award | ||||||
19 | and
the costs of the proceedings in the court to authorize | ||||||
20 | the court to
issue such summons.
| ||||||
21 | The court may confirm or set aside the decision of the | ||||||
22 | Commission. If
the decision is set aside and the facts | ||||||
23 | found in the proceedings before
the Commission are | ||||||
24 | sufficient, the court may enter such decision as is
| ||||||
25 | justified by law, or may remand the cause to the Commission | ||||||
26 | for further
proceedings and may state the questions |
| |||||||
| |||||||
1 | requiring further hearing, and
give such other | ||||||
2 | instructions as may be proper. Appeals shall be taken
to | ||||||
3 | the Appellate Court in accordance
with Supreme Court Rules | ||||||
4 | 22(g) and 303. Appeals
shall be taken from the Appellate
| ||||||
5 | Court to the Supreme Court in accordance with Supreme Court | ||||||
6 | Rule 315.
| ||||||
7 | It shall be the duty of the clerk of any court | ||||||
8 | rendering a decision
affecting or affirming an award of the | ||||||
9 | Commission to promptly furnish
the Commission with a copy | ||||||
10 | of such decision, without charge.
| ||||||
11 | The decision of a majority of the members of the panel | ||||||
12 | of the Commission,
shall be considered the decision of the | ||||||
13 | Commission.
| ||||||
14 | (g) Except in the case of a claim against the State of | ||||||
15 | Illinois,
either party may present a certified copy of the | ||||||
16 | award of the
Arbitrator, or a certified copy of the decision of | ||||||
17 | the Commission when
the same has become final, when no | ||||||
18 | proceedings for review are pending,
providing for the payment | ||||||
19 | of compensation according to this Act, to the
Circuit Court of | ||||||
20 | the county in which such accident occurred or either of
the | ||||||
21 | parties are residents, whereupon the court shall enter a | ||||||
22 | judgment
in accordance therewith. In a case where the employer | ||||||
23 | refuses to pay
compensation according to such final award or | ||||||
24 | such final decision upon
which such judgment is entered the | ||||||
25 | court shall in entering judgment
thereon, tax as costs against | ||||||
26 | him the reasonable costs and attorney fees
in the arbitration |
| |||||||
| |||||||
1 | proceedings and in the court entering the judgment
for the | ||||||
2 | person in whose favor the judgment is entered, which judgment
| ||||||
3 | and costs taxed as therein provided shall, until and unless set | ||||||
4 | aside,
have the same effect as though duly entered in an action | ||||||
5 | duly tried and
determined by the court, and shall with like | ||||||
6 | effect, be entered and
docketed. The Circuit Court shall have | ||||||
7 | power at any time upon
application to make any such judgment | ||||||
8 | conform to any modification
required by any subsequent decision | ||||||
9 | of the Supreme Court upon appeal, or
as the result of any | ||||||
10 | subsequent proceedings for review, as provided in
this Act.
| ||||||
11 | Judgment shall not be entered until 15 days' notice of the | ||||||
12 | time and
place of the application for the entry of judgment | ||||||
13 | shall be served upon
the employer by filing such notice with | ||||||
14 | the Commission, which Commission
shall, in case it has on file | ||||||
15 | the address of the employer or the name
and address of its | ||||||
16 | agent upon whom notices may be served, immediately
send a copy | ||||||
17 | of the notice to the employer or such designated agent.
| ||||||
18 | (h) An agreement or award under this Act providing for | ||||||
19 | compensation
in installments, may at any time within 18 months | ||||||
20 | after such agreement
or award be reviewed by the Commission at | ||||||
21 | the request of either the
employer or the employee, on the | ||||||
22 | ground that the disability of the
employee has subsequently | ||||||
23 | recurred, increased, diminished or ended.
| ||||||
24 | However, as to accidents occurring subsequent to July 1, | ||||||
25 | 1955, which
are covered by any agreement or award under this | ||||||
26 | Act providing for
compensation in installments made as a result |
| |||||||
| |||||||
1 | of such accident, such
agreement or award may at any time | ||||||
2 | within 30 months, or 60 months in the case of an award under | ||||||
3 | Section 8(d)1, after such agreement
or award be reviewed by the | ||||||
4 | Commission at the request of either the
employer or the | ||||||
5 | employee on the ground that the disability of the
employee has | ||||||
6 | subsequently recurred, increased, diminished or ended.
| ||||||
7 | On such review, compensation payments may be | ||||||
8 | re-established,
increased, diminished or ended. The Commission | ||||||
9 | shall give 15 days'
notice to the parties of the hearing for | ||||||
10 | review. Any employee, upon any
petition for such review being | ||||||
11 | filed by the employer, shall be entitled
to one day's notice | ||||||
12 | for each 100 miles necessary to be traveled by him in
attending | ||||||
13 | the hearing of the Commission upon the petition, and 3 days in
| ||||||
14 | addition thereto. Such employee shall, at the discretion of the
| ||||||
15 | Commission, also be entitled to 5 cents per mile necessarily | ||||||
16 | traveled by
him within the State of Illinois in attending such | ||||||
17 | hearing, not to
exceed a distance of 300 miles, to be taxed by | ||||||
18 | the Commission as costs
and deposited with the petition of the | ||||||
19 | employer.
| ||||||
20 | When compensation which is payable in accordance with an | ||||||
21 | award or
settlement contract approved by the Commission, is | ||||||
22 | ordered paid in a
lump sum by the Commission, no review shall | ||||||
23 | be had as in this paragraph
mentioned.
| ||||||
24 | (i) Each party, upon taking any proceedings or steps | ||||||
25 | whatsoever
before any Arbitrator, Commission or court, shall | ||||||
26 | file with the Commission
his address, or the name and address |
| |||||||
| |||||||
1 | of any agent upon whom all notices to
be given to such party | ||||||
2 | shall be served, either personally or by registered
mail, | ||||||
3 | addressed to such party or agent at the last address so filed | ||||||
4 | with
the Commission. In the event such party has not filed his | ||||||
5 | address, or the
name and address of an agent as above provided, | ||||||
6 | service of any notice may
be had by filing such notice with the | ||||||
7 | Commission.
| ||||||
8 | (j) Whenever in any proceeding testimony has been taken or | ||||||
9 | a final
decision has been rendered and after the taking of such | ||||||
10 | testimony or
after such decision has become final, the injured | ||||||
11 | employee dies, then in
any subsequent proceedings brought by | ||||||
12 | the personal representative or
beneficiaries of the deceased | ||||||
13 | employee, such testimony in the former
proceeding may be | ||||||
14 | introduced with the same force and effect as though
the witness | ||||||
15 | having so testified were present in person in such
subsequent | ||||||
16 | proceedings and such final decision, if any, shall be taken
as | ||||||
17 | final adjudication of any of the issues which are the same in | ||||||
18 | both
proceedings.
| ||||||
19 | (k) In case where there has been any unreasonable or | ||||||
20 | vexatious delay
of payment or intentional underpayment of | ||||||
21 | compensation, or proceedings
have been instituted or carried on | ||||||
22 | by the one liable to pay the
compensation, which do not present | ||||||
23 | a real controversy, but are merely
frivolous or for delay, then | ||||||
24 | the Commission may award compensation
additional to that | ||||||
25 | otherwise payable under this Act equal to 50% of the
amount | ||||||
26 | payable at the time of such award. Failure to pay compensation
|
| |||||||
| |||||||
1 | in accordance with the provisions of Section 8, paragraph (b) | ||||||
2 | of this
Act, shall be considered unreasonable delay.
| ||||||
3 | When determining whether this subsection (k) shall apply, | ||||||
4 | the
Commission shall consider whether an Arbitrator has | ||||||
5 | determined
that the claim is not compensable or whether the | ||||||
6 | employer has
made payments under Section 8(j). | ||||||
7 | (l) If the employee has made written demand for payment of
| ||||||
8 | benefits under Section 8(a) or Section 8(b), the employer shall
| ||||||
9 | have 14 days after receipt of the demand to set forth in
| ||||||
10 | writing the reason for the delay. In the case of demand for
| ||||||
11 | payment of medical benefits under Section 8(a), the time for
| ||||||
12 | the employer to respond shall not commence until the expiration
| ||||||
13 | of the allotted 60 days specified under Section 8.2(d). In case
| ||||||
14 | the employer or his or her insurance carrier shall without good | ||||||
15 | and
just cause fail, neglect, refuse, or unreasonably delay the
| ||||||
16 | payment of benefits under Section 8(a) or Section 8(b), the
| ||||||
17 | Arbitrator or the Commission shall allow to the employee
| ||||||
18 | additional compensation in the sum of $30 per day for each day
| ||||||
19 | that the benefits under Section 8(a) or Section 8(b) have been
| ||||||
20 | so withheld or refused, not to exceed $10,000.
A delay in | ||||||
21 | payment of 14 days or more
shall create a rebuttable | ||||||
22 | presumption of unreasonable delay. Notwithstanding the | ||||||
23 | foregoing, any such additional compensation awarded on or after | ||||||
24 | the effective date of this amendatory Act of the 97th General | ||||||
25 | Assembly that is awarded because the benefits under Section | ||||||
26 | 8(a) have been so withheld or refused shall be distributed |
| |||||||
| |||||||
1 | first to the provider of medical services to pay any unpaid | ||||||
2 | amounts due and any interest due under Section 8.2.
| ||||||
3 | (m) If the commission finds that an accidental injury was | ||||||
4 | directly
and proximately caused by the employer's wilful | ||||||
5 | violation of a health
and safety standard under the Health and | ||||||
6 | Safety Act in force at the time of the
accident, the arbitrator | ||||||
7 | or the Commission shall allow to the injured
employee or his | ||||||
8 | dependents, as the case may be, additional compensation
equal | ||||||
9 | to 25% of the amount which otherwise would be payable under the
| ||||||
10 | provisions of this Act exclusive of this paragraph. The | ||||||
11 | additional
compensation herein provided shall be allowed by an | ||||||
12 | appropriate increase
in the applicable weekly compensation | ||||||
13 | rate.
| ||||||
14 | (n) After June 30, 1984, decisions of the Illinois Workers' | ||||||
15 | Compensation Commission
reviewing an award of an arbitrator of | ||||||
16 | the Commission shall draw interest
at a rate equal to the yield | ||||||
17 | on indebtedness issued by the United States
Government with a | ||||||
18 | 26-week maturity next previously auctioned on the day on
which | ||||||
19 | the decision is filed. Said rate of interest shall be set forth | ||||||
20 | in
the Arbitrator's Decision. Interest shall be drawn from the | ||||||
21 | date of the
arbitrator's award on all accrued compensation due | ||||||
22 | the employee through the
day prior to the date of payments. | ||||||
23 | However, when an employee appeals an
award of an Arbitrator or | ||||||
24 | the Commission, and the appeal results in no
change or a | ||||||
25 | decrease in the award, interest shall not further accrue from
| ||||||
26 | the date of such appeal.
|
| |||||||
| |||||||
1 | The employer or his insurance carrier may tender the | ||||||
2 | payments due under
the award to stop the further accrual of | ||||||
3 | interest on such award
notwithstanding the prosecution by | ||||||
4 | either party of review, certiorari,
appeal to the Supreme Court | ||||||
5 | or other steps to reverse, vacate or modify
the award.
| ||||||
6 | (o) By the 15th day of each month each insurer providing | ||||||
7 | coverage for
losses under this Act shall notify each insured | ||||||
8 | employer of any compensable
claim incurred during the preceding | ||||||
9 | month and the amounts paid or reserved
on the claim including a | ||||||
10 | summary of the claim and a brief statement of the
reasons for | ||||||
11 | compensability. A cumulative report of all claims incurred
| ||||||
12 | during a calendar year or continued from the previous year | ||||||
13 | shall be
furnished to the insured employer by the insurer | ||||||
14 | within 30 days after the
end of that calendar year.
| ||||||
15 | The insured employer may challenge, in proceeding before | ||||||
16 | the Commission,
payments made by the insurer without | ||||||
17 | arbitration and payments
made after a case is determined to be | ||||||
18 | noncompensable. If the Commission
finds that the case was not | ||||||
19 | compensable, the insurer shall purge its records
as to that | ||||||
20 | employer of any loss or expense associated with the claim, | ||||||
21 | reimburse
the employer for attorneys' fees arising from the | ||||||
22 | challenge and for any
payment required of the employer to the | ||||||
23 | Rate Adjustment Fund or the
Second Injury Fund, and may not | ||||||
24 | reflect the loss or expense for rate making
purposes. The | ||||||
25 | employee shall not be required to refund the challenged
| ||||||
26 | payment. The decision of the Commission may be reviewed in the |
| |||||||
| |||||||
1 | same manner
as in arbitrated cases. No challenge may be | ||||||
2 | initiated under this paragraph
more than 3 years after the | ||||||
3 | payment is made. An employer may waive the
right of challenge | ||||||
4 | under this paragraph on a case by case basis.
| ||||||
5 | (p) After filing an application for adjustment of claim but | ||||||
6 | prior to
the hearing on arbitration the parties may voluntarily | ||||||
7 | agree to submit such
application for adjustment of claim for | ||||||
8 | decision by an arbitrator under
this subsection (p) where such | ||||||
9 | application for adjustment of claim raises
only a dispute over | ||||||
10 | temporary total disability, permanent partial
disability or | ||||||
11 | medical expenses. Such agreement shall be in writing in such
| ||||||
12 | form as provided by the Commission. Applications for adjustment | ||||||
13 | of claim
submitted for decision by an arbitrator under this | ||||||
14 | subsection (p) shall
proceed according to rule as established | ||||||
15 | by the Commission. The Commission
shall promulgate rules | ||||||
16 | including, but not limited to, rules to ensure that
the parties | ||||||
17 | are adequately informed of their rights under this subsection
| ||||||
18 | (p) and of the voluntary nature of proceedings under this | ||||||
19 | subsection (p).
The findings of fact made by an arbitrator | ||||||
20 | acting within his or her powers
under this subsection (p) in | ||||||
21 | the absence of fraud shall be conclusive.
However, the | ||||||
22 | arbitrator may on his own motion, or the motion of either
| ||||||
23 | party, correct any clerical errors or errors in computation | ||||||
24 | within 15 days
after the date of receipt of such award of the | ||||||
25 | arbitrator
and shall have the power to recall the original | ||||||
26 | award on arbitration, and
issue in lieu thereof such corrected |
| |||||||
| |||||||
1 | award.
The decision of the arbitrator under this subsection (p) | ||||||
2 | shall be
considered the decision of the Commission and | ||||||
3 | proceedings for review of
questions of law arising from the | ||||||
4 | decision may be commenced by either party
pursuant to | ||||||
5 | subsection (f) of Section 19. The Advisory Board established
| ||||||
6 | under Section 13.1 shall compile a list of certified Commission
| ||||||
7 | arbitrators, each of whom shall be approved by at least 7 | ||||||
8 | members of the
Advisory Board. The chairman shall select 5 | ||||||
9 | persons from such list to
serve as arbitrators under this | ||||||
10 | subsection (p). By agreement, the parties
shall select one | ||||||
11 | arbitrator from among the 5 persons selected by the
chairman | ||||||
12 | except that if the parties do not agree on an arbitrator from
| ||||||
13 | among the 5 persons, the parties may, by agreement, select an | ||||||
14 | arbitrator of
the American Arbitration Association, whose fee | ||||||
15 | shall be paid by the State
in accordance with rules promulgated | ||||||
16 | by the Commission. Arbitration under
this subsection (p) shall | ||||||
17 | be voluntary.
| ||||||
18 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||||||
19 | (820 ILCS 305/25.5)
| ||||||
20 | Sec. 25.5. Unlawful acts; penalties. | ||||||
21 | (a) It is unlawful for any person, company, corporation, | ||||||
22 | insurance carrier, healthcare provider, or other entity to: | ||||||
23 | (1) Intentionally present or cause to be presented any | ||||||
24 | false or
fraudulent claim for the payment of any workers' | ||||||
25 | compensation
benefit.
|
| |||||||
| |||||||
1 | (2) Intentionally make or cause to be made any false or
| ||||||
2 | fraudulent material statement or material representation | ||||||
3 | for the
purpose of obtaining or denying any workers' | ||||||
4 | compensation
benefit.
| ||||||
5 | (3) Intentionally make or cause to be made any false or
| ||||||
6 | fraudulent statements with regard to entitlement to | ||||||
7 | workers'
compensation benefits with the intent to prevent | ||||||
8 | an injured
worker from making a legitimate claim for any | ||||||
9 | workers'
compensation benefits.
| ||||||
10 | (4) Intentionally prepare or provide an invalid, | ||||||
11 | false, or
counterfeit certificate of insurance as proof of | ||||||
12 | workers'
compensation insurance.
| ||||||
13 | (5) Intentionally make or cause to be made any false or
| ||||||
14 | fraudulent material statement or material representation | ||||||
15 | for the
purpose of obtaining workers' compensation | ||||||
16 | insurance at less
than the proper rate for that insurance.
| ||||||
17 | (6) Intentionally make or cause to be made any false or
| ||||||
18 | fraudulent material statement or material representation | ||||||
19 | on an
initial or renewal self-insurance application or | ||||||
20 | accompanying
financial statement for the purpose of | ||||||
21 | obtaining self-insurance
status or reducing the amount of | ||||||
22 | security that may be required
to be furnished pursuant to | ||||||
23 | Section 4 of this Act.
| ||||||
24 | (7) Intentionally make or cause to be made any false or
| ||||||
25 | fraudulent material statement to the Division of | ||||||
26 | Insurance's
fraud and insurance non-compliance unit in the |
| |||||||
| |||||||
1 | course of an
investigation of fraud or insurance | ||||||
2 | non-compliance.
| ||||||
3 | (8) Intentionally assist, abet, solicit, or conspire | ||||||
4 | with any
person, company, or other entity to commit any of | ||||||
5 | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||||||
6 | of this subsection (a).
| ||||||
7 | (9) Intentionally present a bill or statement for the | ||||||
8 | payment for medical services that were not provided. | ||||||
9 | For the purposes of paragraphs (2), (3), (5), (6), and (7), | ||||||
10 | and (9), the term "statement" includes any writing, notice, | ||||||
11 | proof of injury, bill for services, hospital or doctor records | ||||||
12 | and reports, or X-ray and test results.
| ||||||
13 | (b) Sentence for violations of subsection (a): Any person | ||||||
14 | violating subsection (a) is guilty of a Class 4 felony. Any | ||||||
15 | person or entity convicted of any violation of this Section | ||||||
16 | shall be ordered to pay complete restitution to any person or | ||||||
17 | entity so defrauded in addition to any fine or sentence imposed | ||||||
18 | as a result of the conviction.
| ||||||
19 | (1) A violation in which the value of the property | ||||||
20 | obtained or attempted to be obtained is $300 or less is a | ||||||
21 | Class A misdemeanor. | ||||||
22 | (2) A violation in which the value of the property | ||||||
23 | obtained or attempted to be obtained is more than $300 but | ||||||
24 | not more than $10,000 is a Class 3 felony. | ||||||
25 | (3) A violation in which the value of the property | ||||||
26 | obtained or attempted to be obtained is more than $10,000 |
| |||||||
| |||||||
1 | but not more than $100,000 is a Class 2 felony. | ||||||
2 | (4) A violation in which the value of the property | ||||||
3 | obtained or attempted to be obtained is more than $100,000 | ||||||
4 | is a Class 1 felony. | ||||||
5 | (5) A person convicted under this Section shall be | ||||||
6 | ordered to pay monetary restitution to the insurance | ||||||
7 | company or self-insured entity or any other person for any | ||||||
8 | financial loss sustained as a result of a violation of this | ||||||
9 | Section, including any court costs and attorney fees. An | ||||||
10 | order of restitution also includes expenses incurred and | ||||||
11 | paid by the State of Illinois or an insurance company or | ||||||
12 | self-insured entity in connection with any medical | ||||||
13 | evaluation or treatment services. | ||||||
14 | (6) For the purposes of this Section, where the exact | ||||||
15 | value of property obtained or attempted to be obtained is | ||||||
16 | either not alleged or is not specifically set by the terms | ||||||
17 | of a policy of insurance, the value of the property shall | ||||||
18 | be the fair market replacement value of the property | ||||||
19 | claimed to be lost, the reasonable costs of reimbursing a | ||||||
20 | vendor or other claimant for services to be rendered, or | ||||||
21 | both. | ||||||
22 | (c) The Department Division of Insurance of the Department | ||||||
23 | of Financial and Professional Regulation shall establish a | ||||||
24 | fraud and insurance non-compliance unit responsible for | ||||||
25 | investigating incidences of fraud and insurance non-compliance | ||||||
26 | pursuant to this Section. The size of the staff of the unit |
| |||||||
| |||||||
1 | shall be subject to appropriation by the General Assembly. It | ||||||
2 | shall be the duty of the fraud and insurance non-compliance | ||||||
3 | unit to determine the identity of insurance carriers, | ||||||
4 | employers, employees, or other persons or entities who have | ||||||
5 | violated the fraud and insurance non-compliance provisions of | ||||||
6 | this Section. The fraud and insurance non-compliance unit shall | ||||||
7 | report violations of the fraud and insurance non-compliance | ||||||
8 | provisions of this Section to the Special Prosecutions Bureau | ||||||
9 | of the Criminal Division of the Office of the Attorney General | ||||||
10 | or to the State's Attorney of the county in which the offense | ||||||
11 | allegedly occurred, either of whom has the authority to | ||||||
12 | prosecute violations under this Section.
| ||||||
13 | With respect to the subject of any investigation being | ||||||
14 | conducted, the fraud and insurance non-compliance unit shall | ||||||
15 | have the general power of subpoena of the Department Division | ||||||
16 | of Insurance.
| ||||||
17 | (d) Any person may report allegations of insurance | ||||||
18 | non-compliance and fraud pursuant to this Section to the | ||||||
19 | Division of Insurance's fraud and insurance non-compliance | ||||||
20 | unit whose duty it shall be to investigate the report. The unit | ||||||
21 | shall notify the Commission of reports of insurance | ||||||
22 | non-compliance. Any person reporting an allegation of | ||||||
23 | insurance non-compliance or fraud against either an employee or | ||||||
24 | employer under this Section must identify himself. Except as | ||||||
25 | provided in this subsection and in subsection (e), all reports | ||||||
26 | shall remain confidential except to refer an investigation to |
| |||||||
| |||||||
1 | the Attorney General or State's Attorney for prosecution or if | ||||||
2 | the fraud and insurance non-compliance unit's investigation | ||||||
3 | reveals that the conduct reported may be in violation of other | ||||||
4 | laws or regulations of the State of Illinois, the unit may | ||||||
5 | report such conduct to the appropriate governmental agency | ||||||
6 | charged with administering such laws and regulations. Any | ||||||
7 | person who intentionally makes a false report under this | ||||||
8 | Section to the fraud and insurance non-compliance unit is | ||||||
9 | guilty of a Class A misdemeanor.
| ||||||
10 | (e) In order for the fraud and insurance non-compliance | ||||||
11 | unit to investigate a report of fraud related to an employee's | ||||||
12 | claim by an employee , (i) the employee must have filed with the | ||||||
13 | Commission an Application for Adjustment of Claim and the | ||||||
14 | employee must have either received or attempted to receive | ||||||
15 | benefits under this Act that are related to the reported fraud | ||||||
16 | or (ii) the employee must have made a written demand for the | ||||||
17 | payment of benefits that are related to the reported fraud. | ||||||
18 | Upon receipt of a report of fraud, the employee or employer | ||||||
19 | shall receive immediate notice of the reported conduct, | ||||||
20 | including the verified name and address of the complainant if | ||||||
21 | that complainant is connected to the case and the nature of the | ||||||
22 | reported conduct. The fraud and insurance non-compliance unit | ||||||
23 | shall resolve all reports of fraud against employees or | ||||||
24 | employers within 120 days of receipt of the report. There shall | ||||||
25 | be no immunity, under this Act or otherwise, for any person who | ||||||
26 | files a false report or who files a report without good and |
| |||||||
| |||||||
1 | just cause. Confidentiality of medical information shall be | ||||||
2 | strictly maintained. Investigations that are not referred for | ||||||
3 | prosecution shall be destroyed upon the expiration of the | ||||||
4 | statute of limitations for the acts under investigation | ||||||
5 | immediately expunged and shall not be disclosed except that the | ||||||
6 | employee or employer who was the subject of the report and the | ||||||
7 | person making the report shall be notified that the | ||||||
8 | investigation is being closed , at which time the name of any | ||||||
9 | complainant not connected to the case shall be disclosed to the | ||||||
10 | employee or the employer . It is unlawful for any employer, | ||||||
11 | insurance carrier, or service adjustment company , third party | ||||||
12 | administrator, self-insured, or similar entity to file or | ||||||
13 | threaten to file a report of fraud against an employee because | ||||||
14 | of the exercise by the employee of the rights and remedies | ||||||
15 | granted to the employee by this Act.
| ||||||
16 | For purposes of this subsection (e), "employer" means any | ||||||
17 | employer, insurance carrier, third party administrator, | ||||||
18 | self-insured, or similar entity.
| ||||||
19 | For purposes of this subsection (e), "complainant" refers | ||||||
20 | to the person contacting the fraud and insurance non-compliance | ||||||
21 | unit to initiate the complaint.
| ||||||
22 | (f) Any person convicted of fraud related to workers' | ||||||
23 | compensation pursuant to this Section shall be subject to the | ||||||
24 | penalties prescribed in the Criminal Code of 1961 and shall be | ||||||
25 | ineligible to receive or retain any compensation, disability, | ||||||
26 | or medical benefits as defined in this Act if the compensation, |
| |||||||
| |||||||
1 | disability, or medical benefits were owed or received as a | ||||||
2 | result of fraud for which the recipient of the compensation, | ||||||
3 | disability, or medical benefit was convicted. This subsection | ||||||
4 | applies to accidental injuries or diseases that occur on or | ||||||
5 | after the effective date of this amendatory Act of the 94th | ||||||
6 | General Assembly.
| ||||||
7 | (g) Civil liability. Any person convicted of fraud who | ||||||
8 | knowingly obtains, attempts to obtain, or causes to be obtained | ||||||
9 | any benefits under this Act by the making of a false claim or | ||||||
10 | who knowingly misrepresents any material fact shall be civilly | ||||||
11 | liable to the payor of benefits or the insurer or the payor's | ||||||
12 | or insurer's subrogee or assignee in an amount equal to 3 times | ||||||
13 | the value of the benefits or insurance coverage wrongfully | ||||||
14 | obtained or twice the value of the benefits or insurance | ||||||
15 | coverage attempted to be obtained, plus reasonable attorney's | ||||||
16 | fees and expenses incurred by the payor or the payor's subrogee | ||||||
17 | or assignee who successfully brings a claim under this | ||||||
18 | subsection. This subsection applies to accidental injuries or | ||||||
19 | diseases that occur on or after the effective date of this | ||||||
20 | amendatory Act of the 94th General Assembly.
| ||||||
21 | (h) The All proceedings under this Section shall be | ||||||
22 | reported by the fraud and insurance non-compliance unit shall | ||||||
23 | submit a written report on an annual basis to the Workers' | ||||||
24 | Compensation Advisory Board the General Assembly, the | ||||||
25 | Governor, and the Attorney General by January 1st and July 1st | ||||||
26 | of each year. This report shall include, at the minimum, the |
| |||||||
| |||||||
1 | following information: | ||||||
2 | (1) The number of allegations of insurance | ||||||
3 | non-compliance and fraud reported to the fraud and | ||||||
4 | insurance non-compliance unit. | ||||||
5 | (2) The source of the reported allegations | ||||||
6 | (individual, employer, or other). | ||||||
7 | (3) The number of allegations investigated by the fraud | ||||||
8 | and insurance non-compliance unit. | ||||||
9 | (4) The number of criminal referrals made in accordance | ||||||
10 | with this Section and the entity to which the referral was | ||||||
11 | made. | ||||||
12 | (5) All proceedings under this Section .
| ||||||
13 | (Source: P.A. 94-277, eff. 7-20-05.)
| ||||||
14 | Section 99. Effective date. This Act takes effect upon | ||||||
15 | becoming law.".
|