Bill Text: IL HB4068 | 2017-2018 | 100th General Assembly | Introduced


Bill Title: Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: when an accidental injury shall not be considered to be "arising out of and in the course of employment" if the accidental injury or medical condition occurred while the claimant was traveling away from the employer's premises; the maximum compensation rate for a period of temporary total incapacity; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2017-07-06 - Rule 19(a) / Re-referred to Rules Committee [HB4068 Detail]

Download: Illinois-2017-HB4068-Introduced.html


100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4068

Introduced , by Rep. Jim Durkin

SYNOPSIS AS INTRODUCED:
See Index

Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: when an accidental injury shall not be considered to be "arising out of and in the course of employment" if the accidental injury or medical condition occurred while the claimant was traveling away from the employer's premises; the maximum compensation rate for a period of temporary total incapacity; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately.
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CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY
FISCAL NOTE ACT MAY APPLY

A BILL FOR

HB4068LRB100 13139 KTG 27545 b
1 AN ACT concerning employment.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 1. The Freedom of Information Act is amended by
5changing Section 7.5 as follows:
6 (5 ILCS 140/7.5)
7 Sec. 7.5. Statutory exemptions. To the extent provided for
8by the statutes referenced below, the following shall be exempt
9from inspection and copying:
10 (a) All information determined to be confidential
11 under Section 4002 of the Technology Advancement and
12 Development Act.
13 (b) Library circulation and order records identifying
14 library users with specific materials under the Library
15 Records Confidentiality Act.
16 (c) Applications, related documents, and medical
17 records received by the Experimental Organ Transplantation
18 Procedures Board and any and all documents or other records
19 prepared by the Experimental Organ Transplantation
20 Procedures Board or its staff relating to applications it
21 has received.
22 (d) Information and records held by the Department of
23 Public Health and its authorized representatives relating

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1 to known or suspected cases of sexually transmissible
2 disease or any information the disclosure of which is
3 restricted under the Illinois Sexually Transmissible
4 Disease Control Act.
5 (e) Information the disclosure of which is exempted
6 under Section 30 of the Radon Industry Licensing Act.
7 (f) Firm performance evaluations under Section 55 of
8 the Architectural, Engineering, and Land Surveying
9 Qualifications Based Selection Act.
10 (g) Information the disclosure of which is restricted
11 and exempted under Section 50 of the Illinois Prepaid
12 Tuition Act.
13 (h) Information the disclosure of which is exempted
14 under the State Officials and Employees Ethics Act, and
15 records of any lawfully created State or local inspector
16 general's office that would be exempt if created or
17 obtained by an Executive Inspector General's office under
18 that Act.
19 (i) Information contained in a local emergency energy
20 plan submitted to a municipality in accordance with a local
21 emergency energy plan ordinance that is adopted under
22 Section 11-21.5-5 of the Illinois Municipal Code.
23 (j) Information and data concerning the distribution
24 of surcharge moneys collected and remitted by wireless
25 carriers under the Wireless Emergency Telephone Safety
26 Act.

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1 (k) Law enforcement officer identification information
2 or driver identification information compiled by a law
3 enforcement agency or the Department of Transportation
4 under Section 11-212 of the Illinois Vehicle Code.
5 (l) Records and information provided to a residential
6 health care facility resident sexual assault and death
7 review team or the Executive Council under the Abuse
8 Prevention Review Team Act.
9 (m) Information provided to the predatory lending
10 database created pursuant to Article 3 of the Residential
11 Real Property Disclosure Act, except to the extent
12 authorized under that Article.
13 (n) Defense budgets and petitions for certification of
14 compensation and expenses for court appointed trial
15 counsel as provided under Sections 10 and 15 of the Capital
16 Crimes Litigation Act. This subsection (n) shall apply
17 until the conclusion of the trial of the case, even if the
18 prosecution chooses not to pursue the death penalty prior
19 to trial or sentencing.
20 (o) Information that is prohibited from being
21 disclosed under Section 4 of the Illinois Health and
22 Hazardous Substances Registry Act.
23 (p) Security portions of system safety program plans,
24 investigation reports, surveys, schedules, lists, data, or
25 information compiled, collected, or prepared by or for the
26 Regional Transportation Authority under Section 2.11 of

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1 the Regional Transportation Authority Act or the St. Clair
2 County Transit District under the Bi-State Transit Safety
3 Act.
4 (q) Information prohibited from being disclosed by the
5 Personnel Records Review Act.
6 (r) Information prohibited from being disclosed by the
7 Illinois School Student Records Act.
8 (s) Information the disclosure of which is restricted
9 under Section 5-108 of the Public Utilities Act.
10 (t) All identified or deidentified health information
11 in the form of health data or medical records contained in,
12 stored in, submitted to, transferred by, or released from
13 the Illinois Health Information Exchange, and identified
14 or deidentified health information in the form of health
15 data and medical records of the Illinois Health Information
16 Exchange in the possession of the Illinois Health
17 Information Exchange Authority due to its administration
18 of the Illinois Health Information Exchange. The terms
19 "identified" and "deidentified" shall be given the same
20 meaning as in the Health Insurance Portability and
21 Accountability Act of 1996, Public Law 104-191, or any
22 subsequent amendments thereto, and any regulations
23 promulgated thereunder.
24 (u) Records and information provided to an independent
25 team of experts under Brian's Law.
26 (v) Names and information of people who have applied

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1 for or received Firearm Owner's Identification Cards under
2 the Firearm Owners Identification Card Act or applied for
3 or received a concealed carry license under the Firearm
4 Concealed Carry Act, unless otherwise authorized by the
5 Firearm Concealed Carry Act; and databases under the
6 Firearm Concealed Carry Act, records of the Concealed Carry
7 Licensing Review Board under the Firearm Concealed Carry
8 Act, and law enforcement agency objections under the
9 Firearm Concealed Carry Act.
10 (w) Personally identifiable information which is
11 exempted from disclosure under subsection (g) of Section
12 19.1 of the Toll Highway Act.
13 (x) Information which is exempted from disclosure
14 under Section 5-1014.3 of the Counties Code or Section
15 8-11-21 of the Illinois Municipal Code.
16 (y) Confidential information under the Adult
17 Protective Services Act and its predecessor enabling
18 statute, the Elder Abuse and Neglect Act, including
19 information about the identity and administrative finding
20 against any caregiver of a verified and substantiated
21 decision of abuse, neglect, or financial exploitation of an
22 eligible adult maintained in the Registry established
23 under Section 7.5 of the Adult Protective Services Act.
24 (z) Records and information provided to a fatality
25 review team or the Illinois Fatality Review Team Advisory
26 Council under Section 15 of the Adult Protective Services

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1 Act.
2 (aa) Information which is exempted from disclosure
3 under Section 2.37 of the Wildlife Code.
4 (bb) Information which is or was prohibited from
5 disclosure by the Juvenile Court Act of 1987.
6 (cc) Recordings made under the Law Enforcement
7 Officer-Worn Body Camera Act, except to the extent
8 authorized under that Act.
9 (dd) Information that is prohibited from being
10 disclosed under Section 45 of the Condominium and Common
11 Interest Community Ombudsperson Act.
12 (ee) (dd) Information that is exempted from disclosure
13 under Section 30.1 of the Pharmacy Practice Act.
14 (ff) Information the disclosure of which is restricted
15 and exempted under Sections 25.5 and 29.2 of the Workers'
16 Compensation Act.
17(Source: P.A. 98-49, eff. 7-1-13; 98-63, eff. 7-9-13; 98-756,
18eff. 7-16-14; 98-1039, eff. 8-25-14; 98-1045, eff. 8-25-14;
1999-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, eff. 1-1-16;
2099-642, eff. 7-28-16; 99-776, eff. 8-12-16; 99-863, eff.
218-19-16; revised 9-1-16.)
22 Section 3. The Criminal Code of 2012 is amended by adding
23Section 17-10.4 as follows:
24 (720 ILCS 5/17-10.4 new)

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1 Sec. 17-10.4. Workers' compensation fraud.
2 (a) It is unlawful for any person, company, corporation,
3insurance carrier, health care provider, or other entity to:
4 (1) Intentionally present or cause to be presented any
5 false or fraudulent claim for the payment of any workers'
6 compensation benefit.
7 (2) Intentionally make or cause to be made any false or
8 fraudulent material statement or material representation
9 for the purpose of obtaining or denying any workers'
10 compensation benefit.
11 (3) Intentionally make or cause to be made any false or
12 fraudulent statements with regard to entitlement to
13 workers' compensation benefits with the intent to prevent
14 an injured worker from making a legitimate claim for any
15 workers' compensation benefit.
16 (4) Intentionally prepare or provide an invalid,
17 false, or counterfeit certificate of insurance as proof of
18 workers' compensation insurance.
19 (5) Intentionally make or cause to be made any false or
20 fraudulent material statement or material representation
21 for the purpose of obtaining workers' compensation
22 insurance at less than the proper amount for that
23 insurance.
24 (6) Intentionally make or cause to be made any false or
25 fraudulent material statement or material representation
26 on an initial or renewal self-insurance application or

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1 accompanying financial statement for the purpose of
2 obtaining self-insurance status or reducing the amount of
3 security that may be required to be furnished pursuant to
4 Section 4 of the Workers' Compensation Act.
5 (7) Intentionally make or cause to be made any false or
6 fraudulent material statement to the Department of
7 Insurance's fraud and insurance non-compliance unit in the
8 course of an investigation of fraud or insurance
9 non-compliance.
10 (8) Intentionally present a bill or statement for the
11 payment for medical services that were not provided.
12 (9) Intentionally assist, abet, solicit, or conspire
13 with any person, company, or other entity to commit any of
14 the acts in paragraph (1), (2), (3), (4), (5), (6), (7), or
15 (8) of this subsection (a).
16 As used in paragraphs (2), (3), (5), (6), (7), and (8),
17"statement" includes any writing, notice, proof of injury, bill
18for services, hospital and doctor records and reports, and
19X-ray and test results.
20 (b) Sentence.
21 (1) A violation of paragraph (a)(3) is a Class 4
22 felony.
23 (2) A violation of paragraph (a)(4) or (a)(7) is a
24 Class 3 felony.
25 (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
26 (a)(6), or (a)(8) in which the value of the property

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1 obtained or attempted to be obtained is $500 or less is a
2 Class A misdemeanor.
3 (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
4 (a)(6), or (a)(8) in which the value of the property
5 obtained or attempted to be obtained is more than $500 but
6 not more than $10,000 is a Class 3 felony.
7 (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
8 (a)(6), or (a)(8) in which the value of the property
9 obtained or attempted to be obtained is more than $10,000
10 but not more than $100,000 is a Class 2 felony.
11 (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
12 (a)(6), or (a)(8) in which the value of the property
13 obtained or attempted to be obtained is more than $100,000
14 is a Class 1 felony.
15 (7) A violation of paragraph (9) of subsection (a)
16 shall be punishable as the Class of offense for which the
17 person convicted assisted, abetted, solicited, or
18 conspired to commit, as set forth in paragraphs (1) through
19 (6) of this subsection.
20 (8) A person convicted under this Section shall be
21 ordered to pay monetary restitution to the insurance
22 company or self-insured entity or any other person for any
23 financial loss sustained as a result of a violation of this
24 Section, including any court costs and attorney fees. An
25 order of restitution also includes expenses incurred and
26 paid by the State of Illinois or an insurance company or

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1 self-insured entity in connection with any medical
2 evaluation or treatment services.
3 For a violation of paragraph (a)(1) or (a)(2), the value of
4the property obtained or attempted to be obtained includes
5payments pursuant to the provisions of the Workers'
6Compensation Act as well as the amount paid for medical
7expenses. For a violation of paragraph (a)(5), the value of the
8property obtained or attempted to be obtained is the difference
9between the proper amount for the coverage sought or provided
10and the actual amount billed for workers' compensation
11insurance. For a violation of paragraph (a)(6), the value of
12the property obtained or attempted to be obtained is the
13difference between the proper amount of security required
14pursuant to Section 4 of the Workers' Compensation Act and the
15amount furnished pursuant to the false or fraudulent statements
16or representations. Notwithstanding the foregoing, an
17insurance company, self-insured entity, or any other person
18suffering financial loss sustained as a result of violation of
19this Section may seek restitution, including court costs and
20attorney's fees, in a civil action in a court of competent
21jurisdiction.
22 Section 5. The Workers' Compensation Act is amended by
23changing Sections 1, 8, 8.1b, 8.2, 8.2a, 14, 19, 25.5, and 29.2
24as follows:

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1 (820 ILCS 305/1) (from Ch. 48, par. 138.1)
2 Sec. 1. This Act may be cited as the Workers' Compensation
3Act.
4 (a) The term "employer" as used in this Act means:
5 1. The State and each county, city, town, township,
6incorporated village, school district, body politic, or
7municipal corporation therein.
8 2. Every person, firm, public or private corporation,
9including hospitals, public service, eleemosynary, religious
10or charitable corporations or associations who has any person
11in service or under any contract for hire, express or implied,
12oral or written, and who is engaged in any of the enterprises
13or businesses enumerated in Section 3 of this Act, or who at or
14prior to the time of the accident to the employee for which
15compensation under this Act may be claimed, has in the manner
16provided in this Act elected to become subject to the
17provisions of this Act, and who has not, prior to such
18accident, effected a withdrawal of such election in the manner
19provided in this Act.
20 3. Any one engaging in any business or enterprise referred
21to in subsections 1 and 2 of Section 3 of this Act who
22undertakes to do any work enumerated therein, is liable to pay
23compensation to his own immediate employees in accordance with
24the provisions of this Act, and in addition thereto if he
25directly or indirectly engages any contractor whether
26principal or sub-contractor to do any such work, he is liable

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1to pay compensation to the employees of any such contractor or
2sub-contractor unless such contractor or sub-contractor has
3insured, in any company or association authorized under the
4laws of this State to insure the liability to pay compensation
5under this Act, or guaranteed his liability to pay such
6compensation. With respect to any time limitation on the filing
7of claims provided by this Act, the timely filing of a claim
8against a contractor or subcontractor, as the case may be,
9shall be deemed to be a timely filing with respect to all
10persons upon whom liability is imposed by this paragraph.
11 In the event any such person pays compensation under this
12subsection he may recover the amount thereof from the
13contractor or sub-contractor, if any, and in the event the
14contractor pays compensation under this subsection he may
15recover the amount thereof from the sub-contractor, if any.
16 This subsection does not apply in any case where the
17accident occurs elsewhere than on, in or about the immediate
18premises on which the principal has contracted that the work be
19done.
20 4. Where an employer operating under and subject to the
21provisions of this Act loans an employee to another such
22employer and such loaned employee sustains a compensable
23accidental injury in the employment of such borrowing employer
24and where such borrowing employer does not provide or pay the
25benefits or payments due such injured employee, such loaning
26employer is liable to provide or pay all benefits or payments

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1due such employee under this Act and as to such employee the
2liability of such loaning and borrowing employers is joint and
3several, provided that such loaning employer is in the absence
4of agreement to the contrary entitled to receive from such
5borrowing employer full reimbursement for all sums paid or
6incurred pursuant to this paragraph together with reasonable
7attorneys' fees and expenses in any hearings before the
8Illinois Workers' Compensation Commission or in any action to
9secure such reimbursement. Where any benefit is provided or
10paid by such loaning employer the employee has the duty of
11rendering reasonable cooperation in any hearings, trials or
12proceedings in the case, including such proceedings for
13reimbursement.
14 Where an employee files an Application for Adjustment of
15Claim with the Illinois Workers' Compensation Commission
16alleging that his claim is covered by the provisions of the
17preceding paragraph, and joining both the alleged loaning and
18borrowing employers, they and each of them, upon written demand
19by the employee and within 7 days after receipt of such demand,
20shall have the duty of filing with the Illinois Workers'
21Compensation Commission a written admission or denial of the
22allegation that the claim is covered by the provisions of the
23preceding paragraph and in default of such filing or if any
24such denial be ultimately determined not to have been bona fide
25then the provisions of Paragraph K of Section 19 of this Act
26shall apply.

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1 An employer whose business or enterprise or a substantial
2part thereof consists of hiring, procuring or furnishing
3employees to or for other employers operating under and subject
4to the provisions of this Act for the performance of the work
5of such other employers and who pays such employees their
6salary or wages notwithstanding that they are doing the work of
7such other employers shall be deemed a loaning employer within
8the meaning and provisions of this Section.
9 (b) The term "employee" as used in this Act means:
10 1. Every person in the service of the State, including
11members of the General Assembly, members of the Commerce
12Commission, members of the Illinois Workers' Compensation
13Commission, and all persons in the service of the University of
14Illinois, county, including deputy sheriffs and assistant
15state's attorneys, city, town, township, incorporated village
16or school district, body politic, or municipal corporation
17therein, whether by election, under appointment or contract of
18hire, express or implied, oral or written, including all
19members of the Illinois National Guard while on active duty in
20the service of the State, and all probation personnel of the
21Juvenile Court appointed pursuant to Article VI of the Juvenile
22Court Act of 1987, and including any official of the State, any
23county, city, town, township, incorporated village, school
24district, body politic or municipal corporation therein except
25any duly appointed member of a police department in any city
26whose population exceeds 500,000 according to the last Federal

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1or State census, and except any member of a fire insurance
2patrol maintained by a board of underwriters in this State. A
3duly appointed member of a fire department in any city, the
4population of which exceeds 500,000 according to the last
5federal or State census, is an employee under this Act only
6with respect to claims brought under paragraph (c) of Section
78.
8 One employed by a contractor who has contracted with the
9State, or a county, city, town, township, incorporated village,
10school district, body politic or municipal corporation
11therein, through its representatives, is not considered as an
12employee of the State, county, city, town, township,
13incorporated village, school district, body politic or
14municipal corporation which made the contract.
15 2. Every person in the service of another under any
16contract of hire, express or implied, oral or written,
17including persons whose employment is outside of the State of
18Illinois where the contract of hire is made within the State of
19Illinois, persons whose employment results in fatal or
20non-fatal injuries within the State of Illinois where the
21contract of hire is made outside of the State of Illinois, and
22persons whose employment is principally localized within the
23State of Illinois, regardless of the place of the accident or
24the place where the contract of hire was made, and including
25aliens, and minors who, for the purpose of this Act are
26considered the same and have the same power to contract,

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1receive payments and give quittances therefor, as adult
2employees.
3 3. Every sole proprietor and every partner of a business
4may elect to be covered by this Act.
5 An employee or his dependents under this Act who shall have
6a cause of action by reason of any injury, disablement or death
7arising out of and in the course of his employment may elect to
8pursue his remedy in the State where injured or disabled, or in
9the State where the contract of hire is made, or in the State
10where the employment is principally localized.
11 However, any employer may elect to provide and pay
12compensation to any employee other than those engaged in the
13usual course of the trade, business, profession or occupation
14of the employer by complying with Sections 2 and 4 of this Act.
15Employees are not included within the provisions of this Act
16when excluded by the laws of the United States relating to
17liability of employers to their employees for personal injuries
18where such laws are held to be exclusive.
19 The term "employee" does not include persons performing
20services as real estate broker, broker-salesman, or salesman
21when such persons are paid by commission only.
22 (c) "Commission" means the Industrial Commission created
23by Section 5 of "The Civil Administrative Code of Illinois",
24approved March 7, 1917, as amended, or the Illinois Workers'
25Compensation Commission created by Section 13 of this Act.
26 (d) To obtain compensation under this Act, an employee

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1bears the burden of showing, by a preponderance of the
2evidence, that he or she has sustained accidental injuries
3arising out of and in the course of the employment.
4 (e) The provisions of this subsection (e) apply only to
5traveling employees.
6 (1) Without limitation, an accidental injury shall not
7 be considered to be "arising out of and in the course of
8 employment" if the accidental injury or medical condition
9 for which compensation is sought occurred while the
10 claimant was traveling away from the employer's premises
11 and the travel was not required for the performance of job
12 duties.
13 (2) In determining whether an employee is required to
14 travel for the performance of job duties, the following
15 factors shall be considered: whether the employer had
16 knowledge that the employee may be required to travel to
17 perform the job; whether the employer furnished any mode of
18 transportation to or from the employee; whether the
19 employee received, or the employer paid or agreed to pay,
20 any remuneration or reimbursement for costs or expenses of
21 any form of travel; whether the employer in any way
22 directed the course or method of travel; whether the
23 employer in any way assisted the employee in making any
24 travel arrangements; whether the employer furnished
25 lodging or in any way reimbursed the employee for lodging;
26 and whether the employer received any benefit from the

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1 employee traveling.
2(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
3eff. 7-13-12.)
4 (820 ILCS 305/8) (from Ch. 48, par. 138.8)
5 Sec. 8. The amount of compensation which shall be paid to
6the employee for an accidental injury not resulting in death
7is:
8 (a) The employer shall provide and pay the negotiated rate,
9if applicable, or the lesser of the health care provider's
10actual charges or according to a fee schedule, subject to
11Section 8.2, in effect at the time the service was rendered for
12all the necessary first aid, medical and surgical services, and
13all necessary medical, surgical and hospital services
14thereafter incurred, limited, however, to that which is
15reasonably required to cure or relieve from the effects of the
16accidental injury, even if a health care provider sells,
17transfers, or otherwise assigns an account receivable for
18procedures, treatments, or services covered under this Act. If
19the employer does not dispute payment of first aid, medical,
20surgical, and hospital services, the employer shall make such
21payment to the provider on behalf of the employee. The employer
22shall also pay for treatment, instruction and training
23necessary for the physical, mental and vocational
24rehabilitation of the employee, including all maintenance
25costs and expenses incidental thereto. If as a result of the

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1injury the employee is unable to be self-sufficient the
2employer shall further pay for such maintenance or
3institutional care as shall be required.
4 The employee may at any time elect to secure his own
5physician, surgeon and hospital services at the employer's
6expense, or,
7 Upon agreement between the employer and the employees, or
8the employees' exclusive representative, and subject to the
9approval of the Illinois Workers' Compensation Commission, the
10employer shall maintain a list of physicians, to be known as a
11Panel of Physicians, who are accessible to the employees. The
12employer shall post this list in a place or places easily
13accessible to his employees. The employee shall have the right
14to make an alternative choice of physician from such Panel if
15he is not satisfied with the physician first selected. If, due
16to the nature of the injury or its occurrence away from the
17employer's place of business, the employee is unable to make a
18selection from the Panel, the selection process from the Panel
19shall not apply. The physician selected from the Panel may
20arrange for any consultation, referral or other specialized
21medical services outside the Panel at the employer's expense.
22Provided that, in the event the Commission shall find that a
23doctor selected by the employee is rendering improper or
24inadequate care, the Commission may order the employee to
25select another doctor certified or qualified in the medical
26field for which treatment is required. If the employee refuses

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1to make such change the Commission may relieve the employer of
2his obligation to pay the doctor's charges from the date of
3refusal to the date of compliance.
4 Any vocational rehabilitation counselors who provide
5service under this Act shall have appropriate certifications
6which designate the counselor as qualified to render opinions
7relating to vocational rehabilitation. Vocational
8rehabilitation may include, but is not limited to, counseling
9for job searches, supervising a job search program, and
10vocational retraining including education at an accredited
11learning institution. The employee or employer may petition to
12the Commission to decide disputes relating to vocational
13rehabilitation and the Commission shall resolve any such
14dispute, including payment of the vocational rehabilitation
15program by the employer.
16 The maintenance benefit shall not be less than the
17temporary total disability rate determined for the employee. In
18addition, maintenance shall include costs and expenses
19incidental to the vocational rehabilitation program.
20 When the employee is working light duty on a part-time
21basis or full-time basis and earns less than he or she would be
22earning if employed in the full capacity of the job or jobs,
23then the employee shall be entitled to temporary partial
24disability benefits. Temporary partial disability benefits
25shall be equal to two-thirds of the difference between the
26average amount that the employee would be able to earn in the

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1full performance of his or her duties in the occupation in
2which he or she was engaged at the time of accident and the
3gross amount which he or she is earning in the modified job
4provided to the employee by the employer or in any other job
5that the employee is working.
6 Every hospital, physician, surgeon or other person
7rendering treatment or services in accordance with the
8provisions of this Section shall upon written request furnish
9full and complete reports thereof to, and permit their records
10to be copied by, the employer, the employee or his dependents,
11as the case may be, or any other party to any proceeding for
12compensation before the Commission, or their attorneys.
13 Notwithstanding the foregoing, the employer's liability to
14pay for such medical services selected by the employee shall be
15limited to:
16 (1) all first aid and emergency treatment; plus
17 (2) all medical, surgical and hospital services
18 provided by the physician, surgeon or hospital initially
19 chosen by the employee or by any other physician,
20 consultant, expert, institution or other provider of
21 services recommended by said initial service provider or
22 any subsequent provider of medical services in the chain of
23 referrals from said initial service provider; plus
24 (3) all medical, surgical and hospital services
25 provided by any second physician, surgeon or hospital
26 subsequently chosen by the employee or by any other

HB4068- 22 -LRB100 13139 KTG 27545 b
1 physician, consultant, expert, institution or other
2 provider of services recommended by said second service
3 provider or any subsequent provider of medical services in
4 the chain of referrals from said second service provider.
5 Thereafter the employer shall select and pay for all
6 necessary medical, surgical and hospital treatment and the
7 employee may not select a provider of medical services at
8 the employer's expense unless the employer agrees to such
9 selection. At any time the employee may obtain any medical
10 treatment he desires at his own expense. This paragraph
11 shall not affect the duty to pay for rehabilitation
12 referred to above.
13 (4) The following shall apply for injuries occurring on
14 or after June 28, 2011 (the effective date of Public Act
15 97-18) and only when an employer has an approved preferred
16 provider program pursuant to Section 8.1a on the date the
17 employee sustained his or her accidental injuries:
18 (A) The employer shall, in writing, on a form
19 promulgated by the Commission, inform the employee of
20 the preferred provider program;
21 (B) Subsequent to the report of an injury by an
22 employee, the employee may choose in writing at any
23 time to decline the preferred provider program, in
24 which case that would constitute one of the two choices
25 of medical providers to which the employee is entitled
26 under subsection (a)(2) or (a)(3); and

HB4068- 23 -LRB100 13139 KTG 27545 b
1 (C) Prior to the report of an injury by an
2 employee, when an employee chooses non-emergency
3 treatment from a provider not within the preferred
4 provider program, that would constitute the employee's
5 one choice of medical providers to which the employee
6 is entitled under subsection (a)(2) or (a)(3).
7 When an employer and employee so agree in writing, nothing
8in this Act prevents an employee whose injury or disability has
9been established under this Act, from relying in good faith, on
10treatment by prayer or spiritual means alone, in accordance
11with the tenets and practice of a recognized church or
12religious denomination, by a duly accredited practitioner
13thereof, and having nursing services appropriate therewith,
14without suffering loss or diminution of the compensation
15benefits under this Act. However, the employee shall submit to
16all physical examinations required by this Act. The cost of
17such treatment and nursing care shall be paid by the employee
18unless the employer agrees to make such payment.
19 Where the accidental injury results in the amputation of an
20arm, hand, leg or foot, or the enucleation of an eye, or the
21loss of any of the natural teeth, the employer shall furnish an
22artificial of any such members lost or damaged in accidental
23injury arising out of and in the course of employment, and
24shall also furnish the necessary braces in all proper and
25necessary cases. In cases of the loss of a member or members by
26amputation, the employer shall, whenever necessary, maintain

HB4068- 24 -LRB100 13139 KTG 27545 b
1in good repair, refit or replace the artificial limbs during
2the lifetime of the employee. Where the accidental injury
3accompanied by physical injury results in damage to a denture,
4eye glasses or contact eye lenses, or where the accidental
5injury results in damage to an artificial member, the employer
6shall replace or repair such denture, glasses, lenses, or
7artificial member.
8 The furnishing by the employer of any such services or
9appliances is not an admission of liability on the part of the
10employer to pay compensation.
11 The furnishing of any such services or appliances or the
12servicing thereof by the employer is not the payment of
13compensation.
14 (b) If the period of temporary total incapacity for work
15lasts more than 5 scheduled 3 working days for the claimant,
16weekly compensation as hereinafter provided shall be paid
17beginning on the 6th 4th day of such temporary total incapacity
18and continuing as long as the total temporary incapacity lasts.
19In cases where the temporary total incapacity for work
20continues for a period of 14 days or more from the day of the
21accident compensation shall commence on the day after the
22accident.
23 1. The compensation rate for temporary total
24 incapacity under this paragraph (b) of this Section shall
25 be equal to 66 2/3% of the employee's average weekly wage
26 computed in accordance with Section 10, provided that it

HB4068- 25 -LRB100 13139 KTG 27545 b
1 shall be not less than 66 2/3% of the sum of the Federal
2 minimum wage under the Fair Labor Standards Act, or the
3 Illinois minimum wage under the Minimum Wage Law, whichever
4 is more, multiplied by 40 hours. This percentage rate shall
5 be increased by 10% for each spouse and child, not to
6 exceed 100% of the total minimum wage calculation, nor
7 exceed the employee's average weekly wage computed in
8 accordance with the provisions of Section 10, whichever is
9 less.
10 2. The compensation rate in all cases other than for
11 temporary total disability under this paragraph (b), and
12 other than for serious and permanent disfigurement under
13 paragraph (c) and other than for permanent partial
14 disability under subparagraph (2) of paragraph (d) or under
15 paragraph (e), of this Section shall be equal to 66 2/3% of
16 the employee's average weekly wage computed in accordance
17 with the provisions of Section 10, provided that it shall
18 be not less than 66 2/3% of the sum of the Federal minimum
19 wage under the Fair Labor Standards Act, or the Illinois
20 minimum wage under the Minimum Wage Law, whichever is more,
21 multiplied by 40 hours. This percentage rate shall be
22 increased by 10% for each spouse and child, not to exceed
23 100% of the total minimum wage calculation, nor exceed the
24 employee's average weekly wage computed in accordance with
25 the provisions of Section 10, whichever is less.
26 2.1. The compensation rate in all cases of serious and

HB4068- 26 -LRB100 13139 KTG 27545 b
1 permanent disfigurement under paragraph (c) and of
2 permanent partial disability under subparagraph (2) of
3 paragraph (d) or under paragraph (e) of this Section shall
4 be equal to 60% of the employee's average weekly wage
5 computed in accordance with the provisions of Section 10,
6 provided that it shall be not less than 66 2/3% of the sum
7 of the Federal minimum wage under the Fair Labor Standards
8 Act, or the Illinois minimum wage under the Minimum Wage
9 Law, whichever is more, multiplied by 40 hours. This
10 percentage rate shall be increased by 10% for each spouse
11 and child, not to exceed 100% of the total minimum wage
12 calculation, nor exceed the employee's average weekly wage
13 computed in accordance with the provisions of Section 10,
14 whichever is less.
15 3. As used in this Section the term "child" means a
16 child of the employee including any child legally adopted
17 before the accident or whom at the time of the accident the
18 employee was under legal obligation to support or to whom
19 the employee stood in loco parentis, and who at the time of
20 the accident was under 18 years of age and not emancipated.
21 The term "children" means the plural of "child".
22 4. All weekly compensation rates provided under
23 subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
24 Section shall be subject to the following limitations:
25 The maximum weekly compensation rate from July 1, 1975,
26 except as hereinafter provided, shall be 100% of the

HB4068- 27 -LRB100 13139 KTG 27545 b
1 State's average weekly wage in covered industries under the
2 Unemployment Insurance Act, that being the wage that most
3 closely approximates the State's average weekly wage.
4 The maximum weekly compensation rate, for the period
5 July 1, 1984, through June 30, 1987, except as hereinafter
6 provided, shall be $293.61. Effective July 1, 1987 and on
7 July 1 of each year thereafter the maximum weekly
8 compensation rate, except as hereinafter provided, shall
9 be determined as follows: if during the preceding 12 month
10 period there shall have been an increase in the State's
11 average weekly wage in covered industries under the
12 Unemployment Insurance Act, the weekly compensation rate
13 shall be proportionately increased by the same percentage
14 as the percentage of increase in the State's average weekly
15 wage in covered industries under the Unemployment
16 Insurance Act during such period.
17 The maximum weekly compensation rate, for the period
18 January 1, 1981 through December 31, 1983, except as
19 hereinafter provided, shall be 100% of the State's average
20 weekly wage in covered industries under the Unemployment
21 Insurance Act in effect on January 1, 1981. Effective
22 January 1, 1984 and on January 1, of each year thereafter
23 the maximum weekly compensation rate, except as
24 hereinafter provided, shall be determined as follows: if
25 during the preceding 12 month period there shall have been
26 an increase in the State's average weekly wage in covered

HB4068- 28 -LRB100 13139 KTG 27545 b
1 industries under the Unemployment Insurance Act, the
2 weekly compensation rate shall be proportionately
3 increased by the same percentage as the percentage of
4 increase in the State's average weekly wage in covered
5 industries under the Unemployment Insurance Act during
6 such period.
7 The maximum compensation rate for the period July 1,
8 2017 through June 30, 2021, except as hereinafter provided,
9 shall be $775.18. Effective July 1, 2021 and on July 1 of
10 each year thereafter the maximum weekly compensation rate,
11 except as hereinafter provided, shall be determined as
12 follows: if during the preceding 12-month period there
13 shall have been an increase in the State's average weekly
14 wage in covered industries under the Unemployment
15 Insurance Act, the weekly compensation rate shall be
16 proportionately increased by the same percentage as the
17 percentage of increase in the State's average weekly wage
18 in covered industries under the Unemployment Insurance Act
19 during 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

HB4068- 29 -LRB100 13139 KTG 27545 b
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

HB4068- 30 -LRB100 13139 KTG 27545 b
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
20hand, head, face, neck, arm, leg below the knee or the chest
21above the axillary line, the employee is entitled to
22compensation for such disfigurement, the amount determined by
23agreement at any time or by arbitration under this Act, at a
24hearing not less than 6 months after the date of the accidental
25injury, which amount shall not exceed 150 weeks (if the
26accidental injury occurs on or after the effective date of this

HB4068- 31 -LRB100 13139 KTG 27545 b
1amendatory Act of the 94th General Assembly but before February
21, 2006) or 162 weeks (if the accidental injury occurs on or
3after February 1, 2006) at the applicable rate provided in
4subparagraph 2.1 of paragraph (b) of this Section.
5 No compensation is payable under this paragraph where
6compensation is payable under paragraphs (d), (e) or (f) of
7this Section.
8 A duly appointed member of a fire department in a city, the
9population of which exceeds 500,000 according to the last
10federal or State census, is eligible for compensation under
11this paragraph only where such serious and permanent
12disfigurement results from burns.
13 (d) 1. If, after the accidental injury has been sustained,
14the employee as a result thereof becomes partially
15incapacitated from pursuing his usual and customary line of
16employment, he shall, except in cases compensated under the
17specific schedule set forth in paragraph (e) of this Section,
18receive compensation for the duration of his disability,
19subject to the limitations as to maximum amounts fixed in
20paragraph (b) of this Section, equal to 66-2/3% of the
21difference between the average amount which he would be able to
22earn in the full performance of his duties in the occupation in
23which he was engaged at the time of the accident and the
24average amount which he is earning or is able to earn in some
25suitable employment or business after the accident. For
26accidental injuries that occur on or after September 1, 2011,

HB4068- 32 -LRB100 13139 KTG 27545 b
1an award for wage differential under this subsection shall be
2effective only until the employee reaches the age of 67 or 5
3years from the date the award becomes final, whichever is
4later.
5 2. If, as a result of the accident, the employee sustains
6serious and permanent injuries not covered by paragraphs (c)
7and (e) of this Section or having sustained injuries covered by
8the aforesaid paragraphs (c) and (e), he shall have sustained
9in addition thereto other injuries which injuries do not
10incapacitate him from pursuing the duties of his employment but
11which would disable him from pursuing other suitable
12occupations, or which have otherwise resulted in physical
13impairment; or if such injuries partially incapacitate him from
14pursuing the duties of his usual and customary line of
15employment but do not result in an impairment of earning
16capacity, or having resulted in an impairment of earning
17capacity, the employee elects to waive his right to recover
18under the foregoing subparagraph 1 of paragraph (d) of this
19Section then in any of the foregoing events, he shall receive
20in addition to compensation for temporary total disability
21under paragraph (b) of this Section, compensation at the rate
22provided in subparagraph 2.1 of paragraph (b) of this Section
23for that percentage of 500 weeks that the partial disability
24resulting from the injuries covered by this paragraph bears to
25total disability. If the employee shall have sustained a
26fracture of one or more vertebra or fracture of the skull, the

HB4068- 33 -LRB100 13139 KTG 27545 b
1amount of compensation allowed under this Section shall be not
2less than 6 weeks for a fractured skull and 6 weeks for each
3fractured vertebra, and in the event the employee shall have
4sustained a fracture of any of the following facial bones:
5nasal, lachrymal, vomer, zygoma, maxilla, palatine or
6mandible, the amount of compensation allowed under this Section
7shall be not less than 2 weeks for each such fractured bone,
8and for a fracture of each transverse process not less than 3
9weeks. In the event such injuries shall result in the loss of a
10kidney, spleen or lung, the amount of compensation allowed
11under this Section shall be not less than 10 weeks for each
12such organ. Compensation awarded under this subparagraph 2
13shall not take into consideration injuries covered under
14paragraphs (c) and (e) of this Section and the compensation
15provided in this paragraph shall not affect the employee's
16right to compensation payable under paragraphs (b), (c) and (e)
17of this Section for the disabilities therein covered.
18 (e) For accidental injuries in the following schedule, the
19employee shall receive compensation for the period of temporary
20total incapacity for work resulting from such accidental
21injury, under subparagraph 1 of paragraph (b) of this Section,
22and shall receive in addition thereto compensation for a
23further period for the specific loss herein mentioned, but
24shall not receive any compensation under any other provisions
25of this Act. The following listed amounts apply to either the
26loss of or the permanent and complete loss of use of the member

HB4068- 34 -LRB100 13139 KTG 27545 b
1specified, 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-

HB4068- 35 -LRB100 13139 KTG 27545 b
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.

HB4068- 36 -LRB100 13139 KTG 27545 b
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.
7 190 weeks if the accidental injury occurs on or
8 after June 28, 2011 (the effective date of Public Act
9 97-18) and if the accidental injury involves carpal
10 tunnel syndrome due to repetitive or cumulative
11 trauma, in which case the permanent partial disability
12 shall not exceed 15% loss of use of the hand, except
13 for cause shown by clear and convincing evidence and in
14 which case the award shall not exceed 30% loss of use
15 of the hand.
16 The loss of 2 or more digits, or one or more phalanges
17 of 2 or more digits, of a hand may be compensated on the
18 basis of partial loss of use of a hand, provided, further,
19 that the loss of 4 digits, or the loss of use of 4 digits,
20 in the same hand shall constitute the complete loss of a
21 hand.
22 10. Arm-
23 235 weeks if the accidental injury occurs on or
24 after the effective date of this amendatory Act of the
25 94th General Assembly but before February 1, 2006.
26 253 weeks if the accidental injury occurs on or

HB4068- 37 -LRB100 13139 KTG 27545 b
1 after February 1, 2006.
2 Where an accidental injury results in the amputation of
3 an arm below the elbow, such injury shall be compensated as
4 a loss of an arm. Where an accidental injury results in the
5 amputation of an arm above the elbow, compensation for an
6 additional 15 weeks (if the accidental injury occurs on or
7 after the effective date of this amendatory Act of the 94th
8 General Assembly but before February 1, 2006) or an
9 additional 17 weeks (if the accidental injury occurs on or
10 after February 1, 2006) shall be paid, except where the
11 accidental injury results in the amputation of an arm at
12 the shoulder joint, or so close to shoulder joint that an
13 artificial arm cannot be used, or results in the
14 disarticulation of an arm at the shoulder joint, in which
15 case compensation for an additional 65 weeks (if the
16 accidental injury occurs on or after the effective date of
17 this amendatory Act of the 94th General Assembly but before
18 February 1, 2006) or an additional 70 weeks (if the
19 accidental injury occurs on or after February 1, 2006)
20 shall be paid.
21 For purposes of awards under this subdivision (e),
22 injuries to the shoulder shall be considered injuries to
23 part of the arm. The foregoing change made by this
24 amendatory Act of the 100th General Assembly to this
25 subdivision (e)10 of this Section 8 is declarative of
26 existing law and is not a new enactment.

HB4068- 38 -LRB100 13139 KTG 27545 b
1 11. Foot-
2 155 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.
5 167 weeks if the accidental injury occurs on or
6 after February 1, 2006.
7 12. Leg-
8 200 weeks if the accidental injury occurs on or
9 after the effective date of this amendatory Act of the
10 94th General Assembly but before February 1, 2006.
11 215 weeks if the accidental injury occurs on or
12 after February 1, 2006.
13 Where an accidental injury results in the amputation of
14 a leg below the knee, such injury shall be compensated as
15 loss of a leg. Where an accidental injury results in the
16 amputation of a leg above the knee, compensation for an
17 additional 25 weeks (if the accidental injury occurs on or
18 after the effective date of this amendatory Act of the 94th
19 General Assembly but before February 1, 2006) or an
20 additional 27 weeks (if the accidental injury occurs on or
21 after February 1, 2006) shall be paid, except where the
22 accidental injury results in the amputation of a leg at the
23 hip joint, or so close to the hip joint that an artificial
24 leg cannot be used, or results in the disarticulation of a
25 leg at the hip joint, in which case compensation for an
26 additional 75 weeks (if the accidental injury occurs on or

HB4068- 39 -LRB100 13139 KTG 27545 b
1 after the effective date of this amendatory Act of the 94th
2 General Assembly but before February 1, 2006) or an
3 additional 81 weeks (if the accidental injury occurs on or
4 after February 1, 2006) shall be paid.
5 For purposes of awards under this subdivision (e),
6 injuries to the hip shall be considered injuries to part of
7 the leg. The foregoing change made by this amendatory Act
8 of the 100th General Assembly to this subdivision (e)12 of
9 this Section 8 is declarative of existing law and is not a
10 new enactment.
11 13. Eye-
12 150 weeks if the accidental injury occurs on or
13 after the effective date of this amendatory Act of the
14 94th General Assembly but before February 1, 2006.
15 162 weeks if the accidental injury occurs on or
16 after February 1, 2006.
17 Where an accidental injury results in the enucleation
18 of an eye, compensation for an additional 10 weeks (if the
19 accidental injury occurs on or after the effective date of
20 this amendatory Act of the 94th General Assembly but before
21 February 1, 2006) or an additional 11 weeks (if the
22 accidental injury occurs on or after February 1, 2006)
23 shall be paid.
24 14. Loss of hearing of one ear-
25 50 weeks if the accidental injury occurs on or
26 after the effective date of this amendatory Act of the

HB4068- 40 -LRB100 13139 KTG 27545 b
1 94th General Assembly but before February 1, 2006.
2 54 weeks if the accidental injury occurs on or
3 after February 1, 2006.
4 Total and permanent loss of hearing of both ears-
5 200 weeks if the accidental injury occurs on or
6 after the effective date of this amendatory Act of the
7 94th General Assembly but before February 1, 2006.
8 215 weeks if the accidental injury occurs on or
9 after February 1, 2006.
10 15. Testicle-
11 50 weeks if the accidental injury occurs on or
12 after the effective date of this amendatory Act of the
13 94th General Assembly but before February 1, 2006.
14 54 weeks if the accidental injury occurs on or
15 after February 1, 2006.
16 Both testicles-
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 16. For the permanent partial loss of use of a member
23 or sight of an eye, or hearing of an ear, compensation
24 during that proportion of the number of weeks in the
25 foregoing schedule provided for the loss of such member or
26 sight of an eye, or hearing of an ear, which the partial

HB4068- 41 -LRB100 13139 KTG 27545 b
1 loss of use thereof bears to the total loss of use of such
2 member, or sight of eye, or hearing of an ear.
3 (a) Loss of hearing for compensation purposes
4 shall be confined to the frequencies of 1,000, 2,000
5 and 3,000 cycles per second. Loss of hearing ability
6 for frequency tones above 3,000 cycles per second are
7 not to be considered as constituting disability for
8 hearing.
9 (b) The percent of hearing loss, for purposes of
10 the determination of compensation claims for
11 occupational deafness, shall be calculated as the
12 average in decibels for the thresholds of hearing for
13 the frequencies of 1,000, 2,000 and 3,000 cycles per
14 second. Pure tone air conduction audiometric
15 instruments, approved by nationally recognized
16 authorities in this field, shall be used for measuring
17 hearing loss. If the losses of hearing average 30
18 decibels or less in the 3 frequencies, such losses of
19 hearing shall not then constitute any compensable
20 hearing disability. If the losses of hearing average 85
21 decibels or more in the 3 frequencies, then the same
22 shall constitute and be total or 100% compensable
23 hearing loss.
24 (c) In measuring hearing impairment, the lowest
25 measured losses in each of the 3 frequencies shall be
26 added together and divided by 3 to determine the

HB4068- 42 -LRB100 13139 KTG 27545 b
1 average decibel loss. For every decibel of loss
2 exceeding 30 decibels an allowance of 1.82% shall be
3 made up to the maximum of 100% which is reached at 85
4 decibels.
5 (d) If a hearing loss is established to have
6 existed on July 1, 1975 by audiometric testing the
7 employer shall not be liable for the previous loss so
8 established nor shall he be liable for any loss for
9 which compensation has been paid or awarded.
10 (e) No consideration shall be given to the question
11 of whether or not the ability of an employee to
12 understand speech is improved by the use of a hearing
13 aid.
14 (f) No claim for loss of hearing due to industrial
15 noise shall be brought against an employer or allowed
16 unless the employee has been exposed for a period of
17 time sufficient to cause permanent impairment to noise
18 levels in excess of the following:
19Sound Level DBA
20Slow ResponseHours Per Day
21908
22926
23954
24973
251002
261021-1/2

HB4068- 43 -LRB100 13139 KTG 27545 b
11051
21101/2
31151/4
4 This subparagraph (f) shall not be applied in cases of
5 hearing loss resulting from trauma or explosion.
6 17. In computing the compensation to be paid to any
7 employee who, before the accident for which he claims
8 compensation, had before that time sustained an injury
9 resulting in the loss by amputation or partial loss by
10 amputation of any member, including hand, arm, thumb or
11 fingers, leg, foot, or any toes, or loss under Section
12 8(d)2 due to accidental injuries to the same part of the
13 spine, such loss or partial loss of any such member or loss
14 under Section 8(d)2 due to accidental injuries to the same
15 part of the spine shall be deducted from any award made for
16 the subsequent injury. For the permanent loss of use or the
17 permanent partial loss of use of any such member or the
18 partial loss of sight of an eye or loss under Section 8(d)2
19 due to accidental injuries to the same part of the spine,
20 for which compensation has been paid, then such loss shall
21 be taken into consideration and deducted from any award for
22 the subsequent injury. For purposes of this subdivision
23 (e)17 only, "same part of the spine" means: (1) cervical
24 spine and thoracic spine from vertebra C1 through T12 and
25 (2) lumbar and sacral spine and coccyx from vertebra L1
26 through S5.

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1 18. The specific case of loss of both hands, both arms,
2 or both feet, or both legs, or both eyes, or of any two
3 thereof, or the permanent and complete loss of the use
4 thereof, constitutes total and permanent disability, to be
5 compensated according to the compensation fixed by
6 paragraph (f) of this Section. These specific cases of
7 total and permanent disability do not exclude other cases.
8 Any employee who has previously suffered the loss or
9 permanent and complete loss of the use of any of such
10 members, and in a subsequent independent accident loses
11 another or suffers the permanent and complete loss of the
12 use of any one of such members the employer for whom the
13 injured employee is working at the time of the last
14 independent accident is liable to pay compensation only for
15 the loss or permanent and complete loss of the use of the
16 member occasioned by the last independent accident.
17 19. In a case of specific loss and the subsequent death
18 of such injured employee from other causes than such injury
19 leaving a widow, widower, or dependents surviving before
20 payment or payment in full for such injury, then the amount
21 due for such injury is payable to the widow or widower and,
22 if there be no widow or widower, then to such dependents,
23 in the proportion which such dependency bears to total
24 dependency.
25 Beginning July 1, 1980, and every 6 months thereafter, the
26Commission shall examine the Second Injury Fund and when, after

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1deducting all advances or loans made to such Fund, the amount
2therein is $500,000 then the amount required to be paid by
3employers pursuant to paragraph (f) of Section 7 shall be
4reduced by one-half. When the Second Injury Fund reaches the
5sum of $600,000 then the payments shall cease entirely.
6However, when the Second Injury Fund has been reduced to
7$400,000, payment of one-half of the amounts required by
8paragraph (f) of Section 7 shall be resumed, in the manner
9herein provided, and when the Second Injury Fund has been
10reduced to $300,000, payment of the full amounts required by
11paragraph (f) of Section 7 shall be resumed, in the manner
12herein provided. The Commission shall make the changes in
13payment effective by general order, and the changes in payment
14become immediately effective for all cases coming before the
15Commission thereafter either by settlement agreement or final
16order, irrespective of the date of the accidental injury.
17 On August 1, 1996 and on February 1 and August 1 of each
18subsequent year, the Commission shall examine the special fund
19designated as the "Rate Adjustment Fund" and when, after
20deducting all advances or loans made to said fund, the amount
21therein is $4,000,000, the amount required to be paid by
22employers pursuant to paragraph (f) of Section 7 shall be
23reduced by one-half. When the Rate Adjustment Fund reaches the
24sum of $5,000,000 the payment therein shall cease entirely.
25However, when said Rate Adjustment Fund has been reduced to
26$3,000,000 the amounts required by paragraph (f) of Section 7

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

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

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17 of this Act, the length of time the weekly payments continue,
2the date upon which the pension payments commence and the
3monthly amount of the payments. The Commission shall 30 days
4after the date upon which payments out of the Second Injury
5Fund have begun as provided in the award, and every month
6thereafter, prepare and submit to the State Comptroller a
7voucher for payment for all compensation accrued to that date
8at the rate fixed by the Commission. The State Comptroller
9shall draw a warrant to the injured employee along with a
10receipt to be executed by the injured employee and returned to
11the Commission. The endorsed warrant and receipt is a full and
12complete acquittance to the Commission for the payment out of
13the Second Injury Fund. No other appropriation or warrant is
14necessary for payment out of the Second Injury Fund. The Second
15Injury Fund is appropriated for the purpose of making payments
16according to the terms of the awards.
17 As of July 1, 1980 to July 1, 1982, all claims against and
18obligations of the Second Injury Fund shall become claims
19against and obligations of the Rate Adjustment Fund to the
20extent there is insufficient money in the Second Injury Fund to
21pay such claims and obligations. In that case, all references
22to "Second Injury Fund" in this Section shall also include the
23Rate Adjustment Fund.
24 (g) Every award for permanent total disability entered by
25the Commission on and after July 1, 1965 under which
26compensation payments shall become due and payable after the

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1effective date of this amendatory Act, and every award for
2death benefits or permanent total disability entered by the
3Commission on and after the effective date of this amendatory
4Act shall be subject to annual adjustments as to the amount of
5the compensation rate therein provided. Such adjustments shall
6first be made on July 15, 1977, and all awards made and entered
7prior to July 1, 1975 and on July 15 of each year thereafter.
8In all other cases such adjustment shall be made on July 15 of
9the second year next following the date of the entry of the
10award and shall further be made on July 15 annually thereafter.
11If during the intervening period from the date of the entry of
12the award, or the last periodic adjustment, there shall have
13been an increase in the State's average weekly wage in covered
14industries under the Unemployment Insurance Act, the weekly
15compensation rate shall be proportionately increased by the
16same percentage as the percentage of increase in the State's
17average weekly wage in covered industries under the
18Unemployment Insurance Act. The increase in the compensation
19rate under this paragraph shall in no event bring the total
20compensation rate to an amount greater than the prevailing
21maximum rate at the time that the annual adjustment is made.
22Such increase shall be paid in the same manner as herein
23provided for payments under the Second Injury Fund to the
24injured employee, or his dependents, as the case may be, out of
25the Rate Adjustment Fund provided in paragraph (f) of Section 7
26of this Act. Payments shall be made at the same intervals as

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1provided in the award or, at the option of the Commission, may
2be made in quarterly payment on the 15th day of January, April,
3July and October of each year. In the event of a decrease in
4such average weekly wage there shall be no change in the then
5existing compensation rate. The within paragraph shall not
6apply to cases where there is disputed liability and in which a
7compromise lump sum settlement between the employer and the
8injured employee, or his dependents, as the case may be, has
9been duly approved by the Illinois Workers' Compensation
10Commission.
11 Provided, that in cases of awards entered by the Commission
12for injuries occurring before July 1, 1975, the increases in
13the compensation rate adjusted under the foregoing provision of
14this paragraph (g) shall be limited to increases in the State's
15average weekly wage in covered industries under the
16Unemployment Insurance Act occurring after July 1, 1975.
17 For every accident occurring on or after July 20, 2005 but
18before the effective date of this amendatory Act of the 94th
19General Assembly (Senate Bill 1283 of the 94th General
20Assembly), the annual adjustments to the compensation rate in
21awards for death benefits or permanent total disability, as
22provided in this Act, shall be paid by the employer. The
23adjustment shall be made by the employer on July 15 of the
24second year next following the date of the entry of the award
25and shall further be made on July 15 annually thereafter. If
26during the intervening period from the date of the entry of the

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

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1 (h) In case death occurs from any cause before the total
2compensation to which the employee would have been entitled has
3been paid, then in case the employee leaves any widow, widower,
4child, parent (or any grandchild, grandparent or other lineal
5heir or any collateral heir dependent at the time of the
6accident upon the earnings of the employee to the extent of 50%
7or more of total dependency) such compensation shall be paid to
8the beneficiaries of the deceased employee and distributed as
9provided in paragraph (g) of Section 7.
10 (h-1) In case an injured employee is under legal disability
11at the time when any right or privilege accrues to him or her
12under this Act, a guardian may be appointed pursuant to law,
13and may, on behalf of such person under legal disability, claim
14and exercise any such right or privilege with the same effect
15as if the employee himself or herself had claimed or exercised
16the right or privilege. No limitations of time provided by this
17Act run so long as the employee who is under legal disability
18is without a conservator or guardian.
19 (i) In case the injured employee is under 16 years of age
20at the time of the accident and is illegally employed, the
21amount of compensation payable under paragraphs (b), (c), (d),
22(e) and (f) of this Section is increased 50%.
23 However, where an employer has on file an employment
24certificate issued pursuant to the Child Labor Law or work
25permit issued pursuant to the Federal Fair Labor Standards Act,
26as amended, or a birth certificate properly and duly issued,

HB4068- 53 -LRB100 13139 KTG 27545 b
1such certificate, permit or birth certificate is conclusive
2evidence as to the age of the injured minor employee for the
3purposes of this Section.
4 Nothing herein contained repeals or amends the provisions
5of the Child Labor Law relating to the employment of minors
6under the age of 16 years.
7 (j) 1. In the event the injured employee receives benefits,
8including medical, surgical or hospital benefits under any
9group plan covering non-occupational disabilities contributed
10to wholly or partially by the employer, which benefits should
11not have been payable if any rights of recovery existed under
12this Act, then such amounts so paid to the employee from any
13such group plan as shall be consistent with, and limited to,
14the provisions of paragraph 2 hereof, shall be credited to or
15against any compensation payment for temporary total
16incapacity for work or any medical, surgical or hospital
17benefits made or to be made under this Act. In such event, the
18period of time for giving notice of accidental injury and
19filing application for adjustment of claim does not commence to
20run until the termination of such payments. This paragraph does
21not apply to payments made under any group plan which would
22have been payable irrespective of an accidental injury under
23this Act. Any employer receiving such credit shall keep such
24employee safe and harmless from any and all claims or
25liabilities that may be made against him by reason of having
26received such payments only to the extent of such credit.

HB4068- 54 -LRB100 13139 KTG 27545 b
1 Any excess benefits paid to or on behalf of a State
2employee by the State Employees' Retirement System under
3Article 14 of the Illinois Pension Code on a death claim or
4disputed disability claim shall be credited against any
5payments made or to be made by the State of Illinois to or on
6behalf of such employee under this Act, except for payments for
7medical expenses which have already been incurred at the time
8of the award. The State of Illinois shall directly reimburse
9the State Employees' Retirement System to the extent of such
10credit.
11 2. Nothing contained in this Act shall be construed to give
12the employer or the insurance carrier the right to credit for
13any benefits or payments received by the employee other than
14compensation payments provided by this Act, and where the
15employee receives payments other than compensation payments,
16whether as full or partial salary, group insurance benefits,
17bonuses, annuities or any other payments, the employer or
18insurance carrier shall receive credit for each such payment
19only to the extent of the compensation that would have been
20payable during the period covered by such payment.
21 3. The extension of time for the filing of an Application
22for Adjustment of Claim as provided in paragraph 1 above shall
23not apply to those cases where the time for such filing had
24expired prior to the date on which payments or benefits
25enumerated herein have been initiated or resumed. Provided
26however that this paragraph 3 shall apply only to cases wherein

HB4068- 55 -LRB100 13139 KTG 27545 b
1the payments or benefits hereinabove enumerated shall be
2received after July 1, 1969.
3(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
4eff. 7-13-12.)
5 (820 ILCS 305/8.1b)
6 Sec. 8.1b. Determination of permanent partial disability.
7For accidental injuries that occur on or after September 1,
82011, permanent partial disability shall be established using
9the following criteria:
10 (a) A physician licensed to practice medicine in all of its
11branches preparing a permanent partial disability impairment
12report shall report the level of impairment in writing. The
13report shall include an evaluation of medically defined and
14professionally appropriate measurements of impairment that
15include, but are not limited to: loss of range of motion; loss
16of strength; measured atrophy of tissue mass consistent with
17the injury; and any other measurements that establish the
18nature and extent of the impairment. The most current edition
19of the American Medical Association's "Guides to the Evaluation
20of Permanent Impairment" shall be used by the physician in
21determining the level of impairment.
22 (b) Where an impairment report pursuant to subsection (a)
23exists, it must be considered by the Commission in its
24determination of the level of permanent partial disability.
25 In determining the level of permanent partial disability,

HB4068- 56 -LRB100 13139 KTG 27545 b
1the Commission shall base its determination on the reported
2level of impairment pursuant to subsection (a). In addition to
3any impairment report submitted, the Commission shall, by a
4preponderance of credible evidence, consider the following
5additional factors to determine disability: (i) the occupation
6of the injured employee; (ii) the age of the employee at the
7time of the injury; (iii) the employee's future earning
8capacity; and (iv) evidence of disability at maximum medical
9improvement corroborated by findings in the treating medical
10records and independent medical exams. In determining the level
11of permanent partial disability, the Commission shall base its
12determination on a report of impairment, after considering by a
13preponderance of credible evidence, the additional factors to
14determine disability. No single enumerated factor shall be the
15sole determinant of disability. In determining the level of
16disability, the relevance and weight of any factors used in
17addition to the level of impairment as reported by the
18physician must be explained in a written order.
19 (c) A report of impairment prepared pursuant to subsection
20(a) is not required for the arbitrator or Commission to approve
21a Settlement Contract Lump Sum Petition.
22 (b) In determining the level of permanent partial
23disability, the Commission shall base its determination on the
24following factors: (i) the reported level of impairment
25pursuant to subsection (a); (ii) the occupation of the injured
26employee; (iii) the age of the employee at the time of the

HB4068- 57 -LRB100 13139 KTG 27545 b
1injury; (iv) the employee's future earning capacity; and (v)
2evidence of disability corroborated by the treating medical
3records. No single enumerated factor shall be the sole
4determinant of disability. In determining the level of
5disability, the relevance and weight of any factors used in
6addition to the level of impairment as reported by the
7physician must be explained in a written order.
8(Source: P.A. 97-18, eff. 6-28-11.)
9 (820 ILCS 305/8.2)
10 Sec. 8.2. Fee schedule.
11 (a) Except as provided for in subsection (c), for
12procedures, treatments, or services covered under this Act and
13rendered or to be rendered on and after February 1, 2006, the
14maximum allowable payment shall be 90% of the 80th percentile
15of charges and fees as determined by the Commission utilizing
16information provided by employers' and insurers' national
17databases, with a minimum of 12,000,000 Illinois line item
18charges and fees comprised of health care provider and hospital
19charges and fees as of August 1, 2004 but not earlier than
20August 1, 2002. These charges and fees are provider billed
21amounts and shall not include discounted charges. The 80th
22percentile is the point on an ordered data set from low to high
23such that 80% of the cases are below or equal to that point and
24at most 20% are above or equal to that point. The Commission
25shall adjust these historical charges and fees as of August 1,

HB4068- 58 -LRB100 13139 KTG 27545 b
12004 by the Consumer Price Index-U for the period August 1,
22004 through September 30, 2005. The Commission shall establish
3fee schedules for procedures, treatments, or services for
4hospital inpatient, hospital outpatient, emergency room and
5trauma, ambulatory surgical treatment centers, and
6professional services. These charges and fees shall be
7designated by geozip or any smaller geographic unit. The data
8shall in no way identify or tend to identify any patient,
9employer, or health care provider. As used in this Section,
10"geozip" means a three-digit zip code based on data
11similarities, geographical similarities, and frequencies. A
12geozip does not cross state boundaries. As used in this
13Section, "three-digit zip code" means a geographic area in
14which all zip codes have the same first 3 digits. If a geozip
15does not have the necessary number of charges and fees to
16calculate a valid percentile for a specific procedure,
17treatment, or service, the Commission may combine data from the
18geozip with up to 4 other geozips that are demographically and
19economically similar and exhibit similarities in data and
20frequencies until the Commission reaches 9 charges or fees for
21that specific procedure, treatment, or service. In cases where
22the compiled data contains less than 9 charges or fees for a
23procedure, treatment, or service, reimbursement shall occur at
2476% of charges and fees as determined by the Commission in a
25manner consistent with the provisions of this paragraph.
26Providers of out-of-state procedures, treatments, services,

HB4068- 59 -LRB100 13139 KTG 27545 b
1products, or supplies shall be reimbursed at the lesser of that
2state's fee schedule amount or the fee schedule amount for the
3region in which the employee resides. If no fee schedule exists
4in that state, the provider shall be reimbursed at the lesser
5of the actual charge or the fee schedule amount for the region
6in which the employee resides. Not later than September 30 in
72006 and each year thereafter, the Commission shall
8automatically increase or decrease the maximum allowable
9payment for a procedure, treatment, or service established and
10in effect on January 1 of that year by the percentage change in
11the Consumer Price Index-U for the 12 month period ending
12August 31 of that year. The increase or decrease shall become
13effective on January 1 of the following year. As used in this
14Section, "Consumer Price Index-U" means the index published by
15the Bureau of Labor Statistics of the U.S. Department of Labor,
16that measures the average change in prices of all goods and
17services purchased by all urban consumers, U.S. city average,
18all items, 1982-84=100.
19 The provisions of this subsection (a), other than this
20sentence, are inoperative after August 31, 2017.
21 (a-1) Notwithstanding the provisions of subsection (a) and
22unless otherwise indicated, the following provisions shall
23apply to the medical fee schedule starting on September 1,
242011:
25 (1) The Commission shall establish and maintain fee
26 schedules for procedures, treatments, products, services,

HB4068- 60 -LRB100 13139 KTG 27545 b
1 or supplies for hospital inpatient, hospital outpatient,
2 emergency room, ambulatory surgical treatment centers,
3 accredited ambulatory surgical treatment facilities,
4 prescriptions filled and dispensed outside of a licensed
5 pharmacy, dental services, and professional services. This
6 fee schedule shall be based on the fee schedule amounts
7 already established by the Commission pursuant to
8 subsection (a) of this Section. However, starting on
9 January 1, 2012, these fee schedule amounts shall be
10 grouped into geographic regions in the following manner:
11 (A) Four regions for non-hospital fee schedule
12 amounts shall be utilized:
13 (i) Cook County;
14 (ii) DuPage, Kane, Lake, and Will Counties;
15 (iii) Bond, Calhoun, Clinton, Jersey,
16 Macoupin, Madison, Monroe, Montgomery, Randolph,
17 St. Clair, and Washington Counties; and
18 (iv) All other counties of the State.
19 (B) Fourteen regions for hospital fee schedule
20 amounts shall be utilized:
21 (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
22 Kendall, and Grundy Counties;
23 (ii) Kankakee County;
24 (iii) Madison, St. Clair, Macoupin, Clinton,
25 Monroe, Jersey, Bond, and Calhoun Counties;
26 (iv) Winnebago and Boone Counties;

HB4068- 61 -LRB100 13139 KTG 27545 b
1 (v) Peoria, Tazewell, Woodford, Marshall, and
2 Stark Counties;
3 (vi) Champaign, Piatt, and Ford Counties;
4 (vii) Rock Island, Henry, and Mercer Counties;
5 (viii) Sangamon and Menard Counties;
6 (ix) McLean County;
7 (x) Lake County;
8 (xi) Macon County;
9 (xii) Vermilion County;
10 (xiii) Alexander County; and
11 (xiv) All other counties of the State.
12 (2) If a geozip, as defined in subsection (a) of this
13 Section, overlaps into one or more of the regions set forth
14 in this Section, then the Commission shall average or
15 repeat the charges and fees in a geozip in order to
16 designate charges and fees for each region.
17 (3) In cases where the compiled data contains less than
18 9 charges or fees for a procedure, treatment, product,
19 supply, or service or where the fee schedule amount cannot
20 be determined by the non-discounted charge data,
21 non-Medicare relative values and conversion factors
22 derived from established fee schedule amounts, coding
23 crosswalks, or other data as determined by the Commission,
24 reimbursement shall occur at 76% of charges and fees until
25 September 1, 2011 and 53.2% of charges and fees thereafter
26 as determined by the Commission in a manner consistent with

HB4068- 62 -LRB100 13139 KTG 27545 b
1 the provisions of this paragraph.
2 (4) To establish additional fee schedule amounts, the
3 Commission shall utilize provider non-discounted charge
4 data, non-Medicare relative values and conversion factors
5 derived from established fee schedule amounts, and coding
6 crosswalks. The Commission may establish additional fee
7 schedule amounts based on either the charge or cost of the
8 procedure, treatment, product, supply, or service.
9 (5) Implants shall be reimbursed at 25% above the net
10 manufacturer's invoice price less rebates, plus actual
11 reasonable and customary shipping charges whether or not
12 the implant charge is submitted by a provider in
13 conjunction with a bill for all other services associated
14 with the implant, submitted by a provider on a separate
15 claim form, submitted by a distributor, or submitted by the
16 manufacturer of the implant. "Implants" include the
17 following codes or any substantially similar updated code
18 as determined by the Commission: 0274
19 (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
20 implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
21 (investigational devices); and 0636 (drugs requiring
22 detailed coding). Non-implantable devices or supplies
23 within these codes shall be reimbursed at 65% of actual
24 charge, which is the provider's normal rates under its
25 standard chargemaster. A standard chargemaster is the
26 provider's list of charges for procedures, treatments,

HB4068- 63 -LRB100 13139 KTG 27545 b
1 products, supplies, or services used to bill payers in a
2 consistent manner.
3 (6) The Commission shall automatically update all
4 codes and associated rules with the version of the codes
5 and rules valid on January 1 of that year.
6 The provisions of this subsection (a-1), other than this
7sentence, are inoperative after August 31, 2017.
8 (a-1.5) The following provisions apply to procedures,
9treatments, services, products, and supplies covered under
10this Act and rendered or to be rendered on or after September
111, 2017:
12 (1) In this Section:
13 "CPT code" means each Current Procedural Terminology
14 code, for each geographic region specified in subsection
15 (b) of this Section, included on the most recent medical
16 fee schedule established by the Commission pursuant to this
17 Section.
18 "DRG code" means each current diagnosis related group
19 code, for each geographic region specified in subsection
20 (b) of this Section, included on the most recent medical
21 fee schedule established by the Commission pursuant to this
22 Section.
23 "Geozip" means a three-digit zip code based on data
24 similarities, geographical similarities, and frequencies.
25 "Health care services" means those CPT and DRG codes
26 for procedures, treatments, products, services or supplies

HB4068- 64 -LRB100 13139 KTG 27545 b
1 for hospital inpatient, hospital outpatient, emergency
2 room, ambulatory surgical treatment centers, accredited
3 ambulatory surgical treatment facilities, and professional
4 services. It does not include codes classified as
5 healthcare common procedure coding systems or dental.
6 "Medicare maximum fee" means, for each CPT and DRG
7 code, the current maximum fee for that CPT or DRG code
8 allowed to be charged by the Centers for Medicare and
9 Medicaid Services for Medicare patients in that geographic
10 region. The Medicare maximum fee shall be the greater of
11 (i) the current maximum fee allowed to be charged by the
12 Centers for Medicare and Medicaid Services for Medicare
13 patients in the geographic region or (ii) the maximum fee
14 charged by the Centers for Medicare and Medicaid Services
15 for Medicare patients in the geographic region on January
16 1, 2017.
17 "Medicare percentage amount" means, for each CPT and
18 DRG code, the workers' compensation maximum fee as a
19 percentage of the Medicare maximum fee.
20 "Workers' compensation maximum fee" means, for each
21 CPT and DRG code, the current maximum fee allowed to be
22 charged under the medical fee schedule established by the
23 Commission for that CPT or DRG code in that geographic
24 region.
25 (2) The Commission shall establish and maintain fee
26 schedules for procedures, treatments, products, services,

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1 or supplies for hospital inpatient, hospital outpatient,
2 emergency room, ambulatory surgical treatment centers,
3 accredited ambulatory surgical treatment facilities,
4 prescriptions filled and dispensed outside of a licensed
5 pharmacy, dental services, and professional services.
6 These fee schedule amounts shall be grouped into geographic
7 regions in the following manner:
8 (A) Four regions for non-hospital fee schedule
9 amounts shall be utilized:
10 (i) Cook County;
11 (ii) DuPage, Kane, Lake, and Will Counties;
12 (iii) Bond, Calhoun, Clinton, Jersey,
13 Macoupin, Madison, Monroe, Montgomery, Randolph,
14 St. Clair, and Washington Counties; and
15 (iv) All other counties of the State.
16 (B) Fourteen regions for hospital fee schedule
17 amounts shall be utilized:
18 (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
19 Kendall, and Grundy Counties;
20 (ii) Kankakee County;
21 (iii) Madison, St. Clair, Macoupin, Clinton,
22 Monroe, Jersey, Bond, and Calhoun Counties;
23 (iv) Winnebago and Boone Counties;
24 (v) Peoria, Tazewell, Woodford, Marshall, and
25 Stark Counties;
26 (vi) Champaign, Piatt, and Ford Counties;

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1 (vii) Rock Island, Henry, and Mercer Counties;
2 (viii) Sangamon and Menard Counties;
3 (ix) McLean County;
4 (x) Lake County;
5 (xi) Macon County;
6 (xii) Vermilion County;
7 (xiii) Alexander County; and
8 (xiv) All other counties of the State.
9 If a geozip overlaps into one or more of the regions
10 set forth in this Section, then the Commission shall
11 average or repeat the charges and fees in a geozip in order
12 to designate charges and fees for each region.
13 (3) The initial workers' compensation maximum fee for
14 each CPT and DRG code as of September 1, 2017 shall be
15 determined as follows:
16 (A) Within 45 days after the effective date of this
17 amendatory Act of the 100th General Assembly, the
18 Commission shall determine the Medicare percentage
19 amount for each CPT and DRG code using the most recent
20 data available.
21 CPT or DRG codes which have a value, but are not
22 covered expenses under Medicare, are still compensable
23 under the medical fee schedule according to the rate
24 described in Section (B).
25 (B) Within 30 days after the Commission makes the
26 determinations required by subdivision (3)(A) of this

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1 subsection (a-1.5), the Commission shall determine an
2 adjustment to be made to the workers' compensation
3 maximum fee for each CPT and DRG code as follows:
4 (i) If the Medicare percentage amount for that
5 CPT or DRG code is equal to or less than 125%, then
6 the workers' compensation maximum fee for that CPT
7 or DRG code shall be adjusted so that it equals
8 125% of the most recent Medicare maximum fee for
9 that CPT or DRG code.
10 (ii) If the Medicare percentage amount for
11 that CPT or DRG code is greater than 125% but less
12 than 150%, then the workers' compensation maximum
13 fee for that CPT or DRG code shall not be adjusted.
14 (iii) If the Medicare percentage amount for
15 that CPT or DRG code is greater than 150% but less
16 than or equal to 225%, then the workers'
17 compensation maximum fee for that CPT or DRG code
18 shall be adjusted so that it equals the greater of
19 (I) 150% of the most recent Medicare maximum fee
20 for that CPT or DRG code or (II) 85% of the most
21 recent workers' compensation maximum amount for
22 that CPT or DRG code.
23 (iv) If the Medicare percentage amount for
24 that CPT or DRG code is greater than 225% but less
25 than or equal to 428.57%, then the workers'
26 compensation maximum fee for that CPT or DRG code

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1 shall be adjusted so that it equals the greater of
2 (I) 191.25% of the most recent Medicare maximum fee
3 for that CPT or DRG code or (II) 70% of the most
4 recent workers' compensation maximum amount for
5 that CPT or DRG code.
6 (v) If the Medicare percentage amount for that
7 CPT or DRG code is greater than 428.57%, then the
8 workers' compensation maximum fee for that CPT or
9 DRG code shall be adjusted so that it equals 300%
10 of the most recent Medicare maximum fee for that
11 CPT or DRG code.
12 The Commission shall promptly publish the
13 adjustments determined pursuant to this subdivision
14 (3)(B) on its website.
15 (C) The initial workers' compensation maximum fee
16 for each CPT and DRG code as of September 1, 2017 shall
17 be equal to the workers' compensation maximum fee for
18 that code as determined and adjusted pursuant to
19 subdivision (3)(B) of this subsection, subject to any
20 further adjustments pursuant to subdivision (5) of
21 this subsection.
22 (4) The Commission, as of September 1, 2018 and
23 September 1 of each year thereafter, shall adjust the
24 workers' compensation maximum fee for each CPT or DRG code
25 to exactly half of the most recent annual increase in the
26 Consumer Price Index-U.

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1 (5) A person who believes that the workers'
2 compensation maximum fee for a CPT or DRG code, as
3 otherwise determined pursuant to this subsection, creates
4 or would create upon implementation a significant
5 limitation on access to quality health care in either a
6 specific field of health care services or a specific
7 geographic limitation on access to health care may petition
8 the Commission to modify the workers' compensation maximum
9 fee for that CPT or DRG code so as to not create that
10 significant limitation.
11 The petitioner bears the burden of demonstrating, by a
12 preponderance of the credible evidence, that the workers'
13 compensation maximum fee that would otherwise apply would
14 create a significant limitation on access to quality health
15 care in either a specific field of health care services or
16 a specific geographic limitation on access to health care.
17 Petitions shall be made publicly available. Such credible
18 evidence shall include empirical data demonstrating a
19 significant limitation on access to quality health care.
20 Other interested persons may file comments or responses to
21 a petition within 30 days of the filing of a petition.
22 The Commission shall take final action on each petition
23 within 180 days of filing. The Commission may, but is not
24 required to, seek the recommendation of the Medical Fee
25 Advisory Board to assist with this determination. If the
26 Commission grants the petition, the Commission shall

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1 further increase the workers' compensation maximum fee for
2 that CPT or DRG code by the amount minimally necessary to
3 avoid creating a significant limitation on access to
4 quality health care in either a specific field of health
5 care services or a specific geographic limitation on access
6 to health care. The increased workers' compensation
7 maximum fee shall take effect upon entry of the
8 Commission's final action.
9 (a-2) For procedures, treatments, services, or supplies
10covered under this Act and rendered or to be rendered on or
11after September 1, 2011, the maximum allowable payment shall be
1270% of the fee schedule amounts, which shall be adjusted yearly
13by the Consumer Price Index-U, as described in subsection (a)
14of this Section. The provisions of this subsection (a-2), other
15than this sentence, are inoperative after August 31, 2017.
16 (a-3) Prescriptions filled and dispensed outside of a
17licensed pharmacy shall be subject to a fee schedule that shall
18not exceed the Average Wholesale Price (AWP) plus a dispensing
19fee of $4.18. AWP or its equivalent as registered by the
20National Drug Code shall be set forth for that drug on that
21date as published in Medispan.
22 (a-4) The Commission, in consultation with the Workers'
23Compensation Medical Fee Advisory Board, shall promulgate by
24rule an evidence-based drug formulary and any rules necessary
25for its administration. Prescriptions prescribed for workers'
26compensation cases shall be limited to those prescription drugs

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1and doses on the closed formulary.
2 A request for a prescription that is not on the closed
3formulary shall be reviewed pursuant to Section 8.7 of this
4Act.
5 (b) Notwithstanding the provisions of subsection (a), if
6the Commission finds that there is a significant limitation on
7access to quality health care in either a specific field of
8health care services or a specific geographic limitation on
9access to health care, it may change the Consumer Price Index-U
10increase or decrease for that specific field or specific
11geographic limitation on access to health care to address that
12limitation.
13 (c) The Commission shall establish by rule a process to
14review those medical cases or outliers that involve
15extra-ordinary treatment to determine whether to make an
16additional adjustment to the maximum payment within a fee
17schedule for a procedure, treatment, or service.
18 (d) When a patient notifies a provider that the treatment,
19procedure, or service being sought is for a work-related
20illness or injury and furnishes the provider the name and
21address of the responsible employer, the provider shall bill
22the employer directly. The employer shall make payment and
23providers shall submit bills and records in accordance with the
24provisions of this Section.
25 (1) All payments to providers for treatment provided
26 pursuant to this Act shall be made within 30 days of

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

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

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1 (e-10) If an employer notifies a provider that the employer
2will pay only a portion of a bill for any procedure, treatment,
3or service rendered in connection with a compensable illness or
4disease, the provider may seek payment from the employee for
5the remainder of the amount of the bill up to the lesser of the
6actual charge, negotiated rate, if applicable, or the payment
7level set by the Commission in the fee schedule established in
8this Section. Once an employee informs the provider that there
9is an application filed with the Commission to resolve a
10dispute over payment of such charges, the provider shall cease
11any and all efforts to collect payment for the services that
12are the subject of the dispute. Any statute of limitations or
13statute of repose applicable to the provider's efforts to
14collect payment from the employee shall be tolled from the date
15that the employee files the application with the Commission
16until the date that the provider is permitted to resume
17collection efforts under the provisions of this Section.
18 (e-15) When there is a dispute over the compensability of
19or amount of payment for a procedure, treatment, or service,
20and a case is pending or proceeding before an Arbitrator or the
21Commission, the provider may mail the employee reminders that
22the employee will be responsible for payment of any procedure,
23treatment or service rendered by the provider. The reminders
24must state that they are not bills, to the extent practicable
25include itemized information, and state that the employee need
26not pay until such time as the provider is permitted to resume

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1collection efforts under this Section. The reminders shall not
2be provided to any credit rating agency. The reminders may
3request that the employee furnish the provider with information
4about the proceeding under this Act, such as the file number,
5names of parties, and status of the case. If an employee fails
6to respond to such request for information or fails to furnish
7the information requested within 90 days of the date of the
8reminder, the provider is entitled to resume any and all
9efforts to collect payment from the employee for the services
10rendered to the employee and the employee shall be responsible
11for payment of any outstanding bills for a procedure,
12treatment, or service rendered by a provider.
13 (e-20) Upon a final award or judgment by an Arbitrator or
14the Commission, or a settlement agreed to by the employer and
15the employee, a provider may resume any and all efforts to
16collect payment from the employee for the services rendered to
17the employee and the employee shall be responsible for payment
18of any outstanding bills for a procedure, treatment, or service
19rendered by a provider as well as the interest awarded under
20subsection (d) of this Section. In the case of a procedure,
21treatment, or service deemed compensable, the provider shall
22not require a payment rate, excluding the interest provisions
23under subsection (d), greater than the lesser of the actual
24charge or the payment level set by the Commission in the fee
25schedule established in this Section. Payment for services
26deemed not covered or not compensable under this Act is the

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

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1 services.
2 (4) Ensure that health care providers have at least 15
3 business days to comply with records requested by employers
4 and insurers for the authorization of the payment of
5 workers' compensation claims.
6 (5) Ensure that health care providers are responsible
7 for supplying only those medical records pertaining to the
8 provider's own claims that are minimally necessary.
9 (6) Provide that any electronically submitted bill
10 determined to be complete but not paid or objected to
11 within 30 days shall be subject to penalties pursuant to
12 Section 8.2(d)(3) of this Act to be entered by the
13 Commission.
14 (7) Provide that the Department of Insurance may impose
15 an administrative fine if it determines that an employer or
16 insurer has failed to comply with the electronic claims
17 acceptance and response process. The amount of the
18 administrative fine shall be no greater than $1,000 per
19 each violation, but shall not exceed $10,000 for identical
20 violations during a calendar year.
21 (b) To the extent feasible, standards adopted pursuant to
22subdivision (a) shall be consistent with existing standards
23under the federal Health Insurance Portability and
24Accountability Act of 1996 and standards adopted under the
25Illinois Health Information Exchange and Technology Act.
26 (c) The rules requiring employers and insurers to accept

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1electronic claims for payment of medical services shall be
2proposed on or before October 1, 2017 January 1, 2012, and
3shall require all employers and insurers to accept electronic
4claims for payment of medical services on or before April 1,
52018 June 30, 2012.
6 (d) The Director of Insurance shall by rule establish
7criteria for granting exceptions to employers, insurance
8carriers, and health care providers who are unable to submit or
9accept medical bills electronically.
10(Source: P.A. 97-18, eff. 6-28-11.)
11 (820 ILCS 305/14) (from Ch. 48, par. 138.14)
12 Sec. 14. The Commission shall appoint a secretary, an
13assistant secretary, and arbitrators and shall employ such
14assistants and clerical help as may be necessary. Arbitrators
15shall be appointed pursuant to this Section, notwithstanding
16any provision of the Personnel Code.
17 Each arbitrator appointed after June 28, 2011 shall be
18required to demonstrate in writing his or her knowledge of and
19expertise in the law of and judicial processes of the Workers'
20Compensation Act and the Workers' Occupational Diseases Act.
21 A formal training program for newly-hired arbitrators
22shall be implemented. The training program shall include the
23following:
24 (a) substantive and procedural aspects of the
25 arbitrator position;

HB4068- 79 -LRB100 13139 KTG 27545 b
1 (b) current issues in workers' compensation law and
2 practice;
3 (c) medical lectures by specialists in areas such as
4 orthopedics, ophthalmology, psychiatry, rehabilitation
5 counseling;
6 (d) orientation to each operational unit of the
7 Illinois Workers' Compensation Commission;
8 (e) observation of experienced arbitrators conducting
9 hearings of cases, combined with the opportunity to discuss
10 evidence presented and rulings made;
11 (f) the use of hypothetical cases requiring the trainee
12 to issue judgments as a means to evaluating knowledge and
13 writing ability;
14 (g) writing skills;
15 (h) professional and ethical standards pursuant to
16 Section 1.1 of this Act;
17 (i) detection of workers' compensation fraud and
18 reporting obligations of Commission employees and
19 appointees;
20 (j) standards of evidence-based medical treatment and
21 best practices for measuring and improving quality and
22 health care outcomes in the workers' compensation system,
23 including but not limited to the use of the American
24 Medical Association's "Guides to the Evaluation of
25 Permanent Impairment" and the practice of utilization
26 review; and

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1 (k) substantive and procedural aspects of coal
2 workers' pneumoconiosis (black lung) cases.
3 A formal and ongoing professional development program
4including, but not limited to, the above-noted areas shall be
5implemented to keep arbitrators informed of recent
6developments and issues and to assist them in maintaining and
7enhancing their professional competence. Each arbitrator shall
8complete 20 hours of training in the above-noted areas during
9every 2 years such arbitrator shall remain in office.
10 Each arbitrator shall devote full time to his or her duties
11and shall serve when assigned as an acting Commissioner when a
12Commissioner is unavailable in accordance with the provisions
13of Section 13 of this Act. Any arbitrator who is an
14attorney-at-law shall not engage in the practice of law, nor
15shall any arbitrator hold any other office or position of
16profit under the United States or this State or any municipal
17corporation or political subdivision of this State.
18Notwithstanding any other provision of this Act to the
19contrary, an arbitrator who serves as an acting Commissioner in
20accordance with the provisions of Section 13 of this Act shall
21continue to serve in the capacity of Commissioner until a
22decision is reached in every case heard by that arbitrator
23while serving as an acting Commissioner.
24 Notwithstanding any other provision of this Section, the
25term of all arbitrators serving on June 28, 2011 (the effective
26date of Public Act 97-18), including any arbitrators on

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1administrative leave, shall terminate at the close of business
2on July 1, 2011, but the incumbents shall continue to exercise
3all of their duties until they are reappointed or their
4successors are appointed.
5 On and after June 28, 2011 (the effective date of Public
6Act 97-18), arbitrators shall be appointed to 3-year terms as
7follows:
8 (1) All appointments shall be made by the Governor with
9 the advice and consent of the Senate.
10 (2) For their initial appointments, 12 arbitrators
11 shall be appointed to terms expiring July 1, 2012; 12
12 arbitrators shall be appointed to terms expiring July 1,
13 2013; and all additional arbitrators shall be appointed to
14 terms expiring July 1, 2014. Thereafter, all arbitrators
15 shall be appointed to 3-year terms.
16 Upon the expiration of a term, the Chairman shall evaluate
17the performance of the arbitrator and may recommend to the
18Governor that he or she be reappointed to a second or
19subsequent term by the Governor with the advice and consent of
20the Senate.
21 Each arbitrator appointed on or after June 28, 2011 (the
22effective date of Public Act 97-18) and who has not previously
23served as an arbitrator for the Commission shall be required to
24be authorized to practice law in this State by the Supreme
25Court, and to maintain this authorization throughout his or her
26term of employment.

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

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1of the Commission, shall have charge and custody of the seal of
2the Commission and also have charge and custody of all records,
3files, orders, proceedings, decisions, awards and other
4documents on file with the Commission. He shall furnish
5certified copies, under the seal of the Commission, of any such
6records, files, orders, proceedings, decisions, awards and
7other documents on file with the Commission as may be required.
8Certified copies so furnished by the Secretary or Assistant
9Secretary shall be received in evidence before the Commission
10or any Arbitrator thereof, and in all courts, provided that the
11original of such certified copy is otherwise competent and
12admissible in evidence. The Secretary or Assistant Secretary
13shall perform such other duties as may be prescribed from time
14to time by the Commission.
15(Source: P.A. 98-40, eff. 6-28-13; 99-642, eff. 7-28-16.)
16 (820 ILCS 305/19) (from Ch. 48, par. 138.19)
17 Sec. 19. Any disputed questions of law or fact shall be
18determined as herein provided.
19 (a) It shall be the duty of the Commission upon
20notification that the parties have failed to reach an
21agreement, to designate an Arbitrator.
22 1. Whenever any claimant misconceives his remedy and
23 files an application for adjustment of claim under this Act
24 and it is subsequently discovered, at any time before final
25 disposition of such cause, that the claim for disability or

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1 death which was the basis for such application should
2 properly have been made under the Workers' Occupational
3 Diseases Act, then the provisions of Section 19, paragraph
4 (a-1) of the Workers' Occupational Diseases Act having
5 reference to such application shall apply.
6 2. Whenever any claimant misconceives his remedy and
7 files an application for adjustment of claim under the
8 Workers' Occupational Diseases Act and it is subsequently
9 discovered, at any time before final disposition of such
10 cause that the claim for injury or death which was the
11 basis for such application should properly have been made
12 under this Act, then the application so filed under the
13 Workers' Occupational Diseases Act may be amended in form,
14 substance or both to assert claim for such disability or
15 death under this Act and it shall be deemed to have been so
16 filed as amended on the date of the original filing
17 thereof, and such compensation may be awarded as is
18 warranted by the whole evidence pursuant to this Act. When
19 such amendment is submitted, further or additional
20 evidence may be heard by the Arbitrator or Commission when
21 deemed necessary. Nothing in this Section contained shall
22 be construed to be or permit a waiver of any provisions of
23 this Act with reference to notice but notice if given shall
24 be deemed to be a notice under the provisions of this Act
25 if given within the time required herein.
26 3. When an Arbitrator conducts a status call of cases

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1 that appear on the Arbitrator's docket in accordance with
2 the rules of the Commission, parties or their attorneys may
3 appear by telephone, video conference, or other remote
4 electronic means as prescribed by the Commission.
5 (b) The Arbitrator shall make such inquiries and
6investigations as he or they shall deem necessary and may
7examine and inspect all books, papers, records, places, or
8premises relating to the questions in dispute and hear such
9proper evidence as the parties may submit.
10 The hearings before the Arbitrator shall be held in the
11vicinity where the injury occurred after 10 days' notice of the
12time and place of such hearing shall have been given to each of
13the parties or their attorneys of record.
14 The Arbitrator may find that the disabling condition is
15temporary and has not yet reached a permanent condition and may
16order the payment of compensation up to the date of the
17hearing, which award shall be reviewable and enforceable in the
18same manner as other awards, and in no instance be a bar to a
19further hearing and determination of a further amount of
20temporary total compensation or of compensation for permanent
21disability, but shall be conclusive as to all other questions
22except the nature and extent of said disability.
23 The decision of the Arbitrator shall be filed with the
24Commission which Commission shall immediately send to each
25party or his attorney a copy of such decision, together with a
26notification of the time when it was filed. As of the effective

HB4068- 86 -LRB100 13139 KTG 27545 b
1date of this amendatory Act of the 94th General Assembly, all
2decisions of the Arbitrator shall set forth in writing findings
3of fact and conclusions of law, separately stated, if requested
4by either party. Unless a petition for review is filed by
5either party within 30 days after the receipt by such party of
6the copy of the decision and notification of time when filed,
7and unless such party petitioning for a review shall within 35
8days after the receipt by him of the copy of the decision, file
9with the Commission either an agreed statement of the facts
10appearing upon the hearing before the Arbitrator, or if such
11party shall so elect a correct transcript of evidence of the
12proceedings at such hearings, then the decision shall become
13the decision of the Commission and in the absence of fraud
14shall be conclusive. The Petition for Review shall contain a
15statement of the petitioning party's specific exceptions to the
16decision of the arbitrator. The jurisdiction of the Commission
17to review the decision of the arbitrator shall not be limited
18to the exceptions stated in the Petition for Review. The
19Commission, or any member thereof, may grant further time not
20exceeding 30 days, in which to file such agreed statement or
21transcript of evidence. Such agreed statement of facts or
22correct transcript of evidence, as the case may be, shall be
23authenticated by the signatures of the parties or their
24attorneys, and in the event they do not agree as to the
25correctness of the transcript of evidence it shall be
26authenticated by the signature of the Arbitrator designated by

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1the Commission.
2 Whether the employee is working or not, if the employee is
3not receiving or has not received medical, surgical, or
4hospital services or other services or compensation as provided
5in paragraph (a) of Section 8, or compensation as provided in
6paragraph (b) of Section 8, or if the employer has refused or
7failed to respond to a written request for authorization of
8medical care and treatment, the employee may at any time
9petition for an expedited hearing by an Arbitrator on the issue
10of whether or not he or she is entitled to receive payment of
11the services or compensation or authorization of medical care.
12Provided the employer continues to pay compensation pursuant to
13paragraph (b) of Section 8, the employer may at any time
14petition for an expedited hearing on the issue of whether or
15not the employee is entitled to receive medical, surgical, or
16hospital services or other services or compensation as provided
17in paragraph (a) of Section 8, whether or not the employee is
18entitled to authorization of medical care and treatment, or
19compensation as provided in paragraph (b) of Section 8. When an
20employer has petitioned for an expedited hearing, the employer
21shall continue to pay compensation as provided in paragraph (b)
22of Section 8 unless the arbitrator renders a decision that the
23employee is not entitled to the benefits that are the subject
24of the expedited hearing or unless the employee's treating
25physician has released the employee to return to work at his or
26her regular job with the employer or the employee actually

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1returns to work at any other job. If the arbitrator renders a
2decision that the employee is not entitled to the benefits or
3medical care that is are the subject of the expedited hearing,
4a petition for review filed by the employee shall receive the
5same priority as if the employee had filed a petition for an
6expedited hearing by an Arbitrator. Neither party shall be
7entitled to an expedited hearing when the employee has returned
8to work and the sole issue in dispute amounts to less than 12
9weeks of unpaid compensation pursuant to paragraph (b) of
10Section 8.
11 Expedited hearings shall have priority over all other
12petitions and shall be heard by the Arbitrator and Commission
13with all convenient speed. Any party requesting an expedited
14hearing shall give notice of a request for an expedited hearing
15under this paragraph. A copy of the Application for Adjustment
16of Claim shall be attached to the notice. The Commission shall
17adopt rules and procedures under which the final decision of
18the Commission under this paragraph is filed not later than 180
19days from the date that the Petition for Review is filed with
20the Commission.
21 Where 2 or more insurance carriers, private self-insureds,
22or a group workers' compensation pool under Article V 3/4 of
23the Illinois Insurance Code dispute coverage for the same
24injury, any such insurance carrier, private self-insured, or
25group workers' compensation pool may request an expedited
26hearing pursuant to this paragraph to determine the issue of

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1coverage, provided coverage is the only issue in dispute and
2all other issues are stipulated and agreed to and further
3provided that all compensation benefits including medical
4benefits pursuant to Section 8(a) continue to be paid to or on
5behalf of petitioner. Any insurance carrier, private
6self-insured, or group workers' compensation pool that is
7determined to be liable for coverage for the injury in issue
8shall reimburse any insurance carrier, private self-insured,
9or group workers' compensation pool that has paid benefits to
10or on behalf of petitioner for the injury.
11 (b-1) If the employee is not receiving medical, surgical or
12hospital services as provided in paragraph (a) of Section 8 or
13compensation as provided in paragraph (b) of Section 8, the
14employee, in accordance with Commission Rules, may file a
15petition for an emergency hearing by an Arbitrator on the issue
16of whether or not he is entitled to receive payment of such
17compensation or services as provided therein. Such petition
18shall have priority over all other petitions and shall be heard
19by the Arbitrator and Commission with all convenient speed.
20 Such petition shall contain the following information and
21shall be served on the employer at least 15 days before it is
22filed:
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;

HB4068- 90 -LRB100 13139 KTG 27545 b
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

HB4068- 91 -LRB100 13139 KTG 27545 b
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

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1with the required information the employee may file said
2petition and required information and shall serve notice of the
3filing upon the employer. The employer may file a motion
4addressed to the sufficiency of the petition. If an objection
5has been filed to the sufficiency of the petition, the
6arbitrator shall rule on the objection within 2 working days.
7If such an objection is filed, the time for filing the final
8decision of the Commission as provided in this paragraph shall
9be tolled until the arbitrator has determined that the petition
10is sufficient.
11 The employer shall, within 15 days after receipt of the
12notice that such petition is filed, file with the Commission
13and serve on the employee or his representative a written
14response to each claim set forth in the petition, including the
15legal and factual basis for each disputed allegation and the
16following information: (i) complete copies of any reports,
17records, documents and affidavits in the possession of the
18employer on which the employer intends to rely in support of
19his response, (ii) a list of any reports, records, documents
20and affidavits which the employer has demanded by subpoena and
21on which the employer intends to rely in support of his
22response, (iii) the name and address of each witness on whom
23the employer will rely to support his response, and (iv) the
24names and addresses of any medical practitioners selected by
25the employer pursuant to Section 12 of this Act and the time
26and place of any examination scheduled to be made pursuant to

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1such Section.
2 Any employer who does not timely file and serve a written
3response without good cause may not introduce any evidence to
4dispute any claim of the employee but may cross examine the
5employee or any witness brought by the employee and otherwise
6be heard.
7 No document or other evidence not previously identified by
8either party with the petition or written response, or by any
9other means before the hearing, may be introduced into evidence
10without good cause. If, at the hearing, material information is
11discovered which was not previously disclosed, the Arbitrator
12may extend the time for closing proof on the motion of a party
13for a reasonable period of time which may be more than 30 days.
14No evidence may be introduced pursuant to this paragraph as to
15permanent disability. No award may be entered for permanent
16disability pursuant to this paragraph. Either party may
17introduce into evidence the testimony taken by deposition of
18any medical practitioner.
19 The Commission shall adopt rules, regulations and
20procedures whereby the final decision of the Commission is
21filed not later than 90 days from the date the petition for
22review is filed but in no event later than 180 days from the
23date the petition for an emergency hearing is filed with the
24Illinois Workers' Compensation Commission.
25 All service required pursuant to this paragraph (b-1) must
26be by personal service or by certified mail and with evidence

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1of receipt. In addition for the purposes of this paragraph, all
2service on the employer must be at the premises where the
3accident occurred if the premises are owned or operated by the
4employer. Otherwise service must be at the employee's principal
5place of employment by the employer. If service on the employer
6is not possible at either of the above, then service shall be
7at the employer's principal place of business. After initial
8service in each case, service shall be made on the employer's
9attorney or designated representative.
10 (c)(1) At a reasonable time in advance of and in connection
11with the hearing under Section 19(e) or 19(h), the Commission
12may on its own motion order an impartial physical or mental
13examination of a petitioner whose mental or physical condition
14is in issue, when in the Commission's discretion it appears
15that such an examination will materially aid in the just
16determination of the case. The examination shall be made by a
17member or members of a panel of physicians chosen for their
18special qualifications by the Illinois State Medical Society.
19The Commission shall establish procedures by which a physician
20shall be selected from such list.
21 (2) Should the Commission at any time during the hearing
22find that compelling considerations make it advisable to have
23an examination and report at that time, the commission may in
24its discretion so order.
25 (3) A copy of the report of examination shall be given to
26the Commission and to the attorneys for the parties.

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1 (4) Either party or the Commission may call the examining
2physician or physicians to testify. Any physician so called
3shall be subject to cross-examination.
4 (5) The examination shall be made, and the physician or
5physicians, if called, shall testify, without cost to the
6parties. The Commission shall determine the compensation and
7the pay of the physician or physicians. The compensation for
8this service shall not exceed the usual and customary amount
9for such service.
10 (6) The fees and payment thereof of all attorneys and
11physicians for services authorized by the Commission under this
12Act shall, upon request of either the employer or the employee
13or the beneficiary affected, be subject to the review and
14decision of the Commission.
15 (d) If any employee shall persist in insanitary or
16injurious practices which tend to either imperil or retard his
17recovery or shall refuse to submit to such medical, surgical,
18or hospital treatment as is reasonably essential to promote his
19recovery, the Commission may, in its discretion, reduce or
20suspend the compensation of any such injured employee. However,
21when an employer and employee so agree in writing, the
22foregoing provision shall not be construed to authorize the
23reduction or suspension of compensation of an employee who is
24relying in good faith, on treatment by prayer or spiritual
25means alone, in accordance with the tenets and practice of a
26recognized church or religious denomination, by a duly

HB4068- 96 -LRB100 13139 KTG 27545 b
1accredited practitioner thereof.
2 (e) This paragraph shall apply to all hearings before the
3Commission. Such hearings may be held in its office or
4elsewhere as the Commission may deem advisable. The taking of
5testimony on such hearings may be had before any member of the
6Commission. If a petition for review and agreed statement of
7facts or transcript of evidence is filed, as provided herein,
8the Commission shall promptly review the decision of the
9Arbitrator and all questions of law or fact which appear from
10the statement of facts or transcript of evidence.
11 In all cases in which the hearing before the arbitrator is
12held after December 18, 1989, no additional evidence shall be
13introduced by the parties before the Commission on review of
14the decision of the Arbitrator. In reviewing decisions of an
15arbitrator the Commission shall award such temporary
16compensation, permanent compensation and other payments as are
17due under this Act. The Commission shall file in its office its
18decision thereon, and shall immediately send to each party or
19his attorney a copy of such decision and a notification of the
20time when it was filed. Decisions shall be filed within 60 days
21after the Statement of Exceptions and Supporting Brief and
22Response thereto are required to be filed or oral argument
23whichever is later.
24 In the event either party requests oral argument, such
25argument shall be had before a panel of 3 members of the
26Commission (or before all available members pursuant to the

HB4068- 97 -LRB100 13139 KTG 27545 b
1determination of 7 members of the Commission that such argument
2be held before all available members of the Commission)
3pursuant to the rules and regulations of the Commission. A
4panel of 3 members, which shall be comprised of not more than
5one representative citizen of the employing class and not more
6than one representative citizen of the employee class, shall
7hear the argument; provided that if all the issues in dispute
8are solely the nature and extent of the permanent partial
9disability, if any, a majority of the panel may deny the
10request for such argument and such argument shall not be held;
11and provided further that 7 members of the Commission may
12determine that the argument be held before all available
13members of the Commission. A decision of the Commission shall
14be approved by a majority of Commissioners present at such
15hearing if any; provided, if no such hearing is held, a
16decision of the Commission shall be approved by a majority of a
17panel of 3 members of the Commission as described in this
18Section. The Commission shall give 10 days' notice to the
19parties or their attorneys of the time and place of such taking
20of testimony and of such argument.
21 In any case the Commission in its decision may find
22specially upon any question or questions of law or fact which
23shall be submitted in writing by either party whether ultimate
24or otherwise; provided that on issues other than nature and
25extent of the disability, if any, the Commission in its
26decision shall find specially upon any question or questions of

HB4068- 98 -LRB100 13139 KTG 27545 b
1law or fact, whether ultimate or otherwise, which are submitted
2in writing by either party; provided further that not more than
35 such questions may be submitted by either party. Any party
4may, within 20 days after receipt of notice of the Commission's
5decision, or within such further time, not exceeding 30 days,
6as the Commission may grant, file with the Commission either an
7agreed statement of the facts appearing upon the hearing, or,
8if such party shall so elect, a correct transcript of evidence
9of the additional proceedings presented before the Commission,
10in which report the party may embody a correct statement of
11such other proceedings in the case as such party may desire to
12have reviewed, such statement of facts or transcript of
13evidence to be authenticated by the signature of the parties or
14their attorneys, and in the event that they do not agree, then
15the authentication of such transcript of evidence shall be by
16the signature of any member of the Commission.
17 If a reporter does not for any reason furnish a transcript
18of the proceedings before the Arbitrator in any case for use on
19a hearing for review before the Commission, within the
20limitations of time as fixed in this Section, the Commission
21may, in its discretion, order a trial de novo before the
22Commission in such case upon application of either party. The
23applications for adjustment of claim and other documents in the
24nature of pleadings filed by either party, together with the
25decisions of the Arbitrator and of the Commission and the
26statement of facts or transcript of evidence hereinbefore

HB4068- 99 -LRB100 13139 KTG 27545 b
1provided for in paragraphs (b) and (c) shall be the record of
2the proceedings of the Commission, and shall be subject to
3review as hereinafter provided.
4 At the request of either party or on its own motion, the
5Commission shall set forth in writing the reasons for the
6decision, including findings of fact and conclusions of law
7separately stated. The Commission shall by rule adopt a format
8for written decisions for the Commission and arbitrators. The
9written decisions shall be concise and shall succinctly state
10the facts and reasons for the decision. The Commission may
11adopt in whole or in part, the decision of the arbitrator as
12the decision of the Commission. When the Commission does so
13adopt the decision of the arbitrator, it shall do so by order.
14Whenever the Commission adopts part of the arbitrator's
15decision, but not all, it shall include in the order the
16reasons for not adopting all of the arbitrator's decision. When
17a majority of a panel, after deliberation, has arrived at its
18decision, the decision shall be filed as provided in this
19Section without unnecessary delay, and without regard to the
20fact that a member of the panel has expressed an intention to
21dissent. Any member of the panel may file a dissent. Any
22dissent shall be filed no later than 10 days after the decision
23of the majority has been filed.
24 Decisions rendered by the Commission and dissents, if any,
25shall be published together by the Commission. The conclusions
26of law set out in such decisions shall be regarded as

HB4068- 100 -LRB100 13139 KTG 27545 b
1precedents by arbitrators for the purpose of achieving a more
2uniform administration of this Act.
3 (f) The decision of the Commission acting within its
4powers, according to the provisions of paragraph (e) of this
5Section shall, in the absence of fraud, be conclusive unless
6reviewed as in this paragraph hereinafter provided. However,
7the Arbitrator or the Commission may on his or its own motion,
8or on the motion of either party, correct any clerical error or
9errors in computation within 15 days after the date of receipt
10of any award by such Arbitrator or any decision on review of
11the Commission and shall have the power to recall the original
12award on arbitration or decision on review, and issue in lieu
13thereof such corrected award or decision. Where such correction
14is made the time for review herein specified shall begin to run
15from the date of the receipt of the corrected award or
16decision.
17 (1) Except in cases of claims against the State of
18 Illinois other than those claims under Section 18.1, in
19 which case the decision of the Commission shall not be
20 subject to judicial review, the Circuit Court of the county
21 where any of the parties defendant may be found, or if none
22 of the parties defendant can be found in this State then
23 the Circuit Court of the county where the accident
24 occurred, shall by summons to the Commission have power to
25 review all questions of law and fact presented by such
26 record.

HB4068- 101 -LRB100 13139 KTG 27545 b
1 A proceeding for review shall be commenced within 20
2 days of the receipt of notice of the decision of the
3 Commission. The summons shall be issued by the clerk of
4 such court upon written request returnable on a designated
5 return day, not less than 10 or more than 60 days from the
6 date of issuance thereof, and the written request shall
7 contain the last known address of other parties in interest
8 and their attorneys of record who are to be served by
9 summons. Service upon any member of the Commission or the
10 Secretary or the Assistant Secretary thereof shall be
11 service upon the Commission, and service upon other parties
12 in interest and their attorneys of record shall be by
13 summons, and such service shall be made upon the Commission
14 and other parties in interest by mailing notices of the
15 commencement of the proceedings and the return day of the
16 summons to the office of the Commission and to the last
17 known place of residence of other parties in interest or
18 their attorney or attorneys of record. The clerk of the
19 court issuing the summons shall on the day of issue mail
20 notice of the commencement of the proceedings which shall
21 be done by mailing a copy of the summons to the office of
22 the Commission, and a copy of the summons to the other
23 parties in interest or their attorney or attorneys of
24 record and the clerk of the court shall make certificate
25 that he has so sent said notices in pursuance of this
26 Section, which shall be evidence of service on the

HB4068- 102 -LRB100 13139 KTG 27545 b
1 Commission and other parties in interest.
2 The Commission shall not be required to certify the
3 record of their proceedings to the Circuit Court, unless
4 the party commencing the proceedings for review in the
5 Circuit Court as above provided, shall file with the
6 Commission notice of intent to file for review in Circuit
7 Court. It shall be the duty of the Commission upon such
8 filing of notice of intent to file for review in the
9 Circuit Court to prepare a true and correct copy of such
10 testimony and a true and correct copy of all other matters
11 contained in such record and certified to by the Secretary
12 or Assistant Secretary thereof. The changes made to this
13 subdivision (f)(1) by this amendatory Act of the 98th
14 General Assembly apply to any Commission decision entered
15 after the effective date of this amendatory Act of the 98th
16 General Assembly.
17 No request for a summons may be filed and no summons
18 shall issue unless the party seeking to review the decision
19 of the Commission shall exhibit to the clerk of the Circuit
20 Court proof of filing with the Commission of the notice of
21 the intent to file for review in the Circuit Court or an
22 affidavit of the attorney setting forth that notice of
23 intent to file for review in the Circuit Court has been
24 given in writing to the Secretary or Assistant Secretary of
25 the Commission.
26 (2) No such summons shall issue unless the one against

HB4068- 103 -LRB100 13139 KTG 27545 b
1 whom the Commission shall have rendered an award for the
2 payment of money shall upon the filing of his written
3 request for such summons file with the clerk of the court a
4 bond conditioned that if he shall not successfully
5 prosecute the review, he will pay the award and the costs
6 of the proceedings in the courts. The amount of the bond
7 shall be fixed by any member of the Commission and the
8 surety or sureties of the bond shall be approved by the
9 clerk of the court. The acceptance of the bond by the clerk
10 of the court shall constitute evidence of his approval of
11 the bond.
12 The State of Illinois, including its constitutional
13 officers, boards, commissions, agencies, public
14 institutions of higher learning, and funds administered by
15 the treasurer ex officio, and every Every county, city,
16 town, township, incorporated village, school district,
17 body politic or municipal corporation against whom the
18 Commission shall have rendered an award for the payment of
19 money shall not be required to file a bond to secure the
20 payment of the award and the costs of the proceedings in
21 the court to authorize the court to issue such summons.
22 The court may confirm or set aside the decision of the
23 Commission. If the decision is set aside and the facts
24 found in the proceedings before the Commission are
25 sufficient, the court may enter such decision as is
26 justified by law, or may remand the cause to the Commission

HB4068- 104 -LRB100 13139 KTG 27545 b
1 for further proceedings and may state the questions
2 requiring further hearing, and give such other
3 instructions as may be proper. Appeals shall be taken to
4 the Appellate Court in accordance with Supreme Court Rules
5 22(g) and 303. Appeals shall be taken from the Appellate
6 Court to the Supreme Court in accordance with Supreme Court
7 Rule 315.
8 It shall be the duty of the clerk of any court
9 rendering a decision affecting or affirming an award of the
10 Commission to promptly furnish the Commission with a copy
11 of such decision, without charge.
12 The decision of a majority of the members of the panel
13 of the Commission, shall be considered the decision of the
14 Commission.
15 (g) Except in the case of a claim against the State of
16Illinois, either party may present a certified copy of the
17award of the Arbitrator, or a certified copy of the decision of
18the Commission when the same has become final, when no
19proceedings for review are pending, providing for the payment
20of compensation according to this Act, to the Circuit Court of
21the county in which such accident occurred or either of the
22parties are residents, whereupon the court shall enter a
23judgment in accordance therewith. In a case where the employer
24refuses to pay compensation according to such final award or
25such final decision upon which such judgment is entered the
26court shall in entering judgment thereon, tax as costs against

HB4068- 105 -LRB100 13139 KTG 27545 b
1him the reasonable costs and attorney fees in the arbitration
2proceedings and in the court entering the judgment for the
3person in whose favor the judgment is entered, which judgment
4and costs taxed as therein provided shall, until and unless set
5aside, have the same effect as though duly entered in an action
6duly tried and determined by the court, and shall with like
7effect, be entered and docketed. The Circuit Court shall have
8power at any time upon application to make any such judgment
9conform to any modification required by any subsequent decision
10of the Supreme Court upon appeal, or as the result of any
11subsequent proceedings for review, as provided in this Act.
12 Judgment shall not be entered until 15 days' notice of the
13time and place of the application for the entry of judgment
14shall be served upon the employer by filing such notice with
15the Commission, which Commission shall, in case it has on file
16the address of the employer or the name and address of its
17agent upon whom notices may be served, immediately send a copy
18of the notice to the employer or such designated agent.
19 (h) An agreement or award under this Act providing for
20compensation in installments, may at any time within 18 months
21after such agreement or award be reviewed by the Commission at
22the request of either the employer or the employee, on the
23ground that the disability of the employee has subsequently
24recurred, increased, diminished or ended.
25 However, as to accidents occurring subsequent to July 1,
261955, which are covered by any agreement or award under this

HB4068- 106 -LRB100 13139 KTG 27545 b
1Act providing for compensation in installments made as a result
2of such accident, such agreement or award may at any time
3within 30 months, or 60 months in the case of an award under
4Section 8(d)1, after such agreement or award be reviewed by the
5Commission at the request of either the employer or the
6employee on the ground that the disability of the employee has
7subsequently recurred, increased, diminished or ended.
8 On such review, compensation payments may be
9re-established, increased, diminished or ended. The Commission
10shall give 15 days' notice to the parties of the hearing for
11review. Any employee, upon any petition for such review being
12filed by the employer, shall be entitled to one day's notice
13for each 100 miles necessary to be traveled by him in attending
14the hearing of the Commission upon the petition, and 3 days in
15addition thereto. Such employee shall, at the discretion of the
16Commission, also be entitled to 5 cents per mile necessarily
17traveled by him within the State of Illinois in attending such
18hearing, not to exceed a distance of 300 miles, to be taxed by
19the Commission as costs and deposited with the petition of the
20employer.
21 When compensation which is payable in accordance with an
22award or settlement contract approved by the Commission, is
23ordered paid in a lump sum by the Commission, no review shall
24be had as in this paragraph mentioned.
25 (i) Each party, upon taking any proceedings or steps
26whatsoever before any Arbitrator, Commission or court, shall

HB4068- 107 -LRB100 13139 KTG 27545 b
1file with the Commission his address, or the name and address
2of any agent upon whom all notices to be given to such party
3shall be served, either personally or by registered mail,
4addressed to such party or agent at the last address so filed
5with the Commission. In the event such party has not filed his
6address, or the name and address of an agent as above provided,
7service of any notice may be had by filing such notice with the
8Commission.
9 (j) Whenever in any proceeding testimony has been taken or
10a final decision has been rendered and after the taking of such
11testimony or after such decision has become final, the injured
12employee dies, then in any subsequent proceedings brought by
13the personal representative or beneficiaries of the deceased
14employee, such testimony in the former proceeding may be
15introduced with the same force and effect as though the witness
16having so testified were present in person in such subsequent
17proceedings and such final decision, if any, shall be taken as
18final adjudication of any of the issues which are the same in
19both proceedings.
20 (k) In a case where there has been any unreasonable or
21vexatious delay of payment or intentional underpayment of
22compensation, or proceedings have been instituted or carried on
23by the one liable to pay the compensation, which do not present
24a real controversy, but are merely frivolous or for delay, then
25the Commission may award compensation additional to that
26otherwise payable under this Act equal to 50% of the amount

HB4068- 108 -LRB100 13139 KTG 27545 b
1payable at the time of such award. Failure to pay compensation
2in accordance with the provisions of Section 8, paragraph (b)
3of this Act, shall be considered unreasonable delay.
4 When determining whether this subsection (k) shall apply,
5the Commission shall consider whether an Arbitrator has
6determined that the claim is not compensable or whether the
7employer has made payments under Section 8(j).
8 (l) If the employee has made written demand for payment of
9benefits under Section 8(a) or Section 8(b), the employer shall
10have 14 days after receipt of the demand to set forth in
11writing the reason for the delay. In the case of demand for
12payment of medical benefits under Section 8(a), the time for
13the employer to respond shall not commence until the expiration
14of the allotted 30 days specified under Section 8.2(d). In case
15the employer or his or her insurance carrier shall without good
16and just cause fail, neglect, refuse, or unreasonably delay the
17payment of benefits under Section 8(a) or Section 8(b), the
18Arbitrator or the Commission shall allow to the employee
19additional compensation in the sum of $30 per day for each day
20that the benefits under Section 8(a) or Section 8(b) have been
21so withheld or refused, not to exceed $10,000. A delay in
22payment of 14 days or more shall create a rebuttable
23presumption of unreasonable delay.
24 (m) If the commission finds that an accidental injury was
25directly and proximately caused by the employer's wilful
26violation of a health and safety standard under the Health and

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1Safety Act or the Occupational Safety and Health Act in force
2at the time of the accident, the arbitrator or the Commission
3shall allow to the injured employee or his dependents, as the
4case may be, additional compensation equal to 25% of the amount
5which otherwise would be payable under the provisions of this
6Act exclusive of this paragraph. The additional compensation
7herein provided shall be allowed by an appropriate increase in
8the applicable weekly compensation rate.
9 (n) After June 30, 1984, decisions of the Illinois Workers'
10Compensation Commission reviewing an award of an arbitrator of
11the Commission shall draw interest at a rate equal to the yield
12on indebtedness issued by the United States Government with a
1326-week maturity next previously auctioned on the day on which
14the decision is filed. Said rate of interest shall be set forth
15in the Arbitrator's Decision. Interest shall be drawn from the
16date of the arbitrator's award on all accrued compensation due
17the employee through the day prior to the date of payments.
18However, when an employee appeals an award of an Arbitrator or
19the Commission, and the appeal results in no change or a
20decrease in the award, interest shall not further accrue from
21the date of such appeal.
22 The employer or his insurance carrier may tender the
23payments due under the award to stop the further accrual of
24interest on such award notwithstanding the prosecution by
25either party of review, certiorari, appeal to the Supreme Court
26or other steps to reverse, vacate or modify the award.

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1 (o) By the 15th day of each month each insurer providing
2coverage for losses under this Act shall notify each insured
3employer of any compensable claim incurred during the preceding
4month and the amounts paid or reserved on the claim including a
5summary of the claim and a brief statement of the reasons for
6compensability. A cumulative report of all claims incurred
7during a calendar year or continued from the previous year
8shall be furnished to the insured employer by the insurer
9within 30 days after the end of that calendar year.
10 The insured employer may challenge, in proceeding before
11the Commission, payments made by the insurer without
12arbitration and payments made after a case is determined to be
13noncompensable. If the Commission finds that the case was not
14compensable, the insurer shall purge its records as to that
15employer of any loss or expense associated with the claim,
16reimburse the employer for attorneys' fees arising from the
17challenge and for any payment required of the employer to the
18Rate Adjustment Fund or the Second Injury Fund, and may not
19reflect the loss or expense for rate making purposes. The
20employee shall not be required to refund the challenged
21payment. The decision of the Commission may be reviewed in the
22same manner as in arbitrated cases. No challenge may be
23initiated under this paragraph more than 3 years after the
24payment is made. An employer may waive the right of challenge
25under this paragraph on a case by case basis.
26 (p) After filing an application for adjustment of claim but

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1prior to the hearing on arbitration the parties may voluntarily
2agree to submit such application for adjustment of claim for
3decision by an arbitrator under this subsection (p) where such
4application for adjustment of claim raises only a dispute over
5temporary total disability, permanent partial disability or
6medical expenses. Such agreement shall be in writing in such
7form as provided by the Commission. Applications for adjustment
8of claim submitted for decision by an arbitrator under this
9subsection (p) shall proceed according to rule as established
10by the Commission. The Commission shall promulgate rules
11including, but not limited to, rules to ensure that the parties
12are adequately informed of their rights under this subsection
13(p) and of the voluntary nature of proceedings under this
14subsection (p). The findings of fact made by an arbitrator
15acting within his or her powers under this subsection (p) in
16the absence of fraud shall be conclusive. However, the
17arbitrator may on his own motion, or the motion of either
18party, correct any clerical errors or errors in computation
19within 15 days after the date of receipt of such award of the
20arbitrator and shall have the power to recall the original
21award on arbitration, and issue in lieu thereof such corrected
22award. The decision of the arbitrator under this subsection (p)
23shall be considered the decision of the Commission and
24proceedings for review of questions of law arising from the
25decision may be commenced by either party pursuant to
26subsection (f) of Section 19. The Advisory Board established

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1under Section 13.1 shall compile a list of certified Commission
2arbitrators, each of whom shall be approved by at least 7
3members of the Advisory Board. The chairman shall select 5
4persons from such list to serve as arbitrators under this
5subsection (p). By agreement, the parties shall select one
6arbitrator from among the 5 persons selected by the chairman
7except that if the parties do not agree on an arbitrator from
8among the 5 persons, the parties may, by agreement, select an
9arbitrator of the American Arbitration Association, whose fee
10shall be paid by the State in accordance with rules promulgated
11by the Commission. Arbitration under this subsection (p) shall
12be voluntary.
13(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
14eff. 1-1-15.)
15 (820 ILCS 305/25.5)
16 Sec. 25.5. Unlawful acts; penalties.
17 (a) It is unlawful for any person, company, corporation,
18insurance carrier, healthcare provider, or other entity to:
19 (1) Intentionally present or cause to be presented any
20 false or fraudulent claim for the payment of any workers'
21 compensation benefit.
22 (2) Intentionally make or cause to be made any false or
23 fraudulent material statement or material representation
24 for the purpose of obtaining or denying any workers'
25 compensation benefit.

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

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1 with any person, company, or other entity to commit any of
2 the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
3 of this subsection (a).
4 (9) Intentionally present a bill or statement for the
5 payment for medical services that were not provided.
6 For the purposes of paragraphs (2), (3), (5), (6), (7), and
7(9), the term "statement" includes any writing, notice, proof
8of injury, bill for services, hospital or doctor records and
9reports, or X-ray and test results.
10 (b) Sentence. Sentences for violations of subsection (a)
11are as follows:
12 (1) A violation of paragraph (a)(3) is a Class 4
13 felony.
14 (2) A violation of paragraph (a)(4) or (a)(7) is a
15 Class 3 felony.
16 (3) A violation of paragraph (a)(1), (a)(2), (a)(5),
17 (a)(6), or (a)(9) in which the value of the property
18 obtained or attempted to be obtained is $500 or less is a
19 Class A misdemeanor.
20 (4) A violation of paragraph (a)(1), (a)(2), (a)(5),
21 (a)(6), or (a)(9) in which the value of the property
22 obtained or attempted to be obtained is more than $500 but
23 not more than $10,000 is a Class 3 felony.
24 (5) A violation of paragraph (a)(1), (a)(2), (a)(5),
25 (a)(6), or (a)(9) in which the value of the property
26 obtained or attempted to be obtained is more than $10,000

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1 but not more than $100,000 is a Class 2 felony.
2 (6) A violation of paragraph (a)(1), (a)(2), (a)(5),
3 (a)(6), or (a)(9) in which the value of the property
4 obtained or attempted to be obtained is more than $100,000
5 is a Class 1 felony.
6 (7) A violation of paragraph (8) of subsection (a)
7 shall be punishable as the class of offense for which the
8 person convicted assisted, abetted, solicited, or
9 conspired to commit, as set forth in paragraphs (1) through
10 (6) of this subsection.
11 (1) A violation in which the value of the property
12 obtained or attempted to be obtained is $300 or less is a
13 Class A misdemeanor.
14 (2) A violation in which the value of the property
15 obtained or attempted to be obtained is more than $300 but
16 not more than $10,000 is a Class 3 felony.
17 (3) A violation in which the value of the property
18 obtained or attempted to be obtained is more than $10,000
19 but not more than $100,000 is a Class 2 felony.
20 (4) A violation in which the value of the property
21 obtained or attempted to be obtained is more than $100,000
22 is a Class 1 felony.
23 (8) (5) A person convicted under this Section shall be
24 ordered to pay monetary restitution to the insurance
25 company or self-insured entity or any other person for any
26 financial loss sustained as a result of a violation of this

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1 Section, including any court costs and attorney fees. An
2 order of restitution also includes expenses incurred and
3 paid by the State of Illinois or an insurance company or
4 self-insured entity in connection with any medical
5 evaluation or treatment services.
6 For a violation of paragraph (a)(1) or (a)(2), the value of
7the property obtained or attempted to be obtained shall include
8payments pursuant to the provisions of this Act as well as the
9amount paid for medical expenses. For a violation of paragraph
10(a)(5), the value of the property obtained or attempted to be
11obtained shall be the difference between the proper amount for
12the coverage sought or provided and the actual amount billed
13for workers' compensation insurance. For a violation of
14paragraph (a)(6), the value of the property obtained or
15attempted to be obtained shall be the difference between the
16proper amount of security required pursuant to Section 4 of
17this Act and the amount furnished pursuant to the false or
18fraudulent statements or representations. For the purposes of
19this Section, where the exact value of property obtained or
20attempted to be obtained is either not alleged or is not
21specifically set by the terms of a policy of insurance, the
22value of the property shall be the fair market replacement
23value of the property claimed to be lost, the reasonable costs
24of reimbursing a vendor or other claimant for services to be
25rendered, or both. Notwithstanding the foregoing, an insurance
26company, self-insured entity, or any other person suffering

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

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1 (d) Any person may report allegations of insurance
2non-compliance and fraud pursuant to this Section to the
3Department of Insurance's fraud and insurance non-compliance
4unit whose duty it shall be to investigate the report. The unit
5shall notify the Commission of reports of insurance
6non-compliance. Any person reporting an allegation of
7insurance non-compliance or fraud against either an employee or
8employer under this Section must identify himself. Except as
9provided in this subsection and in subsection (e), all reports
10shall remain confidential except to refer an investigation to
11the Attorney General or State's Attorney for prosecution or if
12the fraud and insurance non-compliance unit's investigation
13reveals that the conduct reported may be in violation of other
14laws or regulations of the State of Illinois, the unit may
15report such conduct to the appropriate governmental agency
16charged with administering such laws and regulations. Any
17person who intentionally makes a false report under this
18Section to the fraud and insurance non-compliance unit is
19guilty of a Class A misdemeanor.
20 (e) In order for the fraud and insurance non-compliance
21unit to investigate a report of fraud related to an employee's
22claim, (i) the employee must have filed with the Commission an
23Application for Adjustment of Claim and the employee must have
24either received or attempted to receive benefits under this Act
25that are related to the reported fraud or (ii) the employee
26must have made a written demand for the payment of benefits

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1that are related to the reported fraud. There shall be no
2immunity, under this Act or otherwise, for any person who files
3a false report or who files a report without good and just
4cause. Confidentiality of medical information shall be
5strictly maintained. Investigations that are not referred for
6prosecution shall be destroyed upon the expiration of the
7statute of limitations for the acts under investigation and
8shall not be disclosed except that the person making the report
9shall be notified that the investigation is being closed. It is
10unlawful for any employer, insurance carrier, service
11adjustment company, third party administrator, self-insured,
12or similar entity to file or threaten to file a report of fraud
13against an employee because of the exercise by the employee of
14the rights and remedies granted to the employee by this Act.
15 The Department of Insurance's papers, documents, reports,
16or evidence relevant to the subject of an investigation under
17this Section shall be confidential and not subject to subpoena,
18public inspection, or to disclosure under the Freedom of
19Information Act for so long as the Director deems reasonably
20necessary to complete the investigation, to protect the person
21investigated from unwarranted injury, or to be in the public
22interest. No officer, agent, or employee of the Department is
23subject to subpoena in any civil or administrative action to
24testify concerning a matter of which they have knowledge under
25a pending fraud or insurance non-compliance investigation by
26the Department.

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1 No cause of action exists and no liability may be imposed,
2either civil or criminal, against the State, the Director of
3Insurance, any officer, agent, or employee of the Department of
4Insurance, or individuals employed or retained by the Director
5of Insurance, for an act or omission by them in the performance
6of a power or duty authorized by this Section, unless the act
7or omission was performed in bad faith and with intent to
8injure a particular person.
9 (e-5) The fraud and insurance non-compliance unit shall
10procure and implement a system utilizing advanced analytics
11inclusive of predictive modeling, data mining, social network
12analysis, and scoring algorithms for the detection and
13prevention of fraud, waste, and abuse on or before January 1,
142012. The fraud and insurance non-compliance unit shall procure
15this system using a request for proposals process governed by
16the Illinois Procurement Code and rules adopted under that
17Code. The fraud and insurance non-compliance unit shall provide
18a report to the President of the Senate, Speaker of the House
19of Representatives, Minority Leader of the House of
20Representatives, Minority Leader of the Senate, Governor,
21Chairman of the Commission, and Director of Insurance on or
22before July 1, 2012 and annually thereafter detailing its
23activities and providing recommendations regarding
24opportunities for additional fraud waste and abuse detection
25and prevention.
26 (f) Any person convicted of fraud related to workers'

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

HB4068- 122 -LRB100 13139 KTG 27545 b
1the Commission, the Workers' Compensation Advisory Board, the
2General Assembly, the Governor, and the Attorney General by
3January 1 and July 1 of each year. This report shall include,
4at the minimum, the following information:
5 (1) The number of allegations of insurance
6 non-compliance and fraud reported to the fraud and
7 insurance non-compliance unit.
8 (2) The source of the reported allegations
9 (individual, employer, or other).
10 (3) The number of allegations investigated by the fraud
11 and insurance non-compliance unit.
12 (4) The number of criminal referrals made in accordance
13 with this Section and the entity to which the referral was
14 made.
15 (5) All proceedings under this Section.
16(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
17 (820 ILCS 305/29.2)
18 Sec. 29.2. Insurance and self-insurance oversight.
19 (a) The Department of Insurance shall annually submit to
20the Governor, the Chairman of the Commission, the President of
21the Senate, the Speaker of the House of Representatives, the
22Minority Leader of the Senate, and the Minority Leader of the
23House of Representatives a written report that details the
24state of the workers' compensation insurance market in
25Illinois. The report shall be completed by April 1 of each

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1year, beginning in 2012, or later if necessary data or analyses
2are only available to the Department at a later date. The
3report shall be posted on the Department of Insurance's
4Internet website. Information to be included in the report
5shall be for the preceding calendar year. The report shall
6include, at a minimum, the following:
7 (1) Gross premiums collected by workers' compensation
8 carriers in Illinois and the national rank of Illinois
9 based on premium volume.
10 (2) The number of insurance companies actively engaged
11 in Illinois in the workers' compensation insurance market,
12 including both holding companies and subsidiaries or
13 affiliates, and the national rank of Illinois based on
14 number of competing insurers.
15 (3) The total number of insured participants in the
16 Illinois workers' compensation assigned risk insurance
17 pool, and the size of the assigned risk pool as a
18 proportion of the total Illinois workers' compensation
19 insurance market.
20 (4) The advisory organization premium rate for
21 workers' compensation insurance in Illinois for the
22 previous year.
23 (5) The advisory organization prescribed assigned risk
24 pool premium rate.
25 (6) The total amount of indemnity payments made by
26 workers' compensation insurers in Illinois.

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1 (7) The total amount of medical payments made by
2 workers' compensation insurers in Illinois, and the
3 national rank of Illinois based on average cost of medical
4 claims per injured worker.
5 (8) The gross profitability of workers' compensation
6 insurers in Illinois, and the national rank of Illinois
7 based on profitability of workers' compensation insurers.
8 (9) The loss ratio of workers' compensation insurers in
9 Illinois and the national rank of Illinois based on the
10 loss ratio of workers' compensation insurers. For purposes
11 of this loss ratio calculation, the denominator shall
12 include all premiums and other fees collected by workers'
13 compensation insurers and the numerator shall include the
14 total amount paid by the insurer for care or compensation
15 to injured workers.
16 (10) The growth of total paid indemnity benefits by
17 temporary total disability, scheduled and non-scheduled
18 permanent partial disability, and total disability.
19 (11) The number of injured workers receiving wage loss
20 differential awards and the average wage loss differential
21 award payout.
22 (12) Illinois' rank, relative to other states, for:
23 (i) the maximum and minimum temporary total
24 disability benefit level;
25 (ii) the maximum and minimum scheduled and
26 non-scheduled permanent partial disability benefit

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1 level;
2 (iii) the maximum and minimum total disability
3 benefit level; and
4 (iv) the maximum and minimum death benefit level.
5 (13) The aggregate growth of medical benefit payout by
6 non-hospital providers and hospitals.
7 (14) The aggregate growth of medical utilization for
8 the top 10 most common injuries to specific body parts by
9 non-hospital providers and hospitals.
10 (15) The percentage of injured workers filing claims at
11 the Commission that are represented by an attorney.
12 (16) The total amount paid by injured workers for
13 attorney representation.
14 (a-5) The Commission shall annually submit to the Governor
15and the General Assembly a written report that details the
16state of self-insurance for workers' compensation in Illinois.
17The report shall be based on information currently collected by
18the Commission or the Department of Insurance from
19self-insurers, as of the effective date of this amendatory Act
20of the 100th General Assembly. The report shall be completed by
21April 1 of each year, beginning in 2017. The report shall be
22posted on the Commission's Internet website. Information to be
23included in the report shall be for the preceding calendar
24year. The report shall include, at a minimum, the following in
25the aggregate:
26 (1) The number of employers that self-insure for

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1 workers' compensation.
2 (2) The total number of employees covered by
3 self-insurance.
4 (3) The total amount of indemnity payments made by
5 self-insureds.
6 (4) The total amount of medical payments made by
7 self-insureds.
8 (5) The growth of total paid indemnity benefits by
9 temporary total disability, scheduled and non-scheduled
10 permanent partial disability, and total disability.
11 (6) Illinois' rank, relative to other states, for:
12 (i) the maximum and minimum temporary total
13 disability benefit levels;
14 (ii) the maximum and minimum scheduled and
15 non-scheduled permanent partial disability benefit
16 levels;
17 (iii) the maximum and minimum total disability
18 benefit levels; and
19 (iv) the maximum and minimum death benefit levels.
20 (7) The aggregate growth of medical benefit payouts by
21 non-hospital providers and hospitals.
22 Any information collected by the Commission from
23self-insureds shall be exempt from public inspection and
24disclosure under the Freedom of Information Act.
25 (b) The Director of Insurance shall promulgate rules
26requiring each insurer licensed to write workers' compensation

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1coverage in the State to record and report the following
2information on an aggregate basis to the Department of
3Insurance before March 1 of each year, relating to claims in
4the State opened within the prior calendar year:
5 (1) The number of claims opened.
6 (2) The number of reported medical only claims.
7 (3) The number of contested claims.
8 (4) The number of claims for which the employee has
9 attorney representation.
10 (5) The number of claims with lost time and the number
11 of claims for which temporary total disability was paid.
12 (6) The number of claim adjusters employed to adjust
13 workers' compensation claims.
14 (7) The number of claims for which temporary total
15 disability was not paid within 14 days from the first full
16 day off, regardless of reason.
17 (8) The number of medical bills paid 60 days or later
18 from date of service and the average days paid on those
19 paid after 60 days for the previous calendar year.
20 (9) The number of claims in which in-house defense
21 counsel participated, and the total amount spent on
22 in-house legal services.
23 (10) The number of claims in which outside defense
24 counsel participated, and the total amount paid to outside
25 defense counsel.
26 (11) The total amount billed to employers for bill

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1 review.
2 (12) The total amount billed to employers for fee
3 schedule savings.
4 (13) The total amount charged to employers for any and
5 all managed care fees.
6 (14) The number of claims involving in-house medical
7 nurse case management, and the total amount spent on
8 in-house medical nurse case management.
9 (15) The number of claims involving outside medical
10 nurse case management, and the total amount paid for
11 outside medical nurse case management.
12 (16) The total amount paid for Independent Medical
13 exams.
14 (17) The total amount spent on in-house Utilization
15 Review for the previous calendar year.
16 (18) The total amount paid for outside Utilization
17 Review for the previous calendar year.
18 The Department shall make the submitted information
19publicly available on the Department's Internet website or such
20other media as appropriate in a form useful for consumers.
21(Source: P.A. 97-18, eff. 6-28-11.)
22 Section 99. Effective date. This Act takes effect upon
23becoming law.

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1 INDEX
2 Statutes amended in order of appearance